Efeitos da manipulação cervical alta sobre a atividade eletromiográfica dos músculos mastigatórios e amplitude de movimento de abertura da boca em mulheres com disfunção temporomandibular: ensaio clínico randomizado e cego
DOI:
https://doi.org/10.590/1809-2950/15568322042015Resumo
Avaliou-se os efeitos da manipulação cervical alta sobre a atividade eletromiográfica de superfície (sEMG) dos músculos mastigatórios e amplitude do movimento de abertura da boca em mulheres com disfunção temporomandibular (DTM). Foram avaliadas 10 mulheres com diagnóstico de DTM miogênica, segundo o Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD), divididas, aleatoriamente, em grupo experimental (GE) n=5, que recebeu manipulação cervical alta e grupo placebo (GP) n=5, que recebeu manobra sem efeito terapêutico. Cinco intervenções foram aplicadas para ambos os grupos uma vez por semana, e avaliações de pré-intervenção, pós-imediato (após a 1ª intervenção) e pós-tardio (48 horas após a 5ª intervenção) foram realizadas. A atividade sEMG foi processada via raiz quadrada da média e normalizada pelo valor de pico (RMS EMGn). Utilizou-se para comparação os testes t de Student e ANOVA two-way (medidas repetidas), adotando-se como significância o valor de 5%, e o Cohen's d para tamanho de efeito de tratamento. Constatou-se a interação significativa grupo × tempo (p<0,05) no RMS EMGn dos músculos temporal direito e esquerdo, na condição de repouso, assim como para todos os músculos mastigatórios durante contração isométrica máxima de elevação e depressão da mandíbula. Os tamanhos de efeito de tratamento moderado a alto foram observados no GE, destacando-se na avaliação pós-tardia. Foi observado também um aumento significativo (p<0,05) e um alto efeito de tratamento na abertura da boca para o GE. A manipulação cervical alta demonstrou equilibrar o RMS EMGn dos músculos mastigatórios e aumentar a amplitude de movimento de abertura da boca em mulheres com DTM miogênica.Downloads
Referências
Bender SD. Temporomandibular disorders, facial pain, and
headaches. Headache. 2012;52(1):22-5.
Eriksson PO, Haggman-Henrikson B, Zafar H. Jaw-neck
dysfunction in whiplash-associated disorders. Arch Oral
Biol. 2007;52:404-8.
Gomes CA, Politti F, Andrade DV, Sousa DF, Herpich CM,
Dibai-Filho AV, et al. Effects of massage therapy and occlusal
splint therapy on mandibular range of motion in individuals
with temporomandibular disorder: a randomized clinical
trial. J Manipulative Physiol Ther. 2014;37(3):164-9.
Gomes NCMC, Berni-Schwarzenbeck KCS, Packer AC,
Rodrigues-Bigaton D. Effect of cathodal high-voltage
electrical stimulation on pain in women with TMD. Rev Bras
Fisioter. 2012;16:10-5.
Packer AC, Pires PF, Dibai-Filho AV, Rodrigues-Bigaton
D. Effect of upper thoracic manipulation on mouth
opening and electromyographic activity of masticatory
muscles in women with temporomandibular disorder:
a randomized clinical trial. J Manip Physiol Ther.
;38(4):253-61.
Martínez-Segura R, De-la-Llave-Rincón AI, Ortega-Santiago
R, Cleland JA, Fernández-de-Las-Peñas C. Immediate
changes in widespread pressure pain sensitivity, neck pain,
and cervical range of motion after cervical or thoracic thrust
manipulation in patients with bilateral chronic mechanical
neck pain: a randomized clinical trial. J Orthop Sports Phys
Ther. 2012;42(9):806-14.
Mansilla-Ferragut P, Fernández-de-Las Peñas C,
Alburquerque-Sendín F, Cleland JA, Boscá-Gandía JJ.
Immediate effects of atlanto-occipital joint manipulation
on active mouth opening and pressure pain sensitivity in
women with mechanical neck pain. J Manip Physiol Ther.
;32(2):101-6.
Vernon H, Humphreys BK. Chronic mechanical neck pain in
adults treated by manual therapy: a systematic review of
change scores in randomized controlled trials of a single
session. J Man Manip Ther. 2008;16(2):42-52.
Vicenzino B, Wright A. Effects of a novel manipulative
physiotherapy technique on tennis elbow: a single case
study. Man Ther. 1995;1(1):30-5.
Yu X, Wang X, Zhang J, Wang Y. Changes in pressure
pain thresholds and Basal electromyographic activity after instrument-assisted spinal manipulative therapy in
asymptomatic participants: a randomized, controlled trial.
J Manip Physiol Ther. 2012;35(6):437-45.
Herzog W, Scheele D, Conway PJ. Electromyography
responses of back and limb muscles associated with spinal
manipulative therapy. Spine. 1999;24:146-52.
Calixtre LB, Moreira RF, Franchini GH, Alburquerque-Sendín
F, Oliveira AB. Manual therapy for the management of pain
and limited range of motion in subjects with signs and
symptoms of temporomandibular disorder: a systematic
review of randomised controlled trials. J Oral Rehabil.
;42(11):847-61.
Yu H, Hou S, Wu W, He X. Upper cervical manipulation
combined with mobilization for the treatment of atlantoaxial
osteoarthritis: a report of 10 cases. J Manip Physiol Ther.
;34(2):131-7.
Dunning JR, Cleland JA, Waldrop MA, Arnot CF, Young IA,
Turner M, et al. Upper cervical and upper thoracic thrust
manipulation versus nonthrust mobilization in patients with
mechanical neck pain: a multicenter randomized clinical
trial. J Orthop Sports Phys Ther. 2012;42:5-18.
Mansilla Ferragud P, Boscá Gandia JJ. Efecto de la
manipulacion de la charnela occipito-atlo-axoidea en la
apertura de la boca. Osteopat Cientıfica. 2008;3:45-51.
Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle
PG. Manipulation and mobilization of the cervical spine: a
systematic review of the literature. Spine. 1996;21:1746-59.
Erhardt JW, Windsor BA, Kerry R, Hoekstra C, Powell DW,
Porter-Hoke A, Taylor A. The immediate effect of atlantoaxial high velocity thrust techniques on blood flow in the
vertebral artery: A randomized controlled trial. Man Ther.
;20(4):614-22.
Cattrysse E, Swinkels RA, Oostendorp RA, Duquet W. Upper
cervical instability: are clinical tests reliable? Man Ther.
;2(2):91-7.
Licht PB, Christensen HW, Høilund-Carlsen PF. Vertebral
artery volume flow in human beings. J Manip Physiol Ther.
;22(6):363-7.
Berni KC, Dibai-Filho AV, Pires PF, Rodrigues-Bigaton D.
Accuracy of the surface electromyography RMS processing
for the diagnosis of myogenous temporomandibular
disorder. J Electromyogr Kinesiol. 2015;25(4):596-602.
Fernández-de-Las-Peñas C, Alonso-Blanco C, Cleland
JA, Rodríguez-Blanco C, Alburquerque-Sendín F.
Changes in pressure pain thresholds over C5-C6
zygapophyseal joint after a cervicothoracic junction
manipulation in healthy subjects. J Manip Physiol Ther.
; 31(5):332-7.
Cohen J. Statistical power analysis for the behavioral
sciences. 2ª ed. New Jersey: Lawrence Erlbaum; 1988.
Hugger S, Schindler HJ, Kordass B, Hugger A. Clinical
relevance of surface EMG of the masticatory muscles. (Part
: Resting activity, maximal and submaximal voluntary
contraction, symmetry of EMG activity. Int J Comput Dent.
;15(4):297-314.
Pickar JG. Neurophysiological effects of spinal manipulation.
Spine J. 2002; 2(5):357-71.
Bicalho E, Setti JA, Macagnan J, Cano JL, Manffra
EF. Immediate effects of a high-velocity spine
manipulation in paraspinal muscles activity of
nonspecific chronic low-back pain subjects. Man Ther.
;15(5):469-75.
Camargo VM, Alburquerque-Sendín F, Bérzin F, Stefanelli
VC, Souza DP, Fernández-de-las-Peñas C. Immediate
effects on electromyographic activity and pressure pain
thresholds after a cervical manipulation in mechanical neck
pain: a randomized controlled trial. J Manip Physiol Ther.
;34(4):211-20.
Pires PF, Packer AC, Dibai-Filho AV, Rodrigues-Bigaton
D. 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. J Manip Physiol Ther.
;38(8):555-63.
La Touche R, Fernández-de-las-Peñas C, FernándezCarnero J, Escalante K, Angulo-Díaz-Parreño S,
Paris-Alemany A, Cleland JA. The effects of manual
therapy and exercise directed at the cervical spine
on pain and pressure pain sensitivity in patients with
myofascial temporomandibular disorders. J Oral Rehabil.
;36(9):644-52.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2015 Fisioterapia e Pesquisa
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.