Britannica: Muscle Disease Pathology

This is one of the best overviews of pathologies of muscle disease, disorders, and weakness. Written by Walter G. Bradley, Richard Humphrey, Tudor Edwards, and Ronald A. Henson. It's well written so that most who are not medical professionals can follow. I hope you read it! The section over muscle nerves and neurons explains a lot about how weakness is not simply a result of overexertion. I really wish all of this was taught to musicians as a part of their education. Not only is it important, but I find it rather fascinating in general.

https://www.britannica.com/science/muscle-disease?fbclid=IwAR0lkrLChFbcz-p7SUp9abuV6DqTwge62PNu6A3gKnWuj9H3Bj65wPgHrgc

Highlighted Professional Musician and Medical Professional

Highlighted professional musician and medical professional: Dr. Bastepe-Gray.

Please check out this article about her, titled, "Musician's Get Hurt A Lot: Paging Dr. Serap Bastepe-Gray" 

I wanted to highlight her since not many might know about her. Currently located in Baltimore. Her husband is also a fellow guitar teacher at Peabody. Please read the article linked on here, it is worth the read. Can't thank her enough for the substantial amount of work she is doing to further the field of music and medicine through John Hopkins. <3

Dr. Bastepe-Gray, a physician and virtuoso guitarist, moved to the United States from Turkey in 1992 to study spinal cord regeneration as a visiting scholar at the Medical College of Pennsylvania.

She graduated from the Peabody Conservatory with a bachelor and masters in Guitar Performance in 1996 and 1999. She holds an M.D. from Hacettepe University in Ankara, Turkey, and an MScOT from Towson University.

She is the Director for Peabody Occupational Health and Injury Prevention Program, serves on the Performing Arts Medicine Committee of the Maryland State Medical Society, the Research and Education Committees of the Performing Arts Medicine Association, and the Musicians’ Health and Wellness Committee of the International Society for Music Education.

She holds joint appointments at the Johns Hopkins Department of Neurology and the Peabody Conservatory.

Her expertise comprises pain and playing related musculoskeletal and neurological upper extremity disorders that affect musical performers.

In collaboration with Dr. Alex Pantelyat of the Neurology Department, she has assembled an interdisciplinary team of 70 experts to form the Johns Hopkins Center for Music and Medicine in order to promote research and help restore and preserve the proficiencies and talents of musicians all over the world.

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

Month of June Resource Links

Hi everyone! Please forgive me for not tending to my blog lately. I'll be taking some time away this summer to focus on other areas of my life. I do promise though that I won't forget to come on here and update things at least every 2 months at the latest, and hopefully by either September or October I will be diving back into focusing on my blog! I have been going through a lot of changes lately and excited to write more about that later. I just celebrated my birthday...since it is in early June, so thought I'd stop by and update things too while I'm on cloud 9. Also apologies to those who have written to me and I haven't replied back yet. I will be getting around to that tomorrow! :-)

Here are three links I came across recently that I found informative and interesting....

The first one is an article published in the Australian Dental Journal back in 2002 called Specific Orofacial Problems Experienced by Musicians.

Secondly, an article by Medical News Today called "What Causes Your Lip to Twitch?" which covers the different types of reasons a person might experience facial tremors or spasms. This isn't meant to say that what you're experiencing isn't embouchure dystonia if you think you have it, but to hopefully open our eyes to other disorders or situations that cause tremors, and what is typically done in those individual cases, and also most of all how important it is to get diagnosed by a neurologist in order to rule out any of these other possible health concerns.

Lastly, a post by Dr. Kenneth Casey at the Department of Neurological Surgery at Wayne State University in Detroit Michigan over Hemifacial Spasms (spasms in the face)....published on the Benign Essential Blepharospasm Research Foundation (BEBRF) website. This one is great because it covers in more detail the neurological-related reasons of how spasms/tremors occur, and the characteristics of each one. Again, not posting this to try to prove that no one has embouchure dystonia, but the importance in understanding other disorders and causes of involuntary muscle contractions. Also studying these other maladies can help us learn to pinpoint similar and varying characterstics of embouchure dystonia, in both symptoms and treatment.

New Facebook Group and Forum for Musicians with Dystonia

Hi everyone! Just wanted to chime in and share 2 new groups/forums I created for musicians with dystonia on facebook! ....

• Musicians with Focal Dystonia & Neurologist Sharing Knowledge and Resources
    ......This group is for Musicians with FD and Neurologists. The group is focused on scientific-based knowledge, resources, case-studies, and to share personal trial/error done through scientific method of documentation and observation. This is not an emotional group or a place to advertise; no tolerating emotional lashing out or soliciting of cures (or the source of FD) without proper documentation, publication, and that it can be successfully applied to all.
  
  
• Musicians with Focal Dystonia Emotional Support Group
  ........This group is for Musicians with FD, and focuses on leaning on each other and connecting with others who share the same struggle of coping with this disorder. Here we share our progress, relapses, and personal journey.
  
  Hoping that these groups will provide additional support, connections, and resources! :-)

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

Monthly Research Article: A Video Guide to Diagnosis and Evaluation of Embouchure Dystonia by Dr. Frucht

Sorry I haven't had time to post recently! I've been busy with summer camp ending and starting another school year. I will post more soon. Here's this months article! Check it out....

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912816/pdf/40734_2016_Article_35.pdf

Further Experience with Rupture of the Orbicularis Oris in Trumpet Players

I came across this set of articles written by a surgeon who has experience mending torn muscles in trumpet players. There are some pictures of the surgery, just FYI.

1. Jaime Planas, Barcelona Spain: Plastic and Reconstructive Surgery on Embouchures

2. Another Ruptured Orbicularis Oris Case

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. :-)

Who to Contact for Help Rehabilitating from Upper Lip Injury or Muscle Tear

I came across-----> THIS <----great blog a while ago and forgot to post it on here. I also posted it under my resources on the side bar to the right.

The author of the blog writes:

"I’m Jonathan Vieker, a trumpet player who’s been living with a severe lip injury since May 7, 2010. I created The Lip Rip Blues to help brass players understand lip injuries. The morning after I got hurt, as I made a cup of coffee and sat down at the computer to figure out what was wrong with the muscle in my lip, I discovered quickly that there just wasn’t enough information available about embouchure injuries.

This site is my attempt to do something about that."

A HUGE THANK YOU TO JONATHAN for his website/blog! :-)

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

Neurotransmitter: Acetylcholine

I wanted to share this link over Acetylcholine. It plays a huge part in the process of creating smooth muscle movement, convulsion (too many contractions), or the lack thereof too (muscle weakness), as well as it factors into many other important parts of the body and plays a role in both the CNS and PNS (Central, and Peripheral nervous systems).

More Alternative Medicine/Therapies (Part 2): Body Movement Awareness Methods (Somatics), Modifications, and Musical Exercises for Focal Embouchure Dystonia

PART 2: Body Movement Awareness Methods (Somatics).

In my last post I spoke a little about being mindfully aware during physical rehabilitation. This is a huge part of recovery for me; making adjustments and modifications to help improve or redirect my tension into a less tense state of contraction based on both mindful awareness, and understanding of anatomy/functional muscle movement.

There are quite a few body methods out there that you may have heard of. Why these methods are important is because most of them focus on reprogramming a more efficient body map. Your body map is the brains general perception and understanding of ones body/movement/function based on the sensory input it's been receiving. This carries over to how we use our bodies with our instruments.

Body Movement Methods are technically referred to as somatics. Somatics refers to practices in the field of movement studies which emphasize internal physical perception. The term is used in movement therapy to signify an approach based on the soma or "the body as perceived from within."

I'm listing them here as a resource because knowing a little about them or even taking the time to take a course in one of these methods may be helpful to you, as they can help with the rehabilitation process...it doesn't mean that one method or any of the methods are the answer to overcoming dystonia, but can be used in aiding the physical rehabilitation process to an extent.  

I've noticed universities recently incorporating classes on some of these methods which is awesome to see!

Types of Body Movement Methods or Somatics

• Alexander Technique - Most musicians know of this method, and it is not uncommon these days to see it being taught as a course or summer course within music programs at universities or institutes. Alexander practitioners are certified and teach the course between 10-40 sessions. Alexander's approach focuses on mindful action. The instructor uses guided modelling with light hand contact for detecting and guiding the student past chronic pain and effort. It should be noted that A.T. is also used to help with stage-freight and anxiety too. Suggestions for improvements are student-specific/individual-specific, and the instructors analyze the student's responses, as well as using mirrors, video feedback, or classmate observations. The practitioner is well-trained in guiding free-movement.

• Feldenkrais - Feldenkrais was highly influenced by Judo. He taught that increasing a person's kinesthetic and proprioceptive self-awareness of functional movement could lead to increased function, reduced pain, and greater ease and pleasure of movement. The Feldenkrais Method is therefore a movement pedagogy, similar to the Alexander Technique in being educational and not a form of manipulative therapy. The method is experiential, providing tools for self-observation through movement enquiry. The practitioner directs attention to habitual movement patterns using gentle, slow, repeated movements. Slow repetition is believed to be necessary to impart a new habit and allow it to being to feel normal. These movements may be passive (performed by the practitioner on the recipient's body) or active (performed by the recipient). Feldenkrais is used to improve movement patterns rather than to treat specific injuries or illnesses. This holistic focus means that the primary intention is not to treat injuries. However, it can be used as a type of integrative medicine because correcting habitual movement patterns can help heal injury, pain, and physical dysfunction.

• Mitzvah Technique - is focused on dealing iwth body mechanics in a state of motion. It is a development of the Alexander Technique, the Feldenkrais Method and health-oriented work on musculoskeletal problems and stress diseases. Each of these techniques are based on correcting common postural faults by addressing  the neuromuscular system through postural re-education. Yet the Mitzvah Technique encompasses both a unique philosophy and a set of procedures. This includes the discipline, exercises, the work that Mitzvah Technique practitioners do with their hands. The Mechanism consists of a sequence of natural body movements that magnify the ripping motion in the body. There are four components to the Mechanism; (1) The interplay of physical forces acting between the pelvis and spine, (2) the rippling spinal motion, (3) the dynamic relationship involving the pelvis, spine and head in a synchronized motion, and (4) the freedom of the head to balance on its spinal support. All of these together promote the operation of the Mitzvah Mechanism. It is designed to improve posture and release tension and stress through exercises and therapeutic table work. It claims to realign, re-balance, and exercise the entire body during sitting, standing and waling. It's aim is to replace long-term work by practitioners, to have people learn how to use the technique itself. Musicians, actors, and singers have been extensive users.
  
  *These next two listed are not so much a body movement method (except Rolfing is kind of), but more of a alternative physical therapy that integrates somatic education into it's foundation.

• *Oral Myofascial Release (MFR) - This is what I currently have experience with. Myofascial release deals with 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 - 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. Although 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.

• Andover Educators - This is actually not a method, but a service. I wanted to list this here as a resource. Bodymap.org is the home of Andover Educators, a non-profit organization of music educators committed to saving, securing, and enhancing musical careers by providing accurate information about the body in movement. 

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

List of Performance Arts Clinics

I've been so busy with school that I haven't had a chance to write a blog post for the month of October AT ALL. So I'll try to post 2 blogs this month. Right now this current post is a draft. I want to make a list of performing arts clinics around the U.S.

As you can see, I just started this, so let me know if you want to add any and I'll upload the link, or post in the comments. On a different note, just want to say I have 4-5 weeks of fall classes left and then I get a break, which I'll be posting quite a bit within my time off. See you soon! I miss writing on my blog, so hope to get back to it soon!!!! - Katie Berglof

University of Michigan

Allina Health - Minneapolis MN

Performing Arts Rehabilitation Institute of Chicago

Bringham Performing Arts Clinic - Boston MA

Virginia Mason Clinic - Seattle WA

Cleveland Performing Arts Clinic

List of Performing Arts US clinics

New York Presbyterian Clinic

Musicians Clinic - Texas

Performing Arts Physical Therapy - Boston MA

UNT Performing Arts Medicine Clinic

Al Hirschfeld Health Clinic - New York