Sports-Related Injuries and TMJ

Sports fans across the United States passionately follow and promote their favorite teams, football players, baseball stars, hockey athletes, etc. While the excitement of games, the competition, and the big names make up our love of sports, players often face high risks of jaw injuries, concussions, severe headaches, and ensuing neck pain – to name a few possible health issues. These health issues may result from playing contact sports.

With the recent recognition of the Specialty of Orofacial Pain, there are now more trained specialists to help recognize and treat orofacial pain issues. Sports injuries too frequently generate chronic pain issues that require proper diagnosis and treatment.

Recent studies also highlight the relationship between concussion-triggered headaches and temporomandibular disorder (TMD) symptoms. Like in football, sports players often sustain repeat blows to the jaw and temporomandibular joint (TMJ) complex. Wearing a helmet is essential, but impacts on the jaw, head, and neck continue to occur and trigger more complex issues. Even the chinstrap on a helmet can get grabbed frequently during football that it can adversely affect jaw joint, muscles, nerves and soft tissues.

What is the percentage of temporomandibular dysfunction among athletes?

In answer to the question as to what extent competitive athletes develop temporomandibular dysfunctions, NIH’s Effects of competitive sports on temporomandibular dysfunction: a literature review article, states that “In case numbers ranging from eight to 347 subjects, a temporomandibular dysfunction was detected with a prevalence between 11.7% and 100% for athletes and between 11.11% and 14.3% for non-athletes.”

In the US, there are multiple sports games having a higher risk of trauma to participant’s head and TMJ complex. Athletes actively participating in contact sports have a higher occurrence of TMJ-related disorders than non-athletes. Our head, neck, and shoulder structures are complexly related and often associated with the development of facial pain.

Chronic jaw pain can be triggered within:

Facial and neck ligaments.
Cheek bone and jaw muscles.
The articular disk (or meniscus).
Head, neck, and jaw tendons.
The nerves associated with facial sensation and pain.

How frequent are craniofacial tendon issues in US sports?

Stefanie H. Korntner reports “Over 3 million CF traumas occur each year in the U.S., involving injuries to the soft tissues and bones of the face and skull, caused by vehicle and sports accidents, assaults, and combat. Craniofacial (CF) tendons transfer muscle-generated forces to bones, thus enabling critical jaw movements such as mastication, talking, swallowing, and yawning.

The National Institute of Health (NIC) Craniofacial tendon development article assesses that traumatic Craniofacial tensions and soft tissue injuries add up to around 10% of all emergency department visits and up to $200 billion in US medical costs. It summarizes that “Even though these injuries affect multiple CF tissues, including tendons, current treatment approaches to restore jaw function neglect tendons, and instead focus only on reconstructing bone despite failing to fully restore jaw function”.

How Does Teeth Clenching Trigger Jaw Pain?

Sustained trauma to the jaw area frequently leads to TMD development. It occurs too often during intense activities, such as sports. Following the stresses of playing sports or a jaw injury, an athlete’s peripheral muscle may become injured and inflamed and alter pain thresholds and messages. Repeated strain is often the cause. This may incentivize a cycle of chronic pain, especially if an ongoing teeth clenching habit is developed.

Playing sports commonly affects an athlete’s oral and overall health. Competitive stress can lead to chronic bruxism, clenching, and tensing the head and neck. In turn, this can trigger further problems with the TMJ or jaw joint, headaches, and neck pain.

How sports-triggered teeth clenching can lead to jaw pain:

A sudden trauma or repetitive stress to the TMJ.
The person unconscious or consciously develops a habit of muscle guarding and jaw clenching.
Repeat muscle tension triggers muscle fatigue and a lack of oxygen to jaw joint tissues and functions.
This oxygen deprivation changes muscular energy metabolism and may cause anaerobic glycolysis, lactic acid and tissue damage.
The consequences of this swelling increases pro-inflammatory cytokines levels in your muscle’s tissues, adding to stresses on the jaw.
A rise in inflammatory cytokines induces peripheral nerve hypersensitivity and decreased pain thresholds.
When a person experiences increased pain levels, they are prone to further teeth clenching that impact the jaw and perpetuate a negative pain threshold.

NIH has further explains how inflammatory cytokines and a trigeminal neuralgia chronic pain condition may develop.

“Vascular compression of trigeminal or facial nerve roots may induce a rise in variety of cytokines, and IL-6 may play an important role in the signaling pathways to generate ectopic impulses from these cranial nerves.” – NIH: A correlative analysis between inflammatory cytokines and trigeminal neuralgia or hemifacial spasm ^[1]

How are Jaw Pain, Headache, and Neck Pain Related?

The anatomical connection between the nerves of a person’s jaw, head, and neck pain involves your trigeminovascular system and trigeminocervical complex. Cranial nerves send signals between your brain, face, neck and the rest of your body. These cranial nerves assist with taste, smell, jaw movements, and pain sensations. They help you yawn, sing, make facial expressions, blink, and trigger tongue functions.

Neurology Advisor warns that professional American football players are at increased risk for repeated head injuries, leading to the question if recurrent concussions are related to the development of chronic headaches, neck and jaw pain. A significant association also exists between concussion symptom burden during years of active play and odds of post-career hypertension. ^[2]

Sports injury-induced clenching triggers related, local pain sensations. Referral pain can actually generate symptoms throughout the entire trigeminal system. Your overall muscular TMJ complex may be affected when one aspect of your head, neck, or jaw is injured. Conversely, if a trigger point injection is applied near the temporalis tendon or inflamed muscle area, the mechanical sensitivity of the surrounding masticatory muscles often experience temporary relief.

What Non-Surgical Methods Treat Sports-Related Jaw Joint Issues?

In addition to a medically determined needed break from contact sports, and wearing a better helmet, a non-surgical therapeutic approach is where we start.

The temporary use of an oral appliance.
Correcting forward head posture; it’s easy to “slump” when injured.
Improve alignment and strain on the head and neck muscles.
Restoring normal function to the temporomandibular joint.
Treating clenching and bruxism (teeth grinding) to reduce strain to the jaw muscles, head, and neck.
Physical therapy focused on improving the range of motion and tenderness of the injured area.
Training and self-care exercises to improve pain thresholds and avoid re-occurrence.

The value of physical therapy under the direction of a pain specialist cannot be overstated.

“We review current research on temporomandibular joint disorders, discuss relevant risk factors, manifestations of temporomandibular disorders in athletes, and treatment options. Certain sports, particularly contact sports, pose an increased risk for problems with the temporomandibular joint. The stress of athletic performance also may be a contributing factor. Mouthguards should be encouraged for prevention of injury and physical therapy is the most effective treatment.” – ^[3]

How Effective are Mouth Guards in Preventing Sports Injuries?

The use of custom fitted mouth guards can reduce the incidence of jaw and TMJ injuries in contact sports. They also assist in decreasing the likelihood of other types of oral and facial injuries. Awareness of their effectiveness remains an issue. The percentage of sportspersons aware of various protective gears was 23.8%, according to then NIH study The Role of Mouthguards in Preventing Temporomandibular Joint Injuries. During Contact Sports: A Prospective Study.

The MN Head & Neck Pain Clinic strives to increase knowledge regarding the role of mouthguards in preventing temporomandibular joint (TMJ) injuries during contact sports within this post and in training sessions. Additional statistics published in the same NIH study underscore why athletes engaged in contact sports benefit from wearing an oral appliance. We see that damaged jaw tissues are often myofascial pain related.

“The awareness of TMJ injuries following contact sports was 6.9%, and 70.3% of the sportspersons were estimated to wear mouthguards. Clinical assessment of sportspersons using mouthguards revealed pain in 18.6% and clicking in 17.4% of the study subjects. The incidence of TMJ pain and clicking in individuals who did not use mouthguards were 81.4% and 82.6%, respectively.” – Ravalika Singarapu writing for NIH

How Does Teeth Clenching Induced TMJ Occur to Athletes?

It is possible to suffer TMJ when overworking your jaw during sports. Clenching your teeth is common when trying to use all your strength. Meaning that clenching your jaw and grinding teeth often occurs unconsciously during exercise and competitive games. However, impact-related injury is more common.

Let’s look at several individual sports and the risks players face.

Sports-Related Trauma to the Jaw, Head, and/or Neck Statistics
Type of Sport	How Injury May Occur	Statistics	Source
Football	The most common secondary effect of physical impact on the athletic field is the tendency for the teeth to slam together in reaction to the hit. Even an indirect blow to the body can sometimes force the lower jaw to slam hard enough into the upper jaw that fractured teeth or even a fractured jaw bone may result.	One study shows that 40% of respondents suffered facial and jaw injuries while playing football, and 18.6% suffered dental injuries.	wiley.com: https://tinyurl.com/msae83xb
Hockey	Whether a blunt facial hit comes from a hockey stick, puck, or an individual seeking to block another player, its fast pace means more opportunity for facial injury.	Concussions account for 14% to 30% of hockey-related head injuries, and concussions within the NHL are common, with rates of 5.8 to 6.1 concussions per 100 games.	journals.sagepub.com; https://tinyurl.com/23wb6yf9
Martial Arts	This contact sport, like boxing, has the goal of knocking someone out, meaning that an opponent is likely to actively attempt to knock your face.	The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. This includes facial lacerations, mouth injuries, jaw injuries, and shoulder injuries.	researchgate.net: https://rb.gy/frh2x
Boxing	Boxers often absorb hard blows to the jaw. Physical trauma from a punch or hard fall can result in much jaw pain.	Craniofacial Injuries in Boxing Study: Most common presenting box injury was facial fracture (n = 4996; 45.1%), followed by concussion (n = 4292; 38.7%) and facial laceration (n = 1796; 16.2%).	journals.lww.com: https://rb.gy/fai5a
Soccer	Players often skid across the grass and may knock into another player or structure. Also, an air-bourne dense soccer ball may hit you in the face.	Soccer is estimated to cause around 412,607 injuries (in both male and female players) a year, and a projected 22% of these injuries are concussions. Traumatic brain injuries (TBIs), commonly known as concussions, are usually caused by trauma to the head (often by a heavy item or a hard fall).	stlukeshealth.org: https://rb.gy/khgpm
Basketball	Another player may come down from a hoop shoot and knock your jaw, another player’s elbow or a heavy ball may hit it.	According to a study of intercollegiate athletes and dental injury, basketball is the highest-ranked sport for dental injuries. In basketball, dental trauma often occurs from contact with other players, whereas orofacial injury in baseball is usually the result of contact with the ball	orthdds.com: https://rb.gy/cu2pr
Volleyball	Volleyball players use their hands a lot and may use their heads to throw and catch heavy balls. Other team players may push or crash into you while playing.	Despite volleyball rules that limit player contact, concussions are still common. This is largely due to ball-contact-related injuries, accounting for approximately 10% of volleyball-related injuries and 31% of ball-contact injuries on the head or face.	drducic.com: https://rb.gy/sdkg9
Rugby	Because rugby involves a great deal of running at high speed, the problem athletes have is not simply tooth loss, but they may never be able to play the sport again due to various neck and jaw injuries.	Orofacial and dental injuries are far from a rare occurrence on the rugby field. The injury rate of 0.98 indicates that it is highly probable that anyone who participates regularly in rugby will, at some time, suffer from one of these types of injury. Five percent had fractured their mandibles.	researchgate.net: https://tinyurl.com/44upyecn

The following quote applies to any of the above sports, not just hockey. For example, in soccer, a player also often hits the ball with their head to move it in a certain direction toward another player, across the field, or into the opponent’s goal.

“The TMJ is a very interesting and overlooked injury site in hockey. Many TMJ injuries are directly the result of blunt force trauma, overuse, or clenching… Because the TMJ is a hinge joint that is very mobile, it acts like a free moving body such that the head will move first, then the jaw will move by itself.” – The Link Between Sports and TMD – MedCenter TMJ

Are Jaw Clenching and Neck Pain Related?

There is a strong association between neck pain and TMD. Our patients often report increased or decreased neck pain issues in direct relations to TMD pain level fluctuations. Patients suffering with TMD tend to have less endurance in neck muscles, decreased neck mobility, and higher levels of neck disability.

Convergence from nerves within different areas can trigger pain signals that get mixed or confused. Pain patients often report pain in the jaw or in the head, when in the pain’s source may be from the neck muscles. These muscles refer pain to the head and forehead. TMD in athletes, as with any adult, causes compensatory muscle behaviors, and several changes in the masticatory function.

Moreover, patients with TMDs exhibit reduced neck flexor and extensor muscle endurance. Masseter myofascial pain can be measured using the visual analog scale, and TMJ pressure pain threshold levels can be evaluated using a digital pressure and algometer. Neck pain intensity can be lowered with stretching exercises that restore the efficiency of muscle function and improve movement in your head and neck structures.

Accurate assessment of the temporomandibular complex is important to create and adapt the treatment to each case. Impact on the masticatory efficiency seems to be influenced by the presence of TMD. Some patients with sports injury to the jaw show impairment of orofacial motor functions, with alterations to the functions of masseter and temporal muscles during chewing.^[4]

An orofacial pain specialist is a dentist who specializes in the diagnosis and treatment of pain in the jaw, face, head, and neck. They can best assess and treat your potential TMJ sports-related injury.

“A damaged jaw is one of the causes of a misaligned jaw that can have several repercussions, such as difficulties in chewing, speaking or moving. Due to the sudden movement, the head and neck can be jerked too far from the center of the neck. The ligaments of the jaw are over stretched, causing pain to the jaw and ears, and sometimes, complete misalignment. If your jaw is already not symmetrical, whiplash injuries can exacerbate the alignment of your mouth and jawbone.” – Damond Talbot ^[5]

Call (763) 577-2484 to schedule a Clinic Visit for Sports-Related Injuries to the Jaw

About the Author

James Fricton DDS, MS, co-founder of the MN Head and Neck Pain Clinic, is internationally recongnized for his years of treating simple to complex head, neck, orofacial, and TMJ pain conditions.

References:

[1] Ming-Xing Liu, et al, A correlative analysis between inflammatory cytokines and trigeminal neuralgia or hemifacial spasm, https://pubmed.ncbi.nlm.nih.gov/30612530/, April 2019

[2] Maria Arini Lopez, PT, DPT, Concussions May Lead to Hypertension Later in Life Among Football Players, https://www.neurologyadvisor.com/topics/traumatic-brain-injury/concussions-may-lead-to-hypertension-later-in-life-among-football-players/, March 2023

[3] Carter L Starr and Christopher McGrew, TMJ Disorders in Athletes, https://pubmed.ncbi.nlm.nih.gov/36606630/, January 2023

[4] Vanessa Marcelino, et al, Masticatory Function in Individuals with Temporomandibular Disorders: A Systematic Review and Meta-Analysis, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963498/, February 2023

[5] What Can NFL Players Do When Their Jawline Is Fractured?, Damond Talbot, https://nfldraftdiamonds.com/2021/04/jawline/, April 2021