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The temporomandibular joint dysfunction is the second most common musculoskeletal pain after back pain, causing jaw pain, restricted movement, and joint sounds. NPRS and millimeter ruler will be used for the assessment of patient. This study will compare the effects of Mulligan and Maitland mobilization, commonly used treatment, on pain and Temporomandibular joint mobility through a randomized controlled trial, involving 30 participants divided into two groups for treatment.
The temporomandibular joint connects the mandible to the temporal bone near the ear's tragus and plays a key role in mastication. It involves joint or muscle pain, jaw movement limitation, and joint popping sound Risk factors include trauma, bruxism, arthritis, stress, and poor posture, while diagnosis is commonly made using the DC/TMD criteria, focusing on pain and intra-articular dysfunction. Manual therapy techniques widely used to restore joint function and reduce pain.
Among these, Mulligan's Mobilization combines therapist-applied glides with active patient movement, while Maitland mobilization uses graded oscillatory techniques to relieve pain and improve mobility.
This study aims to compare the effects of Mulligan and Maitland mobilization on pain reduction and TMJ hypomobility in adults with TMD.
A randomized controlled trial will be conducted over one year. 30 participants will be selected through purposive sampling and randomly divided into two groups.
The intervention will last two weeks, comprising 06 treatment sessions. Assessments will be conducted at baseline, after the third session, and at the end of the second week.
Treatment will include lateral, anterior, medial, and distraction glides, combined with Rocabado's 6x6 exercises to improve functional movement. Myofascial release for the temporalis and masseter muscles will also be applied.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mulligan Mobilization | Active Comparator | Experimental Group A-Mulligan Mobilization. Myofascial release of temporalis and masseter muscle, Rocabado 6*6 exercise program. |
|
| Maitland Mobilization | Experimental | Experimental Group B-Maitland Mobilization. Myofascial release of temporalis and masseter muscle. Rocabado 6*6 exercise program. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mulligan Mobilization | Procedure | Both Mulligan and Maitland mobilization techniques with Myofascial release of temporalis and masseter and Rocabado 6*6 exercise program are applied over a two-week period with six sessions in total, focusing on improving TMJ mobility and reducing pain. Group A Mulligan mobilization emphasizes active patient involvement combined with therapist-applied glides, including lateral, anterior, medial, and distraction glides performed for 5-10 seconds with 3-5 repetitions per session. These techniques enhance mouth opening, lateral deviation, protrusion, and joint space while reducing stiffness and pain. And baseline treatment of myofascial release of temporalis and masseter muscle and Rocabado's 6*6 exercise program |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity | Pain will be measured through Numeric Pain Rating Scale. The scoring for NPRS involves a scale from 0 to 10, where 0 indicates no pain. The interpretation of scores is as follows: 0 to 3 for mild pain, 4 to 6 for moderate pain, and 7 to 10 for severe pain. | 2 weeks |
| Temporomandibular joint Hypomobility | Mandibular movements were assessed using a millimeter ruler to measure depression (50-60 mm), protrusion (5 mm), and lateral deviation (12-15 mm). Any "click" sounds or deviations during movement were recorded. Jaw movements maintained upper and lower teeth contact. | 2 weeks |
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Inclusion criteria
Exclusion criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mah Noor | Contact | +92310-5351360 | mahnoorbasharat33@gmail.com | |
| Anam Rehman, MS-OMPT | Contact | +923355082299 | anam.rehman@fui.edu.pk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Foundation University College of Physical Therapy | Recruiting | Islamabad | Punjab Province | Pakistan |
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| ID | Term |
|---|---|
| D013705 | Temporomandibular Joint Disorders |
| ID | Term |
|---|---|
| D017271 | Craniomandibular Disorders |
| D008336 | Mandibular Diseases |
| D007571 | Jaw Diseases |
| D009140 | Musculoskeletal Diseases |
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Participant divided into Two groups Group A recieves Mulligan Mobilization and Group B receives Maitland Mobilization with baseline treatment of myofascial release of temporalis and masseter muscle and Rocabado's 6*6 exercise program.
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Participant will just have an idea of two interventions not the one given to him/her.
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| Maitland Mobilization | Procedure | Group B-Maitland mobilization relies on graded oscillatory movements (Grades I-III) for 5-10 seconds with 3-5 oscillations, targeting pain relief and mobility in the pain-free range. Lower grades (I-II) are used for acute pain with gentle oscillations, while higher grades (II-III) provide moderate mobilization to improve protrusion, lateral deviation, and joint capsule mobility. And baseline treatment of myofascial release of temporalis and masseter muscle and Rocabado's 6*6 exercise program. |
|
| D007592 |
| Joint Diseases |
| D009135 | Muscular Diseases |
| D009057 | Stomatognathic Diseases |