Monday, May 14, 2012

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.
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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.

Thursday, May 3, 2012

Quote Of The Year




‎"My reaction when first faced with this disorder, which is not an uncommon reaction, was to work harder, which is the worst thing you can do. I warn musicians about this. I warn them to treat themselves as athletes of the small muscle. They make extraordinary demands of the small muscles of their hands and fingers (and face)." - Leon Fleisher

Focal Dystonia is an Emotional Disorder? Since when? (continued)



Again, I can't emphasize enough to read and talk about dystonia as much as you can to both medical professionals and non-medical/musicians who are rehabilitating or recovered before you make assumptions about what it is, or believe what another person "assumes" it is.

Surprisingly when you do a lot of reading or speaking to others who have various different types of dystonia you'll realize there are a lot of possible triggers. But with musician's dystonia, for some reason, they get stuck in the assumption that it is purely an emotional/psychological condition, and this gets passed around A LOT. What I have learned as I come across various viewpoints is to think critically and objectively....I analyze everything that I come across, but also keep an open mind. But throughout it all, there are some things I just can't help but flat out disagree with....and saying that it is psychological, an emotional condition, mental paralysis, or some type of neurotic perfectionism or anxiety disorder...I can't ever bring myself to believe that, nor support it.

There are professional psychiatrist and psychologist out there that say they can help overcome it, that it is an emotional/psychological condition because musician's are perfectionists who end up mentally blocking themselves from success due to the fear of failure or experiencing trauma, stress, stage freight, that they have seen improvement with many musicians through their work........but what scares me is....are they really recovering and getting to the core of the "unknown" source of dystonia, or is it only the first portion or step of the rehabilitation process, of the bigger picture? Is it a waste of time and money if too much time is spent on this area of recovery?

There are musician's I've talked to that make some type of progress through psychological therapy, and then the doctor takes credit for it as if it validates his belief, yet the musician goes on to spend more money with that doctor and finds years down the road their physical symptoms have not improved any further. Also even more so, I try to look at it objectively....how much information is the doctor giving out about the rehabilitation process? (What exercises is he using? If using some for of retraining muscle groups...then it's obviously not as simply explained as a psychological or emotional condition).That's not to say I don't think therapy isn't helpful, and isn't required, I just highly disagree it is the source of dystonia or the "cure all."

Here is a post I recently wrote in a group a couple weeks ago:

I disagree that is a fear of failure/emotional disorder. I disagree that it is always the cause of dystonia or the main trigger/culprit. 

Like Leon Fleisher (who has Focal Hand Dystonia after physically injuring his hand), I had a muscle tear/physical injury that resulted in nerve damage and Focual Embouchure Dystonia. 

Though I believe psychological therapy helps in the beginning because it is a huge loss and setback and not everyone deals or handles well with their emotions...it's definitely necessary to have your mind in the "right" frame of positive thinking before you start working on physical rehabilitation, to come to terms with everything...I don't think it's the answer or "cure all" to all types of dystonia's. 

There are a lot of guesses as to what the culprit is, for some it's genetic, physical injury, overuse, psychological, a change in mechanics (ex. an embouchure change), or nutritional. There are many cases where these all come into play...the only thing we do know is that when a dystonia is present, it is neurological-based from then on - meaning the brain and sensory are now sending mixed signals which can be reprogrammed....not easy though, not something that can happen overnight, but definitely achievable. 

I've come a long ways and all my spasms are almost completely gone, have been subtle and beneath the surface for the last 2 months, and now I can move my focus onto flexibility. A lot of people avoid talking about the physical/sensory-motor retraining it takes to lead to progress, and a lot focus more on their setback in terms of emotions.

 ‎...a lot of people would rather believe it is something in their head that can be fixed, rather than neurological and real...grounded in reality and physically addressed through rigorous retraining. I think that is a fear in itself. They want a blunt answer, a cure, a direct source, a simple answer right away to focus on.

When I read the statement: "These emotions come from trying not to play the instrument wrong rather than concentrating on playing the instrument right."

Do I honestly say, "oh wow, that is so true, what was I thinking? Maybe I really don't want to play my instrument right? Maybe I can't handle the pressures of the profession? Maybe it is all in my head? I'm mentally paralyzed?"

....lets be honest. For some few that is a possibility, but for many musician's who have been playing their instruments naturally or "right" for many years without anything catastrophic happening to them, it doesn't make sense that all of a sudden they are psychologically rejecting their own instrument just because of stress and stage fright when it has never been an issue before. Now, it would be a different scenario if they had stage fright their whole lives to the point that it really effected their well-being/happiness or chronic anxiety or depression...don't you think it would have stopped them sooner?

ALSO, the thing about dystonia is that it is present even when relaxed/calm. If it was anxiety, you would have symptoms of anxiety; accelerated heart rate, shallower breathing, less focus, nervousness, and somewhat shaky - but usually not isolated to a specific/particular movement (for example with embouchure dystonia you might be able to play a passage in your upper register, but not middle-to-low). When dystonia symptoms occur (the involuntary muscle contractions), they can happen even when you're in your most comfortable place (ex. your room), while relaxed and alone, and not thinking about it....they still occur. So why on earth is this associated to anxiety and fear of failure?

Yes, as musicians we tend to be perfectionists or think critically, but that doesn't make everyone at high risk for being thrown into the circle of "psychologically damaged." It's an illogical fallacy...that's like saying, "Joe plays football. Joe is a dumb jock." Might as well say, "Joe is a musician. Joe is a perfectionist who is blocking his own success."

NOW, I do believe, and again this is my own views/opinion. That adrenaline (the flight-or-fight reaction) heightens the dystonia symptoms...but it is an indirect correlation. The best example I can think of is Migraines. Migraines are genetic...stress heightens the symptoms, and it can even lead to a Migraine, but it is not the source of the Migraine, nor the cure to getting rid of Migraines permanently. This puts musician's with Dystonia at a huge disadvantage then...it may be our last obstacle/hurdle to overcome before playing on stage again. Even the most calm and relaxed musician with dystonia has to deal with the adrenaline rush. We need that adrenaline to perform, because we are passionate, expressive, and it brings out the best in us when we can control it to a degree...but in the case of dystonia, it is less of help. Trying to suppress the adrenaline though is like killing that passion and excitement we bring to stage...the aura...our stage presence. Again, I don't believe dystonia's source or cure is anxiety, a fear of failure, an emotional condition, psychological, or some form of mental paralysis. I believe that it has many culprits that are known to trigger it, and that when it is finally initiated it does so in the brain/through our sensory-motor function...it is neurological. And that is my primary focus in rehabilitation....sensory-motor/embouchure function retraining.

So when someone tells me that it's emotional, all I can say is...of course when a person has a huge setback like this, they aren't immediately going to want to play their instrument, especially when they become debilitated it is easy to start thinking negative (ex. "I don't like the way I sound, I can't do this, it's no use.")....but that doesn't mean it's the source of dystonia....it may be the beginning of what needs to be addressed in recovery, but it is not the source or "cure all." That's just my two cents.