Immediate and Short-Term Effects of Upper Thoracic Manipulation on Myoelectric Activity of Sternocleidomastoid Muscles in Young Women With Chronic Neck Pain: A Randomized Blind Clinical Trial.

OBJECTIVE: The aim of this study was to assess the immediate and short-term effects of upper thoracic spine manipulation on pain intensity and myoelectric activity of the sternocleidomastoid muscles in young women with chronic neck pain. METHODS: A randomized clinical trial was carried out involving 32 women with chronic neck pain (mean age, 24.8 ± 5.4 years) allocated to an experimental group and a placebo group. Three evaluations were carried out: baseline, immediate postintervention, and short-term postintervention (48-72 hours after intervention). Myoelectric activity of the right and left sternocleidomastoid muscles was assessed at rest and during isometric contractions for cervical flexion and elevation of the shoulder girdle. Neck pain intensity was assessed at rest using a visual analog scale. Comparisons of the data were performed using 2-way repeated-measures analysis of variance with the Bonferroni correction. The level of significance was set at P < .05. RESULTS: A moderate treatment effect on myoelectric activity of the right and left sternocleidomastoid muscles during isometric elevation of the shoulder girdle was found in the experimental group only on the short-term postintervention evaluation (d > 0.40). No statistically significant differences were found for any of the variables analyzed in the intergroup comparisons at the different evaluation times (P > .05). CONCLUSION: No statistically significant differences were found in the intragroup or intergroup analyses of the experimental and placebo groups regarding myoelectric activity of the cervical muscles or the intensity of neck pain at rest in the immediate or short-term postintervention evaluations.

Effect of upper thoracic manipulation on mouth opening and electromyographic activity of masticatory muscles in women with temporomandibular disorder: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to assess the effect of upper thoracic manipulation on vertical mouth opening (VMO) and electromyographic activity of the masticatory muscles in women with temporomandibular disorder (TMD). METHODS: A randomized, controlled, blinded study involving 32 women (mean age of 24.78 ± 5.41 years) diagnosed with TMD was performed. Subjects were randomly allocated to an experimental group (n = 16) or a sham manipulation (placebo) group (n = 16). A single session of manipulation was administered to the T1 vertebral area. Electromyography was used to determine activity of masticatory muscles with the mandible at rest and during isometric contraction. Vertical mouth opening was measured using a ruler. Measurements were made before manipulation, immediately after manipulation, and at the short-term follow-up (2 to 4 days after manipulation). RESULTS: No significant differences were found in any of the comparisons of mandibular VMO or electromyographic activity of the masticatory muscles at rest or during isometric contraction of mandibular elevator muscles (P > .05). Regarding isometric contraction of the mandibular depressors, an immediate increase in muscle activity was found in the suprahyoid (P = .014) and left masseter (P = .005) muscles. CONCLUSION: In the present study, no significant differences were found regarding VMO between the experimental and placebo groups or among the different evaluations times in each group. Moreover, Cohen d test revealed no clinical effect of the technique. Therefore, based upon the findings of this study, manipulation administered to the T1 vertebral area appears to have no effect on VMO and electromyographic activity of the masticatory muscles in women with TMD.

Immediate effects of upper thoracic manipulation on the skin surface temperature of the vertebral region in healthy women / Efeitos imediatos da manipulação torácica alta sobre a temperatura superficial cutânea da região vertebral em mulheres saudáveis / Los efectos inmediatos de la alta manipulación torácica de la temperatura superficial de la piel en la región vertebral en mujeres sanas

Manipulation of the spinal column is a manual therapeutic resource characterized by passive thrust of a given joint at a high velocity and low amplitude within the limits of anatomic integrity. The objective of the present study was to assess the immediate effects of upper thoracic manipulation on skin temperature in the vertebral region in healthy women. Thus, a randomized controlled blind trial was realized in the university community. Twenty-six healthy women were randomly allocated into an experimental group (n=13) and a placebo group (n=13). A single session of upper thoracic spine manipulation (segment T3) was performed. Infrared thermography was used to determine changes in skin temperature in the vertebral region. Images were taken prior to, immediately after and both five and 10 minutes after manipulation. Two-way repeated measures analysis of variance with post hoc Bonferroni test was used for inter and intragroup comparisons. The level of significance was set to 5%. No significant differences were found between the different evaluation times in either group (p>0.05). In the intergroup analysis, no statistically significant differences were found in any of the comparisons (p>0.05). Based on the method employed, thoracic spine manipulation of the T3 vertebral segment does not promote changes in skin surface temperature in the region manipulated in asymptomatic individuals.

A manipulação da coluna vertebral é um recurso da terapia manual caracterizado por um impulso passivo de alta velocidade e baixa amplitude dentro dos limites de integridade anatômica de uma articulação (thrust). O objetivo do presente estudo foi avaliar os efeitos imediatos da manipulação torácica alta sobre a temperatura superficial cutânea da região vertebral em mulheres saudáveis. Para tal, foi realizado um estudo clínico randomizado cego na comunidade universitária. Vinte e seis voluntárias saudáveis foram alocadas de forma randomizada em um grupo experimental (n=13) e um grupo placebo (n=13). Uma sessão de manipulação torácica alta (segmento T3) foi realizada. Foi empregada a termografia infravermelha para determinar alterações na temperatura cutânea na região vertebral. Imagens foram capturadas antes, imediatamente após, cinco e dez minutos após a manipulação. Foi usada análise de variância com medidas repetidas (dois critérios) seguida do teste de Bonferroni para as comparações inter e intragrupos. Adotou-se um nível de significância de 5%. Não foi encontrada diferença significativa nas diferentes avaliações ao longo do tempo (p>0,05). Na análise intergrupos, não foi constatada diferença significativa nas comparações realizadas (p>0,05). Com base na metodologia empregada, a manipulação torácica do segmento vertebral T3 não promoveu alterações na temperatura superficial cutânea na região manipulada.

La manipulación de la espina dorsal es un recurso de terapia manual que se caracteriza por un impulso pasivo de alta velocidad y baja amplitud de los límites de integridad anatómica de una articulación (thrust). Esta investigación tuvo por objetivo evaluar los efectos inmediatos de la alta manipulación torácica de la temperatura superficial de la piel en la región vertebral en mujeres sanas. Para eso, se ha realizado un estudio clínico aleatorizado ciego en la comunidad universitaria. Veintiséis voluntarias han sido puestas de forma aleatorizada en un grupo experimental (n=13) y un grupo placebo (n=13). Ha sido realizada una sesión de manipulación torácica alta (segmento T3). Se ha empleado el término infrarrojo para determinar alteraciones en la temperatura de la piel en la región vertebral. Se han capturado imágenes antes, inmediatamente después, cinco y diez minutos tras la manipulación. Se ha hecho un análisis de los cambios con medidas repetidas (dos criterios) seguido de la prueba de Bonferroni para las comparaciones inter e intragrupal. Se ha adoptado un nivel de significancia de 5%. No ha sido encontrado diferencias significativas en las diferentes evaluaciones al largo del tiempo (p>0,05). En el análisis intergrupal, no ha sido constatado diferencias significativas en las comparaciones realizadas (p>0,05). Basándose en la metodología empleada, la manipulación torácica del segmento vertebral T3 no cambió la temperatura superficial de la piel en la región estudiada.

Women with more severe degrees of temporomandibular disorder exhibit an increase in temperature over the temporomandibular joint.

AIM: The purpose of the present study was to correlate the degree of temporomandibular disorder (TMD) severity and skin temperatures over the temporomandibular joint (TMJ) and masseter and anterior temporalis muscles. MATERIALS AND METHODS: This blind cross-sectional study involved 60 women aged 18-40 years. The volunteers were allocated to groups based on Fonseca anamnestic index (FAI) score: no TMD, mild TMD, moderate TMD, and severe TMD (n = 15 each). All volunteers underwent infrared thermography for the determination of skin temperatures over the TMJ, masseter and anterior temporalis muscles. The Shapiro-Wilk test was used to determine the normality of the data. The Kruskal-Wallis test, followed by Dunn's test, was used for comparisons among groups according to TMD severity. Spearman's correlation coefficients were calculated to determine the strength of associations among variables. RESULTS: Weak, positive, significant associations were found between FAI score and skin temperatures over the left TMJ (rs = 0.195, p = 0.009) and right TMJ (rs = 0.238, p = 0.001). Temperatures over the right and left TMJ were significantly higher in groups with more severe TMD (p < 0.05). CONCLUSION: FAI score was associated with skin temperature over the TMJ, as determined by infrared thermography, in this sample. Women with more severe TMD demonstrated a bilateral increase in skin temperature.

The chronicity of myogenous temporomandibular disorder changes the skin temperature over the anterior temporalis muscle.

The aim of the present study was to investigate the correlation between the chronicity of myogenous temporomandibular disorder (TMD) and skin temperature over the masseter and anterior temporalis muscles. A blind, cross-sectional study was carried out involving 30 women with myogenous TMD, aged 18-40 years (mean of 23.60 ± 5.12 years). The volunteers were recruited from the university community. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for the diagnosis of TMD and the determination of chronicity. The volunteers were also submitted to infrared thermography to measure absolute skin temperature over the masseter and anterior temporalis muscles and determine their temperature asymmetries. A significant association was found between duration of TMD and temperature asymmetry of the anterior temporalis muscle (rs = 0.224, p = 0.034). The present findings demonstrate that chronicity of myogenous TMD changes the skin temperature over the anterior temporalis muscle.

Relationship between neck disability and mandibular range of motion.

BACKGROUND AND OBJECTIVE: There is a close interaction between the mandibular and cervical systems due to the existing neurological and biomechanical communications. This study aimed to evaluate the relationship between neck disability and mandibular range of motion (ROM). MATERIALS AND METHODS: Fifty-two women aged between 18 and 40 years were recruited and allocated to four groups using two outcome measures: the Neck Disability Index (NDI) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD): Group I (n=13), healthy volunteers; Group II (n=13), volunteers with TMD and neck disability; Group III (n=13), volunteers with TMD and without neck disability; and Group IV (n=13), volunteers with neck disability and without TMD. Mandibular ROM was evaluated as part of the RDC/TMD clinical examination. Statistical analysis involved one-way ANOVA followed by Tukey's test for comparisons between groups. Spearman's correlation coefficients were calculated to determined correlations among the variables. RESULTS: Significant differences were found in the mandibular ROM of functional opening in the comparisons between Groups I and III (p=0.009) and between Groups III and IV (p=0.024). No significant association was found between mandibular ROM and the NDI score (p > 0.05). CONCLUSION: Based on the methodology employed, there is no association between mandibular ROM and neck disability in university women. In this sense, clinical interventions focusing on the flexibility of the temporomandibular joint does not have repercussions on the neck disability and vice versa.

Effects of upper thoracic manipulation on pressure pain sensitivity in women with temporomandibular disorder: a randomized, double-blind, clinical trial.

OBJECTIVE: The aim of the present study was to evaluate the effects of upper thoracic manipulation on pain in subjects with temporomandibular disorder. DESIGN: Thirty-two women with a diagnosis of temporomandibular disorder were randomly allocated to an experimental group (n = 16), submitted to upper thoracic manipulation, and a placebo group (n = 16), submitted to a procedure in the thoracic region with no therapeutic effect. All volunteers underwent an evaluation of pain in the masticatory muscles and the temporomandibular joint using an algometer and the visual analog scale before and immediately after the procedure as well as after 48-72 hrs. Two-way repeated-measures analysis of variance was used for the intragroup and intergroup analyses, with the level of significance set to 5% (P < 0.05). Cohen d was calculated for the determination of the effect size. RESULTS: No significant group-by-time interaction was found (P > 0.05) for algometry in any analysis, and Cohen d revealed no significant effect of the treatment. Moreover, no significant group-by-time interaction was found for facial pain intensity determined using the visual analog scale (P > 0.05), and Cohen d also revealed no significant effect of the treatment regarding this variable. CONCLUSIONS: On the basis of the present findings, upper thoracic spinal manipulation does not lead to a reduction in pain in women with temporomandibular disorder.

Accuracy of two forms of infrared image analysis of the masticatory muscles in the diagnosis of myogenous temporomandibular disorder.

The aim of the present study was to assess the accuracy of two forms of infrared image analysis (area and extension) of the masseter and anterior temporalis muscles in the diagnosis of myogenous temporomandibular disorder (TMD). A cross-sectional study was carried out involving 104 female volunteers from the university community. Following the application of the Research Diagnostic Criteria for Temporomandibular Disorders, the volunteers were divided into a TMD group (n = 52) and control group (n = 52), and evaluated using infrared thermography. The area and extension of the masseter and anterior temporalis muscles were measured on the images. The receiver operating characteristic (ROC) curve was used to determine diagnostic accuracy (area under the curve), best cutoff point, sensitivity and specificity. A significant difference in skin temperature between groups was only found in the measurement of the area of the left anterior temporalis muscle (p = 0.011). The area under the ROC curve was less than the reference values for all muscles evaluated in the analyses of area and extension. Thus, neither method of infrared thermography tested for the quantification of the masseter and anterior temporalis muscles (analysis of area and extension) is consistent with the RDC/TMD for the diagnosis of myogenous TMD in women.

Correlation between skin surface temperature over masticatory muscles and pain intensity in women with myogenous temporomandibular disorder.

BACKGROUND AND OBJECTIVE: Pain is a common clinical manifestation in individuals with temporomandibular disorder (TMD). The literature report changes in microcirculation in this condition. The aim of the present study was to correlate skin surface temperature at the central point of the masticatory muscles with pain intensity in women with myogenous TMD. MATERIALS AND METHODS: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the visual analogue scale (VAS) were used to divide 40 female university students into four groups: control group (n=10), mild pain group (n=10), moderate pain group (n=10) and severe pain group (n=10). Infrared thermography was used to assess the masticatory muscles. RESULTS: No significant correlations were found between pain intensity and skin surface temperature over the left masseter (p=0.368), right masseter (p=0.618), left anterior temporalis (p=0.293) and right anterior temporalis (p=0.922) muscles. No correlations were found between pain intensity and asymmetry of the masseter (p=0.375) and anterior temporalis (p=0.090) muscles. Moreover, no significant difference in skin surface temperature (p> 0.05) was found among the different groups. CONCLUSION: Pain intensity in women with myogenous TMD was not associated with skin surface temperature at the central point of the masseter and anterior temporalis muscles.

Accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder.

OBJECTIVE: The purpose of this study was to determine the accuracy and reliability of infrared thermography in the diagnosis of arthralgia in women with temporomandibular disorder. METHODS: Thirty women aged between 18 and 40 years were recruited for the study. The Research Diagnostic Criteria for Temporomandibular Disorders was used to allocate the volunteers to the control group (n = 15) and arthralgia group (n = 15). Both groups were submitted to infrared thermography of the temporomandibular joint (TMJ), followed by a punctual analysis of the images. The Mann-Whitney U test was used for the comparison of skin surface temperature between groups. The intraclass correlation coefficient was calculated to determine the reliability of the infrared image analysis. The receiver operating characteristic curve was used to determine the accuracy of the diagnosis. RESULTS: Skin temperature was significantly greater over the left (P = .004) and right (P = .012) TMJ in the arthralgia group. The intraclass correlation coefficient ranged from 0.841 to 0.874. The area under the receiver operating characteristic curve ranged from 0.598 to 0.675. CONCLUSION: Excellent intrarater and interrater reliability was found in the analysis of the infrared images of the TMJ. However, infrared thermography demonstrated a low accuracy in the diagnosis of arthralgia in women with temporomandibular disorder.

Accuracy of infrared thermography of the masticatory muscles for the diagnosis of myogenous temporomandibular disorder.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of infrared thermography of the central point of the masseter and anterior temporalis muscles for the diagnosis of myogenous temporomandibular disorder (TMD). METHODS: This is an observational study of university women with and without TMD. Through the use of the Research Diagnostic Criteria for Temporomandibular Disorders, 104 women were divided into a TMD group (n = 52) and control group (n = 52). All volunteers had their masseter and anterior temporalis muscles evaluated by infrared thermography. The receiver operating characteristic (ROC) curve was used to determine the accuracy of diagnosis (area under the ROC curve), the best cut-off point, sensitivity, and specificity. RESULTS: No significant differences were observed (P > .05) in the skin surface temperature of the masticatory muscles, when the groups were compared. With regard to the ROC curve, the area under the curve was lower than the recommended for all the muscles tested, ranging from 0.433 to 0.502. CONCLUSION: The findings of this study suggest that infrared thermography of the masticatory muscles is not an accurate instrument for the myogenous TMD diagnosis.

Assessment of the upper trapezius muscle temperature in women with and without neck pain.

OBJECTIVE: The purpose of the study was to analyze the upper trapezius muscle temperature using thermography in women with and without neck pain. METHODS: Thirty-six female university students were classified through the Neck Disability Index (NDI) into 2 groups: the neck pain group comprised 18 volunteers diagnosed with mild disability, and the control group, 18 healthy volunteers. All subjects were submitted to evaluation by thermography, which registered the skin surface temperature of the upper bilateral trapezius muscle. Student t test and Mann-Whitney U test were used for the comparison between the groups, and the Spearman correlation coefficient was used for the appropriate correlations between the NDI score and the temperature values. A significance level of 5% was set. RESULTS: No significant difference was found between the groups regarding the temperature values of the upper left (P = .565) and right (P = .917) trapezius muscles, as well as in comparisons of temperature asymmetry (P = .542). In addition, no significant association was found between the study variables (P > .05). CONCLUSION: Women with neck pain, diagnosed with mild disability by NDI, did not present with reduction or asymmetry of upper trapezius muscle temperature when compared with a group without neck pain.