Temporomandibular disorders...a common complaint amongst musicians and singers

Do you sometimes experience tension in your jaw while singing and find it difficult to relax it? Maybe you tend to clench your teeth or have jaw, head and/or neck pain after playing your violin or trumpet?

Playing an instrument can be very demanding since it requires the musician to repeat movements consecutively for a long period of time. This makes them prone to developing playing-related problems in their muscles, joints and ligaments.

Temporomandibular disorder (TMD) is a term encompassing pathologies occurring in the jaw (temporomandibular) joint and its masticatory muscles as well as surrounding anatomical structures. Signs that you might have it might be:

• pain in your neck, pain in front of your ear, headaches, especially above your ear

• limitations in your jaw's range of motion

• cracking sounds in your jaw

• dizziness

• tinnitus

This problem is oftentimes of multifactorial origin. Meaning that we can't really tell where it comes from. Research identified five major factors (but there are many more...):

• problems with occlusion (=depending on the anatomy of your upper and lower jaw as well as how your teeth are placed)

• trauma

• parafunctional habits : for example sucking, tongue thrusting, bruxism, mouth breathing and nail biting.

• hypertonicity of the jaw muscles

• emotional stress

The pressure exerted by the left lower jaw in violin an viola players requires the muscles to contract for longer periods of time. This leads to a high prevalence of bruxism and TMD amongst string players, leading to compression of the right jaw joint and decompression (subluxation) of the right. Using a central instead of a side chin rest can help in that matter.

Performance anxiety also plays a major role in the development of TMD. The fear of failure, the pressure, the tempo of auditions and performances can contribute to higher stress and anxiety levels. These also impact TMD and can lead to pain in face and around the mouth area. Chronic cases of TMD can impact anxiety and this leads to a vicious cycle of depression and anxiety worsening TMD, TMD worsening depression and so on...

So what can you do? Lots of different exercises can help with reducing tension. For example, if your upper and lower jaw are always touching, it might mean that you are always pressing them together. A good way to get rid of this habit is to find something that reminds you to stop doing it. It might be an alarm on your phone or an object or color: for example, checking your jaw placement every time you go through a door..if it is tight, try to take a breath and let it fall. If it does not work, you can always contract your jaw muscles as tight as you can for a few seconds and let it go. This helps the muscle fibers relax. With time, it will become a habit and every time you go through a door, your brain will remember to let your jaw relax.

Manual techniques have also proven to be quite helpful in reducing tension in the musculature, which in turn, helps reducing TMD symptoms.

The muscles of mastication include the masseter (which is the most powerful muscle in the human body!), lateral and medial pterygoid, and temporalis. These muscles and the temporomandibular joint capsule and articular disk play an important role in TMD. If not functioning properly, they can cause abnormal clicking of the lower jaw, jaw locking and ultimately lead to pain and disability.

The jaw is a built as a complex joint and also needs a good mobility of the neck, as well as muscles surrounding it. Hypertonic muscles can cause deviations of the jaw and in time become irritated, causing pain and discomfort.

Osteopathy has been shown to be an effective conservative treatment. Certain techniques can help reduce pain sensitivity and inflammation as well as restore the full mobility of a restricted jaw.

Quotes:

Amorim M., Jorge A. , Association between temporomandibular disorders and music performance anxiety in violinists, Occupational Medicine, Volume 66, Issue 7, October 2016, Pages 558–563, https://doi.org/10.1093/occmed/kqw080

Easterbrook S, Keys J, Talsma J, Pierce-Talsma S. Osteopathic Manipulative Treatment for Temporomandibular Disorders. J Am Osteopath Assoc. 2019 Jun 1;119(6):e29-e30. doi: 10.7556/jaoa.2019.071. PMID: 31135870.

Maini K, Dua A. Temporomandibular Syndrome. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551612/