Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain

Amita Aggarwal; Jayshri Gadekar; Pradnya Kakodkar

doi:10.4103/jdrr.jdrr_58_19

DPU: INTERDISCIPLINARY CONFERENCE

Year : 2020 | Volume : 7 | Issue : 5 | Page : 84-87

Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain

Amita Aggarwal, Jayshri Gadekar, Pradnya Kakodkar
Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Web Publication

26-Feb-2020

Correspondence Address:
Amita Aggarwal
Flat No. 1004, A Wing, Kamalraj Haridwar Society, Near Tanish Icon Society, Dighi, Pune - 411 015, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdrr.jdrr_58_19

Abstract

Context: Temporomandibular disorders are musculoskeletal condition presenting with pain and dysfunction in masticatory muscles, temporomandibular joint (TMJ) and related structure. Aim: To determine the role of myofascial release technique on mobility and function in TMJ Disorder patients with neck pain. Settings and Design: Experimental study design conducted in Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune. Subjects and Methods: Overall 30 subjects who fulfilled the inclusion criteria were randomly divided into two groups. Experimental group (Group A) was given nonsteroidal anti-inflammatory drugs (NSAID's) and myofascial release to Upper trapezius, Sternocleidomastoid, Masseter and Temporalis three times a week for 2 weeks. Control group (Group B) was given NSAID's. At the end of treatment prepost comparison was done for temporomandibular (TM) joint range of motion and function. Statistical Analysis Used: Data was analysed with Primer software using Wilcoxon signed rank sum test and Mann–Whitney U-test. Results: Mobility in terms of mouth opening and lateral excursion post intervention in both groups have been significantly improved, however, in the experimental group significant improvement was seen in lateral excursions only. Limitation of daily function score reduced from 22.2 to 5 in the experimental; group and 21.3–13.5 in the control group. However more statistical reduction was seen in the experimental group (P = 0.001). Conclusions: Myofascial release technique along with NSAIDSs was able to improve mobility and function among the TM joint disorder patients with neck pain.

Keywords: Fascial release, neck pain, temporomandibular joint disorder

How to cite this article:
Aggarwal A, Gadekar J, Kakodkar P. Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain. J Dent Res Rev 2020;7, Suppl S2:84-7

How to cite this URL:
Aggarwal A, Gadekar J, Kakodkar P. Role of myofascial release technique on mobility and function in temporomandibular joint disorder patients with neck pain. J Dent Res Rev [serial online] 2020 [cited 2023 Mar 29];7, Suppl S2:84-7. Available from: https://www.jdrr.org/text.asp?2020/7/5/84/278898

Editor: Dr. Pradnya Kakodkar

Introduction

Temporomandibular disorders (TMDs) are musculoskeletal condition that present with pain and dysfunction in masticatory muscles, temporomandibular joint (TMJ) and related structure.^[1],[2] The symptoms include jaw pain, joint sounds, decrease jaw movements, muscles and joint tenderness.^[3] Other symptoms like tenderness of neck muscles, headache, forward head posture are also sometimes associated with TMD.^[4],[5] Persistence of these symptoms indicates its association with neck pain. Wiesinger et al. in a study found patients with long term spinal pain had 7-fold risk of reporting pain in jaw-face region and 5-fold risk of having TMJ signs.^[6] In particular, TMJ has muscular and ligamentous connection with cervical region forming a functional complex called “cranio cervico – mandibular system.”

Also, maxilla and mandible form skeletal component of stomatognathic system that plays an important role in posture control.^[7] The posture of head affects resting posture of mandible. A study reported positive correlation between jaw and neck disability. Huggare and Raustia studied head posture and cervicovertebral and craniofascial morphology in patients with craniomandibular dysfunction and found that head was more extended in the dysfunction group than in the control group.^[8] Patient with TMD generally report tenderness in masticatory muscles along with upper trapezius and sternocleidomastoid muscle. A study found positive correlation between upper trapezius and temporalis muscles tenderness with neckand jaw dysfunction.^[9]

Many studies have evaluated neck posture and TMJ dysfunction. But studies on effects of physical therapy treatment in patient with TMJ symptoms are few. Hence the present study was conducted to evaluate the effects of myofascial release technique on mobility and function in TMJ disorder patients with neck pain.

Subjects and Methods

After the Institutional Ethical Committee approval (DYPCPT/3/3-2018), 30 TMJ disorder patients who fulfilled the inclusion criteria (25–40 years;^[10] male or female, Acute or chronic temporomandibular (TM) dysfunction patient; Patients presenting with TM dysfunction and neck pain (Neck disability index >4); and who had given written informed consent for participation) The experimental study was conducted in Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune. Any patient with cervical spine injury, Cervical radiculopathy/myelopathy or Fracture dislocation/subluxation were excluded. The subjects were randomized into Group A (experimental) and Group B (control) by chit method. Group A was given nonsteroidal anti-inflammatory drugs (NSAID's) along with myofascial release technique (1 set of 3 repetitions with 90 s hold for 2 weeks) and Group B was given NSAID's (Two times a day for 2 weeks). The myofascial release technique was given to the following muscles.

Upper trapezius

With the patient in comfortable sitting position on an armless chair and both feet firmly placed on the floor and side flexion of cervical spine to opposite side, myofascial release was given to the upper trapezius using ulnar border of both palms.^[11]

Sternocleidomastoid

Patients was made to lie in the supine position on plinth with head rotating laterally. Myofascial release was given by using gross stretch of the muscle by keeping one hand on the mastoid insertion and thumb of other hand to cover the clavicular and sternal attachments and stretched by pushing the clavicle down towards the patients feet.

Temporalis

With the patient in supine position and head rotated laterally, myofascial release was given using gross stretch of the temporalis by placing three widely spaced fingers over as much of the superior insertion as possible andthumb applying stretch proximal to the inferior attachment.

Masseter

With patient in the supine position and head rotated laterally, myofascial release was given through gross stretch of the muscle using the thumb and finger of one hand.

Pre and post values for mobility and function were assessed using TMJ range of motion assessment^[12] and using TMD limitation of daily functions questionnaire.^[13] The collected data was entered in Microsoft excel and statistical analysis were performed using PRIMER software. Wilcoxon signed rank sum test and Mann–Whitney U-test. The level of significance was fixed at P < 0.05.

Results

Out of the 30 samples, there was one drop out from both the groups and hence only 28 samples completed the study. Four were males and 24 were females.

[Table 1] report TM mobility in experimental group for mouth opening preintervention value was 3.1 which post intervention improved to 4.03. For left and right lateral mouth excursion value improved from pre to post intervention as 0.61–0.7. For Protrusion movement preintervention value was 0.5 which also has shown improvement and had increased to 0.7. The P value was statistically significant for all movements.

Table 1: Pre-post temporomandibular joint range of motion in experimental group (n=14)

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[Table 2] reports TM mobility in control group. For mouth opening preintervention value was 3 which post intervention improved to 3.7. For left lateral mouth excursion value improved from pre to post intervention as 0.59–0.64. For right lateral mouth excursion value improved from pre to post intervention as 0.58–0.64. For Protrusion movement preintervention value was 0.62 which also has shown improvement and had increased to 0.71 The P value was statistically significant for all movements.

Table 2: Pre-post temporomandibular joint range of motion in control group (n=14)

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[Table 3] shown mean difference of TMJ mobility comparison in experimental and control group. For mouth opening in experimental group mean difference was 0.8 but in control group value was 0.6. The P value reported was not statistically significant. For left and right lateral mouth excursion experimental group has values as 0.22 and 0.1 whereas for control group excursions were 0.05 for both left and right side. P value was statistically significant for either side excursions. For protrusion mean difference of mobility was 0.12 in experimental group and 0.08 in control group. The P value was not found statistically significant.

Table 3: Comparison of mean difference of temporomandibular joint range of motion of experimental and control groups (n=28)

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[Table 4] shows scoring for limitation of daily functions using TMD questionnaire. In experimental group score has reduced preintervention to postintervention as 22.2–5. Furthermore, the P value was statistically significant. In control group score for scale has also reduced. It was 21.3 preintervention and changed to 13.5 postintervention. P value was statistically significant.

Table 4: Pre-post comparison of limitations of daily function-temporomandibular disorder questionnaire scale in the experimental and control group

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[Table 5] shows mean difference in scoring for limitation of daily functions using TMD questionnaire. For experimental group score has shown mean difference of 17.21 while for control group it was 7.8. P value reported is statistically significant.

Table 5: Comparison of LTF-temporomandibular disorder questionnaire scale in experimental group (n=14) and control (n=14) group

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Discussion

The present study results show that myofascial release technique has been significantly effective in improving right and left lateral excursion movements and significantly effective in reducing the TMD limitations of daily function.

Symptoms of TMJ disorders, especially occlusion difficulty and deep biting, predispose patients toward muscle overuse or hyperactivity. Faulty habits such as Bruxism and emotional stress add on to the masticatory muscle strain and spasm.^[14],[15] Under continued pathology, trigger points are formed in the involved masticatory and associated regions. This induces local hypoxia resulting in tissue distress. Release of bradykinins, substance P further sensitizes the activation of pain receptors.^[16] This maintains the muscle in hypercontracted state with the continued pain, tenderness, and functional problems. Any treatment that improve metabolism at hypercontracted trigger point can help towards relieving TMJ symptoms especially if pathology is nonarticular type. Physical therapy directed toward relieving tension and stress of associated muscles and fascia can help toward alleviation of symptoms.

Use of NSAIDs is directed toward treating the pathology and relieving the symptoms mainly pain and swelling. This will benefit with the improvement of TM joint functional needs.^[17] In physical therapy use of exercises, manual therapy techniques and modalities such as transcutaneous electric nerve stimulation, ultrasound are also gaining interest toward managing TM joint dysfunction.

Masseter along with temporalis are important structures that report tenderness in TMJ dysfunction patients. As fascia is a continuous structure, involvement of other associated structures occurs with time. Jaw dysfunction has positive correlation with neck disability. Treatment oriented toward related structures such as upper trapezius, sternocleidomastoid, and other shoulder structures have to be taken into account.^[18]

According to a systematic review, myofascial release is defined as “form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function.”^[19] This technique places direct pressure and sweeping motion over the restricted muscles and fascia with sustained load. Symptomatic improvement occurs with the achievement of normal length, flexibility and sliding of myofascial mobility.^[20] This even relieves pressure on pain sensitive structures. Myofascial self-release is even used to relieve muscle soreness or fatigue as a recovery technique.

Conclusions

Adding myofascial release technique to normal treatment of TMJ dysfunction patients on medication has shown improvement in mobility mainly for lateral excursion movements and reducing the limitations of daily function.

Acknowledgment

Dental and research department of Dr. D.Y. Patil Vidyapeeth for their help and value guidance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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