Sağlıklı Kadınlarda Servikal Bölgede Oluşturulan Kassal Yorgunluğun Temporomandibular Eklem Üzerine Akut Etkisi

Yıl 2015, Cilt: 26 Sayı: 1, 20 - 25, 12.04.2015

Hasan Erkan Kılınç Burak Ulusoy Nevin Ergun

Öz

Amaç: Bu çalışmanın amacı, boyun kaslarında oluşturulan yorgunluğun, çiğneme kaslarının ağrı eşiği, enduransı ve ağız açma genişliği üzerine akut etkilerini araştırmaktır.

Yöntemler: Yaşları 20 ile 25 arasında (X±SS: 21.7±1.18) 14 sağlıklı kadın çalışmaya dahil
edildi. Olguların öncelikle, eksik dişleri ve bruksizmleri olup olmadığı, demografik bilgileri ile
birlikte kaydedildi. Yorgunluk protokolü öncesi, çiğneme kaslarının ağrı eşiği, maksimum ağız
açma genişliği ve 5 dakika sakız çiğneme testi ile çiğneme kasları yorgunluk seviyelerine
bakıldı. Daha sonra olgulara yüzüstü pozisyonda, Modifiye Borg Yorgunluk Skalasından 10
puan alana dek, baş fleksiyon ve ekstansiyondan oluşan yorma protokolü uygulandı. Yorgunluk
protokolü öncesi uygulanan testler, sonrasında da tekrar edildi.

Sonuçlar: Yorgunluk protokolü sonrası, iki taraf masseter kası, sağ temporomandibular ek-
lem ve sol temporalis kası ağrı eşiğinde, ağrısız ağız açma genişliğinde ve çiğneme endu-
ransında azalma olduğu saptandı (p<0.05). Bireylerin çiğneme kaslarının istirahat yorgunluk
seviyelerindeki değişim, istatistiksel olarak anlamlı değildi (p>0.05).

Tartışma: Çalışmamızda boyun yorgunluğunun akut olarak, çiğneme fonksiyonunun çeşitli
parametreleri üzerine olumsuz etkileri görülmüştür. Boyun kaslarındaki yorgunluğun, tempo-
romandibular eklem disfonksiyonuna zemin hazırlayacağı düşünülmektedir. 

Anahtar Kelimeler

Çiğneme, boyun kasları, boyun ağrısı, temporomandibular eklem

ACUTE EFFECT OF CREATED MUSCLE FATIGUE IN CERVICAL REGION ON TEMPOROMANDIBULAR JOINT IN HEALTHY WOMEN

Öz

Purpose: The aim of study was to investigate acute effects of neck muscles fatigue, on masticator muscle pain threshold, endurance and maximum pain-free mouth opening.

Methods: 14 healty women aged between 20-25 years (Mean±SD: 21.7±1.18) were included in the study. Initially, lack of teeth and bruxism status and demographic information of
cases were recorded. Before fatigue protocole, masticator muscle pain threshold, maximum
pain-free mouth opening and fatigue level of masticator muscles by 5 minutes chewing gum
test were evaluated. After that, participants performed fatigue protocole consisting of head
flexion and extension at prone position until take 10 points from Modify Borg Scale. And all
the tests were re-performed after fatigue protocole.

Results: After fatigue protocol, pain threshold of masseter muscles, right temporomandibular joint and left temporalis muscle, maximum pain-free mouth opening and chewing endurance were reduced (p<0.05). Change of fatigue level of mastication muscles at rest was not
statistically significant (p>0.05).

Discussion: In our study, we identified that neck fatigue negatively affects some parameteres of masticator muscle immediately. Fatigue of the neck muscles are thought to predispose temporomandibular joint dysfunction. 

Anahtar Kelimeler

Mastication, neck muscles, neck pain, temporomandibular joint

Kaynakça

• 1. Laskin DM. Etiology of the pain-dysfunction syndrome. J Am Dent Assoc. 1969;79(1):147-53.
• 2. Ries LG, Berzin F. Analysis of the postural stability in individuals with or without signs and symptoms of temporomandibular di-sorder. Braz Oral Res. 2008;22(4):378-83.
• 3. Zuniga C, Miralles R, Mena B, Montt R, Moran D, Santander H et al.Influence of variation in jaw posture on sternocleidomas- toid and trapezius electromyographic activity. Cranio. 1995; 13(3):157-62.
• 4. Clark GT, Browne PA, Nakano M, Yang Q. Co-activation of sternocleidomastoid muscles during maximum clenching. J Dent Res. 1993;72(11):1499-502.
• 5. Cacchiotti DA, Plesh O, Bianchi P, Mc Neill C. Signs and symptoms in samples with and without temporomandibular disor- ders. J Craniomandib Disord. 1991;5(3):167-72.
• 6. Alanen PJ, Kirveskari PK. Occupational cervicobrachial disorder and temporomandibular joint dysfunction. Cranio. 1984;3(1):69- 72.
• 7. De Laat A. Correlation between cervical spine and temporomandibular disorders. Clin Oral Investig. 1998;2(2):54-7.
• 8. Kritsineli M, Shim YS. Malocclusion, body posture, and temporo- mandibular disorder in children with primary and mixed dentition. J Clin Pediatr Dent. 1992;16(2):86-93.
• 9. Kondo E, Aoba TJ. Case report of malocclusion with abnormal head posture and TMJ symptoms. Am J Orthod Dentofacial Orthop. 1999;116(5):481-93.
• 10. Makofsky HW. The influence of forward head posture on dental occlusion. Cranio. 2000; 18(1):30-9.
• 11. Liem T. Praxis der Kraniosakralen Osteopathie, in Mandibula and Articulativ Temporomandibularis. 2000; p. 255-378.
• 12. Sessle BJ, Hu JW, Amano N, Zhang G. Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurones in trigeminal subnucleus caudalis (medullary dorsal horn) and its implications for referred pain. Pain.1986; 27(2):219-35.
• 13. Broton JG, Hu JW, Sessle BJ. Effects of temporomandibular joint stimulation on nociceptive and nonnociceptive neurons of the cat’s trigeminal subnucleus caudalis (medullary dorsal horn). J Neurophysiol. 1988;59(5):1575-89.
• 14. Borg G, Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health. 1990; 16(Suppl 1):55-8.
• 15. Parazza S, Vanti C, O’Reilly C, Villafañe JH, Tricás Moreno JM, Estébanez De Miguel E. The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain. Chiropractic & Manual Therapies. 2014;22(10):1-7.
• 16 Fredriksson L, Alstergren P, Kopp S. Absolute and relative facial pressure-pain thresholds in healthy individuals. J Orofac Pain. 2000; 14(2):98-104.
• 17. Goulet JP, Clark GT, Flack VF, Liu C. The reproducibility of muscle and joint tenderness detection methods and maximum mandibular movement measurement for the temporomandibular system. J Orofac Pain. 1998;12(1):17-26.
• 18. Haggman-Henrikson B, Osterlund C, Eriksson PO. Endurance during chewing in whiplash-associated disorders and TMD. J Dent Res. 2004;83(12):946-50.
• 19. Yoshida E, Lobbezoo F, Fueki K, Naeije M. Effects of delayed-onset muscle soreness on masticatory function. Eur J Oral Sci. 2012; 120(6):526-30.
• 20. Armijo-Olivo S. Fuentes JP, da Costa BR, Major PW, Warren S, Thie NM et al. Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability. Man Ther.2010; 15(6): 586-92.
• 21. Armijo-Olivo S, Silvestre RA, Fuentes JP, da Costa BR, Major PW, Warren S et al. Patients with temporomandibular disorders have increased fatigability of the cervical extensor muscles. Clin J Pain. 2012; 28(1):55-64.
• 22. Santander H, Miralles R, Pérez J, Valenzuela S, Ravera MJ, Ormeño G et al. Effects of head and neck inclination on bilateral sternocleidomastoid EMG activity in healthy subjects and in patients with myogenic cranio-cervical-mandibular dysfunction. Cranio. 2000;18(3):181-91.
• 23. Fernandez-de-Las-Penas C, Galán-Del-Río F, Alonso-Blanco C, Jiménez-García R, Arendt-Nielsen L, Svensson P et al. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disoders. J Pain. 2010; 11(12):1295-304.
• 24. Silveria A, Armijo-Olivo S, Gadotti IC, Magee, D. Mastictory and cervical muscles tenderness and pain sensitivity in a remote area in subjects with temporomandibular disorder and neck disability. J Oral Facial Pain Headache. 2014;28(2):138-46.
• 25. Mansilla-Ferragut P, Fernández-de-Las Peñas C, Alburquerque-Sendín F, Cleland JA, Boscá-Gandía JJ et al. Immediate effects of atlanto-occipital joint manipulation on active mouth opening and pressure pain sensitivity in women with mechanical neck pain. J Manipulative Physiol Ther. 2009;32(2):101-6.
• 26. Ibanez-Garcia J, Alburquerque-Sendín F, Rodríguez-Blanco C, Girao D, Atienza-Meseguer A, Planella-Abella S et al. Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique. J Bodyw Mov Ther. 2009;13(1):2-10.
• 27. Atkinson TA, Vossler S, Hart DL. The evaluation of facial, head, neck, and temporomandibular joint pain patients. J Orthop Sports Phys Ther.1982;3(4):193-9.
• 28. Eriksson PO, Zafar H, Nordh E. Concomitant mandibular and head-neck movements during jaw opening-closing in man. J Oral Rehabil.1998;25(11):859-70.
• 29. Eriksson PO, Häggman-Henrikson B, Nordh E, Zafar H et al. Coordinated mandibular and head-neck movements during rhythmic jaw activities in man. J Dent Res. 2000;79(6):1378-84.
• 30. Haggman-Henrikson B, Zafar H, Eriksson PO. Disturbed jaw behavior in whiplash-associated disorders during rhythmic jaw movements. J Dent Res, 2002;81(11):747-51.