Temporomandibular Joint Disorders, Myofascial Pain Syndromes, Mandibular Dysfunction
Conditions
Keywords
Temporomandibular Joint Dysfunction, Post-Isometric Relaxation, range of motion
Brief summary
This planned randomized, single-blind clinical trial will investigate the effects of adding the Post-Isometric Relaxation (PIR) technique to a standard postural exercise program in individuals with moderate to severe temporomandibular joint dysfunction (TMD). Forty volunteers aged 18-25 years will be recruited and randomly assigned to either an experimental group (postural exercises + PIR) or a control group (postural exercises only). The intervention will be delivered three times per week for six weeks. Primary outcomes will include cervical range of motion, mandibular mobility, head anterior tilt, and thoracic kyphosis index, measured before and after the intervention. The study aims to determine whether PIR provides additional benefits to standard postural exercises in improving jaw and neck function and postural alignment in young adults with TMD.
Detailed description
Temporomandibular joint dysfunction (TMD) is a common musculoskeletal condition characterized by jaw pain, limited mouth opening, and joint sounds, often accompanied by postural deviations such as forward head posture and thoracic kyphosis. Conservative treatments, including postural exercises and manual therapy, are recommended to improve jaw and neck function and reduce symptoms. The Post-Isometric Relaxation (PIR) technique is a manual therapy method that uses gentle isometric contractions followed by passive stretching to reduce muscle tension and increase mobility. While PIR has been shown to improve masticatory muscle function, its combined use with postural exercises in TMD management has not been fully evaluated. In this planned study, forty volunteers aged 18-25 years with moderate or severe TMD (diagnosed using the Fonseca Anamnestic Questionnaire) will be recruited. Participants will be randomly assigned into two groups: Experimental group: Postural exercise program + PIR technique Control group: Postural exercise program only The postural exercise program will include strengthening, stretching, and mobility exercises for the cervical and thoracic regions, performed three times per week for six weeks. In the experimental group, the PIR technique will be applied to jaw muscles according to a standardized protocol. Outcome measures will include: Cervical range of motion (flexion, extension, lateral flexion, rotation) measured with a goniometer Mandibular mobility (depression, lateral deviation, protrusion) measured with a caliper Head anterior tilt (chin-sternum distance, occiput-wall distance) Thoracic kyphosis index measured with a flexicurve Assessments will be conducted before the intervention and after the six-week program. The primary hypothesis is that the addition of PIR to postural exercises will produce greater improvements in cervical and mandibular mobility than postural exercises alone. This trial is expected to provide new evidence for combining manual therapy with exercise in the management of TMD in young adults and may help guide future rehabilitation strategies.
Interventions
BEHAVIORALPostural Exercises + Post-Isometric Relaxation (PIR) Technique
Participants will perform a standardized postural exercise program (strengthening, stretching, and mobility exercises for the cervical and thoracic regions) three times per week for six weeks. In addition, the Post-Isometric Relaxation (PIR) technique will be applied to jaw muscles during each session to reduce muscle tension and improve mandibular mobility.
BEHAVIORALPostural Exercises
Participants will perform a standardized postural exercise program designed to improve cervical and thoracic mobility and postural alignment. The program will include strengthening, stretching, and mobility exercises targeting the cervical spine, thoracic spine, and related musculature. Each session will last approximately 30-40 minutes and will be conducted three times per week for six weeks under the supervision of a trained therapist.
Sponsors
Sanem ŞENER
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
This is a single-masked trial in which the outcomes assessor is blinded to group allocation. The assessor responsible for measuring cervical range of motion, mandibular mobility, head anterior tilt, and thoracic kyphosis index will not be informed of the participants' assigned intervention group
Intervention model description
Participants will be randomly assigned into two parallel groups: the experimental group will receive postural exercises combined with the Post-Isometric Relaxation (PIR) technique, while the control group will receive postural exercises only. Both groups will follow the intervention protocol three times per week for six weeks, with no crossover between groups.
Eligibility
Sex/Gender
ALL
Age
18 Years to 25 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 25 years * Diagnosis of moderate or severe temporomandibular joint dysfunction (TMD) according to the Fonseca Anamnestic Questionnaire * Presence of TMD symptoms for at least 6 months * No TMD treatment received within the last 6 months * Presence of chewing muscle pain for at least 6 months * Able and willing to participate in the study and follow the exercise program * Signed informed consent form
Exclusion criteria
* History of jaw or facial trauma within the past year * History of temporomandibular joint surgery * Presence of systemic rheumatologic, neurological, or musculoskeletal disorders affecting the jaw, neck, or spine * Pregnancy * Current participation in another clinical trial * Inability to perform the exercise program due to medical or physical limitations * Refusal to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in mandibular depression (mouth opening) | Baseline and after 6 weeks of intervention | The distance between the upper and lower central incisors during maximal mouth opening will be measured in millimeters using a caliper. |
| Change in cervical range of motion | Baseline and after 6 weeks of intervention | Cervical range of motion will be measured in degrees using a goniometer. Movements assessed will include flexion, extension, right and left lateral flexion, and right and left rotation. |
| Change in mandibular lateral deviation (right and left) | Baseline and after 6 weeks of intervention | The horizontal movement of the lower jaw to the right and left will be measured in millimeters using a caliper. |
| Change in mandibular protrusion | Baseline and after 6 weeks of intervention | The anterior translation of the mandible will be measured in millimeters using a caliper. Outcome Measure: Change in head anterior tilt - chin-sternum distance |
| Change in head anterior tilt - chin-sternum distance | Baseline and after 6 weeks of intervention | The vertical distance from the midpoint of the chin to the superior border of the sternum will be measured in centimeters with a measuring tape. |
| Change in head anterior tilt - occiput-wall distance | Baseline and after 6 weeks of intervention | The distance between the occiput and the wall will be measured in centimeters while the participant stands in a natural posture against the wall. |
| Change in thoracic kyphosis index | Baseline and after 6 weeks of intervention | Thoracic kyphosis will be evaluated using a flexicurve ruler to measure curvature from C7 to T12. The thoracic kyphosis index will be calculated as (thoracic width / thoracic length) × 100. |
Contacts
Primary ContactSanem ŞENER
Outcome results
None listed