TMD and contact sport

TMD effects musculoskeletal structures of the head and neck, as well as the temporomandibular joint (TMJ). Symptoms of TMD include orofacial pain, limited or asymmetric mandibular movements, and TMJ sounds. Tinnitus, neck pain, and headaches are also possible symptoms. An individual may suffer from mild discomfort to debilitating chronic pain, which can have psychological consequences.

TMD prevalence in adults ranges from 1% to 75% for objective signs and 5% to 33% for subjective symptoms. There are many factors that contribute to TMD’s ethiology, including age, gender, hormonal imbalances, trauma, stress, and other systemic diseases. The prevalence of TMD is typically greater in young adults, and the peak incidence is reported by previous studies to be between 20 and 40 years of age. It is also important to note that gender is a significant risk factor for TMD development: women are twice as likely to develop TMD as men, due to differences in oestrogen levels and signalling mechanisms. According to studies, oestrogen fluctuations and changes in other sexual hormones (such as progesterone) may contribute to the development of TMD. As a result, symptoms usually begin after puberty and diminish with age.

TMD may also be caused by trauma, which can be classified as macro trauma or microtrauma. There are internal factors that can cause microtraumas, such as parafunctional habits (bruxism), malocclusions or oestrogens, which can damage the condylar fibrocartilage, disk, and entire TMJ structure. There are two types of macro trauma: direct and indirect. Direct trauma involves direct injury to the mandible, while indirect trauma does not involve direct contact with the TMJ.

Crincoli et al in in 2022 conducted a study that investigated the prevalence of temporomandibular disorders in 100 competitive athletes in contact sports, equally grouped by the practiced game: Soccer (SoG), Rugby (RG), American Football (AFG), Boxing (BoG), Basketball (BaG), compared to a randomly control group of 20 non-athletes (CG).

Symptoms and signs were examined according to the standardized Diagnostic Criteria for Temporomandibular Disorders through a questionnaire and clinical evaluation. The results support a relationship between the prevalence of TMD symptoms and signs in competitive athletes in contact sports, especially in Rugby and American Football Group compared to Control Group. Interesting to note that Study groups reported masticatory muscle pain during function, neck and shoulder pain more frequently than Control Group except for Boking Group.

Rugby is one of the most popular professional and recreational team sports in the UK. Have we ever paid attention to their masticatory muscle during neck or shoulder treatment? Did the players suffer from headaches or orofacial pain that were hard to resolve? Maybe players had the habit of grinding or clenching their teeth during the day or during sleep as a result of stress? Have we ever checked if they have Mandibular opening alterations?

So, there is so much to learn as a therapist that I wasn’t aware of until I took the Cranio-Mandibular course. But this is how we develop our skills as therapists, we take courses to deepen our knowledge on topics that weren’t as well covered while in uni.