Temporomandibular disorders, pain in the neck and shoulder area, and headache among musicians

Maurits K A van Selms, Jetske W Wiegers, Hedwig A van der Meer, Jari Ahlberg, Frank Lobbezoo, Corine M Visscher, Maurits K A van Selms, Jetske W Wiegers, Hedwig A van der Meer, Jari Ahlberg, Frank Lobbezoo, Corine M Visscher

Abstract

Background: Uncertainties still exist about the role of playing musical instruments on the report of musculoskeletal complaints and headache.

Objectives: To evaluate the prevalence of and risk indicators for symptoms of temporomandibular disorders, pain in the neck or shoulder, and headache among musicians.

Methods: A questionnaire was distributed among 50 Dutch music ensembles.

Results: The questionnaire was completed by 1470 musicians (response rate 77.0%). Of these, 371 musicians were categorised as woodwind players, 300 as brass players, 276 as upper strings players, 306 as vocalists and 208 as controls; nine musicians had not noted their main instrument. The mean age was 41.6 years (standard deviation [SD] 17.2), and 46.5% were male. Irrespective of instrumentalist group, 18.3% of the musicians reported TMD pain, 52.5% reported pain in the neck and shoulder area, and 42.5% reported headache. Of the functional complaints, 18.3% of the musicians reported TMJ sounds, whereas a jaw lock or catch on opening or on closing was reported by 7.1% and 2.4%, respectively. TMD pain was associated with playing a woodwind instrument, whereas pain in the neck and shoulder was associated with playing the violin or viola. For each complaint, oral behaviours were found as risk indicator, supplemented by specific risk indicators for the various complaints.

Conclusions: The current finding that pain-related symptoms varied widely between instrumentalist groups seems to reflect the impact of different instrument playing techniques. Playing a musical instrument appears not the primary aetiologic factor in precipitating a functional temporomandibular joint problem.

Keywords: TMD pain; TMJ sounds; headache; musician; neck-shoulder pain; temporomandibular disorders.

Conflict of interest statement

None declared.

© 2019 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.

References

    1. Kaufman‐Cohen Y, Ratzon NZ. Correlation between risk factors and musculoskeletal disorders among classical musicians. Occup Med (Lond). 2011;61:90‐95.
    1. Zaza C, Charles C, Muszynski A. The meaning of playing‐related musculoskeletal disorders to classical musicians. Soc Sci Med. 1998;47:2013‐2023.
    1. Kok LM, Huisstede B, Nelissen R. Musculoskeletal complaints in male and female instrumental musicians In: Legato MJ, ed. Principles of Gender‐Specific Medicine (3rd edn). San Diego, CA: Academic Press; 2017:543‐556.
    1. Zaza C. Playing‐related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ. 1998;158:1019‐1025.
    1. Baadjou VA, Roussel NA, Verbunt JA, Smeets RJ, de Bie RA. Systematic review: risk factors for musculoskeletal disorders in musicians. Occup Med (Lond). 2016;66:614‐622.
    1. Jacukowicz A. Psychosocial work aspects, stress and musculoskeletal pain among musicians. A systematic review in search of correlates and predictors of playing‐related pain. Work. 2016;54:657‐668.
    1. Kok LM, Huisstede BM, Voorn VM, Schoones JW, Nelissen RG. The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Environ Health. 2016;89:373‐396.
    1. Zimmers PL, Gobetti JP. Head and neck lesions commonly found in musicians. J Am Dent Assoc. 1994;125(1487–90):92‐94, 96.
    1. Steinmetz A, Zeh A, Delank KS, Peroz I. Symptoms of craniomandibular dysfunction in professional orchestra musicians. Occup Med (Lond). 2014;64:17‐22.
    1. de Leeuw R, Klasser GD. Differential diagnosis and management of TMDs In: de Leeuw R, Klasser GD, eds. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management/American Academy of Orofacial Pain (6th edn). Hanover Park, IL: Quintessence Publishing Co, Inc; 2018:143‐207.
    1. van Selms MKA, Ahlberg J, Lobbezoo F, Visscher CM. Evidence‐based review on temporomandibular disorders among musicians. Occup Med (Lond). 2017;67(5):336‐343.
    1. Clemente MP, Moreira A, Mendes J, Ferreira AP, Amarante JM. Wind instrumentalist embouchure and the applied forces on the perioral structures. Open Dent J. 2019;13:107‐114.
    1. Fernandes G, Franco AL, Goncalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013;27:14‐20.
    1. Goncalves DA, Camparis CM, Speciali JG, Franco AL, Castanharo SM, Bigal ME. Temporomandibular disorders are differentially associated with headache diagnoses: a controlled study. Clin J Pain. 2011;27:611‐615.
    1. Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R. Prevalence of neck pain in migraine and tension‐type headache: a population study. Cephalalgia. 2015;35:211‐219.
    1. Costa YM, Conti PC, de Faria FA, Bonjardim LR. Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123:288‐297.
    1. Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension‐type headache. Cephalalgia. 1996;16(3):175‐182
    1. Glaros AG, Urban D, Locke J. Headache and temporomandibular disorders: evidence for diagnostic and behavioural overlap. Cephalalgia. 2007;27:542‐549.
    1. Brugues AO. Music performance anxiety‐part 1. A review of its epidemiology. Med Probl Perform Art. 2011;26:102‐105.
    1. Sternbach D. Addressing stress‐related illness in professional musicians. Md Med J. 1993;42:283‐288.
    1. Nicholson RA, Houle TT, Rhudy JL, Norton PJ. Psychological risk factors in headache. Headache. 2007;47:413‐426.
    1. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest groupdagger. J Oral Facial Pain Headache. 2014;28:6‐27.
    1. van der Meulen MJ, Lobbezoo F, Aartman IH, Naeije M. Ethnic background as a factor in temporomandibular disorder complaints. J Orofac Pain. 2009;23:38‐46.
    1. Van Vliet IM, Leroy H, Van Megen H. M.I.N.I. international neuropsychiatrisch interview. MINI Plus 500 (Nederlandse versie). 2000:1‐82.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini‐International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM‐IV and ICD‐10. J Clin Psychiatry. 1998;59:22‐33.
    1. van der Meulen MJ, Lobbezoo F, Aartman IH, Naeije M. Self‐reported oral parafunctions and pain intensity in temporomandibular disorder patients. J Orofac Pain. 2006;20:31‐35.
    1. VanVoorhis C, Morgan BL. Understanding power and rules of thumb for determining sample sizes. Tutor Quant Methods Psychol. 2007;3:43‐50.
    1. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373‐1379.
    1. Jang JY, Kwon JS, Lee DH, Bae JH, Kim ST. Clinical signs and subjective symptoms of temporomandibular disorders in instrumentalists. Yonsei Med J. 2016;57:1500‐1507.
    1. Ahlberg JJ, Wiegers JW, van Selms M, et al. Orofacial pain experience among symphony orchestra musicians in Finland is associated with reported stress, sleep bruxism, and disrupted sleep ‐ independent of the instrument group. J Oral Rehabil. 2019;46:807‐812.
    1. Yasuda E, Honda K, Hasegawa Y, et al. Prevalence of temporomandibular disorders among junior high school students who play wind instruments. Int J Occup Med Environ Health. 2016;29:69‐76.
    1. Gotouda A, Yamaguchi T, Okada K, Matsuki T, Gotouda S, Inoue N. Influence of playing wind instruments on activity of masticatory muscles. J Oral Rehabil. 2007;34:645‐651.
    1. Gasenzer ER, Klumpp M‐J, Pieper D, Neugebauer E. The prevalence of chronic pain in orchestra musicians. Ger Med Sci. 2017;15:Doc01.
    1. Steinmetz A, Scheffer I, Esmer E, Delank KS, Peroz I. Frequency, severity and predictors of playing‐related musculoskeletal pain in professional orchestral musicians in Germany. Clin Rheumatol. 2015;34:965‐973.
    1. de Souza Moraes GF, Antunes AP. Musculoskeletal disorders in professional violinists and violists. Systematic review. Acta Ortop Bras. 2012;20:43‐47.
    1. Paarup HM, Baelum J, Holm JW, Manniche C, Wedderkopp N. Prevalence and consequences of musculoskeletal symptoms in symphony orchestra musicians vary by gender: a cross‐sectional study. BMC Musculoskelet Disord. 2011;12:223.
    1. Ohrbach R, Michelotti A. The role of stress in the etiology of oral parafunction and myofascial pain. Oral Maxillofac Surg Clin North Am. 2018;30:369‐379.
    1. van der Meer HA, Speksnijder CM, Engelbert RHH, Lobbezoo F, Nijhuis‐van der Sanden MWG, Visscher CM. The association between headaches and temporomandibular disorders is confounded by bruxism and somatic symptoms. Clin J Pain. 2017;33:835‐843.
    1. Krøll LS, Hammarlund CS, Westergaard ML, et al. Level of physical activity, well‐being, stress and self‐rated health in persons with migraine and co‐existing tension‐type headache and neck pain. J Headache Pain. 2017;18:46.
    1. Yunus MB. Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol. 2007;21:481‐497.
    1. Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain. 2010;11:289‐299.
    1. Vaiano T, Guerrieri AC, Behlau M. Body pain in classical choral singers. Codas. 2013;25:303‐309.
    1. Martin PR, Soon K. The relationship between perceived stress, social support and chronic headaches. Headache. 1993;33:307‐314.
    1. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433‐2445.
    1. Goncalves DA, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain. 2010;24:270‐278.
    1. Heikkilä J, Hamberg L, Meurman JH. Temporomandibular disorders symptoms and facial pain in orchestra musicians in Finland. Music Med. 2012;4:171‐176.
    1. Magnusson T, Egermark I, Carlsson GE. A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age. J Orofac Pain. 2000;14:310‐319.
    1. Wabeke KB, Spruijt RJ. Dental factors associated with temporomandibular joint sounds. J Prosthet Dent. 1993;69:401‐405.
    1. Howard JA, Lovrovich AT. Wind instruments: their interplay with orofacial structures. Med Probl Perform Art. 1989;4:59.
    1. Kalaykova SI, Lobbezoo F, Naeije M. Risk factors for anterior disc displacement with reduction and intermittent locking in adolescents. J Orofac Pain. 2011;25:153‐160.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe