Effects of Soft Tissue Mobilization of Neck Muscles in Individuals With Myogenous Temporomandibular Disorders: Muscle Energy Technique and Strain-counterstrain

Study Overview
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Brief Summary
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This is a prospective case series study.There were 20 individuals with chronic neck pain accompanied by myogenous temporomandibular disorders(mTMD) from Linkou and Taoyuan Chang Gung hospitals, and Chang-Gung university. The purpose of this study was, first, to investigate the effects of muscle energy technique (MET) or strain-counterstrain (SCS) applied on the tender or trigger points of neck muscles on improving pain and pressure pain sensitivity in neck and masticatory muscles, the maximal mouth-opening range of motion, chewing endurance, and head-neck-shoulder posture in patients with chronic neck pain accompanied by mTMD. Second, whether the significant effects could be reached within the four-week intervention duration.

Official Title
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Effects of Soft Tissue Mobilization of Neck Muscles in Individuals With Myogenous Temporomandibular Disorders: Muscle Energy Technique and Strain-counterstrain

Conditions
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Myogenous Temporomandibular Disorders (mTMD)

Intervention / Treatment
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* Behavioral: Muscle energy technique (MET)
* Behavioral: Strain-counterstrain (SCS)
* Behavioral: sham SCS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 20 65 Self-report neck pain ≥3 months (pain occurs between superior nuchal line and 1st level of thoracic spine) At least one tender point at both Upper trapezius and Sternocleidomastoid muscles Diagnosed as mTMD according to the Diagnostic Criteria for Temporomandibular Disorders(DC/TMD) Exclusion Criteria: Cognitive deficit Malignancy, infection, cervical or orthognathic surgery, acute pain, and history of trauma in craniocervical region Neurological problem or cervical radiculopathy/myelopathy Cervical instability with positive rotational alar ligament stress test and transverse ligament stress test, jaw dislocation Tooth implantation or extraction a week before study Vertebrobasilar insufficiency

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Include elements of both longitudinal (three groups) and cross-sectional (four-weeks intervention) research designs
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Muscle energy technique group<br>Use one of the muscle energy technique methods -- postisometric relaxation technique(PIR) as the intervention method. | Behavioral: Muscle energy technique (MET)<br>* A manual therapy technique that uses the gentle muscle contractions of the patient to relax and lengthen muscles and normalize joint motion.<br>|
| Experimental: Strain-counterstrain group<br>Use the Strain-counterstrain technique as the intervention method. | Behavioral: Strain-counterstrain (SCS)<br>* It's also called the positional release technique, a manual therapy technique that passively positions the hypertonic (spasmed) muscles and dysfunctional joints in positions of shortened or comfort.<br>|
| Sham Comparator: Control group<br>Use the modified Strain-counterstrain technique as the intervention method. | Behavioral: sham SCS<br>* SCS intervention that position with opposite site limb and direction, and with modified method as consider the easiness of a practitioner to press the tender points<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity in neck and masticatory muscles | ask participants the self-report pain intensity with the NPRS scale | 4 weeks | 
| Tenderness sensitivity in neck and masticatory muscles | measure the pressure pain threshold with digital pressure algometer | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximal mouth-opening | measure the maximal pain free mouth-opening distance | 4 weeks | 
| Chewing endurance | test for 5 minutes with chewing gum in the affected site | 4 weeks | 
| Head-neck-shoulder posture | measure the Head tilt angle(HTA), Craniovertebral angle(CVA) & Forward shoulder angle (FSA) by Photography in sagittal plane | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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myogenous temporomandibular disorders, neck pain, muscle energy technique, strain-counterstrain, head-neck posture