Wear the Right Masks the Right Way to Prevent Headaches and TMJ
Lessons from physical therapy on how to save face while possibly saving your and your neighbors’ lives.
By Holly Lebowitz Rossi
It’s not up for debate that mask-wearing is the single practice — above even social distancing — required of us whenever we share air with other human beings during the coronavirus pandemic. It’s no surprise that “Wear a mask” is one of the top phrases uttered in 2020.
And.
When many of us do the right thing and mask up, we end up with headaches, earaches, and jaw pain (also known as TMJ). As a chronic TMJ alumna, I was getting worried when more than an hour in a mask had my ears feeling jammed, my face tight, and my temples throbbing.
So I called on Dr. Paul Glynn, a Lexington, Massachusetts-based physical therapist, board-certified Orthopedic Clinical Specialist with positions at Mass General Hospital and Newton-Wellesley Hospital, and TMJ specialist.
Mask-related head, face, and neck pain are not surprising side effects of (smart! necessary!) mask-wearing. But neither are they insurmountable obstacles. “These symptoms are all amenable to some very light stretching and postural correction-type activities,” Glynn said.
So what exactly are we doing “wrong” while we’re rightly wearing our masks?
Mouth-Breathing
When you keep your mouth open to breathe in your mask, you are working against your own musculature, says Glynn. The small muscles of your mouth end up trying to pull your mouth into a closed position as you pull your mouth open to breathe. “This creates a constant tug-of-war in the musculature, a back-and-forth that can create headaches or pain and stiffness in the jaw and cheeks,” he said.
“Muscle Guarding”
If your mask fits you anywhere near correctly, you don’t have to do any work to keep it in place. But just try telling that to your muscles, which are taking in all that sensory input, constantly feeling the mask against your face, and responding by clenching and tensing against an invisible enemy. “Your jaw could overcome the pressure of the mask,” said Glynn, “but the sensory input of the mask creates the impression that it’s a physical obstruction.”
Eustachian Tube Compression
The tiny tubes that go from your inner ear to the back of your throat are sensitive to pressure changes — think of ear pain that can come on when a plane is coming in for a landing. Too-tight ear loops on a mask can combine with clenched jaw muscles and poor neck posture to compress the eustachian tube so much that air circulation through the sinus cavity decreases. “If you have sensitive airways,” said Glynn, “you can feel more pressure in the cheeks and in the sinuses above the eyes as well.”
Jaw Over-Use
Glynn calls the movements we tend to make while wearing masks “an overuse syndrome” akin to too much time at a computer keyboard. Many people jut out their lower jaws to try to push their masks off their lips — many aren’t even aware they are doing that movement.
Ok, so what can we do about this? “Face masks are really important despite these side effects,” Glynn said. He recommends these three main strategies to relieve your symptoms so you can continue to wear your mask.
Find “Neutral Jaw Position”
Start by trying to become more aware of your jaw position, noticing whether and how you’re gripping or clenching your jaw differently while you’re wearing your mask. Then practice coming into a neutral jaw position:
· Close your lips
· Keep your teeth slightly apart from each other
· Rest your tongue on the roof of your mouth, just behind your front teeth
· Pronounce the letter “N” to find the ideal tongue position
Mind Your Posture
Ears-over-shoulders is the ideal position for your head, but few of us are consistently holding ourselves that way. If your mask is too tight — or if you spend all day at a desk — your neck is likely chronically tipping forward. Glynn advises practicing a “retraction” technique where you move your chin straight back toward your spine. Think of a pigeon or a chicken — or just pull your neck back until you make yourself a double chin. You might feel like this is a slight stretch, which tells you your posture needs regular check-ins — and your mask may well be the culprit. “If you are feeling a fair amount of tension when you do this movement, it means the muscles have been tight from the forward pressure of your ear loops,” said Glynn.
Wear the Right Mask
There are so many types of masks, which is good news…unless you’ve chosen the wrong one for you. Glynn says the easiest-fitting masks feature ear or head loops that have a few things in common:
· They are adjustable.
· They are wide enough not to dig into the back of your ear.
· Head loops sit at the back of your head, not the base of your skull/top of your neck.
Properly-fitted masks are also comfortable at all points of contact, including along the chin and across the nose. How do you know if your mask fits you properly? “If an individual finds themselves constantly adjusting or wriggling around the head and neck, they should dig a little bit deeper into where the irritation is coming from,” said Glynn.
“There are the mask parameters and there are the physical parameters,” he added. If we address both, not only are we decreasing the likelihood of discomfort, we can also say we’re maximizing mask use.”