Jaw Pain...no history of TMJ

davidwburns · Post by **davidwburns** » Thu Dec 21, 2006 9:51 am

I'm just getting back into tuba after 15 years. I'm having pain in the joint area where my jaw hinges to my skull. I've never had significant soreness/pain in this area. Could it be related to playing the tuba after so many years of not playing? Anyone else experience this? Does it go away?

MaryAnn · Post by **MaryAnn** » Thu Dec 21, 2006 11:58 am

Nope. But it seems rather easy for you to figure this out yourself; since you're just getting back into it, it's no big deal to quit playing for a week or two and see if the pain goes away. If it does....well, simple conclusion, and then when you go back and try again, figure out what you're doing (pressure, maybe? position, maybe?) that is causing it.
MA

Thinker · Post by **Thinker** » Thu Dec 21, 2006 12:07 pm

I used to have pretty severe jaw pain while playing. So bad that sometimes my jaw would swell and I could barely talk.

After a while I noticed that I also grind my teeth in my sleep. I asked around for a quick solution for the grinding teeth issue and several people pointed me to wearing a retainer. I don't think wearing it stopped my grinding completely, but it has minimized it. And also made it so my jaw does not have great pains or swell. I can definately tell a difference if I forget it on a long trip.

I have also heard of a dentist, or doctor, or somebody being able to give muscle relaxers for this sort of thing...?? But I really have no idea about that one. Worth a shot I guess.

Hope that helps some.

Adam

Rick Denney · Post by **Rick Denney** » Thu Dec 21, 2006 1:56 pm

davidwburns wrote:I'm just getting back into tuba after 15 years. I'm having pain in the joint area where my jaw hinges to my skull. I've never had significant soreness/pain in this area. Could it be related to playing the tuba after so many years of not playing? Anyone else experience this? Does it go away?

Make sure that the mouthpiece is putting equal pressure on both lips with your jaw in the normal position. This is a problem for me--I have an overbite and if the mouthpiece doesn't point up a little I'll also get cramps from having to stick out my lower jaw.

Rick "the jawbone of an ***" Denney

davidwburns · Post by **davidwburns** » Thu Dec 21, 2006 2:05 pm

You guys are taking good care of me. Thanks. Based on what you've said, I see 4 potential issues that could have caused this:

1.) playing a lot after not playing at all for a long time
2.) to much pressure against the mouthpiece
3.) tilting the my embouchure forward against the top of the rim for high notes; thereby, creating more pressure on the top lip
4.) it feels most sore in the morning...perhaps my wife is slugging me in my sleep

Dr. Dave · Post by **Dr. Dave** » Thu Dec 21, 2006 2:39 pm

As a Dentist and a tuba player, my best advice (since you live in Norman) would be to contact and see Dr. Lida Radfar at the OU Dental School, she has expertise in diagnosing and treating orofacial/TMJ pain. She is in the Department of Oral Diagnosis & Radiology and the number to call there for an appointment is (405) 271-6056. Here's a link to the department's website: http://w3.ouhsc.edu/oral%2Ddiagnosis%2Dradiology/ If she can't help you I'm sure she can refer you to someone who can.

You'll be a lot better off if you can have your problem properly diagnosed and treated early, before it becomes worse or a more chronic condition that would become more dificult to treat and resolve. Initial treatment like physical therapy (doing specific stretches for the jaw and massaging the jaw muscles, using ice, perhaps a TENS unit, etc) along with anti-inflammatory pain medicine will often relieve the majority of your acute symptoms.

An acrylic mouthguard called an occlusal splint http://www.kelleydental.com/pages/remov_rem.html or a device called a NTI http://www.nti-tss.com/TM-Disorders.html to wear at night might be prescribed for you, if the Dentist believes you may be grinding and/or clenching your teeth at night. Even though the grinding/clenching may not have caused you any pain as yet, adding the tuba playing may exacerbate the existing strain on your jaw muscles/joints and the combination of these 2 things (clenching/grinding and tuba playing) may have been more than the jaw muscles/tendons/ligaments can handle/tolerate and is now causing you pain.

I'd also recommend seeing a good tuba/low brass teacher in your area, they may be able to help you as well, because while we do change our jaw position when we play the horn in a way that is different from the normal rest position of the jaw, we should be able to do that comfortably so as to not cause any jaw/muscle strain or pain. It's possible that you may be inadvertently causing jaw muscle, tendon or ligament strain due to your jaw position or excessively tensing the jaw or jaw muscles, etc, and I would think that a good teacher would see that and could work with you to help you find a more comfortable and effective way to play.

Hope this helps --

Dave

David Rolf, D.M.D., M.Sc.

TubaRay · Post by **TubaRay** » Thu Dec 21, 2006 2:50 pm

davidwburns wrote:...perhaps my wife is slugging me in my sleep

Would you be bragging, or complaining?
Just checking....

davidwburns · Post by **davidwburns** » Thu Dec 21, 2006 3:02 pm

Would you be bragging, or complaining?
Just checking....

Unfortunately, "slugging" is not our codeword!

davidwburns · Post by **davidwburns** » Thu Dec 21, 2006 3:08 pm

Dr. Dave,

Thank you! This is helpful. I had been considering seeing my dentist about this since he's treated my wife for TMJ. I do grind my teeth a bit...so playing the tuba, along with slouching at a desk all day may have just pushed my jaw/neck tension over the line into TMJ. I'd hate for this to become a chronic condition (it just started this past weekend).

I've been considering lessons or coaching. I'm a big believer in private, individual lessons (many years of voice lessons, but very few tuba lessons). I'm becoming aware this time around that I make a lot of funny faces when I play which means I have a lot of sympathetic tension going on (not good). I could use some good instruction.

TubaRay · Post by **TubaRay** » Thu Dec 21, 2006 3:13 pm

davidwburns wrote:
Would you be bragging, or complaining?
Just checking....
Unfortunately, "slugging" is not our codeword!

LOL!

Dr. Dave · Post by **Dr. Dave** » Thu Dec 21, 2006 3:15 pm

David,

You must have posted your reply mentioning your jaw soreness in the morning while I was writing my reply about recommending going to the Dentist at OU.....

Having jaw pain/soreness in the morning suggests that you are probably clenching your jaw and/or grinding your teeth at night -- and the tuba playing may now be exacerbating this existing problem. The jaw muscles can exert a lot of force, between 200-400 psi, and people who grind or clench their teeth at night can cause a lot of damage to the teeth and jaw structures, and pain is just one symptom of the problem, and pain is usually (and hopefully) the symptom that gets our attention!

I would definitely recommend seeing the Dentist I recommended at OU or one of the OU Faculty Prosthodontists for an evaluation because it sounds like the NTI device could really help you. I believe the OU faculty practice is in Oklahoma City, here's a link about that: http://dentistry.ouhsc.edu/intranet-Web ... tInfo.html

All the best,

Dave

Dr. David Rolf

davidwburns · Post by **davidwburns** » Thu Dec 21, 2006 3:25 pm

Thanks, Dr. D! I wondered if my grinding would eventually cause problems.

Dr. Dave · Post by **Dr. Dave** » Thu Dec 21, 2006 4:08 pm

You're welcome!

The postural issues you mention (slouching posture sitting at the the computer, etc) can definitely contribute to significant head and neck musculoskeletal pain, because our muscles are working against gravity all day to try to keep our head (the weight of a bowling ball) upright on a small "stick" -- our cervical spine. When a lot of us improperly maintain that "slumped forward" head posture all day (alot of folks have that ergonomic problem sitting at a desk in front of a computer at work -- I'm doing that right now!) we're definitely causing musculoskeletal strain -- it may only be a matter of time as to when the strain becomes excessive and the strain turns into pain.

If your jaw pain is due to the clenching and grinding and can be resolved with straightforward treatment such as a NTI or splint and some physical therapy, that's great, but, if you still have symptoms after that treatment and continue to battle with postural issues, ergonomics, etc that may be causing or contributing to persistent musculoskeletal strain and pain, I would strongly recommend something called Active Release Therapy (ART).

ART is not Chiropractic, but a number of Chiropractors (as well as physical therapists and athletic trainers) have been trained in ART. ART is not chiropractic maniupulation, it's more like deep muscle massage and I think it's the most effective treatment out there for muscle overuse conditions. I've had this treatment before and it has worked great. Here's more info about that http://www.activerelease.com/about.asp and some ART providers in your area: http://www.activerelease.com/providerSe ... 7&strCity=

Hope you get some relief soon ---

Dave

TubeNet

Jaw Pain...no history of TMJ

Jaw Pain...no history of TMJ

grinding your teeth

Re: Jaw Pain...no history of TMJ