TMJ disorders and Neck Pain are closely linked. New study shows mechanical and kinematic movement of neck is altered by neck pain.

A recent article (Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.) showed changes in neck function when pain was present. Neck pain is one of the most frequently helped conditions during neuromuscular treatment of TMD disorders. If treating the pain can return normal function this would be an incredible finding.

The article concludes "Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management."

The unanswered question is whether the limitation and pain have a common orgin or if the pain is the cause of the changes noted. If the pain alone causes these changes than more debilitating problems would occur over time. An interesting follow-up study would be to examine changes after treatment of pain.

The PPM, Pure Power Mouthguard has been shown to increse flexibility and balance in athletes. A Rutger's study confirmed this. I have frequently seen normalization in pain and function in patients treated with neuromuscular orthotics but these are subjective improvements. This "virtual reality assesment" may be a more objective method to measure improvement in neck function following rehabilatative medicine, physical therapy, chiropractic or osteopathic adjustments and TMD treatment.

Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.
The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
Bahat HS, Weiss PL, Laufer Y.

Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
Abstract
Sarig Bahat H, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment.

OBJECTIVE: To compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment.

DESIGN: Clinical comparative trial.

SETTING: Participants were recruited from university staff and students, and from a local physical therapy clinic.

PARTICIPANTS: Patients with chronic neck pain (n=25) and asymptomatic participants (n=42).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Kinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant.

RESULTS: Participants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants.

CONCLUSIONS: Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.

Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112430 [PubMed - in process]

Headaches and TMJ Disorders are related to whole body health.

A new article in Practical Pain Management "Head and Neck: Kinetic Chain from the Toes Influences the Craniofacial Region " discusses the kinetic chain and how what happens in the body effects the craniofacial region and how jaw problems, bite stability and joint stability influences the entire body as well. These postural changes are a major cause of Tension-type headaches, neck pain and other types of myalgias.

The field of Posturology is how our posture affects the entire body. Posture includes how we stand, sit, lay down, sleep, work out and more. If we overwork muscles we can cause repetitive strain injuries that lead to myofascial pain and dysfunction.

There are three set points in the body that serve as neuromuscular resetting mechanisms. The teeth when we bite and swallow, our hips when we sit and our feet-legs-hips when we stand.

A second article in the Clinical Journal Pain. 2010 Aug 20. "The Influence of Cranio-cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients With Myofascial Temporomandibular Pain Disorders." found that their data "supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures." The trigeminal nociceptive system is integral in almost all chronic headaches and migraines. (abstract below)

Another recent article "Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects" in Oral Surg Oral Med Oral Pathol Oral Radiol looks at the posture of violinists and how it affects TM Joint stability and symptoms. This is a special case of postural distortion. (abstract below)

Head and Neck: Kinetic Chain from the Toes Influences the Craniofacial Region
Practical Pain Management, 08/04/2010
Rubenstein D – This article on plantar toe flexion and the kinetic chain is very interesting and offers an insight that may play a clinical role in diagnosis of TMJ and facial pain of kinetic postural and muscular origin. It serves to demonstrate that the TMJ and cervico/mandibular regions are both influencers of, and are influenced by, postural stresses, degenerative changes and dysfunctions that are often unrecognized by pain management clinicians.

Clin J Pain. 2010 Aug 20. [Epub ahead of print]
The Influence of Cranio-cervical Posture on Maximal Mouth Opening and Pressure Pain Threshold in Patients With Myofascial Temporomandibular Pain Disorders.
La Touche R, París-Alemany A, von Piekartz H, Mannheimer JS, Fernández-Carnero J, Rocabado M.

*School of Health Science, Department of Physical Therapy daggerGroup for Musculoskeletal Pain and Motor Control Clinical Research double daggerOrofacial Pain Unit of the Policlínica Universitaria, Universidad Europea de Madrid, Villaviciosa de Odón paragraph signDepartment of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain section signFaculty of Business, Management and Social Science, University of Applied Science Osnabrück, Osnabrück, Germany parallelProgram in Physical Therapy, Columbia University, New York, NY musical sharpSchool of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile.
Abstract
OBJECTIVE: The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular disorders pain.

MATERIALS AND METHODS: A total of 29 patients (19 females and 10 males) with myofascial temporomandibular disorders pain participated in the study, aged 19 to 59 years (mean years+/-SD; 34.69+/-10.83 y). MMO and the PPT (on the right side) of patients in neutral, retracted, and forward head postures were measured. A 1-way repeated measures analysis of variance followed by 3 pair-wise comparisons were used to determine differences.

RESULTS: Comparisons indicated significant differences in PPT at 3 points within the trigeminal innervated musculature [masseter (M1 and M2) and anterior temporalis (T1)] among the 3 head postures [M1 (F=117.78; P<0.001), M2 (F=129.04; P<0.001), and T1 (F=195.44; P<0.001)]. There were also significant differences in MMO among the 3 head postures (F=208.06; P<0.001). The intrarater reliability on a given day-to-day basis was good with the interclass correlation coefficient ranging from 0.89 to 0.94 and 0.92 to 0.94 for PPT and MMO, respectively, among the different head postures.

CONCLUSIONS: The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.

PMID: 20733480 [PubMed - as supplied by publisher]

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jan;109(1):e15-9.
Prevalence of temporomandibular disorder-related findings in violinists compared with control subjects.
Rodríguez-Lozano FJ, Sáez-Yuguero MR, Bermejo-Fenoll A.

TMD and Orofacial Pain Unit, Faculty of Medicine and Odontology, University of Murcia, Murcia, Spain. fcojavier@um.es
Abstract
OBJECTIVE: The aim of this study was to determine if there is an association between violin playing and the presence of signs and symptoms of temporomandibular disorder (TMD).

STUDY DESIGN: We studied a group of violinists in the Murcia region of Spain, who were examined for TMD. The results were compared with those from a random control group who did not play any musical instrument. The groups were matched by age and gender. Statistical analysis was carried out using SPSS 15.0 statistical software.

RESULTS: Compared with the control subjects, the violinists as a group had significantly more pain in maximum mouth opening (P < .005), parafunctional habits (P = .001), and occurrence of temporomandibular joint sounds (P < .005) as determined by chi-squared.

CONCLUSIONS: Violin playing appears to be a factor associated with TMD-related findings.

PMID: 20123363 [PubMed - indexed for MEDLINE]