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 TMJ / Jaw pain
Author: alliejayde (---.dyn.optonline.net - ISP in West Haven, CT United States)
Date:   2007-07-03 22:48

Hey everyone, I'm a 17 year old high school senior planning on majoring in music. I know the topic of TMJ has come up in other posts, but no one has really offered any success stories or advice besides "go to your doctor," which I have already done on multiple occasions.

This summer I'm getting ready for college auditions and also dealing with the fact that I have TMJ. This has a severe impact on my ability to play the clarinet. After a good practice or a long rehearsal, I can barely open my mouth without intense pain. I had an MRI of my mouth, which indicated that I have a dislocated meniscus. When I went back to my oral surgeon, he gave me a mouth-piece for my lower teeth that looks just like a retainer to wear during the day. For the nighttime, he gave me a plastic mouthguard for the upper teeth. It seems to me that a retainer will do nothing to lessen the pain/ pressure of my jaw on my embouchure when I play. He says that it may take a few months to ease the pain, but I cannot wait. Playing constantly with this pain has had huge effects on my confidence while playing and my joy in the clarinet.

I feel like my doctor has no idea of the pain my jaw causes while playing the clarinet. He cannot comprehend the physical exertion of the embouchure on the jaw or the intensity of professional playing. Has anyone else had painful TMJ or jaw problems that they felt their doctors didn't understand or treat correctly? What has worked for you to help ease the pain?

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 Re: TMJ / Jaw pain
Author: Chris Hill (---.sxfl.qwest.net - ISP in Denver, CO United States)
Date:   2007-07-03 23:38

I had TMJ problems in 1990 that left me worried that I would have to find a different career. For me, the main culprit seemed to be my then-habit of playing on a very hard set-up in my quest for what I thought was a "dark sound." When I took some lessons with Burt Hara, he told me that a.) I was hurting myself physically, and b.) it wouldn't sound as full in a large room as I thought. He was right on both counts. I switched to an easier mouthpiece/reed set-up, and experimented with ligatures until I found one that was comfortable. For me, this is a regular Bonade. I have discovered that whenever I try to switch away from this, there is a danger that my jaw will hurt.
The good news for me is that I've had more compliments on my sound since getting away from a hard set-up, and it's possible for me to phrase much more beautifully on a more flexible set-up.
For me, a closer facing with a moderately hard reed worked well to get the pain to go away. I always tell my students that if they have to use a teeth cushion, they have to use too much jaw pressure to produce the sound.
An activator-method chiropractor also worked directly on my jaw through this time.

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 Re: TMJ / Jaw pain
Author: MikeH (---.hsd1.pa.comcast.net - ISP in Wayne, PA United States)
Date:   2007-07-03 23:39

You have my sympathy as I have posted here recently on having TMJ pain. I do not know if this is feasible for you but I simply stopped playing for a month. During that time my right TMJ seemed to migrate back into place. I started playing again without pain but there is still motion in the joint and often a considerable amount of cracking especially after eating following a playing session. I am very careful to use mpc's that are easy to control and resist the impulse to use one or another of my older open tip jaw busters. For what it is worth, I would suggest that you take some time off, if you can, to see if your TMJ will return to normal on its own. Time can be a great healer. One bit of advice that came very emphatically from my dentist: do NOT seek an operation. Good luck to you. I hope it works out for you.



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 Re: TMJ / Jaw pain
Author: skygardener (---.catv.ppp.infoweb.ne.jp - ISP in Okayama, 31 Japan)
Date:   2007-07-05 03:50

Do a search for TMJ. We talked about it reciently.
It might not be caused by clarinet, but only agrivated by it. I use a product called Aqualizer when I sleep. This helps me. Ask your doctor about it and it may be better than the plastic splint that your doctor gave you. I have triend the plastic splint/mold and it did nothing for me because, although my teeth were not touching, I was still grinding my teeth and that is was caused problems with the muscles.
For clarinet practice here are some random ideas that help many people. All, some or none of them may help your current situation-
-Do double lip 10-15 minutes.
-Use a softer reed.
-Try to practice at a soft volume. Many people strain when the play loudly.
-Between phrases- Stop, open and close your mouth a few times to become aware of your jaw more.

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 Re: TMJ / Jaw pain
Author: Bartmann (---.poloralphlauren.com - ISP in Lyndhurst, NJ United States)
Date:   2007-07-05 15:27

Alliejayde,

I used to have severe TMJ but now I have occasional TMJ. My jaw pain has abated over the years because I've been playing less clarinet. There are some things I've done to lessen the pain.

First I switched mouthpieces to a narrow profile Vandoren 88 and a Morgan RM6. Because these mouthpieces are flatter, I don't open my jaw so wide and that helps.

Second, chew slower and take smaller bites. And don't chew food that's too hard and crunchy.

Third, several years ago I started playing the flute and don't experience jaw pain when I play it. However, when I play my clarinet for long periods of time, day after day, I notice the beginings of pain. Then I lay off the clarinet for a couple of days and I'm fine.

But switching to the flute has really been a blessing to me because I can still make music. Even though with an excellent reed I prefer the clarinet sound and its range, especially the chalumeau that sounds so distinct among woodwinds, the flute has been a very easy instrument to pick up, especially after years on the clarinet, and is also a very beautiful instrument. Perhaps it's the easiest second instrument for clarinetists to pick up after the sax.

TMJ is a problem that doesn't just go away. And you will be using your jaw to do basic things like chewing and speaking for the rest of your life. So at the tender age of 17 you may want to diversify your selection of instruments.

Imagine you were a tuba player and complained of back pains because of carrying a heavy instrument. And the doctor suggests a back brace. I would say try switching to trumpet or french horn. Because carrying that heavy tuba, year after year would clearly make your back worse.

I suggest you learn another instrument, and spread your music making among more instruments. This way you will not stress the same joints and muscles in the exact same way day after day. The clarinet embouchure is very physically demanding. And it can take its toll on the health of the jaw.

I know about the fear of learning a new instrument and not wanting to be a beginner all over again. However you will never be a true beginner after having learned the clarinet. You know music theory, intervals, breath support, phrasing, and fingerings. If you choose the flute you only have to learn a dozen more fingerings to play the flute and learn a new embouchure.

And the best part, because the flute embouchure is so relaxed, you can play for hours and experience neither pain nor fatigue. So you can improve really fast on the flute. Remember when you first started playing the clarinet you couldn't play more than ten minutes before either your bottom lip got sore or your embouchure died? Well when you play the flute you can literally play for hours, even at the earliest stages of your learning. So improvement on the flute is much faster than on the clarinet because it isn't limited by embouchure decay or pain in the lower lip.

And after you learn another instrument and can play it well, you realize that what's important to you is making music. Each instrument you play brings its unique voice to the music you make.

Bartmann

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 Re: TMJ / Jaw pain
Author: clarinetwife (---.mammothnetworks.com - ISP in Gillette, WY United States)
Date:   2007-07-05 17:50

Very wise advice, Bartmann. My own teacher played very little clarinet by the time I graduated high school due to jaw problems but threw himself enthusiastically into the recorder and the lovely harpsichord he had in his living room. I am not a doctor myself, but my impression is that when a sports orthopedist or other type of doctor sees a patient with activity related health problems, the patient usually comes in asking, more or less, "how can I get my body to do this activity?" The challenge for doctor and patient is to turn the question around and ask "how has my activity contributed to the problem I am having and how can I adjust the activities I am doing and the way I am doing them so that my body can be healthy in the long run?" This is especially crucial when the person is so young.

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 Re: TMJ / Jaw pain
Author: Chris Hill (---.sxfl.qwest.net - ISP in Denver, CO United States)
Date:   2007-07-05 21:47

It may be worth trying the flute, but I actually had to quit playing the flute because it caused me to have more jaw problems. I spend about 40 hours a week playing clarinet without difficulty. This switch won't work for everybody.
Chris

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 Re: TMJ / Jaw pain
Author: connie (---.hr.hr.cox.net - ISP in Washington, DC United States)
Date:   2007-07-11 17:20

I don't think my dentist was very helpful. He made an $800 splint to wear at night, which may have helped a little.

Here's what worked for me: two books.

1. "Taking Control of TMJ" by Robert Upgaard. The exercises he gives helped a lot, as did the insights into what I was doing that made it worse.

2. The Trigger Point Therapy Workbook by Claire Davies. Chapter 4 in particular addresses trigger points in the head and neck. I think working on those trigger points are what helped the most.

I don't think there's anything in those books that will cause harm, but certainly run it by your parents or your dentist.

I still have some discomfort when I open really wide, but how often do you do that? (Just when I go to the dentist!) When it acts up, I start the trigger point massage again. And stop clenching my jaw. Although I did stop playing for a couple of months, I found that I was missing my best stress-reliever and had to pick it up again; lo and behold, I didn't get worse.

Hope this helps. At your age, you should heal much faster than I did!

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 Re: TMJ / Jaw pain
Author: bob49t (---.dyn.gotadsl.co.uk - ISP in United Kingdom)
Date:   2007-07-11 19:55

Yep, we're off again on TMJ dysfunction and from a professional point of view I sympathise greatly alliejayde. As skygardener says there are many threads on this subject...... one of the last ones being just a few pages back.....

http://test.woodwind.org/clarinet/BBoard/read.html?f=1&i=247982&t=247936

bob49t.

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 Re: TMJ / Jaw pain
Author: diz (203.42.75.---)
Date:   2007-07-12 21:57

How awful, please keep us in the loop of your progress, and I wish you well.

Without music, the world would be grey, very grey.

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 Re: TMJ / Jaw pain
Author: alliejayde (---.dyn.optonline.net - ISP in West Haven, CT United States)
Date:   2007-07-14 16:45

Thanks to everyone who has offered their advice on this topic... I appreciate it greatly. Although switching to another instrument such as the flute seems ideal, this would not run over well with my parents and my clarinet teacher, who have all put a lot of effort into buying me a new professional clarinet just a few weeks ago. I will definitely look into those books offered by connie and I hope they will give me temporary relief.

Thanks again.

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