Journals / Journal of Health Sciences and Management / 2026 / Cilt: 6 Sayı: 2

Evaluation of Postural Awareness, Pressure Pain Threshold, Proprioception and Jaw Functionality According to Head Posture in Temporomandibular Disorder

Temporomandibular Bozukluğunda Baş Postürüne Göre Postüral Farkındalık, Basınç Ağrı Eşiği, Propriyosepsiyon ve Çene Fonksiyonelliğinin Değerlendirilmesi

Pages
46–54
Publication Date
2026-07-27
DOI
—
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

We think that in TMD individuals with FHP, postural awareness may have increased due to musculoskeletal system problems, a compensatory strategy may have been developed, or a more adaptive level may have been developed in the relevant parameters.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aims: Although the relationship between temporomandibular disorders (TMD) and forward head posture (FHP) has been investigated previously, specifically posture habits and awareness have not been evaluated together with musculoskeletal system parameters in TMD.
📊
Key Findings & Data:To strengthen the clinical significance level, data from the first quartile (n=12) and fourth quartile (n=12) cases were analysed.
💡
Conclusion & Impact:We think that in TMD individuals with FHP, postural awareness may have increased due to musculoskeletal system problems, a compensatory strategy may have been developed, or a more adaptive level may have been developed in the relevant parameters.
🔬Design:Survey & Empirical Study
📍Scope:Comprehensive Sample
⚙️Variables:temporomandibular eklem bozuklukları · postüral farkındalık · propriyosepsiyon

Abstract

Aims: Although the relationship between temporomandibular disorders (TMD) and forward head posture (FHP) has been investigated previously, specifically posture habits and awareness have not been evaluated together with musculoskeletal system parameters in TMD. Therefore, this study aimed to investigate postural habits and awareness, pressure pain threshold, proprioception, and functionality in individuals with TMD according to the presence of FHP. Methods: Fifty individuals with myogenic TMD participated in the study. FHP was assessed via measurement of Craniovertebral Angle. Postural habits and awareness levels were assessed using the Postural Habits and Awareness Scale (PHAS). Pressure-pain levels were assessed using an algometer, and proprioception was assessed using the Laser Cursor-Assisted Angle Repetition Test (LART). The Helkimo Clinical Dysfunction Index (HCDI) and Mandibular Function Impairment Questionnaire (MFIQ) were used to measure jaw functionality. To strengthen the clinical significance level, data from the first quartile (n=12) and fourth quartile (n=12) cases were analysed. Results: No significant difference was observed between the groups of FHP and control in terms of PHAS scores (p>.05). The pressure pain threshold was significantly higher in the m. temporalis and m. trapezius, as well as in the lateral and dorsal capsules in the FHP group (p<.05) and LART value during both flexion and extension was lower, and scores of HCDI and MFIQ were lower in the FHP group (p<.05). Conclusion: While no difference was found between the groups in terms of postural habits and awareness, higher pressure pain thresholds were observed in the m. temporalis, m. trapezius, and joint capsules, along with better level of proprioception and jaw function in the FHP group. We think that in TMD individuals with FHP, postural awareness may have increased due to musculoskeletal system problems, a compensatory strategy may have been developed, or a more adaptive level may have been developed in the relevant parameters.

Özet

Amaç: Temporomandibular bozukluklar (TMB) ve baş önde postürü (BÖP) arasındaki ilişki incelenmiş olsa da özellikle postür alışkanlığı ve farkındalığı kas-iskelet sistemi parametreleriyle birlikte değerlendirilmemiştir. Bu sebeple bu çalışmada, TMBli bireylerde BÖPe göre postüral alışkanlık ve farkındalık düzeyi, basınç ağrı eşiği, propriyosepsiyon ve fonksiyonelliğin araştırılması amaçlamıştır. Yöntemler: Çalışmaya 50 miyojenik TMBli birey katıldı. BÖP değerlendirmesi amacıyla Kraniyovertebral açı (KVA) ölçümü gerçekleştirildi. Postüral alışkanlık ve farkındalık düzeyi, Postüral Alışkanlık ve Farkındalık Ölçeği (PAFÖ) ile değerlendirildi. Basınç-ağrı düzeyi algometreyle, propriyosepsiyon Lazer İmleç Yardımlı Açı Tekrarlama Testi (LİYATT) ile değerlendirildi. Çene fonksiyonelliği ölçümünde Helkimo Klinik Disfonksiyon İndeksi (HKDİ) ve Mandibular Fonksiyon Bozukluğu Anketi (MFBA) kullanıldı. Klinik anlamlılık düzeyini güçlendirmek adına birinci çeyrekte (n=12) ve dördüncü çeyrekteki (n=12) olguların verileri analiz edildi. Bulgular: BÖP ve kontrol grubu arasında PAFÖ skorları açısından anlamlı bir fark gözlenmedi (p>,05). BÖP grubunda basınç ağrı eşiği; m. temporalis ve m. trapezius, lateral ve dorsal kapsülde daha yüksekti (p<,05), fleksiyon ve ekstansiyon yönlerinde LİYATT testi değerleri daha düşüktü (p<,05) ve HKDİ ve MFBA skorları daha düşüktü (p<,05). Sonuç: Gruplar arasında postür alışkanlığı ve farkındalığı açısından fark saptanmazken, BÖP grubunda m. temporalis ve m. trapezius ile lateral ve dorsal kapsülde basınç ağrı eşiğinin daha yüksek, fleksiyon ve ekstansiyon yönlerindeki propriyosepsiyon duyusunun ve çene eklemi fonksiyonelliğinin daha iyi düzeyde olduğu görüldü. BÖP olan TMBli bireylerde; kas iskelet sistemi problemleri sebebiyle postüral farkındalıklar artmış, kompanse edici bir strateji geliştirilmiş veya ilgili parametrelerde daha adaptif bir seviye geliştirilmiş olabileceğini düşünmekteyiz.

🔖

Cite This Article

Damar, Z., Alla, Ş., Özgül, B. (2026). Evaluation of Postural Awareness, Pressure Pain Threshold, Proprioception and Jaw Functionality According to Head Posture in Temporomandibular Disorder. Journal of Health Sciences and Management, Cilt: 6 Sayı: 2, 46–54. https://ajindex.com/articles/1592307

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (60)

  1. Abd El-Azeim, A. S., Mahmoud, A. G., Mohamed, M. T., & El-Khateeb, Y. S. (2022). Impact of adding scapular stabilization to postural correctional exercises on symptomatic forward head posture: a randomized controlled trial. European journal of physical and rehabilitation medicine, 58(5), 757–766. https://doi.org/10.23736/S1973-9087.22.07361-0
  2. Alghadir, A. H., Zafar, H., & Iqbal, Z. A. (2015). Effect of three different jaw positions on postural stability during standing. Functional neurology, 30(1), 53.
  3. Alonso-Royo, R., Sánchez-Torrelo, C. M., Ibáñez-Vera, A. J., Zagalaz-Anula, N., CastelloteCaballero, Y., Obrero-Gaitán, E.,. & Lomas-Vega, R. (2021). Validity and reliability of the Helkimo clinical dysfunction index for the diagnosis of temporomandibular disorders. Diagnostics, 11(3), 472.
  4. Alshahrani, A., Ghulam, H. S. H., Alqhtani, R. S., Al Sharyah, Y. H. H., Ahmed, H., Aafreen, A., Khan, A. R., Khan, A., & Ahmad, A. (2024). Cervical Health Parameters in Car Drivers: Assessing the Influence of Driving on Neck Pain, Mobility, Proprioception and Craniovertebral Angle - A Cross-Sectional Study. Journal of multidisciplinary healthcare, 17, 2013–2020. https://doi.org/10.2147/JMDH.S458364
  5. Armijo-Olivo, S., & Magee, D. (2013). Cervical musculoskeletal impairments and temporomandibular disorders. Journal of oral & maxillofacial research, 3(4), e4. https://doi.org/10.5037/jomr.2012.3404 Armijo-Olivo, S., Silvestre, R. A., Fuentes, J. P., da Costa, B. R., Major, P. W., Warren, S., Thie, N. M., & Magee, D. J. (2012). Patients with temporomandibular disorders have increased fatigability of the cervical extensor muscles. The Clinical journal of pain, 28(1), 55–64. https://doi.org/10.1097/AJP.0b013e31822019f2
  6. Bayar, B., Güp, A. A., Özen Oruk, D., İpek Dongaz, Ö., Doğu, E., & Bayar, K. (2023). Development of the postural habits and awareness scale: a reliability and validity study. International Journal of Occupational Safety and Ergonomics, 29(2), 815-820.
  7. Bennette, C., & Vickers, A. (2012). Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. BMC medical research methodology, 12(1), 21.
  8. Chiu, T. T., Lam, T. H., & Hedley, A. J. (2005). Correlation among physical impairments, pain, disability, and patient satisfaction in patients with chronic neck pain. Archives of physical medicine and rehabilitation, 86(3), 534-540.
  9. Cramer, H., Mehling, W. E., Saha, F. J., Dobos, G., & Lauche, R. (2018). Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain. BMC musculoskeletal disorders, 19, 1-10.
  10. Cuccia, A., & Caradonna, C. (2009). The relationship between the stomatognathic system and body posture. Clinics, 64(1), 61-66.
  11. Çankaya, M., & Takı, F. N. (2024). Comparison of postural assessment and awareness in individuals receiving posture training using the digital AI posture assessment and correction system. International journal of occupational safety and ergonomics: JOSE, 30(4), 1311–1317. https://doi.org/10.1080/10803548.2024.2397836
  12. De Leeuw R, K. G. (2013). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management (Fifth edition. ed.). Chicago: Quintessence Publishing Co, Inc, [2013].
  13. Fahmy, R. (2022). NASM essentials of corrective exercise training. (No Title).
  14. Gadotti, I., Hicks, K., Koscs, E., Lynn, B., Estrazulas, J., & Civitella, F. (2020). Electromyography of the masticatory muscles during chewing in different head and neck postures-A pilot study. Journal of oral biology and craniofacial research, 10(2), 23-27.
  15. Ha, S. Y., & Sung, Y. H. (2020). A temporary forward head posture decreases function of cervical proprioception. Journal of exercise rehabilitation, 16(2), 168.
  16. Helkimo M. (1974). Studies on function and dysfunction of the masticatory system. IV. Age and sex distribution of symptoms of dysfunction of the masticatory system in Lapps in the north of Finland. Acta odontologica Scandinavica, 32(4), 255–267. https://doi.org/10.3109/00016357409026342
  17. Hogg-Johnson, S., van der Velde, G., Carroll, L. J., Holm, L. W., Cassidy, J. D., Guzman, J.,. & Peloso, P. (2008). The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 33(4S), S39-S51.
  18. Jaffal, S. M. (2025). Neuroplasticity in chronic pain: insights into diagnosis and treatment. The Korean Journal of Pain, 38(2), 89-102.
  19. Kent, P., Laird, R., & Haines, T. (2015). The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC musculoskeletal disorders, 16, 1-19.
  20. Kulkarni, N., Bhandari, R., Soni, S., & Palekar, T. J. (2025). MET to Levator Scapulae Versus MET to Anterior Scalene: Comparative Effects on Craniovertebral Angle and Cervical Joint Position in Forward Head Posture. International journal of therapeutic massage & bodywork, 18(1), 29–38. https://doi.org/10.3822/ijtmb.v18i1.1075
  21. Lin, G., Zhao, X., Wang, W., & Wilkinson, T. (2022). The relationship between forward head posture, postural control and gait: A systematic review. Gait & posture, 98, 316–329. https://doi.org/10.1016/j.gaitpost.2022.10.008
  22. Lotfian, S., Fesharaki, M. J., Shahabbaspour, Z., Akbarzadeh, H., & Moezy, A. (2025). The impact of forward head posture on neck muscle endurance and thickness in women with chronic neck pain: a cross-sectional study. BMC musculoskeletal disorders, 26(1), 468. https://doi.org/10.1186/s12891-025-08705-w
  23. Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Current reviews in musculoskeletal medicine, 12(4), 562-577.
  24. McLean, L. (2005). The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region. Journal of Electromyography and Kinesiology, 15(6), 527-535.
  25. Migliarese, S., & White, E. (2019). Review of forward-head posture and vestibular deficits in older adults. Current Geriatrics Reports, 8(3), 194-201.
  26. Moseley, G. L., & Hodges, P. W. (2005). Are the changes in postural control associated with low back pain caused by pain interference?. The Clinical journal of pain, 21(4), 323-329.
  27. Moustafa, I. M., Youssef, A., Ahbouch, A., Tamim, M., & Harrison, D. E. (2020). Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control? Cross sectional study. Gait & Posture, 77, 29-35.
  28. National Institute of Dental and Craniofacial Research (2018) Prevalence of TMJD and its signs and symptoms. https://www. nidcr.nih.gov/research/data-statistics/facial-pain/prevalence. Accessed 26 March 2020
  29. Nejati, P., Lotfian, S., Moezy, A., & Nejati, M. (2015). The study of correlation between forward head posture and neck pain in Iranian office workers. International journal of occupational medicine and environmental health, 28(2), 295-303.
  30. Neumann, D. A., & Kelly, E. R. (2010). Kinesiology of the musculoskeletal system: foundations for rehabilitation.
  31. Oleksy, Ł., Kielnar, R., Mika, A., Jankowicz-Szymańska, A., Bylina, D., Sołtan, J.,. & Królikowska, A. (2021). Impact of cervical spine rehabilitation on temporomandibular joint functioning in patients with idiopathic neck pain. BioMed research international, 2021(1), 6886373.
  32. Oliveira, A. C., & Silva, A. G. (2016). Neck muscle endurance and head posture: a comparison between adolescents with and without neck pain. Manual therapy, 22, 62-67.
  33. Olmos, S. R., Kritz-Silverstein, D., Halligan, W., & Silverstein, S. T. (2005). The effect of condyle fossa relationships on head posture. CRANIO®, 23(1), 48-52.
  34. Özgören, Ç., CİDDİ, P. K., & SAHİN, M. (2022). Kronik boyun ağrısında eklem pozisyon hissinin ağrı, eklem hareket açıklığı, kas kuvveti, hareket korkusu, fonksiyonellik ve yaşam kalitesi parametreleri ile ilişkisi. Journal of Exercise Therapy and Rehabilitation, 9(1), 48-58.
  35. Pacheco, J., Raimundo, J., Santos, F., Ferreira, M., Lopes, T., Ramos, L., & Silva, A. G. (2018). Forward head posture is associated with pressure pain threshold and neck pain duration in university students with subclinical neck pain. Somatosensory & motor research, 35(2), 103-108.
  36. Pausić, J., Pedisić, Z., & Dizdar, D. (2010). Reliability of a photographic method for assessing standing posture of elementary school students. Journal of manipulative and physiological therapeutics, 33(6), 425–431. https://doi.org/10.1016/j.jmpt.2010.06.002
  37. Pensri, C., Liang, Z., Treleaven, J., Jull, G., & Thomas, L. (2025). Cervical musculoskeletal impairments in migraine and tension-type headache and relationship to pain related factors: An updated systematic review and meta-analysis. Musculoskeletal science & practice, 76, 103251. https://doi.org/10.1016/j.msksp.2024.103251
  38. Quek, J., Pua, Y. H., Clark, R. A., & Bryant, A. L. (2013). Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Manual therapy, 18(1), 65-71.
  39. Revel, M., Andre-Deshays, C., & Minguet, M. (1991). Cervicocephalic kinesthetic sensibility in patients with cervical pain. Archives of physical medicine and rehabilitation, 72(5), 288–291.
  40. Sarig Bahat, H., Levy, A., & Yona, T. (2023). The association between forward head posture and non-specific neck pain: A cross-sectional study. Physiotherapy theory and practice, 39(8), 1736-1745.
  41. Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J. P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., Michelotti, A., Brooks, S. L., Ceusters, W., Drangsholt, M., Ettlin, D., Gaul, C., Goldberg, L. J., Haythornthwaite, J. A., Hollender, L., Jensen, R., … Orofacial Pain Special Interest Group, International Association for the Study of Pain (2014). Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Journal of oral & facial pain and headache, 28(1), 6–27. https://doi.org/10.11607/jop.1151
  42. Shahidi, B., Haight, A., & Maluf, K. (2013). Differential effects of mental concentration and acute psychosocial stress on cervical muscle activity and posture. Journal of electromyography and kinesiology, 23(5), 1082-1089.
  43. Shetty, S. K., Katageri, A. I., Shetty, R., Ragher, M., & Prabhu, U. M. (2025). Evaluation of the effect of temporomandibular joint disorders on craniocervical posture: A cross-sectional study. Journal of Indian Prosthodontic Society, 25(4), 327–333. https://doi.org/10.4103/jips.jips_273_25
  44. Silva, A. G., & Johnson, M. I. (2013). Does forward head posture affect postural control in human healthy volunteers?. Gait & posture, 38(2), 352-353.
  45. Silva, A. G., Sharples, P., & Johnson, M. I. (2010). Studies comparing surrogate measures for head posture in individuals with and without neck pain. Physical Therapy Reviews, 15(1), 12-22.
  46. Stegenga, B., de Bont, L. G., de Leeuw, R., & Boering, G. (1993). Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement. Journal of orofacial pain, 7(2), 183–195.
  47. Szeto, G. P., Straker, L., & Raine, S. (2002). A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers. Applied ergonomics, 33(1), 75-84.
  48. Tang, Y., Xu, L. L., & Fan, S. (2021). Shanghai kou qiang yi xue = Shanghai journal of stomatology, 30(2), 173–176. Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual therapy, 13(1), 2-11.
  49. Więckiewicz, W., Woźniak, K., Piątkowska, D., Szyszka-Sommerfeld, L., & Lipski, M. (2015). The diagnostic value of pressure algometry for temporomandibular disorders. BioMed research international, 2015.
  50. Yıldız, N. T., Alkan, A., & Külünkoğlu, B. A. (2021). Validity and Reliability of the Turkish Version of Mandibular Function Impairment Questionnaire. CRANIO®, 1-11.
  51. Yong, M. S., & Lee, H. Y. (2025). Does Forward Head Posture Influence Muscle Tone, Stiffness, and Elasticity in University Students?. Journal of Clinical Medicine, 14(6), 1888.
  52. Yong, M. S., Lee, H. Y., & Lee, M. Y. (2016). Correlation between head posture and proprioceptive function in the cervical region. Journal of physical therapy science, 28(3), 857-860.
  53. Yost, O., Liverman, C. T., English, R., Mackey, S., & Bond, E. C. (Eds.). (2020). Temporomandibular Disorders: Priorities for Research and Care. National Academies Press (US).
  54. Zieliński, G., Pająk-Zielińska, B., & Ginszt, M. (2024). A meta-analysis of the global prevalence of temporomandibular disorders. Journal of clinical medicine, 13(5), 1365.
  55. Zokaitė, G., Lopatienė, K., Vasiliauskas, A., Smailienė, D., & Trakinienė, G. (2022). Relationship between craniocervical posture and sagittal position of the mandible: A systematic review. Applied Sciences, 12(11), 5331.
  56. Alonso-Royo, R., Sánchez-Torrelo, C. M., Ibáñez-Vera, A. J., Zagalaz-Anula, N., CastelloteCaballero, Y., Obrero-Gaitán, E.,. & Lomas-Vega, R. (2021). Validity and reliability of the Helkimo clinical dysfunction index for the diagnosis of temporomandibular disorders. Diagnostics, 11(3), 472.
  57. Çankaya, M., & Takı, F. N. (2024). Comparison of postural assessment and awareness in individuals receiving posture training using the digital AI posture assessment and correction system. International journal of occupational safety and ergonomics: JOSE, 30(4), 1311–1317. https://doi.org/10.1080/10803548.2024.2397836
  58. De Leeuw R, K. G. (2013). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management (Fifth edition. ed.). Chicago: Quintessence Publishing Co, Inc, [2013].
  59. Hogg-Johnson, S., van der Velde, G., Carroll, L. J., Holm, L. W., Cassidy, J. D., Guzman, J.,. & Peloso, P. (2008). The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 33(4S), S39-S51.
  60. Oleksy, Ł., Kielnar, R., Mika, A., Jankowicz-Szymańska, A., Bylina, D., Sołtan, J.,. & Królikowska, A. (2021). Impact of cervical spine rehabilitation on temporomandibular joint functioning in patients with idiopathic neck pain. BioMed research international, 2021(1), 6886373.