The Effects of Pilates Exercises on Women With Myogenic Temporomandibular Joint Dysfunction: A Randomised Controlled, Single-Blind Study

The aim of this study is to investigate the effects of an 8-week Pilates exercise program on pain, pressure-pain threshold, temporomandibular joint (TMJ) range of motion, cervical posture, stress levels, quality of life, jaw function and disability, depression, and muscle stiffness in women with myogenic temporomandibular disorders (TMD). Eligible volunteers will be recruited from Toros University students and staff through screening with the Fonseca Anamnestic Index and diagnostic criteria for TMD (DC/TMD Axis I). After informed consent, participants who meet the inclusion criteria will be randomly assigned to either a control or an intervention group. Control Group: Receives patient education (including information about parafunctional habits and sleep hygiene) and a standardized home exercise program to be performed three times per week for eight weeks. Compliance will be monitored weekly by phone calls and exercise logs. Intervention Group: Receives the same education and home exercise program plus supervised Pilates training, three sessions per week for eight weeks, each lasting approximately 60 minutes (including warm-up and cool-down). Sessions are delivered by a certified physiotherapist and structured progressively every two weeks. All participants will undergo a comprehensive baseline and post-intervention assessment by a blinded evaluator. Assessments include: Pressure-pain threshold (digital algometer) at masseter, trapezius, and tibialis anterior muscles Temporomandibular joint range of motion (TheraBite scale) Cranio-cervical posture (photogrammetry and ImageJ analysis) Pain intensity and disability (Visual Analog Scale, Graded Chronic Pain Scale) Jaw function and limitation (JFLS-8) Quality of life (SF-36) Depression and anxiety levels (PHQ-4) Muscle stiffness (MyotonPRO) Salivary cortisol analysis for stress evaluation Participants are excluded if they have systemic, neurological, psychiatric, or dental conditions; recent orthodontic treatment or trauma; ongoing use of pain medication; prior Pilates training in the past six months; or other factors that may affect assessment outcomes. Data will be analyzed using SPSS (v26) with appropriate parametric and non-parametric tests, and statistical significance will be set at p\

Inclusion Criteria: * Women aged 18-50 years * Diagnosed with myogenic temporomandibular disorder (TMD) based on standardized, valid, and reliable Diagnostic Criteria for TMD (DC/TMD Axis I) * Presence of TMD-related symptoms for at least the past 6 months * Resting pain intensity of ≥3 on the Visual Analog Scale (VAS) * No regular participation in physical activity within the past 6 months * Having natural dentition, defined as at least 10 natural teeth in both upper and lower jaws, confirmed by dental examination Exclusion Criteria: * Having received treatment related to TMD within the past year * Needing dental treatment due to caries or periodontal disease * Currently undergoing orthodontic treatment * Having removable or fixed partial dentures * Presence of other orofacial disease symptoms such as migraine or toothache * Using a myorelaxant splint * Having major psychosocial problems according to DC/TMD Axis II * Having alcohol or drug addiction * Being diagnosed with or receiving treatment for any psychiatric disorder * Participation in Pilates sessions within the past 6 months * Being pregnant * Regular use of pain or anti-inflammatory medication * Having systemic, rheumatic, endocrine, or connective tissue diseases * History of trauma or surgery to the upper extremity, neck, orofacial region, or -head * Presence of joint damage in the upper extremity, neck, orofacial region, or head