Focal Embouchure Dystonia: Devices, Equipment, and a Few Daily Musts for me in 2020!

I've been meaning to write this blog post for a while! I'm writing this in a hurry, so will come back and edit when can...

• Since 2011, I have been playing on my gold plated Farkas DC, which I've stated before and mentioned how it provides a decent amount of back-pressure which is kind of like a crutch that helps hold me up. Yet, it has such a beautiful tone. It cuts into my endurance though, but it allows me to manage my dystonia symptoms more easily, so I'm willing to take that compromise. It's not a free-blowing mouthpiece that cuts through an orchestra like the typical mouthpieces I use to play on pre-dystonia. Before, I played solely on Moosewood Mouthpieces (i.e. B12, B16, and RBS16 Vienna Cup, and Megamoose; with a Lawson rim). 
  
  My current mouthpiece:
  
  
  
  An example of the Megamoose for comparison (I don't own one anymore, but very happy I returned to my original mp): 
  
  
  
  
• The Tens Unit I use(d) is the model 7000, 2nd edition:
  https://tensunits.com/products/tens-unit-7000-tu7000-original-tens-professional-unit-fda-approved 
  
  To find out more about what tens units are used for you can read this article here: https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/ 
  
  I used a TENS Unit in the past to help with my jaw pain and upper back tension, including fascial soreness which came about in 2013 and I resolved in 2015/16. It also helped relieve tension after intense dystonic relapses.
  
  Later on after myofascial release therapy helped get rid of my jaw pain and tissue build-up. I started using castor oil which was more effective than ice packing, heat packing, massage, and TENS unit combined! You can read more about my myofascial release therapy and stretches in a video on the left hand sidebar on my blog under "highlights". 
  
  I still do myofascial release once a week by myself if playing a lot. I no longer require TENS Unit, but definitely relied on it direly back then. 

• Castor Oil Pulling: This is a must for me after every rehearsal, concert, or practice session. I gently swish 2-3 tablespoons of castor oil in my mouth for 30 minutes, spit it in the garbage, rinse mouth with water, brush teeth, (then myofascial release afterwards - once a week only). If didn't play very long, I don't have to do this at all, but if an hour long intense playing session or I feel any tension in my face whatsoever, I will do a pull.
  
  Most people think of castor oil as a hair product or laxative, but it's actually one of those age-old remedies and a powerful anti-inflammatory that is effective when having TMJ problems, muscle pain, soreness, tooth pain, or any type of joint or muscle swelling anywhere in general. It has several benefits.
  
  I originally started using it to help keep my teeth clean, since oil-pulling is suppose to be better than mouthwash these days (I accidentally purchased it, instead of coconut oil, which is what most use for mouth cleanser), but found it was helping the tension in my face. I looked more information on it and read stories about how people found it helped them with severe jaw pain, mouth problems, salivary gland problems, and muscle problems. I use it all the time. Cannot live without it and so glad I came across it by accident.
  
  You can google more information on castor oil benefits.  Here is a photo of what I use. It has to be cold pressed and hexane-free. This is where I get it on amazon: https://www.amazon.com/GreenIVe-Castor-Pressed-Hexane-Exclusively/dp/B07QYC559Q/ref=sr_1_23?dchild=1&keywords=castor+oil&qid=1593744595&sr=8-23

• Power Lung: http://www.powerlung.com/region/us/models-accessories/powerlung-models/trainer/ 
  
  I use this for breathing exercises. However, I do have to mention that the first year I had it, I had troubles using it because my embouchure dystonia was so bad that it kicked in when I tried to put my lips over the mouthpiece. So I actually found that it was easier to put my lips "against" the mouthpiece and blowing air through it that way.  So that's how I managed using it for the first year. No regrets, because eventually I was able to use it the way intended.
  
  What I love about this device is it has resistance settings for BOTH the inhale and exhale. You can just naturally blow air against various resistance settings and what you are comfortable with. If I don't have it on hand, I just use my mouthpiece and cover the end of the shank with my pinky by various degrees, but the smallness of my mouthpiece usually triggered my dystonia back then too. Now I can use my power lung and my mouthpiece with no symptoms. This device resistance settings also helped me with regaining control of my corner breathing, which was very difficult in the beginning.

• P.E.T.E. Embouchure Trainer: I make sure to use this separately away from practice time and rehearsals just because it definitely can be easily overused and the muscles need time to reset after using it. So don't play right away after using it. I usually wait a few hours before playing, and I only use the device for about 5 minutes of work and sparingly.
  
  What I like about it, is again, you're practicing resistance training; using your muscles to grab/grasp the disc and hold on. Even better is that instead of dealing with resistance such as back-pressure from a mouthpiece or instrument, we’re dealing with resistance from the opposite side of the lips (inside the lips) with an object. With dystonia we don't get a lot of ways to practice keeping our strength up because we can't play. So this is one of the various ways I do that; including free-buzzing and mouthpiece buzzing. But these forms of strength training definitely are NOT a replacement for working on ones actual playing, so use it sparingly and only when you feel it really is helping. I like to use it to change things up...as with dystonia, change in sensation and ways of doing things is sometimes a very good thing. I also use it to help with stretches too. And in the beginning stages of recovery I use mouthpiece buzzing and free buzzing in a completely different way than intended and definitely not as a strengthening tool...been meaning to write a post over this too.

• Guitar Foot Rest: I know this sounds weird. But for a while I found this helpful. For a long time I had to play with the bell on my leg, but my horn would always be at a weird angle. By using an adjustable guitar foot rest under my right foot, it helped me get the correct position for the angle of my lead pipe. I could not play with my bell off my leg for years. My dystonia symptoms were way too overpowering in the beginning and playing off the leg was too unstable. I don't require the foot rest anymore, but I do still practice with it at home sometimes because I really like it.

• DAILY MUST: STRETCHES. As usual. Always, always, always!!! Upper back, shoulder, neck, jaw, tongue, face - both inside and out!
  
  I also want to mention something here I haven't posted in previous blog posts or videos, but will soon. Focal dystonia tends to affect our bodies either from upper body vs lower body, or left side vs right side. For me, the left side of my face has less sensory and control than the right side. The right side of my embouchure tends to do a lot of compensating.
  
  It is not easy to find which muscle groups in the face lack more or less control; but one way you can find it, is by practicing very slow natural movements (away from the horn).
  
  For example: Try to raise/arch your right eyebrow very slowly while looking in a mirror. Observe if it feels like it does it independently. Now try to do the same with the left eyebrow and see if it can move on its own as well. What I found is there where certain muscles that I had in my face (depending on the movement) that lacked less control or independent movement. I simply found this by practicing various facial expressions and movements. Try it and see if it is the same from side to side or any areas where things flare up more.
  
  You can do the same with the neck. What is your range of motion? Try sitting with good posture with your back against a wall. Tilt your right ear to your shoulder while looking in a mirror. Observe how far your neck bends and if with ease towards your shoulder. Now try the left side. Is it the same or different? Is there a huge noticeable area of restriction?
  
  Testing basic movement and by practicing stretches GIVES US a layout or map of our areas of lack of function, our restrictions, and our range of motion. This is another area that journaling comes in handy. 
  
  JOURNAL! Journal! Journal! Be scientific! - like Jonathan Vieker says. Observe and record all habits even if it's basic stuff like the food you eat; especially in the beginning stages of recovery or during onset of a possible injury or dystonia. 

• Lumbar Back support: Whenever you can, start implementing back support and relief now! Back pain is mankind’s #1 Achilles heel, and it’s very common to have it with all dystonia types. I use this back support device which comes with a pamphlet of stretching exercises, and two types of back/tissue massage balls (which can also come in handy for myofascial release around the chest and neck area). I also (not posted here) have a back strap device/splint that helps keep my back straight when sitting at a desk and fits under my shirt.

• Neck Traction Device: This helps with my neck tension from my dystonia. It's done SO MUCH for me. I have to use it, including my stretches. For those with mild to light cervical dystonia, you might find this handy. What it does is lifts the upper spine and skull so that the muscles, nerves, and spine in the neck have a chance to stretch out and reset. Gravity over time compresses your spine, especially in the neck area, and for those with neck problems, finding ways to relieve compression is vital.
  
  If I had space and could afford a Back Inversion Table I would get one! You can find one here if interested. This would be great for those with cervical dystonia: https://www.amazon.com/Innova-ITX9700-Inversion-Memory-Lumbar/dp/B00F950N3K/ref=sr_1_24?dchild=1&keywords=back+inversion+table&qid=1593833741&sr=8-24

• DAILY MUST: YOGA. A mat is inexpensive and very portable to take to work or anywhere! That's all I'm going to say here. Some form of movement exercise that helps the upper body; avoid tension-forming exercises like weight lifting, go for more graceful movement such as tai chi, Alexander Technique sessions also help in addition. Also will mention here, additionally, stepping away from a screen or cubicle and going hiking and getting out in nature helps my overall well-being too so much!
  
  
  
  
  
• DAILY MUST: MEDITATION OR MANTRAS. Something to center your focus and mind before you start diving into rehabilitation work. This goes double for those who are just starting their journey. There are several wonderful guided meditation videos on YouTube. Other forms of focus are "Tapping Meditation" or visualizations of relieving tension from areas of the body. It can simply be whatever you find calms and centers yourself; anything ranging from aromatherapy, to sipping tea and listening to music before you start, and just getting yourself into the right mental place of "mindful observation” so that you are tuning into your body with a calm nervous system and not reacting emotionally or critically to the dystonia and instead going with the flow.
  
  Not to get off topic, but it’s important to make time in the day or week to take care of yourself inwardly. The best advice given to me ever was: "Go to work for yourself before you go to work for anyone else!" Put your needs first daily and get into the routine.
  
  So first thing in the morning, do what YOU need; whether that's prayers, meditation, exercises, relaxing, cooking, or quiet time. Don't pick up the phone and don't check your to-do list. I make it a rule of thumb to not check my phone until I step foot in my office at work. I also turn off all push, SMS, and e-mail notifications for Facebook and social apps. They can wait! And I can always manually check it. Don’t need notifications.
  
  I also make it a rule to not reply to any emails after a certain time of the day. And a rule to turn my phone completely off when in the company of others if possible (unless an emergency or awaiting a very important call). If you have things you need to do in a timely manner that day, then set timers and reminders in a calendar or watch or prepare for it the day prior; but do whatever it takes to avoid going into "Sigh! What do I have to do today?" mentality or stressing about all that needs to be done as soon as you wake up.
  
  Learn to put aside that time in the morning to live for yourself. Time management is key and make yourself solitude/alone time a priority. It is your birthright to participate in happiness and take care of yourself first and foremost. 

 

• DAILY MUST: DRINK WATER. Believe it or not, a full 2 bottles before and after ever practice session. It really helps, and LOTS of it! Calming your nervous system helps you tune into your body, but also keeping your body in a state of wellbeing and running on its primary form of energy and cleanser is necessary too. Just like an athlete, or a person doing a intense workout session, or someone doing heavy work, or even going into surgery...we are ALWAYS required and asked to drink lots of water before hand or given liquids as a pre-requisite.
  
  Another quick daily must which I've written about before is upping my dental/oral health; which my water flosser, castor oil, electric toothbrush, and dental kit really help with. I especially love using the tongue scrapper as disgusting as it seems. Where has it been my whole life?!?!
  
  
  

Topiramate: is an anticonvulsant medication and it works by decreasing abnormal excitement in the brain. Usually this is used for seizures.



Oddly enough, I am taking this currently and just started it last week for weight loss. I was SHOCKED to find it carried over and improved my focal embouchure dystonia drastically!!! I'm actually very excited and hoping I can talk to my doctor about keeping me on it long-term if it helps me with my dystonia. I take a very small dosage of it. The only downside of it, is it makes me feel a little tingle all over...so when I practice, the sensation kind of freaks me out, as usually that warrants not a good sign. But she said it's normal. I use to take Tremor Miracle for a year and that helped me also, but too expensive. It is a dietary supplement for essential tremors that you can buy on Amazon.

• Halo Neuro Sport 2: https://www.haloneuro.com/products/halo-sport-2 

This is actually a device I purchased back in January, but wasn’t able to use it until now because my phone was a piece of junk until I upgraded to my first iPhone ever. Woohoo! About time Katie.

This nifty device is actually a Transcranial Electric Current Stimulator! Usually you see neurologist use these in research studies in the form of a electrode cap placed onto someone’s head after covered in substance. Except, this was designed into a portable headset in order to improve motor skill learning of athletes and it is placed directly over the center of the scalp. The electrodes come in the form of a foam band that soaks in water and magnetically attaches to the inner lining of the headphones. The headset connects via bluetooth to an app on your phone which then takes you through stages of priming and electric currents.

It’s quite expensive, but I found it actually helps me a lot too!!! I am way more in control of my playing the day after using it, than days not using it. However, of course being a electric current stimulator, I have yet to build up my endurance in order to use it on a consistent basis since it is quite intense - it really works you out in a way I can’t describe, and it wasn’t designed for brass players in mind, but more for string players as it says. I am hopeful, even though will admit the priming is a bit uncomfortable. Currently I’m slowly and carefully testing it out. But so far, so good!

Okay that is all I have for now! I'm sure I'm forgetting something, but will come back and add more if I remember! I hope this helps and that some of this is insightful, if not interesting! If anyone has any questions, feel free to comment, e-mail, or reach out! - Katie Berglof

Proposal Accepted for IHS 52

I received my proposal acceptance letter yesterday. The lecture "Focal Embouchure Dystonia Rehabilitations: Retraining Strategies" will be on Friday, August 7th at the 52nd International Horn Symposium at the University of Oregon (Eugene).

Focal Dystonia Recovery: Deviate from the Norm

Focal Embouchure Dystonia Rehabilitation BE LIKE: "Without Deviation from the normal, progress is not possible." - Frank Zappa

Chiropractic Work on Neck Begins!

Day 2 of chiropractic work on my back, upper body - shoulders, neck, jaw! Feeling a ton of relief and tension reduced. 20 more sessions to go.

I know a lot of musicians with dystonia say chiropractic help doesn't work. But for me it is important since I've always carried a lot of tension and problems in my neck. I can't tell you how many times people, especially teachers, would tell me to let my shoulders down and I would reply, "I can't. It's not like I'm forcing them into this position. They are bulky and stuck this way. It takes an absurd amount of work to unwind them. It's also the whole upper body that's this way....it doesn't derive in the shoulders."

When I was 15 my neck muscles were so tight that I couldn't move my head/face to the right. My mother who was a nurse practitioner took me to a neurologist because she thought maybe it was something worse because massage and relaxants didn't help. The neurologist said it was too early to tell if I had cervical dystonia, but most likely not the case as it is rare to onset at my age and I didn't really have more of the symptoms associated with it besides lack of range of motion and zingers attacking the back side of my neck/head. The DYT1 gene also did not show up in my blood work, and he said I would have known in early childhood if this is what I had.

Nonetheless they wanted to play it safe and gave me 10 large needles of botox injections around the base of my neck and 2 months of deep tissue massage/trigger point and it went away.

However, the tension in my neck has always been there. I saw a chiropractor briefly in my mid-20's after I was diagnosed with embouchure dystonia, but only because I threw my back out. The only work they did was on my lower back and hips. However, I never thought of using chiropractic work as a means to help with the tension in my neck and upper body.

That is why I've decided to try it now. Especially after I was informed that it is part of what is getting in the way of my recovery. I know a lot of people don't believe in psychics, but I was told by a medical intuitive that the tension in my neck and upper body has always been due to my spine. That it needs a lot of adjusments around my neck to fix it because it's never been addressed. He said it's been limiting me from recovering from the rest of my embouchure dystonia, that it was blocking my jaw movement, including nerves, and contributing to my lack of sensory feedback. This along with continuing my current rehabilitation strategies should show results.

As you know, I already work hard on relieving tension in my upper body through upper back stretches, shoulder, neck, tongue, and facial stretches. My primary form of rehabilitation has been (deprogramming and rebuilding) relieving tension and then finding a window of opportunity to get leverage and work on rebuilding a new neuropathway in that area that feels most natural, along with everything else - modifications, adaptations, etc. The reliving of the tension has contributed to a lot of my recovery, so I'm hoping the chiropractic work will as well.

Right away the chiropractor told me I need a lot of work on my neck and shoulders. He could tell it was pulling on the right side of my face.

Wish me luck!! I wish you could feel how much relief I feel in my shoulders and neck currently. It's surprising how much additional tension is lingering in there

Embouchure Dystonia: Beginning Physical Rehabilitation Strategies for Brass Players II

(Part 2)

Apologies for how spaced out I sound at times. I work overnights and made this video in the middle of the day, so I was really exhausted! I might go back and remake it, but I hope the video provides some insight into what I do.

You can find part 1 here: https://focalembouchuredystonia.blogspot.com/2018/12/embouchure-dystonia-beginning-physical.html

I'll add more as I go along. :-) Thanks for watching. - Katie

Embouchure Dystonia: Beginning Physical Rehabilitation Strategies for Brass Players I

Rehabilitation Methods for Embouchure Dystonia VS Standard Performance Technique Methods - Including Jacobs Method

It would seem common sense that when one is facing embouchure dystonia or even another type of injury, that the rehabilitation process would require both a different approach and mindset focused on the body, rather than focusing on standard techniques to facilitate recovery efforts. Yet, we unfortunately see so many turning to standard techniques to alleviate their symptoms. Even worse, we see teachers and professors trying to help their students the same way.

It is is not anyone's fault that the symptoms of embouchure dystonia are mistaken for bad technique or faulty mechanics (which it is most certainly not the case) because the symptoms are similar to most setbacks in the early stages.

It would help to understand what having embouchure dystonia is like if more musician with the disorder were open about explaining further details and consistently reminding the public that it is a neurological disorder; or to put it in layman's terms - similar to a sensory disorder. Nonetheless, any setback should be approached with less focus on technique.

As Albert Einstein says, "We cannot solve our problem with the same thinking we used when they were created." 

That is definitely not meant to imply that embouchure dystonia is due to negative reinforced thinking, a mental or emotional block, paralysis by over thinking and perfectionism,  or some type of psychogenic issue; which is unfortunately the most common misconception thrown around.

The quote is simply meant to imply that our focus now must be shifted to what the body is telling us and what we can learn from it. In this way our mindset and approach changes to recovery-mode.

In order to become better attuned with our body and what it is asking of us, we must take on what some consider mindfulness, or what I call body awareness. It is an awareness of not what signals or lack-there-of (sensory feedback from our body) are being sent to us as we adapt. It also involves studying our body functions as a whole which can be understood through learning about body somatics, body mapping, and anatomy. To take it a step further, it helps to learn about other physical traumas and diseases to the face, teeth, glands, nerves, muscles, tissue, and upper body.

In brass playing we are limited to being taught about one muscle called the obicularis oris, and sometimes the buccinator and masseter muscles if lucky. Even then, there is little known about what all is actually involved in the use of an embouchure when it comes to form and function. The embouchure is a complex wiring and intricate system involving many small and large muscle groups of the upper body, face, tongue, nerves, jaw joint, skeletal/teeth structure, and lungs. There are many who avoid going into further detail or even bringing the subject of embouchure form and function into lessons.

The teachers that do bring up embouchure form and function tend be very strict about how an embouchure should look and move, and this is usually tied heavily to Farkas studies. Most often their students are the ones subjected to embouchure changes (sometimes drastic changes when unnecessary), which is seen as one of the many possible gateways into developing embouchure dystonia.

With embouchure dystonia, it helped me to deprogram the entire embouchure. Although if feels like the the signals from the brain are causing overwhelming and unpredictable muscles hyperactivity, it paradoxically allowed me to begin understanding how my body functions as a whole through accepting, observing, and exploring the dysfunctional movements that where happening.

I learned how my dysfunctional embouchure functioned in order to start deprogramming "playing mode" and disassociating the "embouchure setting", and then rebuilt from the ground up.

Throughout rehabilitation, it is important that the mindset shift to one focused on curiosity, exploration, with the determination to embrace the hard work, while continually loving and accepting the sound coming out of our horn despite the lack of control and stability.

In order to really understand the disorder as a whole, we must dig deep to find knowledge to support our understanding of embouchure dystonia, as there are few publically accessible and promoted  resources; scientific research, case studies, information on non-traditional and traditional treatments, knowledge on causes and cures of similar maladies or trauma to the face and upper body, and body somatics in one place.

We also must be open yet objective to everyone's views on what has helped or not helped them find progress or recovery, and most importantly we must be in a good place psychologically in order to not rush rehabilitation and risk creating a secondary injury as a result.

Do not underestimate how important a healthy environment can be as well; i.e. not performing in a high demanding group or continually doing performances in the beginning stages that would take away time from investing in recovery efforts and continually putting stress on an unstable embouchure. However, not everyone can step away due to performance demands, commitments, and even harder when it is what provides ones primary income and sustains their career and reputation.

Almost every musician you speak to who has dystonia will bring up the fact that musician's dystonia is a very individualized experience and requires a personalized recovery plan or at least one that adapts to their needs as they improve. The reason they say this is because the truth is that only they know their body better than anyone else ever will. Only they can navigate through the complex and messed up signals being sent to their embouchure, can tell from day-to-day what symptoms have surfaced and which ones are a more subdued over time. Most importantly, they decide what works and doesn't work best for their own recovery.

The most noticeable symptom with having embouchure dystonia is the lack of feedback you receive from touch/sensory. The best example that I can give is that there is no sense of where your mouthpiece should set on your lips (referred to as the "sweet spot" sometimes), no feeling of grasp on the surface of notes, and an overall foreignness in the face while playing...however, this is not to be confused with tingly or needle/prickly sensations...more like a dull lack of sensation, a lack of familiarity, and no ability to taste the notes. The reason I avoid tingly feelings, is because that is usually associated with a different type of injury such as nerve damage, nerve entrapment, muscle tears, or other more severe health issues.

I constantly compare embouchure dystonia to a sensory disorder. Both dystonia and sensory disorders involve a traffic jam of signals from the brain, and both are neurological-based, yet completely different disorders.

I have a weird description of what dystonia feels like. I liken it to a leg that has fallen asleep (without being aware of it). When you try to stand up and walk, you are suddenly surprised at not knowing what part of the foot to apply pressure to, and therefore your knees begin to buckle under because you have no sensation to guide your movement of the entire leg, and you need to slow down and think about what you are doing in order to keep your balance. All you can think about is how much lack of control you have and 90% chance you'll fall flat onto the floor, so you start panicking. In the meantime, there is someone hitting your knee with a reflex hammer every time you decide to move, which makes it even more frustrating and confusing!

Like I stated above, it is hard to grasp just the surface of a note, let alone hold one out. There is definite sense of foreignness and for some they can't even distinguish the feeling of vibration, vitality, or flexibility in the embouchure.

This is why no set detailed rehabilitation method applies to all, nor can cure all. That is not to say recovery is impossible, as there are a few of us who have, and progress is definitely possible if you put in the time and effort.

How is the focal dystonia individualized you might ask? Does it really vary that much? Yes, in the smallest most delicate subtle movements. It also depends on specific symptoms, and what multiple factors may be contributing to that individuals onset of dystonia. It also depends on what effects them the most, and what helps too.

One person might find that using a sensory trick by touching an area of their face while playing reduces or eliminates a tremor on one specific note, or it could reduced in a specific range, or it could only be when they are playing loud or only when playing soft. A 2nd person might find that no sensory trick or geste works, and after trying a medication (that didn't work for the previous person) works for them and they can actually return to playing at a decent level. A 3rd person might have cervical dystonia or oral mandibular dystonia and it led to them having embouchure dystonia symptoms (coming about as a secondary disorder is very rare though). A 4th person might find that their dystonia symptoms reduce significantly after taking a nutrient supplement.

When it comes to embouchure dystonia there are common symptoms that occur; tremors, twitches, air leaks, muscle pulls/jerks, jaw closure/jaw lock/aperture clamping. But when individuals describe their symptoms in detail, about when/where/how they occur, it can vary greatly. Not everyone has all of the symptoms, and not everyone has the same severity of embouchure dystonia symptoms, and not everyone has the same reaction to different treatments.

This is why it is so hard to diagnose. There is also the issue of misdiagnosis. If someone who claims to have embouchure dystonia and is easily recovered within a month, a few weeks, or even a year by focusing on only technique building or solely emotional therapy, it is most likely a misdiagnosis. Also another sign of misdiagnosis is if the musician's core issue is pain. Embouchure Dystonia is not overuse syndrome and does not elicit pain. Unfortunately a majority of musicians who have embouchure dystonia do not make it to a complete recovery, and even fewer return to playing professionally. Most that do report full recoveries spend years or a lifetime rebuilding their neuropathways and tend to have tried or used a multitude of treatments to overcome it.

With all of that said, I want to discuss the importance of why standard performance technique methods should not be used on musicians with embouchure dystonia. I should say that, it isn't that we cannot use certain techniques, but it is the manner of which it is applied.

When you have embouchure dystonia, you can not continually practice working on articulation, range, *air control, dynamics, efficiency/accuracy, endurance, speed, scales, repertoire, etc. Anything that requires repetitive practice/tasks will only further develop the dystonia. Intense playing or anything that requires endurance or advanced skills will only lead to over-exertion. Working on refining our motor skills will only create more tension and we risk creating an injury on top of already having a disorder.

When you have embouchure dystonia, the focus cannot be on anything resembling the Arnold Jacobs Method. "Singing the music in your head as you play....singing through the phrases...singing the pitch...wind and song."

Although I understand the intention of singing transcending technique (like a sensory trick) and how this might help people with embouchure dystonia not focus on the symptoms. However it does not help to completely ignore the dystonia symptoms, as this makes things worse. Also not to mention the fact that the symptoms can't just be "played through", as musicians with embouchure dystonia lack complete control of their playing and don't even have the ability to sometimes hold onto a note for 0.47 of a second.

Visualizations tend to help musician's sometimes. However, I am talking about manipulatives such as mirror boxes for hand dystonia sufferers, or visualizing blowing on hot tea in order to trick the brain into thinking it is doing something else.

That is not to say this method can't work in the later stages near the end of recovery, because I really do value the Jacobs Method and think it should be used more often in pedagogy practices for non-injured and non-dystonic musicians. But for a majority of the process it should be avoided.

Also a huge thing to mention here that Jacob's method is often used to re-establish correct habits via a focus on purely musicality. Embouchure dystonia is neurological. Meaning it has nothing to do with correcting bad habits, our musicality, level of technical mastery on the instrument, our way of thinking - positive or negative, nor is it about overthinking or perfectionism, or have to do with a lack of correct focus on a more musical-based mindset.

It literally has to do with the brain signal(s). Imagine a CD that has a tiny scratch on it, yet this tiny scratch happens to be in a spot that causes the whole CD to skip over several songs. It is like a domino effect or the domino theory; when one signal gets even slightly messed up, the rest comes tumbling down.

My neurologist brought up a theory that makes the most sense to me, even though no one knows what causes dystonia. He said that the human brain might be attempting hyper-efficiency in order to make things easier by streamlining the refined motor skills, but instead this backfires and turns into a maladaptive trait.

As musicians we refine our motor skills over years of repetitive practice, and the brain starts to refine the signal being sent out and our playing becomes more efficient. A scan of the brain's body map of a healthy musician's hand while playing guitar or piano will show the brain recognizing each finger as an individual limb, whereas a scan of the brains body map of a musician with hand dystonia has shown the brain clumping some of the fingers together into a big blob/blur.

Musician's with hand dystonia have a lot more research on their disorder, devices to help with retraining, and sensory tricks. What does help though as a sensory trick with embouchure dystonia in some cases is touching the area of the face where the tremor is happening while playing, and even sometimes mentally imagining they are touching the area where the tremor is happening reduces it (usually a sign of a more generalized dystonia though if that happens). Some find that ice-packing the face somehow allows them to temporarily regain playing abilities....but again, this is dangerous to work with and should be done carefully as it can easily cause other injuries or mask an already existing injury if you are not sure what setback you have. However, musicians with severe embouchure dystonia, sensory tricks do not always work, and the embouchure is more complex and less understood than a hand.

It's as one of my friends said, "The muscles in the face are meant to eat, chew, and talk, not to blow into a tiny mouthpiece and accurately hit a high C over and over again. It is the strangest body part we could use to create music. It an abnormal use of those muscles."


This brings me to my next point. With embouchure dystonia, the focus cannot be on standard embouchure formation function and correction. I won't write much on this because you could write a book on embouchure form and function. But for those who do not know about it, or haven't read Farkas's studies on the art of brass playing and horn playing, there are some commonalities found among healthy and/or professional embouchures. To put it in a very short description - there are two extremes of the embouchure; a full pucker (corners brought all the way inwards and lips moved outward), and a full smile (where the corners stretch outwards towards the cheeks and the lips become spread thin/flat).
An ideal healthy embouchure should be somewhere in between the two extremes. The corner muscles of our lips hold the bulk of the strength and allow the aperture to be flexible in adjusting size (the small opening between the lips). When the corners are working properly, the chin should remain flat and not bunched. The chin can be flattened by bringing the jaw down (and in lower playing - down and forward). If the chin is bunched it causes a lot of problems later on, and especially dangerous as it puts more pressure onto the upper lip which is spread thin, whereas the lower lip needs to provide the stability. The flatness of the chin allows for more flexibility and fluidity when crossing between registers, and it allows us to adjust the lower lip. With the embouchure set up this way we can also hit the center of the pitch more accurately...or as some say the lower part of the note. This ties into air.

With embouchure dystonia even putting the horn up to the face or going into "playing mode" or "embouchure setting" will cause the dystonia to kick in and go haywire. Like I stated above that we must disassociate this link and deprogram our entire body from recognizing we are playing the horn. I go over this in great detail in the video further down and show examples.

*When you have embouchure dystonia, the focus cannot be on standard breathing techniques or exercises (with some exceptions). Again, for those who do not know about standard breathing techniques or exercises, most often in our university studies we are taught about how to properly intake air and exhale it with fluidity while aligning with the metronome.

You hear a lot about hot air, breathing from the lower abdomen and not raising the shoulders, opening the throat, imagining things like inhaling a basketball, sometimes using words like "ho" or "toh", practicing breathing exercises with the metronome and increasing your lung capacity.
Learning about the anatomy of the diaphragm, learning about the difference between mouth/corner breathing and nose breathing, recognizing the sound of proper breathing, and sometimes use breathing devices to train and measure progress

We also learn about how to exhale well supported air and focus it into a solid stream or like a jet-stream or thread of air directed into the mouthpiece, reaching out past the bell and filling every corner of the room, focusing on filling the entire room up with your sound.
We learn about how to use our air to bend the note (note bending/air bending pitches) down (also why the chin being flat and brought downwards is important) digging into the bottom of a pitch against the resistance in order to find the center of the note where it rings and you can hear the overtones. ...again...could write an entire book on this subject.

We also are taught how to use the tongue to initiate clean articulation at the beginning of a phrase on the front of our notes. This ties into tonguing...another area I will save for later. But tonguing must be left out when recovering from embouchure dystonia, at least in the beginning stage and middle stages until the embouchure becomes more functional.

What people don't realize, is that even with strong air support, we are still exerting muscle control and using proper air isn't just all about air, or just all about muscle control and flexibility...it requires both, and there is a delicate balance between the two. I will talk more about that further below.

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

However, when it comes to embouchure dystonia rehabilitation, it is important to not focus on any of the standard techniques listed above. It must all be cleansed away out of your thoughts, as if you were brainwashed and need to undergo an exorcism of some sort. Do not follow or listen to the following Farkas diagram (I did the courtesy of crossing everything out for you and added a not-allowed sign...a bit over the top perhaps...but you get the point). My primary point is that standard technique can only be applied to functional embouchures. Put that stuff away and out of your mind for years to come...it can only be reintroduced way further down the road when you are almost fully recovered.

Whenever a musician who does not have dystonia tries to use conventional standard methods to address your embouchure dystonia symptoms, ignore everything they say, as it will only make things worse. Embouchure dystonia is so far beyond dysfunctional that there isn't a word that exists for it. If dystonia had an ounce of functionality, then normal standard conventional methods/techniques would fix everything easily.

With embouchure dystonia, we must focus on completely letting the embouchure be loose and letting the air initiates the sound before all else; before the tongue, before the embouchure sets, before articulation, before we even try to control it. It is about the air passing through the aperture in its most basic and relaxed natural way, before everything else goes into action.

Most importantly, we do this in order to deprogram the embouchure. Think of it as uninstalling software. Letting air swell up in our cheeks, in our corners, even frowning our corners if have to. We must practice using different muscle groups than what we are use to, and especially ones that release tension and oppose the normal setting we are use to. The goal being to completely deprogram, then slowly start reprogramming. It is a difficult thing to navigate and requires a lot of body awareness and most of journaling/documenting your observations.

I also want to mention that in standard air technique, there is a delicate balance that must be recognized and kept aware of (this actually applies to both musicians who have dystonia and those who don't). That balance is: 1. Is the air guiding the direction of your embouchure? Is it guiding the function of the embouchure muscles and directing them? OR 2. Is the embouchure/aperture guiding the direction of the air? Is it controlling or overly supporting the sound?

Ideally we want a balance of both. But, the air should be the predominant guide always. However, it is not always easy to tell because we are not usually hyper aware during playing or have time to think about it while in action. Usually when you are a normal (non-dystonia) you just play and trust the feeling of ease and comfortability, and sometimes we get too caught up in the feeling that "It feels natural"  that we forget this delicate balance and how easily the tendency to start controlling the air/sound with solely the embouchure starts to sneak in and cause problems.This is where we can sometimes get in trouble if we don't actively try to keep track of what is going on with our body/face during intense playing periods of time.

I'm not saying that this is what causes embouchure dystonia at all...please don't misinterpret what I'm saying. What I am saying is that the focus on letting the air guide the embouchure is one of the several methods/tools we use to re-establish a production of sound out of the instrument, to deprogram, and then reform a connection. But even so, the method requires tweaking, which I talk a lot about it in this video I did over Beginning Rehabilitation Strategies below:

With FTSED our embouchure is easily thrown off by even the action of bringing the right (or left...whichever is predominantly used in playing) hand up to the face (sometimes not even with the mouthpiece). It is because our muscle memory/programming has developed a embouchure setting over years of practice and growth. Eventually when you go to play, the embouchure naturally sets (also called "embouchure setting"). I call this "Playing Mode". It is because we have this embouchure setting that is programmed to react instantaneously and the signal from the brain goes into "set for playing mode." But when the signal is damaged, such as in embouchure dystonia, how can you deprogram the reaction?

For me, the key was to take away everything; the horn, the mouthpiece, even the action of bringing your dominant arm(s), hands, and body into playing posture.

Sometimes focal embouchure dystonia is so bad it carries over to some of these basic actions. The answer is to bring it all back to simply practicing passing air through the lips gently and practicing using opposite movements in our embouchure than what we are use to using. This is most important in the first month(s) and year of rehabilitating. Some practitioners will have you focus on blowing on a windmill, feather, blowing through a straw, while relaxed. Just re-focusing on letting the air pass through the lips without going into "playing mode."

For some who start rehabilitating, this is the key focus in overcoming their embouchure dystonia, whereas others will require more focus on other areas of recovery once they've re-established a sound. That is why I believe some call it "air dystonia" or say that focusing on their air was key in recovery. It continually plays a role throughout rehabilitation; constantly letting the air guide your playing, however, there are other areas that require equal attention depending on your individual symptoms, and I don't want to give the impression that it is ONLY about this act of blowing gentle air support. Recovery is like peeling layers of onion and you've got 99 million problems, and air isn't just one.

Another huge fact that is overlooked is that when an embouchure sets, most of us bring our chin forward a little bit to align with the mouthpiece if we are downstream players (especially when dropping into the very low register on horn) and opens the aperture up more, thus, the sternocleidomastoid muscle along the sides of our neck flex in order to help support the jaw muscles and movement (even if minimal movement). Go ahead and try free-buzzing high and low while keeping one hand or a couple of fingers on the sides of your neck and you will feel them subtly flex. You can try this while playing too and feel it. Try touching both sides of your neck, and touching different areas of your upper body, face, and neck to locate muscles that activate when playing.
Keep a journal of it and what you become aware of....ex. if one area is more tense than another.

I can't say this for sure, as this is only a speculation. Sometimes I think the sternocleidomastoid muscle is overactive or tension more noticeable in certain people due to their individual anatomy or because the nerve connected to the muscle is easily disturbed. I believe this muscle along with the masseter causes over tension in the neck area when playing and sometimes leads to lock jaw, TMJ, or even just a basic restricting of the air flow because the neck tenses up. I know for me, I have to work on a relieving tension in my neck a lot in order to loosen up my jaw and then facial muscles.

However, that is not to say that muscle tension isn't necessary (every muscle in playing requires one to flex, and another to oppose it, as that is how the body works in balance - antagonist and agonist muscle groups), as it is naturally flexed, but that it often tends to be overly tensed when you have embouchure dystonia and I in particular have to take extra steps to massage and relax my upper body muscles.

I cannot stress the importance of focusing on relieving muscle tension (created by the dystonia/ muscles fighting/ signals clashing) through a variety of means, and the re-direction of letting the air stream pass through the mouth gently with no muscle control. When sound is reestablished, then focusing on practicing opposite muscle movements becomes an equally important area. I cover this in the second video below.

This post has gotten quite long and I could write much more, but will stop here. If you have any questions, comments, or topic suggestions, please let me know and I will respond! Hope that this provided some insight into the neurological disorder Focal Task-specific Embouchure Dystonia.

July & August Videos 2018

I have a couple of videos I uploaded. One was made yesterday on the 2nd briefly going over mouthpieces and lower-lip struggles, but the lighting and resolution turned out not so great. The other video covering scales high and low was filmed back in early April, but I hesitated to post it because I really did not look that good and I am angry at myself (health-wise right now). haha! However, I am very proud of how far I've come in being able to add back in tonguing, and moving up and down through each register step-wise/scale-wise. That's all that really matters, is showing my rehabilitation efforts.

Honestly, one of the reasons I haven't been posting as many videos is because of my health unfortunately. I haven't been in the greatest shape, thus my huge hiatus from blogging and facebook in order to refocus on my efforts to get in shape. Exercise is really important to me, and I have been happy with losing 20 pounds since then, yet I have a long way to go still.

Mouthpieces and Lower Lip Struggles with Embouchure Dystonia Part 1

Mouthpieces and Lower Lip Struggles with Embouchure Dystonia Part 2

Scales High and Low, Fast and Slow

  

April: Important Embouchure Dystonia Research Articles, Information, and Videos

MRI Horn and Brass Repository Project (MBRP)
Dr. Peter Iltis is currently directing this research project in collaboration with the Max Planck Institute for Biophysical Chemistry (Gottingen, Germany) and the Institute for Music Physiology and Musician's Medicine (Hannover, Germany). The goal of the project is to research and find ways to restore function in musician's with Embouchure Dystonia, and also find ways to prevent FTSED in general. If you are interested in more information, please click on the link and scroll to the bottom of the page for Dr. Iltis information. Also if you would like to donate to this important research, there is a link on his webpage as well. Currently the International Horn Society executive committee encourages fellow musicians and horn players to support this research if can!

Here is a video of Dr. Iltis speaking in a new video posted on facebook about the research project. And here are further informative videos over his current research below:

American Academy of Neurology Podcast: Sensorimotor Overactivity as a Pathophysiological Trait of Embouchure Dystonia
An interview with Dr. Bernhard Haslinger about his paper published on sensorimotor overactivity in embouchure dystonia.

Activity and Topographic changes in the Somatosensory System in Embouchure Dystonia
I believe I've posted this before! But here is a more condensed overview of this research publication by Tobias Mantel MD, Christian Dresel MD, Eckart Altenmuller MD, Claus Zimmer MD, Jonas Noe MD, Bernhard Haslinger MD ( <-- Who was speaking in the previous podcast link above).

Allegro: Foundation is Created to Assist Musicians with Dystonia
This is an article from the year 2000 when Glen Estrin and Dr. Frucht founded the Musician's With Dystonia Foundation. It has Dr. Frucht's contact information, and talks about how they assist musicians with information on how to get health care coverage, and where to go when they need a diagnosis. "Dr. Steven Frucht of the Columbia Presbyterian Medical Center Movement Disorders Clinic may be reached at (212) 305-5277...for further information regarding Musicians with Dystonia Foundation, send e-mails to musiciandystonia@aol.com."

Clinical and Epidemiological Correlates of Task-Specific Dystonia in a Large Cohort of Brazilian Musicians
This is a general study on focal task-specific dystonia in musicians around Brazil. The study was conducted by Rita C. Moura, Patrcia Maria de Carvalho Aguiar, Graziela Bortz, and Henrique Ballalai Ferraz. 49 individuals were diagnosed with FD (mean age 26.4 years; 92% male). The instruments most associated with FD were acoustic guitar (36.7%) and brass instruments (30.6%). They concluded that Brazilian FD music players were mainly male, classical music professionals, around 30 years of age, with arms, hands, or oromandibular muscles affected. They end their study by stating that Musicians Focal Dystonia should receive more attention from musicians, teachers, and health professionals.

Worlds First Focal Hand Dystonia Patient in Japan Treated with Focused Ultra-Sound (FUS) Enabling Musician to Play Again
I was quite interested in this and contacted Nadia Scantlebury at SunnyBrook about a current focused ultra-sound study that was going on in Canada. Unfortunately they are only letting Canadian citizens participate. However, she did mention that there is a focused ultra-sound research study or trial going on at University of Virginia. Here is a list of all their current trials going on with focused ultra-sound! If interested, you can contact them directly.

From Embouchure Problems to Embouchure Dystonia? A Survey of Self-reported Embouchure Disorders in 585 Professional Orchestra Brass Players
This research was conducted by Anke Steinmetz, Andreas Stang, Malte Kornhuber, Marc Rollinghoff, Karl-Stefan Delank, and Eckart Altenmuller. "The final publication is available at link.springer.com.

Music and Medicine: A Research Model
These are slide presentations by professor Karendra Devroop of the School of Music and Conservatory at North-West University that cover a variety of music performance-related injuries, disorders, research, knowledge, and statistics. I highly recommend reading it, as it covers a wide variety of very important information we can all benefit from as musicians. Raise awareness!

Review: Music, Motor Control, and the Brain. By Eckart Altenmuller, Mario Wiesendanger, and Jurg Kesselring. 
You have to have a Jstor account in order to read this! Easy to sign up, and easy to access this article, as it is a free read. I highly recommend a Jstor account anyways!...so many articles and quality information.

Carmine Caruso Method Adapted and Taught by Julie Landsman
Last, but definitely not least!!! These are some of my favorite videos to watch. I actually started using the freebuzzing/mouthpiece buzzing exercise video in rehabilitation, as it helps me a ton!!!

The Recovery

Freebuzzing and Mouthpiece Buzzing

The Six Notes

The Harmonic Series

Carmine Caruso Method: Introduction with Julie Landsman

Note Tasting

Noodles

Spider

Intervals

Dynamic Studies

Low Register

Snakes

More Alternative Medicine/Therapies (Part 3): Body Movement Awareness Methods (Somatics), Modifications, and Musical Exercises for Focal Embouchure Dystonia

(PART 3) External Modifications to Playing

A couple of external modifications have helped me with my dystonia. As I progressed the modifications changed over time. Here are some examples...

• Playing with the bell on the leg or off the leg...
  As a horn player (pre-embouchure dystonia) I had always played off my leg. But with embouchure dystonia, it was the complete opposite. I started rehabilitating on my mouthpiece only, and later on in the processes moved onto my horn and found that playing on my leg made things significantly easier. It was as if I had more control and my embouchure didn't have to adjust to any slight external movement that I would have had to deal with if I played off the leg. As I improved over time and regained more abilities, I found that switching back and forth between playing on the leg and off the leg was both helpful, but it just depended on the way my embouchure was feeling that day. With embouchure dystonia, you're highly sensitive to what helps you and what doesn't (even if it is just the slightest tiniest modification).
  
  When I started playing on the leg, it formed a type of  crutch for me. That's what all these external modifications are...everything is a crutch (i.e. something you rely on or lean on for support) in the beginning of rehabilitation. As I regained more control of my embouchure, I didn't need the crutch as often, so I started switching back and forth between playing on the leg and off the leg depending on how my embouchure felt. Some days it felt easier to play off the leg, and other days I couldn't play at all unless I balanced my horn on my leg.
• Using a mouthpiece with a good amount of back-pressure...
  When I first started rehabilitating, I didn't even play my horn. I focused on mouthpiece buzzing ONLY for several months, maybe even a year? and NO tonguing, and NO breath control. In one of my previous posts I wrote about how I basically had to deprogram that feeling of automatic "playing-mode" because once my body was aware that I was physically playing, it completely tensed up or locked up. Therefore, I had to forget about everything and just focus on breathing out normally (without thinking about it and without preparing my lungs through breathing exercises...just let it all go!), and also focusing on just buzzing through very loose lips, even if it meant frowning or scrunching the chin...just playing with the flabbiest most loose lips possible. But sometimes my muscles needed to stretch and squeeze...so I started doing stretches, because sometimes I had to give into the tension I felt and just squeeze my facial muscles into contorted expressions just to relieve the tension...kind of like trying to get rid of a huge muscle cramp. So later on I realized how important it was to do facial muscle stretches first, and then focus on flabby lips in buzzing.
  
  About needing a mouthpiece with back-pressure. It was necessary for me to play on a mouthpiece that provided a little more resistance than normal, because again, it provided a crutch for me. It was much easier for me to buzz and get a sound out. I had less spasms and more control. It may have not been that much more control given, but it was significantly noticeably more efficient than playing on a free-blowing mouthpiece.
  
  Lucinda Lewis does something very similar called blocked-buzzing. This is the best analogy I can think of to describe why the resistance or back-pressure is necessary in rehabilitation. She said that one day when blowing into a soda bottle and looking into a mirror, she realized that because the air wasn't being allowed out of the bottle, it resulted in air resistance against the lips. This air resistance made her embouchure muscles form into a natural embouchure because there was no room for the muscles to relax, they had to fight the air resistance.
  
  It's like jumping on a trampoline. If you are jumping on flat ground, your leg muscles have to carry a lot of your weight, and it takes a great deal more muscle strength to jump on flat ground and it's a lot harder on your joints. But if you are on a trampoline, you are still using your leg muscles to bounce in the air, but it is significantly easier because the trampoline-springs provide that extra back-pressure or support. You push your legs against the trampoline mat and it pushes back, and it's the trampoline's resistance that shoots you off into the air. It's the same with mouthpiece back-pressure! You push up against the resistance and it helps by pushing back, and it's as if your embouchure muscles don't have to try that hard to function.
  
  This only works in the case of embouchure dystonia, because of course if you don't have embouchure dystonia then more back-pressure or resistance just gets in the way. You feel the opposite; like you're trudging through mud and having to work harder to play higher and louder because there is no flexibility. But with embouchure dystonia, we are just focused on trying to hold onto a note without our muscles giving out, spasming, or fighting back. So the back-pressure of the mouthpiece helps us hold on to the note(s) for a split second.
  
  Later on when I didn't need my heavy back-pressured mouthpiece as much, I kept switching back and forth between one that was less resistant and the one that was more resistant. It's like learning how to walk again. Sometimes you get to a point where you don't always need a crutch to walk, but sometimes you do! Some days you feel great, and other days you fall back on your crutches because you're exhausted or the stamina just isn't there from working so hard.
  
  Eventually I reached a point where I felt my muscles actually start to work or that feeling of "kicking in". If that makes sense? I started to see my muscles try to form a stable embouchure without me even trying. It was never forced. But when it did happen, it grabbed my attention.
• Using your right hand to hold your mouthpiece and closer to your mouth when buzzing...
  As a horn player I'm so use to holding my left hand up when I play, that actually buzzing with the mouthpiece in my right hand helped me lessen that "automatic horn-playing mode" that I was working so hard to get out of my body. In a way it is kind of like a sensory trick (neurologist use sensory tricks to help trick the brain into thinking that it is doing something different). It may not seem like it makes a huge difference at first, but over time I found that buzzing out of my right hand helped lessen my spasms.
  
  Also holding the mouthpiece around the cup or closer to the rim with my fingers/hand allowed me to have more control. Usually we are taught by our teachers to hold the mouthpiece with only two fingers near the end of the shank so that way we use more of our embouchure muscles and air to control the buzz, rather than relying on pressure. But with dystonia, the opposite is necessary....we need to help our embouchure out by holding the mouthpiece in a secure way. If we try to buzz while the mouthpiece is loosely set upon our lips, it's a million times harder/worse and brings out the spasms and dystonia symptoms even more. At least this was the case for me! So I absolutely had to do whatever was most comfortable for me and allowed me to work with my dystonia symptoms....none of the traditional methods of playing or pedagogy could help me...I really had to completely ignore or unlearn every so called "good" habit ingrained, and instead had to trust my body and allow it to tell me what to do. I had to be highly in tune with my dystonia symptoms and how they functioned.
  
  Again, as I improved, the less I needed the sensory tricks and crutches to help me play. But these steps were absolutely necessary for my recovery when my dystonia symptoms were at their worst.
  ....same goes for when transferring over to your horn. Try playing your horn with the right hand, and no use of tongue! 
• Playing Stop-Muted
  Playing with a straight mute or practice mute in the bell made my symptoms worse. But stop-muting the bell with my hand actually helped. I don't know why the sensation of the stop-muting helped, but I believe it helped physically and also with my sound. I always sounded much better stop-muted, so I practiced this way about half-way through the second year of retraining.
• Playing With or Without a Mirror
  Before I was diagnosed, I was constantly looking in the mirror at my embouchure when I practiced because it looked as if all of my muscles were melting or becoming distorted. I became too obsessed with trying to correct my dysfunctional embouchure at first; by trying to flatten my chin and straighten my corners, but nothing was working.
  So throughout the first part of retraining after diagnosis, I had to focus more on feeling things, rather than looking at my embouchure in the mirror. However, I eventually did need the mirror, because it did help me become more aware of what my symptoms were; I could see where every little twitch/spasm occurred and on which note. I could see when the left side of my lower lip started to droop, etc.
  It was important to use a mirror, but in moderation, and only when I became less analytical about trying to "fix" my embouchure. It wasn't until I started to focus more on "feel" that I could start using the mirror more often to observe my symptoms.
• Playing other instruments
  At first this didn't help me. Actually it didn't help for quite a few years. But after regaining some abilities. playing other instruments started to help. They helped condition my muscles in a different area or way, and this allowed me to transfer those adapted muscles and use to my horn playing.
• Changing Mouthpiece Angle
  Constantly changing my mouthpiece angle to find a more comfortable position helped greatly. Even though the angle and position of my mouthpiece changed almost every 2 minutes or every day, it still helped to experiment and seek out a spot on my lips and angle that helped me regain more of a grasp on my notes.
• Sensory Work
  This should actually be logged under body-movement methods, because it deals more with retraining your sensation  - sensory tricks or body mapping.
  
  Practicing using non-focused air is key! If you can get either a small windmill to blow on, or a feather, this will help. Practice blowing with loose, wide, and unfocused air coming out of your lips. Think of the type of air you huff and puff when angry....if your lips and your cheek/facial muscles are truly loose, then you should feel the air fill up both cheeks a little, or the air will fill up and puff out near the corners of your lips, or even lower near your chin.
  
  Practice putting things up to your lips; like a spoon touching the surface of your lips, or practice blowing through a really wide straw (like the ones that they give you for bubble tea). It sounds silly, but it's a way of desensitizing your body and brain from constant "mouthpiece/automatic horn playing mode." When your brain realizes that not everything you put up to your lips is a horn, it helps. Because that's basically what it is doing. I had so many problems with drinking from a water bottle or even a coffee cup with a cap on it, just because my spasms would kick in as if I were playing the horn.
  
  Holding bubbles of air in my cheeks and mouth helped a lot to (just don't fill them up too much because it can actually open or damage a gland in your cheek, so be careful). 

There weren't too many external modifications, but the ones that I listed helped me. The exercises that I will write about next are what helped me tame my dystonia symptoms the most.

Ice Packing VS Heat Packing

Article Post: When to Use Hot and Cold Therapy

Every now and then I come across musicians who either swear by ice packing or heat packing (or both, like I do!)......or the opposite...they absolutely refuse to do it when injured, mainly due to misusing one or the other because they were not trained on how to properly ice pack and heat pack, or they heard from a professional musician who misused it...yes, even professionals make mistakes (because not a lot of musicians are trained in how to physically take care of injuries). Therefore, I wanted to share this medical post from the University of Rochester Medical Center over the benefits of ice packing and heat packing and when to use either. 

I feel it is vital to ice pack and heat pack if you have a new or old injury to your embouchure. This post shows not only how to ice pack and heat pack, but when to use it, how long, and what exactly happens to your tissue. I hope this helps many musicians who are newly injured or who have a old injury but still experiencing pain, to heal a bit! Or at least prevent further damage. :-)

Month of March Research Articles

Apologies for not imputing much into my blog this year! My first year teaching has been one of the most challenging, yet rewarding blessing in my life. I'm finally doing what I love, but do feel a bit sad over not having enough time to tend to my blog. This blog means so much to me! I'm writing to you from the desk in the photo...I finally have a place to work at home. Until summer rolls around, I'll be posting mainly resources/research articles.

Here are two research articles I've read recently. I'm been searching a great deal to find information over tests focused around the somatosensory part of the brain in musicians with dystonia. Last month I posted an article that explains what acetylcholine is and how it supports the CNS/PNS systems (and the somatosensory cortical neurons).

The first article below is pretty self explanatory; how we should focus on somatosensory, as it may be another key component in research on musician's dystonia, and what these researchers have found. The second one involves some EMG electrode work in stimulating muscles of musicians who have dystonia and how this has helped restore sensorimotor organization.

That is all for now! I will post more if and when I can. Thank you to those who have reached out...I promise to be in touch as soon as possible.

Focal Dystonia in Musicians: Linking Motor Symptoms to Somatosensory Dysfunction

Regaining Motor Control in Musician's Dystonia by Restoring Sensorimotor Organization