I was diagnosed with TMJ over a year ago and I have tried to ameliorate it with the use of a night guard, a modified diet, physical therapy twice a week, and yoga. I am trying to finish a master's degree in flute performance (this is my last semester). Playing the flute for fourteen years (for up to 10 hours a day) and clenching my teeth have been the cause of my TMJ. Recently, the pain has become excruciating not only when I am playing, but all the time. Through an MRI, I learned that I have slipped both of the discs that are between my lower and upper jaw (The discs might very well be perforated, too). My best options (as stated by my oral surgeon) are steroid injections and arthroscopic surgery. I had to withdraw from all of my classes on disability-- except for the final requirement for my degree: an hour long flute recital. I truly do not think I can last an hour, let alone do all of the practicing required to prepare for the performance.
I have been told by several doctors and physical therapists that I could be doing even more damage to my joints if I continue preparing for this recital (the date is set for April 20th). One even suggested that I end my career as a flutist. I want this degree, but not at the cost of totally destroying my jaw and never being able to play the flute again. Should I withdraw completely from college and have the surgery right away? Would it be possible for me to perform a recital, however painful it might be, and then have surgery? Could steroid injections get me through my recital? Must I consider a new career?
This is all very frightening for me. Since all of the doctors, physical therapists, and surgeons I have spoken to have different opinions, I honestly don't know what to do. I do know that the pain is almost intollerable. Please help me.
Thank you,
Stephanie Farina
Follow Ups:
Re: TMJ/Flute Recital (makes me mad)
Posted by Walt Stoll on February 27, 1999 at 11:51:50:
In Reply to: TMJ/Flute Recital posted by Stephanie Farina on February 26, 1999 at 13:26:09:
Dear Stephanie,
Your story just makes me MAD. The causes of your condition have been known for the past 20 years. The only reason why no one has told you about the causes is that it is a lot more lucrative to treat the symptoms than it is to teach you what to do to resolve the cause. Your present dilemma can be laid directly at the feet of the AMA and ADA (who routinely took the licenses away from those professionals who cared enough to tell their patients about these causes 20 years ago.
This is caused by total body "bracing" that has focused on your jaw muscles. This has been discussed MANY times on this BB for years and can be found in the archives. ALSO, you can get temporary relief with the simple procedure on the homepage of this 'site.
From what you are describing, there may already be too much damage to reverse.
The cortisone injections just might get you through the recital. NOTHING you have mentioned here will do anything about WHY you have this so, even if the surgery was successful, you would just proceed to break it down in the future again-----UNLESS you begin now to deal with the causes.
My granddaughter is a talented flautist and I know that clenching the jaw is NOT necessary to play the flute. Since you may have learned while doing this, you may need to learn a lot of your technique all over again. You might even try doing the flute with the erasers in place.
You have a serious problem. Once you have the above information under your belt, if you have more questions, write again.
Walt
Follow Ups:
Alexander Technique for musicians
Posted by Denise Wyrick on February 27, 1999 at 14:42:15:
In Reply to: Re: TMJ/Flute Recital (makes me mad) posted by Walt Stoll on February 27, 1999 at 11:51:50:
Hi Stephanie, This will not help your immediate problems in terms of your pain and the upcoming recital. However, in the long run it might be an avenue worth pursuing. You do not have to give up on playing the flute. Rather you need to re-educate your neuromuscular system so that when you play the flute you will not harm yourself. I agree with Walt it makes me mad to hear of people suffering needlessly.
There is an intensive Alexander technique workshop in June near Lincoln, Nebraska. At least one of the teachers is a musicians that can work with you to use your body more efficiently.
I just thought I would throw that out as a possibility. I hope it helps. Feel free to email privately if you care to. I am considering going to it myself.
not a talented flautist (but I do play)
Denise
http://www.alexandertechnique.com/nebraska.htm
Follow Ups:
Re: TMJ/Flute Recital (makes me mad)
Posted by Stephanie Farina on February 27, 1999 at 15:56:18:
In Reply to: Re: TMJ/Flute Recital (makes me mad) posted by Walt Stoll on February 27, 1999 at 11:51:50:
Dear Dr. Stoll,
Thank you so much for your quick and informative response. I think I have been "bracing" for years-- not just my jaw, but my back and neck as well. Though I have gotten better about controlling stress, it must have been too late for my jaw. Should I attempt to get through my recital with cortisone injections, or am I setting myself up for more pain in the future/dependence? Where exactly is the cortisone injected?
Believe it or not, I don't clench my jaw while playing the flute (it isn't possible to get a sound out of the instrument that way). However, I have been tensing my jaw muscles in an open position. Does that make sense? When changing octaves, flutists move their mandibles either forward or back-- the difference is slight, yet it could be enough to irritate the joints.
My teacher is always saying that I need to "drop my jaw." Perhaps this is part of my problem as well.
You were right to say that I need to retrain myself in technique. However, I cannot attempt to do that and give a recital worthy of a Master's degree at the same time. Knowing all of this, should I continue to prepare for my recital?
Thanks in advance,
Stephanie
Follow Ups:
Re: TMJ/Flute Recital (makes me mad)
Posted by Walt Stoll on February 28, 1999 at 10:30:42:
In Reply to: Re: TMJ/Flute Recital (makes me mad) posted by Stephanie Farina on February 27, 1999 at 15:56:18:
Hi, Stephanie,
Your teacher saw what you were doing but didn't realize how important her/his recommendations were. Perhaps with your example, s/he will be more pushy with future students!
Perhaps s/he can specifically help you change this once your recital is done.
I would hate to tell you that your career was doomed but it IS at risk.
The cortisone is injected directly into the joint space. At this stage, one injection cannot cause enough additional damage to be worth considering. Your doc will have to tell you how long it will take for the maximum benefit from the injection & that is when you need to schedule the recital.
Remember, the idea is NOT to "control the stress" but to DISCHARGE it. That is why SR must be done regularly at least twice a day.
Alexander Technique IS a good idea as is Rolfing, Feldenkrais, massage and/or Chiropractic for temporary help.
Walt
Re: Alexander Technique for musicians (Great Idea!)
Posted by Walt Stoll on February 28, 1999 at 10:32:13:
In Reply to: Alexander Technique for musicians posted by Denise Wyrick on February 27, 1999 at 14:42:15:
Thanks, Denise!
WONDERFUL suggestion!
Namaste` Walt