Do postural exercises aiming to reduce forward head posture help reduce pain in chronic temporomandibular disorder patients ? A randomized controlled trial

Abstract

Introduction: Chronic temporomandibular disorders (TMD) are defined as a group of conditions affecting the temporomandibular joint (TMJ) and the related structures. They affect a considerable part of the population and create pain, discomfort and an overall difficult day to day life. Usually, the more common treatments are centered around the jaw and disregard the different structures that may affect the symptoms too, like the posture. Objective: The goal of this study is to define whether or not adding an intervention aiming to reduce forward head posture (FHP) helps reduce the pain in chronic TMD patients. The function of the masticatory system, the quality of life and the craniovertebral angle (CVA) are also outcomes that will be measured. The participants will be divided into 2 randomized groups to test the effectiveness of an 8 weeks treatment program targeting the jaw and the posture with scapular stabilization exercises. Methods: This randomized controlled trial will include patients with chronic TMD presenting FHP. The main outcome is pain, the secondary outcomes are function, quality of life and the craniovertebral angle to measure the FHP. The patients will be evaluated using the Graded Chronic Pain Scale version 2 (GCPS), the Jaw Functional Limitation Scale (JF-20), the CVA and the Short Form 12 Items Version 2 Health Survey (SF-12v2). There will be 4 assessments: at baseline (one day before the beginning of the intervention), at 4 weeks, at 8 weeks (one day after the final session) and at 6 months for the follow up. The mixed Anova test will be used for the data analysis with a p value <0.05 for significance. The investigators will be blinded during the study and the patients randomized. Discussion: The results expected are: significant differences between the intervention group and the control group in terms of reduction of pain, as well as a better function of the masticatory system and quality of life. The FHP is expected to be reduced significantly for the intervention group and seen through an augmentation of the CVA