RESUMEN
BACKGROUND: Rhythmic joint mobilizations (RJM) of the temporomandibular joint (TMJ) are employed to relieve pain and improve function in patients with temporomandibular disorders (TMD). However, the evidence on the immediate effects of RJM in patients with TMD is scarce. The aim of this study was to assess the immediate clinical and functional effects of RJM in patients with TMD. MATERIALS AND METHODS: This was a one-group quasi-experimental before and after study. Thirty-eight patients with TMD were assessed by means of pain intensity (visual analogue score, VAS), pressure pain threshold (PPT, measured through pressure algometry on the masseter and temporal muscles), mouth opening (MO, measured with a ruler), and surface electromyographic activity of the masseter and temporal muscles (asymmetry index, AI). Measurements were performed before and after a single, 1-min session of RJM of each TMJ. All statistical analyses were performed using the SPSS version 20.0 statistical package. RESULTS: A statistical significant difference was found in pain intensity, PPT and MO after the intervention (p < 0.05). No difference was found in the AI. A large effect size was observed for pain intensity, PPT of the left and right masseter muscles and MO (d = 0.85-1.13), whereas for the left and right temporal muscles the effect size was moderate (d = 0.62) and small, respectively (d = 0.49). CONCLUSION: In this sample of patients with TMD, a single session of RJM of the TMJ seemed to be effective in reducing pain intensity, increasing PPT and improving MO immediately after the intervention, without differences in the AI.
Asunto(s)
Trastornos de la Articulación Temporomandibular , Articulación Temporomandibular , Humanos , Músculo Masetero , Boca , Umbral del Dolor , Músculo Temporal , Trastornos de la Articulación Temporomandibular/terapiaRESUMEN
Antecedentes y objetivos: Existe escasa información acerca de valores de referencia para el umbral de dolor a la presión (UDP) en el hombro. Nuestros objetivos fueron evaluar el UDP normal en cinco sitios de relevancia clínica del hombro y analizar la influencia de factores como el método de cálculo, el sexo, la composición corporal y la habilidad manual. Materiales y métodos: Este estudio transversal incluyó 58 individuos asintomáticos de ambos sexos de entre 18 a 65años. El UDP fue evaluado a nivel del músculo infraespinoso (IE), del músculo deltoides medio (DM), de la inserción del músculo pectoral menor (IPM), de la articulación acromioclavicular (AAC) y del músculo trapecio superior (TS). En cada sitio se tomaron 3 mediciones, eliminando la primera para el cálculo del valor promedio. Se utilizó el test t de Student para comparar las diferencias entre grupos (nivel de significación del 95%). Resultados: El punto más sensible fue el TS (4,31±2,09kg/cm2), seguido por la IPM (4,63±1,85kg/cm2), el DM (5,60±2,28kg/cm2), el IE (6,33±2,25kg/cm2) y la AAC (6,70±2,26kg/cm2). Solo el DM demostró una diferencia significativa entre ambos lados. Los hombres tuvieron valores de UDP superiores, excepto en el TS. Los sujetos con sobrepeso tuvieron valores superiores de UDP a nivel del DM y la IPM. Conclusiones: No se encontraron diferencias significativas con los valores de referencia reportados previamente. Las discrepancias entre diferentes estudios podrían ser independientes de la metodología utilizada para el cálculo del UDP. Se encontró una correlación estadística entre el UDP del músculo DM y el dominio manual, aunque dicha asociación puede no ser clínicamente relevante. Finalmente, este estudio demostró que el UDP a nivel del DM y la IPM es dependiente del índice de masa corporal (IMC)
Background and aims: There is little evidence regarding reference values for shoulder pressure pain threshold (PPT). Our aims were to assess the normal PPT around the shoulder, and to analyse the influence of the calculation method, gender, body composition and manual dexterity. Methods: In this cross-sectional study, 58 asymptomatic individuals of both genders, aged between 18 and 65years, were recruited. The PPT was assessed in the infraspinatus muscle (IS), middle deltoid muscle (MD), pectoralis brevis muscle insertion (PBI), acromioclavicular joint (ACJ) and upper trapezius muscle (UT). Three measurements were taken at each site, and the first was eliminated to calculate the mean value. The independent t-test was used to determine differences between groups (level of significance of 95%). Results: The most sensitive point was the TS (4.31±2.09kg/cm2), followed by the PBI (4.63±1.85kg/cm2), MD (5.60±2.28kg/cm2), IS (6.33±2.25kg/cm2) and ACJ (6.70±2.26kg/cm2). Only the MD showed a significant difference between sides. Men had higher PPT values, except for the TS. Overweight subjects had higher PPT values in the MD and the PBI. Conclusions: No significant differences with previous reference values were found. Discrepancies between different studies might not depend on the method used to obtain the final value. A statistical correlation was found between PPT at the MD and hand dexterity, although this association may not be clinically relevant. Finally, this study showed that the PPT of the MD and the PBI is BMI-dependent