Rub Out TMJ

Therapeutic massage holds out healing hope for sufferers of jaw joint disorders
By Vesna Vuynovich Kovach
In Anew magazine, Autumn 2005

He was graceful, lean but not quite lanky, with high, well-defined cheekbones, a broad, intelligent forehead, and a thoughtful, artistic intensity in his eyes. He pretty well fit the description of all my youthful crushes – like Fred Astaire and Ludwig Wittengstein (yes, the philosopher) – and also of – maybe you could guess it, but I was 30 before a girlfriend pointed it out to me – my father. My heart leapt. My blood rushed. My brain – scandalized – scolded and denied. I shouldn’t be feeling any of this.

It was my ex-boyfriend from L.A., whom I hadn’t seen for nearly a decade, come to visit. It hadn’t occurred to me that, after years of friendly correspondence, I’d be so primally attracted to him on sight, just like when we first met. I suddenly and painfully recalled that he dumped me. And what a fool of myself I’d made over it.

My body fairly vibrated as I accepted his warm hug. I watched as if from a great distance as he cordially shook hands with my husband. I tensed. I didn’t know what to say.

And then my jaw locked shut.

My jaw remained clenched, frustratingly, through the wonderful Chinese dinner we went out for. (Sucking Lo Mein wasn’t too bad, but oh, those big, juicy dumplings!) Long past that short-lived, but intense, jolt of first encounter. All through the perfectly normal and lovely week the three of us enjoyed together. And a few days thence.

This was one of the many episodes of TMJ (temporomandibular joint, or jaw joint) disorder (sometimes abbreviated as TMD) I’ve experienced over the course of my adult life. And I’m not alone. The National Institute of Dental and Craniofacial Research, one of the National Institutes of Health (www.nidcr.nih.gov), estimates 10.8 million Americans share my pain.

Recently I decided to find out more about TMJ, and explore the possibilities for a healing journey. I discovered some surprises along the way. And I came to the conclusion that the most promising avenue for treatment might be one that most of those millions will, unfortunately, probably never pursue: therapeutic massage.

TMJ problems can be difficult to diagnose, partly because there are so many possible symptoms: pain; impairment of motion; a jaw that’s locked in an open or closed position; clicking, popping and crunchy noises; headaches; eyelid twitching; sleep disturbance; dizziness; a changing bite; flu-like symptoms; bad wear on the teeth; even toothaches. For some, the symptoms are mild and/or infrequent; for unlucky others, persistent and/or excruciating. Episodes are often triggered by stress, as in my case, and are intermittent – and that also makes it hard to judge the effectiveness of therapy.

The cause of “TMJ syndrome,” as this cluster of conditions is often called, is unknown. There are plenty of theories: orthodontic work, malocclusion (bad bite), stress, chewing gum or ice, tooth grinding at night, injuries or trauma to the head or neck, posture, playing woodwind instruments, tooth extractions. But for just about each theory, there’s at least one scientific study that contradicts it.

Treatments include braces to correct jaw position, grinding down the teeth to change the bite, “splints” that can be inserted or else implanted surgically – an irreversible procedure – hot and cold packs, and rather dreary advice to subsist on soft foods for life. None of these are known to work terribly well, according to the NIDCR’s 1996 Management of Temporomandibular Disorders conference assessment statement.

Another wrinkle: 90% of folks seeking treatment are women in their childbearing years, according to the TMJ Association (tmj.org), a national non-profit advocacy, education and support group based in Milwaukee.

So here’s a condition that (1) is generally reported by women, (2) is associated with stress, (3) has no known cause, and (4) resists treatment. Put all that together and you shouldn’t be surprised that TMJ sufferers are too often told that their condition is merely psychological – all in our pretty little female heads, as it were. For many, the legacy of this invisible pain can be alienation from friends and family who have run out of patience, humiliation by condescending or unsympathetic doctors and dentists, frustration and despair.

Add to this the likelihood that the number of TMJ sufferers is far greater than statistics indicate. There’s reason to believe that many, if not most, do not report their condition to anyone. Or that when they do, it’s shrugged off and not referred for treatment, as happened with me some 23 years ago when I consulted a physician soon after first experiencing jaw locking. More recently, I told my dentist that my bite sometimes changes from day to day. He looked puzzled, then told me that was impossible and changed the subject.

This time, I decide to investigate massage therapy. I speak to Rebecca Massman, LMT, a massage therapist who specializes in site-specific, medically directed, therapeutic bodywork. Massman tells me she encounters plenty of TMJ troubles in her work; about one in eight of her clients report it. “I think it’s way more common than people think,” she says. But only rarely is it the reason for their visits.

Massman works at the UW Health Center for of Integrative Medicine, as well as in private practice. She is an instructor of soft tissue techniques and clinical anatomy at the East-West Healing Arts Institute, a local school for therapeutic massage. (“Soft tissue” refers to all sorts of features softer than bone, even though they may not seem squishy-soft to us layfolk.) The massage modalities she uses include myofascial release (the stretching and pulling of fascia, fibrous bands of connective tissue) and trigger point techniques (areas that, when touched, feel painful at that spot and in other “referred” places as well).

Massman is trained in TMJ massage. But having the opportunity to use it is another story. “Clients will usually come for something else, and the TMJ is secondary to other issues,” she says, but as “everything’s connected, everything’s related in the body,” these could be addressed holistically together with the TMJ. “It’s not well known that massage can help,” she says. “They don’t think we can treat it, or what to do. I let them know we can work on it, and they can get relief. They listen. I do a little jaw work to let them know. But then the numbers go way down, like one out of 50 says, yeah, go ahead, let’s do it.”

Why not? One reason is insurance. It’s rare to find coverage for TMJ massage – even though more invasive approaches that are far more expensive, like surgery, are readily covered. What’s more, Massman says TMJ is just one of many conditions that could be treated successfully with massage, but that few people get because of insurance. She lists Carpal Tunnel Syndrome, frozen shoulder and Thoracic Outlet Syndrome, which causes numbness, pain and pins-and-needles sensations along the arm.

Massman says that a full course of TMJ therapy can take anywhere from one to 10 hour-long sessions, “depending on the individual, what’s involved, how long it’s been an issue. Years, or months? The longer it’s been around, the more time and work it will take.” In south central Wisconsin, massage typically costs $60 to $70 per hour.

Another reason could be that physicians traditionally have referred TMJ cases to dentists and orthodontists, who are not usually experienced in soft tissue work in the same way that massage therapists are. These specialists do not ordinarily make referrals to massage therapists.

Another factor that keeps people from diving into TMJ massage treatment: pain. “It’s an ongoing series of treatments, and it can be really painful,” says Massman. “Probably the most painful area of the body to work on.”

I get a demo session from Massman, and I can attest to the pain – but also to the effectiveness. The experience transforms how I think and feel about my TMJ issues.

Massman begins by palpating my subocciptals, the muscles down at the back of my skull. As she presses on the trigger points that she finds there, I feel sensations shoot through my cranium and then subside as the muscle fibers relax. A classic trigger point response.

Next, she squeezes along the length of the sternocleidomastoid (SCM), the long, ropy muscle on the side of the neck that connects chest to collarbone to jaw. Not much pain there, in my case. “I would do the scalenes in further sessions,” she explains, with an explanatory nudge at the raft of muscles that run underneath and crosswise to the SCM. “You have a lot of work to be done there.” Ouch. Sounds right.

Finally Massman moves to the three key muscles of the TMJ assembly. She finds some tension and knotting in the medial pterygoid (poke upwards under your jaw toward the back and you’ll find it) and lateral pterygoid (under the cheekbone). But it’s in the masseter (reach inside your mouth for a tough, fin-like ridge) that she finds scores of trigger points. She methodically applies steady, firm pressure to individual spots. “It feels like a wad of tissue,” she explains, “Thick and hard. Then I can feel it release.” What I feel is exquisite pain during that release, as if she is pushing harder (she isn’t), and then nothing, as if she’s let go (when she hasn’t). Also classic trigger point behavior.

There are plenty more points to be resolved, she assures me, but they will have to wait for future sessions. “They’re deeper. It’s like peeling the layers of an onion,” she says. And it would be a mistake (besides unbearable) to attempt it all in one day: “Your jaw would probably seize up, go into shock.”

Massman explains that the patterns of tensions she has found are unique to me, and have developed over years in response to numerous factors and life events, probably including clenching when stressed, poor postural habits and the trauma to my jaw of wearing braces and then getting them removed. (That doesn’t mean that braces are bad – just that getting massage in conjunction with them is probably a good idea.)

Over the next several days, I feel increased mobility. My jaw feels markedly more open and relaxed – and it’s quieter during chewing. The familiar crunchy feeling is gone. Perhaps most important, my point of view is greatly expanded.

I’ve begun to appreciate the truly marvelous, complex system of muscles and other tissues that keep my jaw in place, allow movement for talking, provide force for chewing. I’ve learned that tensions and knots in some of these muscles have pulled my jaw out of kilter in a highly individualized way.

In other words, there’s a lot of stuff there, and all those parts work really hard, all day, every day. No wonder things go awry fairly frequently. Or that different bits go wacky in different ways for different people. In fact, the very term “TMJ syndrome” begins to sound silly to me. Would we say there is a “knee syndrome” because many people are susceptible to various injuries to that complex and heavily used part of the anatomy?

I’ve discovered that my TMJ tensions are responsible for more of my symptoms than I had dreamed. I’ve learned how far-reaching and variable TMJ effects can be, and how common. I am convinced that therapeutic bodywork, given time and in the hands of a properly trained practitioner, can resolve most, if not all, of these effects in my own case, and that the potential is great to help others, as well. I have a long way to go on my TMJ healing journey. But for the first time, I believe my path is clear.

To learn more about the TMJ and related areas, and for massage you can do yourself, check out The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition, by David G., Md. Simons (New Harbinger Publications, 2004).

Rebecca Massman, LMT, can be reached at 608-222-7473.

Jan Wheaton: All That's Jazz

This reluctant diva is a shy violet offstage
By Vesna Vuynovich Kovach
in ANEW Magazine [Brava Magazine as of 2006]
October 2001
Cover story

Jan Wheaton’s cat is hiding behind the curtain.

All afternoon he’s been out of sight behind the curtain by the sliding glass door leading to the backyard. When I ask about him, Wheaton rises lightly from her forest-green, leather armchair – at the start of my visit, she had melted into it luxuriantly, resting her bare feet on a matching Ottoman – and calls for the cat, a golden-eyed Persian Himalayan.

“Fuji!” Wheaton pads across the room and pulls aside the drape. Fuji lies along the carpet, absolutely unruffled by the reveal. But I am ruffled. Transfixed. It’s not just the ethereal cloud of blizzard-white fur, or the energized tranquility of his eyes. Such explosive glamour, so modestly sequestered – it’s startling.

In a way, Fuji is an apt mirror for Wheaton, a prominent local jazz song stylist who is quick to describe herself as “very reserved.” A bacteriologist by training – she entered the sciences hoping “not to be bothered with people ... so I could be in my little lab room with my lab coat and Petrie dish” – Wheaton is nothing short of a diva, in the truest and best sense of the word. Modest and retiring offstage or not, no lesser label would be sufficient for her star combination of beguiling onstage charisma, vocal talent, inventive approach and musical mastery.

She might spend her days at home – and preferably alone – listening to jazz tunes on her stereo, or on the links practicing her golf swing (she got a hole-in-one at Glenway a while back), but nights and weekends she’s out on the town, drawing cheers from enthusiastic audiences who’ve come to hear the sweet tones of her uniquely high-octane, velvety renditions.

“There are in fact two of me living in this body,” she offers bluntly, but with a wink. “One is this educated university administrator. The other is this bitch who like to hang out in bars.”

On the Madison music scene for 40 years, it seems that only recently Wheaton has been getting the level of recognition she’s earned. Her first CD, Love’s 3 Faces, released in 2001, went into multiple pressings. At the 2002 Isthmus Jazz Festival, she was chosen Jazz Personality of the Year. This year, at the second annual Madison Area Music Awards (the MAMAs), she was named Best Female Vocalist, a distinction that covers all genres. And this year Wheaton became the second-ever recipient of the MAMA’s Michael St. John Lifetime Achievement Award.

Rick Tvedt, executive director of the MAMAs, says that among the award organizers, support of the choice of Wheaton for the lifetime award was “pretty much unanimous right off the bat.” The Lifetime Achievement Award is “for individuals who have dedicated large portions of their lives to music, who have committed themselves to the music community here, and who have stayed local,” he explains.

The timing was right on, he says, because of the way Wheaton’s career has exploded in recent years, including a second CD release this fall, Expressions of Love.

“I’m really happy to see Jan getting some of the attention she so rightfully deserves,” says Tvedt. “She’s very humble and very vibrant. I get a really good buzz when I talk to her.”

Madison’s Mayor Dave Cieslewicz is also a fan. “Jan Wheaton has long been a jazz pioneer in Madison. She is one of the people who opened Madison’s eyes to the jazz scene,” he says. “I asked her to perform at my inauguration party, and she was incredibly well-received.” Cieslewicz even appointed Wheaton to the city’s Alcohol License and Review Commission (the ALRC) because, he says, “she is so well-respected, both within and beyond the local music scene. I felt she would bring a musician’s sensibility to the ALRC’s discussions, and that’s exactly what she’s done.”


Small-Town Roots
Born in 1943 in Cherryvale, Kansas, a predominantly white, “tiny little town of 4,500 people” near the borders to Oklahoma and Missouri, Wheaton grew up on her family’s cattle ranch. She remembers well the discrimination of those days. In the early 1950s, when the town planned a new municipal swimming pool for whites only, Wheaton’s family successfully “raised a bunch of hell,” she remembers. “They were using our tax money.” Besides, she says, “school was integrated. There weren’t enough of us to segregate.”

Getting out of Kansas was top priority, so the young Wheaton followed her parents’ advice to get a college education, studying science at the University of Kansas at Lawrence. Wheaton's mother was a church pianist and organist who taught her daughter to play the piano; her father "thought he could sing," she says, rolling her eyes heavenward. Growing up, Wheaton had sung for her classmates at assemblies and traveled the tri-state region in her church choir. But music as a profession? "They just about killed me when I told them," says Wheaton, with a laugh. Although "they were always pushing me to sing, every time someone came to visit," Wheaton's parents didn't anticipate that their daughter would make music a career. And neither did she.

When she first left for college, Wheaton felt relieved: “OK, I never want to sing another note.” But in her first week away at college, fate got the better of her. Out one night at a local club, Wheaton asked a jazz trio if she could sing a few numbers, just for fun. “They were playing all those sappy love songs Mom and Dad were always singing,” she recalls. So why sing them? "I knew them." And Wheaton has been singing those songs ever since.

After earning an M.S. in bacteriology, Wheaton embarked on a university career that was to span 35 years. She began at the Wisconsin State Laboratory of Hygiene, then soon went on to the UW-Madison Department of Bacteriology for the next 13 years. From there she moved to the UW-Madison College of Agricultural and Life Sciences, where she worked as a teaching specialist and the coordinator for minority and disadvantaged students. For 10 years, she served as an assistant dean for the college before becoming Associate Athletic Director for Student Services. Through much of the 1990s and until retiring from the UW in 2001, Wheaton was Assistant Dean of Students at the Student Affairs Office and the director of the Campus Information and Visitor Center at the Red Gym.

Nights and weekends, she sang.

“Music is my life. It’s what allowed me to stay at the University for 35 years and not go berserk,” she says. “So did changing jobs over the years. I don’t think there’s any job that you just absolutely love every day. Or if there is, I wasn’t in it.”

Wheaton has never married or had children. “I figured out a long time ago, this music takes a lot of time. A career takes a lot of time. And families take a lot of time. So I picked the two I wanted,” she says.


Breaking In
“I kind of muscled my way in,” says Wheaton of breaking into the early 1960s’ Madison music scene. “Subtlety is my mantra. If somebody I liked was playing, I would show up and ask to sing.” For years, she wasn’t taken seriously, she felt. “It’s hard, really, being a girl singer. The other musicians – the men – didn’t consider me a fellow musician. They’d just put me on near the beginning for diversity.

“That's how I was used. The audience would get restless, start talking, waiting for the real act.” She had a different opinion of her role on the music stage. “This is my instrument," she says, and points to her throat. "I don't blow a horn or bang on a drum."

And she began getting phone calls. People who’d heard her sing wanted her to play as a featured artist at parties, cocktail hours, festivals and other functions. No longer the token girl singer, Wheaton now holds the reins, sizing up the budget and scope of the gig and hiring musicians to form a backing combo to fit the venue.


The Third Act
Since retiring, Wheaton has had more time to spend on her musical development. “It’s still the same old music that I’m exploring, but I haven’t done some of these songs in this way,” she explains. “I take more chances. I’m testing my range.”

Pianist Matan Rubinstein, a Ph.D. candidate in music composition at the UW, has Wheaton’s regular accompanist for the past few years. “She’s wonderful to work with. Very tough and strong,” he says. “She’s brilliantly musical. She has some of the most interesting phrasing I’ve ever heard in my life in jazz. Ella Fitzgerald or Sara Vaughn – she’s up there with them. She’s a real musician.”

For her part, Wheaton says, “I feel comfortable scatting with Matan. Other musicians don't always trust that you can do it." ("Scatting," or improvisational singing using nonsense syllables, is the jazz singer's version of an instrumental solo.) "If I do get out there and can't get back, he'll help me back. He gives me that space. What's happened is, I listen differently now."

Their chemistry on Expressions of Love is dynamite. Venerable standards receive novel approaches. On the shimmering first cut, “It’s Almost Like Being In Love,” Wheaton springs effortlessly against Rubinstein’s nimble piano into a breathtaking scat solo. “It’s about being excited. ‘What a day’! ‘What a rare mood’! But people don’t sing it that way,” says Wheaton. To demonstrate, she mimics a more pedestrian interpretation, and I can practically hear a metronome clanging: "What a da-ay-ay this has been...what a ra-a-are mood I’m in..."

“Can’t Help Lovin’ That Man” is similarly refreshing: it’s carefree, defiant, sparkling – not the usual anguished victim’s confessional. And her voice has somehow become more youthful over the past five years.

“Some of these songs, they tell you how to sing them,” she says, explaining how she arrives at her innovative, fully realized interpretations. “Like in ‘Don’t Explain’: ‘Skip that lipstick. Don’t explain...Right or wrong don’t matter...’ ” she says, quoting from the Billie Holiday tearjerker. “That’s pathetic!” I consider myself a strong woman, and here I am singing these weepy songs." I ask how she does it, and how does she pull it off with such conviction? "I'm an actress," she states, plainly.

Another factor, one she would be too modest to claim herself, is what Rubinstein calls her “extraordinary musicianship.” He elaborates, “Her sense of rhythm is really unique. Her sense of harmony is interesting. We really never do the same song in the same way when we play – we take the jazz approach. There are moments when we have the same thoughts, and take the plunge into the same direction, take the same risk. It’s a great treat.”

So what’s next for Jan Wheaton? “I want to play as much golf as I can. It’s the challenge,” she says. “I used to think it was silly, hitting a little white ball. But I cannot let this game beat me.” And, of course, there’s the musical goal of “continuing to live this life of music for as long as I’m able.”


Sidebar
Favorite musical artist: Nancy Wilson.

Why: “Her phrasing. You have no doubt what she’s singing about. The way she ‘works’ her notes.”

Favorite song to sing: “None. I like everything I do. I prefer sultry love songs.”

On expanding her repertoire: “Somebody asks, do you know this song? I look it up and listen to it. If I like it, I add it.”

Formal music training: “My mother taught me piano. I played clarinet in the marching band. I can read music and play a song, but not in a room where anyone else can hear me.”

Community involvement: Board of directors, Dane County Rape Crisis Center; member, Madison CitiARTS Commission, Madison’s Affirmative Action Commission, Madison’s Alcohol Licensing and Review Commission.

On Madison: “This is as big a city as I need. I love to visit big cities, but they’re just too much. This is home. Even if I had been ‘discovered,’ this is where I would be.”