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.