Atividade muscular, alinhamento corporal e avaliação clínica de indivíduos com disfunções temporomandibulares e com desvios posturais antes e após Reeducação Postural Global (RPG)

Abstract

The temporomandibular disorder (TMD) can be described as a set of joint and muscle disorders in the orofacial region. The stomatognathic system integrates the postural system due to its relationship with the muscle chains, anterior and posterior, which establishes a mutual influence between these two systems. The Global Postural Reeducation (GPR) method aims to restore the muscular balance and postural alignment. It can also contribute to alleviate the symptoms of this disorder. This study aimed to evaluate the muscular activity, body alignment (Software SAPo®) and clinical aspects of TMD associated to postural deviations, before and after GPR. Twenty volunteers took place in the study, whose TMD was diagnosed by Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) instrument, Axis I and II, and the presence of postural deviations was confirmed by physical examination (KENDALL). Participants were submitted to analysis of angular measures between anatomical points through digital biophotogrammetry, processed by software SAPO®. The patients were submitted to 10 sessions of GPR, being two global postures each weekly session of therapy, and indicated according their individual needs. The results of the clinical variables were analyzed qualitatively. Quantitative variables (angular measures and values of the EMG signals) were analyzed by non parametric tests of Wilcoxon and paired t test, with significance level of 5%. The results showed significant changes in Axes I and II of the RDC / TMD. It was verified, in the classification of the dysfunction, an increase of the predominance of the Group I (myofascial) and the extinction of the TMD in one individual after treatment. The orofacial pain intensity reduced. In the physical symptoms including pain items the normal classification changed from 10 to 30%. Physical symptoms excluding pain items the normal classification increased from 30 to 55%. The percentage of individuals without depression increased from 10 to 35% after GPR. There was a statistically significant difference in most angular measures of the body structures, except in the frontal angle of the lower limbs and in the right leg/foot angle. The horizontal alignment of the head and the measures of the cervical and lumbar lordosis presented normal values before the RPG, so they did not change with treatment. There was significant reduction of RMS values at rest, during postural alignment and isometry in all studied muscles. It was observed, before and after GPR, predominance of the anterior temporal muscles activity over the masseter muscles, which characterizes the assynergic pattern between them. It was concluded with this study, the RPG method produces positive effects on the body alignment of individuals with TMD associated to postural deviations and improvement of muscular activity of masticatory and cervical muscles during rest, postural alignment and isometry. The muscle balance and body alignment obtained with the GPR still showed a positive impact on the clinical aspects of TMD patients in the study.