A Singer's Introduction to Jaw Tension & Temporomandibular Joint Disorders

Dear Students,

I am delighted to be back in the studio after my travel-heavy spring. I have been grateful to jump back into a few exciting projects, including helping students prepare for the Maine All State Music Festival Chorus, working with them to polish their songs in upcoming musical theatre concerts, beginning production on an upcoming Studio Theatre of Bath Musical Theatre Revue, planning the spring studio recital and more! Less exciting developments in my absence were a resurgence of spring allergies, a few spring viruses going around, and a flair up around the studio of jaw pain and tension!

(Disclaimer, none of the information below is intended to be taken as medical advice. If you have medical concerns, please seek care from a licensed provider).

Jaw pain and tension are common symptoms of a widespread condition known as Temporomandibular Joint Disorder. Referred to colloquially as TMD, TMJ or TMJD,  this refers to an umbrella of symptoms affecting the jaw and masticatory muscles (your chewing muscles). Ranging from severe (such as a jaw that is locked open or closed) to mild (slight pain when chewing hard foods), its symptoms have the potential to significantly impact singing.

It’s common enough and detrimental enough that I screen all incoming students with questions, such as:

·        Do you have difficulty opening your mouth wide?

·        Do you experience jaw pain while chewing, singing, talking, yawning or other similar activities?

·        Do you suffer from frequent headaches or neck pain?

·        Do you grind or clench your teeth at night or throughout the day?

·        Have you ever had an episode where you couldn’t open or close your jaw?

·        Do you deal with significant stress on a daily basis? And if so do you carry it in your jaw or neck?

All of these factors can increase the chances that a singer may be experiencing TMJD. Additionally, I observe the singer in action, looking for visible limitations to jaw movement, jaw deviation, or visible clenching while singing.

When a singer reports significant symptoms or an impacted quality of life, I recommend they seek medical care from a provider, such as a dentist or physical therapist; however, many people live with mild symptoms that are manageable through conservative means. Some people experience only temporary symptom flair-ups. Others don’t meet the criteria for a diagnosis, but still may experience jaw tension while singing.

To better understand how to manage symptoms of TMJD, it is important to understand a little bit of the anatomy involved. The Temporomandibular Joints are the ball-and-socket joints that open and close your jaw for singing, yawning, talking, or chewing. In joint-related TMJD, patients may experience dislocation of or damage to one or both of the joints. These joints are moved by the chewing (masticatory) muscles. The masseter, temporalis, and medial pterygoid muscles close the jaw. Relaxation of these muscles passively open the jaw, while active (wider) opening is achieved by the lateral pterygoid and infrahyoid muscles.

·        Masseter muscles            felt on the cheeks in front of the ears  close the jaw

·        Temporalis muscles        felt at the temples                                          close the jaw

·        Medial pterygoids           felt at the lower corner of the mandible  close the jaw

·        Lateral pterygoids          felt inside the cheek to the back                      open the jaw

·        Infrahyoid muscles         felt under the chin                                       open the jaw wide

Muscle-related TMJD involves tension in one or more of these muscles. Additionally, TMJD is often associated with tongue tension (another common singer ailment!). Muscle-related TMJD is more common than joint-related TMJD.

While a medical provider should be consulted for treatment, there is a lot that someone experiencing symptoms can do at home to improve singing and quality of life. To manage day-to-day symptoms, avoid chewy foods and avoid clicking your jaw or opening it widely for long periods of time. If you are in pain, use over the counter pain relievers like Ibuprofen or Tylenol, alternate heating pads and ice packs. Anecdotally, I have known several providers to recommend magnesium glycinate as a useful supplement to prevent muscle tension. Here are a few easy exercises to ease muscle tension:  

The Four Corners Exercise: Turn your head like you’re looking up to the right upper corner of the room, hold for thirty seconds. Then turn your head to the lower right corner and hold another thirty seconds. Repeat on the left side. Repeat entire exercise 4 times a day.

Masseter release: locate your masseter muscles (slightly below and back from your cheekbones). Dig into the muscle with two fingers and gently and firmly slide your fingers down the side of your face, while consciously relaxing your jaw.

Vocalized tongue stretch: Stick your tongue out like you are trying to touch your tongue and slide your voice up and down an octave on “ah”. Watch in a mirror that your tongue doesn’t pull back into your mouth as you slide to the upper note of the octave. Repeat throughout your vocal range.

Sustained ah jaw release: Sustain an ah on a note in an easy part of your range. As you sing, consciously release your jaw and tongue (it may close a little naturally. Let it)

Jaw/Tongue isolation exercise: Place your hands on the TMJs and relax your masticatory muscles, feeling the entire jaw drop down a few millimeters. Then alternate singing [i] and [a] (as in seen and saw) on a sustained pitch or 5-note scale, while maintaining the relaxed jaw position. Notice how the tongue moves to change vowel but the jaw does not.

Adequate breath support is necessary to prevent jaw tension. Stabilization is necessary for singing with any kind of volume, range, or length, and if the abdominals and ribcage muscles aren’t stepping up, other muscles will step in! Usually, this means either the jaw, tongue, or vocal cords will clench to stabilize the voice, resulting in discomfort, a tense sound, and a diminished vocal range. To relax the jaw (and tongue), make sure you are supporting your voice properly (especially on high notes or long phrases). Any exercises that target breath support will help with this!

Resonance will also ease the burden on the jaw. Exercises that promote vocal resonance (vibrant, easy, naturally loud sound) will help relax the muscles of the face and jaw. Sing sustained vowels with a steady airflow while listening to the vibration of the tone and feeling it vibrate through the tissues of the face and feel the tension melt away!

Emotional Relaxation will cultivate a relaxed jaw. TMJD can literally be caused by stress. Mindfulness techniques will encourage a stress-free baseline, while leaning into your enjoyment of singing or exploring a sense of playfulness while singing will encourage it in the moment.

For more information, please read my doctoral dissertation “The Voice Teacher’s Guide to Temporomandibular Disorders”, available on my website. Do you experience jaw tension? What are your favorite strategies or exercises for dealing with it? Comment below - I’d love to hear from you.

Best,

Dr. Jane