Skip to main content
SpringerLink
Log in

The association between forward head posture and masticatory muscle pressure pain thresholds in patients with temporomandibular joint dissorders: a cross-sectional observational study

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

Forward head posture (FHP) is common in patients with temporomandibular joint disorders (TMDs); however, whether it contributes to TMD symptoms remains unclear. The aim of this study was to investigate the association between (1) FHP and masticatory muscle pressure pain thresholds (PPTs) and (2) neck muscle and masticatory muscle PPTs.

Materials and methods

A total of 145 patients diagnosed with TMD were recruited between December 2020 and April 2021. Data regarding FHP and neck and masticatory muscle PPTs were collected. FHP was characterized by the craniocervical angle (CVA) measured between the horizontal line through C7 and the line between the tragus of the ear and C7. Patients were divided into either the FHP group (CVA ≤ 51°) or the non-FHP group. Differences in the masseter and temporalis muscle PPTs between the two groups were analyzed using the Mann‐Whitney U test. The correlation between the CVA, neck, and masticatory muscle PPTs in all patients was determined by Spearman’s correlation analysis.

Results

There were 70 patients in the FHP group and 75 patients in the non-FHP group. No significant difference in masseter and temporalis muscle PPTs was found between the two groups (p > 0.05). No correlation was found between FHP and masticatory muscle PPTs (p > 0.05). A significant association was found between the neck muscle and masticatory muscle PPTs (p < 0.05). The C5–C6 pillar and masticatory PPTs were either moderately (r = 0.435, masseter muscle) or strongly (r = 0.608, temporalis muscle) correlated, while the correlation between the trapezius and masticatory muscles was moderate (r = 0.378, masseter muscle and r = 0.461, temporalis muscle).

Conclusion

FHP was not directly associated with masticatory muscle PPTs. Masticatory muscle PPTs were strongly or moderately associated with neck muscle PPTs. Therefore, the presence of neck pain, not the degree of FHP, in patients with TMD is of significance.

Clinical relevance

In TMD treatment, we should pay attention to and actively relieve neck pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets used for analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CVA:

Craniocervical angle

DC/TMD:

Diagnostic criteria for temporomandibular disorders

FHP:

Forward head posture

ICC:

Intra-class correlation coefficient

PPT:

Pressure pain threshold

TMD:

Temporomandibular disorder

References

  1. Ohrbach R, Dworkin SF (2016) The evolution of TMD diagnosis: past, present, future. J Dent Res 95:1093–1101. https://doi.org/10.1177/0022034516653922

    Article  Google Scholar 

  2. Cho J, Lee E, Lee S (2017) Upper thoracic spine mobilization and mobility exercise versus upper cervical spine mobilization and stabilization exercise in individuals with forward head posture: a randomized clinical trial. BMC Musculoskelet Disord 18:525. https://doi.org/10.1186/s12891-017-1889-2

    Article  Google Scholar 

  3. Espinosa de Santillana IA, García-Juárez A, Rebollo-Vázquez J, Ustarán-Aquino AK (2018) Frequent postural alterations in patients with different types of temporomandibular disorders. Rev Salud Publica (Bogota) 20:384–389. https://doi.org/10.15446/rsap.V20n3.53529

    Article  Google Scholar 

  4. Nicolakis P, Nicolakis M, Piehslinger E et al (2000) Relationship between craniomandibular disorders and poor posture. CRANIO® 18:106–112. https://doi.org/10.1080/08869634.2000.11746121

    Article  Google Scholar 

  5. Gençosmanoğlu H, Ünlüer NÖ, Akın ME, Demir P, Aydın G (2021) An investigation of biomechanics, muscle performance, and disability level of craniocervical region of individuals with temporomandibular disorder. CRANIO® pp 1–11. https://doi.org/10.1080/08869634.2021.1938854

  6. Chaves TC, Turci AM, Pinheiro CF, Sousa LM, Grossi DB (2014) Static body postural misalignment in individuals with temporomandibular disorders: a systematic review. Braz J Phys Ther 18:481–501. https://doi.org/10.1590/bjpt-rbf.2014.0061

    Article  Google Scholar 

  7. Ballenberger N, von Piekartz H, Paris-Alemany A, La Touche R, Angulo-Diaz-Parreño S (2012) Influence of different upper cervical positions on electromyography activity of the masticatory muscles. J Manipulative Physiol Ther 35:308–318. https://doi.org/10.1016/j.jmpt.2012.04.020

    Article  Google Scholar 

  8. Uritani D, Kawakami T, Inoue T, Kirita T (2014) Characteristics of upper quadrant posture of young women with temporomandibular disorders. J Phys Ther Sci 26:1469–1472. https://doi.org/10.1589/jpts.26.1469

    Article  Google Scholar 

  9. de Farias Neto JP, de Santana JM, de Santana-Filho VJ, Quintans-Junior LJ, de Lima Ferreira AP, Bonjardim LR (2010) Radiographic measurement of the cervical spine in patients with temporomandibular dysfunction. Arch Oral Biol 55:670–678. https://doi.org/10.1016/j.archoralbio.2010.06.002

    Article  Google Scholar 

  10. Santos Silva RS, Conti PC, Lauris JR, da Silva RO, Pegoraro LF (2005) Pressure pain threshold in the detection of masticatory myofascial pain: an algometer-based study. J Orofac Pain 19:318–324

    Google Scholar 

  11. Gomes MB, Guimarães JP, Guimarães FC, Neves ACC (2008) Palpation and pressure pain threshold: reliability and validity in patients with temporomandibular disorders. CRANIO® 26:202–210. https://doi.org/10.1179/crn.2008.027

    Article  Google Scholar 

  12. Pacheco J, Raimundo J, Santos F et al (2018) Forward head posture is associated with pressure pain threshold and neck pain duration in university students with subclinical neck pain. Somatosens Mot Res 35:103–108. https://doi.org/10.1080/08990220.2018.1475352

    Article  Google Scholar 

  13. Bragatto MM, Bevilaqua-Grossi D, Regalo SC, Sousa JD, Chaves TC (2016) Associations among temporomandibular disorders, chronic neck pain and neck pain disability in computer office workers: a pilot study. J Oral Rehabil 43:321–332. https://doi.org/10.1111/joor.12377

    Article  Google Scholar 

  14. Herpich CM, Gomes CAFP, Dibai-Filho AV, Politti F, Souza CDS, Biasotto-Gonzalez DA (2018) Correlation between severity of temporomandibular disorder, pain intensity, and pressure pain threshold. J Manipulative Physiol Ther 41:47–51. https://doi.org/10.1016/j.jmpt.2017.08.001

    Article  Google Scholar 

  15. Greenbaum T, Dvir Z, Emodi-Perelmam A, Reiter S, Rubin P, Winocur E (2020) Relationship between specific temporomandibular disorders and impaired upper neck performance. Eur J Oral Sci 128:292–298. https://doi.org/10.1111/eos.12718

    Article  Google Scholar 

  16. Schiffman E, Ohrbach R (2016) Executive summary of the diagnostic criteria for temporomandibular disorders for clinical and research applications. J Am Dent Assoc 147:438–445. https://doi.org/10.1016/j.adaj.2016.01.007

    Article  Google Scholar 

  17. Schiffman E, Ohrbach R, Truelove E et al (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†. J Oral Facial Pain Headache 28:6–27. https://doi.org/10.11607/jop.1151

    Article  Google Scholar 

  18. Salahzadeh Z, Maroufi N, Ahmadi A et al (2014) Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil 27:131–139. https://doi.org/10.3233/BMR-130426

    Article  Google Scholar 

  19. Gadotti IC, Armijo-Olivo S, Silveira A, Magee D (2013) Reliability of the craniocervical posture assessment: visual and angular measurements using photographs and radiographs. J Manipulative Physiol Ther 36:619–625. https://doi.org/10.1016/j.jmpt.2013.09.002

    Article  Google Scholar 

  20. Walton DM, MacDermid JC, Nielson W, Teasell RW, Chiasson M, Brown L (2011) Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther 41:644–650. https://doi.org/10.2519/jospt.2011.3666

    Article  Google Scholar 

  21. Ylinen J, Takala EP, Kautiainen H et al (2005) Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial. Eur J Pain 9:673–681. https://doi.org/10.1016/j.ejpain.2005.01.001

    Article  Google Scholar 

  22. Javanshir K, Ortega-Santiago R, Mohseni-Bandpei MA, Miangolarra-Page JC, Fernández-de-Las-Peñas C (2010) Exploration of somatosensory impairments in subjects with mechanical idiopathic neck pain: a preliminary study. J Manipulative Physiol Ther 33:493–499. https://doi.org/10.1016/j.jmpt.2010.08.022

    Article  Google Scholar 

  23. Azevedo DC, de Lima PT, de Souza AF, McDonnell MK (2008) Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region. Eur J Pain 12:226–232. https://doi.org/10.1016/j.ejpain.2007.05.004

    Article  Google Scholar 

  24. Cohen J (1977) Statistical power ANALYSIS for the behavioral science. J Am Stat Assoc 2nd 18:109–143. https://doi.org/10.1177/0894318404272144

  25. Francisco FE, Gramani GC, Paulo FP, Costa J (2015) Association between temporomandibular disorders and abnormal head postures. Braz Oral Res 29:1–6. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0064

    Article  Google Scholar 

  26. Cortese S, Mondello A, Galarza R, Biondi A (2017) Postural alterations as a risk factor for temporomandibular disorders. Acta odontol latinoam 30:57–61

    Google Scholar 

  27. Hong SW, Lee JK, Kang JH (2019) Relationship among cervical spine degeneration, head and neck postures, and myofascial pain in masticatory and cervical muscles in elderly with temporomandibular disorder. Arch Gerontol Geriatr 81:119–128. https://doi.org/10.1016/j.archger.2018.12.004

    Article  Google Scholar 

  28. Yoakum CB, Romero AN, Latham C, Douglas EC, Gallagher KM, Terhune CE (2019) Sex and height influence neck posture when using electronic handheld devices. Clin Anat 32:1061–1071. https://doi.org/10.1002/ca.23440

    Article  Google Scholar 

  29. Kim BB, Lee JH, Jeong HJ, Cynn HS (2016) Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol 30:31–37. https://doi.org/10.1016/j.jelekin.2016.05.007

    Article  Google Scholar 

  30. Lee MY, Lee HY, Yong MS (2014) Characteristics of cervical position sense in subjects with forward head posture. J Phys Ther Sci 26:1741–1743. https://doi.org/10.1589/jpts.26.1741

    Article  Google Scholar 

  31. Iaroshevskyi OA, Morozova OG, Logvinenko AV, Lypynska YV (2019) Non-pharmacological treatment of chronic neck-shoulder myofascial pain in patients with forward head posture. Wiadomości lekarskie 72:84–88

    Article  Google Scholar 

  32. Diab AA, Moustafa IM (2012) The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil 26:351–361. https://doi.org/10.1177/0269215511419536

    Article  Google Scholar 

  33. Hanten WP, Olson SL, Russell JL, Lucio RM, Campbell AH (2000) Total head excursion and resting head posture: normal and patient comparisons. Arch Phys Med Rehabil 81:62–66. https://doi.org/10.1016/s0003-9993(00)90223-5

    Article  Google Scholar 

  34. Ghamkhar L, Kahlaee AH (2019) Is forward head posture relevant to cervical muscles performance and neck pain? A case–control study. Braz J Phys Ther 23:346–354. https://doi.org/10.1016/j.bjpt.2018.08.007

    Article  Google Scholar 

  35. Martinez-Merinero P, Nuñez-Nagy S, Achalandabaso-Ochoa A, Fernandez-Matias R, Pecos-Martin D, Gallego-Izquierdo T (2020) Relationship between forward head posture and tissue mechanosensitivity: a cross-sectional study. J Clin Med 9:634. https://doi.org/10.3390/jcm9030634

  36. Ballenberger N, von Piekartz H, Danzeisen M, Hall T (2018) Patterns of cervical and masticatory impairment in subgroups of people with temporomandibular disorders–an explorative approach based on factor analysis. CRANIO® 36:74–84. https://doi.org/10.1080/08869634.2017.1297904

    Article  Google Scholar 

  37. Tashani OA, Astita R, Sharp D, Johnson MI (2017) Body mass index and distribution of body fat can influence sensory detection and pain sensitivity. Eur J Pain 21:1186–1196. https://doi.org/10.1002/ejp.1019

    Article  Google Scholar 

  38. Zhang Y, Zhang S, Gao Y et al (2013) Factors associated with the pressure pain threshold in healthy Chinese men. Pain Med 14:1291–1300. https://doi.org/10.1111/pme.12158

    Article  Google Scholar 

  39. Özdinç S, Ata H, Selçuk H, Can HB, Sermenli N, Turan FN (2020) Temporomandibular joint disorder determined by fonseca anamnestic index and associated factors in 18- to 27-year-old university students. CRANIO®I 38:327–332. https://doi.org/10.1080/08869634.2018.1513442

Download references

Acknowledgements

This study was supported by the Clinical Research Program of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (No. JYLJ201901). The participation of the volunteers is greatly appreciated.

Funding

This study was supported by the Clinical Research Program of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (No. JYLJ201901).

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 500th Quxi Road, Shanghai, 200010, China

    Yuan Yao, Bin Cai, Shuai Fan, Hai Xia Yang, Yu Xin Zhang & Li Li Xu

Authors
  1. Yuan Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bin Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuai Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hai Xia Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu Xin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Li Li Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YY collected and analyzed patient data regarding CVA and PPTs as well as wrote the paper. HXY and YXZ also took part in data collection, specifically PPTs. BC and SHF guided the data analysis. BC and LLX assisted in the coordination of the study and reviewed the manuscript. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Li Li Xu.

Ethics declarations

Ethics approval and consent to participate

All participants were informed of the overall purpose and procedures of the study before the study. The participants participated voluntarily, and the study was approved by the Medical Ethics Committee of the Ninth People’s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (ethics batch number: 2018–96-T87).

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yao, Y., Cai, B., Fan, S. et al. The association between forward head posture and masticatory muscle pressure pain thresholds in patients with temporomandibular joint dissorders: a cross-sectional observational study. Clin Oral Invest 27, 353–360 (2023). https://doi.org/10.1007/s00784-022-04739-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-022-04739-9

Keywords

Search

Navigation