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Saleh MS, Mohamed WM, Elsayed WH, Abdelatief EEM. Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial. J Back Musculoskelet Rehabil 2024:BMR230358. [PMID: 39058437 DOI: 10.3233/bmr-230358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group. CONCLUSION Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.
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Affiliation(s)
- Marwa Shafiek Saleh
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Walaa Mohsen Mohamed
- Department of Orthopedics, Faculty of Physical Therapy, Misr University for Science and Technology, 6th of October City, Egypt
| | - Walaa Hamdy Elsayed
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Menéndez-Torre Á, Pintado-Zugasti AM, Zaldivar JNC, García-Bermejo P, Gómez-Costa D, Molina-Álvarez M, Arribas-Romano A, Fernández-Carnero J. Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis. Chiropr Man Therap 2023; 31:46. [PMID: 37924127 PMCID: PMC10625247 DOI: 10.1186/s12998-023-00489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are the most common cause of orofacial pain of non-dental origin, with approximately 42% of diagnoses corresponding to myofascial pain. Manual therapy and dry needling are commonly used interventions for the treatment of myofascial temporomandibular disorders. However, it is unclear whether one of them could be superior to the other. OBJECTIVES The aim of the present systematic review and network meta-analysis was to compare the effectiveness of manual therapy and dry needling in patients with myofascial TMD. METHODS This is a systematic review and network meta-analysis. Randomized clinical trials were searched in the databases of Pubmed, PEDro, CINAHL, Web of Science, Scopus, Cochrane, Google Academic and EMBASE. The methodological quality of studies included in this review was judged using the Physiotherapy Evidence Database (PEDro) scale. A frequentist network meta-analysis was carried out, assuming random effects, to estimate the effects of interventions for temporomandibular joint pain measured on a 10-point visual analogue scale. RESULTS Out of 3190 records identified, 17 met the inclusion criteria for qualitative analysis and eight were included in the network meta-analysis. Indirect comparisons between dry needling and manual therapy showed no significant differences in their effects on pain reduction (Odds Ratio [95%CI]; - 0.263 [- 1.517, 0.992]). The ranking of treatments shows that manual therapy (SUCRA = 0.932) followed by deep dry needling (SUCRA = 0.775) present the highest values of estimation and can be considered the most likely to reduce pain. CONCLUSIONS The results of the network meta-analysis should be considered with caution due to the low quality of the evidence available and the high variability of the study protocols in terms of the method of application of dry needling and manual therapy interventions. PROSPERO under identifier: (CRD42020186470).
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Affiliation(s)
- Ángela Menéndez-Torre
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933, Alcorcón, Spain
- Servicio de Fisioterapia, Centro Médico Gava, 28600, Navalcarnero, Madrid, Spain
| | - Aitor Martín Pintado-Zugasti
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, 28008, Madrid, Spain
| | - Juan Nicolás Cuenca Zaldivar
- Rehabilitation Service, Guadarrama Hospital, Madrid, Spain.
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain.
| | - Paula García-Bermejo
- DINAMIA Clinic. Alfonso VI, 28806, Alcalá de Henares, Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Diego Gómez-Costa
- Department of Nursing and Estomatology, Faculty of Health Sciences, Rey Juan Carlos University, Avenida de Atemas s/n, Alcorcón, 28922, Madrid, Spain
| | - Miguel Molina-Álvarez
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Madrid, Spain
| | - Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933, Alcorcón, Spain
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madrid, Spain
| | - Josué Fernández-Carnero
- Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madrid, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, 28046, Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, Universidad Rey Juan Carlos-Banco de Santander, 28922, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023, Madrid, Spain
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Li S, Brimmers A, van Boekel RL, Vissers KC, Coenen MJ. A systematic review of genome-wide association studies for pain, nociception, neuropathy, and pain treatment responses. Pain 2023; 164:1891-1911. [PMID: 37144689 PMCID: PMC10436363 DOI: 10.1097/j.pain.0000000000002910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/06/2023]
Abstract
ABSTRACT Pain is the leading cause of disability worldwide, imposing an enormous burden on personal health and society. Pain is a multifactorial and multidimensional problem. Currently, there is (some) evidence that genetic factors could partially explain individual susceptibility to pain and interpersonal differences in pain treatment response. To better understand the underlying genetic mechanisms of pain, we systematically reviewed and summarized genome-wide association studies (GWASes) investigating the associations between genetic variants and pain/pain-related phenotypes in humans. We reviewed 57 full-text articles and identified 30 loci reported in more than 1 study. To check whether genes described in this review are associated with (other) pain phenotypes, we searched 2 pain genetic databases, Human Pain Genetics Database and Mouse Pain Genetics Database. Six GWAS-identified genes/loci were also reported in those databases, mainly involved in neurological functions and inflammation. These findings demonstrate an important contribution of genetic factors to the risk of pain and pain-related phenotypes. However, replication studies with consistent phenotype definitions and sufficient statistical power are required to validate these pain-associated genes further. Our review also highlights the need for bioinformatic tools to elucidate the function of identified genes/loci. We believe that a better understanding of the genetic background of pain will shed light on the underlying biological mechanisms of pain and benefit patients by improving the clinical management of pain.
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Affiliation(s)
- Song Li
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annika Brimmers
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Regina L.M. van Boekel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kris C.P. Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke J.H. Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Coenen is now with the Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
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Sirikaku K, Watinaga GK, de Souza Moraes S, Guimarães TB, Onishi ET. Effect of Dry Needling on the Masseter Muscle in the Tinnitus Perception of Patients with Temporomandibular Disorder. J Maxillofac Oral Surg 2023; 22:571-578. [PMID: 37534338 PMCID: PMC10390393 DOI: 10.1007/s12663-022-01696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the effect of dry needling on the masseter muscle in the perception of tinnitus in patients with temporomandibular disorder. Methods Twenty-five patients with tinnitus and muscular temporomandibular disorders were randomly assigned to groups study (n = 13) and control (n = 12). Three sessions of dry needling (study) and sham (control) were performed. Follow-up was performed 30, 60 and 90 days after the end of treatment. The Analog Visual Scale and Tinnitus Handicap Inventory (THI) were used to evaluate the treatment. Results In study group, 76.9% presented a reduction in the intensity and tinnitus discomfort and total THI. In control group, 66.7% presented a decrease in tinnitus intensity and total THI, and 58.3% reported a decrease in tinnitus discomfort. After 90 days, in the study group, 84.6% maintained improvement in pain intensity and reduction in THI score and 69.2% reported improvement in both intensity and discomfort caused by tinnitus. In control group, 75% achieved improvement in pain intensity, 33.2% maintained improvement in tinnitus intensity, and 41.7% maintained improvement in discomfort caused by tinnitus and total THI. In the total THI score, the study group presented improvement (p = 0.041). Conclusion Dry needling combined with counseling was associated with improvement in pain intensity and tinnitus, decrease in tinnitus discomfort and reduction in total THI score.
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Affiliation(s)
- Katia Sirikaku
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo – UNIFESP, Rua Pedro de Toledo, 947 - Vila Clementino, São Paulo, SP 04039-002 Brazil
| | - Gilson Kazuo Watinaga
- Departamento de Pós-Graduação da Faculdade de Odontologia, Faculdade de Medicina e Odontologia São Leopoldo Mandic, Campinas, Brazil
| | - Samuel de Souza Moraes
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo – UNIFESP, Rua Pedro de Toledo, 947 - Vila Clementino, São Paulo, SP 04039-002 Brazil
| | - Thatiana Bastos Guimarães
- Departamento de Psiquiatria, Universidade Federal de São Paulo – UNIFESP, Avenida Lavandisca52 ap.22-Vila Nova Conceição, São Paulo, SP 04515-010 Brazil
| | - Ektor Tsuneo Onishi
- Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo – UNIFESP, Rua Pedro de Toledo, 947 - Vila Clementino, São Paulo, SP 04039-002 Brazil
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Montemurro N, Trilli I, Bordea IR, Ferrara E, Francesco MD, Caccamo F, Malcangi G, Rapone B. Are Whiplash-Associated Disorders and Temporomandibular Disorders in a Trauma Related Cause and Effect Relationship? A Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1482. [PMID: 37629772 PMCID: PMC10456620 DOI: 10.3390/medicina59081482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Background: Whiplash is associated with a wide variety of clinical manifestations, including headache, neck pain, cervical rigidity, shoulder and back pain, paresthesia, vertigo, and temporomandibular disorders (TMDs). Previous studies reported that TMDs are more common in individuals with chronic whiplash-associated disorders (WAD) than in the general population; however, the pathophysiology and mechanism of this relationship are still not well understood. Methods: A PubMed and Ovid EMBASE review was performed to identify all studies addressing the trauma related cause and effect relationship between WAD and TMDs from January 2003 to March 2023. Results: After screening for eligibility and inclusion criteria, a total of 16 articles met the selection criteria. The various included studies discussed different aspects of the association between WDA and TMDs, including changes in the coordination and amplitude of jaw opening, the severity of the associated symptoms/signs in cases of WAD, the degree of fatigue and psychological stress, difficulty in feeding, cervical and myofascial pain, changes in the MRI signal at various muscle points, muscle tenderness, and quality of life. Conclusions: In this review, we summarized the clinical evidence of any trauma related cause and effect relationship between whiplash and TMDs. An accurate screening of the previous literature showed that, in conclusion, the relationship between whiplash and TMDs is still unclear.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56100 Pisa, Italy;
| | - Irma Trilli
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (I.T.); (G.M.); (B.R.)
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dental Medicine, University of Medicine and Pharmacy ‘Iuliu Hatieganu’, 400012 Cluj-Napoca, Romania
| | - Elisabetta Ferrara
- Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio, 66100 Chieti, Italy;
| | - Maurizio De Francesco
- Department of Neurosciences, Institute of Clinical Dentistry, University of Padua, 35128 Padua, Italy;
| | | | - Giuseppina Malcangi
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (I.T.); (G.M.); (B.R.)
| | - Biagio Rapone
- Interdisciplinary Department of Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (I.T.); (G.M.); (B.R.)
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Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:133-142. [PMID: 36245265 PMCID: PMC10288910 DOI: 10.1080/10669817.2022.2123171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
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Affiliation(s)
- Stephen M. Shaffer
- College of Education, Nursing, and Health Professions, Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Congdon School of Health Sciences, Department of Physical Therapy, High Point University, High Point, NC, USA
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Do Temporomandibular Disorder Patients with Joint Pain Exhibit Forward Head Posture? A Cephalometric Study. Pain Res Manag 2023; 2023:7363412. [PMID: 36776487 PMCID: PMC9911253 DOI: 10.1155/2023/7363412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/14/2022] [Accepted: 11/25/2022] [Indexed: 02/05/2023]
Abstract
Purpose To evaluate head and cervical posture in individuals with or without temporomandibular disorders (TMDs) and to assess the correlations between pain, severity of symptoms, and posture. Methods A total of 384 patients (129 males and 255 females) was included. The Fonseca Anamnestic Index (FAI) was used to assess the severity and prevalence of TMD and the presence of temporomandibular joint (TMJ) pain. Patients were divided into three groups: the TMD-free group, TMD without TMJ pain group, and TMD with TMJ pain group. Subsequently, the patients with TMJ pain were further divided into mild TMD and moderate/severe TMD groups. Nine parameters were traced on cephalograms to characterize the head and cervical posture. Results TMD patients with TMJ pain showed increased forward head posture (FHP) than patients without TMJ pain and TMD-free subjects. No significant difference was observed between the TMD patients without TMJ pain and TMD-free subjects. In the TMD patients with the TMJ pain group, the moderate/severe TMD patients demonstrated increased FHP compared to mild TMD patients. TMD patients with joint pain had greater CVT/RL (B = 3.099), OPT/RL (B = 2.117), and NSL/C2' (B = 4.646) than the patients without joint pain after adjusting for confounding variables (P < 0.05). Conclusion TMD patients with TMJ pain showed increased FHP compared to other groups, and FHP became more significant as TMD severity increased in male patients, indicating the FHP might play an important role in the development of TMJ pain. In the clinical assessment of TMD, the patients' abnormal head and cervical posture might be considered.
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Peck CM, Bereiter DA, Eberly LE, Lenglet C, Moana-Filho EJ. Altered brain responses to noxious dentoalveolar stimuli in high-impact temporomandibular disorder pain patients. PLoS One 2022; 17:e0266349. [PMID: 36240243 PMCID: PMC9565712 DOI: 10.1371/journal.pone.0266349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
High-impact temporomandibular disorder (TMD) pain may involve brain mechanisms related to maladaptive central pain modulation. We investigated brain responses to stimulation of trigeminal sites not typically associated with TMD pain by applying noxious dentoalveolar pressure to high- and low-impact TMD pain cases and pain-free controls during functional magnetic resonance imaging (fMRI). Fifty female participants were recruited and assigned to one of three groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Graded Chronic Pain Scale: controls (n = 17), low-impact (n = 17) and high-impact TMD (n = 16). Multimodal whole-brain MRI was acquired following the Human Connectome Project Lifespan protocol, including stimulus-evoked fMRI scans during which painful dentoalveolar pressure was applied to the buccal gingiva of participants. Group analyses were performed using non-parametric permutation tests for parcellated cortical and subcortical neuroimaging data. There were no significant between-group differences for brain activations/deactivations evoked by the noxious dentoalveolar pressure. For individual group mean activations/deactivations, a gradient in the number of parcels surviving thresholding was found according to the TMD pain grade, with the highest number seen in the high-impact group. Among the brain regions activated in chronic TMD pain groups were those previously implicated in sensory-discriminative and motivational-affective pain processing. These results suggest that dentoalveolar pressure pain evokes abnormal brain responses to sensory processing of noxious stimuli in high-impact TMD pain participants, which supports the presence of maladaptive brain plasticity in chronic TMD pain.
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Affiliation(s)
- Connor M. Peck
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota, United States of America
| | - David A. Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota, United States of America
| | - Lynn E. Eberly
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Christophe Lenglet
- Department of Radiology, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Estephan J. Moana-Filho
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota, United States of America
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Sanchla AD, Shrivastav S, Bharti L, Kamble R. Comparative Evaluation and Correlation of Pain Pattern in Neck Musculature Observed in Mild, Moderate, and Severe Temporomandibular Joint Disorder Cases as Compared to Non-temporomandibular Joint Disorder Cases. Cureus 2022; 14:e30099. [PMID: 36381943 PMCID: PMC9642967 DOI: 10.7759/cureus.30099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Temporomandibular disorder (TMD) is a broad term used to describe several interlinked disorders affecting the temporomandibular joint (TMJ), muscles of the craniofacial region, and associated structures, all of which have common symptoms such as pain and reduced jaw opening. Along with these, extra-craniofacial symptoms may also be present, which need to be assessed for early diagnosis of TMD. Considering the extra-craniofacial symptoms of TMD, this observational study aimed to evaluate the severity of pain in the neck musculature of patients with TMD and correlate it with the severity of the disorder. Material and methods A total of 44 patients were included in the study who were graded for severity of TMD based on the amnestic and dysfunctional components of the Helkimo index separately. The pain was evaluated bilaterally in five groups of neck muscles in all cases using manual palpation. The severity of pain in these neck muscles was then correlated with the severity of both subjective and objective symptoms of TMD and compared with patients without TMD. Results The Chi-square test revealed a statistically significant association between the severity of pain in all five groups of neck muscles and the severity of TMD. The severity of pain increased with the increasing severity of TMD, with a total of 59.09% of TMD patients presenting with varying degrees of pain in the neck musculature and a p-value of 0.0001% which was significant. Negligible pain in the neck musculature was present in patients without TMD. Conclusion Based on the results, it was observed that the severity of TMD directly correlated with pain in various groups of neck muscles. 59.09% of patients with TMD reported varying degrees of pain in the neck musculature. The severity and distribution of pain in the neck muscles increased with the increasing severity of TMD.
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Effects of Occlusal Splints on Spinal Posture in Patients with Temporomandibular Disorders: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10040739. [PMID: 35455916 PMCID: PMC9027546 DOI: 10.3390/healthcare10040739] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
There is still a gap in the scientific knowledge on the linkage between craniofacial structure and spinal postural control in temporomandibular disorder (TMD) patients. This systematic review aimed to assess the role of occlusal splints on spinal posture of TMD patients. PubMed, Web of Science, and Scopus were systematically searched from inception until 5 January 2022 to identify observational studies with a longitudinal study design presenting: patients with diagnosis of TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); occlusal splint therapy as intervention; postural assessment as outcome. Out of 133 records identified, 104 were suitable for data screening, and only 7 articles were included satisfying the eligibility criteria. We found that occlusal splints might have a positive effect on posture in TMD patients, albeit there is little evidence of appropriate investigation for postural assessment. This systematic review suggested that the occlusal splint might be considered a non-invasive therapeutic approach for patients with TMD. However, the low number of studies with high-quality methodology in these patients showed an urgent need for further research using combined force platform stabilometry and kinematic evaluation of the spine to investigate the impact of occlusal splints on posture.
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Dunning J, Butts R, Bliton P, Vathrakokoilis K, Smith G, Lineberger C, Eshleman N, Fernández-de-Las-Peñas C, Young IA. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial. Cranio 2022:1-14. [PMID: 35412448 DOI: 10.1080/08869634.2022.2062137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD). METHODS One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58). RESULTS Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up. CONCLUSION Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL, USA
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Research Physical Therapy Specialists, Columbia, SC, USA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Athletico Physical Therapy, Roscoe, IL, USA
| | | | - Grant Smith
- Advanced Manual Therapies, Alpharetta, GA, USA
| | | | - Noah Eshleman
- Peak Physical Therapy & Sports Rehab, Helena, MT, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Ejercicio, Universidad Rey Juan CarlosCátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Seca y, Alcorcón, Spain
| | - Ian A Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Tybee Wellness & Osteopractic, Tybee Island, GA, USA
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12
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Lee YH, Auh QS, An JS, Kim T. Poorer sleep quality in patients with chronic temporomandibular disorders compared to healthy controls. BMC Musculoskelet Disord 2022; 23:246. [PMID: 35287633 PMCID: PMC8922910 DOI: 10.1186/s12891-022-05195-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to investigate and compare sleep quality between patients with chronic temporomandibular disorder and healthy controls, and to analyze the association of sleep quality with disease characteristics, obstructive sleep apnea risk factors, and excessive daytime sleepiness. METHODS Chronic temporomandibular disorder patients (n = 503, mean age: 33.10 ± 13.26 years, 333 females) and 180 age- and sex-matched healthy controls (mean age: 32.77 ± 12.95 years, 116 females) were included, who completed well-organized clinical report and answered questions on sleep quality (Pittsburgh Sleep Quality Index), sleep apnea risk factors (STOP-Bang questionnaire), and excessive daytime sleepiness (Epworth sleepiness scale). RESULTS Mean global Pittsburgh Sleep Quality Index scores were significantly higher in the patients (6.25 ± 2.77) than in healthy controls (3.84 ± 2.29) (p < 0.001). Poor sleep was significantly more prevalent in the patient group (56.9%) than in healthy controls (22.2%) (p < 0.001). Compared with healthy controls, chronic temporomandibular disorder patients had a higher likelihood of obstructive sleep apnea (STOP-Bang total score ≥ 3; 7.2% vs. 16.1%; p < 0.01) and higher excessive daytime sleepiness (Epworth sleepiness scale score ≥ 10; 12.8% vs. 19.7%; p < 0.05). Age (odds ratio = 2.551; p < 0.001), female sex (odds ratio = 1.885; p = 0.007), total Epworth sleepiness scale score (odds ratio = 1.839; p = 0.014), and headache attributed to temporomandibular disorder (odds ratio = 1.519; p = 0.049) were the most powerful predictors of poor sleep (global Pittsburgh Sleep Quality Index score ≥ 5) in chronic temporomandibular disorder patients. CONCLUSION Chronic temporomandibular disorder patients had markedly impaired sleep quality than healthy controls. Poorer sleep in patients with chronic temporomandibular disorder was associated with a variety of clinical factors, including a higher likelihood of excessive daytime sleepiness, older age, female gender, higher Epworth sleepiness scale scores, and the presence of headache attributed to temporomandibular disorder.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Jung-Sub An
- Department of Orthodontics, Seoul National University Dental Hospital, Seoul, South Korea
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
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13
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Ginszt M, Szkutnik J, Zieliński G, Bakalczuk M, Stodółkiewicz M, Litko-Rola M, Ginszt A, Rahnama M, Majcher P. Cervical Myofascial Pain Is Associated with an Imbalance of Masticatory Muscle Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031577. [PMID: 35162600 PMCID: PMC8834744 DOI: 10.3390/ijerph19031577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
This study aimed to assess the relationship between the occurrence of cervical myofascial pain with active myofascial trigger points (MTrPs) within the upper trapezius muscle and the electromyographic asymmetry index (AsI) of masticatory muscles: temporalis anterior (TA), superficial part of the masseter muscle (MM), and anterior belly of the digastric muscle (DA). The study group comprised 100 subjects (80 women and 20 men) aged 18 to 30 years (mean 23 ± 2.6 years) reporting pain in the neck muscles, diagnosed with myofascial pain with active MTrPs only within the upper trapezius muscle. The control group comprised 60 healthy, pain-free subjects (42 women and 18 men) aged 20 to 30 years (mean 22.8 ± 2.6 years) without MTrPs in the upper trapezius muscle. The palpation measurement, based on the diagnostic criteria of Travell and Simons, was used to diagnose active MTrPs. The masticatory muscle activity was recorded using an 8-channel device for surface electromyography—BioEMG IIITM. Significant differences in electromyographic patterns between the group with MTrPs in the right side of upper trapezius muscle and the control group were observed within resting activity for the AsI TA (MTrPs: 8.64 vs. controls: −3.22; p = 0.001) and AsI MM (MTrPs: 7.05 vs. controls: −2.09; p = 0.018). Controls presented different electromyographic patterns during maximum voluntary clenching with cotton rolls between teeth within masseter muscle compared to the MTrPs group (MTrPs: 9.27 vs. controls: −0.43 vs. p = 0.041). Participants with MTrPs in the left side of upper trapezius muscle presented predomination of left-sided electromyographic patterns at rest within temporalis anterior in comparison to controls (MTrPs: −19.22 vs. controls: −3.22; p = 0.001). MTrPs within the trapezius muscle may be related to asymmetry within the masticatory muscle activity, suggesting that the presence of myofascial pain within the cervical muscles plays a role in the imbalance of the stomatognathic system. A unilateral active MTrPs within the trapezius muscle may increase the sEMG activity on the same side of the temporalis anterior and masseter muscles.
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Affiliation(s)
- Michał Ginszt
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (P.M.)
- Correspondence:
| | - Jacek Szkutnik
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (M.B.); (M.S.); (M.L.-R.)
| | - Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Magdalena Bakalczuk
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (M.B.); (M.S.); (M.L.-R.)
| | - Małgorzata Stodółkiewicz
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (M.B.); (M.S.); (M.L.-R.)
| | - Monika Litko-Rola
- Independent Unit of Functional Masticatory Disorders, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (M.B.); (M.S.); (M.L.-R.)
| | - Apolinary Ginszt
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (P.M.)
| | - Mansur Rahnama
- Department of Oral Surgery, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Piotr Majcher
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (A.G.); (P.M.)
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14
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Fernández-de-Las-Peñas C, Plaza-Manzano G, Sanchez-Infante J, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, Navarro-Santana MJ. The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: a systematic review and meta-analysis. Acupunct Med 2021; 40:299-311. [PMID: 34894759 DOI: 10.1177/09645284211056346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the clinical effects of needling interventions eliciting local twitch responses (LTRs) versus needling without eliciting LTRs when applied to muscle trigger points (TrPs) associated with spinal pain of musculoskeletal origin. DATABASES AND DATA TREATMENT Electronic databases were searched for randomized or non-randomized clinical trials where one group received needling intervention where LTRs were elicited and was compared with another group receiving the same intervention without elicitation of LTRs in spinal pain disorders associated with TrPs. Outcomes included pain intensity, pain-related disability, and pressure pain thresholds. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool or ROBINS-I tool, methodological quality was assessed with the PEDro score, and quality of evidence was evaluated using the GRADE approach. RESULTS Six trials were included. The application of a needling intervention eliciting LTRs was associated with a significant reduction in pain intensity immediately after treatment (mean difference (MD): -2.03 points, 95% confidence interval (CI): -3.77 to -0.29; standardized MD (SMD): -1.35, 95% CI: -2.32 to -0.38, p = 0.02) when compared to the same needling intervention without elicitation of LTRs. No effect at short-term follow-up (MD: -0.20 points, 95% CI: -1.46 to 1.06, p = 0.75) was observed. No significant differences based on elicitation or non-elicitation of LTRs were found in related disability (SMD: -0.05, 95% CI: -0.41 to 0.30, p = 0.77) or pressure pain thresholds (MD: 23.39 kPa, 95% CI: -13.68 to 60.47, p = 0.22). DISCUSSION Low-level evidence suggests an immediate effect of obtaining LTRs during needling interventions on pain intensity, with no significant effects on related disability or pressure pain sensitivity in spinal pain disorders associated with muscle TrPs. REGISTRATION NUMBER OSF Registry-https://doi.org/10.17605/OSF.IO/5ZX9N.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge Sanchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Guido F Gómez-Chiguano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Clínica Dinamia Fisioterapia. Madrid, Spain
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Rehabilitación San Fernando, Madrid, Spain
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15
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Effects of myofascial release applied to neck muscles and craniocervical flexor training in patients with chronic myofascial TMD: A single arm study. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Meng W, Chan BW, Harris C, Freidin MB, Hebert HL, Adams MJ, Campbell A, Hayward C, Zheng H, Zhang X, Colvin LA, Hales TG, Palmer CNA, Williams FMK, McIntosh A, Smith BH. A genome-wide association study finds genetic variants associated with neck or shoulder pain in UK Biobank. Hum Mol Genet 2021; 29:1396-1404. [PMID: 32246137 PMCID: PMC7254846 DOI: 10.1093/hmg/ddaa058] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
Abstract
Background Common types of musculoskeletal conditions include pain in the neck and shoulder areas. This study seeks to identify the genetic variants associated with neck or shoulder pain based on a genome-wide association approach using 203 309 subjects from the UK Biobank cohort and look for replication evidence from the Generation Scotland: Scottish Family Health Study (GS:SFHS) and TwinsUK. Methods A genome-wide association study was performed adjusting for age, sex, BMI and nine population principal components. Significant and independent genetic variants were then sent to GS:SFHS and TwinsUK for replication. Results We identified three genetic loci that were associated with neck or shoulder pain in the UK Biobank samples. The most significant locus was in an intergenic region in chromosome 17, rs12453010, having P = 1.66 × 10−11. The second most significant locus was located in the FOXP2 gene in chromosome 7 with P = 2.38 × 10−10 for rs34291892. The third locus was located in the LINC01572 gene in chromosome 16 with P = 4.50 × 10−8 for rs62053992. In the replication stage, among four significant and independent genetic variants, rs2049604 in the FOXP2 gene and rs62053992 in the LINC01572 gene were weakly replicated in GS:SFHS (P = 0.0240 and P = 0.0202, respectively). Conclusions We have identified three loci associated with neck or shoulder pain in the UK Biobank cohort, two of which were weakly supported in a replication cohort. Further evidence is needed to confirm their roles in neck or shoulder pain.
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Affiliation(s)
- Weihua Meng
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
| | - Brian W Chan
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
| | - Cameron Harris
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, SE1 7EH, UK
| | - Harry L Hebert
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
| | - Mark J Adams
- Division of Psychiatry, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH10 5HF, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Hua Zheng
- Department of Anaesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianwei Zhang
- Department of Anaesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lesley A Colvin
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
| | - Tim G Hales
- Institute for Academic Anaesthesia, Division of Systems Medicine, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Colin N A Palmer
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, SE1 7EH, UK
| | - Andrew McIntosh
- Division of Psychiatry, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH10 5HF, UK
| | - Blair H Smith
- Division of Population Health and Genomics, Medical Research Institute, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, DD2 4BF, UK
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17
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Romero-Morales C, Bravo-Aguilar M, Abuín-Porras V, Almazán-Polo J, Calvo-Lobo C, Martínez-Jiménez EM, López-López D, Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Dis Mon 2021; 67:101210. [PMID: 34099238 DOI: 10.1016/j.disamonth.2021.101210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Eva María Martínez-Jiménez
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | - Emmanuel Navarro-Flores
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain.
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The Influence of Verbal Suggestion on Post-Needling Soreness and Pain Processing after Dry Needling Treatment: An Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084206. [PMID: 33921101 PMCID: PMC8071378 DOI: 10.3390/ijerph18084206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND It remains unclear as to whether verbal suggestions and expectancies can influence the perception of post-needling soreness. The aim of this study was to analyze the effects of verbal suggestions on post-needling soreness after dry needling of the trapezius muscle. METHODS This study is a randomized controlled trial including healthy subjects randomly assigned to one of three groups receiving different verbal suggestions about the effects of dry needling and the occurrence of post needling soreness (positive, negative, or neutral). Then, dry needling on a latent trigger point of the upper trapezius muscle was performed and the following outcomes were measured immediately after, 24, 48, and 72 h, and one week after the intervention: post-needling soreness intensity, pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). RESULTS Seventy-three consecutive participants were screened and 42 participants (12 men and 30 women, aged: 24 ± 8 years old) were eligible and finished the study protocol. The results showed that verbal suggestion did not influence the perception of post-needling soreness, since there were no differences between groups (p < 0.05) on the intensity of post-needling soreness or tenderness over a one-week follow-up. Moreover, verbal suggestion did not associate with changes in sensorimotor variables of TS and CPM. CONCLUSIONS The induction of different types of expectations through verbal suggestion does not influence the perception of acute pain perceived during the performance of a deep dry needling technique and post-needling pain or soreness after deep dry needling on a latent upper trapezius myofascial trigger point (MTrP).
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19
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Electromyographic Patterns of Masticatory Muscles in Relation to Active Myofascial Trigger Points of the Upper Trapezius and Temporomandibular Disorders. Diagnostics (Basel) 2021; 11:diagnostics11040580. [PMID: 33805008 PMCID: PMC8063936 DOI: 10.3390/diagnostics11040580] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 01/04/2023] Open
Abstract
The presented study aimed to analyze and compare the electromyographic patterns of masticatory muscles in subjects with active myofascial trigger points (MTrPs) within upper trapezius, patients with temporomandibular disorders (TMDs) and healthy adults. Based on the diagnostic criteria of MTrPs according to Travell & Simons and the Research Diagnostic Criteria for Temporomandibular Disorders, 167 people were qualified for the study. Subjects were divided into 3 groups: with active MTrPs in the upper trapezius, with diagnosed temporomandibular disorders (TMDs) and healthy adults. Measurements of the bioelectric activity of the temporalis anterior (TA) and masseter muscle (MM) were carried out using the BioEMG III ™. Based on statistical analysis, significantly lower values of TA resting activity were observed among controls in comparison to MTrPs (1.49 μV vs. 2.81 μV, p = 0.00) and TMDs (1.49 μV vs. 2.97 μV, p = 0.01). The POC index values at rest differed significantly between MTrPs and TMDs (86.61% vs. 105%, p = 0.04). Controls presented different electromyographic patterns within AcI in comparison to both MTrPs (4.90 vs. −15.51, p = 0.00) and TMDs (4.90 vs. −16.49, p = 0.00). During clenching, the difference between MTrPs and TMDs was observed within MVC TA (91.82% vs. 116.98%, p = 0.02). TMDs showed differences within AcI in comparison to both MTrPs group (−42.52 vs. 20.42, p = 0.01) and controls (−42.52 vs. 3.07, p = 0.00). During maximum mouth opening, differences between MTrPs and TMDs were observed within the bioelectric activity of masseter muscle (16.45 μV vs. 10.73 μV, p = 0.01), AsI MM (0.67 vs. 11.12, p = 0.04) and AcI (13.04 vs. −3.89, p = 0.01). Both the presence of MTrPs in the upper trapezius and TMDs are related to changes in electromyographic patterns of masticatory muscles.
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Paço M, Duarte JA, Pinho T. Orthodontic Treatment and Craniocervical Posture in Patients with Temporomandibular Disorders: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063295. [PMID: 33806739 PMCID: PMC8004626 DOI: 10.3390/ijerph18063295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022]
Abstract
Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase.
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Affiliation(s)
- Maria Paço
- CESPU, Instituto de Investigacão e Formação Avançada em Ciências e Tecnologias da Saúde, 4585-116 Gandra-Paredes, Portugal;
| | - José Alberto Duarte
- CIAFEL, Faculdade de Desporto da Universidade do Porto, 4200-450 Porto, Portugal;
| | - Teresa Pinho
- CESPU, Instituto de Investigacão e Formação Avançada em Ciências e Tecnologias da Saúde, 4585-116 Gandra-Paredes, Portugal;
- IBMC—Inst. Biologia Molecular e Celular, i3S—Inst. Inovação e Investigação em Saúde, Universidade do Porto, 4585-116 Porto, Portugal
- Correspondence:
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21
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Kang JH. Neck associated factors related to migraine in adolescents with painful temporomandibular disorders. Acta Odontol Scand 2021; 79:43-51. [PMID: 32529877 DOI: 10.1080/00016357.2020.1774649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Migraine is a comorbidity of painful temporomandibular disorders (TMDs). Both migraine and painful TMD have associations with neck pain and head posture. The aim of this study was to clarify the role of neck pain and head posture on the association between migraine and painful TMD in adolescents. MATERIALS AND METHOD In total 314 adolescents were included: 235 adolescents with only painful TMD (pTMD) and 79 adolescents with painful TMD and migraine (TMDMIG). Adolescents were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders and International Classification of Headache Disorders, 3rd edition. Head postures were identified using lateral cephalograms. Myofascial trigger points (TrPs) were evaluated in the temporalis, masseter, trapezius, sternocleidomastoid, sub-occipitalis, and splenius capitis muscles. RESULTS Multivariate logistic regression analysis confirmed the associations among the orofacial pain duration, number of active TrPs in the trapezius muscles, intensity of neck pain, and distance between the occiput and atlas and migraine in adolescents with TMD. The relationships among intensity of neck pain, number of TrPs in the cervical muscles, and head posture were more prominent in the TMDMIG than those in the pTMD. CONCLUSION Neck associated factors seemed to have relevance with migraine in adolescents with painful TMD.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea (ROK)
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Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review. J Clin Med 2020; 9:jcm9113686. [PMID: 33212937 PMCID: PMC7698332 DOI: 10.3390/jcm9113686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.
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Park S, Park JW. Various diagnostic possibilities for zygomatic arch pain: Seven case reports and review of literature. World J Clin Cases 2020; 8:2294-2304. [PMID: 32548159 PMCID: PMC7281041 DOI: 10.12998/wjcc.v8.i11.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pain of the zygomatic arch region is common among patients with orofacial pain, especially in those with temporomandibular disorder-related pain of a myogenic origin. Since zygomatic arch pain may occur due to various causes other than muscle pain, appropriate diagnosis and treatment planning is essential to ensure its successful management. Unfortunately, zygomatic arch pain has not been handled as an independent clinical feature until now, and studies have mainly focused on pain resulting from trauma and surgical procedures.
CASE SUMMARY We describe 7 independent cases, all of which presented with the identical chief complaint of pain in the zygomatic arch region. However, the underlying causes were different for each, being myofascial pain, myositis, tooth crack, dental caries, sinusitis, neuropathic pain, and salivary gland tumor respectively. In this case report, the clinical features of each case are investigated and diseases to be considered in the diagnostic process are suggested, along with the diagnostic modalities (including computed tomography and magnetic resonance imaging) that can lead to the appropriate final diagnosis.
CONCLUSION Zygomatic arch pain is a common complaint encountered in the orofacial pain clinic but may lead to misdiagnosis. Clinicians must have in-depth knowledge of the possible differential diagnoses and evaluation tools.
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Affiliation(s)
- Seoeun Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, South Korea
| | - Ji Woon Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul 03080, South Korea
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Effects on migraine, neck pain, and head and neck posture, of temporomandibular disorder treatment: Study of a retrospective cohort. Arch Oral Biol 2020; 114:104718. [DOI: 10.1016/j.archoralbio.2020.104718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
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25
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De Laat A. Differential diagnosis of toothache to prevent erroneous and unnecessary dental treatment. J Oral Rehabil 2020; 47:775-781. [DOI: 10.1111/joor.12946] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 01/09/2020] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Antoon De Laat
- Department of Oral Health Sciences and Department of Dentistry University Hospitals KU Leuven Leuven Belgium
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26
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Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019; 12:1899-1911. [PMID: 31354339 PMCID: PMC6590623 DOI: 10.2147/jpr.s154728] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient’s expectations, beliefs, previous experiences and patient–clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Hong SW, Lee JK, Kang JH. Relationship among Cervical Spine Degeneration, Head and Neck postures, and Myofascial Pain in Masticatory and Cervical Muscles in Elderly with Temporomandibular Disorder. Arch Gerontol Geriatr 2019; 81:119-128. [DOI: 10.1016/j.archger.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
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Villa S, Raoul G, Machuron F, Ferri J, Nicot R. Improvement in quality of life after botulinum toxin injection for temporomandibular disorder. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:2-6. [DOI: 10.1016/j.jormas.2018.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/27/2018] [Accepted: 10/21/2018] [Indexed: 12/17/2022]
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Okada-Ogawa A, Sekine N, Watanabe K, Kohashi R, Asano S, Iwata K, Imamura Y. Change in muscle hardness after trigger point injection and physiotherapy for myofascial pain syndrome. J Oral Sci 2018; 61:36-44. [PMID: 30568046 DOI: 10.2334/josnusd.17-0453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Assessment and treatment of masticatory myofascial pain syndrome (MPS) are not standardized and remain controversial. We examined whether muscle hardness was useful for evaluating masticatory MPS and analyzed the effectiveness of treatments such as stretching and massage (SM) and trigger point injection (TPI). Twenty healthy volunteers and 20 MPS patients were enrolled. MPS patients were divided into TPI and SM treatment groups. Hardness of masticatory muscle with a taut band (TB) and change in hardness were evaluated after SM and TPI treatments. Hardness values were significantly higher in muscle including a TB (TB point) than in the muscle of healthy controls. Visual analogue scale scores were significantly lower after SM and TPI treatments, and hardness of the TB point was significantly lower after SM but not after TPI. These results suggest that measurement of muscle hardness, including the TB, is useful for evaluating masticatory MPS. However, TPI analgesia might not be caused by change in muscle hardness. The mechanisms underlying the effects of SM and TPI on reducing pain in MPS may differ and thus warrant further research.
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Affiliation(s)
- Akiko Okada-Ogawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Orofacial Pain Clinic, Nihon University Dental Hospital.,Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry
| | - Naohiko Sekine
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Kosuke Watanabe
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Ryutaro Kohashi
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Sayaka Asano
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry
| | - Koich Iwata
- Department of Physiology, Nihon University School of Dentistry.,Division of Functional Morphology, Dental Research Center, Nihon University School of Dentistry
| | - Yoshiki Imamura
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry.,Division of Orofacial Pain Clinic, Nihon University Dental Hospital.,Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry
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Trize DDM, Calabria MP, Franzolin SDOB, Cunha CO, Marta SN. Is quality of life affected by temporomandibular disorders? EINSTEIN-SAO PAULO 2018; 16:eAO4339. [PMID: 30517362 PMCID: PMC6276907 DOI: 10.31744/einstein_journal/2018ao4339] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the impact of temporomandibular disorders in quality of life. METHODS A total of 102 volunteer patients (68 female) aged 19 to 86 years, who sought medical care in health clinics of the university and were evaluated in the period from September to December 2013. The subjects were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders, using a mechanical algometer (Palpeter®) with standardized pressure of 0.5 and 1.0kg, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire, to assess quality of life. The data were tabulated for statistical analysis and the variables were correlated with the clinical findings of the temporomandibular disorders and quality of life. RESULTS Fifty percent of patients were positive for temporomandibular disorders and 39.2% classified as myofascial pain group. The temporomandibular disorder group was significantly associated with uncomfortable bite (p=0.0000), temporomandibular joint clicking (p=0.0001) and tooth clenching (p=0.0001). The Mann Whitney test used to analyze the SF-36 revealed that the domains of pain (mean score of 47.80%; p<0.0001) and mental health (62.67%; p<0.05) were strongly associated with temporomandibular disorders. CONCLUSION The quality of life of individuals with temporomandibular disorders was negatively affected by the presence of pain and mental health disorders.
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Muñoz-García D, López-de-Uralde-Villanueva I, Beltrán-Alacreu H, La Touche R, Fernández-Carnero J. Patients with Concomitant Chronic Neck Pain and Myofascial Pain in Masticatory Muscles Have More Widespread Pain and Distal Hyperalgesia than Patients with Only Chronic Neck Pain. PAIN MEDICINE 2017; 18:526-537. [PMID: 28034980 DOI: 10.1093/pm/pnw274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Insufficient evidence exists to compare widespread pain (WP), pain sensibility, and psychological factors that occur in patients presenting with chronic neck pain (CNP) or a combination of temporomandibular disorder (TMD) and other complaints. The present study compared the pain sensibility and psychological factors of subjects with CNP with those with TMD + CNP. Design Cross-sectional study. Setting Local community. Subjects A nonprobabilistic convenience sample of 86 persons with CNP or TMD was recruited into three groups: CNP, TMD with myofascial pain in masticatory muscles with cocomitant CNP (TMD + CNP), and asymptomatic control groups consisted of 27, 29, and 30 participants, respectively. Methods Participants underwent a clinical examination to evaluate WP with computerized assessment based on the pain drawing, pressure pain thresholds (PPT), and psychological factors, which were evaluated using the pain catastrophizing scale (PCS) and the state-trait anxiety inventory (STAI). Results Statistically significant differences were observed between participants with CNP and TMD + CNP for WP (t = -2.80, P < 0.01, d = -1.06). Post hoc analyses only revealed significant differences between TMD + CNP participants and asymptomatic controls for PPT at extratrigeminal areas. Pearson correlation analyses showed a moderate positive association between symptomatic groups within the WP and STAI ( P < 0.05) and a moderate negative association between PCS and PPT ( P < 0.05) at the right tibialis muscle. Conclusion TMD + CNP participants had more areas of pain and also showed widespread pain hyperalgesia. Both groups of participants had psychological factors positively associated with STAI and WP; further, PCS and the PPT at the extratrigeminal region were negatively associated with each other in both groups, except for the left tibialis in the TMD + CNP group.
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Affiliation(s)
- Daniel Muñoz-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Héctor Beltrán-Alacreu
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Salom-Moreno J, Jiménez-Gómez L, Gómez-Ahufinger V, Palacios-Ceña M, Arias-Buría JL, Koppenhaver SL, Fernández-de-Las-Peñas C. Effects of Low-Load Exercise on Postneedling-Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome. PM R 2017; 9:1208-1216. [PMID: 28483685 DOI: 10.1016/j.pmrj.2017.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The application of dry needling usually is associated with postneedling-induced pain. A postneedling intervention to reduce this adverse event is needed. OBJECTIVE To determine the effectiveness of low-load exercise on reducing postneedling-induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. DESIGN A 72-hour follow-up, single-blind randomized controlled trial. SETTING Urban hospitals. PARTICIPANTS Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle. INTERVENTIONS All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low-load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention. OUTCOME MEASURES Numerical Pain Rating Scale (0-10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0-10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling. RESULTS The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling-induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P < .001) and related disability (Disabilities of the Arm, Shoulder and Hand: P < .001; Shoulder Pain and Disability Index: P < .001) were observed 72 hours after needling, irrespective of the treatment group. CONCLUSIONS Low-load exercise was effective for reducing postneedling-induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short-term pain and disability changes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Jaime Salom-Moreno
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Cátedra de Investigación y Docencia en Fisioterapia, Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain(∗)
| | - Laura Jiménez-Gómez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain(†)
| | - Victoria Gómez-Ahufinger
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain(‡)
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Cátedra de Investigación y Docencia en Fisioterapia, Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain(§)
| | - José L Arias-Buría
- Cátedra de Investigación y Docencia en Fisioterapia, Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid; Department of Physical Therapy, Universidad Francisco de Vitoria, Madrid, Spain(¶)
| | - Shane L Koppenhaver
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX(#)
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine and Cátedra de Investigación y Docencia en Fisioterapia, Terapia Manual y Punción Seca, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain(∗∗).
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Abstract
Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed ‘Atypical Odontalgia’, and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.
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Affiliation(s)
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany
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Blasco-Bonora PM, Martín-Pintado-Zugasti A. Effects of Myofascial Trigger Point Dry Needling in Patients with Sleep Bruxism and Temporomandibular Disorders: A Prospective Case Series. Acupunct Med 2017; 35:69-74. [DOI: 10.1136/acupmed-2016-011102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 12/16/2022]
Abstract
Objectives To investigate the effects of deep dry needling (DN) of myofascial trigger points (MTrPs) of the masseter and temporalis on pain, pressure pain threshold (PPT), pain-free maximal jaw opening and temporomandibular disorder (TMD)-related disability in patients with sleep bruxism (SB) and myofascial TMD. Methods Seventeen subjects (11 women, 6 men) aged 39±13 years (range 23–66) diagnosed with SB and myofascial TMD were invited to participate in this prospective case series study. Each subject received a deep DN intervention in the masseter and temporalis MTrPs. Pain intensity, PPT, pain-free maximal jaw opening and TMD-related disability were assessed before treatment, immediately after treatment and at 1-week follow-up. Jaw disability was assessed using the jaw disability checklist (JDC) at baseline and 1 week post-treatment only. Results One-way analyses of variance showed significant improvements in pain intensity, PPT and jaw opening (p<0.001). Post-hoc analysis revealed significant differences between baseline and post-intervention follow-up time points in pain (immediate: Cohen's d=1.72, p<0.001; 1 week: d=3.24, p<0.001), jaw opening (immediate: d=0.77, p<0.001; 1 week: d=1.02, p<0.001) and PPT in the masseter (immediate: d=1.02, p<0.001; 1 week: d=1.64, p<0.001) and temporalis (immediate: d=0.91, p=0.006; 1 week: d=1.8, p<0.001). A dependent t-test showed a significant improvement in jaw functioning, reflected by a large reduction in 1-week JDC scores relative to baseline (d=3.15, p<0.001). Conclusions Deep DN of active MTrPs in the masseter and temporalis in patients with myofascial TMD and SB was associated with immediate and 1-week improvements in pain, sensitivity, jaw opening and TMD-related disability. Trial registration number Results.
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Hüllemann P, von der Brelie C, Manthey G, Düsterhöft J, Helmers A, Synowitz M, Baron R. Reduced laser-evoked potential habituation detects abnormal central pain processing in painful radiculopathy patients. Eur J Pain 2017; 21:918-926. [DOI: 10.1002/ejp.994] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/06/2022]
Affiliation(s)
- P. Hüllemann
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
| | - C. von der Brelie
- Department of Neurosurgery; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
| | - G. Manthey
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
| | - J. Düsterhöft
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
| | - A.K. Helmers
- Department of Neurosurgery; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
| | - M. Synowitz
- Department of Neurosurgery; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
| | - R. Baron
- Division of Neurological Pain Research and Therapy; Department of Neurology; University Hospital Schleswig-Holstein Campus Kiel; Kiel Germany
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Gil-Martínez A, Grande-Alonso M, López-de-Uralde-Villanueva I, López-López A, Fernández-Carnero J, La Touche R. Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement. J Headache Pain 2016; 17:103. [PMID: 27812883 PMCID: PMC5095086 DOI: 10.1186/s10194-016-0690-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/14/2016] [Indexed: 01/12/2023] Open
Abstract
Background The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). Methods A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). Results A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p < 0.001, d = 1.99; and p < 0.001, d = 1.17), craniomandibular pain and disability (p < 0.001, d = 1.34; and p < 0.001, d = 0.9, respectively), and impact of headache (p < 0.001, d = 1.91; and p < 0.001, d = 0.91, respectively). In addition, significant differences were observed between JP group and MP group for impact of headache (p < 0.001, d = 1.08). Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p < 0.001). In the mixed chronic pain group, neck disability (β = 0.40; p < 0.001) and kinesiophobia (β = 0.30; p = 0.03) were significant covariate (33 % of variance) of craniomandibular pain and disability. Conclusion Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.
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Affiliation(s)
- Alfonso Gil-Martínez
- Hospital La Paz Institute for Health Research, Madrid, Spain. .,Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain.
| | - Mónica Grande-Alonso
- Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Hospital La Paz Institute for Health Research, Madrid, Spain.,Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain
| | - Almudena López-López
- Multidisciplinary Group on Pain Research and Management, Excellence Research Program URJC-Santander, Universidad Rey Juan Carlos, Alcorcón, Spain.,Departamento de medicina y cirugía, psicología, medicina preventiva y salud pública e inmunología microbiología médica, Universidad Rey Juan Carlos, Avda. Atenas s/n, 28922, Alcorcón, Spain
| | - Josué Fernández-Carnero
- Hospital La Paz Institute for Health Research, Madrid, Spain.,Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain.,Multidisciplinary Group on Pain Research and Management, Excellence Research Program URJC-Santander, Universidad Rey Juan Carlos, Alcorcón, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avda. Atenas s/n, 28922, Alcorcón, Spain
| | - Roy La Touche
- Hospital La Paz Institute for Health Research, Madrid, Spain.,Motion in Brains Research Group, Departamento de Fisioterapia, Centro Superior de Estudios Universitarios, Universidad Autónoma de Madrid, Calle La Salle, 10, 28036, Madrid, Spain
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Psychosocial and Somatosensory Factors in Women with Chronic Migraine and Painful Temporomandibular Disorders. Pain Res Manag 2016; 2016:3945673. [PMID: 27818609 PMCID: PMC5081434 DOI: 10.1155/2016/3945673] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 01/01/2023]
Abstract
Introduction. Psychosocial and somatosensory factors are involved in the pathophysiology of chronic migraine (CM) and chronic temporomandibular disorders (TMD). Objective. To compare and assess the relationship between pain catastrophizing and kinesiophobia in patients with CM or chronic TMD. Method. Cross-sectional study of 20 women with CM, 19 with chronic TMD, and 20 healthy volunteers. Pain catastrophizing and kinesiophobia were assessed. The level of education, pain intensity, and magnitude of temporal summation of stimuli in the masseter (STM) and tibialis (STT) muscles were also evaluated. Results. There were significant differences between the CM and chronic TMD groups, compared with the group of asymptomatic subjects, for all variables (p < .05) except kinesiophobia when comparing patients with CM and healthy women. Moderate correlations between kinesiophobia and catastrophizing (r = 0.46; p < .01) were obtained, and the strongest association was between kinesiophobia and magnification (r = 0.52; p < .01). The strongest associations among physical variables were found between the STM on both sides (r = 0.93; p < .01) and between the left and right STT (r = 0.76; p < .01). Conclusion. No differences were observed in pain catastrophizing and kinesiophobia between women with CM and with chronic TMD. Women with CM or chronic TMD showed higher levels of pain catastrophizing than asymptomatic subjects.
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Breton-Torres I, Serre M, Jammet P, Yachouh J. [Masticatory apparatus disorder: how can rehabilitation treatment help?]. Orthod Fr 2016; 87:329-339. [PMID: 27726841 DOI: 10.1051/orthodfr/2016030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/08/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The temporomandibular joint is highly adaptive and masticatory apparatus disorders (MAD) can occur when its ability to adapt is overwhelmed. Occlusal etiologies were long pinpointed as the sole culprits. However, a consensus now exists which minimizes their involvement. It is recognized that the etiology of MAD is multifactorial, combining occlusal problems, parafunctions, postural anomalies, orofacial dyspraxia and stress. MATERIALS AND METHODS In this article, the authors review the role of physiotherapy in managing these pathologies. RESULTS While it remains essential to treat the symptoms in order to relieve pain, optimum treatment requires the underlying pathogenic mechanisms to be identified. Rehabilitation treatment, therefore, offers a physiotherapy-based approach providing an etiological solution. By reeducating function, physiotherapy produces lasting results. DISCUSSION Given the multifactorial nature of MAD etiologies, maxillofacial rehabilitation is an indispensible ally for odontologists or orthodontists adopting a multidisciplinary approach in their treatment of this disorder.
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Affiliation(s)
- Isabelle Breton-Torres
- Département d'ORL, chirurgie cervico-faciale, chirurgie maxillo-faciale et stomatologie, Structure Fédérative de Recherche - AMES, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier cedex 5, France
| | - Manon Serre
- CHU, 545 avenue du Professeur Jean Louis Viala, 34295 Montpellier Cedex 5, France
| | - Patrick Jammet
- Département d'ORL, chirurgie cervico-faciale, chirurgie maxillo-faciale et stomatologie, Structure Fédérative de Recherche - AMES, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier cedex 5, France
| | - Jacques Yachouh
- Département d'ORL, chirurgie cervico-faciale, chirurgie maxillo-faciale et stomatologie, Structure Fédérative de Recherche - AMES, Hôpital Gui de Chauliac, 80 avenue Augustin Fliche, 34295 Montpellier cedex 5, France
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Guarda-Nardini L, Cadorin C, Frizziero A, Masiero S, Manfredini D. Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid. Cranio 2016; 35:276-282. [PMID: 27638344 DOI: 10.1080/08869634.2016.1232788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis. METHODS Forty-nine patients, (79% females, aged between 43-81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol. RESULTS A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol. CONCLUSIONS A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.
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Affiliation(s)
- Luca Guarda-Nardini
- a TMD Clinic, Department of Neuroscience , University of Padua , Padova , Italy.,b Section of Dentistry and Maxillofacial Surgery , Hospital of Treviso , Treviso , Italy
| | - Cristina Cadorin
- c Department of Physical and Rehabilitation Medicine , University of Padua , Padova , Italy
| | - Antonio Frizziero
- c Department of Physical and Rehabilitation Medicine , University of Padua , Padova , Italy
| | - Stefano Masiero
- c Department of Physical and Rehabilitation Medicine , University of Padua , Padova , Italy
| | - Daniele Manfredini
- a TMD Clinic, Department of Neuroscience , University of Padua , Padova , Italy.,d School of Dentistry , University of Padova , Padova , Italy
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Zhang H, Liu X, Jiang H, Liu Z, Zhang XY, Xie HZ. Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial. J Pain Res 2016; 9:653-660. [PMID: 27695359 PMCID: PMC5028176 DOI: 10.2147/jpr.s115889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. Materials and methods The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Results Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07–0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01). Conclusion Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.
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Affiliation(s)
- Hufei Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Xinhe Liu
- Department of Anesthesiology, Shenzhen Hospital, University of Hong Kong, Shenzhen
| | | | - Zimeng Liu
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xu-Yu Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou
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Brodsky M, Spritzer K, Hays RD, Hui KK. Change in Health-Related Quality-of-Life at Group and Individual Levels Over Time in Patients Treated for Chronic Myofascial Neck Pain. J Evid Based Complementary Altern Med 2016; 22:365-368. [PMID: 27539992 DOI: 10.1177/2156587216662779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study evaluated change in health-related quality of life at the group and individual levels in a consecutive series of patients with chronic myofascial neck pain. METHODS Fifty patients with chronic neck pain self-administered the Short Form-36 Version 2 (SF-36 v2) before treatment and 6 weeks later. Internal consistency reliability was estimated for the 8 scale scores and Mosier's formula was used to estimate reliability of the physical and mental health composite scores. Significance of group-level change was estimated using within-group t statistics. Significance of individual change was evaluated by reliable change index. RESULTS Statistically significant ( P < .05) group mean improvement over time was found for all SF-36 scores. At the individual level, 20% of the possible changes were statistically significant (17% improvement, 3% decline). CONCLUSIONS Estimating the significance of individual change in health-related quality of life adds important information in comparing different treatment modalities for chronic myofascial neck pain.
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Affiliation(s)
| | | | - Ron D Hays
- 2 University of California, Los Angeles, CA, USA
| | - Ka-Kit Hui
- 2 University of California, Los Angeles, CA, USA
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42
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Breton-Torres I, Trichot S, Yachouh J, Jammet P. [Temporomandibular joint disorders: Physiotherapy and postural approaches]. ACTA ACUST UNITED AC 2016; 117:217-22. [PMID: 27522242 DOI: 10.1016/j.revsto.2016.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/20/2016] [Indexed: 11/26/2022]
Abstract
Rehabilitation of temporomandibular joint dysfunctions has for a long time tried to treat symptoms: pain relief, joint kinetics restoration, disk re-capture by manual maneuvers. The authors present their own therapeutic approach, which is no longer limited to symptoms, but addresses the causes and identifies risk factors to prevent relapse.
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Affiliation(s)
- I Breton-Torres
- Département de chirurgie maxillo-faciale et ORL, hôpital Gui-de-Chauliac, 34000 Montpellier, France.
| | | | - J Yachouh
- Département de chirurgie maxillo-faciale et ORL, hôpital Gui-de-Chauliac, 34000 Montpellier, France
| | - P Jammet
- Département de chirurgie maxillo-faciale et ORL, hôpital Gui-de-Chauliac, 34000 Montpellier, France
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43
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Conti PCR, Costa YM, Gonçalves DA, Svensson P. Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements? J Oral Rehabil 2016; 43:702-15. [DOI: 10.1111/joor.12410] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/12/2022]
Affiliation(s)
- P. C. R. Conti
- Department of Prosthodontics; Bauru School of Dentistry; University of São Paulo; Bauru Brazil
- Bauru Orofacial Pain Group; University of São Paulo; Bauru Brazil
| | - Y. M. Costa
- Bauru Orofacial Pain Group; University of São Paulo; Bauru Brazil
- Section of Head and Face Physiology; Department of Biological Sciences; Bauru School of Dentistry; University of São Paulo; Bauru Brazil
| | - D. A. Gonçalves
- Department of Dental Materials and Prosthodontics; Araraquara Dental School; Sao Paulo State University; Araraquara Brazil
| | - P. Svensson
- Section of Orofacial Pain and Jaw Function; Department of Dentistry; Aarhus University; Aarhus Denmark
- Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON)
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44
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Shimada A, Castrillon EE, Baad-Hansen L, Ghafouri B, Gerdle B, Wåhlén K, Ernberg M, Cairns BE, Svensson P. Increased pain and muscle glutamate concentration after single ingestion of monosodium glutamate by myofascial temporomandibular disorders patients. Eur J Pain 2016; 20:1502-12. [PMID: 27091318 DOI: 10.1002/ejp.874] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND A randomized, double-blinded, placebo-controlled study was conducted to investigate if single monosodium glutamate (MSG) administration would elevate muscle/serum glutamate concentrations and affect muscle pain sensitivity in myofascial temporomandibular disorders (TMD) patients more than in healthy individuals. METHODS Twelve myofascial TMD patients and 12 sex- and age-matched healthy controls participated in two sessions. Participants drank MSG (150 mg/kg) or NaCl (24 mg/kg; control) diluted in 400 mL of soda. The concentration of glutamate in the masseter muscle, blood plasma and saliva was determined before and after the ingestion of MSG or control. At baseline and every 15 min after the ingestion, pain intensity was scored on a 0-10 numeric rating scale. Pressure pain threshold, pressure pain tolerance (PPTol) and autonomic parameters were measured. All participants were asked to report adverse effects after the ingestion. RESULTS In TMD, interstitial glutamate concentration was significantly greater after the MSG ingestion when compared with healthy controls. TMD reported a mean pain intensity of 2.8/10 at baseline, which significantly increased by 40% 30 min post MSG ingestion. At baseline, TMD showed lower PPTols in the masseter and trapezius, and higher diastolic blood pressure and heart rate than healthy controls. The MSG ingestion resulted in reports of headache by half of the TMD and healthy controls, respectively. CONCLUSION These findings suggest that myofascial TMD patients may be particularly sensitive to the effects of ingested MSG. WHAT DOES THIS STUDY ADD?': Elevation of interstitial glutamate concentration in the masseter muscle caused by monosodium glutamate (MSG) ingestion was significantly greater in myofascial myofascial temporomandibular disorders (TMD) patients than healthy individuals. This elevation of interstitial glutamate concentration in the masseter muscle significantly increased the intensity of spontaneous pain in myofascial TMD patients.
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Affiliation(s)
- A Shimada
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Faculty of Health Sciences, Aarhus University, Denmark. .,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.
| | - E E Castrillon
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Faculty of Health Sciences, Aarhus University, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - L Baad-Hansen
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Faculty of Health Sciences, Aarhus University, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - B Ghafouri
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Pain and Rehabilitation Center, Anaesthetics, Operations and Specialty Surgery Center, County Council of Östergötland, Linköping University, Sweden
| | - B Gerdle
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Pain and Rehabilitation Center, Anaesthetics, Operations and Specialty Surgery Center, County Council of Östergötland, Linköping University, Sweden
| | - K Wåhlén
- Division of Community Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Pain and Rehabilitation Center, Anaesthetics, Operations and Specialty Surgery Center, County Council of Östergötland, Linköping University, Sweden
| | - M Ernberg
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Section of Orofacial Pain and Jaw Function, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - B E Cairns
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - P Svensson
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Faculty of Health Sciences, Aarhus University, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
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45
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Carvalho GF, Chaves TC, Florencio LL, Dach F, Bigal ME, Bevilaqua-Grossi D. Reduced thermal threshold in patients with Temporomandibular Disorders. J Oral Rehabil 2016; 43:401-8. [DOI: 10.1111/joor.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
- G. F. Carvalho
- Department of Biomechanics; Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - T. C. Chaves
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - L. L. Florencio
- Department of Biomechanics; Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - F. Dach
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
| | - M. E. Bigal
- Migraine & Headache Clinical Development; Global Branded R&D; Pennsylvania PA USA
| | - D. Bevilaqua-Grossi
- Department of Biomechanics; Medicine and Locomotor Apparatus Rehabilitation - Ribeirão Preto Medical School; University of São Paulo; Ribeirão Preto-SP Brazil
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Michelotti A, Alstergren P, Goulet JP, Lobbezoo F, Ohrbach R, Peck C, Schiffman E, List T. Next steps in development of the diagnostic criteria for temporomandibular disorders (DC/TMD): Recommendations from the International RDC/TMD Consortium Network workshop. J Oral Rehabil 2016; 43:453-67. [DOI: 10.1111/joor.12378] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- A. Michelotti
- Department of Neuroscience, Reproductive Sciences and Oral Sciences; University of Naples Federico II; Naples Italy
| | - P. Alstergren
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
| | - J. P. Goulet
- Faculty of Dental Medicine; Laval University; Quebec QC Canada
| | - F. Lobbezoo
- Department of Oral Health Sciences; Academic Centre for Dentistry Amsterdam (ACTA); MOVE Research Institute Amsterdam; University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - R. Ohrbach
- Department of Oral Diagnostic Sciences; University at Buffalo; Buffalo NY USA
| | - C. Peck
- Faculty of Dentistry; University of Sydney; Darlington NSW Australia
| | - E. Schiffman
- Division of TMD and Orofacial Pain; University of Minnesota; Minneapolis MN USA
| | - T. List
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Scandinavian Center for Orofacial Neurosciences (SCON); Malmö Sweden
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Fernández-de-Las-Peñas C, Layton M, Dommerholt J. Dry needling for the management of thoracic spine pain. J Man Manip Ther 2015; 23:147-53. [PMID: 26309385 DOI: 10.1179/2042618615y.0000000001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain ; Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain ; Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Michelle Layton
- Myopain Seminars, LLC, Bethesda, MD, USA ; Bethesda Physiocare, Inc, Bethesda, MD, USA
| | - Jan Dommerholt
- Myopain Seminars, LLC, Bethesda, MD, USA ; Bethesda Physiocare, Inc, Bethesda, MD, USA ; Universidad CEU Cardenal Herrera, Valencia, Spain
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Kiyomoto M, Shinoda M, Honda K, Nakaya Y, Dezawa K, Katagiri A, Kamakura S, Inoue T, Iwata K. p38 phosphorylation in medullary microglia mediates ectopic orofacial inflammatory pain in rats. Mol Pain 2015; 11:48. [PMID: 26260484 PMCID: PMC4531532 DOI: 10.1186/s12990-015-0053-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 08/03/2015] [Indexed: 12/22/2022] Open
Abstract
Background Orofacial inflammatory pain is likely to accompany referred pain in uninflamed orofacial structures. The ectopic pain precludes precise diagnosis and makes treatment problematic, because the underlying mechanism is not well understood. Using the established ectopic orofacial pain model induced by complete Freund’s adjuvant (CFA) injection into trapezius muscle, we analyzed the possible role of p38 phosphorylation in activated microglia in ectopic orofacial pain. Results Mechanical allodynia in the lateral facial skin was induced following trapezius muscle inflammation, which accompanied microglial activation with p38 phosphorylation and hyperexcitability of wide dynamic range (WDR) neurons in the trigeminal spinal subnucleus caudalis (Vc). Intra-cisterna successive administration of a p38 mitogen-activated protein kinase selective inhibitor, SB203580, suppressed microglial activation and its phosphorylation of p38. Moreover, SB203580 administration completely suppressed mechanical allodynia in the lateral facial skin and enhanced WDR neuronal excitability in Vc. Microglial interleukin-1β over-expression in Vc was induced by trapezius muscle inflammation, which was significantly suppressed by SB203580 administration. Conclusions These findings indicate that microglia, activated via p38 phosphorylation, play a pivotal role in WDR neuronal hyperexcitability, which accounts for the mechanical hypersensitivity in the lateral facial skin associated with trapezius muscle inflammation.
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Affiliation(s)
- Masaaki Kiyomoto
- Department of Oral Physiology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Masamichi Shinoda
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Kuniya Honda
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Yuka Nakaya
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Ko Dezawa
- Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Ayano Katagiri
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Satoshi Kamakura
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
| | - Tomio Inoue
- Department of Oral Physiology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8310, Japan.
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Rodriguez-Blanco C, Cocera-Morata FM, Heredia-Rizo AM, Ricard F, Almazán-Campos G, Oliva-Pascual-Vaca Á. Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study. J Altern Complement Med 2015. [PMID: 26218883 DOI: 10.1089/acm.2014.0332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD). DESIGN A randomized and double-blind controlled trial was carried out. SETTINGS/LOCATION University-based physical therapy research clinic. SUBJECTS Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30). INTERVENTIONS The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG. OUTCOME MEASURES Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention. RESULTS In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05). CONCLUSION The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.
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Affiliation(s)
- Cleofás Rodriguez-Blanco
- 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
| | | | - Alberto Marcos Heredia-Rizo
- 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
| | | | | | - Ángel Oliva-Pascual-Vaca
- 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain
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Association between muscle trigger points, ongoing pain, function, and sleep quality in elderly women with bilateral painful knee osteoarthritis. J Manipulative Physiol Ther 2015; 38:262-8. [PMID: 25925017 DOI: 10.1016/j.jmpt.2014.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 10/22/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objectives of this study were to investigate if referred pain elicited by active trigger points (TrPs) reproduced the symptoms in individuals with painful knee osteoarthritis (OA) and to determine the relationship between the presence of active TrPs, intensity of ongoing pain, function, quality of life, and sleep quality in individuals with painful knee OA. METHODS Eighteen women with bilateral painful knee OA, aged 79 to 90 years, and 18 matched controls participated. Muscle TrPs were bilaterally explored in several muscles of the lower extremity. Trigger points were considered active if the elicited referred pain reproduced knee symptoms, and TrPs were considered latent if the elicited pain did not reproduce symptoms. Pain was collected with a numerical pain rate scale (0-10), function was assessed with Western Ontario and McMaster Universities, quality of life was assessed with the Medical Outcomes Study Short Form 36 questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index. RESULTS Women with knee OA exhibited a greater number of active TrPs (mean, 1 ± 1; P < .001) but similar number of latent TrPs (mean, 4 ± 2) than healthy women (mean, 4 ± 3; P = .613). A greater number of active TrPs were associated with higher intensity of ongoing pain (r = 0.605; P = .007). Higher intensity of ongoing knee pain was associated with lower physical function (P < .05). CONCLUSIONS The referred pain elicited by active TrPs in the lower extremity muscles contributed to pain symptoms in painful knee OA. A higher number of active TrPs was associated with higher intensity of ongoing knee pain.
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