CLINICAL
PRACTICE
USEFULNESS OF POSTURE TRAINING FOR PATIENTS
WITH TEMPOROMANDIBULAR DISORDERS
EDWARD F. WRIGHT, D.D.S., M.S.; MANUEL A. DOMENECH, PH.D.; JOSEPH R. FISCHER JR., M.S.
A B S T R A C T
Background. Many practitioners have
found that posture training has a positive impact on
temporomandibular, or TMD, symptoms. The
authors conducted a study to evaluate its
effectiveness.
Methods. Sixty patients with TMD and a
primary muscle disorder were randomized into two
groups: one group received posture training and
TMD self-management instructions while the con-
trol group received TMD self-management instruc-
tions only. Four weeks after the study began, the
authors reexamined the subjects for changes in
symptoms, pain-free opening and pressure
algometer pain thresholds. In addition, pretreat-
ment and posttreatment posture measurements
were recorded for subjects in the treatment group.
Results. Statistically significant improve-
ment was demonstrated by the modified symptom
severity index, maximum pain-free opening and
pressure algometer threshold measurements, as
well as by the subjects’ perceived TMD and neck
symptoms. Subjects in the treatment group reported
Poor posture is widespread in the general pop-
ulation and appears to be an adaptive, self-
perpetuating trait that most people lack the cog-
nitive ability or desire to correct by themselves.1,2
Many practitioners have speculated that poor
posture may have a negative effect on
temporomandibular, or TMD, symptoms and
treatment outcome.2-7
Forward head posture is the most common
form of poor posture and is assumed by many
authors to be related to a multitude of myofascial
pain disorders.1-4,8 It requires the person to flex
202 JADA, Vol. 131, February 2000
Copyright ©1998-2001 American Dental Association. All rights reserved.
having experienced a mean reduction in TMD and
neck symptoms of 41.9 and 38.2 percent, respec-
tively, while subjects in the control group reported a
mean reduction in these symptoms of 8.1 and 9.3
percent. Within the treatment group, the authors
found significant correlations between improve-
ments in TMD symptoms and improvements in
neck symptoms (P < .005) as well as between TMD
symptom improvement and the difference between
head and shoulder posture measurements at the
outset of treatment (P < .05).
Conclusions. Posture training and TMD
self-management instructions are significantly
more effective than TMD self-management instruc-
tions alone for patients with TMD who have a pri-
mary muscle disorder.
Practice Implications. Patients
with TMD who hold their heads farther forward rel-
ative to the shoulders have a high probability of
experiencing symptom improvement as a result of
posture training and being provided with self-
management instructions.
the lower portion of the neck forward and bend
the upper portion of the neck backward.9,10
With this posture, the head’s center of gravity
is forward of the spine’s weight-bearing axis,
which increases the strain within the posterior
cervical muscles, ligaments and apophyseal
joints.2,7,10 Two studies have independently demon-
strated that when the head is positioned forward,
the upper trapezius muscle’s electromyocardio-
graphic, or EMG, activity is significantly
(P < .001) higher than it is when the head is in
normal alignment (the greater the EMG activity,

the more likely the patient is to
have pain from overusing the
muscles).11,12
Forward head posture
and TMD. It has been demon-
strated that cervical muscle
activity influences masticatory
muscle activity.13 Practitioners
have theorized that the addi-
tional demand that is placed on
the posterior cervical region by
the forward head posture alters
the masticatory system so that
people are more susceptible to
masticatory muscle strain,
spasm and pain.6,14
Many patients with TMD
have a forward head posture.
Among 164 patients with masti-
catory myofascial pain, Fricton
and colleagues15 identified 139
(85 percent) with forward head
posture and 135 (82 percent)
with rounded shoulders. Inves-
tigations of a relationship
between posture and TMD are
inconsistent; several studies
suggest that patients with TMD
position their head significantly
more forward than do subjects
without TMD,6,16 while other
studies have failed to find a sig-
nificant difference in head posi-
tion between subjects with and
without TMD.17,18
Cervical dysfunction and
TMD. Several authors also
have speculated that forward
head posture contributes to cer-
vical dysfunction (that is, pain
and/or restricted move-
ment).3,4,7,9 Studies investigating
this relationship have been
inconsistent: some support it,9,19
while others have failed to find
a significant relationship.8,20
Cervical dysfunction appears
to be more prevalent among
patients with TMD than among
people without TMD. Clark and
colleagues21 conducted a study
in which subjects with and
without TMD completed ques-
Copyright ©1998-2001 American Dental Association. All rights reserved.
tionnaires; subjects with TMD
reported that they had signifi-
cantly (P < .05) more cervical
pain than did subjects without
TMD. The investigators
reported that 23 percent of sub-
jects with TMD had cervical
dysfunction that was severe
enough to warrant referral for
treatment.
Many practitioners recom-
mend that patients with TMD
be evaluated for cervical dys-
function because they believe it
may have a negative effect on
TMD symptoms and treatment
Posture training
usually involves
exercises performed
repetitively to stretch
structures that poor
posture tends to
shorten, strengthen
structures that poor
posture tends to
weaken and create an
awareness of the
desirable posture.
outcome.3,6,7,21,22 Practitioners
have demonstrated that
patients with both cervical and
TMD pain may experience
improvement in TMD symptoms
as a result of treating the cer-
vical disorder. Carlson and col-
leagues23 injected 2 percent lido-
caine solution (without
epinephrine) into an upper
trapezius trigger point on 20
patients who had upper
trapezius and ipsilateral mas-
seter muscle pain. Thirteen (87
percent) of 15 patients experi-
enced a significant reduction in
masseter muscle pain (P < .001)
CLINICAL PRACTICE
and EMG activity (P < .03).
Posture training is commonly
used to treat poor posture and
cervical dysfunction, and many
practitioners recommend it as
one of the multidisciplinary
treatments for TMD.2,5,22,24 Pos-
ture training usually involves
exercises that are performed
repetitively within the pain-free
range to stretch structures that
poor posture tends to shorten,
strengthen structures that poor
posture tends to weaken and
create an awareness of the
desirable posture.24,25 Patients
are asked to try to maintain
this new posture all of the time,
which is thought to prevent
them from being in positions
that cause undue stress, micro-
trauma and overuse of struc-
tures of the head and neck.
We conducted this random-
ized clinical trial to assess
whether posture training may
be of benefit to patients with
TMD who have a primary mas-
ticatory muscle disorder. Sub-
jects who received posture
training and TMD self-
management instructions were
compared with subjects who
received only TMD self-
management instructions for
changes in a modified symptom
severity index, or SSI, max-
imum pain-free opening and
pressure algometer pain
threshold.
SUBJECTS AND
METHODS
Subjects consisted of patients
who were referred to a TMD
specialty clinic, Lackland Air
Force Base, Texas, for evalua-
tion and treatment. Inclusion
criteria for this study were as
follows:
dthe patient must have had
TMD pain for at least six
months;
JADA, Vol. 131, February 2000 203
CLINICAL PRACTICE
dthe patient must have rated
the pain as at least moderate in
severity;
dthe patient must live within
a 90-minute drive from the
clinic;
dthe patient must not have
been receiving any treatment
for TMD at the onset of the
study (for example, an occlusal
splint, prescription medication);
dthe TMD pain must have
been of masticatory muscle
origin.
One of us (E.W.) performed a
clinical examination, as
described by Dworkin and
LeResche,26 to determine the
primary source of the patient’s
TMD pain and whether the
patient met the research diag-
nostic criteria for TMD. The
patient’s primary source of
TMD pain was identified as the
masticatory muscle or the tem-
poromandibular joint, or TMJ.
Digitally palpating the mastica-
tory muscles and TMJs, as
described by Dworkin and
LeResche,26 was usually suffi-
cient to identify the patient’s
primary source of TMD pain,
but when necessary, additional
tests were performed.27
The study was conducted over
14 months, during which a total
of 168 consecutive patients who
were not receiving any TMD
therapy were referred to the
TMD clinic and considered for
inclusion. We excluded 43
patients from consideration
because their pain had been
present for less than six months
or they rated it as less than mod-
erate in severity. Another 22
patients lived more than 90 min-
utes from the clinic and were not
considered for inclusion. Of the
remaining 103 patients, 33 had
TMD pain originating from the
TMJ and also were excluded
from consideration.
204 JADA, Vol. 131, February 2000
Copyright ©1998-2001 American Dental Association. All rights reserved.
Masticatory muscles. We
determined the primary source
of pain for the remaining 70
patients to be the masticatory
muscles, and all met the TMD
research diagnostic criteria for
a muscle disorder. These
patients were given standard
TMD self-management instruc-
tions.28 These instructions
encouraged patients to rest
their masticatory muscles as
much as possible; become aware
of parafunctional habits, such
as teeth clenching, and elimi-
nate them; apply heat or cold to
The patient’s primary
source of temporo-
mandibular disorder
pain was identified as
the masticatory
muscle or the tem-
poromandibular joint.
the most painful masticatory
areas; and use over-the-counter
anti-inflammatory medications.
The instructions also stated
that improving head and neck
posture may improve TMD
symptoms and encouraged
patients to improve their pos-
ture. Sixty-two of these patients
stated that they were interested
in being taught how to improve
their posture by a physical ther-
apist (free of charge) and then
were informed of this study.
Sixty-one patients agreed to
participate in the study (one
later withdrew). We did not dis-
cuss the self-management
instructions any further and the
following baseline measures
were used to evaluate changes
for each subject:
da modified SSI29;
dmaximum pain-free
opening30,31;
dmuscle pain threshold
assessed with a pressure
algometer.32
The reliability and validity of
these standardized outcome
measures were demonstrated
previously.29,31,32
The modified SSI used five
visual analog scales to identify
the level of TMD and neck
symptoms independently. We
asked patients these five
questions:
dHow intense are your
symptoms?
dHow unpleasant or dis-
turbing is your usual level of
symptoms?
dHow difficult is it to endure
the problem over time?
dHow often do the symptoms
generally occur?
dHow long do the symptoms
usually last?
Maximum pain-free opening
(that is, the widest a patient
can open his or her mouth
before feeling pain) was mea-
sured in millimeters from
incisor to incisor. In addition,
pain thresholds were measured
with a pressure algometer at a
pressure rate of approximately
0.5 kilograms per square cen-
timeter per second. The 1.8-
centimeter-diameter tip was
placed over the right and left
midarea of the masseter mus-
cles and midcervical area of the
trapezius muscle to measure
the point at which the patient
first perceived pain.
The subjects were then ran-
domized into two groups: one
received posture training and
the other served as a control (no
therapy was provided). Subjects
in the control group received
posture training after they com-
pleted the study. The examiner
(E.W.) was blinded to the
assigned groups and the sub-
jects in the treatment group
 CLINICAL PRACTICE

were referred to a physical ther-

apist (M.D.), who also was
blinded to the previously col-
lected data.
The physical therapist exam-
ined the subjects in the treat-
ment group. He used a plumb
line, a metric-based carpenter’s
tri-square with a line-level
attached to the horizontal arm,
and a goniometer with a line-
level attached to the horizontal
arm to make precise measure-
ments. He recorded the posture
positions in centimeters for
head translation (that is, the
distance from the head to the
vertical line), shoulder transla-
tion (the distance from the
shoulder to the vertical line)
and the difference between the
head and shoulder measure-
ments. The methods used and
reliability of these measures
have been described elsewhere.8
Posture exercises. During
a half-hour appointment, the
physical therapist gave the sub-
jects posture exercises thought
to be effective for improving
posture, based on his clinical
experience. He taught the exer-
cises to the subjects (Figure,
Box [“Exercise Instructions”]),
who then demonstrated that
they could correctly perform
them. The subjects were given a
handout of the exercises Figure. Stretching exercises to improve posture. (Detailed instructions
(Figure) and encouraged to appear in the box on page 206.)
become aware of their posture
and to maintain good posture. ical therapist remeasured their Subjects’ views on
One week later, the subjects postures and recorded the symptom improvement. The
returned, and the physical ther- results. dentist then solicited opinions
apist observed them and cor- All subjects returned to the from the subjects. He asked
rected any errors they made TMD clinic four weeks after them what percentage reduction
with the exercises, encouraged they began posture training or in TMD and neck symptoms
them to comply with the exer- were randomized into the con- they had experienced. They
cise schedule, and answered any trol group. The clinican were then asked to which group
questions they had about the (E.W.)—still blinded—reexam- they had been assigned. Sub-
exercises or posture correction ined the subjects using the mod- jects assigned to the treatment
concepts. At the end of the ified SSI, pain-free opening and group also were asked the fol-
fourth week, the subjects pressure algometer pain thresh- lowing questions:
returned again, and the phys- olds, as described above. dTo what extent did they

JADA, Vol. 131, February 2000 205

Copyright ©1998-2001 American Dental Association. All rights reserved.
CLINICAL PRACTICE

EXERCISE INSTRUCTIONS.

Chin Tucks Tuck your chin back over the notch above your sternum, so that
your ear is in line with the tip of your shoulder.

Chest Stretch Stand in a doorway or the corner of a room. Lean forward, with
your hands on the wall, until you feel significant stretching
across the front of your chest. Do this exercise as requested in
both positions.

Wall Stretch Stand with your back against the wall and your arms positioned
as shown in the drawing. Straighten your upper back and
flatten your lower back against the wall. Press your head back
with your chin down and inward, and pull your elbows back
against the wall. Do this exercise as requested in both positions.

On-Your-Back Lie on your back with your hands clasped behind your head. As
Chest Stretch you exhale, slowly bring your elbows together, touching in front
of your face. As you inhale, slowly draw the elbows apart until
they touch the floor.

Face-Down Lie on your stomach as shown in the drawings (position 1 has

Arm Lifts the elbows at shoulder level and bent at 90 degrees, while
position 2 has the elbows at ear level). Lift your arms, head and
chest off the floor and repeat until you move only 50 percent
through the range or until you are fatigued; do this in both
positions.

comply with the exercise
schedule?
dWhy do they think the exer-
cises improved their TMD
symptoms (if improvement was
achieved)?
dDo they think that the exer-
cises benefited their posture?
dIf the physical therapist’s
charge for his service had been
$100, do they feel the benefit
would be worth this charge?
STATISTICAL ANALYSIS
To compare changes in the
treatment group with changes
in the control group, we used
Student’s t-tests for all contin-
uous variables and χ2 analyses
for categorical variables. Stu-
dent’s paired t-tests were used to
test for changes in posture in
patients in the treatment group.
Finally, we used Pearson
product-moment correlation
analysis to study various rela-
tionships between variables.
Because only one dentist and one
physical therapist participated in
the study and they collected dif-
ferent information, calibration
between them was not indicated.
RESULTS
The treatment group was com-
posed of 30 subjects (26 women,
four men); their ages ranged
from 18 through 56 years, with
a mean age of 32.7 years. The
control group was composed of
30 subjects (25 women, five
men), whose ages ranged from
18 through 60 years, with a
mean age of 30.8 years. In both
groups, 28 (93 percent) of 30
subjects reported having neck
pain or tightness at the outset
of the study. Table 1 lists the
SSI, maximum pain-free
opening and pressure algometer
threshold measurements, as
well as the perceived improve-
ment percentages for TMD and
neck symptoms. Table 2 lists
the mean measurements for
posture at the beginning and
end of the study.
Symptom improvement.
As shown in Table 1, the mean
reductions in TMD and neck
symptoms, as measured by the
modified SSI, were 22.8 and
14.5, respectively, for patients
in the treatment group, com-
pared with 3.2 and −0.1, respec-
tively (both P < .001), for
patients in the control group
(scores range from 0 to 100,
with 100 being the worst symp-
toms). The mean maximum
pain-free opening increased by
5.3 millimeters for patients in
the treatment group, which was
significantly (P < .05) greater
than the 1.2-mm improvement
for patients in the control
group.
Within the treatment group,
we found significant correla-
tions between improvement in
TMD symptoms and neck symp-
toms (P < .005). We also found
significant correlations between
improvements in TMD symp-

206 JADA, Vol. 131, February 2000

Copyright ©1998-2001 American Dental Association. All rights reserved.
 CLINICAL PRACTICE

TABLE 1

CLINICAL TEST RESULTS AND PERCEIVED SYMPTOM IMPROVEMENTS.

TREATMENT GROUP (n = 30) CONTROL GROUP (n = 30)

Mean Mean Mean Mean Mean Mean

MEASUREMENT
(SD)* (SD) (SD) (SD) (SD) (SD)
Initial Final Improve- Initial Final Improve-
Measure- Measure- ment Measure- Measure- ment
ment ment ment ment

Modified Symptom 61.4 38.6 22.8 59.5 56.3 3.2

Severity Index (TMD)† (16.1) (19.9) (15.9)‡ (18.3) (20.9) (10.7)
(0 to 100)

Modified Symptom 47.4 32.9 14.5 45.1 45.2 -0.1

Severity Index (neck) (25.2) (21.8) (13.9)‡ (24.1) (22.3) (11.8)
(0 to 100)

Maximum Pain-Free 32.9 38.2 5.3 33.2 34.4 1.2

Opening (millimeters) (12.5) (11.5) (8.8)§ (10.1) (11.6) (5.6)

Pressure Algometer Pain 2.63 3.18 0.55 2.80 2.83 0.03

Threshold (masseter) (0.98) (1.22) (0.86)§ (0.80) (0.99) (0.56)
(kilograms per square
centimeter)

Pressure Algometer Pain 3.26 3.93 0.67 3.09 3.10 0.01

Threshold (trapezius) (1.19) (1.61) (1.04)§ (0.93) (1.13) (0.68)
(kilograms per square
centimeter)

Perceived TMD Symptom NA** NA 41.9 NA NA 8.1

Improvement (percentage) (32.3)‡ (30.0)

Perceived Neck Symptom NA NA 38.2 NA NA 9.3

Improvement (percentage) (33.8)‡ (24.9)

* Standard deviation.
† TMD: Temporomandibular disorder.
‡ P < .001.
§ P < .05.
** NA: Not applicable.

toms and the pretreatment dif-
ference in head and shoulder
posture measurements (the
greater the pretreatment differ-
ence, the greater the symptom
improvement) (P < .05).
Of the 30 subjects in the
treatment group, three (10 per-
cent) reported that their TMD
symptoms resolved completely
and one (3 percent) reported
that her neck symptoms
resolved completely. Con-
versely, three subjects (10 per-
cent) in the treatment group
reported experiencing no
improvement in, or an aggrava-
tion of, their TMD symptoms
and six subjects (20 percent)
reported experiencing no
improvement in, or an aggrava-
tion of, their neck symptoms.
Responses from the remaining
subjects were between these
extremes.
Compliance with exercise
regimen. Patients in the treat-
ment group reported a range of
compliance with the exercise
schedule from 45 through 100
percent, with a mean compli-
ance of 75 percent. We found no
significant correlation between
improvements in TMD symp-
toms and reported compliance
with the exercise regimen.
When asked how they
thought posture training
improved their TMD symptoms,
16 (53 percent) of the 30 sub-
jects responded that the exer-
cises relaxed their neck muscles
and thereby caused the mastica-
tory muscles to relax as well.
Twenty-seven (90 percent) of

JADA, Vol. 131, February 2000 207

Copyright ©1998-2001 American Dental Association. All rights reserved.
CLINICAL PRACTICE
TABLE 2
POSTURE MEASUREMENTS.
MEASUREMENT
Head Translation
(centimeters)
Shoulder Translation
(centimeters)
Head and
Shoulder Difference
(centimeters)
* SD: Standard deviation.
† No significant changes were found at α = .05.
the 30 patients in the treatment
group thought that posture
training improved their posture,
and 23 patients (77 percent)
responded that if the physical
therapist’s charge for this ser-
vice was $100, the benefit they
received justified this expense.
DISCUSSION
Within the limits of this ran-
domized clinical trial, the
results of this study suggest
that posture training and TMD
self-management instructions
are significantly more effective
than self-management instruc-
tions alone.
This study was designed for
its generalizability to most gen-
eral dental practices. Once a
diagnosis of TMD is made, we
believe that the most common
initial treatment protocol is to
provide patients with self-
management instructions and
to schedule an appointment for
splint insertion. This study was
designed to determine whether
posture training during splint
fabrication would be a beneficial
adjunctive treatment.
We evaluated only patients
with TMD who had a primary
208 JADA, Vol. 131, February 2000
Copyright ©1998-2001 American Dental Association. All rights reserved.
MEAN (SD)*
INITIAL POSTURE
7.08 (2.61)
5.74 (2.51)
1.49 (2.07)
muscle diagnosis because we
speculated that these subjects
would be more likely to benefit
from posture training than
patients with a primary joint
diagnosis. In addition, we did
not include patients who said
they were not interested in
improving their posture,
because of potential noncompli-
ance with the exercise schedule.
We were surprised to find that
after reading the self-manage-
ment instructions, only eight
(11 percent) of 70 patients
reported being uninterested in
improving their posture.
Each subject in the treatment
group had two dental appoint-
ments and three physical
therapy appointments during
the study, while subjects in the
control group had only the two
dental appointments. Because
of the interaction between the
physical therapist and the sub-
jects in the treatment group, a
placebo effect may have devel-
oped such that these subjects
reported an inflated degree of
symptom improvement. We con-
sidered providing sham posture
instructions or exercises for
subjects in the control group,
MEAN (SD)*
FINAL POSTURE†
6.69 (2.16)
5.67 (2.20)
1.26 (1.66)
but felt that any interaction
emphasizing posture might
cause the subjects to develop a
greater awareness of their pos-
ture, thus creating a treatment
effect. We chose this study
design because we thought it
best mimicked the typical
response of a general practi-
tioner (that is, to provide or not
provide posture training),
affording better generaliz-
ability.
We observed that patients in
the control group relied on the
self-management instructions
more than the patients in the
treatment group; this was
expected since patients in the
control group did not receive
any other means of helping
them control their pain.
Comparing posture
training with other TMD
therapies. We used the modi-
fied SSI to independently assess
the masticatory and neck symp-
toms. Patients in the treatment
group experienced a mean
reduction of 22.8 in their masti-
catory score after receiving pos-
ture training. Wright and col-
leages33 and Shaefer and
colleagues34 conducted studies

in which they assessed subjects’
masticatory symptoms using
this modified SSI measure and
reported a mean decrease of 29
after soft-splint therapy among
patients with TMD who had a
primary muscle disorder33 and
41 after arthrocentesis among
patients with TMD who had a
primary joint disorder.34
The mean increase in max-
imum pain-free opening for
patients in the treatment group
was 5.3 mm, which compares
favorably with the mean
increases of 4.9, 5.3 and 12.4
mm reported by three studies
evaluating splint therapy.30,31,33
Even though 90 percent of the
patients in the treatment group
perceived that their posture had
improved, actual changes in pos-
ture were not found to be statis-
tically significant. We speculate
that the benefit reported by sub-
jects may be associated with
their most common response
that the exercises caused the
neck muscles to relax, thereby
relaxing the masticatory mus-
cles as well. A highly significant
correlation was found between
improvements in neck and TMD
symptoms.
We found a significant corre-
lation between TMD symptom
improvement and the difference
between pretreatment head and
shoulder posture measure-
ments. This suggests that
patients with TMD who hold
their heads farther forward rel-
ative to the shoulders have a
higher probability of achieving
TMD symptom improvement
from posture training.
The figure and box provide
posture exercises that practi-
tioners can give their patients
and/or the physical therapist to
whom they most often refer
patients with TMD. We recom-
mend that practitioners who
Copyright ©1998-2001 American Dental Association. All rights reserved.
CLINICAL PRACTICE
instruct their patients in the It is impor-
use of posture exercises follow tant to keep in
up with them to ensure that mind that we
they are complying and properly evaluated sub-
performing these exercises. In jects in the
his clinical experience, the phys- treatment
ical therapist in this study Dr. Wright is a group after
colonel, U.S. Air
(M.D.) has found that most Force, Lackland Air
only four
patients need some modification Force Base, Texas, weeks of pos-
of their exercise technique at and is the chief den-
tist for temporo-
ture training
their first follow-up appoint- mandibular disor- (in addition to
ment. If these exercises are ders, U.S. Air Force. having pro-
Address reprint
done improperly, they may requests to Dr.
vided them
cause the patient’s TMD or neck Wright, 83 Cross with self-
Canyon, San
symptoms to exacerbate. A Antonio, Texas
management
follow-up appointment (or more 78247. instructions).
The long-term
effects of pos-
We speculate that the ture training were not evalu-
benefit reported by ated and we recommend that a
long-term study be conducted.
subjects may be
associated with their CONCLUSIONS
most common The results of this study suggest
that posture training may be a
response that the
beneficial therapy for most
exercises caused patients with TMD who have a
the neck muscles primary masticatory muscle dis-
order and who are interested in
to relax, thereby
improving their posture. On
relaxing the mastica- average, subjects who received
tory muscles as well. posture training in addition to
self-management instructions
reported a 42 and 38 percent
than one if needed) also tends to reduction, respectively, in their
motivate a patient to better TMD and neck symptoms.
comply with the exercise Twenty-three (77 percent) of the
schedule, especially if the subjects reported that a $100
patient knows that he or she charge for physical therapist’s
will be asked about compliance services would be worth the
as well as to demonstrate the benefit received. We found that
exercises. patients who hold their head
Monitoring posture. Effec- farther forward relative to the
tive posture training also shoulders have a high prob-
involves instructing the patient ability of experiencing improve-
to continually monitor his or her ment in TMD symptoms as a
improved posture. This can be result of posture training and
done in conjunction with other being provided self-management
forms of continuous monitoring, instructions. ■
such as tongue posture, jaw pos- Dr. Domenech is a lieutenant colonel, U.S.
ture and jaw muscle tension; Air Force, Lackland Air Force Base, Texas,
and the chief of the Physical Therapy
when warranted, modifications Element, Lackland Air Force Base.
can be made.
JADA, Vol. 131, February 2000 209
CLINICAL PRACTICE
Mr. Fischer is the statistical consultant,
Clinical Research Squadron, Lackland Air
Force Base, Texas.
The opinions expressed in this article are
those of the authors and do not reflect the offi-
cial policy of the Department of Defense or
other departments of the U.S. Government.
The authors acknowledge Ernie J. Liddle
for assisting with the design of the study and
Nick Vu for drawing the posture exercises.
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