The Comparison of Jaw Muscle Exercises and Neck Isometric Exercises in the Treatment of Chronic Neck Pain: A Randomised, Controlled Trial

Öz

Aim: The aim of our study is to compare the effects of neck isometric exercises and jaw muscles exercises on pain severity, neck and temporomandibular joint motions, quality of life (QoL) and disability status in patients with chronic neck pain.

Material and Methods: Forty subjects were randomized into 2 groups (Group A, mean age: 39.6±10.4; Group B, mean age: 41.4±12.2). The cervical and temporomandibular joint range of motions (ROMs), pain severity, disability status and QoL were evaluated. The patients in Group A were included in the home programs that included 5 cervical isometric exercises and the patients in Group B included 5 chin exercises. Both groups continued their own programs for three-weeks. All evaluations were repeated at the end of the treatment.

Results: In Group A; pain severity was decreased, cervical flexion, extention, left lateral flexion, right and left rotation ROMs and maximum mouth opening were increased, QoL and disability were improved (p<0.05). In Group B; pain severity was decreased, cervical flexion, extention, right and left lateral flexion, right and left rotation ROMs and maximum mouth opening, mandibular movements were increased, improvements in QoL and disability were observed (p<0.05). The obtained change in mandibular protrusion (p=0.009) and right lateral deviation (p=0.032) were better in Group B compared with Group A.

Conclusion: Our results showed that jaw muscles and isometric neck exercises had similar effects on pain, cervical ROMs, maximum mouth opening, QoL and disability, and jaw muscles exercises may provide more increase in mandibular movements in subjects with chronic neck pain.

Anahtar Kelimeler

• Neck pain,rehabilitation,exercise,temporomandibular joint

Kronik Boyun Ağrısı Tedavisinde Çene Kasları Egzersizleri İle Boyun İzometrik Egzersizlerinin Etkinliklerinin Karşılaştırılması: Randomize, Kontrollü Çalışma

Öz

Amaç: Çalışmamızın amacı, kronik boyun ağrılı bireylerde, boyun izometrik egzersizleri ile çene kasları egzersizlerinin; ağrı şiddeti, boyun ve temporomandibular eklem hareketleri, yaşam kalitesi ve özürlülük durumu üzerindeki etkilerini karşılaştırmaktır.

Gereç ve Yöntemler: Kırk kronik boyun ağrılı birey 2 gruba randomize edildi (Grup A, ortalama yaş: 39,6±10,4; Grup B, ortalama yaş: 41,4±12,2). Servikal ve temporomandibular eklem hareket açıklıkları (EHA), ağrı şiddetleri, özürlülük durumu ve yaşam kaliteleri değerlendirildi. Grup A’daki olgular 5 adet servikal izometrik egzersizini, Grup B’deki olgular ise 5 adet çene egzersizini içeren ev programlarına dâhil edildi. Her grup için tedavi programları 3 hafta boyunca sürdürüldü. Tedavi sonunda değerlendirmeler tekrarlandı.

Bulgular: Grup A’da; ağrı şiddeti azaldı, servikal fleksiyon, ekstansiyon, sol lateral fleksiyon, sağ ve sol rotasyon EHA ve maksimum ağız açıklığı arttı, yaşam kalitesi ve özürlülük durumu iyileşti (p<0,05). Grup B’de; ağrı şiddeti azaldı, servikal fleksiyon, ekstansiyon, sağ ve sol lateral fleksiyon, sağ ve sol rotasyon EHA, maksimum ağız açıklığı ve mandibula hareketleri arttı, yaşam kalitesi ve özürlülük durumunda iyileşme gözlendi (p<0,05). Mandibula protrüzyonu (p=0,009) ve mandibula sağ lateral deviasyonu’nda (p=0,032) elde edilen değişim Grup B’de, Grup A’ya göre daha iyiydi. 

Sonuç: Sonuçlarımız, kronik boyun ağrılı bireylerde, çene kasları ve izometrik boyun egzersizlerinin; ağrı, servikal EHA, maksimum ağız açıklığı, yaşam kalitesi ve özürlülük üzerinde benzer etkileri olduğunu ve çene kasları egzersizlerinin mandibula hareketlerinde daha çok artış sağlayabileceğini göstermektedir.

Anahtar Kelimeler

• Boyun ağrısı,rehabilitasyon,egzersiz,temporomandibular eklem

Kaynakça

1. 1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal. 2006; 15(6): 834-48.
2. 2. Takasawa E, Yamamoto A, Kobayashi T, Tajika T, Shitara H, Ichinose T, et al. Characteristics of neck and shoulder pain in the Japanese general population. Journal of Orthopaedic Science. 2015; 20(2): 403-9.
3. 3. Borghouts JA, Koes BW, Bouter LM. The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain. 1998; 77(1): 1-13.
4. 4. Visscher CM, Lobbezoo F, De Boer W, Van Der Zaag J, Verheij JG, Naeije M. Clinical tests in distinguishing between persons with or without craniomandibular or cervical spinal pain complaints. European Journal of Oral Sciences. 2000; 108(6): 475-83.
5. 5. Bevilaqua-Grossi D, Chaves TC, de Oliveira AS. Cervical spine signs and symptoms: perpetuating rather than predisposing factors for temporomandibular disorders in women. Journal of Applied Oral Science. 2007; 15(4): 259-64.
6. 6. Sipila K, Suominen AL, Alanen P, Heliovaara M, Tiittanen P, Kononen M. Association of clinical findings of temporomandibular disorders (TMD) with self-reported musculoskeletal pains. European Journal of Pain. 2011; 15(10): 1061-7.
7. 7. Pallegama RW, Ranasinghe AW, Weerasinghe VS, Sitheeque MA. Influence of masticatory muscle pain on electromyographic activities of cervical muscles in patients with myogenous temporomandibular disorders. Journal of Oral Rehabilitation. 2004; 31(5): 423-9.
8. 8. Wiesinger B, Malker H, Englund E, Wänman A. Does a dose-response relation exist between spinal pain and temporomandibular disorders? BMC Musculoskeletal Disorders. 2009; 10(1): 28.

9. 9. La Touche R, Fernandez-de-las-Penas C, Fernandez-Carnero J, Escalante K, Angulo-Díaz-Parreño S, Paris-Alemany A, et al. The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disorders. Journal of Oral Rehabilitation. 2009; 36(9): 644-52.
10. 10. Olivo SA, Fuentes J, Major PW, Warren S, Thie NM, Magee DJ. The association between neck disability and jaw disability. Journal of Oral Rehabilitation. 2010; 37(9): 670-9.
11. 11. da Costa DR, de Lima Ferreira AP, Pereira TA, Porporatti AL, Conti PC, Costa YM, et al. Neck disability is associated with masticatory myofascial pain and regional muscle sensitivity. Archives of Oral Biology. 2015; 60(5): 745-52.
12. 12. Calixtre LB, Gruninger BL, Haik MN, Alburquerque-Sendin F, Oliveira AB. Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. Journal of Applied Oral Science: Revista FOB. 2016; 24(3): 188-97.
13. 13. O'Riordan C, Clifford A, Van De Ven P, Nelson J. Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle. Archives of Physical Medicine and Rehabilitation. 2014; 95(4): 770-83.
14. 14. Cheng C-H, Su H-T, Yen L-W, Liu W-Y, Cheng H-YK. Long-term effects of therapeutic exercise on nonspecific chronic neck pain: a literature review. Journal of Physical Therapy Science. 2015; 27(4): 1271-6.
15. 15. Suvarnnato T, Puntumetakul R, Uthaikhup S, Boucaut R. Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain: a randomized controlled trial. Journal of Pain Research. 2019; 12: 915-25.
16. 16. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017; 47(7): 1-83.
17. 17. Otman AS, Köse N. Tedavi hareketlerinde temel değerlendirme prensipleri. 7. baskı. Ankara: Pelikan Yayıncılık; 2015.
18. 18. Walker N, Bohannon RW, Cameron D. Discriminant validity of temporomandibular joint range of motion measurements obtained with a ruler. Journal of Orthopaedic & Sports Physical Therapy. 2000; 30(8): 484-92.
19. 19. Wheeler AH, Goolkasian P, Baird AC, Darden BV. Development of the neck pain and disability scale: item analysis, face, and criterion-related validity. Spine. 1999; 24(13): 1290-4.
20. 20. Bicer A, Yazici A, Camdeviren H, Erdogan C. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disability and Rehabilitation. 2004; 26(16): 959-62.
21. 21. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item short-form health survey (SF-36): II. psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care-Philadelphia. 1993; 31(3): 247-63.
22. 22. Koçyigit H. Kısa Form-36 (KF-36)'nın Türkçe versiyonunun güvenilirligi ve geçerliliği. İlaç ve Tedavi Dergisi. 1999; 12(2): 102-6.
23. 23. Seyhan T. TME disfonksiyonunun cerrahi olmayan tedavileri ve klinik sonuçlarımız. KBB ve Baş Boyun Cerrahisi Dergisi. 1999; 7(3): 175-9.
24. 24. Aksoy C. Temporomandibüler eklem rahatsızlıkları ve ağrı. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri. Baş, Boyun, Bel Ağrıları Sempozyum Dizisi. 2002; 30: 109-17.
25. 25. Jorritsma W, Dijkstra PU, de Vries GE, Geertzen JH, Reneman MF. Detecting relevant changes and responsiveness of neck pain and disability scale and neck disability index. European Spine Journal. 2012; 21(12): 2550-7.
26. 26. Kumar S, Narayan Y, Prasad N, Shuaib A, Siddiqi ZA. Cervical electromyogram profile differences between patients of neck pain and control. Spine. 2007; 32(8): 246-53.
27. 27. Falla D, Rainoldi A, Merletti R, Jull G. Myoelectric manifestations of sternocleidomastoid and anterior scalene muscle fatigue in chronic neck pain patients. Clinical Neurophysiology. 2003; 114(3): 488-95.
28. 28. Feipel V, Rondelet Bt, Le Pallec J-P, Rooze M. Normal global motion of the cervical spine: an electrogoniometric study. Clinical Biomechanics. 1999; 14(7): 462-70.
29. 29. Yip CHT, Chiu TTW, Poon ATK. The relationship between head posture and severity and disability of patients with neck pain. Manual Therapy. 2008; 13(2): 148-54.
30. 30. Ris I, Barbero M, Falla D, Larsen MH, Kraft MN, Søgaard K, et al. Pain extent is more strongly associated with disability, psychological factors, and neck muscle function in people with non-traumatic versus traumatic chronic neck pain: a cross sectional study. European Journal of Physical and Rehabilitation Medicine. 2019; 55(1): 71-8.
31. 31. Ylinen J. Physical exercises and functional rehabilitation for the management of chronic neck pain. Europa Medicophysica. 2007; 43(1): 119-32.
32. 32. Ylinen J, Takala EP, Nykanen M, Häkkinen A, Mälkiä E, Pohjolainen T, et al. Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial. JAMA. 2003; 289(19): 2509-16.
33. 33. Martin-Gomez C, Sestelo-Diaz R, Carrillo-Sanjuan V, Navarro-Santana MJ, Bardon-Romero J, Plaza-Manzano G. Motor control using cranio-cervical flexion exercises versus other treatments for non-specific chronic neck pain: a systematic review and meta-analysis. Musculoskeletal Science and Practice. 2019; 42: 52-9.
34. 34. Alpayci M, Ilter S. Isometric exercise for the cervical extensors can help restore physiological lordosis and reduce neck pain: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. 2017; 96(9): 621-6.
35. 35. Chung S, Jeong YG. Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: a randomized controlled trial. Physiotherapy Theory and Practice. 2018; 34(12): 916-25.
36. 36. Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, et al. Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2015; 28(1): CD004250.
37. 37. Bertozzi L, Gardenghi I, Turoni F, Villafañe JH, Capra F, Guccione AA, et al. Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: systematic review and meta-analysis of randomized trials. Physical Therapy. 2013; 93(8): 1026-36.
38. 38. Polaski, AM, Phelps AL, Kostek MC, Szucs KA, Kolber BJ. Exercise-induced hypoalgesia: a meta-analysis of exercise dosing for the treatment of chronic pain. PloS One. 2019; 14(1): e0210418.
39. 39. Hertling D, Dussault L. The temporomandibular joint. In: Biblis M, DiPalma D, Amico A, Scheinin SC, editors. Therapeutic exercise. Philedelphia: Lippincott Williams & Wilkins Co; 1999. p. 499-524.
40. 40. Mansilla-Ferragut P, Fernández-de-las Peñas C, Alburquerque-Sendín F, Cleland JA, Boscá-Gandía JJ. Immediate effects of atlanto-occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain. Journal of Manipulative and Physiological Therapeutics. 2009; 32(2): 101-6.
41. 41. Dusunceli Y, Ozturk C, Atamaz F, Hepguler S, Durmaz B. Efficacy of neck stabilization exercises for neck pain: a randomized controlled study. Journal of Rehabilitation Medicine. 2009; 41(8): 626-31.
42. 42. Yesil H, Hepguler S, Dundar U, Taravati S, Isleten B. Does the use of electrotherapies increase the effectiveness of neck stabilization exercises for improving pain, disability, mood, and quality of life in chronic neck pain?: a randomized, controlled, single-blind study. Spine. 2018; 43(20): 1174-83.
43. 43. Iversen VM, Vasseljen O, Mork PJ, Fimland MS. Resistance training vs general physical exercise in multidisciplinary rehabilitation of chronic neck pain: a randomized controlled trial. Journal of Rehabilitation Medicine. 2018; 50(8): 743-50.