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This planned randomized, single-blind clinical trial will investigate the effects of adding the Post-Isometric Relaxation (PIR) technique to a standard postural exercise program in individuals with moderate to severe temporomandibular joint dysfunction (TMD). Forty volunteers aged 18-25 years will be recruited and randomly assigned to either an experimental group (postural exercises + PIR) or a control group (postural exercises only). The intervention will be delivered three times per week for six weeks. Primary outcomes will include cervical range of motion, mandibular mobility, head anterior tilt, and thoracic kyphosis index, measured before and after the intervention. The study aims to determine whether PIR provides additional benefits to standard postural exercises in improving jaw and neck function and postural alignment in young adults with TMD.
Temporomandibular joint dysfunction (TMD) is a common musculoskeletal condition characterized by jaw pain, limited mouth opening, and joint sounds, often accompanied by postural deviations such as forward head posture and thoracic kyphosis. Conservative treatments, including postural exercises and manual therapy, are recommended to improve jaw and neck function and reduce symptoms.
The Post-Isometric Relaxation (PIR) technique is a manual therapy method that uses gentle isometric contractions followed by passive stretching to reduce muscle tension and increase mobility. While PIR has been shown to improve masticatory muscle function, its combined use with postural exercises in TMD management has not been fully evaluated.
In this planned study, forty volunteers aged 18-25 years with moderate or severe TMD (diagnosed using the Fonseca Anamnestic Questionnaire) will be recruited. Participants will be randomly assigned into two groups:
Experimental group: Postural exercise program + PIR technique
Control group: Postural exercise program only
The postural exercise program will include strengthening, stretching, and mobility exercises for the cervical and thoracic regions, performed three times per week for six weeks. In the experimental group, the PIR technique will be applied to jaw muscles according to a standardized protocol.
Outcome measures will include:
Cervical range of motion (flexion, extension, lateral flexion, rotation) measured with a goniometer
Mandibular mobility (depression, lateral deviation, protrusion) measured with a caliper
Head anterior tilt (chin-sternum distance, occiput-wall distance)
Thoracic kyphosis index measured with a flexicurve
Assessments will be conducted before the intervention and after the six-week program. The primary hypothesis is that the addition of PIR to postural exercises will produce greater improvements in cervical and mandibular mobility than postural exercises alone.
This trial is expected to provide new evidence for combining manual therapy with exercise in the management of TMD in young adults and may help guide future rehabilitation strategies.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Arm: Postural Exercises + Post-Isometric Relaxation (PIR) Technique | Experimental | Participants in this group will perform a standardized postural exercise program targeting cervical and thoracic regions, three times per week for six weeks. In addition, the Post-Isometric Relaxation (PIR) technique will be applied to the jaw muscles during each session, following a standardized manual therapy protocol to reduce muscle tension and improve mandibular mobility. |
|
| Control Arm: Postural Exercises Only | Active Comparator | Participants in this group will perform the same standardized postural exercise program targeting cervical and thoracic regions, three times per week for six weeks, without the addition of the PIR technique. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Postural Exercises + Post-Isometric Relaxation (PIR) Technique | Behavioral | Participants will perform a standardized postural exercise program (strengthening, stretching, and mobility exercises for the cervical and thoracic regions) three times per week for six weeks. In addition, the Post-Isometric Relaxation (PIR) technique will be applied to jaw muscles during each session to reduce muscle tension and improve mandibular mobility. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in mandibular depression (mouth opening) | The distance between the upper and lower central incisors during maximal mouth opening will be measured in millimeters using a caliper. | Baseline and after 6 weeks of intervention |
| Change in cervical range of motion | Cervical range of motion will be measured in degrees using a goniometer. Movements assessed will include flexion, extension, right and left lateral flexion, and right and left rotation. | Baseline and after 6 weeks of intervention |
| Change in mandibular lateral deviation (right and left) | The horizontal movement of the lower jaw to the right and left will be measured in millimeters using a caliper. | Baseline and after 6 weeks of intervention |
| Change in mandibular protrusion | The anterior translation of the mandible will be measured in millimeters using a caliper. Outcome Measure: Change in head anterior tilt - chin-sternum distance | Baseline and after 6 weeks of intervention |
| Change in head anterior tilt - chin-sternum distance | The vertical distance from the midpoint of the chin to the superior border of the sternum will be measured in centimeters with a measuring tape. | Baseline and after 6 weeks of intervention |
| Change in head anterior tilt - occiput-wall distance | The distance between the occiput and the wall will be measured in centimeters while the participant stands in a natural posture against the wall. | Baseline and after 6 weeks of intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sanem ŞENER | Contact | +90 5535918396 | sanemsener@yahoo.com |
| Name | Affiliation | Role |
|---|---|---|
| Sanem ŞENER | Zonguldak Bulent Ecevit University | Principal Investigator |
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Individual participant data will not be shared because the study's ethics committee approval does not include provisions for external sharing of raw participant-level data. Data will be stored securely at Yeniyüzyıl University and will only be accessible to the research team for purposes of analysis and reporting
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| ID | Term |
|---|---|
| D013705 | Temporomandibular Joint Disorders |
| D009209 | Myofascial Pain Syndromes |
| ID | Term |
|---|---|
| D017271 | Craniomandibular Disorders |
| D008336 | Mandibular Diseases |
| D007571 | Jaw Diseases |
| D009140 | Musculoskeletal Diseases |
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| ID | Term |
|---|---|
| D008722 | Methods |
| ID | Term |
|---|---|
| D008919 | Investigative Techniques |
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Participants will be randomly assigned into two parallel groups: the experimental group will receive postural exercises combined with the Post-Isometric Relaxation (PIR) technique, while the control group will receive postural exercises only. Both groups will follow the intervention protocol three times per week for six weeks, with no crossover between groups.
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This is a single-masked trial in which the outcomes assessor is blinded to group allocation. The assessor responsible for measuring cervical range of motion, mandibular mobility, head anterior tilt, and thoracic kyphosis index will not be informed of the participants' assigned intervention group
|
| Postural Exercises | Behavioral | Participants will perform a standardized postural exercise program designed to improve cervical and thoracic mobility and postural alignment. The program will include strengthening, stretching, and mobility exercises targeting the cervical spine, thoracic spine, and related musculature. Each session will last approximately 30-40 minutes and will be conducted three times per week for six weeks under the supervision of a trained therapist. |
|
| Change in thoracic kyphosis index | Thoracic kyphosis will be evaluated using a flexicurve ruler to measure curvature from C7 to T12. The thoracic kyphosis index will be calculated as (thoracic width / thoracic length) × 100. | Baseline and after 6 weeks of intervention |
| D007592 |
| Joint Diseases |
| D009135 | Muscular Diseases |
| D009057 | Stomatognathic Diseases |