Jaw tension in singers – conversation with a physiotherapist!

What is the TMJ? 

You will often hear people call the TMJ the “jaw”. TMJ stands for temporomandibular joint. This is the joint between the mandible (jawbone) and your skull. If you wanted to palpate and feel the joint itself, you can place your fingertips just in front of your ear and then open and close your mouth. You should feel a popping sensation out towards your finger, and this is the head of the mandible which is pressing some of the jaw muscles outwards. This is right where the TMJ is located.

Can you tell us a bit about the effects of a chronically tense jaw? What muscles and body functioning does it affect? 

TMJ dysfunction often results from tightness in some of the muscles that surround the jaw. The two most affected muscles are the masseter and temporal muscles, which are deep muscles. TMJ can result from various factors including stress, anxiety, motor vehicle accidents, dental procedures, chewing gum too often, and having bad posture including a forward head posture and a tight thoracic spine (mid-back tightness from a predominantly sitting sedentary lifestyle or occupation). 

Does it have a connection with the diaphragm, the abdominals, and/or the neck muscles? What are some common reasons why someone develops a tense jaw? How does a tense /locked jaw affect the process of breathing?

In my years of experience in Physiotherapy as well as numerous research studies, most patients with jaw dysfunction have altered breathing. This usually presents where the patients are more overactive through their accessory muscles such as their scalene, sternocleidomastoids, and trapezius muscles which results in less diaphragm movement, less of a pump (upward) and bucket handle (outward) movement of the lower rib cage and lungs and less efficient oxygenation which in turn will affect pitch, tone and holding of your singing notes efficiently and effectively. The overuse of the accessory muscles will cause a tightness of the jaw muscles and usually results in a tight thoracic spine and a forward head posture which results in weakness of your deep cervical neck flexor muscles. Thus, if your deep cervical neck flexors are weak from forward head posture, this will alter your movement of your larynx due to the neck and jaw not being in the correct position. With less movement of your lower rib cage, you will also have less activity in your abdominals due to less muscle activation as well as possibly having an anterior pelvic tilt due to your tight jaw, upper neck and back muscles and thoracic spine. The anterior tilt of your pelvis will cause inhibition of your abdominals as your pelvis is not in the correct position to ensure adequate abdominal muscle activation, and I am sure Jorgelina has urged the importance of your abdominals whilst singing!!! This is a bit confusing…… but basically everything is interconnected. 

How can a person that has built a tense jaw over the years, work on it in a holistic way to get rid of the problem for good? What does an integral treatment involve? Is there any other resource that you would recommend to start the process of healing?

Your Physiotherapist will determine if your jaw muscles are tight and then likely to perform massage or intramuscular stimulation (IMS) which uses needles to release trigger points in the affected muscles. As we discussed often the tighter two muscles are quite deep and thus massage and stretching is not enough, and IMS is required. If the joint itself is out of alignment or not functioning adequately, your physiotherapist or health practitioner might perform some manual traction of the mandible with combined gentle joint glides in specific directions. Your physiotherapist will also go over some breathing exercises to make sure that you are breathing adequately and not overusing your accessory breathing muscles as discussed above, as well as an individualized tailored exercise program to stretch certain muscle groups, strengthen certain muscle groups, and some joint mobilizations that you can perform to ensure your TMJ is functioning adequately and that you are able to open your jaw throughout the full range of motion when singing. It will also be key to have a look at the body as a whole and address any neck, upper back, abdominal pr pelvic issues. It is also very important to have a holistic approach in managing as best you can any stress/anxiety which is contributing to altered breathing and hence a tight jaw. I would also suggest trying some acupuncture, meditation, Pilates or yoga, attention training technique, or cognitive behavior therapy to best manage stress or anxiety in the busyness of life today.