Effects of myofascial release applied to neck muscles and craniocervical flexor training in patients with chronic myofascial TMD

Participants

• Number: 14 women
• Criteria of inclusion: women, age 18-40 years, with orofacial pain of an intensity of at least 3 measured with NPRS, for at least 3 months, with trigger point in the superficial neck muscles; at baseline, diagnosis of myofascial temporomandibular disorder issued by a physiotherapist with 6 years of experience and research in the field, with presence of at least one trigger point, active or latent, in one of the following muscles: sternocleidomastoid, suboccipital and upper trapezius
• Criteria of exclusion: fibromyalgia, a history of trauma or surgery to the neck or temporomandibular joint, previous dental therapy or physiotherapy for temporomandibular disorder in the last 6 months
• Groups of study: 1 group
  Group 1: treatment, 14 women (mean age 23.9 years)

Interventions and evaluations

• Evaluation of the threshold pain through threshold pain test applied to masseter and temporalis muscles, of the maximum pain experienced during the last week through NPRS, of mouth opening through analog caliper, of the mandibular function through MFIQ and of the function of the deep neck flexor muscles through craniocervical flexion test using a pressure biofeedback device at baseline, after 3 weeks and at the end of the study (ie, after 5 weeks)
• 10 30-minute treatment sessions, twice a week for 5 weeks
• Treatment: strain-counterstrain technique directed to the trigger points, associated to stabilization exercises for the craniocervical flexor muscles
• Evaluation carried out by one physiotherapist and treatments performed by a second physiotherapist
  • both physiotherapists followed a training in order to recognise the trigger points

Results

• Primary outcome: the treatment favored a statistically significant increase in pain threshold with a large effect-size (actual relevance of the result obtained). In particular, at the end of the treatment period the threshold pain at the level of the masseter and left temporal muscle increased. With regard to the masseter and the right temporal muscle, there was an improvement throughout the study.
• Secondary outcomes: The treatment favored a statistically significant reduction in the maximum pain experienced during the last week with a large effect-size also. Similarly, with statistically significant results and defined by large effect-size, the treatment favored an improvement in mandibular function and craniocervical flexor muscles. On the contrary, it does not seem to have affected mouth opening in a statistically significant manner, although it increased throughout the study.

Discussion

An intervention consisting of a manipulative technique and muscle stabilization exercises showed to be able to act positively on the chronic myofascial temporomandibular disorder, both statistically and, in particular, clinically significantly, as all the positive results obtained were higher than the minimum thresholds indicating a real clinical improvement in the patients’ condition. The mouth opening was also increased by a clinically significant value.

Although there is a lot of debate about trigger points, having achieved positive results with techniques aimed specifically at them supports the idea of their primary role.

Studies are needed to analyze these results more in depth as well as the role of trigger points in myofascial temporomandibular disorder and the effectiveness of other techniques. In addition, studies are needed to fill the limits of current research, such as the recruitment of a more diverse sample and the use of one or more control groups.