Temporomandibular Disorders and Facial Pain: A Psychophysiological Perspective

This article presents a psychophysiological perspective on temporomandibular muscle and joint disorders (TMJD) and facial pain. After a brief introduction to TMJD, the article presents data, largely derived from work carried out in my laboratory, that address four questions: (1) What are the consequences of parafunctional activities? (2) Do TMJD patients engage in parafunctional activities? (3) Why are TMJD patients unaware of these activities? and (4) What are the implications of these findings for treatment? The findings suggest that low-level parafunctions increase pain in otherwise pain-free individuals and can produce symptoms sufficiently severe to meet the diagnostic criteria for TMJD diagnoses of myofascial pain and/or arthralgia. Patients with certain forms of TMJD report very high levels of parafunctional tooth contact. Their lack of awareness of these behaviors may arise from uncertain definitions of the term “clenching”, from proprioceptive deficits, or from the presence of adjunctive behaviors. Preliminary work shows that reduction in tooth contact via habit reversal techniques may be a promising mechanism for reducing pain in these patients.     

Spatial reorganisation of muscle activity correlates with change in tangential force variability during isometric contractions

The aim of this study was to quantify the effects of spatial reorganisation of muscle activity on task-related and tangential components of force variability during sustained contractions. Three-dimensional forces were measured from isometric elbow flexion during submaximal contractions (50 s, 5–50% of maximal voluntary contraction (MVC)) and total excursion of the centre of pressure was extracted. Spatial electromyographic (EMG) activity was recorded from the biceps brachii muscle. The centroids of the root mean square (RMS) EMG and normalised mutual information (NMI) maps were computed to assess spatial muscle activity and spatial relationship between EMG and task-related force variability, respectively. Result showed that difference between the position of the centroids at the beginning and at the end of the contraction of the RMS EMG and the NMI maps were different in the medial–lateral direction (P < 0.05), reflecting that muscle regions modulate their activity without necessarily modulating the contribution to the task-related force variability over time. Moreover, this difference between shifts of the centroids was positively correlated with the total excursion of the centre of pressure at the higher levels of contractions (>30% MVC, R² > 0.30, P < 0.05), suggesting that changes in spatial muscle activity could impact on the modulation of tangential forces. Therefore, within-muscle adaptations do not necessarily increase force variability, and this interaction can be quantified by analysing the RMS EMG and the NMI map centroids.     

Muscular sound and force relationship during isometric contraction in man

The contracting muscle generates a low frequency sound detectable at the belly surface, ranging from 11 to 40 Hz. To study the relationship between the muscular sound and the intensity of the contraction a sound myogram (SMG) was recorded by a contact sensor from the biceps brachii of seven young healthy males performing 4-s isometric contractions from 10% to 100% of the maximal voluntary contraction (MVC), in 10% steps. Simultaneously, the electromyogram (EMG) was recorded as an index of muscle activity. SMG and EMG were integrated by conventional methods (iSMG and iEMG). The relationship between iSMG and iEMG vs MVC% is described by parabolic functions up to 80% and 100% MVC respectively. Beyond 80% MVC the iSMG decreases, being about half of its maximal value at 100% MVC. Our results indicate that the motor unit recruitment and firing rate affect the iSMG and iEMG in the same way up to 80% MVC. From 80% to 100% MVC the high motor units' discharge rate and the muscular stiffness together limit the pressure waves generated by the dimensional changes of the active fibres. The muscular sound seems to reflect the intramuscular visco-elastic characteristics and the motor unit activation pattern of a contracting muscle.     

Effect of innervation zones in estimating biceps brachii force-EMG relationship during isometric contraction

Measuring muscle forces in vivo is invasive and consequently indirect methods e.g., electromyography (EMG) are used in estimating muscular force production. The aim of the present paper was to examine what kind of effect the disruption of the physiological signal caused by the innervation zone has in predicting the force/torque output from surface EMG. Twelve men (age 26 (SD ±3) years; height 179 (±6) cm; body mass 73 (±6) kg) volunteered as subjects. They were asked to perform maximal voluntary isometric contraction (MVC) in elbow flexion, and submaximal contractions at 10%, 20%, 30%, 40%, 50% and 75% of the recorded MVC. EMG was measured from biceps brachii muscle with an electrode grid of 5 columns × 13 rows. Force-EMG relationships were determined from individual channels and as the global mean value. The relationship was deemed inconsistent if EMG value did not increase in successive force levels. Root mean squared errors were calculated for 3rd order polynomial fits. All subjects had at least one (4-52) inconsistent channel. Two subjects had inconsistent relationship calculated from the global mean. The mean root mean squared error calculated using leave one out method for the fits of the individual channels (0.33 ± 0.17) was higher (P < 0.001) than the error for the global mean fit (0.16 ± 0.08). It seems that the disruption of the physiological signal caused by the innervation zone affects the consistency of the force-EMG relationship on single bipolar channel level. Multichannel EMG recordings used for predicting force overcame this disruption.     

Muscle activation patterns of selected lower extremity muscles during stepping and cutting tasks

Lower extremity muscle activations during crossover and side step cut tasks are hypothesized to play an important role in controlling knee motion, and therefore, impact the design of knee injury prevention and rehabilitation programs. However, the contribution of lower extremity muscles to frontal and transverse plane moments during cutting tasks is unclear. The purpose of this study was to compare the muscle activation patterns of selected lower extremity muscles (vastus lateralis, medial/lateral hamstrings and medial/lateral gastrocnemius) of subjects performing a stepping down and side step cut, a stepping down and crossover cut and an equivalent straight ahead task. Ground reaction force was used to determine the cut angle, stance time and compare the lower limb loading during each task. Electromyography data during all tasks were normalized to the average activation during the straight ahead tasks to determine relative changes in muscle activation between the straight ahead and different cut styles (crossover and side step). There were no differences in the pattern of muscle activation of the vastus lateralis, or lateral hamstring muscles when comparing the cutting tasks to the equivalent straight ahead task. However, the crossover cut task resulted in significantly higher muscle activation of the medial hamstrings and lateral gastrocnemius muscles relative to both the side step cut and straight ahead tasks. These results suggest the medial/lateral hamstrings and medial/lateral gastrocnemius play a role in transverse and frontal plane control during cut tasks.     

Muscle activity reduces soft-tissue resonance at heel-strike during walking

Muscle activity has previously been suggested to minimize soft-tissue resonance which occurs at heel-strike during walking and running. If this concept were true then the greatest vibration damping would occur when the input force was closest to the resonant frequency of the soft-tissues at heel-strike. However, this idea has not been tested. The purpose of this study was to test whether muscle activity in the lower extremity is used to damp soft-tissue resonance which occurs at heel-strike during walking. Hard and soft shoe conditions were tested in a randomized block design. Ground reaction forces, soft-tissue accelerations and myoelectric activity were measured during walking for 40 subjects. Soft-tissue mass was estimated from anthropologic measurements, allowing inertial forces in the soft-tissues to be calculated. The force transfer from the ground to the tissues was compared with changes in the muscle activity. The soft condition resulted in relative frequencies (input/tissue) to be closer to resonance for the main soft-tissue groups. However, no increase in force transmission was observed. Therefore, the vibration damping in the tissues must have increased. This increase concurred with increases in the muscle activity for the biceps femoris and lateral gastrocnemius. The evidence supports the proposal that muscle activity damps soft-tissue resonance at heel-strike. Muscles generate forces which act across the joints and, therefore, shoe design may be used to modify muscle activity and thus joint loading during walking and running.     

The effect of exercise induced hyperthermia on muscle fibre conduction velocity during sustained isometric contraction

This study investigated the effect of dynamic exercise in a hot environment on muscle fibre conduction velocity (MFCV) of the knee extensors during a sustained isometric contraction. Seven trained male cyclists (mean [±SD], age, and were 35 ± 9.9 and 57.4 ± 6.6 ml kg⁻¹ min⁻¹) cycled for 50 min at 60% of peak power output in either: (1) 40 °C (HOT); or (2) 19 °C (NEUTRO); and (3) remained passive in 40 °C (PASS). Post-intervention a 100 s maximal sustained isometric contraction (SMC) of the knee extensors was performed. Rectal temperature increased (p < 0.01) for both HOT and NEUTRO with PASS unchanged and with HOT rising higher (p < 0.01) than NEUTRO (38.6 ± 0.4 vs. 37.6 ± 0.4 °C). Muscle temperature increased (p < 0.01) for all three conditions with HOT rising the highest (p < 0.01) (40.3 ± 0.5 vs. 38.3 ± 0.3 and 37.6 ± 1.3 °C for NEUTRO and PASS, respectively). Lactate showed higher accumulation (p < 0.01) for HOT than NEUTRO (6.9 ± 2.3 vs. 4.2 ± 2.1 mmol l⁻¹). During SMC the torque, electromyography root mean squared (RMS) and MFCV all significantly (p < 0.01) declined. Only in HOT did MFCV decline significantly (p < 0.01) less than torque and RMS (9.9 ± 6.2% vs. 37.5 ± 17.8% and 37.6 ± 21.4%, respectively). In conclusion, during exercise induced hyperthermia, reduced motor unit recruitment as opposed to slower conducting properties of the muscle fibre appears to be responsible for the greater reduction in torque output.     

Inspiratory muscle activity during bird song

The apparently continuous flow of bird song is in reality punctuated by brief periods of silence during which there are short inspirations called minibreaths. To determine whether these minibreaths are accompanied, and thus perhaps caused, by activity in inspiratory muscles, electromyographic (EMG) activity was recorded in M. scalenus in zebra finches and in M. scalenus and Mm. levatores costarum in cowbirds, together with EMGs from the abdominal expiratory muscles, air sac pressure and tracheal airflow. EMG activity in Mm. scalenus and levatores costarum consistently preceded the onset of negative air sac pressure by ∼11 ms during both quiet respiration and singing in both species. The electrical activity of these two muscles was very similar. Compared with during quiet respiration, the amplitude of inspiratory muscle EMG during singing was increased between five- and 12-fold and its duration was decreased from >200 ms to on average 41 ms during minibreaths, again for both species, but inspiratory muscle activity did not overlap with that of the expiratory muscles. Thus, there was no indication that the inspiratory muscles acted either to shorten the duration of expiration or to reduce the expiratory effort as might occur if both expiratory and inspiratory muscles were simultaneously active. Inspiratory and expiratory muscle activities were highly stereotyped during song to the extent that together, they defined the temporal pattern of the songs and song types of individual birds. © 1998 John Wiley & Sons, Inc. J Neurobiol 36: 441–453, 1998     

Association between force fluctuation during isometric ankle abduction and variability of neural drive in peroneus muscles

Analyzing motor unit (MU) activities of peroneus muscles may reveal the causes of force control deficits of ankle eversion. This study aimed to examine peroneus muscles’ MU discharge characteristics and associations between force fluctuation and variability of the neural drive in healthy participants. Thirty-one healthy males participated in this study. MU activities were identified from high-density surface electromyography of peroneus muscles during ankle eversion at 15 and 30% of maximal voluntary contraction (MVC). Participants increased the contraction level until reaching the target and held it for 15 s. The central 10 s of the hold phase were used for analysis. A cumulative spike train (CST) was calculated using MU firings. Variabilities of the force and CST are represented by the coefficient of variation (CoV). Spearman’s rank correlation coefficient was used to assess the association between CoV of force and CoV of CST. For 15 and 30 % MVC trials, CoV of force was 1.86 ± 1.59 and 1.57 ± 1.26%, and CoV of CST was 5.01 ± 3.24 and 4.51 ± 2.78%, respectively. The correlation was significant at 15% (rho = 0.27, p < 0.001) and 30% (rho = 0.32, p < 0.001) MVC. Our findings suggest that in peroneus muscles, force fluctuation weakly to moderately correlates with neural drive variability.     

EMG power spectra of trunk muscles during graded maximal voluntary isometric contraction in flexion-rotation and extension-rotation

The purpose of this study was to determine the electromyographic (EMG) power spectral characteristics of seven trunk muscles bilaterally during two complex isometric activities extension-rotation and flexion-rotation, in both genders to describe the frequency-domain parameters. Eighteen normal young subjects volunteered for the study. The subjects performed steadily increasing isometric extension-rotation and flexion-rotation contractions in a standard trunk posture (40 degrees flexed and 40 degrees rotated to the right). A surface EMG was recorded from the external and internal oblique, rectus abdominis, pectoralis, latissimus dorsi, and erector spinae muscles at the 10th thoracic and the 3rd lumbar vertebral levels, at 1 kHz and 25%, 50%, 75% and 100% of maximal voluntary contraction (MVC). The median frequency (MF), mean power frequency (MPF), frequency spread and peak power were obtained from fast Fourier transform analysis. The MF and MPF for both extension-rotation and flexion-rotation increased with the grade of contraction for both males and females. The EMG spectra in flexion-rotation were different from those of extension-rotation (P < 0.001). The left external and right internal oblique muscles played the role of antagonists in trunk extension-rotation. There was an increase in the MF of the trunk muscles with increasing magnitude of contraction. Frequency-domain parameters for both the male and female subjects were significantly different (P < 0.001).     

Motor unit firing patterns of lower leg muscles during isometric plantar flexion with flexed knee joint position

The ankle flexor and extensor muscles are essential for pedal movements associated with car driving. Neuromuscular activation of lower leg muscles is influenced by the posture during a given task, such as the flexed knee joint angle during car driving. This study aimed to investigate the influence of flexion of the knee joint on recruitment threshold-dependent motor unit activity in lower leg muscles during isometric contraction. Twenty healthy participants performed plantar flexor and dorsiflexor isometric ramp contractions at 30 % of the maximal voluntary contraction (MVC) with extended (0°) and flexed (130°) knee joint angles. High-density surface electromyograms were recorded from medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) muscles and decomposed to extract individual motor units. The torque-dependent change (Δpps /Δ%MVC) of the motor unit activity of MG (recruited at 15 %MVC) and SOL (recruited at 5 %MVC) muscles was higher with a flexed compared with an extended knee joint (p < 0.05). The torque-dependent change of TA MU did not different between the knee joint angles. The motor units within certain limited recruitment thresholds recruited to exert plantar flexion torque can be excited to compensate for the loss of MG muscle torque output with a flexed knee joint.     

Slow expiration reduces sternocleidomastoid activity and increases transversus abdominis and internal oblique muscle activity during abdominal curl-up

The aim of this study was to investigate the effects of quiet inspiration versus slow expiration on sternocleidomastoid (SCM) and abdominal muscle activity during abdominal curl-up in healthy subjects. Twelve healthy subjects participated in this study. Surface electromyography (EMG) was used to collect activity of bilateral SCM, rectus abdominis (RA), external oblique (EO), and transversus abdominis/internal oblique (TrA/IO) muscles. A paired t-test was used to determine significant differences in the bilateral SCM, RF, EO, and TrA/IO muscles between abdominal curl-up with quiet inspiration and slow expiration. There were significantly lower EMG activity of both SCMs and greater EMG activity of both IOs during abdominal curl-up with slow expiration, compared with the EMG activity of both SCMs and IOs during abdominal curl-up with quiet inspiration (p < .05). The results of this study suggest that slow expiration would be recommended during abdominal curl-up for reduced SCM activation and selective activation of TrA/IO in healthy subjects compared with those in abdominal curl up with quiet inspiration.     

Subject-specific thumb muscle activity during functional tasks of daily life

BackgroundThe trapeziometacarpal joint is subjected to high compressive forces during powerful pinch and grasp tasks due to muscle loading. In addition, muscle contraction is important for stability of the joint. The aim of the present study is to explore if different muscle activation patterns can be found between three functional tasks.MethodsIsometric forces and fine-wire electromyographic (fEMG) activity produced by three intrinsic and four extrinsic thumb muscles were measured in 10 healthy female volunteers. The participants performed isometric contractions in a lateral key pinch, a power grasp and a jar twist task. The tasks were executed with and without EMG recording to verify if electrode placement influenced force production.ResultsA subject-specific muscle recruitment was found which remained largely unchanged across tasks. Extrinsic thumb muscles were significantly more active than intrinsic muscles in all tasks. Insertion of the fEMG electrodes decreased force production significantly in all tasks.ConclusionThe thumb muscles display a high variability in muscle activity during functional tasks of daily life. The results of this study suggest that to produce a substantial amount of force, a well-integrated, but subject-specific, co-contraction between the intrinsic and extrinsic thumb muscles is necessary.     

Comparison of electromyographic activity during eccentrically versus concentrically loaded isometric contractions

Electromyographic (EMG) amplitude and mechanical tension are directly related during isometric contraction. Maximal voluntary isometric contractions are typically elicited through two different procedures; resisting a load, which is eccentric in nature, and contracting against an immovable object, which is concentric in nature. A wealth of literature exists indicating that EMG amplitude during concentric contractions is greater than that of eccentric contractions of the same magnitude. However, the effects of different methods to elicit isometric contraction on EMG amplitude have yet to be investigated. The purpose of this study was to compare EMG amplitudes under different loading configurations designed to elicit isometric muscle contraction. Twenty healthy volunteers (10 males and 10 females, age = 23 ± 2 yrs, height = 1.7 ± 0.09 m, mass = 69.9 + 16.8 kg) performed a maximal voluntary plantarflexion effort for which the vertical ground reaction force (GRFv) sampled from a force plate and surface EMG of the soleus were recorded. Participants then performed isometric plantarflexion at 20%, 30%, 40%, and 50% GRFv_max in a seated position, from a neutral ankle position, under two different counterbalanced isometric loading conditions (concentric and eccentric). For concentric loading conditions, the subject contracted against an immovable resistance to the specified %GRFv identified via visual and auditory feedback. For eccentric loading conditions, subjects contracted against an applied load placed on the distal anterior thigh that produced the specified %GRFv. This applied load had the tendency to force the ankle into dorsiflexion. Therefore, plantarflexion force, in an attempt to maintain the ankle in a neutral position, resisted lengthening of the plantarflexor musculature, thus representing eccentric loading during an isometric contraction. Mean EMG amplitude was compared across loading levels and types using a 2 (loading type: concentric, eccentric) × 4 (loading level: 20%, 30%, 40%, 50% GRFv) repeated-measures ANOVA. The main effect for loading level was significant (p = 0.007). However, the main effect for loading type, and the loading type × loading level interaction were non-significant (p > 0.05). The present findings provide evidence that isometric muscle contractions loaded in either concentric or eccentric manners elicit similar EMG amplitudes, and are therefore comparable in research settings.     

Muscle activity during maximal isometric forearm rotation using a power grip

This study aimed to provide quantitative activation data for muscles of the forearm during pronation and supination while using a power grip. Electromyographic data was collected from 15 forearm muscles in 11 subjects while they performed maximal isometric pronating and supinating efforts in nine positions of forearm rotation. Biceps brachii was the only muscle with substantial activation in only one effort direction. It was significantly more active when supinating (µ = 52.1%, SD = 17.5%) than pronating (µ = 5.1%, SD = 4.8%, p < .001). All other muscles showed considerable muscle activity during both pronation and supination. Brachioradialis, flexor carpi radialis, palmaris longus, pronator quadratus and pronator teres were significantly more active when pronating the forearm. Abductor pollicis longus and biceps brachii were significantly more active when supinating. This data highlights the importance of including muscles additional to the primary forearm rotators in a biomechanical analysis of forearm rotation. Doing so will further our understanding of forearm function and lead to the improved treatment of forearm fractures, trauma-induced muscle dysfunction and joint replacements.     

Differential contributions of ankle plantarflexors during submaximal isometric muscle action: A PET and EMG study

The objective of this study was to investigate the relative contributions of superficial and deep ankle plantarflexors during repetitive submaximal isometric contractions using surface electromyography (SEMG) and positron emission tomography (PET). Myoelectric signals were obtained from twelve healthy volunteers (27.3 ± 4.2 yrs). A tracer ([¹⁸F]-FDG) was injected during the exercise and PET scanning was done immediately afterwards. The examined muscles included soleus (Sol), medial gastrocnemius (MG), lateral gastrocnemius (LG), and flexor hallucis longus (FHL). It was found that isometric maximal voluntary contraction (MVC) force, muscle glucose uptake (GU) rate, and SEMG of various plantarflexors were comparable bilaterally. In terms of %EMG MVC, FHL and MG displayed the highest activity (∼34%), while LG (∼21%) had the lowest activity. Cumulative SEMG from all parts of the triceps surae (TS) muscle accounted for ∼70% of the combined EMG signal of all four plantarflexors. As for GU, the highest quantity was observed in MG (2.4 ± 0.8 μmol * 100 g⁻¹ * min⁻¹), whereas FHL (1.8 ± 0.6 μmol * 100 g⁻¹ * min⁻¹) had the lowest uptake. Cumulative GU of TS constituted nearly 80% of the combined GU. The findings of this study provide valuable reference for studies where individual muscle contributions are estimated using models and simulations.     

Preferred step frequency during downhill running may be determined by muscle activity

It is well established that metabolic cost is minimized at an individual’s running preferred step frequency (PSF). It has been proposed that the metabolic minimum at PSF is due to a tradeoff between mechanical factors, however, this ignores muscle activity, the primary consumer of energy. Thus, we hypothesized that during downhill running, total muscle activity would be greater with deviations from PSF. Specifically, we predicted that slow step frequencies would have greater stance activity while fast step frequencies would have greater swing activity. We collected metabolic cost and leg muscle activity data while 10 healthy young adults ran at 3.0 m/s for 5 min at level and downhill at PSF and ±15% PSF. In support of our hypothesis, there was a significant main effect for step frequency for both metabolic cost and total muscle activity. In addition, there was greater muscle activity in the stance phase during the slower step frequency while muscle activity was greater in the swing phase during the fast step frequency. This suggests that PSF is partially determined by the tradeoff between the greater cost of muscle activity in the swing phase and lower cost in the stance phase with faster step frequency.