DISCUSSION
This randomized controlled trial provided evidence regarding the effects
of MT and KTMT interventions on muscle thickness, muscle stiffness,
pain, sleep quality, and quality of life in patients with bruxism. The
results showed significant improvement in muscle stiffness, pain, sleep
quality and quality of life following a 4-weeks MT and KTMT
physiotherapy program.
To date, there are only a few studies investigating the effect of MT
applied to the masticatory muscles and cervical muscles in bruxism. Even
though studies focusing on the effects of massage therapy in patients
with bruxism can be found in literature, massage and MT differ in many
aspects; massage therapy is the use of rhythmically applied pressure to
the skin and soft tissues of the body. Massage therapy is used to reduce
tension, anxiety, stress, and promote overall circulation, relaxation
and flexibility. However, MT is the application of hands-on techniques
to body tissues with the intent to therapeutically treat these tissues.
MT techniques include soft tissue mobilization, myofascial release,
strain-counter strain, muscle energy techniques, joint mobilizations and
manipulations and mobilization with movement. MT techniques are utilized
to enhance the healing process and correct positional faults of
irritated tissues. Therefore, the results of our study were not
discussed with the results of studies focusing on massage therapy in
bruxism.
The current study included the application of MT on the masticatory
muscles and cervical muscles. The cervical muscles were included in MT
due to the nature of masseter and temporal muscle hyperactivity bringing
about headaches and neck pain in patients with bruxism [28, 29] and
it could be seen that there was a decrease in headaches in both groups.
When literature is examined there is a pilot study investigating the
results of osteopathic MT in six patients with bruxism. Even though the
utilized MT techniques are not the same, the researchers concluded that
that osteopathic MT treatment may help patients with bruxism by reducing
their perceived pain and stress levels [30]. Similarly, a case study
was published by Knutson, G., which reports the results of MT in a
six-year-old child. MT was applied on the upper cervical spine and
following treatment the patient had reported a cessation of pain and
sleep bruxing activity [31]. These findings are consistent with our
study. The results of our study suggest that the use of MT as an initial
treatment brings about a decrease in masseter muscle stiffness and pain
perception, and an increase in sleep quality and quality of life. Our
results put forth that MT is a beneficial intervention that could
potentially be useful in the treatment of patients with bruxism.
In literature studies with KT application in patients with bruxism are
present. Keskinruzgar et al., [32] compared the effects of KT with
occlusal splints and concluded that KT was an easy-to-use treatment
method for bruxism and was found to significantly reduce muscle pain and
increase mouth opening in patients with Bruxism. Likewise, in the study
by Rathi et al. [33], KT application had significantly improved pain
and masseter muscle activity in individuals with Bruxism. The authors
concluded that KT can be used along with other therapy methods to manage
symptoms of Bruxism. Our results are in line with the results of these
studies. In this study we have applied KT in addition to MT. It can be
seen that KT has brought about further positive effects when applied in
conjunction with MT. In patients in the KTMT group it was observed that
jaw pain decreased, and pain in bilateral temporalis and right occipital
region of the trapezius muscle decreased more in the KTMT group compared
to the MT group. Previous studies have shown that following KT
application, circulation increases due to an increase in
epidermal-dermal distance and thus edema and inflammation decrease
underneath the application region [34]. Therefore, the additional
effects of KT may have occurred due to the local circulatory increase
taking place underneath the applied tape. In our study, KT used in
conjunction with MT has shown to lead to further improvements and
therefore, in patients with bruxism whose primary complaint is jaw pain,
applying KT on the masseter muscle in addition to MT may bear further
benefits.
This study was not the first to utilize MT however, it was the first
randomized clinical trial assessing the effects of MT and, KT used in
conjunction with MT.
There are some limitations of the present study. The lack of a control
group made it difficult for comparative analysis however, the authors
have found it to be unethical to not provide patients with a treatment
and therefore this study lacks a control group. Additionally, the
effects of these interventions were not compared with the use of
occlusal splints which are a widely used treatment modality in bruxism.
Furthermore, this study only provides the short-term effects of MT and
KTMT in patients with bruxism and long-term effects in larger groups
should be investigated to draw definite conclusions.