The Influence of Cranio-cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients With Myofascial Temporomandibular Pain Disorders

Pre-Surgical Factors Influencing Post-Surgical Outcomes in Orthognathic Surgery Patients: A Longitudinal Study

Background/Objectives: This study aims to assess the relationship between physical and psychosocial pre-surgical factors and post-surgical evolution in patients undergoing orthognathic surgery. Methods: A cohort study with 3 months of follow-up after maxillofacial surgery was conducted. Participants were recruited from the Maxillofacial Surgery Unit of Hospital Universitario La Paz in Madrid, Spain. Primary variables included the range of motion of mouth opening, protrusion tongue force, anxiety, depression and kinesiophobia. Assessments were realised on-site or via video call. Statistical analysis was conducted using mixed-effects models. Results: The initial recruitment yielded 22 patients, with 19 ultimately eligible for analysis. The study found significant impacts of pre-surgical factors on post-surgical evolution. Both ranges of motion and anxiety showed influences from baseline measures, with the range of motion affected by a pre-surgical range of motion (estimate: 3.89) and positive expectations (estimate: 4.83). Anxiety was influenced by both pre-surgical (estimate: 0.48) and baseline anxiety levels (estimate: 0.64). Kinesiophobia demonstrated a trend toward significance, with baseline levels affecting post-surgical evolution (estimate: 0.77). Conclusions: Our results highlight the relationship between pre-surgical factors and post-surgical outcomes in orthognathic surgery patients. Pre-surgical range of motion and positive expectations were found to influence post-surgical range of motion, while pre-surgical anxiety levels impacted post-surgical anxiety evolution. Pre-surgical kinesiophobia also showed potential as a post-surgical kinesiophobia predictor, but further investigation is needed to confirm this relationship.

The effectiveness of cervical rehabilitation interventions for pain in adults with myogenic temporomandibular disorders: A systematic review and meta-analysis

OBJECTIVE

Little evidence exists for the most effective conservative treatment approach for adults with myogenic temporomandibular disorders (MTMD). We aim to assess the effectiveness of cervical rehabilitation interventions on pain intensity and sensitivity in adults with MTMD compared to comparison intervention such as placebo, sham treatment, education or no intervention.

METHODS

For this systematic review and meta-analysis, we searched PubMed, EMBASE, Medline, PEDro databases, forward and backward citations and grey literature studies through PROSPERO, clinical trials and data registries without language or date restrictions between inception and 1 December 2021. We selected randomised controlled trials (RCTs) based on adult populations with MTMD who had a cervical rehabilitation intervention which was defined as any conservative intervention targeting the anatomical structures of the cervical spine. The primary outcome measures for pain were self-reported pain intensity and pain sensitivity through the pressure pain threshold (PPT) of the masseter and temporalis muscles. Secondary outcome measures of maximal mouth opening (on MMO) were included. Included studies were assessed for bias with the Cochrane risk of bias tool for randomised trials. Evidence from RCTs was synthesised to determine treatment effect size as differences between standardised mean difference (SMD) for changes in pain intensity, PPT and MMO comparing adults with MTMD who were treated with cervical rehabilitation interventions compared to a control group. This study is registered on Prospero, number CRD 42021289299.

RESULTS

Our general search yielded 2647 studies where seven RCTs met eligibility criteria with low to some concerns in their risk of bias. Pain intensity (five studies, n = 223, SMD -0.98, 95% CI -1.67 to -0.28, I2 = 79%), PPT of the masseter muscle (six studies, n = 395, SMD 0.64, 95% CI 0.43 to 0.86, I2 = 90%) and the temporalis muscles (five studies, n = 295, SMD 0.76, 95% CI 0.07 to 1.45, I2 = 84%) showed large treatment effect estimates favouring cervical rehabilitation interventions compared to no treatment, sham cervical treatment, patient education or non-cervical neuromuscular techniques. Compared to control interventions, one type of cervical rehabilitation intervention, cervical manual therapy alone or in combination with a neck exercise program was associated with statistically significant, large treatment effect estimates on pain intensity (four studies, n = 203, SMD -1.52, 95% CI -2.50 to -0.55).

CONCLUSIONS

This review found that in the short-term, cervical rehabilitation interventions especially upper cervical MT alone or in combination with a neck exercise program are effective in improving multiple pain outcomes in adults with MTMD. However, further research is needed to measure the long-term effects of this type of intervention.

Measurement proprieties of the CROM instrument for assessing head posture, neck retraction and protraction

BACKGROUND

The CROM instrument is widely used clinically and in research to measure neck range of motion. However, its measurement proprieties during the assessment of protraction and retraction movements were not examined so far.

OBJECTIVE

To analyse the intra- and inter-rater reliability, the concurrent validity of the CROM for measuring head posture, retraction and protraction in healthy subjects.

METHODS

Thirty-three asymptomatic subjects were recruited and assigned in a random order to one of two raters. After a 10-min break, they were examined by a second rater (Assessment 1). After a 30-min break, both raters repeated the examination (Assessment 2). The examination consisted of measuring the head posture, maximum head protraction and maximum retraction. Each movement was repeated 3 times and measured simultaneously with the CROM and with a 3D capture system laboratory.

RESULTS

The intra-rater reliability of the CROM was excellent for both raters for head posture and all head movements (ICC>0.9, 95% CI: 0.82-0.99, p < 0.01). The inter-rater reliability was excellent for head posture (ICC>0.95, 95% CI: 0.92-0.98, p < 0.01) and good-to-excellent for all movements at both time-points (ICC = 0.73-0.98, 95%CI: 0.45-0.99, p < 0.01). The validity analysis showed moderate-to-strong correlation between instruments for the head posture and head movements [(r) = -0.47 to -0.78), 95% CI: 0.99 to -0.24, p < 0.01].

CONCLUSION

The CROM instrument has good-to-excellent reliability and adequate validity for measuring cervical position and displacement in the sagittal plane.

Quality of life, craniomandibular function, and psychosocial factors related to pain and movement in patients with head and neck cancer

PURPOSE

To describe the characteristics of and the associations between health-related quality of life, pain, craniomandibular function, and psychosocial factors related to pain and fear of movement in patients with head and neck cancer.

METHODS

Seventy-eight patients diagnosed with HNC were recruited. Measurements of the maximum mouth opening range and pressure pain thresholds on the masseter muscle and the distal phalanx of the thumb were conducted, as well as a battery of self-report questionnaires were administrated, including the QoL Questionnaire (EORT QLQ-H&N35), Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), the Spanish translation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the short version of the Craniofacial Pain and Disability Inventory (CF-PDI-11).

RESULTS

The study sample (66.7% men, mean age 60.12 [11.95] years) experienced a moderate impact on their QoL levels (57.68 [18.25] EORT QLQ-H&N35) and high kinesiophobia values (20.49 [9.11] TSK-TMD). Pain was present in 41% of the patients, but only 3.8% reported severe pain. 26.4% had a restricted mouth opening range, and 34.62% showed significant catastrophism levels. There were strong positive correlations between EORT QLQ-H&N35 and CF-PDI-11 (r = 0.81), between NRS and CF-PDI-11 (r = 0.74), and between PCS and CF-PDI-11 (r = 0.66).

CONCLUSION

Patients with HNC experience negative effects in their QoL, related to their impairment in craniomandibular function. Fear of movement, pain intensity, and catastrophism are associated with poorer functionality; relationships that should be considered when attempting to improve health care.

Is temporomandibular joint involvement more frequent in patients with epilepsy? A clinical study

STATEMENT OF PROBLEM

Epileptic seizures may affect the stomatognathic system via transmission of an increased load to the dentition and the temporomandibular joint (TMJ), resulting in temporomandibular joint dysfunction (TMD).

PURPOSE

The purpose of this clinical study was to assess whether TMD was more prevalent in patients with epilepsy than in those without epilepsy.

MATERIAL AND METHODS

A total of 107 participants diagnosed with epilepsy and 100 healthy controls were enrolled in the study. Those with epilepsy were divided according to their dental manageability into 3 subgroups: mild group, moderate group, and severe group. Following general, dental, and TMJ-related history, the range of maximal mouth opening (MMO), laterotrusion, possible deviation and deflection, and presence of crepitation and clicking was recorded, as suggested by the diagnostic criteria for temporomandibular diseases (DC/TMD). Pressure pain threshold (PPT) was also measured by using a pressure algometer on 3 points bilaterally.

RESULTS

Incidence of TMJ complaints was not significantly different between the control (30%) and the group diagnosed with epilepsy (33%); however, the number of complaints experienced was significantly higher in the epilepsy group (C: 3%, E: 16% had 3 or more complaints; P<.001). Joint clicking was significantly more prevalent in the entire epilepsy group (P=.012) and in the mild group (P=.004) than in controls. Crepitation and joint pain were not significantly more common in the epilepsy group. Maximal mouth opening, laterotrusion, and the ratio of restricted mouth opening did not differ significantly in the epilepsy group. Deflection occurred significantly more often in the epilepsy subgroups (mild and moderate groups; P<.001), and the extent of deflection was also significantly higher in all the epilepsy subgroups (P<.001) than in controls. Regarding the pressure pain threshold, significant difference was observed in the severe group at the left masseter muscle points M1 (P=.046) and M2 (P=.028) compared with controls.

CONCLUSIONS

All parameters typical of TMD could be found frequently in patients with epilepsy. Because of the seizures and the consequent joint overload, the TMJ involvement was more common or more serious in those diagnosed with epilepsy. Outcomes of this study support the assumption that epilepsy is a risk factor for the development of TMD.

The effect of temporomandibular joint dysfunction on the craniocervical mandibular system: A retrospective study

BACKGROUND

Temporomandibular disorders are the most common condition affecting the orofacial region, resulting in pain and dysfunction.

OBJECTIVE

This study aimed to elucidate the ambiguous association between cervical features and temporomandibular disorders by measuring the rotations between the skull-atlas, atlas-axis and mandible-atlas and examining the relationship between these rotations and temporomandibular disorders.

METHODS

Cone-beam computed tomography (CBCT) images from 176 patients, 97 females and 79 males with an average age of 25.7 years were used in this study. The patients were divided into two groups: those with joint dysfunction (n = 88) and those without (n = 88). The study employed various methods to determine rotations in the skull-atlas, atlas-axis and mandible atlas based on anatomical landmarks and measurements. These methods include the use of specific planes, angles and distances to identify and measure rotation. Data analysis was performed using the TURCOSA statistical software (Turcosa Analytics Ltd Co, Turkey, www.turcosa.com.tr).

RESULTS

The results showed that the degree of rotation between the skull and the atlas was higher in the TMD group than in the control group (p < .001). Similarly, Atlas-axis rotation was significantly higher in the TMD group (p < .001). However, no significant difference was found between mandible atlas rotations in the two groups (p = .546). The study also found a significant difference between the direction of rotation between the atlas and axis and the direction of mandible atlas rotation (p < .001) as well as between skull and atlas rotations and mandible-atlas rotations (p < .001).

CONCLUSION

Overall, the study suggests that there is a relationship between the skeletal structures of the cranio-cervico-mandibular system and TMD. Skull-atlas and atlas-axis rotations may play an important role in the aetiology of TMD in individuals with TMD. Therefore, it is important to evaluate rotations in the skull-atlas-axis region for the treatment of TMD.

Relationship of temporomandibular joint disorders with cervical posture and hyoid bone position

OBJECTIVE

To evaluate craniocervical posture and hyoid bone position in patients with and without temporomandibular joint disorder (TMD).

METHODS

A total of 113 people were included in the study, including 55 TMD patients and 58 healthy controls. Using lateral cephalograms, the craniofacial, craniocervical, and hyoid bone positions of the participants were evaluated in terms of 27 variables.

RESULTS

There was no significant difference in craniocervical angles between participants with or without TMD. While the Hy-B, Hy-NSL, Hy-NL measurements and FMA (°), AFH (mm) measurements of participants with TMD were lower than the control group, the hyoid angle was greater than the control group.

CONCLUSION

These study findings provide evidence that TMD is not related to craniocervical posture but to the position of the hyoid bone and craniofacial morphology.

An investigation of biomechanics, muscle performance, and disability level of craniocervical region of individuals with temporomandibular disorder

OBJECTIVE

To investigate biomechanics, muscle performance, and disability of the craniocervical region in temporomandibular disorder (TMD) patients and compare them with controls.

METHODS

Craniocervical posture was evaluated using lateral photography and radiography. Range of motion, muscle performance, disability, and TMD severity were assessed using an inclinometer, Functional Strength Testing of Cervical Spine, Neck Disability Index, and Fonseca Anamnestic Index, respectively.

RESULTS

Compared to the control group, the TMD group demonstrated higher cervical flexion angle (p=0.005) and neck disability (p<0.001) as well as lower cervical extension (p=0.040), right cervical rotation (p=0.005), left cervical rotation (p<0.001), and tragus-C7-horizontal (p=0.048) angles, and reduced muscle performances (p≤0.001). Most patients had higher than normal craniocervical angle (p<0.001). Muscle performance in each cervical motion (p<0.005) and disability (p<0.001) were associated with TMD severity in the TMD group.

CONCLUSION

Biomechanics, muscle performance, and disability of craniocervical region were altered in the TMD group.

Additional effects of therapeutic exercise and education on manual therapy for chronic temporomandibular disorders treatment: a randomized clinical trial

BACKGROUND

Previous studies have evaluated the implementation of behavioral approaches in individuals with chronic temporomandibular disorders (TMDs).

OBJECTIVE

To evaluate the benefits of a behavioral approach to craniofacial pain. Second, we assessed the benefits of kinesiophobia, catastrophizing, mouth opening without pain, and forward head posture.

METHODS

Individuals with chronic TMDs were treated for five weeks. The intervention group (n = 17) underwent pain neuroscience education, manual therapy, and therapeutic exercise, whereas the control group (n = 17) underwent manual therapy only. Outcomes were evaluated immediately, at seven and 19 weeks follow-up. The assessment tools used were the Craniofacial Pain Disability Inventory, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Mandibular Range of Motion Scale, and Cervical Range of Motion Tool.

RESULTS

The interventions did not influence the differences in the improvements between the groups observed for craniofacial pain disability (inter-subject p 0.4). The intervention had a moderate influence on the improvement of kinesiophobia and catastrophizing (Inter-subject p 0.09 and 0.1 respectively) with a clinically significant effect size (Estimated mean (EM) -8.6 standard deviation (SD) ±3.48 p 0.019; and EM -7.6 SD ± 5.11 p 0.15 respectively).

CONCLUSION

The behavioral approach improved catastrophizing and kinesiophobia outcomes in individuals with chronic TMDs.

Is core stability training effective in temporomandibular disorder? A randomized controlled trial

OBJECTIVES

This study investigated the effect of core stability training on pain, function, quality of life, and posture in individuals with temporomandibular disorder.

MATERIALS AND METHODS

Participants were divided into the following: the core stability group and the control group. For pain assessment, the Graded Chronic Pain Scale 2.0; for function, the 20-item Jaw Functional Limitation Scale (JFLS-20); for oral health-related quality of life, Oral Health Impact Profile-14 (OHIP-14); and for posture assessment, the New York Scale were used. Rocabado exercises were applied to the control group. Additionally, spinal stabilization exercises were applied for the core stability group for 6 weeks.

RESULTS

Both types of exercise contribute positively to the quality of life associated with oral health. Rocabado exercise provided a significant change in Chronic Pain Intensity and Disability Score.

CONCLUSION

Rocabado exercise and core stability training, implemented with Rocabado, provide significant changes in pain values. When evaluated in terms of function, no significant difference was found in both exercise programs.

CLINICAL RELEVANCE

Core stability training with Rocabado provides significant changes.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04755621.

Craniofacial disorders and headaches. A narrative review

OBJECTIVES

Craniofacial- and headache disorders are common co-morbid disorders. The aim of this review is to provide an overview of the research discussing craniofacial pain, especially temporomandibular disorders, and its relationship and impact on headaches, as well as suggestions for diagnostic assessment tools and physical therapeutic management strategies.

METHOD

A narrative structured review was performed. A search was conducted in MEDLINE using terms related to craniofacial pain and headaches. Additionally, papers regarding this topic were also extracted from the authors' personal libraries. Any study design (i.e., RCT, observational studies, systematic review, narrative review) that reported the concepts of interest was included, using Covidence. Results were narratively synthesized and described.

RESULTS

From an epidemiological perspective, craniofacial pain and headaches are strongly related and often co-existing. This may be due to the neuroanatomical connection with the trigeminal cervical complex, or due to shared predisposing factors such as age, gender, and psychosocial factors. Pain drawings, questionnaires, and physical tests can be used to determine the cause of pain, as well as other perpetuating factors in patients with headaches and craniofacial pain. The evidence supports different forms of exercise and a combination of hands-on and hands-off strategies aimed at both the craniofacial pain as well as the headache.

CONCLUSION

Headaches may be caused or aggravated by different disorders in the craniofacial region. Proper use of terminology and classification may help in understanding these complaints. Future research should look into the specific craniofacial areas and how headaches may arise from problems from those regions. (249 words).

The efficacy of orofacial myofunctional therapy in oral dysphagia accompanying temporomandibular dysfunction

OBJECTIVE

Patients with temporomandibular dysfunction (TMD) may develop oral-stage dysphagia (OD) in the chronic phase.

METHODS

This study investigated the effect of orofacial myofunctional therapy (OMT) in individuals with TMD-related OD. Fifty-one patients aged 18-65 years with TMD-related OD were separated into three groups using a simple randomization method: the control group (n = 12) underwent patient education and a home-exercise program; additionally, to an exercise program the manual therapy (MT) group (n = 19) received MT; and the OMT group (n = 20) received the OMT program. MT and OMT were applied in two sessions per week for 10 weeks. The patients were re-evaluated after treatment and at 3 months.

RESULTS

The OMT group showed the most improvement in jaw functionality, swallowing-related quality of life, pain, and dysphagia (p < .05).

DISCUSSION

OMT was superior to MT and exercises alone in reducing dysphagia and improving the swallowing-related quality of life.

Cervical Range of Motion Analysis Performed with an Accelerometer: A Study of Intersession Reliability for Dental Practice

During the clinical examination of subjects with temporomandibular disorders (TMDs), the dentist sometimes must evaluate the cervical spine, due to the anatomical and functional connections between the cervical portion of the spine and the stomatognathic apparatus. The accelerometer is a device that evaluates the Range of Motion (ROM) of the main movements of the head on the neck. To date, only a few studies have investigated the repeatability of the use of the accelerometer in the assessment of cervical ROM. Therefore, the present longitudinal observational study analyzed the repeatability of acquired cervical movements on a sample of volunteer subjects who underwent accelerometer testing. A sample of 32 subjects was tested twice within 14 days to assess cervical ROM using a standardized protocol based on a review of existing literature. The results show that the examination is reliable for all the positions of the jaw, except for the parameters regarding the asymmetries of rotation and bending. In conclusion, the accelerometer can be considered a reliable tool for evaluating the active cervical ROM. However, further studies will be necessary to make better evaluations.

Correlation between Temporomandibular Disorders (TMD) and Posture Evaluated trough the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): A Systematic Review with Meta-Analysis

Background: Temporomandibular disorders (TMDs) are a series of disorders that affect the muscles and joint. Symptoms include joint pain, muscle pain, and limitation of mouth opening. One of several multifactorial diseases, temporomandibular dysfunction has mostly been linked to five etiological factors: occlusion, trauma, severe pain stimuli, parafunctional activities, and psychological elements, including stress, anxiety, and depression. The position of the human body as it is displayed in space is referred to as posture. Several nerve pathways regulate posture, and through ligaments, TMD and posture affect each other. The purpose of this study is to evaluate the possible correlation between posture and TMD through a meta-analysis of the literature; Methods: A literature search was performed on PubMed, Lilacs, and Web of science, and articles published from 2000 to 31 December 2022 were considered, according to the keywords entered. The term “temporomandibular disorders” has been combined with “posture”, using the Boolean connector AND; Results: At the end of the research, 896 studies were identified from the search conducted on the 3 engines. Only three were chosen to draw up the present systematic study summarizing the article’s main findings. The meta-analysis showed through forest plot analysis a correlation between posture and TMD Conclusions: This literature meta-analysis showed a correlation between posture and TMD. Nerve pathways probably regulate both body posture and mandibular posture. Further clinical studies will be needed to confirm this hypothesis and to indicate the main conclusions or interpretations.

Effectiveness of manual therapy and cervical spine stretching exercises on pain and disability in myofascial temporomandibular disorders accompanied by headaches: a single-center cohort study

BACKGROUND

Previous studies have demonstrated a relationship between headaches and temporomandibular disorders (TMDs). Moreover, recent studies have shown functional, anatomical, and neurological associations between the temporomandibular joint (TMJ) and upper cervical spine. This study aimed to investigate the effectiveness of manual therapy and cervical spine stretching exercises for pain and disability in patients with myofascial TMDs accompanied by headaches.

METHODS

Thirty-four patients recruited from Gyeryong Hospital with headaches and diagnosed with TMDs were randomly assigned to the experimental (n = 17) and control (n = 17) groups. Headache impact was assessed using the Korean Headache Impact Test-6. Masseter myofascial pain was measured using the visual analog scale, and TMJ pressure pain threshold levels were evaluated using an algometer. Neck pain intensity was assessed using the numerical rating scale. Once per week for 10 weeks, the experimental group received cervical spine-focused manual therapy and stretching exercises alongside conservative physical therapy, and the control group received conservative physical therapy alone. Patients were evaluated at baseline and 5 and 10 weeks post-intervention.

RESULTS

After the intervention, the experimental group exhibited significant reductions in the cervical kyphotic angle, Korean Headache Impact Assessment score, neck pain intensity, TMJ pain pressure threshold, Neck Disability Index score, and Jaw Functional Limitation Scale level compared with the control group (p < 0.01).

CONCLUSION

Manual therapy and stretching exercises could help resolve TMDs accompanied by headaches through biomechanical changes in the cervical spine. These findings may guide protocols and clinical trials involving manual therapy that align morphological structures.

Investigation of the predictors of temporomandibular disorders in engineers across different variables: sociodemographic characteristics, neck pain and neck awareness

PURPOSE/AIM

This study aimed to investigate the predictors of temporomandibular disorders (TMD) in desk-bound engineers.

MATERIALS AND METHODS

The Fonseca Anamnestic Index (FAI), The Visual Analogue Scale (VAS), The Neck Pain and Disability Scale (NPDS), Neck Bournemouth Questionnaire (NBQ) and The Fremantle Neck Awareness Questionnaire-Turkish (FreNAQ-T) were used for TMD severity, pain, disability, neck awareness.

RESULTS

The study was conducted with 208 desk-bound engineers. Mild-to-severe TMD was detected in 78.9% of the subjects. Intensity of pain at rest and during activity was higher in female engineers compared to male engineers (p = 0.002 and <0.01, respectively) and mean FAI, NBQ, NPDS and FreNAQ-T scores were also higher than that of male engineers (p = 0.005, 0.005, 0.006 and 0.016, respectively). FAI, VAS, NPDS, NBQ and FreNAQ-T were found to be correlated with each other (p < 0.05). A statistically significant contribution to the regression model was observed for the variables gender, daily duration of computer use, neck pain at rest, and NBQ (p = 0.043, p = 0.043, p = 0.031 and p = 0.003, respectively). NBQ was identified as the most influential variable in this model, followed by neck pain at rest.

CONCLUSIONS

Temporomandibular disorders are common among desk-bound engineers and are associated with neck pain, disability, and neck awareness. For this reason, it is important to take preventive and protective ergonomic approaches at the personal and institutional levels in desk-bound engineers.

Evaluation of the Relationship Between Head Posture, Mandibular Movements and Emotional Tension

Introduction: The head, due to its structure and assigned functions, is a unique part of our body. In a number of studies, an association has been confirmed between the base of the head, the cervical spine, and temporomandibular joint disorders. Research objective: The aim of the study was to evaluate the correlation of spatial head position, temporomandibular joint mobility and emotional tension. Material and methods: The study comprised32 participants, aged 20 to 30 years. The position of the head in the sagittal and frontal planes was evaluated via the photogrammetric method. The mobility of the temporomandibular joints was assessed by measurements made with a ruler. Electrodermal activity was measured with the "Bitalino 3DP by BEEVERYCREATIVE" device, and stress intensity assessment was estimated using the PSS-10 scale. Results: A significant (p<0.01) linear correlation was found between electrodermal activity (EDA Min) and the values of angles describing head tilt (FHT1 and HTA). Higher EDA values are associated with higher angle values. No significant correlations (p>0.05) were found between mandibular mobility and EDA scores, or between mandibular mobility measurements and head position. Conclusions: The study revealed a relationship between head positioning and electrodermal EDA activity.

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.

Modified-Active Release Therapy in Patients with Scapulocostal Syndrome and Masticatory Myofascial Pain: A Stratified-Randomized Controlled Trial

Modified-active release therapy (mART) was developed to treat patients experiencing upper quarter pain. The objective of the study was to determine the effectiveness of the mART in treating pain, promoting function, and measuring emotions in patients with scapulocostal syndrome (SCS) and masticatory myofascial pain (MMP). A stratified-randomized controlled trial was employed in 38 participants separated into two groups. All participants underwent the same series visual analog scale (VAS), pressure pain threshold (PPT), mouth opening (MO), maximum mouth opening (MMO), craniovertebral angle (CV-angle), and pain catastrophizing scale Thai version (PCS-Thai-version) at the baseline. The mART group underwent the mART program three times a week for 4 weeks with a hot pack and an educational briefing while the control group received only a hot pack and the educational briefing. After treatment, both groups showed significant improvement (p < 0.05) in all parameters except MO, MMO, and CV-angle. When comparing outcomes between the groups, the mART group showed a statistically significant greater number of improvements than did the control group. In conclusion, the mART program can improve pain experienced by patients with SCS and MMP and it can be used as an adjuvant technique with conservative treatment.

Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis

OBJECTIVE

To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT.

DESIGN

Systematic review and meta-analysis (MA).

METHODS

A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies' objectives. The qualitative analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

RESULTS

Regarding cervical MT, MA included three studies and showed statistically significant differences in pain intensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervical MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with a large clinical effect.

CONCLUSIONS

Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free MMO over cervical intervention alone in TMD and headache, with low evidence.

Plantar Pressure Variations Induced by Experimental Malocclusion-A Pilot Case Series Study

Background: All body systems involved in ensuring a healthy posture (musculoskeletal system, oculomotor, oto-vestibular and occluso-cranial-mandibular) are essential in maintaining postural balance. Research Question: Does experimental malocclusion in subjects in static position determine variations in plantar pressure? Methods: Overall, 31 subjects were included in the study. The plantar pressure was evaluated in five different points: lateral and medial heel, midfoot, 1st and 5th metatarsal area. Using a specially designed splint, an artificial malocclusion was induced on the right hemimandibular arch. The pressure was measured at 0 (T0), 15 (T1) and 30 min (T2) after splint application. Results: The right external plantar sensors recorded statistically significant differences in pressure values after 15 min of splint wear (5th metatarsal area, p = 0.05; midfoot, p = 0.04). Important pressure values were also recorded by the left internal plantar sensors (1st metatarsal, p = 0.01; medial heel, p = 0.006), after 30 min of splint wear. Conclusions: Asymmetrical experimental malocclusion produces early changes in plantar pressure, a proof of compensatory mechanisms induced by secondary postural imbalance.

Efficacy of different combinations of physiotherapy techniques compared to exercise and patient education in temporomandibular disorders: A randomized controlled study

OBJECTIVE

This study aims to investigate the efficacy of different types of physiotherapy approaches in individuals with cervical myofascial painful temporomandibular disorders (TMDs).

METHODS

Seventy-five participants with myofascial pain of jaw muscles and cervical myofascial pain were randomized into three groups: exercise group (E), low-level laser therapy group (LLLT), and manual pressure release group (MPR). All patients were assessed before treatment and after 12 sessions of treatment.

RESULTS

Significant improvement was seen in all groups' pressure pain threshold (PPT) values (p < 0.01). Some masticatory and neck muscles' PPT changes in MRP and LLLT groups were significantly higher than the exercise group (p < 0.05).

CONCLUSION

Exercise therapy is an effective approach for treatment of TMDs. Additionally, LLLT combined with exercise and MPR combined with exercise have better effects than only exercise therapy. Multimodal treatment approaches should include exercise to achieve better results in clinical practice.

Temporomandibular disorders and cervicogenic dizziness: Relations between cervical range of motion and clinical parameters

OBJECTIVE

To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS).

METHODS

CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS.

RESULTS

TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension.

DISCUSSION

Present findings demonstrated a relation between spine movement impairment and TMD.

Influence of the Craniocervical Posture on Tongue Strength and Endurance

Tongue strength has an important role in the swallowing process, and previous research has suggested that tongue position, concerning the craniomandibular region, could affect the oral function. This study aimed to evaluate the strength and endurance of three areas of the tongue in three experimentally induced craniocervical postures. A cross-sectional study with a nonprobabilistic sample of 37 participants (mean age: 3.85 ± 3.64 years; 20 men, 17 women) was performed. Tongue strength and endurance were assessed using a pressure device entitled Iowa Oral Performance Instrument (IOPI), in three different craniocervical positions: neutral head position (NHP), anterior head translation-or forward head position (FHP), and posterior head translation-or retracted head position (RHP). Measurements taken using the IOPI system showed significant differences in tongue strength for the anterior (p = 0.015) and middle areas of the tongue (p = 0.01). Significant differences were observed in analysis of variance (ANOVA) in the FHP (p = 0.02) and NHP (p = 0.009). The results of tongue endurance measurements showed statistically significant differences for FHP (p = 0.001), NHP (p = 0.00), and RHP (p = 0.007). The craniocervical position influences tongue strength, especially in the anterior and middle tongue areas, concerning the posterior, and, in the anterior and neutral head posture, regarding the retracted position. No differences were found in tongue resistance between the various craniocervical positions, but differences were found in resistance between the different tongue areas.

Effects of mental and physical orofacial training on pressure pain sensitivity and tongue strength: A single-blind randomized controlled trial

OBJECTIVES

The main objective of this study was to analyze differences on pain pressure thresholds, tongue strength and perceived effort between various orofacial motor exercise training dosages of mental representation training through motor imagery (MI) and action observation (AO), first in isolation and then in combination with real exercise performance.

METHODS

A single-blind randomized controlled trial was designed. 48 asymptomatic individuals were randomized into two groups: Intensive training group (IG) and Moderate training group (MG). Both groups performed a first session of MI and AO of orofacial exercises training and a second session of actual orofacial exercises combined with mental representation training, but with different dosage in terms of series and repetitions. Pain pressure thresholds (PPTs) in the masseter and temporal muscles and tongue muscle strength were the main variables.

RESULTS

Regarding the PPT, ANOVA revealed significant between-group differences, where MG showed a significantly higher PPT than IG at post-day2, with a medium effect size. Both groups showed with-in group differences between pre and post intervention measures in the first session, but only the IG showed differences in the second. Regarding tongue muscle strength, ANOVA revealed significant within-group differences only in MG between the pre-day and post-day first intervention.

CONCLUSION

The results of the present study suggest that movement representation training performed in isolation may have a positive effect on PPTs and tongue muscle strength. In addition, the combination with the actual execution of the exercises could be considered effective, but it is necessary to take into account the training dosage to avoid fatigue responses.

Electromyography of the masticatory muscles during chewing in different head and neck postures - A pilot study

Objectives

The objectives of this pilot study were to analyze the electromyography (EMG) activity of masseter and anterior temporalis muscles during chewing in 2 different posture conditions: natural head posture (NHP) and maximum yet comfortable forward head posture (FHP) in healthy individuals; and to compare EMG activity between subjects based on their NHP during chewing.

Methods

Fifteen subjects participated. Sagittal head posture in sitting position was clinically assessed using a plumb line. Participants were classified as having FHP or upright head posture (UP). Surface EMG was used to evaluate superficial masseter and anterior temporalis bilaterally during chewing in NHP and FHP. Three trials with five chewing cycles were recorded. EMG data were normalized using a maximum voluntary contraction. An independent t-test was used to calculate differences between sides. If no differences were found, both sides were analyzed together. To analyze differences between the 2 conditions, a paired t-test was used. Independent t-test was used to calculate difference between subjects with UP and FHP.

Results

A significant increase in muscle activity was found for masseter muscle in the FHP condition. No differences were found in muscle activity in natural head position by posture classification. A trend of increased activity was observed for masseter and temporalis muscles during chewing in FHP.

Conclusion

Head and neck posture was found to influence masticatory muscle activity during the function of chewing. The results of this study may help clinicians to better understand the association between head and neck posture alterations with masticatory muscles related disorders.

Association between constitution, medical history, axiography and postural control in women aged between 21 to 30 years

The aim of this study was to determine association between constitutional, medical history and axiographic parameters with postural control parameters. Overall, 106 healthy female subjects aged between 21 and 30 years were measured. Data collection was carried out by completing a questionnaire on constitutional parameters, illnesses, accidents and medical/orthodontic therapies, as well as by axio- and posturographic measurements. Data were analyzed using correlations, pair comparisons and group comparisons. The significance level was set at p ≤ 0.05. The statistical evaluation showed significant correlations between sporting exercise and body sway in the sagittal direction (p ≤ 0.03), the BMI and the load on the forefoot/rear foot (p ≤ 0.01), the mouth opening and the load on the forefoot/rearfoot (p ≤ 0.01) and the presence of a deviation with the load on the left/right foot (p ≤ 0.01). The physical condition as well as the temporo-mandibular system are associated with the postural control in young women. Therefore, a holistic diagnosis and therapy will be supported by the present outcomes.

Upper cervical spine abnormalities as a radiographic index in the diagnosis and treatment of temporomandibular disorders

OBJECTIVE

The aim of this study was to investigate the clinical characteristics and treatment outcomes of patients with temporomandibular disorders (TMD) according to the presence of upper cervical spine abnormalities and craniofacial morphology.

STUDY DESIGN

Clinical examinations were conducted on 43 patients with TMD. Upper cervical spine characteristics (fusion, posterior arch deficiency [PAD], and craniofacial morphology) reflecting head-and-neck posture were evaluated on lateral cephalograms. Condylar bone changes in the temporomandibular joint were evaluated by using cone beam computed tomography. Clinical characteristics and treatment outcomes after 1 year of conservative therapy were statistically analyzed between groups, according to the presence of upper cervical spine abnormalities.

RESULTS

Pain on neck muscle palpation was more frequent in patients with cervical fusion (P = .019) and with either fusion or PAD (P = .004) before treatment. Patients with PAD had smaller comfortable mouth opening ranges compared with those without the deficiency (P = .044) before treatment and smaller comfortable (P = .020) and maximum (P = .021) mouth opening ranges after treatment. Patients with PAD also had mouth opening limitation (P = .028) and pain on masticatory muscle palpation (P = .014) more frequently after treatment compared with patients without the deficiency.

CONCLUSIONS

Associations exist between upper cervical spine characteristics and treatment outcomes in patients with TMD, suggesting such parameters as a possible radiographic index in TMD diagnosis and treatment.

Thoracic spine manipulation did not improve maximal mouth opening in participants with temporomandibular dysfunction

BACKGROUND AND PURPOSE

Temporomandibular joint disorders (TMD) have a prevalence of more than 5% in the general population. A positive correlation exists between temporomandibular joint mobility and cervical spine mobility. Similarly, a relationship exists between thoracic and cervical spine mobility. However, it is unknown if interventions to improve the mobility of the thoracic spine positively impact temporomandibular joint motion and pain. This study tested the hypothesis that a single thoracic thrust joint manipulation (TJM) would improve maximum mouth opening (MMO) compared with participants without TMD as well as decrease TMD symptoms.

METHODS

Forty-eight people with TMD (30.9 years old ±11.3) and 55 people without TMD (28.5 years old ±9.2) participated. Both groups received a seated upper thoracic TJM and were measured for MMO before and immediately following the TJM. The duration of TMD symptoms and pre-thrust current pain, using the 11-point Verbal Pain Rating Scale (VPRS), was recorded in the TMD group. Participants in the TMD group were contacted 2-3 days after TJM to report current VPRS and improvement utilizing the Global Rating of Change (GROC) scale.

RESULTS

No difference in MMO treatment response over time was observed between groups (p = .56). The MMO in the TMD group improved from 40 to 41.3 mm, and the non-TMD similarly improved from 44.5 to 45.4 mm. The VPRS decreased from 2.4 (±1.8) to 1.3 (±1.5) following thoracic TJM (p < .001), and the average GROC score was 1.8 (±2.25), which was statistically different than zero (no change; p < .001). The duration of TMD symptoms prior to TJM was not associated with GROC scores (r = .018, p = .90) or VPRS change scores (r = -.07, p = .64).

CONCLUSION

The observed treatment effects did not exceed previously reported standards for clinical relevance (5 mm and 2 points, respectively).

Persistent Idiopathic Facial Pain Originating from Cervical Abnormalities

BACKGROUND

Persistent idiopathic facial pain is characterized by persistent facial or oral pain in the absence of a neurologic deficit. This underexplored pain may be conducted by various nerves, including cranial nerves and upper cervical spinal roots, and its etiology is unclear.

CASE DESCRIPTION

A patient presented with persistent idiopathic facial pain associated with occipital muscle stiffness after an improper neck massage. The patient achieved almost complete pain relief by coblation of right upper cervical nerves (C1 and C2 spinal roots) followed by continuous cervical epidural analgesia for a period of 3 weeks. The analgesic effect was stable during the 3-month follow-up period.

CONCLUSIONS

Persistent idiopathic facial pain may be cervicogenic, and treatments focusing on cervical spinal roots may provide satisfactory pain control in patients with cervical abnormalities.

Widespread mechanical pain hypersensitivity in patients with chronic migraine and temporomandibular disorders: relationship and correlation between psychological and sensorimotor variables

OBJECTIVE

This study aimed to assess mechanical hyperalgesia in the trigeminal and extra-trigeminal regions in patients with chronic migraine (CM) and temporomandibular disorders (TMD) in comparison to asymptomatic subjects and to determine the association between sensorimotor variables and psychological and disability variables and evaluate the prediction of a sensorimotor variables though psychological and disability variables in patients with CM and TMD.

MATERIAL AND METHODS

A total of 52 subjects with concomitant CM and TMD and 30 asymptomatic subjects were included in the study. The pressure pain threshold (PPT), maximal mouth opening (MMO) and a series of self-reported factors were compared.

RESULTS

There were 52 CM and TMD (92.3% women and 7.7% men; age = 46.2 ± 9.5) and 30 asymptomatic subjects (80% women and 20% men; age = 47.4 ± 10). Differences were found between patients with CM and TMD and asymptomatic participants (p < .01) when comparing the PPTs in the trigeminal and extra-trigeminal regions. The PPT for the trigeminal region was predicted by depressive symptoms (variance of 18%) as well as disability and craniofacial pain (variance of 20%). The extra-trigeminal region PPT was predicted by depressive symptoms (variance of 10%), and pain-free MMO was predicted by disability and craniofacial pain (variance of 24%).

CONCLUSIONS

This study suggests that patients with CM and TMD present with generalized mechanical hyperalgesia. In addition, an association between sensorimotor, psychological and disability variables was observed.

Relationship between Cervical Spine and Skeletal Class II in Subjects with and without Temporomandibular Disorders

Aim

To assess changes in the craniocervical structure and in hyoid bone position in skeletal Class II subjects with and without temporomandibular disorders (TMD).

Materials and Methods

The cephalometric analysis of 59 subjects with skeletal Class II was evaluated and compared. The measurements considered were ANB as a parameter of Class II and C0-C1 distance, C1-C2 distance, craniocervical angle, and hyoid bone position for the cervical spine analysis. Patients were divided into patients with TMD (group A) and patients without TMD (group B). TMD were evaluated with Diagnostic Criteria for TMD (DC/TMD). Descriptive statistics and Pearson's and Spearman's correlation analysis, with p value <0,005, were performed.

Results

C0-C1 and C1-C2 distance values and hyoid bone position resulted within the normal range in the majority of patients examined. Craniocervical angle was altered in 33 patients. The reduction of this angle with the increase of the ANB value resulted to be statistically significant in group A, according to Pearson's correlation index. No other data were statistically significant.

Conclusions

The significant relationship between skeletal Class II and cervical spine cannot be highlighted. The alteration of craniocervical angle seems to be mildly present, with backward counterclockwise rotation of the head upon the neck in the sample (groups A and B). The presence of TMD as a key factor of changes in neck posture could explain the different result between the two groups about the relationship between ANB and craniocervical angle. This result should be further analyzed in order to better understand if cervical spine changes could be related to mandibular postural ones in the craniocervical space or to temporomandibular joint retropositioning, more recognizable in Class II with TMD, which could determine functional changes in other structures of this unit; neck posture could be the result of a compensatory/antalgic mechanism in response to TMD.

Effect of Different Head-Neck Postures on the Respiratory Function in Healthy Males

Normal respiration is a very intricate function that comprises mechanical as well as nonmechanical components. It is shown to be affected by various factors including age, lifestyle, disease, and change in posture. With the increased use of hand held devices, everyone is prone to poor sitting postures like forward head posture. The purpose of this study was to evaluate the effect of assumed forward head posture and torticollis on the diaphragm muscle strength. A sample of 15 healthy males, aged 18-35 years, was recruited for this study. All subjects performed spirometry to measure the forced expiratory volume in 1 second (FEV₁), the forced vital capacity (FVC), and FEV₁/FVC ratio. SNIP was measured during upright sitting, induced forward head posture, and torticollis. Subject's mean age (SD) was 23(6) years. The SNIP score of the subjects during sitting with FHP was lower as compared to that during upright sitting. It decreased significantly during induced right torticollis position. This is the first study exploring the impact of different head and neck positions on respiratory function. Alteration of head and neck positions had an immediate negative impact on respiratory function. Clinicians should be prompted to assess respiratory function when assessing individuals with mal-posture.

Influence of the presence of Temporomandibular Disorders on postural balance in the elderly

Purpose

To investigate the influence of the presence of Temporomandibular Disorders (TMD) on postural balance in elderly individuals.

Methods

The study sample consisted of 150 elderly: 103 women (67.7±5.0 years) and 47 men (69.3±5.5 years). Evaluation of the presence and severity of TMD included an anamnesis questionnaire, an evaluation of the temporomandibular joint (TMJ), and a muscular examination, which allowed the division of the elderly into 2 groups: G1 (experimental, n=95), with TMD; G2 (control, n=55), without TMD. Postural balance was assessed by means of the one-leg stance test (OLST) on a force platform (BIOMEC400), thus permitting the following measurements: center of foot pressure (COP); mean sway velocity (MV) and frequency (MF) of COP in both the anteroposterior (VAP and FAP) and medial/lateral (VML and FML) directions. The statistical analysis of data was performed using independent t-test, Variance Analysis, and Chi Square test (α=5%).

Results

Presence of TMD was observed in 63.3% of the individuals (Group 2), with different degrees of severity (mild: 42.7%, moderate: 14.7%, severe: 6%). Significantly higher TMD was observed for women (73.8%) compared with men (40.4%) (p=0.0002). No significant difference was found in between the groups for all balance parameters, e.g., presence and severity of TMD, presence of pain to palpation of TMJ and of masticatory and cervical muscles.

Conclusion

The presence and severity of TMD, in addition to the presence of pain to palpation of TMJ and masticatory and cervical muscles did not alter the variables related to postural balance in this population.

Does altered mandibular position and dental occlusion influence upper cervical movement: A cross-sectional study in asymptomatic people

OBJECTIVE

Gross mandibular position and masticatory muscle activity have been shown to influence cervical muscles electromyographic activity. The purpose of this study was to investigate the influence of three different mandible positions including conscious occlusion, tongue tip against the anterior hard palate (Palate tongue position) and natural resting position (Rest), on sagittal plane cervical spine range of motion (ROM) as well as the flexion-rotation test (FRT) in asymptomatic subjects.

MATERIALS AND METHODS

An experienced single blinded examiner evaluated ROM using an Iphone in 22 subjects (7 females; mean age of 29.91years, SD 5.44).

RESULTS

Intra-rater reliability for range recorded was good for the FRT with ICC (intraclass correlation) 0.95 (95% CI: 0.88-0.98) and good for sagittal plane cervical ROM with ICC 0.90 (95% CI: 0.77-0.96). A repeated measures ANOVA determined that mean ROM recorded during the FRT differed significantly between assessment points (F(1.99, 41.83) = 19.88, P < 0.001). Bonferroni Post hoc tests revealed that both conscious Occlusion and Palate tongue position elicited a significant large reduction in ROM recorded during the FRT from baseline (p < 0.01). Despite this, one activation strategy did not influence ROM more than the other. An additional repeated measures ANOVA determined that mean sagittal cervical ROM did not significantly vary between assessment points (F(2, 42) = 8.18, P = 0.08).

CONCLUSION

This current study provided further evidence for the influence of the temporomandibular region on upper cervical ROM. Results suggest that clinicians should focus on the natural mandible rest position when evaluating upper cervical mobility.

Influence of the mandibular position on the active cervical range of motion of healthy subjects analyzed using an accelerometer

OBJECTIVE

The aim of this study is to analyze the influence of the mandibular positions (habitual rest position, habitual maximum intercuspation, habitual maximum intercuspation with clenching, and mandibular position with cotton rolls) on the active cervical range of motion (ROM) (flexion-extension, lateroflexions, rotations) using an accelerometer in a sample of healthy subjects.

METHODS

A total of 21 (14 M, 7 F) healthy volunteers aged from 18 to 27 years (mean age 23.88 ± 2.34 years; mean weight 67.86 ± 11.38 kg; mean height 172.52 ± 9.00 cm) underwent a cervical range of movement examination using a 9-axis accelerometer. A one-way ANOVA analysis was performed in order to statistically evaluate the effective influence of the mandibular position on the recorded parameters.

RESULTS

The analysis showed no statistically significant differences (all p-values > 0.1) with variations smaller than three degrees among the different mandibular positions.

DISCUSSION

The mandibular position seems to have no influence on the active cervical ROM in healthy subjects. Further studies are needed to assess the usefulness of the accelerometer in the cervical analysis of temporomandibular disorder subjects.

Do subjects with acute/subacute temporomandibular disorder have associated cervical impairments: A cross-sectional study

BACKGROUND

There is preliminary evidence of cervical musculoskeletal impairment in some temporomandibular disorder (TMD) pain states.

OBJECTIVES

To determine whether people with TMD, classified as either mild or moderate/severe TMD, have more cervical signs of dysfunction than healthy subjects.

DESIGN

Cross-sectional survey.

METHOD

Based on the Conti Amnestic Questionnaire and examination of the temporomandibular joint (Axis I classification of the Research Diagnostic Criteria for TMD), of 144 people examined 59 were classified to a mild TMD group, 40 to a moderate/severe TMD group and 45 to an asymptomatic control group without TMD. Subjects were evaluated for signs of cervical musculoskeletal impairment and disability including the Neck Disability Index, active cervical range of motion, the Flexion-Rotation Test, mechanical pain threshold of the upper trapezius and obliquus capitis inferior muscles, Cranio-Cervical Flexion test and passive accessory movements of the upper 3 cervical vertebrae.

RESULTS

According to cervical musculoskeletal dysfunction, the control group without TMD were consistently the least impaired and the group with moderate/severe TMD were the most impaired. These results suggest, that the more dysfunction and pain is identified in the temporomandibular region, the greater levels of dysfunction is observable on a number of cervical musculoskeletal function tests. The pattern of cervical musculoskeletal dysfunction is distinct to other cervical referred pain phenomenon such as cervicogenic headache.

CONCLUSION

These findings provide evidence that TMD in an acute/subacute pain state is strongly related with certain cervical spine musculoskeletal impairments which suggests the cervical spine should be examined in patients with TMD as a potential contributing factor.

Validity and reliability of wheelchair sitting posture measures using Coach's Eye in abled subjects

People in wheelchairs spend a long time in the sitting position and often incur alignment problems resulting in neck and back pain. This study: (1) assessed the validity/reliability of Coach's Eye (CE) smart device application, (2) examined the effect of seat to back support angle adjustments on head, neck, and shoulder posture in the sitting position, and (3) compared changes in cervical rotation at each back support angle. Abled subjects sat in a wheelchair with back support angles positioned at 90°, 100°, and 110°. CE, as well as ImageJ software, was used to analyze three angles: sagittal head angle (SHA), cervical angle (CVA), and shoulder angle (SA). There were highly significant differences for CVA and SA (p < 0.001) among the three seat to back support angles. Validity of CE was examined by correlating CE with ImageJ scores. CE had high validity for all angles (r = 0.99, 0.98, 0.99 respectively, p < 0.001). Inter-rater reliability for SHA, CVA, and SA was high (intraclass correlation coefficient [ICC] ranged from 0.95 to 0.99). Head (CVA) and shoulder (SA) alignment was closest to neutral posture with back support angles set at 110° and 90°, respectively.

Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

Relationships between craniocervical posture and pain-related disability in patients with cervico-craniofacial pain

Objectives

This cross-sectional correlation study explored the relationships between craniocervical posture and pain-related disability in patients with chronic cervico-craniofacial pain (CCFP). Moreover, we investigated the test–retest intrarater reliability of two craniocervical posture measurements: head posture (HP) and the sternomental distance (SMD).

Methods

Fifty-three asymptomatic subjects and 60 CCFP patients were recruited. One rater measured HP and the SMD using a cervical range of motion device and a digital caliper, respectively. The Spanish versions of the neck disability index and the craniofacial pain and disability inventory were used to assess pain-related disability (neck disability and craniofacial disability, respectively).

Results

We found no statistically significant correlations between craniocervical posture and pain-related disability variables (HP and neck disability [r=0.105; P>0.05]; HP and craniofacial disability [r=0.132; P>0.05]; SMD and neck disability [r=0.126; P>0.05]; SMD and craniofacial disability [r=0.195; P>0.05]). A moderate positive correlation was observed between HP and SMD for both groups (asymptomatic subjects, r=0.447; CCFP patients, r=0.52). Neck disability was strongly positively correlated with craniofacial disability (r=0.79; P<0.001). The test–retest intrarater reliability of the HP measurement was high for asymptomatic subjects and CCFP patients (intraclass correlation coefficients =0.93 and 0.81, respectively) and for SMD (intra-class correlation coefficient range between 0.76 and 0.99); the test–retest intrarater reliability remained high when evaluated 9 days later. The HP standard error of measurement range was 0.54–0.75 cm, and the minimal detectable change was 1.27–1.74 cm. The SMD standard error of measurement was 2.75–6.24 mm, and the minimal detectable change was 6.42–14.55 mm. Independent t-tests showed statistically significant differences between the asymptomatic individuals and CCFP patients for measures of craniocervical posture, but these differences were very small (mean difference =1.44 cm for HP; 6.24 mm for SMD). The effect sizes reached by these values were estimated to be small for SMD (d=0.38) and medium for HP (d=0.76).

Conclusion

The results showed no statistically significant correlations between craniocervical posture and variables of pain-related disability, but a strong correlation between the two variables of disability was found. Our findings suggest that small differences between CCFP patients and asymptomatic subjects exist with respect to the two measurements used to assess craniocervical posture (HP and SMD), and these measures demonstrated high test–retest intrarater reliability for both CCFP patients and asymptomatic subjects.

Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study

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.

Dry needling for management of pain in the upper quarter and craniofacial region

Dry needling is a therapeutic intervention that has been growing in popularity. It is primarily used with patients that have pain of myofascial origin. This review provides background about dry needling, myofascial pain, and craniofacial pain. We summarize the evidence regarding the effectiveness of dry needling. For patients with upper quarter myofascial pain, a 2013 systematic review and meta-analysis of 12 randomized controlled studies reported that dry needling is effective in reducing pain (especially immediately after treatment) in patients with upper quarter pain. There have been fewer studies of patients with craniofacial pain and myofascial pain in other regions, but most of these studies report findings to suggest the dry needling may be helpful in reducing pain and improving other pain related variables such as the pain pressure threshold. More rigorous randomized controlled trials are clearly needed to more fully elucidate the effectiveness of dry needling.