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The Somatic Connection  |   May 2016
Manual Therapy for Hamstring Hypertonicity Improves Temporomandibular Dysfunction in Athletes
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   May 2016
Manual Therapy for Hamstring Hypertonicity Improves Temporomandibular Dysfunction in Athletes
The Journal of the American Osteopathic Association, May 2016, Vol. 116, 328-329. doi:10.7556/jaoa.2016.069
The Journal of the American Osteopathic Association, May 2016, Vol. 116, 328-329. doi:10.7556/jaoa.2016.069
Espejo-Antúnez L, Castro-Valenzuela E, Ribeiro F, Albornoz-Cabello M, Silva A, Rodríguez-Mansilla J. Immediate effects of hamstring stretching alone or combined with ischemic compression of the masseter muscle on hamstrings extensibility, active mouth opening and pain in athletes with temporomandibular dysfunction [published onlineJanuary 7, 2016]. J Bodyw Mov Ther. doi:10.1016/j.jbmt.2015.12.012. 
Temporomandibular disorder (TMD) affects more than 25% of the population. Because the use of local manual therapy in the management of TMD may have limitations when patients are in acute pain, there is increasing interest in myofascial release and trigger point therapy. Physiotherapists in Spain evaluated the immediate effects of the hold-relax proprioceptive neuromuscular facilitation (HR-PNF) stretching technique applied to a distant site—the hamstring muscle—with and without ischemic compression of masseter muscle trigger points on “hamstring extensibility, maximal amplitude of vertical mouth opening, pressure pain thresholds, and pain intensity in athletes diagnosed with TMD and hamstring shortening.” 
Forty-two amateur athletes aged 18 years or older (mean [SD] age, 21.2 [1.6] years) with regular sports practice, no previous hamstring injuries, a right-straight leg raise test outcome of less than 80°, a clinical diagnosis of TMD, and myofascial pain in the temporomandibular joint were randomly allocated to 1 of 2 groups (n=21 in each). Both groups received a bilateral HR-PNF hamstring stretching technique from a physiotherapist, and group 2 additionally received ischemic compression of masseter muscle trigger points. 
For the HR-PNF treatment session, a physiotherapist stretched the participants’ hamstrings to the maximum level of pain tolerated, followed by the participants engaging in a series of isometric contractions and relaxations of their hamstring muscles, ending with further passive stretching performed by the physiotherapist. After the stretching technique, the ischemic compression technique was applied to the participants in group 2. The physiotherapist located a central trigger point of the masseter muscle and gradually applied pressure until the participant experienced a sensation of both pressure and pain. This pressure was maintained for 90 seconds. 
Active knee extension, vertical mouth opening, pressure pain thresholds, and pain intensity measurements were taken before and after each intervention. After the stretching techniques, both groups had significantly improved hamstring extensibility, active mouth opening, and pressure pain thresholds, as well as decreased pain (P<.01). Masseter ischemic compression in group 2 offered no statistically significant difference in outcomes from group 1. 
Although there was no control group, this randomized clinical trial found that a single HR-PNF session helped manage the symptoms of TMD, lending support to the osteopathic tenets of body unity and structure-function interrelationships. Adding a nonintervention control group, a sham manual therapy control group, or an osteopathic manipulation group would be an interesting follow-up study, which could help elucidate the role of osteopathic manipulative medicine in the treatment of athletes with TMD.