Evaluation of Soft Tissue Mobilization in Patients with Temporomandibular Disorder-Myofascial Pain with Referral

Joanna Kuć, Krzysztof Dariusz Szarejko, Maria Gołębiewska, Joanna Kuć, Krzysztof Dariusz Szarejko, Maria Gołębiewska

Abstract

The aim of the study was functional evaluation of soft tissue mobilization in patients with temporomandibular disorder-myofascial pain with referral. The study group consisted of 50 individuals-37 females and 13 males. The average age was 23.36 ± 2.14 years. All subjects were diagnosed with myofascial pain with referral (diagnostic criteria for temporomandibular disorders). Soft tissue mobilization was applied three times. Electromyography of selected masticatory muscles was performed six times-before and after the treatment. After each mobilization, a decreasing tendency of muscular activity was observed in the entire study group. The Friedman test indicated that mobilization altered the activity of the right temporal muscle (p = 0.00010), both masseters (p = 0.0000), right sternocleidomastoid (p = 0.00251), left sternocleidomastoid (p = 0.00033), and right and left digastric muscles (p = 0.00045 and p = 0.00000, respectively). With respect to symmetry a statistically significant difference was noted in the case of the sternocleidomastoid muscles (p = 0.00729). In conclusion, soft tissue mobilization seems to be effective in the relaxation of masticatory muscles in patients with temporomandibular disorders. Our findings proved that soft tissue mobilization does not improve the symmetry and synergy of the masticatory muscles limited by dental occlusion.

Keywords: electromyography; masticatory muscles; myofascial pain with referral; orofacial rehabilitation; soft tissue mobilization; temporomandibular joint.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
BioEMG (eight channel device for recording the muscular activity) and electrode locations.
Figure 2
Figure 2
Unilateral soft tissue mobilization of the temporal muscle.
Figure 3
Figure 3
Bilateral soft tissue mobilization of the temporal muscles.
Figure 4
Figure 4
Soft tissue mobilization (upward—downward technique for masseter and temporal muscles; combined technique) [3].
Figure 5
Figure 5
Soft tissue mobilization (masseter-oriented technique) [3].
Figure 6
Figure 6
Trigger points of the masseter (marked by yellow, green, purple and cyan × signs) and temporal muscles (marked by pink, dark brown, blue and light brown dots) and patterns of referred pain (marked by arrows) according to Travel and Simons [3].

References

    1. Travell J., Rinzler S.H. The myofascial genesis of pain. Postgrad. Med. 1952;11:425–434. doi: 10.1080/00325481.1952.11694280.
    1. Khan M., Nishi S.E., Hassan S.N., Islam M., Gan S.H. Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: An update. Pain Res. Manag. 2017;2017:7438326. doi: 10.1155/2017/7438326.
    1. Simons D.G., Travell J.G., Simons L.S. Travell & Simons’ Myofascial Pain and Dysfunction: Upper Half of Body. Volume 1 Lippincott Williams & Wilkins; Philadelphia, PA, USA: 1999.
    1. Mense S., Gerwin R.D. Muscle Pain: Diagnosis and Treatment. Springer Science & Business Media; Berlin/Heidelberg, Germany: 2010.
    1. Jafri M.S. Mechanisms of myofascial pain. Int. Sch. Res. Not. 2014;2014:523924. doi: 10.1155/2014/523924.
    1. Gerber L.H., Sikdar S., Armstrong K., Diao G., Heimur J., Kopecky J., Turo D., Otto P., Gebreab T., Shah J. A systematic comparison between subjects with no pain and pain associated with active myofascial trigger points. PMR. 2013;5:931–938. doi: 10.1016/j.pmrj.2013.06.006.
    1. Vázquez Delgado E., Cascos-Romero J., Gay Escoda C. Myofascial pain syndrome associated with trigger points: A literature review.(I): Epidemiology, clinical treatment and etiopathogeny. Med. Oral Patol. Oral Cir. Bucal. 2009;14:494–498. doi: 10.4317/medoral.14.e494.
    1. Svensson P., Graven-Nielsen T. Craniofacial muscle pain: Review of mechanisms and clinical manifestations. J. Orofac. Pain. 2001;15:117–145.
    1. Mortazavi H., Javadzadeh A., Delavarian Z., Zare Mahmoodabadi R. Myofascial pain dysfunction syndrome (MPDS) Iran. J. Otorhinolaryngol. 2010;22:131–136.
    1. Gerwin R.D. Classification, epidemiology, and natural history of myofascial pain syndrome. Curr. Pain Headache Rep. 2001;5:412–420. doi: 10.1007/s11916-001-0052-8.
    1. Osiewicz M., Manfredini D., Biesiada G., Czepiel J., Garlicki A., Aarab G., Pytko-Polończyk J., Lobbezoo F. Prevalence of function-dependent temporomandibular joint and masticatory muscle pain, and predictors of temporomandibular disorders among patients with Lyme disease. J. Clin. Med. 2019;8:929. doi: 10.3390/jcm8070929.
    1. Okeson J.P. Management of Temporomandibular Disorders and Occlusion-E-Book. Elsevier Health Sciences; Beijing, China: 2014.
    1. Fiorillo L., Musumeci G. TMJ Dysfunction and Systemic Correlation. J. Funct. Morphol. Kinesiol. 2020;5:20. doi: 10.3390/jfmk5010020.
    1. Ohrbach R., Gonzalez Y., List T., Michelotti A., Schiffman E. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Clinical Examination Protocol. [(accessed on 2 June 2013)];2013 Available online: .
    1. Kuć J., Szarejko K.D., Sierpinska T. Evaluation of Orofacial and General Pain Location in Patients with Temporomandibular Joint Disorder-Myofascial Pain With Referral. Front. Neurol. 2019;10:546. doi: 10.3389/fneur.2019.00546.
    1. Khaled Y., Brennan M., Napeñas J., Quach J. Using physical therapy to treat temporomandibular disorders. A cohort study. J. Dent. Sci. Oral Maxillofac. Res. 2018;1:31–35.
    1. Falsiroli Maistrello L., Geri T., Gianola S., Zaninetti M., Testa M. Effectiveness of trigger point manual treatment on the frequency, intensity, and duration of attacks in primary headaches: A systematic review and meta-analysis of randomized controlled trials. Front. Neurol. 2018;9:254. doi: 10.3389/fneur.2018.00254.
    1. Ginszt M., Zieliński G., Berger M., Szkutnik J., Bakalczuk M., Majcher P. Acute Effect of the Compression Technique on the Electromyographic Activity of the Masticatory Muscles and Mouth Opening in Subjects with Active Myofascial Trigger Points. Appl. Sci. 2020;10:7750. doi: 10.3390/app10217750.
    1. Shaffer S.M., Brismée J.-M., Sizer P.S., Courtney C.A. Temporomandibular disorders. Part 2: Conservative management. J. Man. Manip. Ther. 2014;22:13–23. doi: 10.1179/2042618613Y.0000000061.
    1. Bialosky J.E., Bishop M.D., Price D.D., Robinson M.E., George S.Z. The mechanisms of manual therapy in the treatment of musculoskeletal pain: A comprehensive model. Man. Ther. 2009;14:531–538. doi: 10.1016/j.math.2008.09.001.
    1. Bishop M.D., Torres-Cueco R., Gay C.W., Lluch-Girbés E., Beneciuk J.M., Bialosky J.E. What effect can manual therapy have on a patient’s pain experience? Pain Manag. 2015;5:455–464. doi: 10.2217/pmt.15.39.
    1. Vigotsky A.D., Bruhns R.P. The role of descending modulation in manual therapy and its analgesic implications: A narrative review. Pain Res. Treat. 2015;2015:92805. doi: 10.1155/2015/292805.
    1. Gil-Martínez A., Paris-Alemany A., López-de-Uralde-Villanueva I., La Touche R. Management of pain in patients with temporomandibular disorder (TMD): Challenges and solutions. J. Pain Res. 2018;11:571. doi: 10.2147/JPR.S127950.
    1. Weerapong P., Hume P.A., Kolt G.S. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35:235–256. doi: 10.2165/00007256-200535030-00004.
    1. Carlson C.R., Okeson J.P., Falace D.A., Nitz A.J., Anderson D. Stretch-based relaxation and the reduction of EMG activity among masticatory muscle pain patients. J. Craniomandib. Disord. 1991;5:205–212.
    1. Biasotto-Gonzalez D.A., Bérzin F. Electromyographic study of patients with masticatory muscles disorders, physiotherapeutic treatment (massage) Braz. J. Oral Sci. 2004;3:516–521.
    1. Capellini V.K., De Souza G.S., De Faria C.R.S. Massage therapy in the management of myogenic TMD: A pilot study. J. Appl. Oral Sci. 2006;14:21–26. doi: 10.1590/S1678-77572006000100005.
    1. Manzotti A., Viganoni C., Lauritano D., Bernasconi S., Paparo A., Risso R., Nanussi A. Evaluation of the Stomatognathic System before and after Osteopathic Manipulative Treatment in 120 Healthy People by Using Surface Electromyography. Int. J. Environ. Res. Public Health. 2020;17:3250. doi: 10.3390/ijerph17093250.
    1. Lerman M.D. The muscle engram: The reflex that limits conventional occlusal treatment. CRANIO®. 2011;29:297–303. doi: 10.1179/crn.2011.044.
    1. Alajbeg I.Z., Valentic-Peruzovic M., Alajbeg I., Cifrek M. The influence of age and dental status on elevator and depressor muscle activity. J. Oral Rehabil. 2006;33:94–101. doi: 10.1111/j.1365-2842.2006.01541.x.
    1. Gerdi Kittel Ries L., Correa Alves M., Berzin F. Asymmetric activation of temporalis, masseter, and sternocleidomastoid muscles in temporomandibular disorder patients. CRANIO®. 2008;26:59–64. doi: 10.1179/crn.2008.008.
    1. Tartaglia G.M., da Silva M.A.M.R., Bottini S., Sforza C., Ferrario V.F. Masticatory muscle activity during maximum voluntary clench in different research diagnostic criteria for temporomandibular disorders (RDC/TMD) groups. Man. Ther. 2008;13:434–440. doi: 10.1016/j.math.2007.05.011.
    1. Ballenberger N., von Piekartz H., Danzeisen M., Hall T. Patterns of cervical and masticatory impairment in subgroups of people with temporomandibular disorders—An explorative approach based on factor analysis. CRANIO®. 2018;36:74–84. doi: 10.1080/08869634.2017.1297904.
    1. Von Piekartz H., Lüdtke K. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: A single-blind, randomized controlled study. CRANIO®. 2011;29:43–56. doi: 10.1179/crn.2011.008.
    1. Cuccia A., Caradonna C., Annunziata V., Caradonna D. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: A randomized controlled trial. J. Bodyw. Mov. Ther. 2010;14:179–184. doi: 10.1016/j.jbmt.2009.08.002.
    1. Ismail F., Demling A., Hessling K., Fink M., Stiesch-Scholz M. Short-term efficacy of physical therapy compared to splint therapy in treatment of arthrogenous TMD. J. Oral Rehabil. 2007;34:807–813. doi: 10.1111/j.1365-2842.2007.01748.x.
    1. Espí-López G.V., Arnal-Gómez A., Cuerda del Pino A., Benavent-Corai J., Serra-Añó P., Inglés M. Effect of manual therapy and splint therapy in people with temporomandibular disorders: A preliminary study. J. Clin. Med. 2020;9:2411. doi: 10.3390/jcm9082411.
    1. Calixtre L., Moreira R., Franchini G., Alburquerque-Sendín F., Oliveira A. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: A systematic review of randomised controlled trials. J. Oral Rehabil. 2015;42:847–861. doi: 10.1111/joor.12321.
    1. Nitecka-Buchta A., Nowak-Wachol A., Wachol K., Walczyńska-Dragon K., Olczyk P., Batoryna O., Kempa W., Baron S. Myorelaxant Effect of Transdermal Cannabidiol Application in Patients with TMD: A Randomized, Double-Blind Trial. J. Clin. Med. 2019;8:1886. doi: 10.3390/jcm8111886.
    1. Ashok A., Suganya M., Arun B. Comparison of Myofascial Release, Muscle Energy Technique and Cervical Manual Therapy in Postural Neck Pain. Asian J. Orthop. Res. 2019;2:1–6.
    1. Fonder A. The dental distress syndrome quantified. Basal Facts. 1987;9:141–167.
    1. Adrian E.D., Umrath K. The impulse discharge from the Pacinian corpuscle. J. Physiol. 1929;68:139. doi: 10.1113/jphysiol.1929.sp002601.
    1. Downey P.A., Barbano T., Kapur-Wadhwa R., Sciote J.J., Siegel M.I., Mooney M.P. Craniosacral therapy: The effects of cranial manipulation on intracranial pressure and cranial bone movement. J. Orthop. Sports Phys. Ther. 2006;36:845–853. doi: 10.2519/jospt.2006.36.11.845.
    1. Kandasamy S., Greene C.S. The evolution of temporomandibular disorders: A shift from experience to evidence. J. Oral Pathol. Med. 2020;49:461–469. doi: 10.1111/jop.13080.

Source: PubMed

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