Proprioceptive Neuromuscular Facilitation Exercises in Temporomandibular Dysfunction

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

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.

Study Overview

• Status: Completed
• Conditions: Pain; Temporomandibular Joint Disorders; Temporomandibular Disorder
• Intervention / Treatment: Other: PNF exercises

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 25

Contacts and Locations

Study Locations

• Turkey
  • Beykoz
    • Istanbul, Beykoz, Turkey, 34810
      • Istanbul Medipol University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 25 years (Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

University students

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
PNF group; Proprioceptive Neuromuscular Fascilitation exercises were given this group	Other: PNF exercises; 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.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Istanbul Medipol University Hospital
• Investigators: Study Chair: Esra Atılgan, PhD, Medipol University

Study record dates

Study Major Dates

• Study Start (Actual): January 7, 2020
• Primary Completion (Actual): December 30, 2022
• Study Completion (Actual): December 31, 2022

Study Registration Dates

• First Submitted: July 8, 2021
• First Submitted That Met QC Criteria: July 8, 2021
• First Posted (Actual): July 19, 2021

Study Record Updates

• Last Update Posted (Actual): May 1, 2025
• Last Update Submitted That Met QC Criteria: April 28, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Orofacial Pain; Proprioceptive Neuromuscular Facilitation; Temporomandibular Joint Disorders; Therapeutic Management; Threshold Pressure; Pressure Pain
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Stomatognathic Diseases; Muscular Diseases; Jaw Diseases; Mandibular Diseases; Craniomandibular Disorders; Myofascial Pain Syndromes; Joint Diseases; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
• Other Study ID Numbers: 10840098-604.01.01-E.60748

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No