Effects of therapeutic exercise in TMDs with pain

Abstract

Introduction: Temporomandibular disorders (TMDs) concerns a heterogeneous group of pathologies that manifest in the orofacial region, head and neck [1] and is defined as a group of musculoskeletal and neuromuscular conditions that involve the TMJs, the masticatory muscles and all associated structures in a reciprocal interaction and influence [2]. This disorder results in one or more signs and symptoms: orofacial pain, masticatory muscle pain or a combination of both. Other symptoms include impaired mandibular range of motion, joint noises associated with function, muscle and joint tenderness as well as head and neck pain [3]. Pain represents the main reason for medical seek [4,5] and certain psychological factors, such as pain catastrophizing, fear, and depression can influence pain thresholds and pain tolerance [4,5]. Taking into account that the literature has shown that pain thresholds and pain tolerances have been found to increase following exercise [4], we have performed a study that aimed to evaluate the immediate effects of therapeutic exercises (TE) in TMDs patients with chronic pain.

Material and Methods: A prospective clinical study was conducted having 20 subjects with muscular TMDs diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders with chronic pain. The subjects were assigned to two groups: 10 in the experimental group (G1) and 10 in the control group (G2). The G2 group consisted of subjects on the waiting list who were evaluated at all times in conjunction with the G1 group, but who were not submitted to any intervention. The experiment was conducted approximately 90 min in duration. During the session, participants: 1) completed the Pain Catastrophizing Scale (PCS); 2) had their pressure pain threshold (PPT) measured before, immediately after and 30 min after TE; and 3) had their pain intensity measured before, immediately after and 30 min after TE through numeric pain rating scale (NPRS). The data evaluation was conducted in a SPSS with an exploratory analysis and a two-way mixed ANOVA to assess the difference between groups, with a significance level of 5%. All the assumptions of the Helsinki Declaration have been fulfilled.

Results: PPT values increased from T0 to T2 in the G1 (p < 0.001). NPRS values decreased at T2 when compared with the T0 in the G1 (p = 0.001).

Discussion/Conclusion: Therapeutic exercises promoted an increase in the PPT values and a decrease in the NPRS value, reinforcing its value in the treatment of muscular TMDs. However, further investigation should be done with an increased sample.