###### Abstract  
Temporomandibularibular disorders (TMD) are primarily characterized by pain as well as issues concerning the proper functioning of individual elements of the stomatognathic system. The aim of the study was to assess the safety and efficacy of physical exercise, with or without radial Extracorporeal Shock Wave Therapy (rESWT), in patients with TMD. Eligible patients were adults (\(\geq\)18 years) with diagnosed myocardial pain with or without mouth opening limitation (Group Ia, Ib) based on the Diagnostic Criteria for TMD (DC/TMD). Enrolled patients (\(n=15\)) were randomly assigned 1:1 to receive physical exercise combined with rESWT (\(n=8\)) or sham rESWT (\(n=7\)) for four weeks. The primary endpoint was the pain intensity measured by a visual analogue scale (VAS). The secondary endpoints were muscle activity and function assessed through the surface electromyography evaluation of the anterior temporalis and the masseter muscles. The rESWT group (mean age: 28.50 \(\pm\) 8.85 years) showed a statistically significant pain reduction (VAS Right side: \(\Delta\)T0-T1 MD = -3.00; \(p=0.023\), Left side: \(\Delta\)T0-T1, MD = 3.57, \(p=0.021\)), whereas patients in the sham WBV group (mean age: 30.71 \(\pm\) 8.98 years), did not reach statistical significance (VAS: Right side: \(\Delta\)T0-T1 MD = 1.00, \(p=0.155\); Left side: \(\Delta\)T0-T1 MD = 1.25 SE = 0.25, \(p=0.094\)). Concurrently, muscle activity and performance significantly improved in the active rESWT group, with an improvement in the percentage of the overlapping coefficient (POC) compared to the control group. No dropouts and no side effects were recorded. Taken together, the findings of this pilot RCT suggested that rESWT combined with physical therapy could be effective in relieving pain and improving function in muscle-related TMD patients. extracorporeal shock wave therapy; temporomandibularibular disorders; temporomandibularibular disorders; physical therapy; physical agent modalities; pain management; electromyography +
Footnote †: journal: _Sci._  
disc displacement with reduction, IIb disc displacement without reduction with limited opening, IIc disc displacement without reduction without limited opening); and Group III, arthralgia (IIIa), arthritis (IIIb), and arthrosis (IIIc) [3]. Axis II of the DC/TMD provides an evaluation of the pain-related disability, predicting the treatment outcome as well as the chronicity of pain [5]. Temporomandibular disorders are the most common cause of pain of non-dental origin in the maxillofacial region [6]. Particularly, muscle-related disorders are considered as the main cause of TMD, with an overall prevalence in the general population of approximately 90% [7]. The muscular-related TMD aetiology has been accepted as multifactorial, often associated with parafunctional habits, clenching of teeth, grinding, local or systemic diseases, as well as psychosocial issues, including anxiety [8; 9]. Pain is the most common clinical manifestation of TMD, followed by irregular and limited jaw motion, that could lead to discomfort or difficulty in performing daily activities, such as chewing, talking, swallowing, yawning, with a significantly reduced quality of life [10; 11; 12]. Several studies have examined the effects of conservative therapies, such as oral non-steroidal anti-inflammatory drugs, orthodontics, electrotherapy, physical therapy, occlusal splints, oxygen-ozone therapy, and extracorporeal shockwave therapy (ESWT) in patients affected by TMD [13; 14; 15; 16; 17; 18; 19; 20; 21; 22; 23]. Among them, ESWT has been demonstrated to be effective in reducing pain and improving the function of the stomatognathic system; however, this treatment is relatively slow in relieving pain for patients and needs additional functional therapy to preserve the long-term therapeutic result [23].