Cervical spine range of motion, posture and electromyographic activity of masticatory muscles in temporomandibular disorders

Amaral, Franciele Aparecida; Dall’Agnol, Simone Mader; Socolovski, Gabriela; Kich, Camila; Franco, Gilson Cesar Nobre; Bortoluzzi, Marcelo Carlos

doi:10.1590/1980-5918.033.AO25

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ORIGINAL ARTICLE • Fisioter. mov. 33 • 2020 • https://doi.org/10.1590/1980-5918.033.AO25 copy

Cervical spine range of motion, posture and electromyographic activity of masticatory muscles in temporomandibular disorders

Amplitude de movimento articular cervical, postura e atividade eletromiográfica da musculatura mastigatória na disfunção temporomandibular

Rango del movimiento articular de la columna cervical, postura y actividad electromiográfica de la musculatura masticatoria en la disfunción temporomandibular

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Temporomandibular joint disorders (TMD or TMJD) involve clinical problems and symptoms affecting the temporomandibular joint (TMJ) and associated structures. The temporomandibular joints are anatomically connected to the cervical region, where cervical spine movements occur simultaneously to masticatory muscle activation and jaw movements.

Objective:

Our study sought to assess the relationship between the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), surface electromyography (sEMG) of the masticatory muscles, posture and cervical flexibility in women with TMD.

Method:

Fifty women with an average age of 27.0 ± 6.37 years, diagnosed with TMD according to RDC/TMD, were assessed for craniocervical posture, cervical flexibility and sEMG of the masticatory muscles.

Results:

There were no differences in jaw function limitations, depression, pain level and its interference in work ability and daily activities, posture and sEMG between TMD diagnoses or between muscle classification (p > 0.05). Depression scores were higher among participants with biarticular dysfunction (p = 0.023). The group with bruxism exhibited a higher pain level at assessment (p = 0.001) and a greater reduction in work ability (p = 0.039). Subjects with muscular and mixed TMD showed less cervical rotation to the right when compared with those with articular TMD.

Conclusion:

There was no difference in posture or sEMG values for TMD diagnoses, joint and muscle dysfunctions and the presence of bruxism. Muscle dysfunction is associated with reduced cervical rotation to the right. Jaw function limitations did not interfere in posture or sEMG and depression was associated with pain.

Keywords:
Temporomandibular Joint; Joint Range of Motion; Electromyography; Posture

Oral condition / Diagnosis		n - %
General diagnosis	Muscular	15 - 30
	Articular	2 - 4
	Mixed	33 - 66
Side of the joint impairment	No joint dysfunction	15 - 30
	Both joints	19 - 38
	Right joint	7 - 14
	Left joint	9 - 18
Muscle dysfunction classification	No diagnosis	2 - 4
	Muscular	16 - 32
	Muscular with limited mouth opening	32 - 64

	A	B	C	D
	p	p	p	p
Jaw function limitations	0.451	0.682	0.171	0.069
Depression	0.222	0.547	0.017*	0.440
Pain level at assessment	0.147	0.148	0.928	0.001*
Worst pain level over the last six months	0.086	0.072	0.891	0.138
Average pain level over the last six months	0.120	0.123	0.639	0.076
Sick days taken due to pain in the last six months	0.479	0.824	0.121	0.510
Extent to which pain interfered in daily activities	0.209	0.191	0.604	0.452
Extent to which pain interfered in leisure, social and family activities	0.265	0.203	0.239	0.495
Extent to which pain affected work ability	0.307	0.390	0.359	0.039*

	A	B	C	D
Posture	p	p	p	p
Craniovertebral	0.611	0.428	0.879	0.803
Head position	0.433	0.990	0.420	0.166
Head tilt	0.820	0.800	0.370	0.928
Forward head posture	0.980	0.237	0.865	0.937
Cervical rotation	0.473	0.393	0.742	0.084
Cervical ROM
Cervical flexion	0.163	0.181	0.623	0.883
Cervical extension	0.290	0.538	0.058	0.510
Right lateral cervical inclination	0.283	0.107	0.258	0.964
Left lateral cervical inclination	0.490	0.825	0.260	0.847
Right cervical rotation	0.021*	0.047*	0.075	0.937
Left cervical rotation	0.948	0.732	0.184	0.023*
Surface electromyography Isometric RMS
Right masseter muscle	0.809	0.721	0.997	0.928
Left masseter muscle	0.828	0.584	0.630	0.666
Right temporalis muscle	0.408	0.154	0.848	0.733
Left temporalis muscle	0.692	0.266	0.382	0.683
Chewing RMS
Right masseter muscle	0.819	0.785	0.926	0.617
Left masseter muscle	0.909	0.690	0.661	0.803
Right temporalis muscle	0.757	0.245	0.981	0.964
Left temporalis muscle	0.755	0.412	0.468	0.803
Resting RMS
Right masseter muscle	0.706	0.201	0.482	0.076
Left masseter muscle	0.489	0.642	0.425	0.229
Right temporalis muscle	0.324	0.355	0.650	0.140
Left temporalis muscle	0.151	0.323	0.323	0.650
Chewing MVC%
Right masseter muscle	0.257	0.995	0.199	0.134
Left masseter muscle	0.172	0.862	0.141	0.166
Right temporalis muscle	0.668	0.481	0.885	0.716
Left temporalis muscle	0.231	0.903	0.222	0.318
Resting MVC%
Right masseter muscle	0.891	0.932	0.902	0.481
Left masseter muscle	0.975	0.775	0.937	0.097
Right temporalis muscle	0.682	0.562	0.857	0.066
Left temporalis muscle	0.499	0.119	0.329	0.146

	Jaw function limitations
Posture	ρ	Ρ
Craniovertebral	0.170	0.237
Head position	0.104	0.472
Head tilt	0.127	0.379
Forward head posture	−0.064	0.661
Cervical rotation	0.021	0.883
Cervical ROM
Cervical flexion	0.205	0.153
Cervical extension	−0.243	0.089
Right lateral cervical inclination	−0.315	0.026*
Left lateral cervical inclination	−0.099	0.496
Right cervical rotation	−0.266	0.062
Left cervical rotation	−0.098	0.499
Surface electromyography Isometric RMS
Right masseter muscle	−0.115	0.427
Left masseter muscle	−0.027	0.850
Right temporalis muscle	−0.051	0.723
Left temporalis muscle	0.064	0.661
Chewing RMS
Right masseter muscle	0.023	0.876
Left masseter muscle	−0.154	0.285
Right temporalis muscle	−0.215	0.134
Left temporalis muscle	0.128	0.376
Resting RMS
Right masseter muscle	−0.048	0.741
Left masseter muscle	0.060	0.681
Right temporalis muscle	0.065	0.653
Left temporalis muscle	0.082	0.569
Chewing MVC%
Right masseter muscle	−0.115	0.427
Left masseter muscle	−0.027	0.850
Right temporalis muscle	−0.051	0.723
Left temporalis muscle	0.064	0.661
Resting MVC%
Right masseter muscle	0.023	0.876
Left masseter muscle	−0.154	0.285
Right temporalis muscle	−0.215	0.134
Left temporalis muscle	0.128	0.376

	Jaw function limitations
	ρ	p
Depression	0.343	0.015*
Pain level at assessment	0.173	0.230
Worst pain level in the last six months	0.246	0.085
Average pain level over the last six months	0.187	0.193
Sick days taken due to pain in the last six months	0.252	0.077
Extent to which pain interfered in daily activities	0.298	0.036*
Extent to which pain interfered in leisure, social and family activities	0.333	0.018*
Extent to which pain affected work ability	0.341	0.015*

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[1] *FAA: MS, e-mail: franciamaralft@yahoo.com.br SMD: MS, e-mail: Monemader@hotmail.com GS: BS, e-mail: gabysocolovski@hotmail.com CK: BS, e-mail: camila.kich@hotmail.com GCNF: PhD, e-mail: gilsoncnf@gmail.com MCB: PhD, e-mail: mbortoluzzi@gmail.com