Skip to main content
OpenTrials
Completed

NCT Number: NCT07681570

Cervical Proprioception, Masticatory Pain Threshold and Craniovertebral Angle in TMD

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.

Completed

Looking for future studies?

Notify Me

Key information

Conditions

Temporomandibular Dysfunction (TMD) Craniomandibular Disorders Jaw Diseases Joint Diseases Mandibular Diseases Muscular Diseases Musculoskeletal Diseases Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms Stomatognathic Diseases Temporomandibular Joint Disorders

Age range

18 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

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

Ankara, Turkey (Türkiye)

About this study

Temporomandibular disorder (TMD) is a condition affecting the temporomandibular joint (TMJ), masticatory muscles, and associated structures. Patients with TMD may present with a variety of symptoms, including pain, headache, joint locking, limited mouth opening, and joint sounds. Because the cervical vertebrae are anatomically and functionally connected to the cranium and masticatory structures through neurovascular components, muscles, and joints, alterations in one region may influence the other. Shortening of the cervical extensor muscles and the sternocleidomastoid muscle may contribute to the development of a forward head posture, which is associated with increased cervical lordosis. The primary clinical manifestation of TMD is pain related to mandibular movement limitation and joint sounds during function. In addition, TMD-related pain has been reported to be associated with increased psychological distress, autonomic dysfunction, motor impairments, balance deficits, and sleep disturbances. The craniovertebral angle is defined as the angle formed between a horizontal line and a line connecting the tragus of the ear to the spinous process of the seventh cervical vertebra . It is widely used to assess head posture. In a study evaluating cranio-cervical posture using lateral radiographs, Joy et al. reported that individuals with TMD had significantly greater craniovertebral angles than healthy individuals. Proprioception is the ability to perceive joint position and movement without visual input and plays an essential role in maintaining postural balance. Proprioceptors are particularly abundant in the cervical region. Damage or dysfunction affecting the cervical spine may disrupt proprioceptive input, leading to altered head and body position, impaired postural reflexes, and deficits in balance and gait. Based on the current literature, no previous study has simultaneously compared cervical joint position sense, craniovertebral angle, and the pressure pain threshold of the masticatory muscles between individuals with TMD and healthy controls. Therefore, this study was designed to investigate these parameters comprehensively and to contribute to the existing literature.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

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.

Exclusion criteria

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

Treatment and study plan

Primary outcomes

  1. pain threshold

    Time frame: Day 1

    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

  2. pain intensity

    Time frame: Day 1

    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."

  3. sense of joint position in the cervical region

    Time frame: Day 1

    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.

Secondary outcomes

  1. craniovertebral angle

    Time frame: Day 1

    The craniovertebral angle will be measured using digital image analysis of a lateral-view photograph obtained while each participant is seated on the same standardized chair. Participants will be instructed to sit comfortably with their thoracic and lumbar regions in contact with the backrest, their eyes facing forward, and both feet placed flat on the floor with the knees flexed at 90°. To facilitate image analysis, a reflective marker will be attached over the spinous process of the seventh cervical vertebra (C7) using adhesive tape, and the tragus of the ear will be clearly visible in the photograph. The C7 spinous process will be identified by palpation during active cervical rotation. The images will be analyzed using Kinovea software (version 0.8.15). The craniovertebral angle will be defined as the angle formed between a horizontal line passing through the C7 spinous process and a line connecting the C7 spinous process to the tragus of the ear.

Sponsors and collaborators

Lead sponsor

Ankara Yildirim Beyazıt University

Other

Registry information

Official study title

A Comparison of Cervical Region Position Sensation, Masticatory Muscle Pain Threshold, and the Craniovertebral Angle in Individuals With Temporomandibular Joint Dysfunction and Healthy Individuals

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jul 2, 2026
Registry last updated
Jul 6, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.