Forward Head Posture and Myogenic TMD Association in Smartphone Overuse

Study Overview
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Brief Summary
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The goal of this observational study is to determine the correlation between forward head posture and myogenic temporomandibular disorder, pain pressure threshold and endurance of masticatory and neck muscles in addicted smart phone users. The main question it aims to answer is: • What is the correlation between forward head posture and myogenic temporomandibular disorder, pain pressure threshold and endurance of masticatory and neck muscles in addicted smart phone users?

Detailed Description
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Temporomandibular joint (TMJ) and cervical spine are closely related to each other due to their anatomical, mechanical and neurophysiological relationships. That's why pain and dysfunction in the cervical spine can be observed in patients with temporomandibular disorders (TMD) who may suffer from clinical problems in the masticatory muscles, the temporomandibular joint and other associated structures. Millions of people worldwide use their smartphone devices excessively. Prevalence of smartphone addiction among Egyptian university students was 62.4% revealing that females had a higher addiction than men. This excessive use where subjects downwardly flex their neck to enable them to look at the screen, affects head and neck postures leading to forward head posture (FHP) which consequently alters the position of the mandible along with its functions, resulting in an increase tension in the masticatory muscles causing TMD. Addicted smartphone users contribute to changes in craniocervical region which led to myogenic TMD in young teenagers. Pain, tenderness in masticatory muscles and cervical muscle endurance are common clinical findings in patients with TMD; where muscle tenderness is reduced and cervical muscle endurance was found to have a shorter duration holding time when performing neck extensor endurance test due to higher fatigability of neck extensor muscles.

Official Title
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Correlation Between Forward Head Posture And Myogenic Temporomandibular Disorder In Addicted Smartphone Users

Conditions
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Temporomandibular Disorder

Intervention / Treatment
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* Other: Assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject's age range from 18 - 40 years. Both males and females will be recruited. Subjects diagnosed as myogenic TMD according to the presence of trigger points in masseter, temporalis, upper trapezius and C5-C6 articular pillars according to the myofascial diagnostic criteria that includes a taut band and hypersensitive spot All subjects are heavy smartphones users, using the SAS-SV, the cuffof value for males is 31 and for females is 33. All subjects will have forward head posture assessed by CVA less than 49.9 degrees. Exclusion Criteria: History of head, neck or TMJ trauma Patients who underwent orthodontic treatment Congenital, or acquired postural deformity No previous neck or spinal or TMJ surgery Subjects who are on anti-inflammatory or analgesic drugs for pain

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| subjects with myogenic TMD<br>Subjects diagnosed as myogenic TMD according to the presence of trigger points in masseter, temporalis, upper trapezius and C5-C6 articular pillars Subjects are heavy smartphones users, using the SAS-SV, the cuffof value for males is 31 and for females is 33. Subjects have forward head posture assessed by CVA <49.9 degrees | Other: Assessment<br>* All subjects will be assessed for FHP by taking a lateral view picture to calculate the CVA using the Kinovea software. Each subject with FHP will be examined for myofascial trigger points done by the therapist finger to palpate bilaterally on tender nodules in masticatory and neck muscles. Then using a pressure algometer, the PPT value will be scored for each trigger in each muscle bilaterally. Masticatory muscle endurance will be measured by asking the subject to bite on load sensor for as long as the subject can until exhaustion. Using a stopwatch, the time will be recorded in seconds. Using the craniocervical extension endurance test, the subject will lie prone with their head unsupported and with a bubble inclinometer attached to their head. Using a stopwatch, time in seconds will be recorded to test how long the subject can sustain the neck in neutral position. Finally, a smartphone addiction scale will be answered by the subject to identify how much they are addicted to its use.<br>|
| subjects without myogenic TMD<br>Subjects are heavy smartphones users, using the SAS-SV, the cuffof value for males is 31 and for females is 33. Subjects have forward head posture assessed by CVA <49.9 degrees | Other: Assessment<br>* All subjects will be assessed for FHP by taking a lateral view picture to calculate the CVA using the Kinovea software. Each subject with FHP will be examined for myofascial trigger points done by the therapist finger to palpate bilaterally on tender nodules in masticatory and neck muscles. Then using a pressure algometer, the PPT value will be scored for each trigger in each muscle bilaterally. Masticatory muscle endurance will be measured by asking the subject to bite on load sensor for as long as the subject can until exhaustion. Using a stopwatch, the time will be recorded in seconds. Using the craniocervical extension endurance test, the subject will lie prone with their head unsupported and with a bubble inclinometer attached to their head. Using a stopwatch, time in seconds will be recorded to test how long the subject can sustain the neck in neutral position. Finally, a smartphone addiction scale will be answered by the subject to identify how much they are addicted to its use.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pressure pain threshold | For the masticatory muscles, the subject will be sitting and the therapist will place the pressure algometer on the belly of the masseter and temporalis muscles. A gradual pressure will be applied until the subject experiences pain. The value displayed on the device will be recorded. This will be repeated 3 times on each side. For the upper trapezius muscles, subject will be seated. Using the algometer, a pressure will be applied on midpoint of the trapezius. Then subject will lie prone, to apply pressure by the algometer on a point 1 cm laterally to the midpoint between C6 and C5 spinous processes. A value will be recorded when subject feels pain. This will be repeated 3 times on each side. | 5 mintues | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| muscle endurance | To assess masticatory muscles, subject will sit in an upright position and will bite on the first molar at maximum voluntary contraction until exhaustion on an I load mini bite load cell. Using a stopwatch, time in seconds will be recorded for both sides. long maintenance time means good endurance.Test will be terminated when any pain or discomfort is felt in the masticatory muscles.Craniocervical extension endurance test will assess neck extensors endurance. Subject will lie prone on a plinth with the head and neck unsupported and a bubble inclinometer will be fixed on the head using a strap. Subject will be asked to sustain a neutral position for as long as possible and time in seconds will be recorded. The test will be terminated if pain is felt in the neck or if the head failed to maintain its neutral position or if it moved more than 5 degrees shown by inclinometer. | 10 minutes | 
| smartphone addiction scale short version | Smartphone addiction scale - short version (SAS-SV) is a screening tool to identify individuals that are dependent on smartphone use. Maximum score is 60 and the minimum is 10. The cut off value of smartphone addiction use differ by gender, in males it is 31 and in females it is 33. higher score means patient were addicted on the smartphones. | 2 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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forward head posture, smartphone