Packer Amanda Carine, Pires Paulo Fernandes, Dibai-Filho Almir Vieira, Rodrigues-Bigaton Delaine
Master's Student, Laboratory of Therapeutic Resources, Postgraduate Program in Physical Therapy, Methodist University of Piracicaba, Piracicaba, SP, Brazil.
Doctoral Student, Laboratory of Therapeutic Resources, Postgraduate Program in Science of Human Movement, Methodist University of Piracicaba, Piracicaba, SP, Brazil.
J Manipulative Physiol Ther. 2015 May;38(4):253-61. doi: 10.1016/j.jmpt.2015.04.001. Epub 2015 Apr 27.
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).
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).
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.
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.
本研究旨在评估上胸椎整复手法对颞下颌关节紊乱病（TMD）女性患者垂直开口度（VMO）及咀嚼肌肌电图活动的影响。
进行了一项随机、对照、双盲研究，纳入32名诊断为TMD的女性（平均年龄24.78±5.41岁）。受试者被随机分为实验组（n = 16）或假手法（安慰剂）组（n = 16）。对T1椎体区域进行单次整复手法治疗。采用肌电图测定下颌处于休息位及等长收缩时咀嚼肌的活动。使用直尺测量垂直开口度。在手法治疗前、治疗后即刻以及短期随访（治疗后2至4天）进行测量。
在下颌VMO或咀嚼肌在休息时或下颌升肌等长收缩时的肌电图活动的任何比较中，均未发现显著差异（P > 0.05）。关于下颌降肌的等长收缩，发现舌骨上肌（P = 0.014）和左侧咬肌（P = 0.005）的肌肉活动立即增加。
在本研究中，实验组与安慰剂组之间或每组不同评估时间的VMO方面均未发现显著差异。此外，Cohen d检验显示该技术无临床效果。因此，基于本研究结果，对T1椎体区域进行的整复手法似乎对TMD女性患者的VMO及咀嚼肌肌电图活动没有影响。
