Finding A Balance Between Tension And Relaxation

There was a point in time where I was talking about the importance of not avoiding my symptoms, but also trying to find ways to release tension in my face. I talked about finding a leverage point; a spot or setting on my face where I felt I could maneuver even just a little bit/have leverage even when the symptoms occurred. I didn't want to rely on an immobile collapsed embouchure, but I also didn't want to force a stabilized embouchure that looked stretched, I wanted to find a middle ground where I could have some type of leverage, yet work with my symptoms. This can be extremely difficult to find when dealing with dystonia. It helps to use a mirror, but even more just trying different settings and so forth to see what causes more spasms and what lessens them. Then once I found that spot, I usually found a pattern (i.e. 5 note chromatic, or scale, or low note pattern, or stretches) that helped relieve tension over time. Then once the tension had gone down I was able to rebuild sensory and movement/motion slowly back into my playing.

I felt during that point in time where I was seeking "leverage" was a very important transitional area of recovery. In the beginning I had nothing but tension in my face. I felt I could neither hold an embouchure position, nor do the opposite - relax it. So in the beginning I relied on playing on a collapsed embouchure...there was no other way I could steady my symptoms, and this was frustrating because a collapsed embouchure, though comfortable, did not offer any mobility, flexibility, I felt stuck in a ditch/mud and any movement away from that formation was like an electric fence shock.

But! The more I played on a collapsed embouchure, there had come a point where I felt my corner muscles were trying to transition more upwards instead of downwards frown/collapsed. My embouchure was in constant limbo for a while trying to move from a collapsed embouchure to a more stabilized "yet" relaxed position. I also can't stress enough that this happened naturally. I never tried to force my embouchure to be one way or the other. Recovery can NOT be forced, and believe me your body/embouchure will let you know, so it's just better to let things develop as they do and keep patience. I felt my embouchure was trying to do one or the other constantly, and sometimes I had to practice both ways - "today I feel like my muscles/embouchure wants to play less collapsed. My corners are wanting to go up, or one corner tends to." I know that sounds weird, but it is this awareness of how my muscles want to maneuver which became a key part of recovery (being aware of how my dysfunctional embouchure functioned). Another example is the change in angle of my mouthpiece. In the beginning I felt a very downward angle of the mouthpiece was comfortable, but over time this became more restricting and eventually I found myself playing less downward angled, and additionally also noticed this happened while my embouchure muscles regained their coordination and strength.

First I went from buzzing and freebuzzing to eventually playing on the horn again. Buzzing and freebuzzing helped me greatly because it is different than playing horn. I use my embouchure muscles, but there is a big enough difference in physical sensation that it allows my sensory a little more leeway. Then when I played horn, I started from a collapsed embouchure and slowly moved to a less collapsed looking embouchure with a different mouthpiece angle too; and this happened as my muscles slowly and naturally over time went from a more downward frown to a more steady support, and then the lower lip muscle started to change....I went from rolled out to more rolled in, and then somewhere in between kind of now. Then my chin muscle sensory came back, and I began to see it fluctuate between flat and bunched, and regained jaw flexibility (which is still a huge thing I'm working on right now - I feel like this is a huge area of recovery if I am to overcome it). I even felt the change in my upper lip too. I can't explain the sensations of "knowing" how I know/feel things are either working or not, or how I know if somethings changed, but I just do over time. Once you become more aware of your embouchure tendencies, you become sensitive to the changes that happen; even little changes like less of a twitch in the upper right side of the upper lip, or being able to grasp a note and dig deeper into it/bend it with air, or knowing when a spasm is going to happen.

For a long time I felt like things were so uncontrollable. I eventually went from guessing - "I'm not sure what's going to happen this time? I was doing good grabbing this note yesterday, but today it could be different," to "I know I can grab this note without contractions," or "This note is doable, but still has some tiny glitches to work out of it before I can grab fully hold the note out longer."

Sometimes I think I sound crazy when I write about the details of how my embouchure dystonia effects me. But it's just like anyone else who has a major physical change to their body or sensory....you have to think about things for once and notice things and be aware/sensitive.

I felt my recovery went from completely deprogramming my embouchure - playing on a collapsed embouchure, trying to relax my muscles as much as possible, to slowly reprogramming it - finding ways to keep strength, regain muscle coordination and new movement patterns after ironing out the spasms. How do you move your embouchure differently? Well I guess I listen to my body. An important thing to remember is don't let anyone tell you "HOW" your embouchure should look or feel when you have dystonia, your embouchure is basically shot right now  and also natural abilities shot...your body will tell you, and the reason it looks the way it does right now is because that's the closest setup that works for your embouchure as it develops.

This is slightly different for hornists who don't have embouchure dystonia. Though they can go through embouchure changes (a scary thing), and have natural abilities, they can get messed up physically if not careful, or if their teacher or professor requires an embouchure change to happen in a set limit of time or REQUIRE it. Though I believe knowledge on embouchure form and function is necessary for every brass musician, and also important to know when going through recovery/setback or an embouchure change; however, I REALLY don't like it when changes to a persons embouchure are not taken seriously (teachers forget that physical changes are PERMANENT, and forced movement/changes can be more damaging than helpful. Think of it like surgery; don't risk it if it's not a career-ending situation), or seen as a "fix", or as "necessary" because it looks abnormal ....I think that if a person wants to work on their embouchure, they need to take their time getting to know their own embouchure and it's tendencies, learn about form and function/knowledge of their anatomy/muslces and the different types of embouchures there are, and what their natural setting is, then slowly taking their time with building a healthy embouchure. It should be on their own time...and not rushed. Even if it takes years. I hate it when a teacher "requires" something like this, and ESPECIALLY if a student sounds great and doesn't struggle, yet they change their embouchure just because they think it looks weird.

It's a touchy subject. So word of advice, just stick to what your body is telling you to do...if you have to play on a bunched chin until your chin flattens out 12 years into playing, or have to take your time, so be it! I'd rather see someone playing comfortably and sounding great than knowing they are in physical pain or awkwardness trying to keep up their stamina with an embouchure that isn't natural fit to them, or forcing an embouchure change just to please their teacher.

Yes, there are commonalities of good brass playing embouchure form and function; a flat chin, and relaxed yet firm corner muscles that leave flexibility in the upper lip, and  good breath support to resist damage/pressure....but if these are not common in your embouchure, don't force it. Take your time building a healthy embouchure, and don't force things or tell yourself there's something wrong with you, or that it MUST be achieved now...especially if you already feel what you are doing is natural and feels good and isn't harming you, don't mess with it. Don't fix it if it isn't broke. My phrase of my lifetime is, "KEEP IT NATURAL. TAKE IT EASY."

Am I trying to blame my dystonia on an embouchure change? No. But when I became injured I did avoid the signs my body was telling me. There were a lot of things that contributed to my injury, but I do think this lack of awareness of my embouchure was a key factor. Even when I was injured I did not like the thought of playing on a collapsed embouchure (as it kept collapsing on me ALL the time) because I had heard it was harmful...so I kept trying to force a stabilized embouchure (but it was more of a stretched one because I was forcing it) while I had little endurance left already, and hold it/tape it all together with pressure, so it hurt...and I believe this led to my muscle tear. I should have taken the drastic changes in my face as a sign that I was losing physical control/abilities fast.

It takes a long time to for the body to work out/allow that natural release of tension, and a lot of time to naturally rebuild more fluid/coordinated muscle movement without slipping back into tension. If you think about it, embouchure dystonia is like hand dystonia or writers cramp; you can only practice specific movements so long and repetitively in a certain way before it becomes too much of a strain on your body, especially if you don't get a break. I felt I never got long enough breaks, I also had a bad habit of practicing too much without breaks during that intense year, but then again, after being injured, I'm not sure any break would have helped in college, unless it was a long-term break...and I didn't get around to that until after I graduated.

Think about if you were a professional typewriter - you might practice typing fast all the time. Let's say you usually have good fluid movement that isn't cramped, but over time as you get older or during an especially intense season, you are overdoing it, and you realize the more you type, the more you feel that strain on your hand, but you kind of ignore it because it's not too noticeable. Then over time your hand movement changes to accommodate the tension, and you don't even realize it. Some people are able to recover from slight setbacks, and others it's more serious. Then lets say you get injured and this just adds to the extra strain, and all of a sudden your hand can't type without spasms and flexes. You don't know what's going on or how all of a sudden this all happened? It is a bit scary. But my point is to try to explain why that tension got there (it usually is because of a variety of contributing factors) is important to recognize, and that it is (like someone else very well put it) like an overexerted muscle. An overly used muscle. An overactive muscle! It should be viewed like this, as if you are an athlete, a master of fine delicate movement of a small group of muscles.

Anywhoo, the point of this blog was suppose to be about finding a balance between tension and relaxation. I feel once my embouchure finds this spot (and I still have to search for it on some notes), it is my doorway/point of focus in recovery. Like I said in my video; It's as if you want to flex your arm outwards away from you, but your involuntary muscle contractions cause it to flex inwards towards you. You can't FORCE your arm to move outwards because it will just cause the contractions to happen more violently and fight back more. So you have to EASE your way into it. You slowly push resistance against the contracting muscle by pushing outwards very gently and not pushing out very far, and then let your arm contract back inwards. Then you keep working on that until your body allows you to flex outwards a little more...and eventually...day after day, month after month, year after year, you're able to flex your arm outwards all the way and hold it there. Sometimes for a long time, and maybe there's a slight twitch in the muscle, but you've almost resolved it!!!"

That's how I feel about my embouchure dystonia and leverage. I find that leverage point where I can work both with the symptoms and against them. I'm able to test them, but gently, just by being aware of where/when they happen and finding that transitional area between tension and relaxation. Then there are external factors that also contribute to my well-being; such as taking vitamins, stretching, ice-packing, aleve, playing on my leg, playing on a comfortable mouthpiece, and also the specific exercises that I do that I find help relieve tension or help build coordination and strength back. All of it goes hand-in-hand. But I wanted to write about this awareness of the state inbetween tension and relaxation. It's a HUGE part of recovery to me.

10/04/12 Embouchure Dystonia Video Update

Part 1

Part 2

Oven Mitten Sensory

Today I realized that some more sensory is coming back. Before I had dystonia, grasping onto a note was like a magnet grasping onto a metal bowling ball; and even could adjust the grip if I wanted. But with dystonia, it's like your hand in an oven mitten trying to grasp a bowling ball with no magnetic leeway.

In the past I've talked about how the sensations feel over time as I've regained sensory. At first it felt like I couldn't hold onto a note at all, it was worse than the oven mitten feeling....it was more like two magnets that repel each other/push away from one another. But fortunately I can say I am past that stage. More hopeful than ever, I'm now at a point where recently I noticed I can bend lower into the note or aim and hit the lower portion of a note. If you're into lip bending (I tell my students it should be renamed Airbending), you'll understand what I'm talking about, or if you understand the concept of finding the center of a note.

Non-dystonia suffer's have control over adjusting their grasp on a note. They can bend it up, bend it down (lip bending) by pushing air/resistance against it and adjusting it. The closest analogy I can think of is something the four hornsmen said which perfectly described it:

Imagine you have a tank of water, the further you try push your air through that water to go deeper, the more resistance you feel, but when you are just skimming the surface of the note their is less resistance, and also equally less resistance once you've bent a note too far and right on the edge of flipping the note. To find the center of the note, you push down into that water deeper, and when you hit the core of the note, it resonates. You can feel this, hear it, and even overtones if listening carefully....it fills the whole room and usually right on center pitch if you're playing with a strobe tuner. This isn't their word-for-word, so I'll probably have to find the piece of paper that I kept which explains it and put it on here. But this is the best way I can describe it.

For months on end I've only had grip over the top of the note...fluctuating between skimming the surface and grabbing onto the surface momentarily or for a couple seconds. As it's improved over time, the grasp has slowly gotten better...yet, it fluctuates, just as all my dystonia symptoms effect me - it can seem sporadic. However, today I felt I could hit the bottom of the note, and almost to the center, but not quite yet....but very close...and for a longer period of time.

Taking A Stand!

This is how I feel about the lovers outside my practice room...haha!

Wow!!! More progress to post about! It's been a month since I last wrote a blog post though. :-s It would be an understatement to say I've barely had time to tend to my blog lately. But I'm going to make an effort to at least once or twice a month until late Spring rolls around. Things have gotten very busy, but like I've said before, in a great way! I kind of promised myself I wouldn't teach this year because I wanted to focus on my college applications, but....I totally gave in. haha! I love teaching, and was so happy that I was asked to teach again. On top of a full-time job, teaching at school, college applications, trying to find time to hit the gym, and practice ...(and blog/record)...I was also asked to teach a couple more students at a nearby school.

Don't worry, I'll be exhausted, but a very happy exhausted person! :)

I'm going to try to record a video next week to get on here. Just within the last two weeks I've seen yet another long waited significant change!!...and that is.....*drum roll*....

....I'm able to stand up and play!!!!!!!!!!!!!!!!!!!

As you've seen in other posts, I've always heavily relied on playing with the bell on my leg while sitting down throughout this rehabilitation. But within the last 2 weeks while listening to my body (like I said before, it takes just following your gut feeling sometimes)...I felt the need to stand up and play because it seemed like playing on my leg was limiting the mobility of my face (if that makes sense). I just couldn't seem to get the mouthpiece to pivot like my body was asking it to do. I just thought "For some reason I feel if I stand up and play, it might be more comfortable and easier to play. I just need to stand up and see what happens."

...and I did! and it felt miraculous! I can tell there's still some work I need to get done while sitting down; I need to work out my kinks while sitting down before standing up; and even then, I need to test some things back and forth between sitting down and standing up. But otherwise, I have also noticed I'm able to play higher than normal because the shifts and pivots between my mouthpiece and embouchure are synchronized, and the pivots in my lower register where my dystonia effects me were more smooth. I don't know how to explain this....but what I'm talking about isn't AIR. Don't go there! ...yes air helps, but missing the primary point....what I felt in my embouchure and noticed in the mirror is what's important here.

I feel I'm now in the transition area between being able to adjust from playing on my leg to playing off my leg. Usually when sitting and playing with the bell on the leg, it helps with dystonia because the horn is stabilized...it doesn't move around and the angle of playing into the horn doesn't change much, so it's easier to adjust to the horn when having dystonia symptoms for some reason. You adjust to the horn sitting there...

...Whereas, when standing up and playing, the bell rests on right hand only, and your left arm adjusts the angle of the mouthpiece/leadpipe. In other words, the horn adjusts to you; you can adjust your horn to your body more easily. Though, it is this very free-moving mobility that makes dealing with the dystonia symptoms a lot harder to deal with while standing and playing or playing with the bell off the leg; because you need a target that isn't moving, or something you can try to adapt to since the horn definitely can't adapt to your dystonia symptoms right away; your embouchure barely knows how to function if not at all.

Working with dystonia is like trying to navigate a minefield sometimes. It's part of the retraining, I feel like I'm always searching for what works and what sets off the symptoms; in the beginning it was the slightest little movement (or anything I tried) that could set off the spasms and contractions, but now it takes more searching to find them, and some days not so much...I can sense the tension already on my relapse days, but takes 30 minutes to work out the kinks...give me an hour and a half, and I can regain some sense of normalcy in my playing.

Today I also was shocked, because I played my first effortless high Bb. Usually I don't ever venture up into my higher register because it causes way too much built up tension in my face, and then I have to spend another 20 minutes of just low playing patterns to reduce it after playing high for literally half-a-second.

Anywhoo, my embouchure felt really good today. I was standing up and playing, I started working my way up at first to the high F at the top of the staff (which is about as high as I usually get and stop),but then I felt a shift and saw a shift in the mirror.....the horn adjusted to my embouchure (again, I can't stress the importance of this brain-body connection!!! The rewiring is happening!!!) and I immediately felt things come out effortlessly as I went up to my high Bb. It was a feeling I haven't had in a VERY long time. So long, that I had forgotten how much I use to love playing high horn, and how comfortable/easy it use to be for me...without tension, without strain, without lack of endurance, without throbbing pain, without numbness, without instant swelling, without feeling like it would set me back in my retraining.

So I went for the high Bb, working my way up to it, and once I reached it, oh my god, it was so beautiful!!!!!! I almost cried. Sounds cheesy, but I honestly wanted to cry like a baby. I haven't played anything that high and beautiful in what feels like an eternity. I literally sat there and prayed "Thank you God, even if this is the last effortless note I'm ever able to play again. Have mercy on me. Thank you, thank you, thank youuuuuuuu!" I can't explain the feeling! I was so happy despite there being a couple directly in front of my practice room, lying on the floor in the hallway literally making-out and loudly saying sweet-nothings to each other (awkward is an understatement too)....I was happy! I stopped while things felt good in my embouchure and took off to lunch and work.

I had to write about it today, I was very happy!!!!! I believe I'll be able to play again someday. For now though, I'm preoccupied with teaching, applying to schools, working, hitting the gym, and usually practicing in my mute at home everyday (today I was lucky to find time to go to the University to play)! So, I'm sorry that I won't be on here as often, but definitely will try to write 2 blogs a month (3 if lucky!) when I get a chance. Thanks everyone for reading my update!!!!! Will post a video in a week or two! Tootles!!!!! :-)

Video Update On Current Progress (August 8th, 2012)

I wanted to make a video over the progress I've made so far. So here they are!!! Wanted to add that my current symptoms are not nearly as bad as they use to be. If you want to see more videos over my playing in the past, there are videos linked under "important blog posts" and under my "practice journals." I've come a long way and sound more like I'm bordering beginner/amateur horn player, than completely crippled like at the height of my symptoms long ago where I could barely buzz without tremors or where my symptoms stopped me from playing. Hope that you can see the difference from the last video I made over my symptoms (around 2 months ago on June 2nd 2012) compared to now, because I definitely can - even if subtle, it's a significant improvement to me!!!!

List of Practitioners

I wanted to write out a list of practitioners so that it may become a helpful resource to others who come across the blog. It's very important to know that they do not diagnose musician's with FTSED (except Dr. Frucht who is a neurologist listed on here, and Dr. Mcgrail a surgeon who has worked on muscle tears) or injuries, but primarily help as far as retraining and recovery after diagnosis.  Musicians who have embouchure dystonia or other embouchure problems/injuries don't have nearly as many direct resources as hand dystonia musicians do when it comes to seeking out someone to help guide them throughout the rehabilitation process. (If you are a person who has been diagnosed with hand dystonia and is looking for rehabilitators who specifically focus on hand dystonia recovery, please contact: Jerald Harscher. His website The Poised Guitarist can be found here: http://thepoisedguitarist.com/. He is a wonderful person  and guitarist who has helped many musicians with hand dystonia.)

I will have to come back and edit this....but I'll try to leave a brief description of the person/method when can, but don't want to go into too much detail, because it would be best to contact them and ask any questions about the help they can offer you; I can not do them justice. I am glad to see so many professional musicians that have aided those who have faced this disorder, or who can lend support to those who are having setbacks due to injuries or embouchure problems.

I wanted to start off with brass playing practitioners first. Though that's not to say they limit themselves to helping just brass players with FTSED, when many of them assist other types of instrumentalists too.
I'll start off with a list of the most recognized for their work with FTSED.
I also added some people who can provide more information on dystonia or other injuries, or point you in the right direction as far as finding a professional to properly diagnose you. Again, I'll come back and edit this...

For more information on common medical treatments for dystonia, please check out the DMRF page here: Dystonia Treatment Questions by DMRF

Jan Kagarice - Adjunct Professor of Trombone, University of North Texas
Jan uses a more holistic approach, one that addresses the overall well-being of the musician and covers many areas; physical, mental, emotional, psychological, brain pathways, etc. She has helped many types of instrumentalist, as well various embouchure problems and FTSED. She is very sought after, as she has a unique ability to help players who are experiencing performance difficulties. She attributes this to a combination of factors: her Montessori teaching experience, her study with Arnold Jacobs and her own struggle with neuromuscular disease. Jan currently serves as the chair of the International Trombone Association’s Committee on Focal Task Specific Dystonia and is an artist/clinician for the Conn-Selmer Instrument Company.

David Vining - Professor of Trombone, Northern Arizona University
David has successfully recovered from FTSED. He uses a more holistic approach I think, but has a lot of knowledge on brain/body-mapping, and addressing not only tension in the embouchure, but your body as a whole.

Laurie Frink - Trumpet Faculty, NYU Steinhardt  ....Unfortunately Laurie passed  away this year. We have lost a significant musician and person in this world. I will leave her information on here because it is still helpful to others and her work deserves to be recognized.
Laurie has been highly trained in Carmen Caruso Method, and does a lot of work involving calisthentics - preparing the body to play music. Focusing more on the process of developing into a musician through the act of making music vs. the act of just executing music. Rather than achieving set standards within a time limit or forcing improvement, she has a broader/well-rounded view on the overall development of a musician and preparing the body. She has helped many brass players with embouchure problems recover. Laurie and John McNeil wrote a calisthentic exercise book for trumpet called Flexus.

Janine Gaboury-sly - Associate Professor of Horn, Michigan State University. Has recovered from FTSED. She had also tried medication like Artane in the past too, but not sure if it helped in her recovery. She is a former student of Verne Reynolds. You can find her contact information here: https://www.msu.edu/~olsonc/JanineGaboury-Sly.html ....her colleague, trombonist Curtis Olsen  who is also a professor of music at Michigan State had lost his ability to play due to embouchure dystonia, though I'm not sure if he made a full recovery.

Dr. Peter Iltis - Professor of Kinesiology and Horn at Gordon College. Has FTSED, and made significant progress in overcoming it. He has published articles in the Horn Call over dystonia, as well he has some videos over dystonia which explain the neurology involved more in detail. If you click his name, the link leads you to a review of his video on Horn Matters Blog and another link to one of his videos.

Glen Estrin - Founder of Musicians with Dystonia through the Dystonia Medical Research Foundation
He has done the most outstanding work with the DMRF, being able to give musician's a place to go for guidance/direction, knowledge, support, and help with FTSED/FTSHD.
Dr. Frucht is a neurologist at the Columbia Presbyterian Medical Center, and has diagnosed many musicians with dystonia. He is also the co-founder of Musicians with Dystonia.

Lucinda Lewis - Principal Horn, New Jersey Symphony, and author of "Broken Embouchures," "Embouchure Rehabilitation," and her site dedicated to embouchure injuries: Embouchure.com. She is well known for her blocked-buzzing technique and exercises that she used to rehabilitate herself, and for her knowledge on different types of embouchure injuries. She studied at the Manhattan School of Music with Clarendon Van Norman, principal horn of the Metropolitan Opera Orchestra, and earned bachelor’s and master’s degrees in Music Performance. Lewis has served as principal horn of the Brooklyn Symphony, Chamber Opera Theatre in New York City, summer Chautauqua Festival Orchestra, Jerusalem Symphony, Israel Chamber Orchestra and Israel Philharmonic; she was appointed principal horn of the NJSO in 1977. She has been a soloist with the Brooklyn Symphony, Jerusalem Symphony and NJSO. Lewis has taught at the Rubin Academy in Jerusalem, Israel and Princeton University. She has been an officer and governing board member of the International Conference of Symphony and Opera Musicians since 1990.

Thomas Wilson - Trumpeter and conductor in Colorado Springs has helped some of my friends with embouchure problems and FTSED symptoms as well. Thomas Wilson is currently Music Director of the Chamber Orchestra of the Springs, Associate Conductor of the Colorado Springs Philharmonic, Cover Conductor for the New-York based pops show Symphonic Night at the Oscars, serves on the music faculties at Colorado College and the Colorado Springs Conservatory, and maintains an active guest conducting schedule. Mr. Wilson previously conducted for the Colorado Springs Youth Symphony program and founded the Young Concert Artists of Colorado Springs.Winner of international recognition as a trumpeter, Mr. Wilson has extensive experience performing, touring, and recording with orchestras, ensembles, and artists. He is one of only three trumpeters ever selected as a finalist for both the International Trumpet Guild Orchestral and Solo Performance Competitions in the same year. Thomas’ compositions and arrangements have been performed widely in the United States, Europe and Japan.

‎ Dr. Seth Fletcher - Senior Lecturer in Music, serves on the faculty at the University of Nebraska at Kearney where he teaches private low brass. Seth’s doctoral research regarding focal task-specific embouchure dystonia presented a comprehensive literature review and detailed case study, laying the groundwork for the further development of healthy pedagogical methods and philosophies.

Denver Dill - recently published his book over recovery from a muscle tear and surgery called Still Playing: My Journey Through Embouchure Surgery and Rehabilitation. Staff Sergeant Denver Dill, a bugler in the Hellcats, holds a Master of Music from the Juilliard School and was a doctoral candidate at the Eastman School of Music. Denver has risen to the highest level of trumpet playing, all the while battling the effects of a debilitating lip injury. While in high school, Denver began experiencing herniation, stretching and tearing of the obicularis oris, known to brass players as “broken embouchure.” Denver describes his complications as, "blood was coming out the end of my horn." After the acute injury healed, Denver resumed playing the trumpet, placing his mouthpiece slightly off to one side of his mouth. Throughout his undergraduate education, the center of his embouchure moved further and further away from the center of his lips. Denver compensated for the injury extremely well, not only winning several international trumpet competitions, but winning a position in the West Point Band. Over time, effects from the old injury began to hamper Denver's playing in ways for which he could no longer compensate. He went to West Point’s Keller Army Community Hospital and spoke with plastic surgeon and Deputy Commander of Clinical Services, Colonel Andrew Friedman, who was instrumental in enabling Denver to see the specialist Dr. Simon McGrail of the Scollard Clinic in Toronto, Canada. While Dr. McGrail conducted Denver’s surgery, West Point’s Dr. Friedman also accompanied Denver in the operating room to observe the intricate procedure. In fact, Dr. Friedman is now the only surgeron in the Armed Forces to offer the operation to other musicians in the military. In 2008, the New York Philharmonic celebrated twentieth-century composer Luciano Berio with several performances of his works, to include "Day of Berio" on February 2nd. Musicians from the New York Philharmonic performed all fourteen of Berio's Sequenzas. The fourteen Sequenzas are a series of virtuosic solo pieces. Sequenza X is for solo trumpet and piano resonance. The piano is played silently and certain strings are allowed to resonate when the trumpet plays loudly into the strings. Sequenza X makes ample use of extended techniques for the trumpet. Valve shakes, flutter tonguing, valve tremolos, hand stops and many other techniques are employed to get the widest possible array of timbres from the instrument. Sequenza X is over fourteen minutes in length and is one of the most physically taxing pieces in the trumpet repertoire. The Philharmonic's principal trumpet player, Phil Smith, asked Denver if he would join other principal players of the New York Philharmonic to perform the work as a part of its “Day of Berio.” Denver was able to accept the invitation because the surgery to repair his embouchure was a complete success. While the recovery was long, Denver says he is no longer hampered by the effects of the injury and is able to advance as a trumpet player both technically and musically....

...another trumpeter who has undergone surgery for a muscle tear is Brad Goode, a  jazz trumpet player who resides in Colorado. He also went to Dr. J Simon Mcgrail for surgery. I have a couple links on the sidebar over lip surgery done by Dr. Mcgrail.

Contact Information for Dr. Mcgrail: 91 Scollard Street, Toronto, on M5R1G4- Phone: (416) 926-7767. The esteemed Dr. Simon McGrail had been a pioneer in the field of facial cosmetic and reconstructive surgery for over 30 years. He has led the field in pioneering new surgical techniques, and is currently one of the only surgeons in the world that perform a specific reconstructive lip repair procedure. Dr. McGrail, brings his vast experience and tremendous surgical skills and passion for his work to the Scollard clinic. He was trained as a physician in Manchester, England, He completed Specialty and fellowship work in Otorhinolaryngology at the University at the University at Wayne County Hospital in Michigan. He completed further training in Facial Reconstructive Surgery along with exhaustive clinical research in areas ranging from Carcinoma of the nasal vestibule, Angeodema of the larynx and Orbital complications and Pathology. Because of his tremendous training and qualifications, Dr McGrail, was appointed Professor of Otolaryngology at the University of Toronto and subsequent Chief at the Wellesley Hospital. His specialty training and interest in Facial Cosmetic and Reconstructive surgery has put Dr. McGrail at the forefront of his field and led to such positions as: Physician to the Toronto Maple Leafs, Physician to Team Canada Hockey at the World Championships, and Founding Member of The Canadian Institute for Facial Plastic and Surgery, and Founding Member of The American Academy of Facial Plastic and Reconstructive Surgery. He has been consulted by numerous celebrities and people in the entertainment industry for his specialty knowledge in the area of vocal pathologies and surgical lip repair, namely Frank Sinatra, Phil Collins, tom Jones, Tony Bennett, Luciano Pavarotti, Placido Domingo, and Jim Cuddy of Blue Rodeo along with theatrical singers from various productions including the Lion King, The Phantom of the opera and the Canadian Opera Company. He is the leading authority on lip injuries in brass players. Not sure if this is his current contact info. I'm told that he is now in semi-retirement, in his office a few days a month.

Some Inspiration

Practice Journal: July 16th, 2012

One of my co-workers at work quit a couple weeks ago, so for the past 3 weeks I've been literally working over-time along with my other team members. Unfortunately I haven't had much time to blog, but I did have a great practice session today and got up early just so I could blog about it! I'm going to tag it under my practice journals.

I've noticed lately that I've been regaining control over my lower lip and chin muscles...and surprisingly I just realized how much of a huge impact they have over my playing. I guess I'm more wide-eyed because I naively always thought that my corner muscles were always the main muscle group being effected in my embouchure. But now I see that though my corners are the support, it's my chin muscles which give me flexibility, and my lower lip movement (rolling in/rolling out motion) has more freedom to flex if my chin muscles have the control to support it. Maybe this sounds crazy?

I guess what I'm trying to say is that I always felt like dystonia took away control in my upper lip and corners more, and even though I know it was effecting my chin muscles, that it effected my whole embouchure, I never realized how much control it took away from my chin muscles as well, because it's more visually noticeable than physically...until now where I finally feel the impact it's had as I regain control over this group of muscles.

So much of my progress has been sporadic in the past, for almost a year, until recently I've been having less re-lapses. I also noticed that my progress comes in layers, very gradually, and my symptoms reduced in a reversed order.

 For example: when I first started having dystonia symptoms it was subtle and just on my G and A, I started noticing air-leaks, then spasms started to creep in now and then, next I started to struggle with decrescendo's, then with playing soft, then with tonguing, and certain passages, and certain styles were more difficult too because it exposed my symptoms more (like Mozart's horn concerto's which had always been a favorite of mine and suddenly it became my worst nightmare), I started losing control of my larger movements (larger interval jumps and register changes/transitions), and pretty soon the spasms were more than noticeable, especially after I took time away from my horn (though I still think that's very important and absolutely necessary - taking time off, and pacing yourself), and also buzzing became difficult as well, and pretty soon I just struggled to grab onto a note or move or produce a sound....or even drink out of pop can! I even had to collapse my corners in order to drink out of a tin pop can or water bottle, it was such an odd sensation.

But when I started to recovery through rehabilitation the process went in the opposite order: First buzzing abilities came back, then it took a while to grab onto a note on my horn (I had to focus on the notes I could hold and work my way into others when could by adjusting or finding patterns), at first I could only play in my pedal register, then I worked my way into to low register, then middle register, then mid-to-high register (which is still very difficult for me endurance-wise). For a very very long time it was just learning how to reduce the spasms, and focusing on finding a comfortable spot that I could keep working on even if I had spasms...I was always searching for leverage. When I improved, it was very small steps, and slow and also every time I started working in a new register the progress in each register varied....of course it was much more difficult in my mid-to-low range. Gradually I learned how to grab a note, then articulate them through air-attacks, I found passages that worked for me, then I regained control over smaller motions (interval to interval; m2 to m2), then eventually it widened, then over slightly larger movements, and then different range transitions. As well it took a lot of slow practice, lots of patients, and I had to listen to my body....I couldn't do certain things until my muscles had regained some type of control over a long period of time; when my spasms reduced, then I saw my corner muscles improve and this helped me be able to work my way into different registers, then later my lower lip with transitions, and now....

....lately I've noticed my chin muscle control improving, as well my lower lip flexibility. When I look in the mirror and see and feel the flexibility I noticed this also helps support my corner muscles because it some-how evens out. I'm just listening to my body, and I though my chin muscles may not always flatten out or pull down all the time when I go lower, they do it a lot more than they use to...and it's not that I'm forcing them to either, it's that they naturally want to now for some reason....it's very weird when I notice these subtle changes, because most often it's as if your brain decides to cooperate and send the right signal to your face? You're lucky if it happens once, but to see it two times or three or four...then you know somethings giving way to a new re-wiring or improvement.

It's also one of my good days! However, I always look as everything as a step forward in a positive direction; the good days are the best days, and the re-lapse days are a sign that I've made improvement.....like someone else stated in the musician's with dystonia group, "You can't have a re-lapse without improvement!"

As well, it's important to not overwork yourself on those "good days", which can be easy to do....you get so excited to see improvement and pretty soon you can hear yourself thinking "Maybe just a little bit of Mahler"....nahhhh! haha...just joking, but it seriously is easy to push yourself too hard in the beginning, especially when you see improvement because you want to hold onto that good feeling, that sense of feeling and control you have for the time-being, and then you end up with more tension in your face and need to take a 3-4 days off of playing just doing stretches, resting, and ice-pack if swollen. However, like I said, rehabilitation takes a lot of patience and being very aware of your body and signs of tension.

My best example of what embouchure dystonia can be like is; imagine if someone injected a sticky substance like glue into your lips (but not a really hard type of glue, one that melts and hardens and melts), it makes your muscles stiff (like hardened glue) and your movements seem so difficult to adjust, and when you try to focus on holding a note that's when things are very unstable (like melted glue or something slippery) and you can't grab onto a note and your lips won't stop quivering or spasming  due to no stability, and when symptoms are at their peak/height you try to blow into your mouthpiece and can't produce a sound because it feels like your lips are glued together, and when you try to play a certain passage your tongue acts like it's been injected with Novocaine. It's like trying to go right and your brain sends you left...you try to articulate a low G, and you end up playing a completely different note or no note at all...your brain is sending mixed signals and you don't know why. Again, this is when dystonia is at it's worst, but it starts off very subtle, which is why it's hard to catch or know if you have dystonia. Mine started off as air-leaks and a bit of wobbles on and off in my low register, and it was fairly easy to cover up in the beginning when things weren't so bad, so it's easy to mistake it as technique issue that needs work on, when it was dystonia and something out of my control.

Anywhoo, I'm so happy to see the progress that is coming along, I can't wait to record my next video...someone had asked me to do a video where I show what my symptoms are like when I play through an etude or excerpt. I can understand why, because I haven't played anything melodic or solo examples in my videos, except just scales. So that will be posted soon, as well a video where I am playing into a transparent mouthpiece.

Woohoo!!! :-)

Also I was thinking, and maybe I'll write a blog over this, but my past attempts at rehabilitation were good, but not patient enough to see a full-recovery. Part of it was because I needed more time off for my injury to heal, but also I think part of it was because I lacked the patients I do now. Progress doesn't come in a day or a week, or a couple weeks, it comes in months, and in the beginning like many others I had unrealistic expectations and was a bit impatient sometimes. Patience is key! Not to rush things, and not to expect improvement over-night or for the progress you do make to stick around as long...re-lapses happen all the time in the beginning (ups and downs/very sporadic), it can be unbelievably frustrating, especially if a majority of your abilities use to be primarily naturally given. It's definitely been a long journey, and like many others I realize it's a change in life-style as well...you are forced to focus on rehabilitation as a journey, and as a very slow process, but enlightening as well. In a sense it has been a huge life-altering change for me, but also a blessing in some senses....I'm now much more pro-active about musician's injuries and trying to get others to treat themselves more like athletes within this profession. 

Additional Buzzing Exercises

This is an additional video I made and posted under my buzzing routine. I forgot to add these in there, so here's a 3rd video.

'Pops': About Farkas Embouchure

Dr. Philip Farkas

Happy 4th of July!!!!

I really wanted to re-post this on my blog, as I found it very interesting! I also love articles and sites I come across over embouchure function and/or types. Trumpet players seem to be studying the embouchure or are more interested in it than most horn players it seems (maybe that's just what I've witnessed as a horn player)...and though horn players are different than trumpet players, all embouchures have some similarities or commonalities in terms of basic function. I find what Pops wrote very interesting....here is a link to the actual site (I also posted it on my sidebar somewhere): 'Pops': Farkas Embouchure Is Self-Limiting

___________________________________

Date: Thu, 14 Jan 1999 23:20:04 -0600 (CST)
From: Bbtrumpet@webtv.net ('Pops')
Subject: Re: Farkas embouchure
Subject: Farkas is self limiting

I hope that we ALL know that Dr. Farkas was a French horn player (and a great one ). His work was the first serious attempt to discuss brass embouchures. And as a result of being the first by a man with a PHD it became THE college textbook for brass playing. That was a very logical thing at the time. However Dr. Farkas didn't play trumpet he had to rely on interviews of others. A lot of what he said is good however the Farkas is the most HALF taught embouchure there is. If you got 100 Farkas embouchure players in a room and asked questions like ' What is the main function of the mouthcorners in the register above high c? ' I would faint or die if 2 could give the answer. They move in toward the center to shorten the vibrating surface. The funny thing is it is in the book. So my main gripe is way don't teachers read what they teach.

Middle c takes twice as much lip resistance to fight the air as low c does. 2X low c
High c takes twice as much. 4x low c
Super c takes twice as much. 8X low c
Triple high c takes twice as much. 16X low c

The Farkas tends to be a self limiting embouchure because it requires the facial muscles to provide all of the resistance to the air stream. Not only is this TOO tiring to keep up, there is also a limit to how tight you can make the lips. Due to the time factor most people are stopped at a f or g. So they start using an embouchure shift. Some players push the tongue to the top of the mouth, adding  resistance before the air hits the lips. This thins out the sound. Some players add a lip curl to the lower lip. It helps a little. Some curl in the upper lip. By the time you do this now you are in a Stevens setting.

Think of this example:

       1. Take two pieces of paper hold them so that the top piece and the bottom piece touch but do not overlap. Now blow see how the paper ( lips) does nothing to resist the air. This is the Farkas embouchure. We are going to make the paper (lips) strong enough to resist the air.
      2. Take the same two pieces of paper and let the top overlap the bottom. Now blow . Again they offer no resistance. This is the Super chops / Screamin embouchure. If we put the mouthpiece in front then mouthpiece pressure WILL create resistance.
      3. Take the pieces and put them together so that they both curl out away from you. Now blow. Again there is no resistance. This is the Maggio embouchure. We will put the mouthpiece in the way to let mouthpiece pressure create resistance.
      4. Take the paper and put them together so that they curl in toward you. Now blow. There IS now built in resistance. It needs no mouthpiece pressure, or years and years of lip ups to build a mass of muscle. The air does the work for you.
Most people do not play in the super to triple c range because they depend on their mouth corners and mouthpiece pressure to create tension. All we want is to resist the air by rolling the lips in (slightly ) we create a one way valve. Only in this case we are blowing the air against the valve the wrong way. This causes a great deal of resistance with a very little tension. Therefore a super c is now played with high c tension and a lip curl in. ....
 
As for the dog whistle sound that is a bad application of an embouchure. That is controlled by the shape of the lip aperture. Apertures fall in 3 types. Flat causing a thin shrill sound. Oval causing the full sound we all seek. And Round causing a dull too dark sound. Aperture is controlled by the mouth corners. If they pull out from normal then it is flat. If they stay put or come in slightly it is oval. And if they draw in to make a fish face it is round. When you draw the corners to make a more rounded or oval aperture then you must use a little more vertical lip compression or the lips separate.

These aperture shapes as well as the size are completely controlled by the muscles forming the embouchure and are independent of tongue level. There was a study involving a floroscope machine done in the 60's that was published in the Instrumentalist. The arch of the tongue (tongue level ) can affect the direction of the airstream and certainally the airspeed but not the shape or size of the lip aperture.

Finally aperture size can be affected in two directions height and length. It is the ability to control the length that most people ignore. There are some remarkable results to be found here by those willing to work on this. Jake said it very simply "think of making a fist with your mouth". It draws in from all sides.

There are lots of people who play what WE call the Stevens embouchure. It was first written about in 1614.

It is outlined in books like:
" Prelude to brass playing " by Rafael Mendez
" The Psychology of cornet & trumpet playing " by Clyde Noble PHD
" The embouchure " by Maurice Porter
" The encyclopedia of the pivot system " by Dr. Don Reinhardt
" The trumpeters' handbook " by Roger Sherman

It is not mentioned by name in these books. However an inward lip curl is not part of the other embouchures and each of these books call for a lip curl in the setup.

 It is mentioned by name in these books:
"New approach to trumpet playing " J.H. Lynch
" The no nonsense trumpet from a - z. " by me
" Embouchure self-analysis & the Stevens - Costello triple c embouchure technique " by Dr. Roy Stevens
'Pops'

   A collection of some past posts & information about my book.
http://www.bbtrumpet.com/

---

Wilktone: Guess The Embouchure Type - Denver Dill

Link: Wilketone Blog: Guess The Embouchure Type - Denver Dill

I had to share this great blog post, the one I posted above! As I've said it many times before, I'll say it again...I love wilktone's blog. He has some spectacular videos over embouchure function; that show other people's embouchure types, and about embouchure dysfunction as well...it amazes me! I love it and think it's very important to know about and study embouchure form and function. He just posted a blog over a video of Denver Dill's embouchure. There should be a couple links on my sidebar about Denver Dill - he has written a book over his recovery from surgery done on a torn obicularis oris. Wilktone's blog shows a video of what Denver Dill's old embouchure setting use to be compared to the one he plays on now. It is very inspiring to see someone who has gone from injured to surgery then to fully recovered and then some! He sounds absolutely amazing!

(Video) June 21st, 2012 Practice Session

I'm starting to record my practice sessions now on camera when I can get into the university practice rooms. I promised myself I'd record more often. It took 1.5-2 hours of prep-work (breathing, buzzing, stretching, free-buzzing exercises, etc.) to feel ready to start working on my horn playing. So as soon as I felt ready to record my horn playing, I hit record and started to show exercises I do to work on a particular group of notes or range. There are a lot of different basic exercises that I apply to what I am focusing on at the moment (I'm going to record these too soon just to explain more)....Today was great! My embouchure felt really good! I'll also post this under my practice journals link on the side bar.

One last thing, a disclaimer: This is not recorded as a means to prove a rehabilitation method, I believe not one singular method works for everyone since it is a very personalized process and everyone's embouchure function is complex and unique in it's own individual way. This is recorded as a means to document the process I'm going through; the relapses, progress, and anything else that happens as I go through rehabilitation.

If you would like to view a video where I show my FTSED symptoms, you can access it via the side bar or by clicking on the link here...that video post is labled: Taking an Inventory of My Symptoms. I show what my symptoms are like when I haven't done any prep-work. Whereas in this current blogpost/practice session, I have done my prep-work...

Taking an inventory of my Embouchure Dystonia Symptoms

I decided to do an updated video over my Focal Task-Specific Embouchure Dystonia Symptoms. I show how I take an inventory of my symptoms and how to test them a bit. I tried to do it all in 1 video and ended up being 3!

Again, just wanted to let you know that this is what my symptoms are like when I haven't included any of my routine or modifications. I show a little bit of my playing routine at the end just as a short example. However, I also don't ever work on my horn playing exercises until I've done any of my prep-work (my buzzing, breathing, etc. other exercises and modifications). 

I wanted to correct a statement I said near the end. I should have said "You don't want to avoid embracing sounds you might typically think are bad sounding, instead you want to face them."

Also a disclaimer: This is in no way to show a proven method of rehabilitation, nor do I imply it will work for anyone. Rehabilitation is an individualized process, and not everyone has symptoms that effect them the same way, and every embouchure is very unique, especially in the way they function.

I want to make an important note that this is not the sum of my rehabilitation either, this is part of what I address in my rehabilitation: finding what works/doesn't work...learning how my dysfunctional embouchure functions. Rehabilitation is a process, one blog post can not cover this process as it develops over time. I can only show you what has helped me, and the learning process and developments that I do make.

When it comes to rehabilitation, I view my embouchure dystonia as neurological, not psychological, mental paralysis, or some other type of diagnosis that other non-medically trained people try to convince me it is. I address my symptoms through retraining exercises, making these types of adaptations, and using the exercises I do in other portions of my routine that I show in other videos, while always viewing my disorder as neurological. I try to find ways to adapt my sensory...to rewire my sensory and muscle memory if that makes more sense.

Here is the other video showing my embouchure dystonia symptoms. This one I did way back in December...so 5 months ago. You can actually see some contractions in my upper right side of my lip a little above my corner when I play. This was recorded on one of my better days. I only play a C major scale here 2 octaves, and then up to an high F and back down. Also, honestly, at that time while trying to make my first video I debated what to show in the video...it was really hard to show my symptoms so I made it a short video. But I know in the long run, it's for the better. I feel more comfortable with recording now, so I will be doing this a lot more often and posting them under my practice journals.

Conversations: Mark Denekas

A picture of Mark in his youth.

It seems like forever ago that I spoke with Mark Denekas about Focal Task Specific Embouchure Dystonia. Talking to him was so important for me because he is someone I look up to and can relate to as a hornist. First off, here is a bit of bio about him beforehand. I also posted a clip of his playing with the Denver Symphony at the end of this blog, it is very moving and inspiring.

Mark retired in 1997 from the Colorado Symphony after experiencing Embouchure Dystonia symptoms that gradually heightened. He held the principal horn position longer than anyone in the orchestra's history:

As a junior in high school Mark was accepted as a student by Dale Clevenger, the newly appointed principal horn of the Chicago Symphony.  While in high school he performed as principal horn with the Youth Orchestra of Greater Chicago, winning the soloist competition in his senior year.  He was subsequently asked to perform on Louis Sudler’s Artist Showcase, on Chicago Public Television.  He was one of the only high school students selected to play in the Civic Orchestra of Chicago, the training orchestra of the Chicago Symphony.  Mark attended Carnegie Mellon University where he continued his horn studies with Forrest Standley.  In the summer following his sophomore year Mark was selected as Principal horn with the Colorado Philharmonic, now known as the National Repertory Orchestra. There he gave his first performance of the Second Horn Concerto of Richard Strauss. The following year he was appointed the principal horn of Chicago’s Grant Park Symphony, where he performed for the next five summers and was featured as soloist with Gliere’s Horn Concerto.  His professional status now firmly established, Mark was engaged as an extra and substitute player with both the Chicago and Pittsburgh Symphony Orchestras.  He graduated with honors (Phi Kappa Phi) from CMU with degrees in Horn Performance and Music Education.

Following graduation Mark’s career rapidly unfolded with contracts with the New Jersey Symphony, the Chicago Lyric Opera, the Winnipeg Symphony, and the Pittsburgh Symphony.  During the early years of his career Mark was privileged to continue his studies with Philip Farkas, the great former principal horn with the Chicago Symphony.  He also studied with the legendary tuba player Arnold Jacobs, whose knowledge of pulmonary physiology (lung function) and symphonic and operatic repertoire made him the highly sought after coach of many professional wind and brass players and vocalists. In September of 1974 Mark became the principal horn with the Denver Symphony which later became the Colorado Symphony Orchestra.  Here he was one of the most frequently featured soloists. Once established as the leading horn player in the Rocky Mountain region, he was invited to perform outside of Colorado as guest principal horn with the Omaha, Columbus, and Honolulu Symphony Orchestras. At the invitation of Ling Tung, Mark was appointed principal horn in the prestigious Grand Teton Music Festival. 

In Colorado his teaching career also flourished with students ranging from young beginners to professionals performing with the Boulder and Colorado Springs Symphonies and the military bands and orchestras.  He was a charter member of the Board of Directors which founded the Denver Young Artists Orchestra. DYAO quickly became the outstanding performance opportunity for serious young musicians in Colorado. As part of the Colorado Symphony Residency programs, Mark gave master classes and clinics throughout the state. He was a part time lecturer in horn studies at both CU and UNC. After retiring, Mark has become registered in all levels of Suzuki Training, and has established one of the leading Suzuki piano studios in Southeast Denver.

--------------------------------------------------------------------------------------------------------

I was fortunate enough to contact Mark through a former horn student of his that is now attending Peabody Conservatory. I spoke to Mark about what I was experiencing and asked about his experience and advice on Embouchure Dystonia.

One of the first things we talked about was the importance of relieving the stress from all the demands that are often placed on us, letting go, and switching to a different mind-frame than what we've been schooled on. Training, studying, and performing music requires a much different mind-frame (focused on technique) and physical approach (focused on mastering difficult repertoire, breathing, meeting demands and working harder) than that which is required for rehabilitation. This is our mental hurdle in rehabilitation.

In rehabilitation, if we are to use any form of analytical thinking, it can't be used to analyze or criticizing ones skills, techniques, sound, etc. ....it should be focused on awareness of tension that exists in our embouchure and fully embracing it, working with it, not against it. Mark stated that you have to relax your mind first so you can be more attuned to what's going on physically. This is so true! He said that this state of mind should be peaceful....you should enjoy playing your horn (even with involuntary muscle contractions and all). This is the first step: embracing it all, loving it, enjoying it, a positive attitude/self-esteem no matter how you sound...once you get past that then you can start focusing on your body/physical recovery .

The next thing Mark spoke about is the importance of learning to separate our worth from our instrument before we can start physical rehabilitation. This is our emotional hurdle in rehabilitation. This is similar to the issue that Denver Dill brings up in his book, learning to completely let go of the ego. [So much of our success on our instrument starts to define who we are and becomes too intertwined; this is especially often true the more you excel or succeed and are rewarded for it - winning competitions, auditions, awards, etc. We forget why we do what we love, it becomes about depending on external praise and rewards, trying to keep up with the successful streak, RATHER than focusing on internal enjoyment and love of what we do - no matter where we do it, or at what level of playing we are at. Without a doubt such a huge setback forces us to question and remember why we love our instrument/what we do....it enlightens us.

It's also similar to my views and how important it is to treat success and failure as one and the same. All musicians are blessed with "the gift of music" or "creative calling", it will always remain in us, but sometimes in life we are taught or forced to see there is more than one way of sharing it; for example sometimes it comes in the form of teaching/passing on our knowledge, learning another instrument, another art or endeavor that we love, becoming passionate about another area of music like music medicine or injuries, conducting, etc. Sometimes it allows you to focus on other areas of your life like your health or family, and this in return allows you to see the bigger picture...whatever that comes to be....believe me, it is better than what we were striving for before.]

Like Mark said, it's this huge mental and emotional hurdle we must jump over before we can put effort into physical rehabilitation. Grieving is a huge process to get through in time. He goes on to talk about physical rehabilitation with Embouchure Dystonia, the exercises he does. This is our physical hurdle in rehabilitation....

First of all he spoke to me about being aware of tension/symptoms, where it happens, when, and also the opposite - when it doesn't happen and where. Make it a point to play your instrument so you can get use to building on this awareness....the exercises help with spotting areas of tension while helping you learn how to work your way around. Physical recovery requires working out the tension through very basic exercises and using your awareness to make slow and subtle changes in the way you play a specific thing. Sometimes it's not just a change in your movements, but it can be bigger changes too in your body (ex. how you hold your instrument, your posture, breathing, etc). But you must be relaxed in order to do so, in order to understand how things are functioning under the hood, to become aware of what's happening. [Also I think it helps to have studied embouchure function at some point (ex. Farkas's 40 virtuosic Embouchures, Farkas's Art of Brass Playing, etc. Also check out Wilketone's Embouchure Function blog/videos]. Here are a few exercises, or aspects of playing that Mark spoke to me about and why he does them:

1. It's important for him to play on his leg because it allows the mouthpiece to come to him, rather than him coming to the mouthpiece. It also gives some stability to hold the horn this way, because playing off of the leg creates more movement in general due to the arm trying to keep still/trying to hold the horn stable...this just makes the embouchure even more harder to work with because it has to additionally focus on trying to adjust to these external movements. [This is true for me as well! I didn't think about it until now, but I wonder if working with Pip Eastop's "Pipstick" would help with external stability/balancing the horn as well? Especially for instruments that don't have the option of playing on the leg.]

2. "Always warm up" - getting good blood circulation in the embouchure is necessary.

3. "Don't forget to work on breathing." Even if we aren't required of using a huge expansive breath yet for louder/stronger playing, doesn't mean our breathing should go neglected or that it isn't important; it is another area of rebuilding our physical well-being as a musician that needs to be addressed during recovery, it also is a part of keeping up our physical stamina...and good-feeling for us in general.

4. "Don't do long tones as part of rehabilitation because they tend to lock in faults or cause more irritation/tension in the embouchure." Don't do them too soon/prematurely, unless you feel you've recovered and can handle them; remember they are an intense form of training because it involves so much stamina/endurance. Yes you want to work with your spasms/symptoms, but long tones are not a good approach because they require so much control over your embouchure that you haven't regained yet. Recovery requires taking baby-steps when confronting your symptoms and making slow subtle changes.

5. "Try to focus on a more relaxed playing if possible" - meaning not really high, not loud...more of a free flowing feeling; soft, gentle, and slow in the most comfortable range you can.

6. Start on a comfortable note like middle F, of the F below that. Do light tonguing - four groups of 16th notes. Start on a speed that you can do, and work on slowing it down over time. Doesn't matter if fast or slower...but for most people it's harder to do slow. This is in most cases for people with embouchure Dystonia; they can play faster passages, but slow sustained passages are terribly difficult. So when you practice the four groups of 16ths, for some reason it doesn't give you embouchure enough time to spasm or jerk, it distracts the brain from sending the wrong signal. Eventually you will be able to slow your playing down. [Perhaps this is like a sensory-trick...a way of tricking the brain? This exercise also reminds me of the slowing-down exercises that helped classical guitarist Mark Ashford successfully recover from his Focal Hand Dystonia. How amazing this is to see a similarity in approaches!]

7. Start on the most comfortable note you can hold. Hold it, then focus working your way into the note below it. Work on one note at a time...even if you have to work on the same note day after day. [I do this exercise too, but I start in my pedal register. It's not that I can't start higher and work my way down to my middle-to-low ranger, it's that for some reason I feel working in my pedal range requires less pressure on my lips and doesn't sap my endurance right away, though it does require a lot deeper air, and it relaxes my face more while giving good blood circulation, though it's also not the easiest register to improve upon.] He also said that Max Schlossberg's Daily Trumpet Drills have helped him out a lot.

8. Mark said that an excerpt that is usually very difficult for horn players with Embouchure Dystonia to play is Mussorgsky's Pictures at an Exhibition; it reveals most symptoms associated with Embouchure Dystonia because it's in the middle-to-low register, it is moderate to slow tempo, slurred, has some wide intervals and lyrical....this is an excerpt that is usually very easy for horn players as it covers our most basic abilities - what would normally be comfortable. Therefore it is a good reference to see how you are doing every now and then by trying to play it. Also if you do think you have Embouchure Dystonia, this might be something you should test to see if you can play through or not, because for most it is such a grueling challenge to get through.

9. Practice in a room that is large and sounds good, it will boost your confidence/liking of your own sound. It's much better than being in a small muffled sounding room. Also it helps you face your fears...most people are afraid of being heard by someone because the way they are physically struggling and how it comes to sound. [I totally agree...however, if not comfortable playing in a larger room yet, start by practicing somewhere public like a University practice room, then work your way to practicing in a larger classroom, then to a stage; but always imagine someone is listening, and remind yourself positive thoughts - that you accept and love your sound, flaws and all, that you are doing your best and that no one has a right to judge you, that you are doing this for yourself, for your love and passion, even for a higher being if that is what it takes! Also for me, I found by teaching my 6th-8th grade brass playing students it helped me cope with things as well because I had to play with them and for them...it was also humbling because we played around the same level, yet they never judged me and thought I was the best sounding horn player ever! It was so therapeutic to feel I was doing something with what I love...even if I barely could play at the time.]

The last thing Mark and I talked about was botox treatments with brass musicians who have Embouchure Dystonia. Studies show it doesn't help a majority of brass players with Embouchure Dystonia (it has shown improvement in Hand Dystonia though), but he said there are some brass musician's he knows who do receive botox injections and have had success with it. But Mark also warned about being cautious of botox because it is still a risk even in small doses, and that it is one of those things a person would come to rely on completely... they would depend on it, and he can only imagine it must be like a roller coaster ride where one probably feels relieved of their disorder temporarily until the botox starts to wear off. It is perhaps better off without it. He also said if you are young, take care of yourself, and remember that the body/brain can adapt, it may be possibly heal itself in time. He also mentioned that he believes what lead to his Embouchure Dystonia was overuse. He was diagnosed by Dr. Steven Frucht; Dr. Frucht and horn player Glen Estrin founded Musician's With Dystonia at the Dystonia Medical Research Foundation (DMRF). 

Mark's conversation meant a lot to me, coming from a former professional horn player of one of my favorite orchestras! (I am also a past Colorado/UNC horn student). His legend lives on, and I know that when I hear recordings of his playing with the former Denver/Colorado Symphony Orchestra, his personality shines through...and that remains with him always. Here is a recording of him! Absolutely outstanding tone and musicality! 

Ravel – Pavan for a Dead Princess. Denver Symphony Orchestra; Philippe Entremont; Mark Denekas, horn solo.