Background <p>Nonpharmacological therapies are widely used for adult myogenic temporomandibular disorders (TMD), but their comparative effectiveness for pain and mandibular function remains uncertain. This study compared multiple interventions using a frequentist random-effects network meta-analysis.</p> Methods <p>MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar were searched from inception through October 31, 2025, without language restrictions. Randomized controlled trials enrolling adults (≥ 18 years) with myogenic TMD were included if they compared at least one predefined nonpharmacological modality (including photobiomodulation therapy [PBMT], manual therapy [MT], exercise therapy [EX], occlusal splint therapy [OST], acupuncture [ACU], electrotherapy [ELEC], combined therapy [COMB], cognitive behavioral therapy [CBT], central neuromodulation, or extracorporeal shock wave therapy) with sham or placebo control, usual care or no-treatment control, or another predefined active nonpharmacological modality. Primary outcomes were pain and maximum mouth opening, and outcome data were extracted at the short-term assessment closest to completion of the intervention. Effects were summarized as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using a frequentist random-effects model implemented in Stata. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA), which provides a probabilistic ranking rather than a direct measure of treatment superiority. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (RoB 2.0).</p> Results <p>Forty-one trials (2021 participants) were included. For pain, PBMT ranked highest (SUCRA, 88.9%) and was superior to CBT (SMD, − 2.00; 95% CI, − 2.99 to − 1.00), ELEC (SMD, − 1.64; 95% CI, − 2.55 to − 0.73), conventional care (SMD, − 1.49; 95% CI, − 2.07 to − 0.91), OST (SMD, − 1.43; 95% CI, − 2.29 to − 0.56), and ACU (SMD, − 1.07; 95% CI, − 1.93 to − 0.21). MT (SUCRA, 79.9%) and COMB (SUCRA, 72.5%) also showed significant analgesic advantages versus several comparators. For maximum mouth opening (31 trials; 1463 participants), MT ranked highest (SUCRA, 92.9%) and improved opening more than conventional care (SMD, 2.79; 95% CI, 1.33 to 4.26), PBMT (SMD, 2.23; 95% CI, 0.19 to 4.28), ACU (SMD, 2.01; 95% CI, 0.12 to 3.90), and EX (SMD, 1.85; 95% CI, 0.05 to 3.64). Inconsistency was detected for pain in the ELEC versus MT comparison; no significant inconsistency was observed for maximum mouth opening.</p> Conclusion <p>Among adults with myogenic TMD, PBMT showed the most favorable short-term comparative profile for pain relief, whereas MT ranked highest for improving maximum mouth opening. These findings support targeted selection of specific nonpharmacological modalities, prioritizing PBMT when pain reduction predominates and MT when restoration of mandibular mobility is the primary goal.</p> Trial registration <p>PROSPERO (CRD420261278458)</p>