Análise cinemática em indivíduos com e sem dor no pescoço: relação entre cabeça e mandíbula e influência do sexo
Rosa, Lianna Ramalho de Sena
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Cervical dysfunction is associate with musculoskeletal and structural changes, with neck pain being the most common symptom. Kinematic analysis of the neck has been performed focusing the assessment of range of motion. However, the association between head/neck and jaw movements was not investigated in subjects with neck pain, despite the recognition of the close (neuroanatomical and biomechanical) relationship between these segments. Therefore, there is a relevance in clarifying this relationship during both dynamic tasks and isolated movements. Another relevant aspect in this context is the difference between sexes, since the prevalence of neck pain is higher in females, and the recent literature has pointed out a difference in motor behavior between sexes. Two studies were developed and compose this doctoral thesis. In study I we investigated the correlation between head/neck and jaw movements in both females with neck pain and asymptomatic, as well as differences in the range of motion of these segments, and differences in head oscillation during dynamic tasks. In study II we investigated sex differences in the range of head/neck and jaw movements in healthy male and female during isolated movements and dynamic tasks. The correlation between head/neck and jaw movements in the sagittal plane was also investigated, as well as the muscular endurance of deep cervical flexors and joint position sense of the head. The results of studies I and II allowed us to affirm that there is a strong correlation between head/neck extension and jaw depression during maximum mouth opening in females with neck pain and asymptomatic, and also in males; females with neck pain have higher range of motion and greater variability of head/neck movements in specific tasks when compared to asymptomatic females; males have greater magnitude and variability of errors in the joint position sense of the head than females. Both studies are consistent in showing the strong correlation between head/neck extension and jaw depression during maximum mouth opening. Future studies should investigate the correlation between movements of these segments in different populations, and using tasks requiring greater biomechanical demand than the ones we used. Pain seems do not avoid females with neck pain to perform functional tasks. However, clinicians should be aware about the greater range of motion and variability observed in head movements of females with pain compared to asymptomatic ones. In the long term, there might have tissue overload. In addition, differences between sexes should be considered in the assessment and treatment of head/neck and temporomandibular joint disorders.