Proprioceptive Neuromuscular Facilitation Exercises in Temporomandibular Dysfunction

Study Overview
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Brief Summary
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Individuals who were diagnosed with reduction disc displacement by Research Diagnostic criteria for Temporomandibular Disorder (TMD / RDC) were included in the study. Proprioceptive neuromuscular facilitation exercises were performed for 30 minutes using neck jaw and tongue patterns with rhythmic stabilization (RS) and combination of isotonics (CI) techniques by physiotherapist. Maximal mouth openings were measured with caliper, pain intensities were measured with visual analogue scale and pressure pain thresholds with hand algometer.

Detailed Description
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TMD patients who are diagnosed by TMD/RDC are firstly assessed by physiotherapist for maximal mouth opening(MMO), pain intensity and pressure pain threshold. Then they will taught exercises with rhythmic initiation which includes repetation of the patern and 15 repetitions are applied as warm-up period. Proprioceptive neuromuscular facilitation (PNF) exercises are performed in the neck and jaw patterns with rhythmic stabilization (RS) and combination of isotonics (CI) techniques. In the neck, right rotation-right lateral flexion, left rotation-left lateral flexion pattern, and the opening and closing pattern according to the working mechanics of the masseter and temporal muscle in the chin, RS and CI techniques are used. By providing maximum resistance in accordance with the needs of each individual, the RS protocol consist of isometric contractions that would not involve changing movements for 10 seconds. The combination of isotonics technique include combined concentric, isometric, and eccentric contraction of the agonist muscle for 5 seconds of each contraction without rest. CI exercises consist of 15 repetitions per set. A 30-second rest given between sets to include recovery. After exercises immediate MMO, pain intensity and pain treshold assessment will be applied.

Official Title
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The Immediate Effect of Proprioceptive Neuromuscular Facilitation on Pain and Maximal Mouth Opening in Temporomandibular Dysfunction: Pilot Study

Conditions
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Pain, Temporomandibular Disorder, Temporomandibular Joint Disorders

Intervention / Treatment
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* Other: PNF exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Volunteers between 18-25 years female, admitted to the study with clenching, grinding, clicking, jaw pain when eating hard foods, and limited and painful mouth movements. Exclusion Criteria: Having orthopedic, neurological or rheumatological cervical disorders which affect the jaw motions; receiving occlusal therapy as a companion to treatment, those who have an operation in the area of jaw, head and neck and those with vertigo that prevents head movements during exercises.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PNF group<br>Proprioceptive Neuromuscular Fascilitation exercises were given this group | Other: PNF exercises<br>* PNF exercises were applied in 3 sets of 15 repetitions based on movement in the diagonal plane, using head, neck and chin patterns. Contractions were sustained for at least 10 seconds.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain Treshold | The pain threshold will be measured with an algometer at certain points on the muscles in the area where the exercise is applied. | the immediate effect will be measured as soon as the exercise is finished | 
| Pain intensity | The level of pain felt will be marked with a visual analog scale on a 10-centimeter paper. | the immediate effect will be measured as soon as the exercise is finished | 
| Maximum mouth opening | Individuals will be asked to open their mouths as much as they can, and mouth opening will be measured with a caliper. | the immediate effect will be measured as soon as the exercise is finished | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unassisted opening | the individual is told to open their mouth and the gap is measured with a caliper. | the immediate effect will be measured as soon as the exercise is finished | 
| maximum unassisted opening | Without trying to increase the mouth opening with hand or any help, the individual actively opens mouth as much as they can and the opening is measured with a caliper. | the immediate effect will be measured as soon as the exercise is finished | 
| maximum assisted opening | It is measured with a caliper by asking individuals to open their mouths as much as they can and open more by helping with their hands at the last point. | the immediate effect will be measured as soon as the exercise is finished | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Orofacial Pain, Proprioceptive Neuromuscular Facilitation, Therapeutic Management, Threshold Pressure, Temporomandibular Joint Disorders, Pressure Pain