Effect of the dry needling vs manual myofascial therapy at the trigger points in temporomandibular dysfunction

Abstract

Introduction: The etiology of Temporomandibular Dysfunction (TMD) is multidimensional, considering biomechanical, neuromuscular and biopsychosocial [1]. TMDs are defined in subgroups as problems involving temporomandibular joint (TMJ), masticatory system muscles, and musculoskeletal structures associated with the head and neck [2]. The most relevant signs of TMD are the presence of joint sounds (clicking and crepitation), reduced mouth opening, and disrupted jaw movements. However, pain is the primary problem of this pathology, and it is typically the reason these patients request medical care [3]. The muscular etiology TMD includes the myofascial pain syndrome, which is characterized by the presence of trigger points (TP). The intervention of physical therapy in TP involves myofascial manual therapy and dry needling [4]. The purpose of this study was to investigate the effect of physiotherapy technique for the treatment of muscular TMD by applying manual myofascial therapy and dry needling.

Material and Methods: This was a quasi-experimental study that enclosed a group of 15 individuals with a diagnosis of TMD, selected as sample through the questionnaire of Diagnostic Criteria for Research in Temporomandibular Dysfunction (RDC/TMD) and the Fonseca questionnaire, in which they have at least level II of severity. The subjects were randomized into two groups: group one (G1) was submitted to myofascial manual therapy and group two (G2) was submitted to dry needling. Subjects had the pressure pain threshold (PPT) and pain intensity (VAS) evaluated, through algometry and EVA scale respectively, at beginning (M0) and one hour (M1) after being submitted to interventions. This study follows all the principles of the Declaration of Helsinki.

Results: The results indicate that both therapies increase the PPT and decrease the VAS, with statistic significantly differences (p < 0.05) between M0 and M1 within both groups. When comparing techniques, no significant differences were observed.

Discussion and conclusions: Myofascial manual therapy and dry needling focused in masseter and temporal promoted an increased in the PPT values and a decrease in the VAS value after a single session on patient’s symptoms with TMDs. However, further studies with larger samples should be carried out in order to analyze which technique presents superior results.