Thursday, March 22, 2012
Summary of my Embouchure Dystonia Rehabilitation
Please do not contact me asking if you have dystonia, as I am not a certified neurologists. I had to put this note here because I get a lot of people asking me to diagnose them after reading this blog post.
I've spoken with several professionals and musicians who have been debilitated, either by an injury to their face, or who have embouchure dystonia. I believe it is important to understand what works and doesn't work for others, and to look at everything objectively.
As I've rehabilitated over the years, I tried so many suggestions and advice at first because I didn't know what worked for me yet. I've had to deal with constant messages about who I should go to, what I should do, correct, or fix. All of which is mostly given out of good intention...however can be very unintentionally disrespectful, sometimes very misinformed, and can be frustrating having to deal with when I've recovered significantly. I also go to great depths to share my process and feel like no one takes the time to read it before writing to me.
Recovering from Embouchure Dystonia is a very individualized process. I can only take and leave what works and doesn't for me. It has been an evolving process to say the least, and I'm beginning to realize that trying to summarize it does not do it justice and difficult to explain thoroughly from all angles.
Also I want to mention that embouchure dystonia it is often mistaken for overuse injury or overuse syndrome. If you do not know much about the disorder, and especially if you don't have it, please realize that statements based on assumptions are not helpful and can be misleading to others. Also if you haven't read my blog very much, please don't assume things without first getting to know my process through reading several posts. I've invested several years into this blog to not only share my journey, but have links to several research, case studies, information, and studies on the disorder that can help you understand it further.
This is the simplest way I can try to explain my current process, and I'm sure I'll come back and make edits and add more as I begin to understand how to word it more properly.
Right now my rehabilitation is based on 3 main things, and is more of a holistic approach; meaning one that addresses many different layers such as retraining sensory/muscle function, body mapping, mental awareness, emotional coping/healthy self-esteem, and modifications.
Again, I am only sharing what has helped me. Embouchure Dystonia recovery is a very individualized process, so what works for me might not work for you. However, it is important for me to share what I have learned and benefited from, as there are no publicly documented recovery efforts by any musician's with embouchure dystonia in existence. Hoping this will provide a rare insight into what the neurological disorder can be like.
 Understanding what Dystonia is from a medical standpoint as much as I possibly can. Reading research, talking to people (medical and non-medical who deal with the disorder and the different types of dystonia), searching out various viewpoints. First and foremost, always thinking objectively while also balancing an open mind. Don't believe everything anyone tells you, but also don't avoid considering others thoughts/advice without first thinking it all through and seeing it from multiple angles. When someone says something that doesn't make sense or isn't thoroughly explained, ask more questions that pertain to how they got A+B = C and ask for them to explain and give examples or share a video if can of what they are talking about.
Also study as many articles, research, and related facial injuries or information. I have many links on this site under "links of interest" and along my sidebar on the right. I also feel it is vitally important to study not only embouchure form and function, but more importantly to study anatomy of the face; not just the muscles or the "obicularis oris" but all the muscles of the face and how they function together (Gray's Anatomy Book helps), as well all the nerves (facial and trigeminal nerves of the face), what feeds into what, what each muscles function does in the face, and also nerve-related injuries and alternative medicines and options outside of mainstream traditional medical care.
Even though there is not one culprit known to trigger dystonia, nor one method of recover that works for everyone, doesn't mean we know nothing about it.
What we do know is that it is a neurological disorder. Reprogramming sensory through retraining is what my rehabilitation routine is based on, and addressing many other areas; emotionally, mentally, physically. I believe many factors contributed to the onset of my dystonia, therefore it takes a great deal of work to not only overcome it, but approach my horn in a different way than before.
I should mention here that if you are having any pain alongside your dystonia symptoms, it's best to resolve the pain first and quit playing until fully recovered. It will only make things worse if you keep playing in pain. Sometimes rehabilitating and trying to play after being diagnosed with dystonia can cause a secondary injury from too much effort put into recovery. It is important to remember it is a process and takes significant time and patience and slow work. Nothing should be forced.
 Focusing on sensory-movement: reprogramming sensory by retraining muscle movement. This consists of three areas: (a) Relocation - basically playing in a different location than I normally do and building a foundation of playing based off that location. (b) embouchure tension awareness - learning how my dysfunctional embouchure functions; knowing when and where the tension and involuntary contractions/lateral pulls occur when I play, and making slight adjustments, and finding opposing movements and exercises that help release or lessen contractions in the embouchure. (c) practicing formation/muscle group motions or movements and regaining strength through specific exercises outside of playing. This is only focused on in my buzzing exercises, and not when playing the horn - I'm not trying to force a stabilized embouchure and avoid focusing on what it should look like. I explained this better in my "beginning rehabilitation" blog posts and videos. When you become debilitated your embouchure does lose strength too because you can't play as much and you don't want to cause a secondary injury or create more tension.
Reprogramming embouchure functionality involves: rebuilding muscle strength, muscle memory, and sensory...they all go hand-in-hand. (d) stretches - moving your muscles in different ways and different stretches than you're use to doing.
 Building a personal routine: Which consists of (a) performance psychology - incorporating a positive mentality and rebuilding self-esteem...this helps a lot with the depression that comes with being affected by dystonia or an injury (b) retraining exercises - I use a large amount of buzzing exercises and range specific exercises. Again, I will outline my exercise routine more clearly on here soon. Also I have started posting videos of my routine...so it will all eventually be on here.
I want to add a note of caution here: Rehabilitation is a layered process, so my routine (or parts of my routine that I show) as a whole is an example of what I've slowly come to focus on as my embouchure function develops/recovers. It is an ongoing process...so for example; in the beginning I just focused on trying to produce a buzz into my mouthpiece, and slowly over time I was able to adapt and do more on my mouthpiece...so for months I worked on this; just buzzing. As I worked on buzzing and saw improvement, I was able to add on more exercises. Then a couple months later I started to focus on moving from buzzing to playing on my horn, and focused on producing a sound and eventually was able to move around and start to get to know my dysfunctional embouchure. So it is a very rigorous process because it is literally one baby step at a time...and it comes down to just relearning everything, small things that use to not be difficult before dystonia...like buzzing into a mouthpiece. I just wanted to re-emphasize that my routine is not so much a set routine, but a cumulative ...or I should say an example of what I've slowly built upon as I've recovered....what I was able to do step-by-step as my symptoms were relieving. My rehabilitation is learning how to reprogram/retrain my embouchure function or motor-skills after it's been completely deprogrammed...I don't know if I'm making an sense, but that's the best way I can describe it.
Annnnd.... I forgot! Some adjustments: I forgot to mention how important ice pack/heat packing is for me, and taking "women's 1-a-day vitamins". Also playing on my leg helped a ton in the beginning, and even now sometimes I don't feel comfortable enough to play off the leg. Breathing exercises and stretching exercises ...I always do them first and foremost before I start my routine! And most importantly, I play on a mouthpiece that feels good; is comfortable, and the first mouthpiece I started on actually. I played on it for a good 5-6 years since I started horn 12 years ago before switching...and now that I've gone back to it, I feel it helps out with the muscle memory some-how, and it has enough supportive back-pressure.
I have come a long ways, as my dystonia symptoms use to be prevalent in every register, and even when I buzzed. You can see this in some of my early videos under "Practice Journals" or "(Videos) Rehabilitation Practice Journal" on the side bar to the left.