A Physical Therapy Clinical Framework for Temporomandibular Disorders: Integrating DC/TMD, ICOP and Multidimensional Patient Phenotyping

Abstract

Temporomandibular disorders (TMDs) are clinically heterogeneous, and patients sharing the same diagnosis may differ substantially in pain mechanisms, functional impairments, behavioral contributors, comorbidities, psychosocial burden, prognosis, and treatment response. Although the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), the International Classification of Orofacial Pain (ICOP), and the International Classification of Headache Disorders (ICHD-3) provide essential diagnostic standards, they do not directly translate diagnosis into individualized physiotherapy management. This Masterclass proposes an evidence-informed clinical framework designed to bridge this gap and support personalized, evidence-based practice. Developed through targeted literature searches, citation tracking, and narrative synthesis of diagnostic standards, clinical practice guidelines, systematic reviews, consensus documents, and key phenotyping studies, the framework retains established diagnoses as clinical anchors while adding a physiotherapy-oriented translational layer. Assessment focuses on clinically relevant and potentially modifiable features, including familiar pain, mandibular mobility and motor control, behavioral load, regional and sleep-related comorbidities, psychosocial factors, prognosis, and pain-mechanism hypotheses. These findings are integrated with patient goals and preferences to identify dominant treatment targets, inform intervention intensity, select appropriate outcomes, and determine when interdisciplinary care is required. Education, therapeutic exercise, selected manual therapy, and behavioral strategies are therefore considered according to explicit clinical objectives rather than diagnostic labels alone. The framework distinguishes evidence-supported components from extrapolated and hypothesis-generating propositions and aims to make physiotherapy management more transparent, reproducible, patient-centered, and testable.