Myofascial Release and Focal Embouchure Dystonia

Answering a question asked during a live-stream about how to do the myofascial release stretches/tissue work:

Part 1

Part 2

Part 3

Jonathan Vieker: McGrail Lip Exercises Post-surgery for Ruptured Obicularis Oris (Embouchure)

Wanted to share another great post by Jonathan. The exercises are very similar to the stretches I do. You can find his awesome blog and post here.

Some Alternative Medicine/Therapies (Part 1: Non-traditional Medicine or Treatment) for Facial Pain, Trauma, and Dystonia

PART 1: NON-TRADITIONAL MEDICINE OR TREATMENTS

Happy post-day-of-Halloween! Here are a couple of things that may possibly support the recovery process for various facial ailments such as TMJ, Nerve Damage, Muscle Tears, Bell's Palsy, and Focal Embouchure Dystonia.

Again! These do not cure, nor is there any guarantee that this will help you. There is research on some of the methods applied to specific issues, for example - Bell's Palsy and Acupuncture, which can be found online.

However, embouchure dystonia doesn't leave you with many options, and when there is no known cure, one cannot help but do what is natural and test/observe various treatments through trial and error in the hopes of finding a small glimmer of hope.

It is important to realize that there are few musicians with dystonia that go out on a limb and share their personal process and do trial and error publicly. It is important to share the process, even if it cannot be applied to all. It is my hopes to bring more awareness of this disorder and provide a rare look at what this disorder can be like by sharing my own experiences. Although my experience is subjective, I am someone who thinks objectively, therefore I posted the statement above.

•  Acupuncture, provides blood flow/circulation to specific areas and activates the nerves. I received acupuncture for once a week, for a year. It wasn't until about my 15th session I started to feel and notice drastic improvement in reduced tension overall in my face. It cost about $65.00 a session, and my acupuncturist had a passion for helping people with facial trauma.
  
  She had previously helped many people overcome Bell's Palsy, Nerve Damage from car accidents or injuries, etc. She also was certified in John F. Barnes Myofascial Therapy, so that was also included in my sessions.
  
  Just a note of caution though: I did find that the acupuncture made my nerves in my face very overly sensitive and it took about 2 years to fully wear off. At times it limited me from playing because my muscles were so loose (like jelly) and my muscles/nerves could only handle so much playing. I had to be very careful when working on my playing. I also would not suggest playing at all if you are receiving re-ocurring acupuncture treatments because the acupuncture is actually quite exhausting on the face because it is bringing in so much blood flow to a centralized area. Most acupuncturists will tell you to drink lots of water and to rest a lot after receiving treatment.
  
  I also would say that if you are going to try acupuncture, to consider doing as a last resort. Although I felt it helped me in the long-run, it was scary how overly sensitive my muscles and nerves became. The best example I can give is if you received a muscle relaxer. It feels great and there's not tension whatsoever left, but you're also left with no endurance, strength, and the muscles and nerves are much more sensitive to playing and get twice as sore. So please be careful. Maybe don't do a years worth of acupuncture and only do it 2 times a month or not every month.

• *Oral Myofascial Release (MFR), which released built up/rigid connective tissue or fascia in the jaw-joint and muscles surrounding the face. My acupuncturist was a specialist in John F. Barnes technique of MFR, which is a much gentler approach to releasing the tissue tension than the traditional way. Typically they will wear a glove and push their fingers against pressure points inside of your mouth (in the cheek or back of jaw) and they hold it for 2-6 minutes until the tissue releases; this is highly painful but extremely relieving afterwards.When I think of the jaw-joint, I compare it to the wrist-joint. A lot of woodwind players or typist get carpel tunnel, which is connective tissue built up in the wrist. The same thing can happen to our jaw-joint...it too can build connective tissue and cause our jaw to be unaligned, in pain, cause TMJ, or build more tension.
  
• *Rolfing - I haven't received rolfing, but wanted to list it here. It is very similar to myofascial release to an extent. It is a holistic system of soft tissue manipulation and movement education that organizes the whole body in gravity. It is essentially identical to structural integration. The difference between myofascial release is the cumulative process over ten session. Althogh myofascial release techniques derived form the work of Ida Rolf, it does not have the same strategic planning as rolfing. The various parts of the human body relate synergistically to each other, therefore rolfing integrates the whole body or various parts of the body, rather than focusing on one central area.
  
  *I've listed Myofascial Release and Rolfing also on my blog post over Body Movement Methods too. Since it crosses over into that area as well.

• TENS unit, which sends electric pulses that interfere with the signal of pain being sent to the brain, it stimulates the nerves and endorphins, and helps control pain. This allows the muscles to relax instead of being in a state of contraction all the time (which dystonia causes our muscles to be in a state of chronic contraction...therefore the TENS helps me a lot). I use to receive a light does of TENS unit or electromagnetic therapy in acupuncture, but it wasn't until I started seeing a neuromuscular dentist that I used a heavier dose of TENS unit therapy which helped me tremendously. Now I  even have my own TENS unit at home after borrowing a friends for a while...decided I needed to invest in one for long-term relief.
  
  I feel like the TENS unit is more effective than acupuncture in relieving tension. Acupuncture was too over the top. Whereas TENS unit I can control the strength of output, and it doesn't overly-relax my face to the point of weakness. It helps relieve the right amount of tension. It takes time to get use to knowing how to use it and works best.

• Po Sum On Oil, which can help with many ailments, including neuralgia. It provides deep muscle pain relief, headache relief, etc. It consists of Peppermint Oil 45%, Dragon's blood 1%, Cinnamon oil 1.5%, Camellia oil 100%, and Methanol 15%. It only cost about 6 bucks or more for a little bottle which will last forever. 

• Ice packing/Heat packing. Alternating the two is highly important! Sometimes I will drink hot tea instead of heat packing, and then apply ice pack between drinks. I'll hold the tea in my mouth so that it warms up all my muscles.

• Facial Muscle Stretches. i.e. Making certain facial expressions or movements to help relieve tension. I have various names for them too like duck lips/goldfish lips, the scrunchy face, the clown-frown, the angry brow, marshmellow cheeks, the horror screamer, the side-grin, etc. 

• TMJ Jaw Stretches. i.e. Specific jaw stretches that help the mandibular joint. (I'll try to find a link to post on here of some stretches I use)....also buying a mouthguard may help relieve jaw pressure, even if you don't have TMJ.
  
• Tongue Stretches

• Neck and upper back stretches, which help relieve tension and keep the muscles flexible in the neck and upper back. (I posted a link somewhere in one of my posts on the stretches I use, I'll try to find it and repost it here)....this is important because the neck and shoulder muscles DO pull on the jaw muscles. They are all connected and work together. Think big picture! :-)

• Taking off as much external pressure on your upper body as you can. Ex. Not wearing backpacks, heavy instrument cases, non-supportive or constricting bras that may dig too far into the shoulder, baby slings, avoiding lifting heavy things that require the shoulders or upper back. If you have pain at all on a certain side of your face, avoid sleeping on that side. If you have clenching problems with your jaw, avoid putting any pressure on the bottom of the chin/jaw when sleeping and practice holding the tip of your tongue in between your upper and lower teeth...this takes the pressure off the jaw immediately. Even if keeping your hair down and not pulled back it into a bun helps lessen muscle constriction on the face/head, then do it. 

• Taking daily vitamins - keep your body provided with enough nutrients. I take women's one-a-day, and also GinkoSmart, and sometimes Fish Oil. There's also men's-one-a-day. It just depends on what your body needs or what you think will help boost your nutrients. It can even be in the form of a shake.
  I also write a blog on natural supplements.

I'm hoping to come back and add more to this post, because there's quit a bit more detailed information I'd like to share about each area. But for now, if you google any of the things I listed, you should find a wealth of information. 

Berklee College of Music: A New Understanding of Overuse Injuries by Dr. William F. Brady, D.C.

I just had to share this amazing find! It is an article titled: A New Understanding of Overuse Injuries by Dr. William F. Brady, D.C. Please read the article linked, because it provides a new way of looking at overuse injuries or repetitive strain. I highly recommend it.

I find this highly fascinating because my acupuncturist and myofascial therapist told me a similar thing when I went in for treatment. She said that part of my problem was built up connective tissue in the back of my jaw. She felt around my face and the inside of my mouth (I know, weird) and said I had an overwhelming amount of it.

So I basically went under several months of myofascial release therapy where she released the connective tissue from the inside of my mouth by using pressure. The connective tissue started in the middle of my cheek and went back deep into my jaw and even as far back as the corner of my lower jaw. Equally important is we worked a lot on releasing tissue and tension around my whole upper body, and predominantly around my neck.

Many other forms of therapy such as rolfing and feldenkrais use similar methods of helping the body release tension. It was very very very painful releasing the tissue. But! It was definitely needed and it actually changed the way my face looked and felt (my right side of my lip and face looks more equal to my left now without the upper lip pulling back and upwards on that side, which gave me a weird appearance). I wish I had known about it before, even as a non-injured musician in the past! A professional European horn player told me that he also received this, even if he isn't injured because it's important to take care of the body. Warming-up is always not enough.

We have to treat our bodies like athletes, even if it's use of smaller muscles. A lot more goes into playing than we give credit because we are not aware, and tension can build up over the years....and not necessarily because we're doing anything wrong, but because it is natural. Some people can take a beating for years and years and not feel anything, whereas others are more prone to overuse because of their physical makeup, or even genetics in the case of onset of dystonia.

We just have to take extra measures that are not traditional to keep check on tension....which is hard to do since most often injuries sneak up on us and slowly degenerate our ability over time before we are even aware of it.

Also a lot more muscles come into play than we know. Most brass musicians consider their embouchure as only the use of the muscles around the lips, and never understand the actual anatomy or function of the muscles in the face (where the muscles connect to, what each on initiates) and that the neck and upper back muscles make a great impact on your playing too, since they tie into the facial muscles and nerves around the jaw.

Additional notes: Thank you to Scott King, DC for getting in touch with me! If any injured musicians are in the Denver/Colorado area and looking for soft tissue diagnosis and treatment, Scott is available and has trained with Dr. Brady who wrote the article I shared above. I offered to share his contact information below:

Scott King, DC
Novo Soft Tissue & Spine

720 S Colorado Blvd Ste 610S

Denver, Co 80246

(303) 990-0159

May Video Blog

This video was done on a whim, but I think I covered a couple improvements in the short amount of time filmed. Next time I'll use a tripod. haha! Will try get on here when can. :)

Stretches, Deep Tissue Massage, Myofascial Release, and Horn Playing

Two sessions ago I had some tissue relieved around my back. After that session I had all the soreness and tension move up into primarily my neck. I felt like the contractions around my neck were so strong they were choking me (I'm being overdramatic, but it really did hurt). I could feel a lightening like shock start from the back of my head, run down my neck, and into my shoulder blade and right shoulder. This happened everytime I tried to turn my head to the left. I didn't have tremors, but if I tried to pull my face to the left and hold it there, a spasm would creep up and jerk my head to the right. I knew this feeling in the past....

It felt very similar to my encounter with neck dystonia in the past. I kind of got freaked out. I asked my doctor about it and they said it was definitely a pinched nerve, trapped by the surrounding tissue. We were doing everything we could to release the tissue in the places I felt either pain, soreness, contractions, spasms, or tenderness. But just recently it had flaired up in my neck.

So this week I've had a lot of deep tissue massage to help loosen up the tissue in my back, shoulders, neck, and lower jaw, then combined with acupuncture, and myofascial release. My neck feels so much better now!!! I can still feel the nerve a bit irritated in the right side, but there's definitely been a softening of the tissue. My shoulders and neck have never felt this light, relaxed, and fluid....like butter. My right side is of course still a little tense in areas. 

This most recent acupuncture session was very good. She said there's been a significant break-through. We made great progress. She was working on loosening up the tissue right on that fleshy mound at the back of my neck. She did some type of stretch with my lower jaw and was also pushing on tissue back there, and there was a huge release. We also did a lot of needles around nerve points. My skin has been red for 2-3 days straight now. She said that was normal though and that this is great news because it means the blood circulation is consistent now, and that the pink around my face will go away in time, but for now it is a good sign we hadn't seen before. I also was very lucky to receive a device that will help me at home. 

I'm feeling really good right now. The pain in my face has gone down significantly, and I only feel slight throbbing up near the sides of my eyes along the zygomatic nerve. Otherwise most of my tension and pain is still in my neck and shoulders, but less intense than before...wayyyyy less tense. One a scale of 1-10, my pain before was close to a 9, and now it feels more like a 4 or 5. Again, I'm not playing my horn at all. I'm not allowed to until my body is 100% free of pain, soreness, muscle contractions, and spasms. 

I've also been doing stretches to help with my muscles around my upper back, neck, and shoulders. Here are a couple that help me out a lot (I tried to find them online as best as I could), and have done wonders for me within the last couple of weeks:  

Also this too ---> :) Link: Upper Back Stretches

Treble Clef Range and Adding in Tonguing Begins!!!

I've been so happy since the recording of my last video! That recording went amazing and captured a lot of the exciting improvements! But even more exciting, is the fact that there's been more progress made since then. I will record a video soon! Lately I've been able to go higher, and noticed my chin finally started to flex more in my treble clef range. It's working hard just like it did in my middle range before. My lower lip that was sticking out, is much more flexible now, and I feel I have a little more control over it. I can practice for about 2 hours before my endurance is shot.

The downside about improvement as I am able to finally venture higher into my range is I have to take an even longer break after practicing. I have to take 4-6 days off just to make sure my face feels refreshed and ready to go again. I'm being very careful.

In the past, I was very concerned about how long I ventured into my treble clef range because it often, if not all the time, caused tension to build back up quite fast. I spoke about how if I played in my treble clef range for a bit, and then tried to jump back down into my low range or mid-to-low range, it would be difficult for my embouchure to relax again and for the tension to go down. Playing in my treble clef range (i.e. from space F up to space C) was very taxing on my facial muscles before. It also effected me in the way that I could play a repetitive passage in my treble clef range for a couple seconds before the tension took over and my embouchure collapsed. It was a huge combination of the tension restricting me, and lack of endurance....so two separate things, yet, both effected me when I ventured higher. 

The tension from the dystonia is harder to tell how it effects me in my higher range, since you can't see any involuntary contractions, or twitches, but you can tell it limits my mobility as my face seems to have a hard time just relaxing in my higher register, and my chin, just like how it use to react to my middle register, couldn't make up it's mind on whether it wanted to flatten out or bunch...it fluctuates as I hold a note out. 

However! Recently these issues have been lessening since last month. Today during practice, I noticed my endurance was a million times better than usual. As well, even though I felt tense in my face and thought maybe I was going through another relapse, it didn't take long to iron out the tension. Then after the tension was relieved, I noticed how much more the control of that lower lip sticking out was improved and felt less limp, and the movements in my face as I tongued was a ton less than before, and the movements in my face when I jumped around were less of that "stuck in the mud" type of feeling, even on my open harmonics it's less noticeable movement and difficulty in my playing. My muscles don't seem to be freaking out as much as they usually do, nor does it take a long time to relax them after playing in a higher register. The air leaks in my treble clef range didn't kick in until about 2 hours into practice, and also didn't show up on my "space C", but on  my "line D"...so my range has expanded one more note! WOOHOO!!! :D I can usually play up to a high F, but my lack of endurance restricts me to only be able to reach the note 2 times if lucky. But, I can usually go through a practice with a range from "space C" all the way down to "pedal B" right below pedal F. 

A lot of people might think...you can practice for 2 hours? Then you must have good endurance. Not necessarily. With dystonia, practicing for 2 hours includes a lot of breaks and waiting...a lot of stretches! More stretches than practicing, and also taking the time to message my face inside and out, or even eating ice or putting some in the side of my cheek while I take a break, and playing in my pedal range to relax.

Majority of practice time is spent on relieving the tension, and the last quarter (sometimes it's half and half) of my practice, near the end, I test my larger interval motions, or melodic passages, or test to see how my tonguing, etc. is, and I'm always doing warm-down or lower pedal playing exercises between treble clef playing just to make sure I counteract the high playing with lower vibrations/playing ...I feel the pedal range vibrations around my embouchure help relax the tension. I feel this has been a huge part of my recovery too! Thank god for my pedal range. It is my life safer, along with buzzing, and stretches. 

Now that I feel it is safe to, and my muscles are adjusting to my treble clef range. With much carefulness, I am now beginning to focus on adding tonguing back into my playing, and holding notes out in my treble clef range....and of course...this requires the emphasis of good breath control to support it all; which thank god, I'm also able to do now. 

I can't wait to record my next video!!!! However, it may be in a week or 1.5 weeks, since I need time to rest. So far things are going great!!!! I will be reconnecting my blogger account with my google+ profile since I quit facebook. I need to focus more on myself, and getting things done. Be back soon! 

- Katie! :) 

July 31st Working with Relapse Symptoms - Vlog Practice

 Yay! Finally got a video up. Haven't been able to find a place to record since moving to Denver. Luckily University of Denver music building was open yesterday evening...first time I heard myself play out loud/outside a mute in a longgggg time. 

Yesterday's session was pretty rough due to the relapse symptoms. But good that I captured it on camera...approx. 1 hour and 20 minutes of playing. [Also, I'm going to upload a video of what my playing is like after the relapse has passed; Link will be highlighted -->here ...as soon as it's posted.] 

You can see the areas where I struggle the most with the symptoms, but also how I work at ironing them out/reducing them. Tried to not talk a whole lot...but you know with me, I love talking/writing.

Anywhoo, here's the videos!! Lots of slow methodical practice. I was happy with the work done!!!







Part 1 - prep-work...and pedal range (working way upwards)

Part 2 ...more pedal range work and middle register, etc.

Part 3 - ...a bit of excerpts near the end. Thought I'd have a couple seconds of fun! :)

Part 4 ...arpeggios/open-harmonics, and octaves.

Welcome Back!?!?! (Some Observations)

The view from my balcony!

My visit to DU with a friend.

Between my place and Boulder

Part of my work is in Glendale.

Hey everyone! It's been forever  since I've updated my blog. I started work in Denver on May 5th. It's been a little over a month since I last was on blogger. A lot has been happening, and I'm definitely busy still getting all my ducks in a row here. So far things are going great!!!!!! I'm all moved into a beautiful townhouse near red rocks, have been meeting/playing guitar with some local musicians, have lost 15 pounds (Yay!!!!), got a couple of students, and will be coaching a brass section in the fall. I'm excited!!! Especially for next year too at CU! :)

As far as my dystonia, things are still going good! I haven't been able to practice as much as I've wanted to, but this has been beneficial as it's paced out my practice/playing schedule; a break is always good now and then as long as I feel physically it doesn't makes things worse...and at this point in time, a break doesn't hurt me. It's like my friend Rhodri says - Recovery is up and down, but in general it's constantly on an upward scale. As I've slowly recovered, I'm obviously more of a believer now than ever before that I'm able to overcome embouchure dystonia. I can rest assured that improvement is on it's way every step I take and that there is no need to rush or worry like I had definitely done in the beginning/past. Yes, it's been painstakingly slow, but I look back and see how far I've come...and I know it is not all for nothing. I'm halfway there or more! :)

Today I was practicing, and I have some observations to note. I'm still working on my paper by the way! I had to post this on here though since I can't record. I don't have a practice space where I can play openly and record. I'm practicing with my silent mute at home, and because I have very close neighbors. I'm hoping I can find a place to practice openly and record again soon! It's been way too long without a video.

Anywhoo! Observations...

Right now a lot of stretching and freebuzzing has been my focal point. Huge emphasis on stretching though.

This is hard to describe. In the very beginning there was so much tension in my embouchure that I felt like it was STUCK in a very fixed tense position or movement....it was either stuck in an extreme pucker, or a extreme collapse/frown. I couldn't find a middle ground. The tension and contractions were so intense that I literally had no control or flexibility or sensation in my upper lip or around my embouchure. Slowly over time I started to iron out the tension and contractions by deprogramming my embouchure. I did this by playing on a collapsed embouchure at first for a very long time, with no tonguing, and focusing on just slurring chunks/sections of chromatics in my pedal register. The low register because the vibrations were less intense and allowed the muscle around my aperture to relax, and allowed me to build things from bottom up. I literally had to derive the movements/settings of my embouchure as far away as possible than the embouchure that I had known for so long and played on for so long. Basically a ton of miniscule painstaking frustrating adjustments in the way I played over a long period of time....I mean things as tiny as being aware of how contact there is between the lower lip and rim of the mouthpiece and if there needs to be less pressure or a tish more to allow the upper part of it to vibrate. It's like learning how to walk again. If you're an Olympic runner, your muscle memory and coordination is so entwined and ingrained over the years that you'd don't have to think about things....but once you have a huge injury/setback, it's literally like learning how to go from crawling to walking with a crutch, to literally being aware of every movement you make along the way towards recovery - like noticing what foot you should put more weight on, or if you have to bend your knee a little more to move forward, or how your hips play a huge role in movement, etc. You become so much more highly aware and in tune with your body - in what it can and can't do, and what it's ready to do.

Eventually I got to that point where I moved from a less collapsed embouchure to a more flexible embouchure...where my corners were naturally wanting to transition more on their own than me slowly nudging them while trying to not trigger a bomb of contractions. As my corners started to naturally relearn how to move on their own, the flexibility of my lower lip and jaw/chin started to kick in too and was a struggle too; since it controls so much more than what I was aware of. Anywhoo, soon I was able to control my lower jaw and lower lip support better.

Now I'm at a point where my embouchure is drawing me more towards focusing on the flexibility around my aperture, rather than corners or lower lip or jaw etc. I don't know how to describe this....

....it's like I'm focusing on the gracefulness/flexibility that develops between movements. Like in my stretches - the movement between point A and point B is the most important thing to be aware of. A good example is like watching a ballerina. They are very muscular and there are specific moves that require a great deal of control, tension, but also they are required to go from a very intense move to a very graceful delicate move...they have to be able to portray body language that requires both tense muscle movement and also graceful movement.

It's that release of the contraction that I'm talking about. If you squeeze your fist as tight as you can and then relax it, the tension goes down pretty fast as soon as you release your fist/grip. But with dystonia it's like that tension is stuck there...you try to release it and relax but it won't go down...it usually requires a ton of exercise and stretches etc to move it back into a more relaxed feeling/position.

This ability to move from tense to relaxed feeling in the embouchure is very difficult...no...extremely difficult with dystonia. It's the one thing I feel is the biggest obstacle to overcome with dystonia. I think that's why dystonia is so noticeable in the middle/low register; because the embouchure muscles are required to have the most about of control and flexibility in this register.
In my pedal register my lower and upper lip are more relaxed and vibrate like a flag and my corners allow me to adjust to changes. In the upper/treble clef range I feel like here it's easier to play even though it seems tighter playing, my embouchure is more able to adjust to the smaller aperture opening easier....and I know this is just an assumption...but I think it's because of the way we are built/designed to eat food and drink....when I go to drink out of a straw, or chew something, the muscles around my mouth/embouchure are similar to the setting I use to play in my upper register. I have a small upper bite, so when my teeth align when I blow into my horn, the upper lip is curved over the surface of my upper teeth...(I know I'm over-exaggerating) it reminds me of a beak on a bird. Or like how I see flute players embouchure when they blow out.

In the middle register/lower register it's difficult to play because it requires the duality of being able to adjust the tiniest feelings/things here and there. It's like I have to be able to relax and tense up in certain areas more often, and depending on what movement/pattern I'm playing. It's like the middle register/lower register requires so much more of the small details and adjustments of the embouchure to come into play. Sometimes I'll be holding out a low F# or low A and I notice the corners of my embouchure need to feel relaxed yet stable/tense, and my aperture needs to be able to relax but also squeeze in sometimes.

I don't know how to describe this...

...the middle register/low register is like a bringing together of opposing muscle groups, the synchronization of relaxation and tension..the synchronization of opposing muscle groups...and this is exactly where dystonia has the most difficult, because dystonia is a war between two opposing muscles. So to try to get them to work together in a register where they're both required to work together fluidly...not going to happen so easily! So frustrating!!!

Anywhoo, I'm now at a point where the fluidity and sensation in my upper lip is more focused on. The area around the aperture can relax and contract too...so this is an area where I'm now observing how it contributes to the fluid movement between point A and B. So lets say I'm playing a slurred passage from upper register down into my pedal register; before my upper lip would just sit there and let the rest of my embouchure do the work...and I'd end up with a double buzz....but now I notice the muscles around my aperture are doing there part to contract as I go into the upper register and relax/let go of that tension immediately as I descend into the lower register.

To normal players, the ability to contract and release a muscle while playing is not even thought about...but with dystonia, this is the focal point of my troubles...it's all about learning how to reprogram my embouchure, which requires relearning how to contract and release/tense up and relax my embouchure throughout playing, and to regain the ability to do it naturally over time...just like a person learning how to walk again...eventually it will be natural, but for a long time it requires a high awareness and observation of miniscule movements and redefining the way you move/play or adjust. It is frustrating to have to think about it...but there are moments where I don't have to...and it's those moments where I know I must be doing something right or on the right pathway to recovery! :)

Embouchure Stretches / Lip Stretches And Massaging Lip Tissue

I guess I could have recorded this on camera as it would have been easier. But I'm so use to doing this when I wake up and still lying down, so took photos instead. Just a warning, there are some not-so-pleasant close shots of my embouchure ahead. Let me tell you, these are super flattering pictures of me! (sarcasm). It's just photos of the stretches I do, but not the most pleasant to look at, and quite comical to me. What can I say? Sometimes working with embouchure dystonia takes weird distorted movements in the face in order to get all the spasms out.

Why stretch? Just like with larger muscles, stretching increases flexibility, it is elongating a muscle - squeezing the muscle and then completely relaxing it. It is the relaxing which is the most important (sometimes our muscles don't want to, for example like in our calf...instead of relaxing it might turn into a muscle cramp instead). It helps prevent overuse injury, and allows you to get blood circulation going. However, too much stretching can be dangerous if you start to feel pain or numbness or no blood circulation; you don't want to overdo it...so if it hurts, take it easy. It's like trying to do the splits....that type of flexibility doesn't come easily and takes time to build...not always going to happen the first day! Stretching in a sense is also a workout in itself, so this why it is important to not overdo it. I think it is the most important thing for me to do though before playing horn. Low-warmups are not always enough to get all the tension out of my face.

The most important part of stretching is what the muscles do between point A and point B. The first exercise I do works on this concept. Let's say you want to flex the muscles in your arm (as if you were showing off); your arm is at rest, and then when you flex it it jumps right into position...you don't have to think about it, or the motion of the muscle movement getting there from point A (at rest) to point B (flexed).

With Embouchure Dystonia it IS very important to be aware of the motion between the movements; from point A and B; it is usually the between motions where you will see spasms and quivers occur, so this is the area you wan to be aware and take notice what happens. So here we have the first exercise I do to test to see how my symptoms are for the day. Usually I do this when I wake up. Some dystonic people find that your symptoms are not as strong right when you wake up, and this is usually because sleeping helps as it increases dophamine levels. For some dystonic people it doesn't effect them...for me not so much...but I like to stretch in the morning anyways just to get circulation going.

The most important thing about stretching is (1) The motion between point A and B, and (2) Holding the stretch once you arrive to point B. Just like when you stretch you're legs, you hold the stretch in position for a couple of seconds or a minute and then release. 

STRETCH NO. 0 AIR OR WATER STRETCHES (whoops, forgot to add this one first...so labeled it 0).

I do this one on camera all the time. I either roll air or water around the inside of my mouth, making sure to get under my upper lip, chin area, cheeks, etc. This helps stretch from the inside-out, and it can also help with other injuries, for example if you have a muscle tear. This is actually one Dr. McGrail's exercises for musician's with lip muscle tears! 

So this first exercise below I call the "GOLDFISH LIP STRETCH." I start at point A which is at rest (meaning relaxed and still/no executing movement yet), and then slowly (I mean unbelievably slow) starting to move my muscles into formation...moving towards my destination of point B (the goldfish lips):

STRETCH NO. 1 GOLDFISH LIPS

I start to slowly form an opening...

I slowly start to stretch my lower and upper lip outwards, and it is usually this first motion which has the most spasms or shakes since it requires me to keep my muscles relaxed yet while flexing them.

As I keep slowly stretching my lips into formation, I want to make sure I don't jump directly into the final formation. Usually with dystonia your muscles can handle point A and point B, but it's the getting there/between state which is difficult to maintain and execute. So I try to not flex too fast in an outward motion with my lips!

And the final formation...the comical goldfish lips! After they are formed, I hold them like this for a couple seconds and then release/relax my face back into a resting position/stillness. I do this many times until I can go from point A to B with less spasms. I'm at a point where the spasms go away fast and melt away as I stretch. May look crazy, but what's weird is I can feel my muscles wanting to stretch in a certain direction...it's much like when you wake up and stretch your arms above your head...or how you see a cat stretch...you just FEEL like you have to do it! Another interesting observation is I can feel the sore-spots; the areas or muscle groups in my embouchure that have been working the most in my embouchure at the time (ex. my chin muscles are doing a lot of work lately more so than my corners, so they feel sore as I stretch).

STRETCH NO. 2 EXTREME FROWNING STRETCH

Pretty much explains itself. However, I feel like when I frown my corners go so extreme that they feel like they are along the sides of my chin and I can definitely feel the stretch! Good stretch! ahhh...:)

STRETCH NO. 3 THE SOUR LEMON STRETCH

This one makes me laugh! When I do this one it's important that there are two areas of "scrunching"; I want to feel as if the upper most region of my upper lip (near my nose) is scrunching up into my nose.  and secondly I want my nose to scrunch as if the apples of my cheeks are being pulled inwards towards the sides of my nose. This not only stretches my upper lip muscles (in a non-linear way), but it stretches the muscles that run from my nose down to the corners of my lips and also the muscles that buccinator muscles in an upward stretch/vertical. 

STRETCH NO. 4 THE CORNER STRETCH OR SMILE STRETCH

This is just a mini-embouchure crunch. I form an embouchure, with my lips closed, and focusing on my corners, I want to stretch them as far out as they can go in a horizontal direction <----->. Then I bring the corners back in. I do this flexing my corners back and forth/in and outward. Similarly...

STRETCH NO. 5 THE PUCKER STRETCH

Similarly...I do the pucker stretch which is also part of an embouchure crunch. I form an embouchure , with my lips closed, then while focusing on my corners being firm, I move my corners inwards, resulting in a pucker. Then I move them back out...I move them out and in/back and forth, then go back to relaxing.

STRETCH NO. 6 THE CIRCULAR STRETCH

I didn't get a photo of this one, since this one takes quite a bit of movement. It's basically a combination between the Goldfish lips stretch and the smile stretch (but with mouth open)...moving in a circular pattern. I always do this one on camera too. I'm just moving the muscles in my face all over the place in order to stretch the whole group of muscles in my face all at once. 

I know I may seem crazy posting all these weird looking photos, but honestly! I'd do anything to regain my playing abilities on horn, even if it means I have to make weird faces in order to stretch and reduce the spasms/symptoms before I play. These stretches really help me a lot, especially right now since I'm working a lot in my mid-to-upper range that builds up a lot of tension.

Also a little bit about massaging. Massaging the inside of my upper/lower lips moving horizontally outwards rather than in a vertical motion, and also massaging the inside of my jaw line helps with sore muscles. I don't massage both the outside and inside with my thumb and index in a circular pattern like most people suggest, I just use my index to caress the tissue on the inside.

What I find most beneficial to me is using the thumb to push against the inside of the cheeck (starting at the center of the cheek, and stretching the tissue outwards and holding it for a cuple seconds. As soon as this releases, I move on down to the bottom of my jaw line (still near the center of my lower jaw, and eventually make my way to the back of my jaw.

Most of the tension I find in the back of the jaw, and believe me it is painful to release!!! So that is why I start near the center of my cheek and work my way back to the bottom of the jaw. Alright! Enough awkward rambling about my lips. :-/ I'm out! Will be back again soon!!!