Why does my jaw hurt when I exercise?

(CNN) - Asked by Sara, Texas,

When I'm exercising, I often get jaw pain. It feels like someone is pressing inward on the joint with their fingers very hard. I've been very careful to maintain a relaxed posture and avoid tensing while I exercise, but the pain still comes. The kind of exercise I'm doing is low impact on the elliptical machine. I've even stopped using the arm holds because I've been worried the back and forth motion was making me tense. I've looked online and found that this could be a sign of heart problems, but I'm only 23 with no family history. Should I be concerned?

Expert Answer

Dear Sara:

I am glad you've asked this question, as pains in the chest, left arm and jaw are a very common concern among people beginning an exercise regimen. The bottom line is, anyone who is planning to begin working out should get clearance from a physician before starting. Even children getting into a school sport should get medical clearance. Most importantly, those who begin a regimen and have any unexpected pains and discomforts should stop the activity and seek evaluation from a physician. You should not restart the activity until the cause of the pain is determined and measures are planned to prevent it.

Angina, or pain from the heart muscle not getting enough oxygenated blood, can present as mild to severe chest pain, a pain or numbness running up the left arm, pain in the jaw or even as a headache. Angina is typical in patients with cardiovascular disease undergoing strenuous exertion. Strenuous activity increases the heart's need for oxygen. Partial obstruction in the coronary arteries leads to less than adequate flow of oxygenated blood to the heart. The discomfort usually decreases or goes away with rest. If the heart is deprived of blood long enough, some of the heart muscle will die. This is commonly called a myocardial infarction or a heart attack. Death of heart muscle can lead to heart rhythm problems and difficulty in the heart pumping blood. The latter is known as congestive heart failure.

The typical person with cardiovascular disease and angina is in his or her 50s or older. In younger people, discomfort of the chest, the left arm, and the jaw during exercise is more commonly due to non-heart problems. Physicians will assess the young individual with these symptoms for abnormalities of the heart valves and congenital malformations of the heart. These findings are rare. Even rarer is the young person with coronary artery blockages. Young people with coronary artery disease usually have a family and personal history of high serum cholesterol or serum triglyceride or have a history of radiation therapy to chest for another disease such as a cancer.

Patients under evaluation may get electrocardiograms, ultrasound studies of the heart or exercise stress tests. In an exercise stress test, the heart performance is evaluated during exertion with an electrocardiogram, and often with ultrasound and nuclear medicine -- use of traceable material injected into the blood vessels to look for blockages.

Among young people, chest discomfort during exercise is commonly due to indigestion, acid reflux, or even muscular and skeletal pain in the rib cage. Pain in the jaw can be due to tensing of the jaw or malocclusion of teeth (a bad bite). Numbness and pain in the forearm are commonly due to carpal tunnel syndrome from gripping exercise machines.

Again I stress that one should not self-diagnose this discomfort. It should be evaluated by a health professional.

- Dr. Otis Brawley
  Chief Medical Officer,
  American Cancer Society