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TMJ and violin/viola playing


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#1 rainyann

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Posted 18 May 2004 - 03:55 PM

My 16 year old violist son has developed what I think is TMJ after 8 years of playing the viola. I am taking him to the doctor in the morning.

Anyone else have the problem?

Is it due to poor posture? A natural hazard? Something else? Or just a fluke?

In 2 months he will be going to orchestra camp again where they play for 7 to 8 hours a day 6 days a week. I am wondering how he will manage if it hasn't cleared up by then.

Your thoughts?

Thanks

rainyann

#2 Karla

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Posted 18 May 2004 - 04:21 PM

I cannot speak to this issue specifically but I can recommend to anyone experiencing these types of problems to go see an Alexander Technique teacher. This saved my job and my body a few years ago and I am not even worried about playing my instruments about injuries at all now. I can play guitar or type on the keyboard just as much as I want. (I've done 9 hours in a stretch already with guitar) I am not hurting at all in learning the violin and my violin teacher is amazed at how relaxed and moveable I am. BTW: I'm 40 years old!

#3 HoosierGirl

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Posted 18 May 2004 - 04:23 PM

I have a mild case. Mine improved dramatically after I had my wisdom teeth removed. If it is TMJ, he can also get an oral splint made that will relieve the pressure on the joints. It's a clear device that fits over either the upper or lower teeth... somewhat like those clear braces you see advertised, but a bit bulkier. It's about $400 and just takes a couple of weeks to have made.

#4 rainyann

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Posted 18 May 2004 - 05:08 PM

thanks... he had all 4 wisdom teeth removed about 1 1/2 years ago. Let's see what the dentist says tomorrow

#5 Primrose84

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Posted 18 May 2004 - 07:23 PM

any stress of late? worries over anything?

a while back i was way stressed out and the tension showed up all over my playing, i was a wreck. i had tendonosis in my thumbs and forearms, what seemed like rotator cuff damage in my right shoulder (i could barely raise it above my head, and it hurt constantly), and what felt like TMJ. i had some time to cool off and started being conscious of tension and it all went away, with exception to the odd twinge in the forearms if i overplay or am down to crunch time. just a thought. best wishes.

#6 Omobono

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Posted 18 May 2004 - 07:38 PM

I didn't know what this was so I looked it up:

http://www.drshankland.com/tmj.html

Haven't heard of violists with that problem - most of my acquaintances have more difficulty with arm, shoulder hand, tendon troubles.

Omobono: 12th Century citizen of Cremona
and patron saint of its craftsmen.

#7 Andrew Victor

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Posted 18 May 2004 - 08:03 PM

I have tried an incredible number of violin and viola chinrests that I am sure would give me TMJ if I persisted in using them.

I was lucky enough to find my dream chinrests 35 years ago a buy enough to last me. Other chinrests I try would never do, I wonder how anyone can use them.

Did your son recently change anything - chinrest, shoulder rest - they work together (or not!!).

Andy

#8 rainyann

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Posted 18 May 2004 - 10:29 PM

First off, stress. Yes, my son is in the midst of SATs, seating auditions, AllState auditions and the end of junior year. So that is stressful.

The only other thing I can think of is that he generally plays a 16 1/4 inch viola. However, one of the pieces his youth orchestra will be performing at Lincoln Center on June 6th is Mozart's Mass in C and there is no viola part. So since he adores anything Mozart, he has opted to play the violin, which he has never played in concert. The orchestra conductor thought it might be the change from viola (with shoulder rest) to violin (and he is not using a shoulder rest). Could that possibly be it? A combination of the two?

We'll see. Thanks all!

#9 D_A

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Posted 19 May 2004 - 12:52 AM

I have two violist and one flutist friends who have had the problem -- dental braces and other bite-altering dental work were what was prescribed.

#10 Gray Violiner

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Posted 19 May 2004 - 09:10 AM

Quote:




The orchestra conductor thought it might be the change from viola (with shoulder rest) to violin (and he is not using a shoulder rest). Could that possibly be it? A combination of the two?



Hey Rainy! Sounds like you've probably found the culprit right there. Why isn't he using a shoulder rest? He may either be consciously or unconsciously clamping down on the violin with his jaw, possibly because it feels like it's not sitting solidly. Has he tried playing the violin with a shoulder rest? Have you thought about watching his neck/shoulder/head position when he plays his viola, then observe him playing the violin? Might be helpful to try that. If you have a camcorder, you might want to videotape him playing both instruments so he can have a look as well.

One thing for sure, TMJ isn't something you want to mess around with. It can cause some very serious problems if it gets a grip on your son.

#11 rainyann

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Posted 19 May 2004 - 04:18 PM

Hey, GV!!

I have been thinking about it and I guess I will take him to trya chinrest. He has a violin chin rest but doesn't like the one he has.

The desntis said he should give it a couple of weeks and see if it calms down before sending him to a specialist.

#12 La Folia

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Posted 20 May 2004 - 10:38 AM

I think the previous messages were right on the mark. Your son must relieve pressure on his jaw while playing. A violin is thinner than a viola, and frankly too thin for many people. Playing without a shoulder rest and a well-designed chin rest encourages players to lower the head, change the angle, and try to hold the instrument tight with the jaw. They also raise the shoulder in an unhealthy way.


The ideal technique is to minimize holding the instrument with the jaw. Violin technique, as actually taught, is quite variable. I don't want to ignite the shoulder pad wars again, but many teachers insist on students using their technique and the same equipment. Often, they fail to recognize that their students' necks are not short enough to reach the chin rest comfortably.

There are several papers in the dental literature that indicate an association between violin or viola playing and TMJ disorders. Symptoms also seem to be correlated with frequency of play. While the evidence is somewhat weak, I think it is weak because disfunction depends so much on equipment and technique. In one report (I can't find the reference right now), symptoms were alleviated with a custom-made chin rest. I assume, however, that relief of symptoms must depend strongly on relief of pressure from the jaw.

#13 rainyann

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Posted 20 May 2004 - 05:52 PM

Thanks....
Good lord, I kept saying chin rest in my last post and I meant he doesn't use a shoulder rest with his violin. I really must be tired.

#14 La Folia

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Posted 20 May 2004 - 06:43 PM

No doubt about it, this could be a lifelong problem. It's best to take this seriously.

If possible, try to get a chin rest that is high enough to bridge the gap up to his jaw and shaped well enough so it doesn't cause high pressure against the angle of the jaw. Then he needs to learn to use it very lightly, with a little momentary pressure when he shifts.

Did you ever notice how many people use handkerchiefs? In my opinion, that's a sign of something wrong.

Many people who can't find the perfect chin rest get relief from a shoulder pad.

#15 HoosierGirl

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Posted 20 May 2004 - 07:52 PM

Quote:



Did you ever notice how many people use handkerchiefs? In my opinion, that's a sign of something wrong.


I think folks misunderstand the purpose of the handkerchiefs. My husband uses one for formal concerts. The fabric used in his tux/tails and dress shirts is very slick, and a cotton handkerchief provides "traction control" on the back of the fiddle (where it contacts his collarbone) so that he doesn't have to press or alter his posture. He doesn't even have a violin hickey. The handkerchief isn't intended to alter the chin rest, and he doesn't use one with street clothes or anything other than slippery concert attire. It just allows him to play the same way he would at home in a t-shirt. The exception would be his Becker... he used a handkerchief constantly with it the first year because the varnish was so soft.

#16 La Folia

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Posted 21 May 2004 - 09:05 AM

Lots of performing artists use handkerchiefs over the chin rest. I think there is something wrong.

#17 HoosierGirl

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Posted 21 May 2004 - 09:16 AM

You need to hook part of it over the chin rest to keep the rest of the handkerchief in place.

#18 paulinefiddle

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Posted 27 May 2004 - 11:10 PM

I have a very severe case of TMJ/TMD/myofacial pain, and it is the pain from hell. At its worst, it extends over my face, head, neck, shoulders, upper back and chest, and, sometimes, all the way down to my waist. I have a very long neck, and I have been playing the violin since childhood, over 40 years ago. Many dentists have told me that I'll never get well unless I stop playing the violin. "You can learn to play another instrument," I've been told. Of course, this is unthinkable!

I have learned to manage my pain, and I'll share what I've learned:

First, a splint alone won't do it. In fact, there are simpler, cheaper, and more effective ways to manage the condition.

Be sure that your violin is outfitted to fit you well. Violin or viola playing is very physical. This is especially important if you have a long neck. I use a very high shoulder rest and some additional padding, like a small, soft towel or even my cloth violin cover, under the shoulder. If you scrunch down with your chin or up with your shoulder, you'll get muscle stiffness and pain, so you'll need to figure out why and make any necessary adjustments.

Stretching and yoga are almost miracle cures. I teach my students to do what I do: stretch after playing. If you start to feel your muscles tighten while you're playing, stop and stretch. Shoulder rolls and deltoid (shoulder muscle) stretches are especially good. Doing a forward bend brings blood and warmth to your face and neck and feels good. Yoga is great for stretching and overall relaxation. Also great is a massage to the neck and shoulders. This is the most fun treatment. :-)

If your muscles get stiff and stay stiff and painful for a period of days, you must stop playing the violin for a while. :-( The most effective treatments are moist heat (alternate 20 minutes on and 20 minutes off) and Alleve taken evry four hours, if necessary. I once asked my dentist for a prescription for a painkiller, muscle relaxant, or anti-inflammatory drug, and he told me that wet heat and lots of Alleve would work better. He was right.

A splint can be useful as part of a long term treatment plan. It's painless and you only need to wear it while you sleep. The only downside is the cost, several hundred dollars.

Although I have an unusually severe casde of TMJ, the methods of treatment I have described are good for anyone who plays the violin or viola. An ounce of prevention is worth more than a pound of cure. Besides, the treatments I've described feel s-o-o-o good and relaxing.




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