Effect of Posture Correction in Myofascial Pain and Dysfunction Patients with Limited Mouth Opening

Abstract

Treatment for temporomandibular disorders (TMD) have changed variously with the times because the etiology of TMD was not well-defined, and points of view from various disciplines resulted in a complex overview, area such as prosthodontics, oral surgery, orthodontics, orthopedics, otorhinolaryngology, and psychiatrics. The principal treatment methods for TMD from the '30s to the '60s were the occlusal treatment, and from the '70s to the '80s anatomical approaches like a disk repositioning appliance, or arthroscopic surgery were emphasized. In the 1990's, the concepts have been changing from the treatment to the conservative management on the grounds of treatment failures in the past decades and reconsideration of what constitutes TMD. Signs and symptoms of TMD had been called the “TMD triad”: joint/muscle pain, limited range of motion, and joint sounds. However, at present, the major problem is considered to be pain, and the elimination of painful limited mouth opening should be the prime clinical focus in treating this disease.
Since the relationship between head posture and mandibular function, and between the forward head posture and TMD have been stated, the efficacy of physical therapy has been recognized. While some studies have reported on the efficacy of physical therapy for such cases as myofacial pain and dysfunctional patients, for internal derangement of TMJ patients, and for post operative TMJ surgical patients, the relationship between the treatment and the improvement was not clear in these studies because of too many methods being applied to the patients.
In this study, the subjects were the patients suffering from he myofascial pain and dysfunction patients with limited mouth opening (17 females and 4 males) . This was followed by rating according to the Research Diagnostic Criteria of NIDR. However, patients who had already been treated in the other clinics, obvious occlusal interference, prostheses of broad area, history of orthodontic treatment, recent facial or cervical trauma and other medical history were excluded. The maximum unassisted mouth opening was measured immediately before and after the mouth opening training including the posture correction. The patients were then given instruction to correct faulty posture in sitting, standing, sleeping, eating, and other activities in order to achieve behavioral modification in daily life.The measurements were made and the instructions given every month, and carried out for 12 months. The degree of pain intensity at maximum mouth opening and the disturbance of mouth opening in daily life were simultaneously evaluated on a 100mm visual analogue scale (VAS) . Mouth opening training and posture correction were performed simultaneously. Sitting on a stool, the patient leaned backwards slightly with no support, allowing full movement of the head. Mouth opening was effected as much as possible by the subject alone without any help from the examiner. This opening training was performed just three times at each monthly appointment for 12 months. We gave instruction to all patients on correcting posture in their daily life. These were basically proper to Japanese traditional life style. The patients were given this instruction for 12 months. The extent of the maximum unassisted mouth opening after training was significantly greater than that before training at the first appointment. The VAS scores of pain intensity at maximum mouth opening and disturbance in daily life after 6 and 12 months were significantly decreased compared with those at the first appointment in each group. These findings suggested that the posture correction in daily life was efficacious in alleviating the myofascial pain and dysfunction patients with limited mouth opening.