title: Immediate Effects of Combining Local Techniques in the Craniomandibular Area and Hamstring Muscle Stretching in Subjects with Temporomandibular Disorders: A Randomized Controlled Study.
abstract: OBJECTIVE
  To assess the immediate effects on vertical mouth opening, orofacial mechanosensitivity, and lumbar and suboccipital mobility after adding a myofascial induction technique to a multimodal protocol in subjects with temporomandibular disorders (TMD).
  
  
  METHODS
  A randomized and double-blind controlled trial was carried out.
  
  
  METHODS
  University-based physical therapy research clinic.
  
  
  METHODS
  Sixty subjects (35±11.22 years) with TMD, and restricted mobility of the mandibular condyles and the first cervical vertebrae, were recruited and randomized to either a control group (CG) (n=30) or an experimental group (EG) (n=30).
  
  
  METHODS
  The CG underwent a neuromuscular technique over the masseter muscles and passive hamstring muscle stretching. A suboccipital muscle inhibition technique was added to this protocol in the EG.
  
  
  METHODS
  Primary measurements were made of vertical mouth opening and pressure pain threshold of the masseter muscles. Secondary outcome measures included pressure algometry of the trigeminal nerve, suboccipital range of motion, and lumbar spine mobility, assessed with the sit-and-reach (SAR) test and lumbar forward bending. All evaluations were collected at baseline and immediately after intervention.
  
  
  RESULTS
  In the intragroup comparison, the EG observed an increase in suboccipital flexion (p<0.001; F1,29=14.47; R(2)=0.33) and the SAR test (p=0.009; F1,29=7.89; R(2)=0.21). No significant differences were found in the between-group comparison for any variable (p>0.05).
  
  
  CONCLUSIONS
  The inclusion of a myofascial induction maneuver in a protocol combining local (neuromuscular treatment) and distal techniques (hamstring stretching) in subjects with TMD has no impact on improving mouth opening, suboccipital and lumbar mobility, and orofacial sensitivity to mechanical pressure.
authors.affiliation: 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain .
authors.forename: Cleofás
authors.initials: C
authors.lastname: Rodriguez-Blanco
authors.affiliation: 2 Madrid Osteopathic School , Madrid, Spain .
authors.forename: Francisco Miguel
authors.initials: FM
authors.lastname: Cocera-Morata
authors.affiliation: 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain .
authors.forename: Alberto Marcos
authors.initials: AM
authors.lastname: Heredia-Rizo
authors.affiliation: 2 Madrid Osteopathic School , Madrid, Spain .
authors.forename: François
authors.initials: F
authors.lastname: Ricard
authors.affiliation: 2 Madrid Osteopathic School , Madrid, Spain .
authors.forename: Ginés
authors.initials: G
authors.lastname: Almazán-Campos
authors.affiliation: 1 Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla , Sevilla, Spain .
authors.forename: Ángel
authors.initials: Á
authors.lastname: Oliva-Pascual-Vaca
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007568:Jaw / Q000502:physiology; D007866:Leg / Q000502:physiology; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D018583:Pliability; D016059:Range of Motion, Articular / Q000502:physiology*; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult