Monday, January 28, 2013

Hung-Kuan Chen (Piano): On Overcoming Hand Dystonia



I saw this absolutely amazing post on the Musician's With Dystonia Bulletin Forum. It's a PDF file, but doesn't require downloading. Hung-Kuan Chen, a pianist, speaks about his personal challenges with dystonia over the years, and how he eventually overcame it. I know I posted this under Q&A/Interview's even though it's a document that he posted himself on the forum. I posted the link below.





He approaches it very intelligently, and describes in detail why he chose a certain way of approaching his symptoms, and how. With so much respect for this man for sharing his wisdom and journey, I wanted to share it with you, as I feel it can benefit many.



Link: Hung-Kuan Chen (Piano): on Overcoming Hand Dystonia

I especially relate to the issue of overcoming the opposing muscle groups. Even though embouchure dystonia is much less understand than hand dystonia, I still find it similar in more ways than we think. He speaks about how the muscles are fighting for dominance, as there are different signals being sent to the hand, and how these signals overlap and cause tension/the contractions. He also talks about finding the threshold.

I immediately thought of the threshold being similar to how I find what I call the "leverage" area (I spoke a lot about this in my blog titled "Natural Release". I find the leverage area by finding the middle ground between the signals. I feel like the primary/dominant signals that are overlapping in my playing are not that difficult to point out; I feel like one of the many yet very dominant signals is trying to relax my embouchure from tensing up too much - to collapse it, and another dominant signal is trying to form a natural stabilized/functional embouchure but fighting the collapsing by stretching out too far and tensing up, and I can't seem to get a grasp on either one. It's like working with stubborn tissue, and any movement or attempt to form an embouchure is like touching an electric fence...it immediately causes bursts of spasms. As soon as I found my leverage, the contractions gave way slowly over time.

I had to first reduce the overall contractions by finding ways to relax them through anything I found that helped; buzzing, stretching, certain patterns, playing in the pedal register, etc. It wasn't an automatic release of the tension, it was more similar to massaging a knotted muscle over a period of months before the first layer of the knot gave way to the second. I kept working on reducing the overall contractions to a point where I finally could regain a tiny bit of sense or grasp over certain notes (usually just the tops of notes at first/skimming the surface). Then those certain notes helped me find my leverage...an area where I had reduced contractions, but could still maneuver enough to work my way into other notes, then registers, then patterns, etc....by slowly returning to those key areas every day and just touching upon them lightly.

My best analogy is; pretend you are going to try to pull your arm towards you like you're lifting a small weight. You try to pull your arm towards you, but the opposing muscle contraction instead fights it and tries to pull it away from you. In order to overcome this, you can't force your arm to pull towards you, it will cause more fighting/tension/contractions. Instead, you have to gently test the contractions. You stretch your arm/muscles, try to relax it, soak it in warm water, whatever relaxes it before you start to work on these contractions. Then you slowly pull your arm towards you just a tiny bit, and once the contractions happen, you release your arm. You keep doing this, just slowly pulling your arm towards you at tiny increments over time....every time the contractions happen, you release your arm, and eventually over time the contractions lesson as your body realizes what you are asking it to do. Pretty soon you are able to pull your arm towards you with less tension..the opposing muscle movement isn't nearly as dominant, and then eventually the movement of "pulling" towards you becomes the dominant signal to your brain. But it also takes even longer to learn how to pull your arm towards you with added weight, so you also have to learn carefully how to add weight slowly without regaining/causing tension to build again and take over....the added weight can easily trigger the body to overlap signals again by sensing that what you are doing causes possible strain. So with all this said, this is why it takes so long, many months or years to overcome this. It's like re-wiring your body, or how Hung-Kuan says, trying to undo the cluster of knotted wires that you might see on a computer...they are all knotted and sending various signals...you have to undo each and every knot with gentle movement and patience.

I feel like I've had to slowly rebuild every aspect of my playing through awareness and patience, and calmly listening to what my embouchure/body was telling me. It takes a lot of focus to become aware and intune with your dysfunctional embouchure. I feel like I've had to go from completely deprogramming my embouchure to slowly rebuilding it by navigating every movement through patient awareness.

The best way I can describe it is: imagine if you had a repetitive injury in your leg from running; the injury was so severe you had to quit running. You had to take time off, and heal. But then when you returned to running, things weren't the same. Your muscles were stiff and not working properly. One might say that in order to avoid the injury, you need not run again, but you actually do, but not right away...you would have to first stretch the muscles, relax them, move in slow motions, and then slowly work on rebuilding muscle endurance, and not rush things. Eventually you would get to a point where you could start speed-walking, or light jogging, but with much more awareness of your body and knowing when to not rush things. You would do all of this in order to properly regain your abilities in your leg. You wouldn't just jump head first into running miles upon miles, and hit the gym for 3 hours doing weights and laps, or try to use your leg like it's 100% stable as before.

This is the same with my embouchure dystonia. I once thought like many brass musician's are taught... to approach it like a normal player...like I had normal function. A lot of brass players will tell me or point out to me, "Your chin seems to have some bunching....your corners seem to collapse...I think this can be resolved through good breath support/air, and holding a stable embouchure formation." Farkas definitely influenced the way we look(ed) at embouchure form and function, but the problem with his concept was that it was to generalized of a view. It's not our fault as students we were never prepared to understand embouchure form and function beyond a book and pictures...there isn't a lot of studies on it as there should be, but that's definitely changing today. I really like Dr. Wilketone's blog because he analysis embouchure form and function unlike anyone else, and dedicates his time to studying it in motion. He shows observations of many things we can't see in a picture, and the various differences between different embouchure types.

SO the problem with Farkas's concept is that (1) if one wants a stabilized embouchure or in better words ...a functional embouchure, practicing holding one compared to a picture of another's is not realistic in the sense that an embouchure does not develop that way. If you want to have healthy strong arms to row a boat, you don't just sit there and hold your arm in a flexed position.....muscles develop through motion, and naturally develop best with time, rather than force/strain, and MOST importantly, they learn to function in a specific way depending on what you are doing (our muscle memory helps us to remember to move in specific ways as we develop, and our sensory helps our brains recognize what it feels like to do it). Embouchures develop through motion. Here is the (2) second problem,...everyone's embouchure functions differently, and not all are the same. There are some similarities among players, but there are also many who function severely different due to their facial build/makeup. (3) Air does NOT help a dysfunctional embouchure, especially if dystonic, it can make it worse. Don't get me wrong, breathing is good (if it's used as a warm-up/to focus ones self, or in prep-work like buzzing if it doesn't cause too much tension), but it can only come in handy when a certain level of function has been restored.
For example; In the beginning when my symptoms were severe, practicing long-tones made things worse and were out the of the question. Long-tones take a certain amount of muscle control, endurance, and abilities restored. Over a year later now, I finally am at a safe enough level to work on long-tones, and this also includes air. The dysfunctional embouchure can't focus and air stream, so the more air you try to blow through, the more it tenses up because it can't handle it. BOTH can cause more tension or strain on the muscles in the beginning. Light relaxed air via nose breaths or light intakes, combined with air-attacks/poofing in short durations was much safer and effective over a long period of time.

You can not approach a dysfunctional embouchure with such generalizations as "use more air", "work on holding that chin flat," "we must stop the movement in your face." Healthy normal embouchures take a while to develop over time, but dysfunctional ones take even longer to restore, and can be trickier, due to the fact that the pathway to recovery is not so simply summed up. The dysfunctional embouchure needs extra awareness, care, patience, and most of all TIME. It's not something you can develop through "lessons" every week....lessons require set goals, practice routines, pieces of music, technique-focus, and work/effort. Dysfunctional embouchures need to take it easy, they shouldn't play all the time, or every week, or have set requirements...they have a pathway to recovery of their own, and the only person best at understanding that pathway is usually the player themselves, as they can "feel" what's going on that no outsider can understand easily. That is why some injured/disordered/debilitated musician's chose not to work with anyone, or to not work with someone who hasn't ever been through the same thing.

Anywhoo, I'm rambling about my own experiences again! I wanted to explain how I related. The opposing muscle groups, the individual challenges/personalized process, and some areas/generalizations/techniques that cause more harm than help.

I hope you enjoy his article! It is truly amazing!!!

Wednesday, January 16, 2013

(Video) Rehabilitation Work: Very Important Elements On Recovering

This video was mainly suppose to show how I work on my most current symptoms, but I ended up also covering some key things that have helped me get to the place I am at now, having significantly reduced my embouchure dystonia symptoms. I decided on this title and used the word "recovering" because I am slowly but surely recovering. I've posted a lot of videos on my blog of me playing, and being able to look back and watch them compared to where I'm at...I see the small improvements gradually accumulate into big improvements.

Here is a link to the first video I made for my blog on December 29th, 2011.  Another video I did in June of 2012 I tried to show my full range of symptoms more accurately. You can see and hear how much more heavy they were in my playing. But as you can imagine, they weren't nearly as bad as the height of my symptoms in 2010 and early spring 201l when I struggled to get a sound out of my horn! That's how bad the contractions where...trying to blow air out and nothing happened but spasms!

I think this is one of my more well-planned out videos covering my playing. It was a great session, but definitely took a lot of endurance...ended up being 5 videos long! Auf'da!!

Part 1

Part 2

Part 3

Part 4

Part 5


There's some more comments I want to post right here, but will eventually update this post with them, as there are some things I left out that I forgot to mention too.

Video Response From A Musician Friend: On Singing and Horn Playing






One of my friends and former colleagues posted a video response to the video I just recently posted (should be the blog post above this one). I was going to post this in the comment section of that blog post, but it deserves a blog post of it's own!

Both Josh and I attended University of Northern Iowa and met around 2006; I had transferred to UNI in January 2006. We both studied with Dr. Thomas (Tom) Tritle and Dr. Yu-ting Su, and played in orchestra, wind symphony, horn quartet, and chamber winds together. I also played with his wife and some of the other studio members in All-state many years previous while in high school and didn't even remember until I saw them again! Josh went on to University of Iowa, then graduate school at Lincoln Nebraska, and North Texas. He's a tremendously gifted horn player, and I'm grateful to have him as a friend. As you can tell, he's definitely doing great things in his playing! He sounds like a professional...he always has!

I'll try to summarize my reply/message: "....it will definitely help with the higher register, as I don't get to work on that area a whole lot due to the amount of endurance it takes. This may be a safer way of approaching it and working on building it without wearing myself out or building up to much tension. I can play up to a (line) F on the top of the staff safely, and on really good days a high C maybe once. But I rarely do that, as I'm still concerned with my scar tissue irritation. This is actually one of the more helpful advice that I've heard in a long time!!!! As like many things, I couldn't have worked on this in the beginning...I can only work on certain aspects of my playing at a given time, and sometimes it's hard for people to understand that, and also to understand that I can't approach my dystonia like I have normalcy or normal abilities which allow me to focus on what they think is best. But I believe this, what you've posted, is something that can help me, and that I can definitely work on at this time. So I'm looking forward to trying it out!"

Thank you Josh!

Sunday, January 13, 2013

Embouchure Change vs. Embouchure Adaptation




I was writing a reply to a post online earlier today (today is Jan. 20th, but I'm posting this under the 13th instead). I misread what they wrote.......:-S... now that I look back. The topic I thought they were talking about was a good one though! I still wrote a reply to something that I think is an important observation, even if that's not what the post's focus was. I wrote:

"I think that is a great observation (about the changes you feel in your embouchure)! I immediately thought... an embouchure change vs. an embouchure that HAS changed. I feel there is a difference though!... An embouchure change I usually think of mechanical....mechanical work....something intentional. Where an embouchure that HAS changed is something unintentional. 

I have heard of musician's who have developed embouchure dystonia-like symptoms after going through an embouchure change - meaning, changing the embouchure while it is still naturally set...intentionally changing what is natural. 


But an embouchure that HAS changed, is one that has done so on it's own... changed from it's former way/movements due to natural development, or from an injury, or from dystonia..something that was not intentional from one's own efforts.  


I feel like dystonia and/or an injury can cause an unintentional change (one out of our control), and this causes us to adapt to that change...so in a sense it is a change in how we re-wire the way we use our embouchure. I have heard of musician's overcoming embouchure dystonia through this adaptive change too (and it is something that has helped me recover a great deal of my abilities!). Some call it neuroplasticity or body mapping, but it is also in a sense or in general terms - an adaptive embouchure change...or even better worded... embouchure adaptation! 


Well, I just went on a rant! I was pondering about all this, and trying to find a way to explain how I feel there is a difference. I knew what you were trying to say, but it is hard to put in words how it is different than an embouchure change in a sense. When embouchure change is spoken, we typically think of - one that is intentional, for example; One that some students go through because their professor or teacher makes them."


As I was stating before that there is a difference between an embouchure change and adapting to a change of the embouchure. Some musician's that undergo an (intentional) embouchure change have been reported to have dystonia-like symptoms either a couple months afterwards or a couple years after one, and that the quivers/shakes are a result of the embouchure trying to resort to it's former function that existed before the embouchure change.

I believe this is similar to how a person with embouchure dystonia adapts to the (unintentional) changes/dysfunction over time...the body wants to re-wire the way the embouchure functions. The body knows how to restore function, but it takes time to not only re-develop (normal development already takes a lot of time, so 2x that with dystonia), but it's hard to listen to your body and understand how it wants to develop. With embouchure changes that required not too many changes from their previous form, it can be easier to restore sometimes; like a change in angle, or if they were a lower lip player who switched to upper lip. With dystonia however, it involves more than just adaptation and is very complex to work with, but it is still an important part of recovery!

With embouchure change, the symptoms are thought to be leaning more towards the body wanting to restore the previous way of doing things; the pre-existing function before the natural embouchure was changed . With dystonia though, any attempt to form an embouchure is very difficult. This is because the brain trying to piece together missing information from different areas of the brain to regain sensory/sensation and build new function...a new way to do things. The brain treats these messed up sensory signals as if permanent-damage was done, such as a blow to the head; it tries to piece the missing parts together and create new brain signals...to build a new map/representation so it can somehow function again. Except with dystonia, the missing parts are not due to a blow to the head, but due to the overlapping of sensory signals; they blur together and cause a malfunction, sending too many signals out...the agonist muscle activates while at the same time an antagonist muscles opposes it and they convulse/fight (in other words, you try to move your muscle, and an opposing one cuts it off ...resulting in contractions). You can see this really well in map representations of hand dystonia (the brain no longer senses the individual fingers...they become blurred).  That's my attempt at describing it best I can...not doing it justice though! :-S

I think whether you're dealing with a change to the embouchure unintentionally or intentionally, it is important to approach with this sense of awareness and intuition: to trust your own body, to respect natural development, to remember that your embouchure is a muscle and treat it with care, to be aware of your individual embouchure form and function, to study knowledge on embouchure form and function but be wary of misguided information/always keep an open mind and ponder things/also remember an embouchure is something that acts in motion (not a picture), and most of all....always think things through very seriously before you decide to do anything permanent to your embouchure.

I'll come back and edit this blog. I often write these blogs while thinking a million miles per hour, typing fast, with no regard for grammar or flow, and I repeat a lot of things. So will get around to that soon! 

Saturday, January 12, 2013

(Video) Practice Session Jan. 10th 2013

Well! It's been a while since a video recording. Not very well planned out, but did my best to cover all the bases. My camera kept dying, so it cut off quite a bit of my playing at the end of each video. I think I did a really good job of showing the alleviation of symptoms over the course of my practice session, and though it's hard to explain how it physically happens, the improvement is definitely visible and audible if you pay close attention to when I'm working on my Low Db, and Gb, and even the movements in my face on the larger interval stuff evens out near the end and has improved a bit. :-) 

First part: Buzzing, Stretches, Chromatic Runs (descending) - Ironing Out Small Intervals

Part 2: Chromatic Runs (ascending) - Ironing Out Small Intervals. Octave Jumps...

Part 3: Octaves and Larger Intervals/Melodies