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Table of Contents   
LETTER TO EDITOR  
Year : 2020  |  Volume : 31  |  Issue : 5  |  Page : 826-827
A case of temporomandibular joint pain in a competitive weight lifter


Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India

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Date of Submission27-Jan-2019
Date of Decision22-Mar-2019
Date of Acceptance28-Oct-2019
Date of Web Publication08-Jan-2021
 

How to cite this article:
Wakhloo T, Shukla S, Chug A. A case of temporomandibular joint pain in a competitive weight lifter. Indian J Dent Res 2020;31:826-7

How to cite this URL:
Wakhloo T, Shukla S, Chug A. A case of temporomandibular joint pain in a competitive weight lifter. Indian J Dent Res [serial online] 2020 [cited 2021 Jan 28];31:826-7. Available from: https://www.ijdr.in/text.asp?2020/31/5/826/306461


Sir/Madam,

It is said that observation is a passive science. Thus, we would like to present this brief review on a rapidly changing lifestyle trend not conducive to the temporomandibular joint (TMJ) function, which may lead to TMJ disorders (TMD).

A 27-year-old male was referred to the dental outpatient department for dull aching pain around left ear following consultations from the departments of Otorhinolaryngology and Orthopedics, respectively, where local causes like ear pain and cervical spine disorders were ruled out and no abnormality was detected. On further history it was discovered that the patient was a competitive weight lifter by profession and complained of a dull aching pain since 1 month which was severe since 3 days. The dull aching pain was interspersed with episodes of sharp pain in the left preauricular region which was sudden in onset, spontaneous in origin, progressively increased during jaw function, and radiated to the neck and left shoulder. The patient also reported ringing sensation in the left ear suggestive of tinnitus. On intraoral examination, the patient had normal mouth opening, well-aligned occlusion with no signs of dental caries or wear facets. Accentuated linea alba or crenations on tongue were not observed. There was no deviation on mouth opening or on lateral movements of the jaw. There were no trigger points, however, on palpation, left temporalis, masseter, lateral pterygoid, and sternocleidomastoid muscles were tender and the left TMJ was hypermobile.

These findings were strongly suggestive of a TMD of myogenic origin, where the treatment is mostly conservative including a soft diet, hot fomentation, analgesics, and muscle relaxants along with counseling regarding relaxation and stress management, physiotherapy modalities, and oral splints.[1] The focus should be on pain relief, restoring normal jaw movement and function, and also to improve quality of life. No radiographic examination was done as the patient was planned for initial conservative management followed by investigations such as magnetic resonance imaging if the symptoms persisted. In the present case, the patient was treated conservatively and was advised custom fabricated mouth guard. The patient responded well to the treatment and is on regular follow-up.

Developing a non-chemical and economically viable ergogenic advantage is often a challenge for athletes. It is common for competitive athletes to clench jaw, develop muscle tension in head and neck, and activate the core muscles to acquire an ergonomic advantage during strength and power tasks.[2] Several studies have investigated the effect of remote voluntary contractions (RVC) such as jaw clenching on athletic tasks and have reported that RVC enhances the rate of force development providing immediate performance benefit. RVC manifests as a potentiation phenomenon termed as concurrent activation potentiation (CAP) whereby stronger muscle contractions occur when muscles other than the prime movers or synergists are activated at the same time.[3] Hungarian physician Erno Jendrassik developed a technique Jendrassik Manoeuvre (JM) in the late 19th century, which involves clenching and interlocking the hands together and attempting to pull them apart while simultaneously increase the strength of reflexes.[4] Other mechanisms by which the RVC potentiates the prime movers include the intercortical communication or motor overflow which means that activation of one part of motor cortex occurring during RVC affects other areas of the motor cortex.[2]

Weight lifting incorporates exercises that demand heavy stress on the muscles and causes hard clenching of teeth which forces the mandible upward and backward causing the cartilaginous disc within the joint to be pushed forward. Excessive forward gliding results in laxity and overstretching of the surrounding capsule, ligaments, and the temporalis tendon leading to disk displacement/derangement to occur in one or both TMJ over time. Net joint moment (NJM) is the most common biomechanical measure of muscle force or effort in a multi-joint task. It has been reported that NJM is the resultant of forces from all agonist and antagonist muscles, ligaments, and joint forces and not from a particular muscle group only.[5]

TMJ pain can radiate down the neck and back and can be exacerbated by poor posture. The patient in this case had moderate to severe head forward posture while lifting weights.[1] Tinnitus, one of the less common symptoms of TMJ, experienced by the current patient was attributed to stretching of the oto-mandibular ligaments and the proximity of tender masticatory muscles to the muscles inserted in middle ear.[6] However, it has also been reported that the nerve supply of TMJ has connections with the parts of the brain that are involved with both hearing and interpretation of sound.[6]

Aqualizer™, a fluid filled hydrostatic oral splint producing muscle dominated mandibular repositioning has been a major breakthrough. The fluid within it distributes forces evenly across the bite, reducing TMJ pressure and pain and hence ensuring relief.[7] Furthermore, distraction while lifting heavy weights like making noise, talking or touching the palate with tongue, and wearing a bite guard can decrease jaw clenching.[8] It is also important to check the constituents of the pre-workout supplements as added caffeine has been positively associated with TMD.[9]

Nowadays, there is an enhanced focus on a healthier lifestyle among the younger generation who are engaging in weight lifting, being more among males than females. Although observed in weight lifters, it can occur in any strenuous sports activity by similar mechanisms. The solution lies in proper education and awareness regarding this problem and timely intervention to treat and preferably prevent such disorders.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Wright EF, North SL. Management and treatment of temporomandibular disorders: A clinical perspective. J Man Manip Ther 2009;17:247-54.  Back to cited text no. 1
    
2.
Ebben WP, Flanagan EP, Jensen RL. Jaw clenching results in concurrent activation potentiation during the countermovement jump. J Strength Cond Res 2008;22:1850-4.  Back to cited text no. 2
    
3.
Ebben WP. A brief review of concurrent activation potentiation: Theoretical and practical constructs. J Strength Cond Res 2006;20:985-91.  Back to cited text no. 3
    
4.
Gregory JE, Wood SA, Proske U. An investigation into mechanisms of reflex reinforcement by the Jendrassik manoeuvre. Exp Brain Res 2001;138:366-74.  Back to cited text no. 4
    
5.
Chiu LZ. Biomechanical methods to quantify muscle effort during resistance exercise. J Strength Cond Res 2018;32:502-13.  Back to cited text no. 5
    
6.
Kusdra PM, Stechman-Neto J, De-Leão BLC, Martins PFA, Moreira de Lacerda AB, Zeigelboim BS. Relationship between otological symptoms and TMD. Int Tinnitus J 2018;22:30-4.  Back to cited text no. 6
    
7.
Srivastava R, Jyoti B, Devi P. Oral splint for temporomandibular joint disorders with revolutionary fluid system. Dent Res J (Isfahan) 2013;10:307-13.  Back to cited text no. 7
    
8.
Cerezen [Homepage on the internet]. Weight lifting and jaw pain. [updated: July 2017, cited December 2018]. Available from: https://www.cerezen.eu/blog/weightlifting-and-jaw-painsurvey/.  Back to cited text no. 8
    
9.
Nandhini J, Ramasamy S, Ramya K, Kaul RN, Felix AJ, Austin RD. Is nonsurgical management effective in temporomandibular joint disorders?–A systematic review and meta-analysis. Dent Res J 2018;15:231-41.  Back to cited text no. 9
  [Full text]  

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Correspondence Address:
Dr. Tulika Wakhloo
Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_80_19

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