THE EFFECT OF A CONSERVATIVE PHYSIOTHERAPY TREATMENT PROGRAM ON FORWARD HEAD POSTURE IN CASES OF TEMPOROMANDIBULAR JOINT DYSFUNCTION

T. Shousha^1,2, I. Moustafa^1,3, M. Behiry⁴

Background: Anatomical correlations between the craniomandibular region and the cervical spine have been a matter of interest for several years. Several researchers have studied the head posture, most often in association with cranio-cervical changes and temporomandibular dysfunctions (TMD). Studies suggest that the forward head posture moves the mandibular condyle from its normal anatomical position and shifts it to be higher and more posteriorly displaced within the mandibular fossa when comparing it to normal head posture. With time, this abnormal displacement can produce an irritation and discomfort, which may end up affecting the utility of the temporomandibular joint (TMJ) leading to TMD. Moreover, the exact relationship between the incidence of TMD and position of head and neck is still not very clear. Although physical therapy has been reported to relieve and treat the symptoms and problems that result from the TMJ being affected in cases of TMD, However, till present, very limited studies were conducted to find out the effects of conservative physical therapy approaches on the Craniovertebral Angle in treatment of TMD.

Purpose: The Purpose of this study was to examine the effects of a 4-weeks conservative physiotherapy treatment program on forward head posture in cases of TMD among male and female subjects. The secondary research questions were to identify:

1. Is there an influence of gender on the responsiveness to the Conservative Physical therapy program in cases of TMJ Dysfunction?
2. Is there a significant relationship between an individual age and the severity of orofacial pain and TMJ range of motion (ROM) limitation in cases of TMJ Dysfunction? 

Methods: A quasi experimental design with a convenient sample was adopted. Forty two patients with mild to moderate TMD (n=42; 20 male and 22 female), age (18-24) mean (20.44 ± 2.21y) were recruited. Pre and post the intervention, all subjects were assessed for forward head posture, TMJ range of motion (ROM), and orofacial pain intensity by using the craniovertebral angle, manual Vernier caliper and the visual analogue scale respectively. The severity of the TMD condition was assessed by the Fonseca’s Anamnestic Index (IAF). The physical therapy intervention included stretching of the Masseter and Medial pterygoid muscles and a tongue relaxation exercise for three times weekly. Assessment and treatment procedures were delivered by one experienced therapist.

Results: Post treatment results revealed significant improvement in the CVA, TMJ ROM, orofacial pain as well as the IAF (P=0.31, 0.42, 0.33 and 0.38 respectively). On the other hand, the Kendall’s tau-b test revealed no gender influence on the responsiveness to the intervention(p=0.6). Similarly, the Spearman’s  test revealed no correlation between the orofacial pain level and the individual’s age (p=0.44).

Conclusion(s): Conservative Physiotherapy Treatment may effectively reduce the degree of forward head posture, orofacial pain, and improve the TMJ range of motion in mild to moderate cases of TMD.

Implications: Forward head posture should be considered as a primary consequence in cases of TMD. Addition of stretching of masticatory muscles as well as tongue relaxation should be implemented to improve forward head posture as well as TMJ pain and ROM.

Funding, acknowledgements: None

Keywords: Temporomandibular joint, Forward head posture, Pain

Topic: Musculoskeletal

Did this work require ethics approval? Yes

Institution: University of Sharjah

Committee: UoS Research Ethics Committee

Ethics number: REC-18-02-11-01-S