Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial

Bortolazzo, Gustavo Luiz; Pires, Paulo Fernandes; Dibai-Filho, Almir Vieira; Berni, Kelly Cristina dos Santos; Rodrigues, Bruno Mascella; Rodrigues-Bigaton, Delaine

doi:10.590/1809-2950/15568322042015

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ORIGINAL RESEARCH • Fisioter. Pesqui. 22 (4) • Oct-Dec 2015 • https://doi.org/10.590/1809-2950/15568322042015 copy

Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

We evaluated the effects of upper cervical manipulation on the surface electromyographic activity (sEMG) of masticatory muscles and range of motion of the opening movement of the mouth in women with temporomandibular disorders (TMD). We evaluated 10 women with myogenic a TMD diagnosis, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and divided randomly into an experimental group (EG) n=5, which received upper cervical manipulation, and a placebo group (PG) n=5, which received maneuvers without therapeutic effects. Five interventions were performed in both groups, once a week, with performance of pre-intervention assessments, post-immediate assessments (after 1st intervention) and post-delayed assessments (48 hours after the 5th intervention). The sEMG activity was processed using the root mean square and normalized by the peak value (RMS EMGn). We used for comparison the Student's t-test and ANOVA two-way repeated measures, adopting as significance the amount of 5%, and the Cohen d for treatment effect size. We found a significant interaction of group vs time (p<0.05) in the RMS EMGn of the left and right temporal muscles at rest, as well as for all masticatory muscles during maximal isometric contraction during jaw-elevation and jaw-depression. Treatment effect size, high to moderate, was observed in the EG, especially in the post-delayed assessment. We also observed a significant increase (p<0.05) and a high treatment effect during mouth opening in the EG. The upper cervical manipulation demonstrated a balance of the RMS EMGn of the masticatory muscles and increase the opening range of motion of the mouth in women with myogenic TMD.

Keywords:
Manipulation, Spinal; Electromyography; Range of Motion, Articular; Temporomandibular Joint Disorders

	PRE Mean ± SD	POST Mean ± SD	Δ POST x PRE (95%CI)
Experimental Group	27,60±8,56	37,60±11,15	10,00 (3,35;16,65)*, d=1,00
Placebo Group	40,60±11,76	42,40±14,67	1,80 (-4,85;8,45), d=0,13

	PRE Mean ± SD	POSI Mean ± SD	POST Mean ± SD	Δ POSI x PRE (95%CI)	Δ POST x PRE (95%CI)
Left Temporal Muscle					Δ POST x PRE (95%CI)
Experimental Group	0.76±0.41	0,32±0,12	0,32±0,10**	-0,44(-0,85; -0,02)*, d=-1,45	-0,44(-0,89;0,01), d=-1,49
Placebo Group	0.70±0.37	0,76±0,46	0,79±0,36	0,06(-0,35;0,47), d=0,14	0,09(-0,36;0,54), d=0,24
Left Masseter Muscle					0,09(-0,36;0,54), d=0,24
Experimental Group	0.55±0.42	0,26±0,04	0,27±0,08	-0,29(-0,68;0,10), d=-0,99	-0,28(-0,67;0,11), d=-0,93
Placebo Group	0.54±0.32	0,46±0,28	0,52±0,13	-0,08(-0,47;0,31), d=-0,25	-0,02(-0,41;0,37), d=-0,09
Right Temporal Muscle					-0,02(-0,41;0,37), d=-0,09
Experimental Group	0.97±0.48	0,71±0,54	0,38±0,17**	-0,26(-0,56;0,05), d=-0,49	-0,59(-1,01;-0,17)*, d=-1,62
Placebo Group	0.91±0.28	0,92±0,25	0,99±0,18	0,02(-0,28;0,32), d=0,07	0,09(-0,33;0,51), d=0,37
Right Masseter Muscle					0,09(-0,33;0,51), d=0,37
Experimental Group	0.42±0.20	0,30±0,10	0,25±0,04	-0,12(-0,28;0,04), d=-0,77	-0,18(-0,40;0,05), d=-1,19
Placebo Group	0.53±0.41	0,51±0,41	0,62±0,48	-0,01(-0,17;0,15), d=-0,03	0,10(-0,13;0,32), d=0,22
Supra-Hyoid Muscles					0,10(-0,13;0,32), d=0,22
Experimental Group	1.96±1.52	1,26±0,58	0,84 ±0,19	-0,70(-1,66;0,26), d=-0,61	-1,11(-2,72;0,49), d=-1,03
Placebo Group	1.89±1.42	1,87±1,42	2,36 ±2,21	-0,02(-0,98;0,94), d=-0,01	0,47(-1,14;2,08), d=0,25

	PRE Mean ± SD	POSI Mean ± SD	POST Mean ± SD	Δ POSI x PRE (95%CI)	Δ POST x PRE (95%CI)
Left Temporal Muscle - Maximal isometric lifting contraction of the jaw					Δ POST x PRE (95%CI)
Experimental Group	0.61±0.25	0.73±0.31	0.84±0.38**	0.13 (-0.00;0.26), d=0.45	0.24 (0.07;0.40)*, d=0.73
Placebo Group	0.69 ±0.35	0.72±0.34	0.65±0.34	0.03 (-0.10;0.16), d=0.09	-0.04 (-0.21;0.13), d=-0.12
Left Masseter Muscle - Maximal isometric lifting contraction of the jaw					-0.04 (-0.21;0.13), d=-0.12
Experimental Group	0.49±0.25	0.65±0.26	0.68±0.23	0.16 (0.04;0.28)*, d=0.62	0.20 (0.08;0.31)*, d=0.80
Placebo Group	0.51±0.15	0.52±0.17	0.48±0.18	0.01 (-0.10;0.13), d=0.09	-0.04 (-0.15;0.08), d=-0.21
Right Temporal Muscle - Maximal isometric lifting contraction of the jaw					-0.04 (-0.15;0.08), d=-0.21
Experimental Group	0.47±0.16	0.57±0.13	0.59±0.13	0.10 (0.04;0.16)*, d=0.67	0.12 (0.06;0.18)*, d=0.81
Placebo Group	0.52±0.26	0.52±0.23	0.54±0.26	0.01 (-0.05;0.07), d=0.03	0.02 (-0.04;0.08), d=0.08
Right Masseter Muslce - Maximal isometric lifting contraction of the jaw					0.02 (-0.04;0.08), d=0.08
Experimental Group	0.51±0.35	0.65±0.39	0.73±0.39	0.14 (0.05;0.23)*, d=0.37	0.22 (0.14;0.30)*, d=0.58
Placebo Group	0.46±0.19	0.45±0.17	0.43±0.18	-0.01 (-0.10;0.08), d=-0.03	-0.03 (-0.11;0.05), d=-0.16
Supra-Hyoid Muscles - Maximal isometric depression contraction of the jaw					-0.03 (-0.11;0.05), d=-0.16
Experimental Group	0.92±0.09	1.38±0.16	1.73±0.23**	0,46 (0.26; 0.66)*, d=3.52	0.81 (0.62;1.01)*, d=4.62
Placebo Group	1.05±0.20	1.13±0.24	1.08±0.15	0,08 (-0.12; 0.28), d=0.37	0.03 (-0.16;0.23), d=0.18

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