Is PNF Application Effective on Temporomandibular Dysfunction

Investigation of the Effectiveness of Proprioceptive Neuromuscular Facilitation Exercises in Individuals With Temporomandibular Dysfunction With Forward Head Posture

The goal of this clinical trial is to compare effects of Rocabado exercises which is conventional physiotherapy treatment alone vs. combine it with proprioceptive neuromuscular facilitation (PNF) in people with temporomandibular dysfunction (TMD) with forward head posture. The main question aims to answer:

- Does adding neck and jaw PNF techniques to the treatment affect the pain and functional status of the jaw compared to Rocabado exercises alone?

Participants will be randomized into two groups (Group 1: only Rocabado exercises, Group 2: Rocabado + PNF) and perform 8 weeks long exercises. They will be assessed in the beginning of the study and at the end of the 8th week.

Infrared heat will be applied to the neck and face areas for 15 minutes for individuals with TMD with forward head posture in both groups. Then Group 1 will perform Rocabado exercises only, and Group 2 will perform PNF exercises in addition to Rocabado exercises. Exercises will be demonstrated and applied by a physiotherapist at the university clinic.

Pain intensity, pain threshold, TMJ functions, joint range of motion and Mandibular Function are among the parameters to be evaluated. All evaluations will be made by a blinded evaluator at baseline (baseline t=0), before exercise and after exercise (post-exercise, t=8.week).

Inclusion Criteria:

• Diagnosis of TMD according to the diagnostic criteria for temporomandibular disorders (RDC/TMD),
• Presence of trigger points in the relevant muscles,
• Presence of pain

Exclusion Criteria:

• Intra-articular or degenerative joint disorders and subluxation requiring urgent treatment;
• History of temporomandibular joint (TMJ) or cervical region surgery in the last 3 months;
• Treatment history from relevant areas;
• Presence of rheumatic diseases, including TMJ diseases;
• TMJ instability or fracture;
• Presence of perception-cognition disorder;
• Presence of chronic pain such as trigeminal neuralgia
• Orthopedic, neurological or rheumatological cervical disorders affecting jaw movements
• History of surgery in the jaw, head and neck area
• Presence of vertigo that prevents head movements during exercise