Journal of Back and Musculoskeletal Rehabilitation - Volume 6, issue 2
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: The field of orofacial pain and temporomandibular disorders (OFP/TMD) is a relatively new area of clinical and scientific interest that parallels the expanding interest in pain conditions in the back and other areas of the body. This new field is concerned with the understanding and care of patients with disorders that cause pain and dysfunction of the masticatory system and related orofacial, head, and neck structures. Because orofacial structures are integrally involved in communication, sustenance, sexuality, appearance, and self esteem, the personal impact of these disorders can be high, motivating patients to seek care and be a significant part of…the clinical practice of dentistry and medicine. As a result of recent developments in research, education, and patient care in the past 10 years, significant progress has been made in helping patients with these disorders. These efforts can provide an example of what can be done with other pain disorders to advance efforts in research, teaching, and patient care. The purpose of this paper is to review these recent advances in OFP/TMD and their implications for patient care.
Keywords: Orofacial pain, Temporomandibular disorders, Patient care
Abstract: Orofacial pain is a complex problem that requires careful assessment, understanding and appropriate therapy. This article reviews the function of the nervous system as it pertains to orofacial pain and introduces an organ based classification system that can be used to help differentiate the patient with orofacial pain. Current concepts in the pathogenous of each disorder and therapies are reviewed.
Abstract: The interexaminer reliability of six orthopedic tests, applied to the masticatory system, was determined in a group of 79 patients with signs and/or symptoms of TMD. Multitest Scores were composed for each test and combinations of tests for the three main symptoms of TMD, namely, pain, joint sounds, and restriction of movement. Although the tests showed different reliability scores, the reliability of detecting these three main symptoms of TMD was satisfactory. All the tests contributed to the diagnostic process, with active movements being the most powerful test. The combination of active movements, passive movements, and palpation provided valuable diagnostic information.…Other tests could be used for specific diagnostic problems. The scores of the orthopedic tests applied to the neck show that extension and flexion can be evaluated most reliably with active movements and by assessing end feel. The interexaminer agreement for recording pain was also satisfactory for flexion and extension. The interexaminer reliability of the tests recording pain and end feel in the shoulder girdle was moderate for anteflexion.
Abstract: Systemic ligament hypermobility (benign hypermobile joint syndrome or BHJS) and masticatory parafunction (clenching/bruxism) were evaluated in intracapsular TMD (n = 110 ) and non-TMD (n = 112 ) populations. Individuals that had a ligament mobility index greater than four were classified as benign hypermobile joint syndrome (BHJS) utilizing the modified Carter-Wilkinson systemic ligament hypermobility scale. All subjects in the TMD and control groups were female, between the ages of 10 and 79 with Angles’ Class I molars and cuspids. This study found Benign Hypermobile Joint Syndrome (BHJS) and masticatory parafunction, when present simultaneously in females, to…be significantly associated with intracapsular TMD symptoms (P < 0.001 ).
Abstract: Rhythmic masticatory muscle activities are probably part of normal jaw motor behavior. Certain factors, like disease, stress, personality, alcohol, and medication, may turn this normal activity into a condition that might include abnormal tooth wear, myofascial pain, and temporomandibular joint problems. This condition then corresponds with bruxism. Bruxism and masticatory muscle pain may reciprocally influence one another: although not a compulsory finding, bruxism may be associated with the predisposition, initiation, and perpetuation of temporomandibular disorders and orofacial pain. On the other hand, the presence of jaw muscle pain may reduce bruxism motor activity. Research on the integrity and nature of…the relationship between bruxism and pain is hampered by controversies that exist regarding definition, diagnostic criteria, and measurement techniques. Moreover, the pathophysiology of bruxism and its association with other sleep-related and movement disorders are still unclear. Consequently, there is no real cure for bruxism, although several treatments may be used to control its adverse effects. However, there is very limited research to support the efficacy of behavioral, physical, dental, pharmacological, and orthopedic treatments. Probably the best current treatment modality for bruxism is the occlusal stabilization splint. Although such an orthopedic device may not actually prevent bruxism, it may help to reduce its symptoms.
Abstract: Myofascial pain (MFP) is a regional muscle pain disorder characterized by localized muscle tenderness and pain and the most common causes of persistent pain in the head and neck. The affected muscles may also display an increased fatigability, stiffness, subjective weakness, pain in movement, and slight restricted range of motion that is unrelated to joint restriction. MFP is frequently overlooked as a diagnosis because it is often accompanied by signs and symptoms in addition to pain, coincidental pathology conditions such as joint disorders, and behavioral and psychosocial problems. As MFP persists, chronic pain characteristics often precede or follow its development.…Evaluation of myofascial pain includes locating the trigger points and muscles involved as well as recognition of these contributing factors. Management of the syndrome naturally follows with muscle exercises, therapy to the trigger points, and reducing all contributing factors. The difficulty in managing MFP lies in the critical need to match the level of complexity of the management program with the complexity of the patient.
Abstract: Although most painful conditions affecting the temporomandibular joint (TMJ) can be managed non-surgically, when such treatment fails, surgery is often recommended as an alternative. The success of surgery depends on accurate diagnosis, an understanding of which conditions are amenable to operation, and knowing what to do and when to do it. This article provides the information needed by the clinician to determine when surgery should be done for chronic TMJ pain and what can be accomplished by such treatment.