Umber Nawaz - University of Lahore
Muhammad Waqar Afzal - University Institute of Physical Therapy, University of Lahore, Lahore Pakitan
Kashif Siddique - University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
Naveeda Ashraf - University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
Hana Aziz - School of Dentistry, Fatima Jinnah dental college for women, Karachi, Pakistan.
Saima Aziz Khan - DOW University of Health Sciences, Institute of Physical Therapy and Rehabilitation, Karachi, Pakistan
Asim Chaudhary - Research department, Knowledge research and innovation center, Lahore, Pakistan
Muhammad Anwar Behr - Research Department, Knowledge Research and Innovation Center, Lahore, Pakistan
Muhammad Yahya Qureshi - Research Department, Knowledge Research and Innovation Center, Lahore, Pakistan
Mehwish Naz - School of Physiotherapy, Liaquat National Hospital, Karachi, Pakistan

Abstract Background: The studies in the literature have focused on the biomechanical and neurophysiological aspects of cervical and temporomandibular joint function. Addressing the cervical spine correlation with the temporomandibular joint may lead to long-term improvement in the derangement. This study desired to deduce the effectiveness of deep neck muscle strengthening exercises on jaw motion and clicking sounds in anterior disc displacement with reduction of the temporomandibular joint.Methods: This controlled clinical trial was conducted using a single-blinded design in a tertiary care teaching hospital affiliated with The University of Lahore- from March ۲۰۲۰ to January ۲۰۲۱. A count of ۶۸ patients were enrolled each with ۳۴ patients. The inclusion criteria were being ۱۸–۵۰ years old, suffering from temporomandibular joint pain and disc displacement with reduction, medical referral for temporomandibular disorders by a dentist or a maxillofacial surgeon, and having symptoms for more than one month before the first treatment. The exclusion criteria were having a tumor, fracture, or trauma in recent medical history, systemic, rheumatic diseases, degenerative changes, and history of surgery of the cervical spine or temporomandibular joint. The control group (Group A) was only given temporomandibular joint mobilization and soft tissue release. The Intervention group (Group B) did neck strengthening exercises in addition to the temporomandibular joint mobilization. The subjects were assessed twice.Results: To analyze the data, SPSS version.۲۱ was used. To assess the frequency of qualitative factors like clicking, the chi-square test was employed. The mean scores of quantitative factors such as mandibular lateral deviation and maximal mouth opening were approximated between the two categories of subjects using the Mann-Whitney test. The findings demonstrated that there was no change between the groups' pre- and post-treatment means for jaw mobility and clicking sounds. Nonetheless, the Intervention group's mandibular lateral deviation significantly improved (P-value ≤۰.۰۳۷)*. Conclusion: The findings revealed that neck strengthening exercises in addition to routine physical therapy of the temporomandibular joint do not affect clicks and mobility between the two groups. The exercises were found out to be effective only in improving the lateral deviation of the mandible.

Key words: temporomandibular joint disorders, temporomandibular joint disc, temporomandibular disorders, therapy, Exercise