Efficacy of Scapulothoracic Exercises on Postural Stability, Proprioception, Muscular Features and Mandibular Functions

Study Overview
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Brief Summary
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The goal of this Randomized, Double-Blind, Clinical Trial is to investigate the effects of scapulothoracic exercises on postural stability, muscle strength, muscular endurance, mandibular functions and proprioception in sedentary individuals aged 18-45 years with head forward posture and temporomandibular joint dysfunction (Cranio-Cervico-Mandibular Malalignment). The main questions it aims to answer are: • Do Scapulothoracic exercises given in addition to cervical posture exercises have an effect on postural stability, proprioception, muscle strength, muscular endurance and mandibular functions in individuals with Cranio-Cervico-Mandibular malalignment? Researchers will compare conventional neck exercises (control group) and scapulothoracic exercises applied in addition to conventional neck exercises (treatment group) to see the effects of scapulothoracic exercises on the neck and jaw area.

Detailed Description
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The investigators aimed to investigate the effects of scapulothoracic exercises on postural stability, muscle strength, muscular endurance, mandibular functions and proprioception in sedentary individuals aged 18-45 years with cranio-cervico-mandibular malalignment including head-first posture and temporomandibular joint dysfunction problems.

Official Title
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The Effects of Scapulothoracic Exercises on Postural Stability, Muscle Strength, Muscular Endurance and Proprioception in Sedentary Individuals With Cranio-Servico-Mandibular Malalignment

Conditions
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Temporomandibular Joint Dysfunction Syndrome, Forward Head Posture

Intervention / Treatment
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* Other: Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female students and employees between the ages of 18-45, Individuals with a craniovertabral angle (CVA) <50° and a Fonseca questionnaire score between 20-100, Individuals with a Helkimo clinical dysfunction index score between 1-25, Individuals with a low level of physical activity according to the International Physical Activity Questionnaire. Exclusion Criteria: Serious problems of the musculoskeletal system, including the cervical and thoracic spine, Presence of serious chronic diseases such as hypertension, diabetes, cancer, Presence of neurological disease at a level that will affect balance and postural control, Being pregnant, Tooth and jaw problems in the last 6 months, Individuals with a total denture or prosthesis on the anterior teeth.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized Comparative Double-Blind Study
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional Exercise Group (Control Group)<br>Conventional neck exercises were applied to the control group. | Other: Exercises<br>* For control group; Cervical conventional exercises. For treatment group; scapulothoracic exercises including strengthening, proprioceptive and stabilization exercises in addition to cervical conventional exercises<br>|
| Experimental: Scapulothoracic Exercise (Treatment Group)<br>In the treatment group, scapulothoracic exercises were applied in addition to conventional neck exercises. | Other: Exercises<br>* For control group; Cervical conventional exercises. For treatment group; scapulothoracic exercises including strengthening, proprioceptive and stabilization exercises in addition to cervical conventional exercises<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postural Stability | Five different data were obtained: the peripheral length value of the total sway degree (°) made on the device during balance, the percentile value of the area gap (%) showing the percentage of the area drawn according to the reference circle, the sway velocity value (°/sec), the average values (°) reached in the sway in the antero-posterior (AP) and medio-lateral (ML) directions. | Postural stability was measured at 3 different times (before treatment, 8 weeks after treatment, 12 weeks follow up). The average measurement time for each participant was 5 min. | 
| Joint Position Sense | Mandibular and cervical joint position sense measurements were made. | Proprioception measurements were made at 3 different times (before treatment, 8 weeks after treatment, 12 weeks follow up). The mean measurement time for mandibular position sense for each participant was 8 min. Cervical joint position sense measure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle Strength | Isometric muscle strength test will be performed on TMJ depressor muscles and cervical region muscles. | Muscle strength measurements were made at 3 different times (pre-treatment, 8th week post-treatment, 12th-week follow-up). The temporomandibular joint depressor muscle strength measurement time for each participant lasted 3 minutes. The st | 
| Endurance Measurement of Deep Neck Flexor Muscles | The muscular endurance measurement of the deep neck flexors will be made using the craniocervical flexion test and a stabilizer device. | Muscular endurance of deep neck flexors was measured at 3 different times (pre-treatment, 8th week post-treatment, 12th week post-treatment follow-up). It took an average of 15 minutes for each participant. | 
| Mandibular Function Disorder Questionnaire (MFBA) | It is used to evaluate the level of impairment in jaw functions in patients with TMED. | Mandibular Function Disorder Questionnaire (MFBA) was measured at 3 different times (pre-treatment, 8th week post-treatment, 12th week post-treatment follow-up). It took an average of 2 minutes for each participant. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Musculoskeletal Rehabilitation, Temporomandibular Joint Treatment, Scapulothoracic Exercises, Cranio-Cervico-Mandibular Malalignment