Manual Therapy group
Manual Therapy (MT) applied on the masticatory muscles intra and extra orally alongside MT of the cervical region were used in treatment of bruxism. MT brings about benefits by increasing local circulation and decreasing muscle tonus. Additionally, stretching exercises aiming to decrease pain and elongate shortened masticatory muscle fibers by autogenic inhibition of the masseter muscle were also applied. Extra-oral applications consisted of; emphasis on the masseter and temporalis muscle using kneading, friction (performed in the direction of muscle fiber orientation), intramuscular stretching, sliding and ischemic compression for trigger point release. Myofascial release techniques were used to eliminate pain. Additionally, active and passive exercises were applied on the masseter, temporalis, digastric, medial pterygoid and lateral pterygoid muscles. Intra-oral applications consisted of; emphasis on the masseter muscles using kneading, friction (performed in the direction of muscle fiber orientation), intramuscular stretching and sliding, and ischemic compression for trigger point release. Applications of the cervical region consisted of; upper cervical flexion mobilization, C2-C5 central posterior-anterior mobilization, and also kneading, friction (performed in the direction of muscle fiber orientation), intramuscular stretching and sliding maneuvers for the cervical muscles [25]. MT was performed by a physiotherapist certified in MT.