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Physiotherapy in Temporomandibular Disorders and Headaches

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 34560

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Prof. Dr. Roy La Touche Arbizu

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Guest Editor

1. Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, 28023 Madrid, Spain
2. Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, 28023 Madrid, Spain
3. Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28023 Madrid, Spain
Interests: headaches; chronic pain; neuropathic pain; virtual reality; chronic low back pain; joint pain; rehabilitation; physical therapy; physiotherapy; behavioral neuroscience; therapeutic exercise

Special Issue Information

Dear Colleagues,

Temporomandibular disorders and headaches are conditions that cause high levels of pain and craniofacial disability and this makes therapeutic approaches to them more complex. In the last decade, research on physiotherapy treatments in patients with temporomandibular disorders and headaches has increased exponentially. Emerging research also demonstrates that multimodal physiotherapy treatments that include therapeutic education, manual therapy, and exercise are promising options to improve function and reduce pain and disability without producing significant adverse effects on these patients.

For an upcoming Special Issue in the Journal of Clinical Medicine (PubMed indexed ISSN 2077-0383; IF = 5.688), we invite investigators to contribute original research articles (trials, cohort studies, case-control studies, and cross-sectional studies) or reviews of the literature (systematic reviews and meta-analyses or narrative reviews) that are of high quality and novelty and focus on the physiotherapeutic treatment of patients with temporomandibular disorders and headaches.

Potential topics may include, but are not limited to:

-the effects of exercise on patients with temporomandibular disorders and headaches;

-research on the most appropriate exercise models for patients with temporomandibular disorders and headaches;

-the effectiveness of a multimodal physiotherapy treatment in temporomandibular disorders and headaches;

-the effects of therapeutic education in patients with temporomandibular disorders and headaches;

-the effects of orthopedic manual physiotherapy and exercise on patients with temporomandibular disorders and headaches;

-biobehavioral approaches to physiotherapy in the treatment of patients with temporomandibular disorders and headaches;

-psychological factors involved in physiotherapy treatments applied to patients with temporomandibular disorders;

-adequate diagnostic and prognostic factors to establish physiotherapy treatments in patients with headache and temporomandibular disorders; and

-outcome measures to assess the function, pain, and disability of patients with temporomandibular disorders and headaches.

Prof. Dr. Roy La Touche
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

temporomandibular disorders
headaches
migraine
physiotherapy
therapeutic education
exercise
biobehavioral approaches
manual therapy
psychological factors

Published Papers (8 papers)

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Research

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23 pages, 16364 KiB

Open AccessArticle

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

by Marta Díaz-Sáez, Cristina Sáenz-Jiménez, Jorge Hugo Villafañe, Alba Paris-Alemany and Roy La Touche

J. Clin. Med. 2021, 10(19), 4434; https://doi.org/10.3390/jcm10194434 - 27 Sep 2021

Cited by 2 | Viewed by 2316

Abstract

Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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11 pages, 767 KiB

Open AccessArticle

Transcultural Adaptation and Validation of the Fonseca Anamnestic Index in a Spanish Population with Temporomandibular Disorders

by Carmen María Sánchez-Torrelo, Noelia Zagalaz-Anula, Roger Alonso-Royo, Alfonso Javier Ibáñez-Vera, Jesús López Collantes, Daniel Rodríguez-Almagro, Esteban Obrero-Gaitán and Rafael Lomas-Vega

J. Clin. Med. 2020, 9(10), 3230; https://doi.org/10.3390/jcm9103230 - 9 Oct 2020

Cited by 17 | Viewed by 2527

Abstract

Background: The Fonseca Anamnestic Index (FAI) offers a simple method to screen temporomandibular disorders (TMD). This study aimed to validate the Spanish version of the FAI in patients with TMD. Methods: The sample consisted of 125 subjects (66 TMD and 59 controls) aged over 18 years. Construct validity, internal consistency, test-retest reliability, concurrent validity and capacity to discriminate between TMD and healthy subjects were analyzed. Results: The Spanish version of the FAI showed a structure formed by three factors. Cronbach’s alpha was 0.826. The reliability of the items varied between substantial to almost perfect and was excellent for the total score (intraclass correlation coefficient = 0.937). The standard error of measurement (SEM) was 6.52, with a minimum detectable change (MDC) of 12.78. FAI score showed a significant correlation with headache, neck pain and vertigo measurements. A cut-off point >35 showed a sensitivity = 83.33% and a specificity = 77.97% in differentiating between healthy and TMD patients, with an area under the curve (AUC) = 0.865. Conclusions: The Spanish version of the FAI is a valid and reliable instrument for diagnosing people with TMD, with appropriate general clinimetric properties. Discrimination between patients with and without TMD is excellent. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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11 pages, 236 KiB

Open AccessArticle

Evaluation of Temporomandibular Joint by Anesthetists in Florida When Conducting Orotracheal Intubation—A Pilot Study

by Inae C. Gadotti, Melanie Geronimo, Gabriela Rodriguez, Stephanie Caceres, Yasmine Campbell, Jorge Valdes and Derrick Glymph

J. Clin. Med. 2020, 9(10), 3229; https://doi.org/10.3390/jcm9103229 - 9 Oct 2020

Cited by 5 | Viewed by 2307

Abstract

Background: Orotracheal intubation has been considered a risk factor for the development or exacerbation of disorders related to the temporomandibular joint (TMJ). The objective of this pilot study was to evaluate TMJ assessment performed by anesthetists in Florida when conducting orotracheal intubation. Methods: An online questionnaire was created using Qualtrics. The survey included 22 questions related to demographics, TMJ related to anesthesia procedures, and education/awareness regarding TMJ related to intubation. Descriptive statistics and cross-tabulation analysis were performed. Results: One hundred and eight providers participated (mean 46 years-old ± 12; 59% female). About 50% reported to always evaluate TMJ prior non-emergency intubation. Of those, 56% used an alternative intubation technique based on the TMJ status and 60% never/rarely evaluated TMJ post-intubation. Twenty-five percent reported they did not know of possible intubation effects on TMJ and 47% reported that they did not receive adequate information/education on TMJ management related to intubation in school. After participation, 81% reported to be more aware of the importance of evaluating TMJ. Conclusions: Only half of the providers who frequently performed intubation in Florida evaluated TMJ prior to intubation. This survey increased the awareness regarding the importance of evaluating TMJ when conducting intubation. This may contribute to reducing TMJ issues associated with non-emergency intubations. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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16 pages, 1365 KiB

Open AccessArticle

Cross-Cultural Adaptation and Psychometric Properties of the Spanish Version of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders

by Roy La Touche, Joaquín Pardo-Montero, Ferran Cuenca-Martínez, Corine M Visscher, Alba Paris-Alemany and Ibai López-de-Uralde-Villanueva

J. Clin. Med. 2020, 9(9), 2831; https://doi.org/10.3390/jcm9092831 - 1 Sep 2020

Cited by 12 | Viewed by 2947

Abstract

The aim was to perform a translation, cross-cultural adaptation, and psychometric evaluation of the Spanish version of the Tampa Scale of Kinesiophobia for Temporomandibular Disorders (TSK-TMD-S). The study sample included 110 patients with TMD. We translated and cross-culturally adapted the TSK-TMD-S using standard methodology and analysed its internal consistency, test-retest reliability, construct validity, floor and ceiling effects, and discriminant validity. Confirmatory factor analysis extracted two factors and 10 items deemed essential for the scale. The TSK-TMD-S demonstrated good internal consistency (Cronbach’s α of 0.843, 0.938, and 0.885 for the entire scale, activity avoidance subscale, and somatic focus subscale, respectively; intraclass correlation coefficient, 0.81–0.9). No floor or ceiling effects were identified for this final version of the scale. The TSK-TMD-S total score showed moderate positive correlation with the craniofacial pain and disability inventory, visual analogue scale, general TSK and pain catastrophizing scale, and a moderate negative correlation with maximal mouth-opening. The receiver operating characteristic curve analysis showed that the subclassification employed for the TSK-TMD-S discriminates different kinesiophobia levels with a diagnostic accuracy between sufficient and good. The optimal cut-off point for considering kinesiophobia is 23 points. TSK-TMD-S appears to be a valid and reliable instrument for measuring kinesiophobia in patients with TMD. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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15 pages, 8144 KiB

Open AccessArticle

Effect of Manual Therapy and Splint Therapy in People with Temporomandibular Disorders: A Preliminary Study

by Gemma Victoria Espí-López, Anna Arnal-Gómez, Alba Cuerda del Pino, José Benavent-Corai, Pilar Serra-Añó and Marta Inglés

J. Clin. Med. 2020, 9(8), 2411; https://doi.org/10.3390/jcm9082411 - 28 Jul 2020

Cited by 20 | Viewed by 4414

Abstract

Background: Isolated manual therapy techniques (MT) have shown beneficial effects in patients with temporomandibular disorders (TMD) but the effect of the combination of such techniques, together with the well-stablished splint therapy (ST) remains to be elucidated. Objective: This study was conducted to ascertain whether a combined program of MT techniques, including intraoral treatment, plus traditional ST improves pain and clinical dysfunction in subjects with TMD. Methods: A preliminary trial was conducted. 16 participants were assigned to either the MT plus ST-Experimental Group (EG, n = 8) or the ST alone—Control Group (CG, n = 8). Forty-five minute sessions of combined MT techniques were performed, once a week for four weeks. Three evaluations were conducted: baseline, post-treatment, and one-month follow-up. Outcome measures were pain perception, pain pressure threshold (PPT), TMD dysfunction, and perception of change after treatment. Results: EG showed significant reduction on pain, higher PPT, significant improvement of dysfunction and significantly positive perception of change after treatment (p < 0.05 all). Additionally, such positive effects were maintained at follow-up with a high treatment effect (R² explaining 26.6–33.2% of all variables). Conclusion: MT plus ST showed reduction on perceived pain (3 points decrease), higher PPT (of at least 1.0 kg/cm²), improvement of disability caused by pain (4.4 points decrease), and positive perception of change (EG: 50% felt “much improvement”), compared to ST alone. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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Review

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42 pages, 1263 KiB

Open AccessReview

Patient-Reported Outcome Measurements in Temporomandibular Disorders and Headaches: Summary of Measurement Properties and Applicability

by Aroldo dos Santos Aguiar, Helen Cristina Nogueira Carrer, Mariana Romano de Lira, Gabriela Zuelli Martins Silva and Thais Cristina Chaves

J. Clin. Med. 2021, 10(17), 3823; https://doi.org/10.3390/jcm10173823 - 26 Aug 2021

Cited by 12 | Viewed by 3176

Abstract

Introduction: Several patient-reported outcome measurements (PROMs) are available in the literature to support the evaluation and diagnosis of temporomandibular disorders and headaches. However, clinicians and researchers usually complain that they had no education on PROMs and low overall knowledge about PROMs. Objective: This study aimed to summarize, describing the measurement properties and clinical applicability of the main condition-specific PROMs available in the literature to the assessment of patients with Temporomandibular Disorders and Headaches. Methods: The current manuscript reviewed 10 PROMs commonly used in the field. Four instruments about functioning and disability: 1. Mandibular Function Impairment Questionnaire (MFIQ), 2. Craniofacial Pain and Disability Inventory (CF-PDI), 3. 8-item and 20-item Jaw Functional Limitation Scale (JFLS), and 4. Manchester Orofacial Pain Disability Scale (MOPDS). Two instruments about headache-related disability: 5. Headache-Related Disability Index (HDI) and 6. Headache Impact Test-6 (HIT-6). Three instruments focused on TMD and headache screening: 7. 3Q/TMD, 8. Short-Form Anamnestic Fonseca Index (SFAI), 9. Headache Screening Questionnaire. In addition, one instrument about maladaptive beliefs regarding pain and injury: 10. Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD). Conclusions: The knowledge about the limitations and applicability of the PROMs commonly used to assess TMDs and Headaches can help clinicians and researchers to obtain reliable and valid outcomes to support the decision-making process. The current review recognizes the importance of using patient-reported outcome measures in research and clinical practice. However, our findings call the attention that further studies on the measurement properties of such instruments are imperative. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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21 pages, 5785 KiB

Open AccessReview

Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review

by César Fernández-de-las-Peñas and Harry Von Piekartz

J. Clin. Med. 2020, 9(11), 3686; https://doi.org/10.3390/jcm9113686 - 17 Nov 2020

Cited by 18 | Viewed by 11661

Abstract

The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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31 pages, 1570 KiB

Open AccessReview

Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies

by Ferran Cuenca-Martínez, Aida Herranz-Gómez, Beatriz Madroñero-Miguel, Álvaro Reina-Varona, Roy La Touche, Santiago Angulo-Díaz-Parreño, Joaquín Pardo-Montero, Tamara del Corral and Ibai López-de-Uralde-Villanueva

J. Clin. Med. 2020, 9(9), 2806; https://doi.org/10.3390/jcm9092806 - 30 Aug 2020

Cited by 15 | Viewed by 4242

Abstract

To assess neck disability with respect to jaw disability, craniocervical position, cervical alignment, and sensorimotor impairments in patients with temporomandibular disorders (TMD), a systematic review and meta-analysis of observational studies trials were conducted. The meta-analysis showed statistically significant differences in the association between neck disability and jaw disability (standardized mean difference (SMD), 0.72 (0.56–0.82)). However, results showed no significant differences for cervical alignment (SMD, 0.02 (−0.31–0.36)) or for the craniocervical position (SMD, −0.09 (−0.27–0.09)). There was moderate evidence for lower pressure pain thresholds (PPT) and for limited cervical range of motion (ROM). There was limited evidence for equal values for maximal strength between the patients with TMD and controls. There was also limited evidence for reduced cervical endurance and conflicting evidence for abnormal electromyographic (EMG) activity and motor control in TMD patients. Results showed a clinically relevant association between cervical and mandibular disability in patients with TMD. Regarding sensory-motor alterations, the most conclusive findings were observed in the reduction of PPT and cervical ROM, with moderate evidence of their presence in the patients with TMD. Lastly, the evidence on impaired motor control and cervical EMG activity in patients with TMD was conflicting. Full article

(This article belongs to the Special Issue Physiotherapy in Temporomandibular Disorders and Headaches)

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