PNF Exercises on Treatment of Temporomandibular Dysfunction

Study Overview
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Brief Summary
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Temporomandibular joint dysfunction (TMJD) is an important health problem that occurs approximately in 22 to 35 percent of adults, different physiotherapy methods are reported as treatment options for management of TMJD. Although that, there is no previous studies about the efficacy of PNF exercises in treatment of TMJD in patients with forward head posture. So, the purpose of the present double-blind, randomized, controlled trial is to investigate the efficacy of PNF exercises in treatment of TMJD in patients with forward head posture.

Official Title
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Efficacy of PNF Exercises on Treatment of Temporomandibular Dysfunction in Patients With Forward Head Posture: A Double-blind, Randomized, Controlled Trial

Conditions
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Temporomandibular Joint Disorders

Intervention / Treatment
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* Other: proprioceptive neuromuscular facilitation exercises
* Other: traditional physical therapy treatment


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Patients of both genders of age between 20-40 years having symptoms of TMD for at least six weeks duration established by an expert physician or orthopaedician having forward head posture with CVA < 53 pain over TMJ between 3 to 6 on NPRS mouth opening < 25mm. Exclusion criteria: Patients will be excluded if they exhibited any of the following criteria: TMJ fracture undergone any surgical procedure for TMJ Fracture surrounding TMJ Dislocation or subluxation of TMJ systemic generalized joint diseases, such as rheumatoid arthritis, and osteoporosis, congenital diseases, or facial paralysis recently any dental treatment is taken or surgery over TMJ hematological cervical disorders which may affect the jaw Neurological deficits e.g. Bells palsy, Trigeminal neuralgia. Recent infections (within the last six months) affecting the head and neck e.g. bone infections, meningitis, encephalitis, malaria, ear infection Participants who were using any functional appliances e.g. dentures, braces, bite appliances which had been adjusted or fitted in the last 12 weeks prior to the commencement of this study DDwR, DDwoR Patients were excluded from the study if they were receiving any other form of treatment for their TMJ dysfunction.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 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
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: study group<br> | Other: proprioceptive neuromuscular facilitation exercises<br>* PNF exercises will be done for Masseter, Temporalis, Lateral pterygoid and medial pterygoid muscles. Each contraction will be held for 10 seconds, and each stretch (relaxation phase) will be allowed to continue as long as the muscle tension continued to give away.<br>|
| Active Comparator: control group<br> | Other: traditional physical therapy treatment<br>* Ultrasound: Continuous ultrasound at 1MHZ to temporomandibular joint at 1.0-1.25 W/CM2 for 5 min over each affected TMJ and masseter area, with the mouth in a slightly open position. Forward head posture correction exercises including: chin tuck exercise, Strengthening shoulder retractors, stretching of sternocleidomastoid muscle, and Stretching of pectoralis muscle.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pressure Pain Threshold | A pressure algometer will be used for the objective measurement of the PPT. The algometer was pressed on the masseter, temporalis muscles until the patient feel pain. The unit of measurement will be in kg/cm2, and three measurements will be taken every 30 seconds. The average of the three consecutive measurements will be taken as the final value. | change from base line at 6 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ROM assessment | A caliper will be used to measure mandibular depression, protrusion and lateral deviation. | change from base line at 6 weeks. | 
| Temporomandibular Disorder Disability Questionnaire | This questionnaire consists of the following: The Temporomandibular Disorder Disability Index. It consists of 10 questions with 5 possible answers, rating a 0 to 4 score level for each of the answers. The Temporomandibular Disorder symptom intensity scale and the Temporomandibular Disorder symptom frequency scale are two visual analogue scales which address the frequency and intensity of a patient's TMJ symptoms and consist of 7 sections for each scale where the patient must rate his/her intensity and frequency of symptoms on a scale of 0 to 10 score level. The Pain Drawing sheet is used by the patients to capture pain location and quality. | change from base line at 6 weeks. | 
| Numerical Rating Scale (NRS) | The patient will be asked to indicate a number between 0 and 100 on a horizontal line, that best described his/her perceived level of pain intensity when it is at its worst and when it is at is least. The average of these two totals indicates the average pain experienced by the patient as a percentage. | change from baseline at 6 weeks. |