TMJ problems

Question: I’ve had RSI (2xMouse shoulders) for 2 years. I’ve continued to try and find the prime cause of my RSI because in spite of doing lots of the recovery techniques I feel that my management of the symptoms is good but I’m not sure if I’m recovering! My problems seemed to be traced back my neck muscles and I saw a neurologist regarding Thoracic Outlet Syndrome but he said there was no evidence of TOS. There is a section in the Bonnie Prudden Trigger Point book about TMJD (Temporo Mandibular Joint Dysfunction (Jaw joint) and although the connection seemed farfetched (to me) I don’t have wonderful teeth and I did have a molar crown done a few months before my first signs of RSI started. The crown has never felt all that comfortable given the timing coincidence I thought I should follow it up.

My dentist was almost hostile at my question as to whether the crown/bite could be the problem but at my insistence agreed to refer me to the specialist in TMJ problems. At the Maxillo-fascial unit consultation the specialist agreed I do have a TMJ problem and I asked whether it was possible that it was causing my RSI problems. Oh yes she said it could be causing muscular problems in the sternocleidomastoid(neck) and trapezius(back) muscles. Has anyone else had any such problems or had any investigations done? I have seen nothing on any of the web sites to link TMJ problems with RSI, yet TMJ problems are apparently not uncommon.

Answer 1: I also have TMJ problems, in my case stiff/aching masseter muscle with the occasional crunch occurring in the TMJ. The problems with the joint are due to spasm in the muscles around it. Mine started before I had RSI, about once a fortnight my masseter muscle would get stiff and ache. When it was really bad it would make my molars ache as well! Only when my RSI began to affect my shoulders did it start to set off the aches in the masseter muscle. Now if I get stiff shoulders my masseter muscles always aches as well, BUT ONLY if I am using my computer. If I don’t use my computer the stiff shoulders do not make the masseter muscles ache.

Having discovered trigger points I found several occur in the masseter muscle when it aches. Pressing on those reduces the pain. Also massaging my shoulders (a bit difficult, but you can do it) can turn off the pain in my masseter muscle just as effectively. I have also recently seen a specialist about this problem and they said that the shoulders/neck/head muscles are all closely ‘interlinked’ (surprise, surprise) and that any of them could set of the TMJ problems. The ‘bite’ of your teeth can also cause the problem, as can clenching your teeth. As an aside, my local RSI support group recently had a session with an Alexander Teacher who said we all clenched our teeth! I found that when I was having Alexander Technique lessons, I did not get the problem with my masseter muscles at all. This lasted for about nine months until I had to stop going for lessons and partly gave up the Alexander Technique. The problem with my masseter muscles then returned.

The specialist I saw will make a splint (a rubbery plastic thing that goes in your mouth) to improve my bite, after I have had my remaining wisdom teeth removed, as they could be causing the problem as well. I will also try to take up the Alexander Technique again as it really made a difference. If you want to read up on TMJ then look at the Janet Travel book on myfascial pain as this has a large section on TMJ.

Answer 2: There is a connection between TMJ and RSI. I have both: RSI first, then TMJ secondary to a car accident (whiplash), but they are connected. TMJ doesn’t have to come about through dental problems, can be posture, childhood head injury, etc. A person sensitive to RSI through anatomy, lifestyle, workstation, posture, etc., etc., can also be sensitive to TMJ for same reasons. It doesn’t follow that if you have RSI you will have TMJ, but in some people the predisposition is there and bingo, after time and bad luck, it’s yours. Posture has a lot to do with it, and I developed walking problems about a year into my TMJ – it is a chain reaction with muscles compensating for others and creating an anomaly in a different part of the body. I wrote some posts to SOREHAND entitled “Jawbone connected to your anklebone?” but I don’t have them on my computer. Ralph Strauch, Feldenkrais practitioner was especially helpful to me, though after doing his exercises, I am still suffering from TMJ. (He’s in California). And, BTW, typing brings on my TMJ symptoms simultaneously with RSI – so I’d better stop this now!

MD’s don’t know much about TMJ. I have an orthodontist here in Canada who has been very helpful (I wear a night splint from him), also my physio who is from Britain originally, specializes in TMJ. She says in UK it is even less well known than here, she did not even know if they had a name for it! She trained under someone in States who is the guru in TMJ matters. Sorry, I can’t be more specific or scientific, but this is a lead. You should be able to proceed from here. I understand TMJ is “curable” in 90% of cases if caught early. Unfortunately, mine went undiagnosed for 6 months, and untreated (due to insurance company) for one year. I am stuck with it and have to curtail talking and static activities.

Answer 3: Thanks for your replies. As with lots of RSI type problems this seems to be a chicken and egg situation. Did the TMJ problem cause my shoulder problems or have the shoulder problems (or something else) caused the TMJ problem. I’ve read bits about myofascial pain and they left me thinking “Oh my god it could be a million different things”.  It’s the timing that makes me think that the TMJ problem caused the shoulder problem. If I’m right that it was either the fitting of the crown or some associated change because of the crown that started or perhaps just worsened a TMJ problem then it could have caused the series of non-computer related hand and arm strains over the year that I had prior to me developing mouse shoulder.

TMJ problems, as I understand it, can be very sinister. Tension in the masseter makes me feel stressed rather than thinking of it as a specific muscle. Tension in your Sternocleidomastoid and trapezeous(sp?) seems to go unnoticed unless you specifically try to stretch them, there is no pain. I have had the rubbery splint for about 3 weeks. It does relax my masseter muscles but I don’t wear it at work as I find it difficult to talk when it’s in my mouth. I’m going to see my physio also and have stepped up my relaxation sessions. I’m like the idea of it being the root cause rather than another unrequested problem.

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