Progressive Muscle Relaxation According to Jacobson in Treatment of the Patients With Temporomandibular Joint Disorders
Condition: TEMPOROMANDIBULAR JOINT DYSFUNCTION SYNDROME
MeSH terms: Joint Diseases; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Interventional

Summary: 
      Temporomandibular joint disorders are ranked third among the most common stomatological
      diseases after dental caries and periodontal problems. Type of dysfunction is determined by
      environmental, genetic and psycho-emotional factors. It has been observed that increasing
      level of stress leads to the increase of harmful parafunctional habits in the stomatognathic
      system whose long-term effect prevents the ability of the organism to compensate and adapt
      the function, which contributes to the pain within the masticatory system. Nowadays applied
      methods in treatment of temporomandibular joint disorders are still under investigation.
      However, they have not been developed effectively yet. Satisfactory methods of masticatory
      muscle relaxation (with the exception for drug treatment) are only related to mental
      patients. Significant impact factor and psycho-emotional stress in the etiology of
      dysfunction indicate the need of the routine approach in the treatment of patients with
      temporomandibular joint disorders to be changed. The attempt to cooperate with a psychologist
      may facilitate the effectiveness of traditional rehabilitation of patients with dysfunction.
    

Detailed description: 
      Introduction In the 30s of the previous century, Edmund Jacobson developed the method of
      progressive muscle relaxation, which is based on the premise that mental relaxation should
      naturally result from physical relaxation. The primary objective of Jacobson's relaxation is
      to increase patient's awareness associated with the feeling of muscle tension, no matter how
      intense it is. This method teaches patients how to take control over the factors causing
      stress, with simultaneous relaxation of skeletal muscles, and alternating tension and
      relaxation deliberately in the next group of striated muscle. Regular training is aimed at
      developing a habit of locating the tension and loosening individual muscle groups. Data from
      the literature indicates the usefulness of Jacobson's progressive muscle relaxation method as
      a supportive therapy for the treatment of neurological disorders, depression, anxiety,
      bronchial asthma, and cardiological conditions. Positive therapeutic results have also been
      reported in the treatment of peptic ulcer, chronic headache, tinnitus, sleep disorders, and
      psychological treatment of neurological conditions. The additional benefits of this
      therapeutic approach include reduced anxiety, decreased arterial hypertension and improved
      heart function, improved gastric and intestinal function, increased imagination and thought
      processes, increased trust between the patient and the physician, and improved control of
      one's mood. Jacobson's progressive muscle relaxation has not been used in the treatment of
      temporomandibular joint disorders. The above has become an inspiration to undertake research
      in this field. The significant impact of psycho-emotional factors and stress on the rise or
      worsening of dysfunction as well as cooperation with the psychologist can significantly
      influence the course and treatment of functional disorders. The elimination of psychological
      components in patients with temporomandibular joint disorders may contribute to the reduction
      of pain and frequency of parafunctional habits.

      The aim of the study was to obtain data, documented test results as to the efficiency of
      progressive muscle relaxation in the treatment of pain caused by temporomandibular joint
      disorders, as a supplement to previous methods using occlusal splint and other physical
      therapies. The study also included the treatment of post-isometric muscle relaxation. In
      order to ensure an objective comparative evaluation of these two methods of adjunctive
      treatment, clinical studies and surveys were conducted. The aim of the study was to answer
      the following questions:

        1. Does the use of Jacobson's progressive relaxation method will be beneficial to reduce
           pain and improve the functioning of the stomatognathic system being evaluated in
           clinical trials?

        2. Does the relaxation method obtain a positive opinion of the patients and can complement
           the previously used prosthetic rehabilitation with occlusal splint as well as other
           physical therapies?

        3. Which one of assessed methods (progressive muscle relaxation according to Jacobson and
           method of post- isometric relaxation) gains an advantage in the treatment used in the
           adjunctive therapy of temporomandibular joint disorders, and assessment of which
           according to their impact on muscle relaxation on the basis of the clinical trial and
           the results of the survey? Material and Methods The study included 100 patients of both
           sexes, aged from 20 to 35 years who were diagnosed with pain due to temporomandibular
           joint disorders accompanied with high muscle tension of masticatory muscles. The study
           included patients reported to prosthetic treatment to Department of Prosthodontics at
           the Jagiellonian University, Medical College in Krakow between 2014 and 2016. Patients
           were divided into two groups of 50 people each. In the group number I-test group,
           treatment was performed by progressive muscle relaxation according to Jacobson. In the
           group number II- control group, post-isometric muscle relaxation treatment was
           instituted. The following criteria the patients had to meet in order to be included in
           the study: good general health, painful form of temporomandibular joint disorders with
           high muscle tension, pain lasting for at least 3 weeks prior to admission, and also
           patients with full arches without previous orthodontic treatment.

      The exclusion criteria included: joint component of functional disorders (pain in the
      temporomandibular joints, acoustic symptoms), deterioration of the posture resulting from
      relaxation training (aggravation of muscular pain, worsening of mental state) unstable
      musculoskeletal system (frequent painful muscle spasms), tetanus, other diseases that prevent
      the patient from continuing the study (fever), and the lack of the patient's informed
      consent.

      The criterion for the allocation of patients to groups I and II was the consent to perform
      relaxation treatments for the treatment of functional disorders of the chewing organ and the
      lack of contraindications.

      Relaxation therapy schedule was adapted to clinical and laboratory stages of occlusion
      splint. For the purposes of the research both physiotherapy and pharmacological treatment
      were eliminated. Following the purpose of the studies, comparative evaluation of two
      supporting methods of treatment were undertaken: for the patients with temporomandibular
      joint disorders, the performance of 5 cycles of progressive muscle relaxation according to
      Jacobson in the group I - the study one, and 5 cycles of post- isometric muscle relaxation in
      group II - control. The qualification and assignment of the patients into group I and II were
      based on the results of clinical and specialist examination. In group I the training was held
      twice a week and was conducted by a qualified psychologist. Each meeting lasted 45 minutes.
      The procedure was to tighten the subsequent muscle groups for 5-7 seconds, followed by a
      20-second relaxation time. The basic part of the training performed during the first two
      meetings included alternating tension and relaxation of muscles in the limbs, abdomen and
      face based on Jacobson's classic training. The next session was modified taking into account
      the muscles of the neck and face, and the fourth and fifth sessions included exercises with
      which the patient was familiarized during earlier training, but done separately for each part
      of the face.In group II the treatment was conducted by a qualified physiotherapist and also
      was held twice a week, 45 minutes each, and next exercises were repeated three times.
    

Intervention name(s): Muscle relaxation according to Jacobson
Intervention type(s): Behavioral
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: TMJ- temporomandibular joint-disorder; Muscle relaxation; Psychoemotional factor; Stress