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Review Article - (2023) Volume 10, Issue 2

Neck impairment is connected with temporomandibular joint myofascial pain and segmental muscle flexibility

Saif Alam*
Department of Rheumatology, Science & Technology, Qatar
*Correspondence: Saif Alam, Department of Rheumatology, Science & Technology, Qatar, Email:

Received: 23-Mar-2023, Manuscript No. ipar-23-13606; Editor assigned: 25-Mar-2023, Pre QC No. ipar-23-13606(PQ); Reviewed: 08-Apr-2023, QC No. ipar-23-13606; Revised: 13-Apr-2023, Manuscript No. ipar-23-13606(R); Published: 20-Apr-2023, DOI: 10.36648/ipar.


The primary objectives of this study are to examine the relationship between neck disability and muscle pain and to compare masticatory myofascial pain subjects' neck disability to that of asymptomatic controls.


Neck impairment; Temporomandibular joint; Asymptomatic; Muscle flexibility


A person's quality of life is frequently impacted by musculoskeletal disorders. The coexistence of multiple painful conditions in the body could partially account for this negative effect. Because both of these prevalent disorders frequently coexist in the same subject, temporomandibular and cervical pain disorders may be two of the most common examples. A large number of clinical conditions, or signs and symptoms, that affect the masticatory system and cervical structures, respectively, are referred to as temporomandibular disorders and cervical disorders [1].

Significant proof exists for a potential relationship between the signs and side effects of TMD and cervical movement hindrance or stance contrasts. Between 2006 and 2013, at least two systematic reviews on this topic were published, but neither came to clear conclusions, indicating the need for additional research. The relationship between mechanical sensitivity of the masticatory and cervical muscles, presence of TMD, and self-reported neck disability has been underexplored in reviews of this kind, even though this relationship could be indicative of how pain affects one's daily activities. In contrast, the biomechanical and anatomical aspects of the review are frequently given the most attention. Notably, the first paper measuring neck disability in TMD patients using a well-known and validated instrument was published in 2010. The paper basically stated that jaw disability and TMD-related disability were linked to neck disability. A better comprehension of how masticatory and cervical muscle pain may be affected by neck disability and TMD signs and symptoms may result from focusing on this relationship [2].

The pressure pain threshold is one of the most reliable assessments of mechanical muscle sensitivity. Specifically, PPT information gives a pathophysiological premise to assess fringe or focal sensory system irregularities and modifications in torment discernment and regulation. Also, muscle delicacy is an express measure for masticatory myofascial torment, the most well-known sort of TMD. Lastly, comprehending the connection between the cervical spine and the trigeminal region necessitates examining the PPT correlation between the cervical and masticatory muscles. Taking into account the pain spread and referral patterns that were observed between the trigeminal and cervical muscles, the experimental pain that was experienced by healthy volunteers also indicated a partial overlap [3].

The primary objectives of this study were, on the basis of these findings: a) to look at the level of self-detailed neck inability between subjects with MMP and asymptomatic controls, and (b) to relate the level of self-revealed neck handicap with (1) torment force, (2) PPT of the temporomandibular joint, (3) masticatory and cervical muscles and (4) the extracephalic site. Correlation between the PPT values of the extracephalic site, cervical muscles, and masticatory sites was another goal. Our hypotheses, based on these goals, were: The self-reported neck disability of the MMP subjects will be higher than that of the asymptomatic control patients; there will be a positive relationship among self-detailed neck handicap and (1) torment power, (2) PPT upsides of masticatory cervical muscles and (3) the extracephalic site; (c) The PPT values of the masticatory sites will be correlated positively with those of the cervical muscles or the extracephalic site [4]. Methods This case–control study was approved by the Human Research Ethics Committee of the same institution in May 2011 and carried out at the Orofacial Pain Laboratory of the Federal University of Sergipe. Advertisements were used to find study participants. Qualified members included college understudies and nearby local area volunteers of the two sexes, who went through a clinical assessment for TMD signs and side effects. They were put into two groups based on the criteria for inclusion and exclusion: group with symptoms and the control group.

The symptomatic group's inclusion criteria were as follows: people between the ages of 18 and 35; for at least six months, a complaint of pain in the orofacial region; the updated Research Diagnostic Criteria diagnosis of masticatory myofascial pain20. The exclusion criteria for the symptomatic group were as follows: background marked by facial or cervical injury, cervical or potentially craniofacial surgeries; fibromyalgia or other neurological conditions; any TMD treatments you've had in the past three months; currently undergoing orthodontic treatment or occlusal risk factors for TMD; and the use of alcohol, analgesics, anxiolytics, antidepressants, oral contraceptives, and other drugs. Volunteers aged 18 to 35 were the eligibility criteria for the control group's eligible participants. The prohibition models for the benchmark group were: any TMD that is painful, as determined by the most recent Research Diagnostic Criteria; a history of trauma to the face or neck, cervical surgery, or craniofacial surgery; fibromyalgia or other neurological conditions; currently undergoing orthodontic treatment or occlusal risk factors for TMD; and the use of alcohol, analgesics, anxiolytics, antidepressants, oral contraceptives, and other drugs [5].

Age and gender were comparable between the two groups. The eligible subjects were evaluated independently and blindly by two experts in RDC/TMD assessment and orofacial pain. Only those who received the same diagnostic from both experts were included and assigned to the appropriate group. In light of the fact that a total sample size of approximately 47 subjects was required, an alpha level of 0.05 and a beta level of 0.2 were the least determinants of a small to moderate correlation.

Quantitative variables were described in terms of gender distribution and expressed as means and standard deviation in statistical analysis. The Kolmogorov–Smirnov test was used to check that all quantitative variables had a normal distribution prior to the inferential analysis.

The Pearson item second connection coefficient was utilized to correspond NDI with VAS and PPT values in the suggestive gathering, as well as to associate PPT upsides of the masticatory destinations with those of cervical muscles and the extra cephalic site, according to the whole example. Based on the r coefficient, each effect's magnitude was evaluated as a small, moderate, or strong correlation. The study's sample size was thought to be too small to use regression models that could account for all variables and avoid multiple comparisons. To conquer this issue, a Bonferroni remedy was applied and the importance level was brought down to 0.7% and 0.5% as the endpoint to decide the factual importance, separately, of the connection between’s NDI with VAS and PPT, and the relationship between’s the PPT upsides of the masticatory locales with those of the cervical muscles and the extra cephalic site [6]. Results A total of 119 eligible subjects were evaluated, and 55 of them met the requirements. The symptomatic group included 27 individuals with Masticatory Muscle Pain, while the asymptomatic group included 28 volunteers. A summary of the clinical and demographic characteristics is provided. The majority of people in each group were women. The symptomatic and control groups had mean ages of 24.7 and 23.2, respectively. Gender or age did not differentiate Groups 1 and 2 from one another. However, there were differences in the NDI, with mean scores of 11.8 and 2.7 indicating that the symptomatic group had mild neck disability and the control group did not, respectively. In addition, for the majority of the structures that were evaluated, the symptomatic group had lower PPT values [7].


The purpose of this study was to investigate the connection between the clinical parameters of TMD and the symptoms of cervical disorders. In particular, these findings indicated that: compared to asymptomatic controls, subjects with masticatory myofascial pain have greater neck disability; the sensitivity of the anterior temporalis, sternocleidomastoid, and upper trapezius muscles increases with neck disability; there is a strong connection between the sensitivity of masticatory or TMJ muscles, cervical muscles, and the extracephalic site [8].

The connection between temporomandibular disorders and cervical disorders has sparked interest due to their anatomical proximity, neuronal interconnections, and convergence inputs. Currently, both conditions are very common in the world's population and subjects with TMD and cervical disorders may exhibit symptoms that overlap. In fact, our findings reinforced the notion of comorbidity between TMD and cervical disorders by indicating greater neck impairment scores and lower upper trapezius pressure pain thresholds were found in TMD patients. Disability measurements based on the NDI and PPT values for cervical muscles may indicate dysfunction in the cervical region despite the lack of comprehensive evaluations of cervical structures. In addition, our findings are comparable to those of a pioneering study by Armijo Olivo, which revealed a significant difference in the NDI between healthy controls and myogenous TMD [9].

In people with worse self-reported neck problems, regardless of the presence of MMP, the association between low PPT and neck disability indicated increased sensitivity. Muscle sensitivity may be understood as a result of a widely altered perception or hypervigilant behavior, making it difficult to determine the underlying mechanisms underlying this correlation. In addition, this sensitivity may be influenced by a variety of other factors, such as demography, metabolism, and lifestyle, as well as by those attributed to central or peripheral neurons and associated with modulated pain pathways [10].

Several of the limitations of this study should be noted. First, due to the observational nature of the study and the small sample, causal inferences may not be supported using the same design, despite the significance and magnitude of our correlations. The absence of a physical examination of the cervical structures is a second limitation. As a result, any further inferences from this study should be treated with caution.


Masticatory myofascial pain is associated with greater neck disability, which, regardless of the presence of pain, is correlated with regional muscle sensitivity. Additionally, it's possible that this muscle sensitivity is widespread. All things considered, a more far reaching appraisal, e.g., nitty gritty clinical history, palpation or potentially quantitative tangible testing of cervical and neck muscles and trigger point screening, alongside the assessment of endogenous torment tweak systems, is suggested and may support assessing fringe and focal variables related with outer muscle agony or neck handicap, taking into account that the presence of these elements has suggestions for illness guess.




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