ABSTRACT
BACKGROUND: Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles. OBJECTIVE: This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment. METHODS: Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n= 24) or the control group (CG, n= 25). STEG included progressive strengthening, proprioceptive, and stabilization exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca's Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used. RESULTS: The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p< 0.05), however medio-lateral body sway did not differ between groups (p> 0.05). CONCLUSIONS: Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment.
ABSTRACT
Background: Neck and jaw pain is common and is associated with jaw functional limitations, postural stability, muscular endurance, and proprioception. This study aimed to investigate the effect of jaw and neck pain on craniocervico- mandibular functions and postural stability in patients with temporomandibular joint disorders (TMJDs). Methods: Fifty-two patients with TMJDs were included and assessed using Fonseca's Questionnaire and the Helkimo Clinical Dysfunction Index. An isometric strength test was performed for the TMJ depressor and cervical muscles. The TMJ position sense (TMJPS) test and cervical joint position error test (CJPET) were employed for proprioception. Total sway degree was obtained for the assessment of postural stability. Deep neck flexor endurance (DNFE) was assessed using the craniocervical flexion test. The mandibular function impairment questionnaire (MFIQ) was employed to assess mandibular function, and the craniovertebral angle (CVA) was measured for forward head posture. Results: Jaw and neck pain negatively affected CVA (R2 = 0.130), TMJPS (R2 = 0.286), DNFE (R2 = 0.355), TMJ depressor (R2 = 0.145), cervical flexor (R2 = 0.144), and extensor (R2 = 0.148) muscle strength. Jaw and neck pain also positively affected CJPET for flexion (R2 = 0.116) and extension (R2 = 0.146), as well as total sway degree (R2 = 0.128) and MFIQ (R2 = 0.230). Conclusions: Patients with painful TMJDs, could have impaired muscle strength and proprioception of the TMJ and cervical region. The jaw and neck pain could also affect postural stability, and the endurance of deep neck flexors as well as mandibular functions in TMJDs.
ABSTRACT
BACKGROUND: Maintaining scapular mechanics is important for upper extremity functionality and posture. Determining the extent to which the scapular stabilizer muscles affect the scapular position may guide the creation of an exercise program for people with scapular dyskinesis. HYPOTHESIS: The serratus anterior (SA), upper trapezius (UT), middle trapezius (MT), and lower trapezius (LT) muscles play different roles on scapular position when humeral elevation increase. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 70 women aged 40 to 65 years (mean age, 49 ± 7 years) who met the inclusion criteria were included in the study. Isometric muscle strength of the SA, UT, MT, and LT was evaluated with a handheld dynamometer. For assessment of scapular position, the lateral scapular slide test (LSST) was used. Multiple stepwise regression analysis was used to evaluate scapular parameters. RESULTS: There were positive and statistically significant correlations between the isometric muscle strength of the SA, UT, MT, and LT muscles and the values at different humerus positions in the LSST (P < 0.05). The UT and SA muscles greatly affected the changes in the position of the inferior region of the scapula (R2 > 24.5%). The LT (11.3%) in neutral position, MT (25.4%) with arm abducted at 45°, and SA (34.5%) with arm abducted 90° had a major effect on the changes in the mediolateral position of the scapula. CONCLUSION: While the LT muscle affects the mediolateral position of the scapula to a large extent, the strength of the MT and SA muscles becomes effective as the shoulder elevation increases. SA and UT muscle strength have a greater effect on the position of the inferior region of the scapula. CLINICAL RELEVANCE: Dyskinesis can be observed at different levels of the scapula; therefore, it is important to determine at which level the dyskinesis is more prominent for each individual and consequently to form a personalized exercise program to increase function and control dyskinesis.
