The Immediate Effects of Atlanto-occipital Joint Manipulation and Suboccipital Muscle Inhibition Technique on Active Mouth Opening and Pressure Pain Sensitivity Over Latent Myofascial Trigger Points in the Masticatory Muscles

Abstract

t desiGn: A randomized controlled trial.t obJectiVe: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles.t bacKGRound: Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve.t MetHods: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction.t Results: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P.01) and temporalis (P = .003) muscle latent TrPs and also for active mouth opening (P.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. t conclusions: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. t leVel oF eVidence: Therapy, level 1b.

Intra and inter-rater reliability of infrared image analysis of masticatory and upper trapezius muscles in women with and without temporomandibular disorder

“…Therefore, considering the results found in this study, we recommend the use of infrared thermography as an aid tool in assessing TMD, mainly when the objective is to determine the effect of different therapeutic resources used for the TMD treatment, such as electrotherapy 33,34 , laser therapy 35,36 and manual therapy 37,38 . Table 3.…”

Early Stage Physical Therapy After Ankylosing Temporomandibular Joint Surgery: A Multidisciplinary Approach: Case Report

“…11,21 Özellikle kas kaynaklı TMD'lerde, çiğneme sisteminde ağrı varlığı servikal omurga bozukluklarına ya da tam tersi servikal omurga bozuklarının TMD'lere sebep olabileceği vurgulanmıştır. 10 Literatür ile paralel olarak bu olguda da baş-boyun kaslarında, ayrıca skapulotorasik bölge kaslarında yumuşak doku gerginlikleri ve tetik nokta varlığı saptanmıştır. Fizyoterapi programı oluşturulur iken, yumuşak doku göz önünde bulundurularak hem çene bölgesine hem de servikal ve skapulotorasik bölgeye yönelik uygun fizyoterapi yaklaşımlarından faydalanılmış-tır.…”

Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders

“…Two studies evaluated mouth opening in asymptomatic individuals immediately after the manual therapy treatment compared to the control group. Among these, George et al [16] observed no improvement, whereas Oliveira Campello et al [29] noted significant improvement in mouth opening. Since asymptomatic individuals were assessed in these studies, the clinically significant measurement of pain-free MMO could not be used.…”

“…However, the lack of a control group in this study does not allow distinction of the actual treatment effect in TMD. Oliveira Campello et al [29] reported that atlanto-occipital joint manipulation and suboccipital muscle inhibition increased PPT on the latent trigger points of masticatory muscles in asymptomatic patients immediately after application of the technique when compared to a control group. In this study, an increase of approximately 0.2 kg/cm 2 in PPT, which was not clinically significant, was observed on the latent trigger points in the trigemi- nal region.…”