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Relationship between cervical musculoskeletal impairments and temporomandibular disorders: clinical and electromyographic variables Open Access


Other title
Temporomandibular Disorders, Neck, cervical, impairments, muscles, relationship
Type of item
Degree grantor
University of Alberta
Author or creator
Armijo Olivo, Susan
Supervisor and department
Magee, D (Rehabilitation Medicine)
Examining committee member and department
Da Fonseca, Sergio (Physical Therapy)
Warren, Sharon (Rehabilitation Medicine)
Thie, Norman (Dentistry)
Major, Paul (Dentistry)
Syrotuik, Dan (Physical Education and Recreation)
Faculty of Rehabilitation Medicine

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Temporomandibular disorders (TMD) consist of a group of pathologies affecting the masticatory muscles, the temporomandibular joint and related structures. The association between the cervical spine and TMD has been studied from different perspectives; however, the study of cervical muscles and their significance in the development and perpetuation of TMD has not been elucidated. Thus, this project was designed to investigate the association between cervical musculoskeletal impairments and TMD. A sample of subjects who attended the TMD/Orofacial Pain clinic, and students and staff at the University of Alberta participated in this study. All subjects underwent a series of physical tests and electromyographic assessment (i.e. head and neck posture, maximal cervical muscle strength, cervical flexor and extensor muscles endurance, and cervical flexor muscle performance) to determine cervical musculoskeletal impairments. All subjects were asked to complete the Neck disability Index and the Jaw Function Scale, and the Chronic Pain Grade Disability Questionnaire. A strong relationship between neck disability and jaw disability was found (r=0.82). Craniocervical posture (measured using the eye-tragus-horizontal angle) was statistically different between patients with myogenous TMD and healthy subjects. However, the difference was too small (3.3º) to be considered clinically relevant. Maximal cervical flexor muscle strength was not statistically or clinically different between patients with TMD and healthy subjects. No statistically significant differences were found in electromyographic activity of the sternocleidomastoid or the anterior scalene muscles in patients with TMD when compared to healthy subjects while executing the craniocervical flexion test (p=0.07). However, clinically important effect sizes (0.42-0.82) were found. Subjects with TMD presented with reduced cervical flexor as well as extensor muscle endurance while performing the flexor and extensor muscle endurance tests when compared to healthy individuals. Furthermore, patients with mixed TMD presented with steeper negative slopes (although modest) at several times during the neck extensor muscle endurance test than healthy subjects. The results of this research provided an important clinical contribution to the area of physical therapy and TMD. It identified impairments in the cervical spine in patients with TMD that could help guide clinicians in the assessment and prescription of more effective interventions for individuals with TMD.
License granted by Susan Armijo Olivo ( on 2010-04-14T21:23:43Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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