Comparison of Balance, Kinesiophobia and Spinal Status Between Individuals with Temporomandibular Joint Disorder and Healthy Controls

Öz

Objective: Temporomandibular joint disorder (TMD) can affect jaw joint function as well as impair neuromuscular control and postural stability. This study aims to compare balance, kinesiophobia, and spinal function parameters in individuals with TMD with healthy controls. Methods: A total of 71 participants were included in the study, comprising 35 individuals with TMD and 36 healthy controls. Participants’ static and dynamic balance was assessed using the Biodex Balance System, kinesiophobia was evaluated using the Tampa Kinesiophobia Scale, and spinal function was measured with the Spinal Mouse device. Results: When individuals with TMD were compared to the healthy control group, significant differences were found between the groups in favour of the healthy control group in static and dynamic balance (anterior-posterior, medial-lateral, and overall) and spinal assessment parameters (spine check score, posture and mobility) (p<0.05). Furthermore, it was found that individuals with TMD had significantly higher levels of kinesiophobia (p<0.05). Conclusion: This study demonstrates that parameters relating to static and dynamic balance, kinesiophobia, spinal condition, mobility and posture are adversely affected in individuals with TMD compared to healthy individuals. The findings highlight the importance of interventions targeting these parameters in TMD management and suggest that they may contribute to the personalisation of treatment strategies.

Anahtar Kelimeler

• Temporomandibular joint disorder
• balance
• kinesiophobia
• spine

Temporomandibular Eklem Bozukluğu olan Bireyler ve Sağlıklı Kontroller Arasında Denge, Kinezyofobi ve Spinal Durumun Karşılaştırılması

Öz

Amaç: Temporomandibular eklem bozukluğu (TMB), çene eklemi fonksiyonunu etkileyebileceği gibi nöromüsküler kontrolü ve postüral stabiliteyi de bozabilir. Bu çalışma, TMB’li bireylerde denge, kinezyofobi ve spinal fonksiyon parametrelerini sağlıklı bireylerle karşılaştırmayı amaçlamaktadır. Yöntemler: Çalışmaya 35 TMB’li birey ve 36 sağlıklı kontrol olmak üzere toplam 71 katılımcı dahil edildi. Katılımcıların statik ve dinamik dengeleri Biodex Denge Sistemi ile, kinezyofobi düzeyleri Tampa Kinezyofobi Ölçeği ile ve spinal fonksiyonları Spinal Mouse cihazı ile değerlendirildi. Bulgular: TMB’li bireyler sağlıklı kontrol grubu ile karşılaştırıldığında, statik ve dinamik denge parametrelerinde (antero-posterior, medio-lateral ve genel skorlar) ve spinal değerlendirme parametrelerinde (spinal kontrol skoru, postür ve mobilite) sağlıklı grup lehine anlamlı fark bulundu (p<0.05). Ayrıca TMB’li bireylerin kinezyofobi düzeylerinin anlamlı derecede yüksek olduğu saptandı (p<0.05). Sonuç: Bu çalışma, statik ve dinamik denge, kinezyofobi, omurga durumu, mobilite ve postürle ilgili parametrelerin, TMB'li bireylerde sağlıklı bireylere kıyasla olumsuz etkilendiğini göstermektedir. Bulgular, TMB yönetiminde bu parametreleri hedefleyen müdahalelerin önemini vurgulamakta ve tedavi stratejilerinin kişiselleştirilmesine katkı sağlayabileceğini düşündürmektedir.

Anahtar Kelimeler

• Temporomandibular eklem bozukluğu
• denge
• kinezyofobi
• omurga.

Kaynakça

1. 1.Greene CS, Klasser GD, Epstein JB. Revision of theAmerican Association of Dental Research’s scienceinformation statement about temporomandibulardisorders. J Can Dent Assoc. 2010;76(76):a115.
2. 2.Leeuw Rd, Klasser GD. Orofacial pain: guidelinesfor assessment, diagnosis, and management.Quintessence, Chicago. 2008.
3. 3.Detamore MS, Athanasiou KA. Structure andfunction of the temporomandibular joint disc:implications for tissue engineering. J Oral MaxillofacSurg. 2003;61(4):494–506.
4. 4.Camacho JGDD, Oltramari-Navarro PVP, NavarroRdL, et al. Signs and symptoms oftemporomandibular disorders in the elderly. Paperpresented at: CoDAS2014.
5. 5.Sulowska-Daszyk I, Handzlik-Waszkiewicz P,Gamrot S. The effect of a single temporomandibularjoint soft tissue therapy on cervical spine mobility,temporomandibular joint mobility, foot loaddistribution, and body balance in women withmyofascial pain in the temporomandibular jointarea—A randomized controlled trial. AppliedSciences. 2024;14(22):10397.
6. 6.Munhoz WC, Hsing WT. The inconclusiveness ofresearch on functional pathologies of thetemporomandibular system and body posture:paths followed, paths ahead: a critical review.CRANIO®. 2021;39(3):254–65.
7. 7.Jørgensen MB, Skotte JH, Holtermann A, et al. Neckpain and postural balance among workers with highpostural demands-a cross-sectional study. BMCMusculoskelet Disord. 2011;12(1):176.
8. 8.Sessle BJ, Hu JW, Amano N, Zhong G. Convergenceof cutaneous, tooth pulp, visceral, neck and muscleafferents onto nociceptive and non-nociceptiveneurones in trigeminal subnucleus caudalis(medullary dorsal horn) and its implications forreferred pain. Pain. Nov 1986;27(2):219–35.

9. 9.Kim JY, Yeo SS. Change of balance ability insubjects with pain-related temporomandibulardisorders. The Journal of Korean Phy Ther.2022;34(6):321–5.
10. 10.Cuccia A, Caradonna C. The relationship betweenthe stomatognathic system and body posture.Clinics. 2009;64(1):61–6.
11. 11.Bracco P, Deregibus A, Piscetta R. Effects ofdifferent jaw relations on postural stability inhuman subjects. Neuroscience letters.2004;356(3):228–30.
12. 12.Tardieu C, Dumitrescu M, Giraudeau A, et al.Dental occlusion and postural control in adults.Neuroscience letters. 2009;450(2):221–4.
13. 13.Häggman-Henrikson B, Jawad N, Acuña XM, et al.Fear of movement and catastrophizing inparticipants with temporomandibular disorders.Journal of Oral & Facial Pain and Headache.2022;36(1):3060.
14. 14.Silva LMCP, Rodrigues BA, Lucena HidS, et al.Prevalence of kinesiophobia and catastrophizing inpatients with temporomandibular disorders.Revista CEFAC. 2022;24(6):e3322.
15. 15.Kaynak BA, Taş S, Salkın Y. The accuracy andreliability of the Turkish version of the Fonsecaanamnestic index in temporomandibular disorders.Cranio®. 2023;41(1):78–83.
16. 16.Glave AP, Didier JJ, Weatherwax J, Browning SJ,Fiaud V. Testing postural stability: are the starexcursion balance test and Biodex Balance Systemlimits of stability tests consistent? Gait & posture.2016;43:225–7.
17. 17.Yilmaz O, Yakut Y, Uygur F, Ulug N. Turkishversion of the Tampa Scale for Kinesiophobia and itstest-retest reliability. Turkish Journal ofPhysiotherapy Rehabilitation-FizyoterapiRehabilitasyon. 2011;22(1).
18. 18.Mannion AF, Knecht K, Balaban G, Dvorak J, GrobD.A new skin-surface device for measuring thecurvature and global and segmental ranges ofmotion of the spine: reliability of measurements andcomparison with data reviewed from the literature.Eur Spine J. 2004;13:122–36.
19. 19.Lin G, Zhao X, Wang W, Wilkinson T. Therelationship between forward head posture, & posture. 2022;98:316–29.
20. 20.Nota A, Tecco S, Ehsani S, Padulo J, Baldini A.Postural stability in subjects with temporomandibular disorders and healthy controls: A comparative assessment. J Electromyogr Kinesiol. 2017;37:21–4.
21. 21.Ries LGK, Bérzin F. Analysis of the posturalstability in individuals with or without signs andsymptoms of temporomandibular disorder.Brazilian oral research. 2008;22:378–83.
22. 22.Oltramari-Navarro PVP, Yoshie MT, Silva Rad, etal. Influence of the presence of TemporomandibularDisorders on postural balance in the elderly. Paperpresented at: CoDAS2017.
23. 23.Lira MR, da Silva RRL, Bataglion C, et al. Multiplediagnoses, increased kinesiophobia?-Patients withhigh kinesiophobia levels showed a greater numberof temporomandibular disorder diagnoses.Musculoskelet Sci Pract. 2019;44:102054.
24. 24.Marciniak T, Kruk-Majtyka W, Bobowik P,Marszałek S. The relationship betweenkinesiophobia, emotional state, functional state andchronic pain in subjects with/withoutTemporomandibular Disorders. J Clin Med.2024;13(3):848.
25. 25. Saito ET, Akashi PMH, Sacco IdCN. Global body posture evaluation in patients with temporomandibular joint disorder. Clinics. 2009;64:35–9.
26. 26.Lee W-Y, Okeson JP, Lindroth J. The relationshipbetween forward head posture and temporomandibular disorders. Journal of orofacial pain. 1995;9(2).
27. 27.Mielcarek M, Złotnicka K, Jaranowska K, et al.Impact of temporomandibular joint disorders onbody posture. Journal of education, health and sport.2019;9(10):160–5.
28. 28.Ferreira MP, Waisberg CB, Conti PCR, Bevilaqua‐Grossi D. Mobility of the upper cervical spine andmuscle performance of the deep flexors in womenwith temporomandibular disorders. J Oral Rehabil.2019;46(12):1177–84.
29. 29.Wolan-Nieroda A, Maciejczak A, Mańko G, et al.Comparative analysis of mandibular and cervicalmobility in young adults with temporomandibularjoint disorders: a case-control study. Med Sci Monit.2023;29:e940653–940651.
30. 30.Arslan M, Dursun O, Celenay ST. Effectiveness ofcervical stabilization training in individuals withtemporomandibular joint disorders: a randomizedcontrolled trial. BMC Musculoskelet Disord.2025;26(1):78.