Cervical Proprioception, Masticatory Pain Threshold and Craniovertebral Angle in TMD

NCT07681570 | Completed

• 1 other identifier: 01/1105
• Study Type: observational
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Temporomandibular disorder (TMD) is a group of conditions involving the masticatory muscles, temporomandibular joint (TMJ), and associated structures of the head, neck, and cervical region. TMD may cause pain in the ear region and over the masseter muscle, restricted mandibular movement, and clicking or crepitus sounds in the temporomandibular joint. It may also be accompanied by cervical dysfunction, limited range of motion, pain, and postural abnormalities. Due to the close anatomical and functional relationship between the cervical region and the TMJ, disorders affecting one region are likely to influence the other. Alterations in the TMJ may lead to changes in the cervical spine and consequently affect proprioception. Head posture can be evaluated using the craniovertebral angle. Increases or decreases in this angle may reflect changes in anterior head tilt. Cervical impairments associated with TMD may also result in alterations in the craniovertebral angle. Therefore, the aim of this study is to compare cervical joint position sense, pressure pain threshold of the masticatory muscles, and craniovertebral angle values between individuals with TMD and healthy controls.

Conditions

Temporomandibular Dysfunction (TMD)

Keywords

temporomandibular dysfunciton; pain threshold; proprioception; pain

Outcome Measures

Primary Outcomes (3)

• pain threshold

  Pressure pain threshold (PPT) of the temporalis and masseter muscles will be assessed using a digital algometer (J-Tech Commander Algometer, Preston Co., USA), an objective measurement device. Participants will be instructed to lie comfortably in the supine position. To familiarize them with the sensation of pressure, pressure will first be applied to an area that is not included in the assessment. During the evaluation, participants will be instructed to raise one hand when the applied pressure first becomes uncomfortable or painful. The algometer will then be applied perpendicularly to the predetermined assessment points: bilaterally over the masseter muscle (1 cm superior and 2 cm anterior to the mandibular angle) and bilaterally over the temporalis muscle (2 cm superior to the zygomatic arch, between the lateral canthus of the eye and the anterior aspect of the ear). The value displayed on the algometer at the moment the participant reports pain will be recorded in kg/cm². A one-m

  Day 1

• pain intensity

  Pain associated with TMD will be assessed using the Visual Analog Scale (VAS). Participants will be asked to indicate the intensity of pain perceived in both temporomandibular joints (TMJs). The VAS, developed by Max Freyd, is one of the most widely used methods for pain assessment. It consists of a 100-mm horizontal line with two anchor points representing the extremes of the parameter being measured. Participants will be instructed to mark the point on the line that best reflects their perceived pain intensity. They will be informed that 0 cm represents "no pain" and 10 cm represents "the worst imaginable pain."

  Day 1

• sense of joint position in the cervical region

  Joint position sense (JPS) will be assessed using an Acumar Dual Digital Inclinometer® (Acu360, Acumar, Lafayette, IN, USA). Cervical joint position sense will be evaluated during flexion, extension, right and left lateral flexion, and right and left rotation at a target angle of 30°. This target angle was selected based on the normal range of cervical motion to minimize the influence of soft tissue tension surrounding the joint on joint position sense. First, the examiner will position the participant at the target angle, where the position will be maintained for 2 seconds to allow the participant to memorize it. The participant will then be passively returned to the neutral position and instructed to actively reproduce the target angle. Each movement will be performed three times with the participant's eyes closed, and the mean value of the three trials will be used for analysis.

  Day 1

Secondary Outcomes (1)

• craniovertebral angle

  Day 1

Study Arms (2)

temporomandibular dysfunction group

The study sample will consist of individuals with temporomandibular disorder and healthy controls from the Faculty of Health Sciences at Ankara Yıldırım Beyazıt University. Individuals who voluntarily agree to participate will be included in the study.

Healthy group

The study sample will consist of individuals with temporomandibular disorder and healthy controls from the Faculty of Health Sciences at Ankara Yıldırım Beyazıt University. Individuals who voluntarily agree to participate will be included in the study.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Ankara Yıldırım Beyazıt University Faculty of Health Sciences

You may qualify if:

• Temporomandibular dysfunction group:
• Volunteering to take part in the study
• Scoring over 15 on the Fonseca scale
• Being aged 18 or over
• Healthy group:
• Willingness to participate in the study, Fonseca score of 15 or below
• Being aged 18 or over.

You may not qualify if:

• Temporomandibular dysfunction group:
• Having undergone any medical treatment or physiotherapy for the temporomandibular joint within the last 6 months
• A history of spinal surgery
• Neuropathy involving the cervical region
• A herniated disc and additional conditions that may cause pain
• Having any neurological or rheumatological condition
• Healthy group:
• A history of spinal surgery
• Cervical spine pathologies
• Having any neurological or rheumatological condition

Sponsors & Collaborators

• Ankara Yildirim Beyazıt University: lead

Study Sites (1)

Ankara Yıldırım Beyazıt University,Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

Ankara, Turkey (Türkiye)

Location

Related Publications (13)

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  PMID: 2755707 BACKGROUND

• Ozdinc S PhD, Ata H MSc, Selcuk H MSc, Can HB MSc, Sermenli N MSc, Turan FN PhD. Temporomandibular joint disorder determined by Fonseca anamnestic index and associated factors in 18- to 27-year-old university students. Cranio. 2020 Sep;38(5):327-332. doi: 10.1080/08869634.2018.1513442. Epub 2018 Sep 8.

  PMID: 30198391 BACKGROUND

• Akbaş, E., Erdem, E. U., & Ünver, B. (2019). Depresyon düzeyinin boyun ağrısı, eklem hareket açıklığı ve servikal eklem pozisyon hissine etkisi. Sağlık Bilimleri ve Meslekleri Dergisi, 6(3), 555-563.

  BACKGROUND

• Zárate-Tejero, C. A., Rodríguez-Rubio, P. R., Brandt, L., Krauss, J., Hernández-Secorún, M., Hidalgo-García, C., & Lucha-López, O. (2024). Measuring Craniovertebral Angle Reference Values in Adults Using Kinovea Software. Applied Sciences, 14(19), 8639. https://doi.org/10.3390/app14198639

  BACKGROUND

• Wieckiewicz W, Wozniak K, Piatkowska D, Szyszka-Sommerfeld L, Lipski M. The diagnostic value of pressure algometry for temporomandibular disorders. Biomed Res Int. 2015;2015:575038. doi: 10.1155/2015/575038. Epub 2015 Mar 26.

  PMID: 25883964 BACKGROUND

• Iunes, D. H., Carvalho, L. C. F., Oliveira, A. S., & Bevilaqua- Grossi, D. (2009). Craniocervical posture analysis in patients with temporomandibular disorder. Brazilian Journal of Physical Therapy, 13, 89-95. 13-) Oliveira, S. S. I., Pannuti, C. M., Paranhos, K. S., Tanganeli, J. P. C., Laganá, D. C., Sesma, N.,

  BACKGROUND

• Joy TE, Tanuja S, Pillai RR, Dhas Manchil PR, Raveendranathan R. Assessment of craniocervical posture in TMJ disorders using lateral radiographic view: A cross-sectional study. Cranio. 2021 Sep;39(5):391-397. doi: 10.1080/08869634.2019.1665227. Epub 2019 Sep 13.

  PMID: 31516098 BACKGROUND

• Cuccia A, Caradonna C. The relationship between the stomatognathic system and body posture. Clinics (Sao Paulo). 2009;64(1):61-6. doi: 10.1590/s1807-59322009000100011.

  PMID: 19142553 BACKGROUND

• Cuenca-Martinez F, Herranz-Gomez A, Madronero-Miguel B, Reina-Varona A, La Touche R, Angulo-Diaz-Parreno S, Pardo-Montero J, Del Corral T, Lopez-de-Uralde-Villanueva I. Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies. J Clin Med. 2020 Aug 30;9(9):2806. doi: 10.3390/jcm9092806.

  PMID: 32872670 BACKGROUND

• Balthazard P, Hasler V, Goldman D, Grondin F. Association of cervical spine signs and symptoms with temporomandibular disorders in adults: a systematic review protocol. JBI Evid Synth. 2020 Jun;18(6):1334-1340. doi: 10.11124/JBISRIR-D-19-00107.

  PMID: 32813383 BACKGROUND

• Wadhokar OC, Patil DS. Current Trends in the Management of Temporomandibular Joint Dysfunction: A Review. Cureus. 2022 Sep 19;14(9):e29314. doi: 10.7759/cureus.29314. eCollection 2022 Sep.

  PMID: 36277551 BACKGROUND

• Tran C, Ghahreman K, Huppa C, Gallagher JE. Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg. 2022 Sep;51(9):1211-1225. doi: 10.1016/j.ijom.2021.11.009. Epub 2022 Mar 23.

  PMID: 35339331 BACKGROUND

• Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015 Mar 15;91(6):378-86.

  PMID: 25822556 BACKGROUND

MeSH Terms

Conditions

Temporomandibular Joint Disorders; Pain

Condition Hierarchy (Ancestors)

Craniomandibular Disorders; Mandibular Diseases; Jaw Diseases; Musculoskeletal Diseases; Joint Diseases; Muscular Diseases; Stomatognathic Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Emine Kübra AY

  Ankara Yildirim Beyazıt University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 26, 2026
• First Posted: July 2, 2026
• Study Start: June 1, 2026
• Primary Completion: June 20, 2026
• Study Completion: June 25, 2026
• Last Updated: July 6, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)