Aim: Child sexual abuse exerts severe psychological and physiological effects on victims, frequently resulting in enduring and complex mental health difficulties throughout the lifespan. For this purpose, we examined the impact of physiotherapy-based aerobic exercise interventions on selected indicators of post-traumatic stress, physical activity levels and flexibility in children who have experienced sexual abuse.Method: The study was designed with three groups, comprising a total of 34 participants. The groups included a control group, a home-exercise group, and a physiotherapist-guided exercise group, each receiving a 12-week intervention. Post-traumatic stress symptoms (Adolescent Dissociative Experiences Scale, A-DES), physical activity level (Physical Activity Questionnaire for Older Children, PAQ-C) and flexibility (Trunk Lateral Flexion Test) were assessed both before and after the intervention period.Results: Statistically significant improvements were observed in the Trunk Lateral Flexion Test in all groups (p<0.05). However, no statistically significant intra- or intergroup differences were found for dissociative experiences or physical activity levels (p>0.05).Conclusion: While no significant effects were observed on dissociative symptoms or physical activity levels, the findings may suggest that aerobic exercise has the potential to be integrated as a supportive component of multidisciplinary treatment approaches, particularly in future studies involving larger and more heterogeneous samples.

OBJECTIVE:To compare the effects of initiating a rehabilitation program with open kinetic chain (OKC) versus closed kinetic chain (CKC) exercises on clinical outcomes in degenerative meniscal tears (DMT). DESIGN:Fifty-six patients with DMT were randomized to an 8-week one-on-one synchronous telerehabilitation program. For the first 2 weeks, rehabilitation was initiated with either OKC or CKC exercises. From weeks 3 to 8, both groups performed strengthening exercises targeting their assigned kinetic chain alongside identical functional exercises. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes included the Visual Analog Scale, active range of motion, isometric muscle strength, Lysholm Knee Scoring Scale, and Short Form-12 (SF-12). RESULTS:Both groups showed significant improvements in KOOS subscales after 8 weeks ( P <0.05). However, the OKC group demonstrated greater improvements in KOOS Pain and Knee-related Quality of Life subscales, with mean differences of 12.01 (95% CI: 0.71-18.71) and 17.60 (95% CI: 4.84-30.36), respectively. In addition, the OKC group showed superior results in pain intensity, isometric knee extensor strength, and the SF-12 Physical Component Score ( P <0.05). CONCLUSIONS:Initiating rehabilitation with OKC exercises for the first 2 weeks might offer therapeutic advantages by enhancing early symptom management and quality of life in DMT.

Esports athletes require exceptional cognitive and motor performance, particularly rapid reaction times (RTs). Although caffeine is widely recognized for its ergogenic effects, the benefits of combining caffeine with l-theanine or diaphragmatic breathing on esports performance have not been thoroughly examined. In this randomized, single-blind, three-arm crossover trial, 15 professional male esports athletes (mean age = 22.9 ± 3.8 years) each received three interventions in randomized order: (1) caffeine only, (2) caffeine + l-theanine, and (3) caffeine + diaphragmatic breathing, with a 7-day washout period between sessions. Primary outcomes included auditory and visual RTs and Aim Lab performance scores. Statistical analysis was performed using the Friedman and Wilcoxon signed-rank tests with Bonferroni correction. Both caffeine + l-theanine and caffeine + diaphragmatic breathing significantly improved auditory RT compared to caffeine alone (P = .027). AimLab scores also improved significantly in both combined intervention arms (P = .015 and P = .006, respectively). Visual RT did not differ between conditions. These findings suggest that combining caffeine with either l-theanine or diaphragmatic breathing may offer synergistic cognitive benefits for esports athletes, particularly in enhancing auditory RT and precision, supporting in-game performance beyond caffeine supplementation alone. Trial Registration: This study was registered at ClinicalTrials.gov (ID: NCT06621797).

BACKGROUND:Despite the widespread use of exercise in managing tension-type headache, there remains a lack of research on the effectiveness of combined structured exercise programs. The aim of this study was to investigate the effects of a structured exercise program versus aerobic exercise of equal duration on tension-type headache (TTH). METHODS:Fifty-four female participants aged between 18 and 55 years were randomised to receive a 12-week exercise program, conducted twice a week for 45 min per session. The Structured Exercise Group (SEG) participated in a combination of aerobic, strengthening, and stretching exercises, whereas the Aerobic Exercise Group (AEG) performed only aerobic exercises. The primary outcome measure was the Headache Impact Test (HIT-6), a quality-of-life questionnaire. Secondary outcome measures included headache intensity, disability level, pressure pain threshold, proprioception, muscle strength, cervical posture, exercise capacity, anxiety, and depression. RESULTS:Both groups showed statistically significant improvements in quality of life, pain intensity, disability, anxiety, depression, exercise capacity, pressure pain threshold, and proprioception (p < 0.05). Between-group comparisons revealed that the SEG demonstrated significantly greater improvements in quality of life, pressure pain threshold, proprioception, muscle strength, and posture (p < 0.05), whereas the AEG showed superior gains in exercise capacity (p < 0.05). CONCLUSION:Both exercise programs appear similarly effective for self-reported outcomes. Based on clinical measurement results, we recommend incorporating strengthening and stretching exercises into the aerobic exercise program and extending the duration to 12 weeks for additional benefits. SIGNIFICANCE STATEMENT:This study highlights the clinical value of supervised, physiotherapist-led exercise and the integration of personalised, multi-component strategies in managing tension-type headache. While both structured and aerobic programs improved pain, activity, and participation, the structured approach provided additional benefits in pressure pain threshold, proprioception, muscle strength, and posture. Tailoring interventions to individual clinical needs and extending the duration beyond 8 weeks may further enhance outcomes.

The 25-Question Geriatric Locomotive Function Scale (GLFS-25) is an assessment tool developed by Japanese researchers to evaluate locomotive functions in older adults. The purpose of this study is to translate and culturally adapt the GLFS-25 for use in Turkey, then determine the scale’s reliability and validity in the Turkish context. A total of 264 older adults (124 males; mean age: 71.7 ± 6.2 years) participated in the study. To assess test–retest reliability, 248 participants (112 males; mean age: 71.8 ± 6.2 years) completed the GLFS-25 twice, with an interval of 3 to 14 days. Construct validity was evaluated using the Katz Index of Activities of Daily Living (ADL) and the Lawton Instrumental Activities of Daily Living Scale (IADL). Convergent validity was assessed on the Visual Analogue Scale (VAS) for pain and the Geriatric Depression Scale. The GLFS-25 Turkish showed excellent internal consistency with Cronbach’s alpha coefficient = 0.95 (95

Temporomandibular disorders (TMD) involve complex interactions among behavioral and musculoskeletal factors, and machine learning (ML) has increasingly been used to model these multidimensional relationships. This study aimed to investigate the relationship between smartphone addiction and TMD symptoms by evaluating the possible contributions of clinical variables such as head posture, cervical dysfunction, and masseter muscle sensitivity to this relationship and by examining the multivariate structure using ML methods. A single-blind, cross-sectional study was conducted among university students in Turkey. Participants completed several assessments: Smartphone Addiction Scale-Short Version (SAS-SV), Fonseca Anamnestic Index for TMD severity, Neck Disability Index, Numerical Rating Scale, forward head posture, and masseter muscle pressure pain threshold using algometry. Data were analyzed using Pearson correlation, logistic regression, and various ML classification algorithms (e.g., extreme gradient boosting [XGBoost], support vector machines). Shapley additive explanations analysis was applied to determine variable importance in ML models. In this study, XGBoost demonstrated the most successful performance in determining the relationships between smartphone addiction and TMD symptoms, while the support vector machines model showed the most successful performance in classifying participants. The findings suggest that this ML based approach, taking into account postural abnormalities and masseter muscle sensitivity, could contribute to the early identification of individuals at risk for TMD and the planning of targeted intervention strategies. Research findings have revealed complex relationships between SAS-SV and TMD symptoms among university students. In analyses conducted using ML algorithms, the support vector machines model stood out with the highest classification accuracy (area under the curve [AUC] = 0.94) and performance indicators. Shapley additive explanations analyses showed that smartphone usage time, masseter muscle sensitivity, and Fonseca Anamnestic Index score were the most decisive variables on SAS-SV. In TMD prediction, the highest predictive power was explained by temporomandibular joint pain. Ensemble models such as random forest and gradient boosting yielded more successful results with lower error rates and higher R-2 values compared to classical regression methods. The findings indicate that smartphone use indirectly affects TMD through postural disorders and muscle sensitivity.

Hypertension (HT) is a common chronic condition linked to increased cardiovascular risk, reduced functional capacity, altered muscle properties, and impaired psychosocial well-being. Therefore, this study aimed to compare the 12-week effects of chair-based yoga and manual therapy on cardiovascular, functional, musculoskeletal, and psychosocial outcomes in individuals with HT. This single-blinded, randomized controlled trial included 75 participants (48 females) who were randomly allocated to three groups: Group I (Patient Education-PE), Group II (PE+Chair Yoga), and Group III (PE+Manual Therapy). Interventions were conducted twice weekly for 45 min over 12 weeks. Outcome measures included systolic and diastolic blood pressure (SBP/DBP), heart rate (HR), the 6-Minute Walk Test, muscle tone and stiffness (Myoton PRO), anxiety and depression, and mental well-being. Both Group II and Group III led to significant within-group reductions in SBP (p = 0.02 and p = 0.03, respectively) and HR (p = 0.04 and p = 0.02, respectively), with significant group-by-time interactions favoring Groups II and III over Group I. Functional capacity improved significantly in Groups II and III compared to Group I (p = 0.04). Group III specifically demonstrated significant reductions in muscle tone (p = 0.03) and stiffness (p = 0.04). Group II showed superior improvements in anxiety scores (p = 0.04) and mental well-being compared to other groups. Chair-based yoga and manual therapy are effective non-pharmacological strategies for enhancing autonomic regulation and reducing blood pressure in hypertensive patients. While both interventions improve cardiovascular and functional parameters, manual therapy is more effective for modulating muscle viscoelastic properties. In contrast, chair yoga provides greater benefits for psychosocial well-being and anxiety reduction.

Objectives This randomised clinical trial aims to compare the effectiveness of cervical core stabilization, Rocabado’s protocol and their combination on musculoskeletal and psychosocial outcomes in female patients with myogenic temporomandibular disorders (TMDs). Materials and Methods 59 female patients with myogenic TMDs were allocated to three groups; Rocabado’s exercises, cervical core stabilization, or a combined protocol. All interventions were performed over and eight-week period. Primary outcomes were pain intensity, pressure pain thresholds (PPT), mandibular and cervical range of motion, craniovertebral angle, and deep cervical flexor endurance. Additionally, jaw functional limitation, neck disability, and psychological distress were assessed. All measures were assessed at baseline and post-intervention. Results In within-group comparisons of all groups, statistically significant improvements were observed in almost all outcomes, including pain, PPT, mandibular and cervical mobility, and craniovertebral angle (p<0.05). In between-group comparisons, the Rocabado exercises and cervical core stabilization exercises group showed a significantly greater reduction in night-time pain intensity and craniovertebral angle compared to the combined group (p<0.05). NDI and left temporal muscle PPT results were statistically significantly different in the combined group compared to others (p<0.05). Conclusion Cervical core stabilization was as effective as the Rocabado’s protocol in myogenic TMDs, The combined protocol may provide additional benefits in some outcomes. Adding cervical core stabilization exercises to standard physiotherapy protocols may provide further benefits for myogenic TMD rehabilitation. Clinical Relevance Targeting cervical motor control in addition to mandibular exercises may improve pain, function and psyhcosocial outcomes in patients with myogenic temporomandibular disorders, supporting a multidimensional approach in dental and physiotherapy practice.

PURPOSE:To investigate the effects of core stabilization training (CST), combined with standard rehabilitation, on pain, upper extremity function, shoulder muscle strength, and core stability in patients with subacromial impingement syndrome (SIS). METHODS:Forty-four patients with SIS were randomly assigned to either the core stabilization group (CST + standard rehabilitation) or the control group (standard rehabilitation) and received the interventions for 12 weeks. Primary outcomes were pain and upper extremity function, and secondary outcomes were shoulder muscle strength and core stability parameters. Assessments were performed at baseline and at weeks 3, 6, and 12. RESULTS:A significant main effect of time was observed for pain, upper extremity function, shoulder strength, and core stability (p < 0.001). Significant group × time interactions in favor of the core stabilization group were found for rest pain (p = 0.006), activity pain (p = 0.035), upper extremity function (p < 0.001), and core stability (p < 0.01). Other outcomes showed no significant differences between groups (p > 0.05). CONCLUSIONS:CST combined with standard rehabilitation is effective in reducing pain, improving upper extremity function and core stability in patients with SIS. While it does not provide additional benefits for shoulder muscle strength over standard rehabilitation. CLINICALTRIALS.GOV ID:NCT05966298.

Amaç: Bu çalışmanın amacı, 8-14 yaş aralığındaki Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB) tanılı çocukların fiziksel aktivite düzeyleri, depresyon ve anksiyete durumlarını incelemek ve bu bulguları sağlıklı kontrol grubu ile karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya 35 DEHB tanılı ve 35 sağlıklı çocuk katılmıştır. Fiziksel aktivite düzeyi PAQ-C, depresyon düzeyi CDI ve anksiyete düzeyi STAI envanteri ile değerlendirilmiştir. Bulgular: DEHB grubunda fiziksel aktivite, depresyon ve anksiyete düzeyleri kontrol grubuna kıyasla anlamlı şekilde farklı bulunmuştur (p 0.05). Kontrol grubunda anlamlı korelasyon gözlenmemiştir. Sonuç: DEHB’li çocuklarda fiziksel aktivitenin kaygıyı azaltabileceği, depresyonun ise kaygı ile ilişkili olduğu görülmektedir. Fiziksel aktivite, DEHB’li çocuklarda kaygının yönetiminde koruyucu bir rol oynayabilir.

Background Musicians are performing artists, and parameters such as strength and dexterity are required for their performance. In violinists, who the instrument group with a high prevalence of performance-related musculoskeletal pain (PRMP), the effects of performance on PRMP and these parameters, and the correlation between these parameters and PRMP are also intriguing. Objective To investigate the effects of performance on PRMP, finger grip strength, finger dexterity, and hand grip strength in violinists and also to provide perspective on parameters correlated with PRMP. Methods This study included 78 violinists (mean age: 22.50 ± 2.87, 55 Female-23 Male). Violinists were evaluated for PRMP with the Numeric Rating Scale, finger grip strength with the pinch meter, finger dexterity with the Purdue Pegboard Test, and hand grip strength with the hand dynamometer. Musicians were evaluated on two separate days: 1) during rest and one week later, 2) after playing the Concerto in B Minor (post-performance). Results Post-performance, there was an improvement in PRMP and finger grip strength and a decrease in finger dexterity. There was no change in hand grip strength. PRMP was only correlated with left-hand grip strength, and the explanatory power of left-hand grip strength was low. Conclusions Contrary to the literature, there was a decrease in PRMP post-performance in young violinists. It is noteworthy that finger grip strength increased while finger dexterity decreased. Left-hand grip strength may contribute to the reduction of PRMP. It is clear that more research is needed on musician health and that clear conclusions are still far off.

INTRODUCTION:Primary headaches, particularly migraine and tension-type headaches, as chronic and painful conditions, have a significant impact on individuals' health and overall quality of life, including aspects such as sexual health parameters. OBJECTIVES:The aim of this study was to review observational studies and to summarize the presence of sexual dysfunction in patients with primary headache and to discern whether it is more common in patients with primary headache than in healthy control subjects. METHODS:Observational studies published between January 1, 2000, and May 21, 2023 were searched in Medline (PubMed), Web of Science, Scopus, and EBSCO. This review included 23 observational studies that evaluated sexual dysfunction with or without comparison with healthy control subjects. RESULTS:As a result, the mean Female Sexual Function Index score, a score of <26.55 indicating sexual dysfunction, ranged from 19.25 ± 8.18 to 27.5 ± 7.5 in patients with primary headache. The prevalence of sexual dysfunction and erectile dysfunction was found to be between 10.7% and 93.75% in female patients and between 54.83% and 80% in male patients. Both migraineurs and tension-type headache sufferers had statistically significantly lower sexual function scores in females and lower erectile function scores in males compared with healthy control subjects. CONCLUSION:Sexual function is significantly affected in patients with primary headache, which is a chronic painful disorder. Therefore, it is very important to ask these patients about their sexual health and, if necessary, to seek support from a sexual health professional. Additionally, future studies may prioritize tension-type headaches and male patients due to the limited amount of research available on these subjects.

Introduction: The continuity of the kinetic chain, stomatognathic functions and Temporomandibular Disorders (TMD) are interrelated, but the relationship between them and core stabilization has yet to be known. To investigate the relationship between TMD, forward head posture, tongue strength, and endurance with core stabilization. Material and Methods: This study was conducted on university students aged 18-31. In the evaluation were used that; "Fonseca Anamnestic Index (FAI)" for TMD, "Diagnostic Criteria for Temporomandibular Disorders Examination Form" for pain-free maximum mouth opening (MMO), presence of sound in temporomandibular joint movements, and palpation parameters of the temporomandibular joint and surrounding muscles, "Craniovertebral Angle (CVA)" for forward head posture, "Iowa Oral Performance Instrument" for tongue strength and endurance, "Trunk Flexor Endurance Test and Biering Sorenson Test" for static endurance of the core muscles, and "Sit-ups Test and Modified Push-ups Test" for dynamic endurance of the core muscles. Results: Seventy university students (mean age=20.77 +/- 2.22 years) participated in the study. There was a difference between participants with/without TMD in terms of gender, pain-free MMO, tongue endurance, CVA, and FAI (p<0.05). CVA for FAI (p=0.004), CVA, tongue endurance for the Sit-ups Test (p=0.001, p=0.044 respectively), and tongue endurance for the Modified Push-up Test (p=0.012) were statistically significant predictors. Discussion: There was no direct relationship between TMD and core stabilization. The performance of global core muscles decreased with the increase in TMDrelated forward head posture and a decrease in tongue endurance. Evaluating individuals with TMD holistically may be necessary for successful rehabilitation.

Neuromuscular electrical stimulation (NMES) may enhance the treatment results in the musculoskeletal rehabilitation by increasing the efficiency of the muscle contraction. The aim of our study was to determine the effectiveness of NMES applied simultaneously to exercise on pain, static endurance of cervical deep flexor muscles, fear of movement, and disability in chronic neck pain. A total of 32 patients with chronic neck pain were included. In Group I (mean age: 38 ± 14.85 years), only clinical pilates exercises were performed while in Group II (mean age: 34 ± 11.08 years), NMES was applied simultaneously on lower trapezius and serratus anterior muscles during the same exercises. The primary outcomes, the pain intensity, and disability were assessed with visual analog scale (VAS) and neck disability index (NDI), respectively. As secondary parameters, range of motion (ROM), The Deep Neck Flexor (DNF) Endurance Test and Tampa Scale of Kinesiophobia (TSK) were assessed. In both groups, within group changes were found statistically significant for all the parameters (p = 0.001). In between group comparison, the changes in right/left rotation ROM and in scores of VAS and DNF Endurance Test were found significantly greater in Group II (p = 0.01, d = 1.47; p = 0.003, d = 1.59; p = 0.001, d = 5.35; p = 0.001, d = 2.08, respectively). However, no significant differences were found in terms of ROM (except rotation), NDI and TSK between groups (p > 0.025). Applying NMES simultaneously to exercise was found to be superior to the only exercise in terms of improving pain intensity, ROM of cervical rotation, and muscle endurance, however, no added benefits for disability were observed in chronic neck pain. ClinicalTrials.gov (NCT06320340, retrospectively registered).

Investigating the validity and reliability of the Turkish version of the Breathing Self-Assessment Questionnaire (SEBQ), a tool for measuring dysfunctional breathing. Ninety-two healthy adults (mean (range) age 29.4 (19-56) years; 39 males) were analysed. The SEBQ was translated and adapted into Turkish. At baseline, data were collected using the SEBQ, Nijmegen Questionnaire (NQ), breath-holding time, and Short Form 36 (SF-36). The SEBQ was repeated within 7-14 days. SEBQ validity was assessed through content, structural, and convergent/divergent validity analyses, while reliability was evaluated for internal consistency, stability, and reproducibility. One item was removed based on exploratory factor analysis. The SEBQ has a two-factor structure and explains 50.1% of total variance, confirmed by confirmatory factor analysis. It has a positive correlation with the NQ and a negative correlation with SF-36 subscales, but not with breath-holding time and general health. The Cronbach's alpha coefficient was 0.931, and the intraclass correlation coefficient was 0.814. The Standard Error of Measurement and Smallest Real Difference were 5.06 and 15.03, respectively. The SEBQ is well-structured, valid, internally consistent, stable, and reproducible for assessing subjective unexplained respiratory symptoms in the Turkish population.

Objective: Motor imagery is a therapeutic tool in healthcare, and evaluating motor imagery ability is increasingly important. This study assessed the validity and reliability of the Turkish version of the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2-T). Materials and Methods: 248 young adults (mean age: 21.34±2.33 years) participated in the study. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). Cronbach's alpha determined the internal consistency. Construct validity was assessed through the correlation analysis between the VMIQ-2-T and the Turkish version of the Movement Imagery Questionnaire-3 (MIQ-3-T). Results: The VMIQ-2-T demonstrated good test-retest reliability (ICC2,1=0.74 for external imagery, ICC2,1=0.77 for internal imagery, and ICC2,1=0.82 for kinaesthetic imagery), adequate internal consistency (α=0.94 for all subscales), and good construct validity. Moderate correlations were observed between the subscales of the VMIQ-2-T and MIQ-3-T (r=-0.58 to -0.69, p

ABSTRACT Background Transcutaneous auricular vagus nerve stimulation (TAVNS) stands out as a neuromodulation method that shows therapeutic potential thanks to its ability to regulate autonomic responses. However, the role of TAVNS in the management of bruxism‐related clinical parameters has not been sufficiently investigated. Objective This study aimed to investigate the holistic effects of TAVNS added to exercise therapy on bruxism‐related clinical parameters in patients with clinically based bruxism. Methods This randomised, controlled, single‐blind experimental clinical study included 40 individuals diagnosed with clinically based bruxism, who were randomly assigned to two groups: the TAVNS group ( n = 20) and the control group ( n = 20). Both groups performed the Rocabado exercise program for 8 weeks, while the TAVNS group additionally performed TAVNS. Oral health‐related quality of life, sleep quality, perceived stress level, pain intensity, pain threshold, biomechanical properties of masticatory muscles, masseter muscle activation and autonomic parameters were evaluated before and after treatment. Results The TAVNS group showed significantly better results in oral health‐related quality of life, stress levels, masseter muscle functional parameters (resting activation, tonus, stiffness), and autonomic parameters (pulse rate, respiratory rate, sympathetic activity, sympathovagal balance) compared to the control group ( p < 0.05). Conclusion This study revealed that TAVNS added to exercise therapy provided significant improvements in key clinical parameters associated with bruxism, including both local symptoms (muscle activation and biomechanical properties) and systemic parameters (autonomic parameters, stress, oral health‐related quality of life) in bruxism. Although our findings support the clinical potential of TAVNS as a non‐invasive complementary option for managing bruxism‐related dysfunctions, these effects need to be confirmed in larger samples and long‐term follow‐ups. Trial Registration ClinicalTrials.gov identifier: NCT06386809

BackgroundWhile it is known that smartphone use (SU) affects the musculoskeletal system, the effect of repetitive thumb movements on the masseter muscle has not been systematically investigated.ObjectiveTo investigate the effects of repetitive thumb movements due to SU on the masseter muscle through thenar muscle activity.MethodsThe students' pressure pain thresholds of the thenar and masseter muscles were assessed with an algometer, and bilateral masseter muscle activation was assessed with Electromyography (EMG). Students were asked to perform repetitive thumb taps with their dominant hand for 5 min using the "Fast-Tap" smartphone application.ResultsThis cross- sectional observational study included 105 students aged 20.96 (2.44) years. Post-SU, right thenar (p < .001), right masseter (p < .001), and left masseter (p = .040) pressure pain threshold decreased, and right masseter muscle activation was higher in terms of %MVC values ​​(p < .001). The right and left thenar and masseter muscle pressure pain thresholds were moderately to highly correlated (p < 0.001). Additionally, the number of thumb taps was moderately correlated with right masseter muscle activation (p < 0.001) and weakly correlated with left masseter muscle activation (p = .005).ConclusionRepetitive thumb movements due to SU may affect the masseter muscle, and the thenar-masseter relationship may lead to innovative treatment approaches in the future.