Cervical Muscle Endurance and Pressure Pain Threshold in University Students With TMD: A Case-Control Study (TMED-CME-PPT)

February 10, 2026 updated by: BİNNAZ BOZKURT AKPULAT, Kırıkkale University

Investigation of Cervical Muscle Endurance and Pressure Pain Threshold in University Students With Temporomandibular Joint Dysfunction: A Case-Control Study

Aim: This study aims to compare the static endurance of cervical region muscles, pressure pain thresholds of selected muscles of the stomatognathic system, and postural characteristics in young adults with and without temporomandibular joint dysfunction (TMD).

Method: A total of 60 university students aged between 18 and 25 years will be included in the study. Participants will be divided into two groups: individuals with temporomandibular joint dysfunction (TMD group, n=30) and healthy controls (control group, n=30). The static endurance of cervical flexor and extensor muscles will be assessed using standardized endurance tests. Pressure pain thresholds of the temporalis, masseter, sternocleidomastoid, and upper trapezius muscles will be measured using a pressure algometer. Postural characteristics will be evaluated using the New York Posture Analysis (NYPA).

Study Overview

Status

Completed

Conditions

Detailed Description

The socio-demographic data of the individuals, including age, height, weight, etc., were recorded. The Fonseca Anamnestic Index (FAI) was used to identify the presence of TMD, and individuals with a score above 15 (FAI≥15) were determined to have TMD. Additionally, individuals' muscular endurance was assessed using a standard endurance test, pressure pain thresholds were measured with an algometer, and posture was evaluated using the New York Posture Analysis.

Study Type

Observational

Enrollment (Actual)

60

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

The study population consisted of university students aged 18-25 studying at Igdir University Karaagac Campus.

Description

Inclusion Criteria:

  • Currently enrolled as a student at Igdır University.
  • The inclusion criterion for the TMD group was defined as scoring 15 points or more on the Fonseca Anamnesis Index (FAI), while the criterion for the control group was an FAI score below 15.

Exclusion Criteria:

  • Underwent surgery in the neck or mandibular regions
  • Had a history of intervertebral disk problems, regardless of clinical symptoms
  • Experienced mechanical neck pain for ≥3 months
  • Had scoliosis
  • Had reducible or irreducible displacement of the temporomandibular joint disk
  • Had a history of trigeminal neuralgia
  • Were undergoing orthodontic dental treatment

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
TMD Group
TMD group was defined as scoring 15 points or more on the Fonseca Anamnesis Index (FAI).
Control Group
Control group was an FAI score below 15.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cervical Muscle Endurance Assessment
Time Frame: 2 week
Static endurance of cervical flexor and extensor muscles was measured in seconds. Extensors: participants lay prone, lifted the head slightly, and held a 2-kg weight as long as possible. Flexors: participants lay supine, performed slight craniocervical flexion, and maintained the position. Test ended with pain, loss of position, or sufficient endurance. Intra-observer reliability: flexors 0.71-0.93, extensors 0.73-0.85.
2 week
Pressure Pain Threshold Assesment
Time Frame: 2 week
Pressure pain threshold (PPT) was measured using a Baseline Push-Pull Force Gauge® algometer with a 1 cm rubber tip. After familiarization, pressure was applied perpendicularly to the most sensitive points of the upper trapezius, masseter, temporalis, and SCM muscles until participants reported pain. Each site was tested three times with ≥20 s intervals, and the average value was recorded as the PPT.
2 week

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Posture Assessment
Time Frame: 2 week
Posture was assessed using the NYPA, evaluating alignment of 13 body regions including head, neck, shoulders, back, waist, hips, and ankles. Each region was scored 1 (severe impairment), 3 (moderate), or 5 (good), giving a total score of 13-65. Scores were categorized as very good (≥45), good (40-44), moderate (30-39), poor (20-29), or bad (≤19). Reliability coefficients range from 0.93 to 0.98.
2 week

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Kırıkkale University

Investigators

  • Study Director: Aydan AYTAR, Prof. Dr., University of Health Sciences, Gulhane Faculty of Physiotherapy and Rehabilitation
  • Principal Investigator: Binnaz Bozkurt Akpulat, MSc., Igdir University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 10, 2024

Primary Completion (Actual)

June 15, 2024

Study Completion (Actual)

June 15, 2024

Study Registration Dates

First Submitted

February 1, 2026

First Submitted That Met QC Criteria

February 10, 2026

First Posted (Actual)

February 12, 2026

Study Record Updates

Last Update Posted (Actual)

February 12, 2026

Last Update Submitted That Met QC Criteria

February 10, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IGDU-EC-27-03-2024

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared to protect participant confidentiality and because the data were collected solely for the purposes approved by the ethics committee.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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