The aim of this randomized controlled trial is to find the effect of muscle energy technique for trigger points of muscle of mastication for reducing pain , improving mouth opening and jaw functional limitations.
The primary muscles of mastication (chewing food) are the temporalis, medial pterygoid, lateral pterygoid, and masseter muscles. The masticatory muscles are divided into elevator and depressor groups. The collective term 'hamstrings' refers to four muscles- semimembranosus (SM), semitendinosus (ST), biceps femoris long head (BFlh) and biceps femoris short head (BFsh). The hamstring muscles are the major flexors of the knee and also aid hip extension. Trigger point is classically defined as a hyperirritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Latent trigger points located in the muscles can interfere with muscular movement patterns, cause cramps, and reduce muscle strength. Active MTrPs can be associated with a reduced range of motion through muscle dysfunction and muscle weakness, causing orefacial pain, MTrPs in the masticatory muscles may restrict active maximum mouth opening (MMO). It is possible that stretching the hamstring muscles may activate the dorsal periaqueductal grey area of the midbrain \[PAG\], and activate descending inhibitory control pathways. It is known that descending projections from the PAG to the medulla have collateral branches that terminate in various areas including the upper cervical spinal cord. Convergence of the nociceptive afferents from the receptive fields of cervical roots C1-C3 and those of the trigeminal nerve, which include the masseter muscle, occurs in the nucleus caudalis. If hamstring muscle stretching is capable of activating the PAG, then decreased sensitivity should affect a greater number of muscles, including the remaining masticatory muscles. Muscle energy technique (MET) is a manual technique developed by osteopaths that is now used in many different manual therapy professions. It is claimed to be effective for a variety of purposes, including lengthening a shortened or contractured muscle, strengthening muscles, as a lymphatic or venous pump to aid the drainage of fluid or blood, and increasing the range of motion (ROM) of a restricted joint. MET may influence pain mechanisms and promote hypoalgesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
42
They would be receiving treatment as follow: The patient is instructed to gently attempt to push down on the practitioner's shoulder with the leg against the practitioner's resistance( 75% of his and her available strength). After the relaxation, the muscle is lengthened more aggressively beyond the barrier and held for up to 15 seconds. Frequency: 10 reps for 4 times/week for 2 consecutive weeks. Intensity: moderate intensity (pain free) Time: 20 mins
They would be receiving conventional treatment as follow: including hot pack for 10 mins ischemic compression for 60 seconds .Frequency: 5 reps with 60 sec hold for 4 times/week for 2 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 10 mins
Railway General Hospital
Rawalpindi, Punjab Province, Pakistan
RECRUITINGVisual Analog Scale VAS
The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable. A patient marks a point on the line that matches the amount of pain he or she feels.
Time frame: 2 weeks
Inch Tape
A measuring tape is a flexible tool used for measuring. It is marked in centimeters and inches.
Time frame: 2 weeks
Jaw Functional Limitation Scale
The JFLS-20 is an organ-specific instrument comprising 3 constructs for assessing functional status of the masticatory system; the 3 scales exhibit properties that are ideal for both research and patient evaluation in patient groups with a range of functional limitations of the jaw.
Time frame: 2 weeks
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