Investigation of the Effects of Limbic System-Oriented Combined Manual Therapy on Pain, Joint Range of Motion, Muscle Strength, Joint Position Sense, Balance, Functional Status, Emotional State, Quality of Life, and Sleep Quality in Temporomandibular Joint Dysfunction
Investigation of the Effects of Limbic System-Oriented Combined Manual Therapy on Pain, Joint Range of Motion, Muscle Strength, Joint Position Sense, Balance, Functional Status, Emotional State, Quality of Life, and Sleep Quality in Temporomandibular Joint Dysfunction
Temporomandibular joint disorders (TMD) are common conditions that may cause jaw pain, limited jaw movement, and reduced quality of life. Individuals with TMD can also experience neck-related problems, balance impairments, emotional changes, and sleep disturbances.
This interventional study aims to investigate the effects of a combined physiotherapy and rehabilitation program in individuals with temporomandibular joint dysfunction. The intervention consists of conventional manual therapy techniques applied to the temporomandibular joint and cervical region, combined with specific manual therapy techniques targeting the limbic system, along with therapeutic exercise applications.
The study will evaluate the effects of this combined treatment approach on pain, jaw range of motion, joint position sense, balance, emotional status, patient satisfaction, and quality of life and sleep in individuals with TMD.
Temporomandibular joint dysfunction is a complex condition that affects the masticatory system and is frequently associated with cervical musculoskeletal impairments, altered sensorimotor control, and psychosocial factors. In addition to local biomechanical dysfunctions, individuals with temporomandibular disorders may experience changes in pain processing, emotional regulation, balance, and overall quality of life. These factors highlight the need for a comprehensive rehabilitation approach that addresses both peripheral and central mechanisms.
Physiotherapy and rehabilitation interventions for temporomandibular joint dysfunction traditionally focus on the temporomandibular joint and cervical region using manual therapy techniques and therapeutic exercises. While these approaches are effective in improving physical impairments, emerging evidence suggests that central mechanisms, including the limbic system, may influence pain perception, emotional status, and functional outcomes in individuals with temporomandibular disorders.
This interventional study is designed to investigate the effects of a combined physiotherapy and rehabilitation approach that integrates conventional manual therapy techniques applied to the temporomandibular joint and cervical region with specific manual therapy techniques oriented toward the limbic system, along with therapeutic exercise applications. The combined approach aims to address musculoskeletal, sensorimotor, and emotional components of temporomandibular joint dysfunction within a holistic rehabilitation framework.
Participants diagnosed with temporomandibular joint dysfunction will undergo the intervention program and will be evaluated before and after the treatment period. The study focuses on changes in pain, jaw function, sensorimotor control, balance, emotional status, patient satisfaction, and quality of life and sleep, providing a multidimensional assessment of treatment effects.
By examining the outcomes of this combined intervention, the study seeks to enhance the understanding of integrative physiotherapy strategies in the management of temporomandibular joint dysfunction and to support the development of more comprehensive rehabilitation approaches that consider both physical and emotional aspects of the condition.
Inclusion Criteria:
Aged between 18 and 60 years
Diagnosed with temporomandibular joint dysfunction (TMD - disc displacement or degenerative joint disease) by an Oral and Maxillofacial Surgery specialist
Clinical findings consistent with temporomandibular joint dysfunction
Presence of symptoms and pain related to TMD for at least 6 months
No history of acute trauma, infection, or neurological disease
No limitation of joint range of motion in the angles assessed for joint position sense
No history of any treatment or physiotherapy for TMD within the last 6 months
Not using occlusal splints, orthodontic appliances, and/or medications for pain
Use of no more than one fixed prosthetic restoration (bridge or implant-supported crown) in a single region
Voluntary participation and provision of written informed consent
Exclusion Criteria:
History of jaw and/or cervical region surgery or trauma within the last 6 months
Presence of rheumatological or psychiatric disorders
History of fracture involving the temporomandibular joint, cervical, or upper thoracic region
Presence of acute cervical disc pathology or other acute conditions affecting the cervical region
Presence of skin infection or open wounds
Presence of perceptual or communication disorders
Partial edentulism classified as Kennedy Class I, II, or III, or multiple missing teeth that impair masticatory function, except for single-tooth loss
Presence of fixed prosthetic restorations for more than one missing tooth
Use of removable partial or complete dentures
Unwillingness to participate in the study