One study in the Occupational Medicine Journal posits that up to 80% of professional musicians are affected by some sort of musculo-skeletal disorder. I am part of that 80% and can attest specifically to how TMJ disorder has affected my flute playing career.
I've suffered my share of performance injuries and for the most part have managed to adapt and recover. What has been a constant struggle for me though, has been an ongoing battle with neck pain and severe TMJ.
QUICK DISCLAIMER: I am not a doctor. I'm almost a doctor of musical arts... but not a medical doctor so I'm speaking from personal experience and the reading and research I've done on this subject as a part of my own treatment plan. Let this post simply serve as a starting place if you find yourself coping with TMJ.
What is TMJ disorder?
If you're unfamiliar with TMJ, the acronym simply stands for the actual jaw joint, called the temporomandibular joint, but when I refer to it here I'm referencing specifically the disorder that causes pain, discomfort, headaches, etc.
It can be caused by any number of things: neck/face injury like whiplash, bruxism (teeth clenching, grinding, gnashing), excessive use of the jaw/chewing, stress and anxiety, poor posture. Really anything that will anger the muscles in and around your neck and jaw can contribute to TMJ.
What does TMJ feel like? How do I know if I have it?
When I first was diagnosed, I was actually seeing an ENT about my sinuses and mentioned having really severe ear pain. He asked if I had TMJ and I said "I'm finishing a degree in flute performance, how could I play flute if I have TMJ?"
With no sign of ear infection, he put on a pair of gloves and stuck two fingers in my mouth and poked my masseter muscle. It felt like lightning had struck inside my head and I nearly bit him. He said, "Congratulations, you have TMJ. Go to your dentist for a mouth guard" and then sent me on my way.
At the time I blew him off and in hindsight I wish I hadn't, but you live and learn.
Ear pain was my first symptom. But over the next 6 years, I developed more symptoms and it became more and more debilitating, affecting almost every facet of my life.
Other symptoms include:
Pain or tenderness in the jaw, face, and/or neck area. (Sometimes it might feel like a toothache)
Pain or discomfort stretching to open the mouth
Clicking, popping, or grating sounds come from your jaw when opening or closing it (may or may not be painful/uncomfortable)
Trouble chewing or uncomfortable bite
Feeling tired, overworked muscles in and around the face/jaw
Ear pain
Neck/shoulder pain
Headaches/migraines
Sound awful?
It is. And when it comes to playing the flute, TMJ often dictates how long I can play the instrument, what I sound like, and my overall comfort level while playing.
The first year of my DMA, my TMJ took a turn for the worse and got so bad that one day my jaw locked and it just so happened we were playing a sitzprobe for Lucia di Lammermoor that day. I was playing principal flute and because I was in so much pain, the director graciously allowed me to mark my part the entire sitz until the mad scene. I played the mad scene and cadenza and then was in so much pain I had tears running down my face and decided I had to see someone for it.
So, I finally followed the advice the ENT had given me a few years prior and saw my dentist for a mouth guard to wear at night while I slept so that I wouldn't clench.
Treating TMJ
When you suffer from TMJ, the first line of defense is getting a mouth guard to wear at night to prevent you from grinding and clenching while you sleep. For a lot of people this seems to do the trick and they get enough relief that all they need is the mouth guard. Most dentists are able to do custom molds either using putty (if you've had braces you know what I'm talking about...) or a 3D scanning wand that scans your teeth and bite.
(Side note: TMJ mouth guards work but putting distance between your teeth so that they don't actually touch when you close your bite. Since your teeth aren't touching it takes some of the pressure off of the main muscle groups, giving them time to rest while you sleep.)
When a TMJ night guard isn't enough....
I wear my mouth guard every night and have been for 3 years, but I still struggle with TMJ thanks to a neck injury and the stress of completing a doctorate. I really thought I was doomed to suffer the rest of my life and that my mouth guard was the only treatment option.
But this time, instead of calling my dentist (again), I called my sports medicine doctor who has worked with me on treating my neck injury. And we now have a second, third, and fourth line of defense for TMJ and a medical plan that is specifically set up so that I can not only gain lasting relief but also play flute comfortably.
So...
2nd line of defense: physical therapy
a physical therapist will look at all of the mechanics that go into making a jaw move. They'll not only evaluate the exterior anatomy of your jaw and neck, but they'll evaluate the interior anatomy, gaining a full picture of how your jaw is moving and working. If your jaw is out of alignment or deviated, they'll be able to assess that too.
they'll teach you stretches and exercises to do at home to provide relief, prevent repeat flare ups, and strengthen your anatomy in a way that promotes the healthiest movement.
many PTs will do manual therapy on your neck and jaw muscles (this is a hurts so good treatment that involves lots of massage, heat, ultrasound, and electrical stimulation)
3rd line of defense: oral surgeon
oral surgeons generally have a much more specialized knowledge about the jaw than your regular dentist does
oral surgeons also may have additional treatment options beyond the custom night guard that do not involve surgery
oral surgeons may also have additional surgical treatment options if that's the route you end up pursuing
4th line of defense: pain management
pain management doctors specialize in treating chronic pain conditions and can offer treatments like medication therapy, physical rehab, psychological support, injection therapy, among others.
many times these doctors specialize in disorders of the neck and upper spine and, according to my referring doctor, "they're usually much more hip to the newer ways to treat stuff like this because they see it all the time and read more literature on the specifics."
So, if you find yourself suffering from symptoms of TMJ just remember you have more options beyond seeing your dentist. And when it comes to playing a wind instrument seriously, going a step further to work with a physical therapist can only prove beneficial.
Here's a bonus picture of me at physical therapy this morning during my heat and electrical stimulation treatment. 10/10 recommend
