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Fisioterapia e manipulação muscular para tratamento de dor associada a disfunção temporomandibular
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Objetivo: Avaliar a eficácia da fisioterapia e manipulação muscular exclusivamente feita pelo paciente (ou pelo clínico) no controlo da dor miofascial em pacientes com disfunção muscular temporomandibular, e comparar a eficácia de adicionar um protocolo de manipulação feita pelo clínico a fisioterapia feita pelo paciente.
Materiais e Métodos: Conduziu-se um estudo clínico em duas participantes, diagnosticadas com DTM Grupo I de acordo com os Critérios de Diagnóstico para Disfunção Temporomandibular (CDP-DTM), com sintomatologia dolorosa superior a 3 na Escala Numérica de Dor (END) na primeira consulta. Ambas as participantes foram educadas sobre a sua patologia, e instruídas sobre os exercícios de autocuidado a serem realizados em casa. A uma das participantes foi aplicado um protocolo de manipulação clínica (participante B) aliados a exercícios de autocuidados, enquanto a participante A, apenas realizou os últimos mencionados. Decorridos 48 dias, procurou-se compreender se ocorreram alterações ao nível de dor e amplitude de movimentos.
Resultados: Ambas as participantes alcançaram um estado assintomático na dor “atual” e dor “pico”. A participante B apresentou uma redução de pontos musculares dolorosos substancialmente superior na última semana (com quase todos os valores com uma redução de 100%) comparado com a participante A. Verificou-se um aumento da extensão de todos os movimentos verticais e excursivos em ambas as participantes, sendo que a participante B registou uma melhoria superior à participante A na sexta semana, em relação à abertura máxima indolor (10,6% para 46,9%).
Conclusão: A manipulação clínica associada à fisioterapia feita pelo paciente apresentou resultados superiores em termos de redução da dor muscular durante a palpação e aumento da amplitude de movimentos. São necessários mais estudos, com maior amostra e maior período de controlo para determinar a eficácia da fisioterapia no tratamento da dor miofascial.
Purpose: To evaluate the effectiveness of manual therapy and muscular manipulation in control of patients with pain associated with muscular temporomandibular disorder and compare the value of adding intra-oral myofascial therapy performed by a clinician to manual therapy and humid heath performed by the patient. Materials and Methods: A clinical study was conducted in two participants, diagnosed with TMD Group I, using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD), with a history of daily peri-auricular pain superior to 3 in the pain scale in the first consultation. Both participants were educated about their pathology and instructed about the self-care exercises to be performed at home. To one of the participants (participant B) was applied a protocol of intra-oral myofascial therapy associated with self-care exercises, while participant A only did the last mentioned. After 48 days, the outcomes in pain and range of motion were assessed. Results: Both participants reached an asymptomatic state when considering pain in the moment of consultation and worst pain in the previous week. Participant B showed better results in reducing muscular pain during palpation, on the last evaluation (with reductions of 100% in almost all muscles) when compared to participant A. There was an increase in the range of motion, vertical and horizontal, for both participants, being that participant B exhibited greater amplitude, comparing to participant A, on the sixth week, when considering the maximum painless opening (10,6% para 46,9%).
Purpose: To evaluate the effectiveness of manual therapy and muscular manipulation in control of patients with pain associated with muscular temporomandibular disorder and compare the value of adding intra-oral myofascial therapy performed by a clinician to manual therapy and humid heath performed by the patient. Materials and Methods: A clinical study was conducted in two participants, diagnosed with TMD Group I, using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD), with a history of daily peri-auricular pain superior to 3 in the pain scale in the first consultation. Both participants were educated about their pathology and instructed about the self-care exercises to be performed at home. To one of the participants (participant B) was applied a protocol of intra-oral myofascial therapy associated with self-care exercises, while participant A only did the last mentioned. After 48 days, the outcomes in pain and range of motion were assessed. Results: Both participants reached an asymptomatic state when considering pain in the moment of consultation and worst pain in the previous week. Participant B showed better results in reducing muscular pain during palpation, on the last evaluation (with reductions of 100% in almost all muscles) when compared to participant A. There was an increase in the range of motion, vertical and horizontal, for both participants, being that participant B exhibited greater amplitude, comparing to participant A, on the sixth week, when considering the maximum painless opening (10,6% para 46,9%).
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Saúde oral Teses de mestrado - 2019