Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE: To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS: A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18–40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS: There was no significant difference between both groups pre-treatment (p > 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p < 0.05) in favor of the PNF group. CONCLUSION: Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.