Psychological Aspects of Recovery: Mental and Emotional Obstacles Faced with Musician's Dystonia (FTSED and FTSHD).

In the past I would have refrained from writing about this area of recovery because of the tendency of others to immediately hop on the psychological bandwagon belief that Musician's Dystonia is simply an underlying psychological or emotional disorder. As I have stated throughout many of my writings that I do not support that belief whatsoever, nor do I believe it is the true cause of this neurological disorder. That is not to say that there is no psychological effect involved that must be addressed.

It is what I consider one of the 3 major stages of rehabilitation; (1) Educating oneself on the disorder, treatments, rehabilitation methods, other related injuries/areas, the body (movement and anatomy), and literally anything involving musician's health. (2) retraining the mind (psychological cognitive restructuring). (3) Rebuilding Neuro-pathways (Physical Rehabilitation). 

These are my own opinions. However, it is safe to say that without a doubt anyone who has been marked with a major physical setback or injury naturally inherits emotional hurdles afterwards. As it takes a huge blow to ones self worth, it leaves us with doubts in our capabilities, dislike in our concept of sound, we start to over-analyze out of pure confusion and trying to fix what is going wrong with technique, and it leaves us overwhelmed and lost in the stages of grief. Sometimes we don't even realize that we are in grief or are in denial of it.

It is best to address the psychological aspects first and foremost before any musician tries to start physically rehabilitating. I believe they should be in a healthy frame of mind and emotionally stable. Many musicians who are hit with this disorder panic and want answers right away. They are very confused and don't want to accept the current state they are in. The only problem is that part of the answer IS embracing the current state. Mind you that embracing a temporary state/setback does not mean it defines you or that you're giving up. The disorder does not define who you are or who you will be. There is a difference.

Being diagnosed with what is considered a career-ending disorder is scary and devastating. It is hard to see the silver lining when it seems there are vague answers and not just one solution to overcoming it. It takes a great deal of courage and optimism to look at it in positive light, and no one is ready to do that until they've allowed themselves to grieve and face the possibility of their worst fears.

But I look at it as facing ones fears and saying, "Even though I believe I will beat this disorder, I'm not scared of the worst that could happen because here are the good things that can come out of it...." It's like facing your fear in order to overcome it. Once you experience it, it no longer holds a death grip on you.

I can already hear my musician friends saying, "What good could come out of this awful situation?" In order to come to that point, you have to go through the stages of grief. You must cry over the misfortune, get angry, yell, curse others, become bitter if you have to, go through highs and lows, desperately ask for help, ask "why me?"...whatever it takes to heal no matter how bad it feels. But then there comes a time where you do feel you have a choice; you can continue mourning or build up the courage and say, "I'm tired of being sad. I'm tired of hating the way I sound due to the spasms. I'm tired of fearing my instrument, being frustrated, confused, fearing the worst, and living like this in misery." Then you find the strength to fight. Once you are ready, there is a lot you must change about the way you think, and in a big picture type of way...

• The first and most important thing I have found is learning to separate your worth from the instrument and center yourself.

We are gifted with the love of (sharing) music. It initially started off as a feeling and transferred to an instrument that resonated with us personally. Yet this gift of the love of music is still with us, even if we can not play for the time being. The instrument does not define who we are or our gift, just like our disorder does not. We must believe that our knowledge of music and passion is meant to be shared, that all we've done in the field is not for nothing. Being gifted with music means we have the choice to share it in more ways than just one. Focusing on another area of music or field/activity that reminds us of that love surprisingly allows us to still remain connected to the gift. It may not give us as "full" of a feeling as we had before, but it can as time goes by and we find our confidence returning in something music or non-music related that we didn't know we had a talent for.

Having Dystonia allows us to focus on other areas of our lives that we didn't get to do while focused on performance. We have more time to build relationships, explore new areas, work on our health, study something we never got a chance to do.  Some are too afraid to try to live again, to seek out something similar out of fear that it won't be the same.

We are literally brought back to the major question of "Why do we love our instrument so much? and where do our priorities fall? It also makes us question what is success? Did we love our success more than the music? Dystonia really grounds us and brings us back to why we love music. Success and failure are one and the same. There are no rewards/praise for success. The reward we found in music when younger was that feeling of exploration. We could make a million mistakes and still love the way we sounded. Yet the more advanced you become you lose that sense of exploration, creativity, curiousity, and unconditional love and acceptance of how one sounds.

• That leads me to the second thing. You must embrace the way you sound and love it.

I am dead serious when I say it is vital that you revert back to that childhood state of mind in order to embrace your dystonia. Dystonia must be confronted with that same feeling of exploration, curiosity, and unconditional love and acceptance of how one sounds.

Seeing other people play music, even small children, reminds me of what a tremendous blessing music is in this world. It's meant to be used as a form of expression whether or not it sounds good or bad...it has meaning and that is all that matters. Technique no longer matters, all the blabbering about breathing, hitting the notes, using articulation, etc. All that matters is embracing the love of music and letting go of the ego, the success, or judgement, and really appreciating what a gift it is to have music in the world. I imagine my feeling is similar to that of someone who has lost one of their senses like sight or hearing. We don't realize how truly miraculous something is until it is gone. We appreciate it more, aim to protect it, and love it in a way that is no longer criticizing, demanding, or taking it for granted as we did before.

I'm serious when I say I absolutely love hearing beginning band students play.
I believe that is the kind of love it takes; to embrace music with no judgement, or at least an appreciation for it that is much deeper than before.

• Third. Shift your focus from the performance mentality to relaxed awareness. 

I learned to not fight my symptoms or judge them, but to let them happen and just relax into a state of awareness. (ex. "I'm noticing that it's easier to grab an F than a G, and the angle of my mouthpiece made a difference today"). That way you are focused more on feeling things out than fixing things with technique or judging the way you sound. Your body knows what to do and is trying to tell you something, so listen to it and get to know the symptoms well. I started taking an inventory of my symptoms and recording myself. The more I played with an open, loving, and aware mind, the more I discovered and adjusted my playing over time and saw improvement.

Performance mentality focuses on analyzing technique, physical agility, skills and accuracy. Relaxed awareness is what is needed instead. Focusing on embracing the symptoms, getting to know when they happen, looking at them with curiosity, exploring ways to lessen them through adjustments and modifications.It seems pretty simplistic and basic, but it works if you have patience and don't rush the process of recovery.

Though this may sound odd, there are some other things I did to help embrace my dystonia sound; telling my horn thank you and that I loved it no matter how it sounded, recording myself and listening to it with love, sympathy, and curiosity. Also practicing mantras, visualizations, building self-esteem, and treating myself like a survivor and not a victim were other major factors in changing my state of mind. Also farther down the road I liked listening to recordings of the horn before I fell asleep and visualized that my playing felt just as smooth and effortless. Pretty soon I started having vivid dreams about playing easily and this boosted my energy and happiness the more it occurred.

I started off practicing in a practice room with a piece of paper over the window. As I got more comfortable with accepting my sound, I removed the paper. Eventually I moved into a larger classroom, and then a stage. I adapted myself so that I did not fear the way I sounded in front of others. Whenever the thought that someone might be judging me popped up I would tell myself, "They are not judging me, I must be judging myself harshly to assume so. Even if they are, they do not know what they are doing. If they are, I feel sorry that they have been brainwashed to look down so shallowly on the act of making music which is a beautiful thing. I must remember I am now at a higher state of mind than what I had before and I love the way I sound no matter what. I must let go of the inner critic. I love myself. I love my sound. I accept it."

• This leads me to the fourth thing that I have learned. It is important to surround yourself with people and environments that help promote a healthy state of mind.

Teaching beginning band students helped me a lot, and this is actually why I'm going into teaching. I love working with students who are just starting to learn music because that is when I most clearly see the importance of music. In a way it is living my life up to my ultimate rule...that it's always about the expression of music and imagination more than anything else. It is similar to developing strong morals and values and sticking to them, living them, breathing them, becoming them.

My students never judged the way I sounded and instead thought it was the best thing on earth. It reminded me of how children are much more centered (mentally and emotionally) than adults can be. They are in that state of daydreaming and imagination all the time. I am happy to influence them in a positive way and help them find balance in not only their abilities, but way of thinking/approach too. It was much healthier for me to be around children with this state of mind than performing in a group full of adults that are way too hard on themselves and others.

Many Dystonic musicians who talk to me usually ask me how I feel about playing in a group. They hate it when I tell them that I am against people playing in an ensemble of high caliber or even of musicians that would not understand what they are going through. I think it is important at the beginning of rehabilitation to focus on yourself and spend time playing alone and not aggravating things. Later on as playing gets better, then maybe if psychologically prepared for it, but playing in a group can add even more anxiety, pressure, demands, fear, frustration, and stress that you already deal with when facing the dystonia symptoms; not knowing if things will come out correctly, or if you'll be able to play a passage, etc. Live concerts are the worst because it adds in adrenaline, and the adrenaline heightens the dystonic symptoms just like loud noise heightens or triggers a migraine. It's best to remove oneself from anything that worsens the symptoms for the time being.

Instead, surround yourself with a network of people who understand; whether it be the musician's dystonia group on facebook, write or visit with other musicians from the group or who you've come across online with dystonia, lean on a supportive teacher/mentor, etc. If you feel comfortable with talking to me, then by all means call me or message me if you need to. It's the least I can do for others.

If can, speak out about your dystonia. It is oddly relieving. Not everyone is comfortable with that, but for me it is a way of healing. Knowing that I am informing others (non-dystonic people) about this disorder that is rarely spoken of, makes me feel like I'm not wallowing in pain while keeping my mouth shut. I want others to know so that some day others who are in the same boat won't feel as alone or outcast. Yet, I always speak positively of it; never victimizing myself, but instead aim to promote awareness and understanding of the disorder.

I know this is not how everyone feels, but I believe that my dystonia was meant to happen for a reason. I may not understand the reason, but I choose to believe that it is because I am strong enough to handle it and navigate the tremendous loss, and that I am to help others and promote awareness about this disorder. I believe that what I'm experiencing is unique and it is rare to see anyone share their experiences about this disorder, so it must be done for the sake of healing and helping. I see a lot of injured musicians do this, and it makes me happy to see them channeling their love and support to others in need before themselves. This leads me to the importance of belief or hope....

• Last, but not least. Do your best to find the silver lining and say it out loud.

Physical rehabilitation tests your patience unlike any other. There are many days where you will get better, then relapse. There are many days where one adjustment might work and the next not. There are even more days where you just plain sink into depression again. The wound from losing what you love never truly goes away. It is not easy to stay optimistic about it all the time, and I don't suggest that anyone avoid their emotions; whether it be sad, angry, happy, excited, etc. It is important to go through the motions and let whatever you feel happen so that you can heal.

Creating some strong beliefs in yourself and your recovery will carry you further and support you when things get tough. When you are able to find the silver lining...even if it's not something you necessarily completely 100% believe yet...say it out loud no matter what. It could be something as simple as, "Maybe not today. But tomorrow." or "Can't have progress without some relapses." I always say it out loud, whisper it, or say it to myself in a mirror because it somehow feels more grounded and reassuring. I know I sound crazy for doing such things, but it makes a difference and that is all that matters. Whatever gives you strength, believe in it and hold onto it....not matter how ridiculous it may seem, look, or sound to others.

The psychological aspects of recovery are a huge obstacle to overcome! It is probably the most difficult part of rehabilitation. I see these psychological aspects as a very heavy fog that blinds us from the physical obstacles beyond that. Once the fog is lifted you can focus on the dystonic symptoms and alleviate them through physical therapy and rebuilding the neuro-pathways slowly over time. But first and foremost you have to be willing to embrace what is right in front of you and keep tremendous patience. Not everyone is ready to do that or needs help with it. Some good options to help find what centers you is meditation, hypnosis, or it could be something spiritual or religious like going to church, it could even be helping others...whatever allows you to reflect inwards and face the grief at your own pace and allows you to think about a meaningful purpose of this experience. The good news is that you will see progress without a doubt, and time really does heal both the mind, body, and soul.

Good Times: Friends, Horn Players, Traveling, and TENS unit therapy!

I've had a busier month than expected! A lot of great blessings despite several car problems. I currently work in Denver while living in Boulder. It's quite the commute, but I don't mind since I love driving long-distance. However, my car has broken down three times in the last month....let's just leave it at that and hope the terrible 3's are finally over. I'm so thankful for the many friends and family that have helped out throughout that stress-ball.

Back to the positive stuff! A fellow FTSED musician lent me their TENS unit to use! My neuromuscular dentist wanted me to undergo several sessions of using the TENS unit since it showed signs of improvement, yet I couldn't afford it. I'm literally a broke college student again. Boy am I grateful for this generous person to let me borrow their unit!!! It's helped tremendously. I'm already experiencing less pain. Even when the pain does happen it goes away quicker. I just have to make sure that I keep up the ice/heat packing and the TENS unit consistently especially after practicing.

They lent me four electric pads, so I've been using it on my face and my back shoulder and neck. My jaw is popping less, but still just enough to keep me worried. However, I have to say that my jaw feels more sticky in a good way...before I felt like it would pop or crack so easily by the slightest touch, and now it doesn't feel as loose or crackly or off. It's weird, the more I use the TENS unit along the line of my shoulder blade in my back, the more relieved I feel.

Another risk I'm taking is bringing back slight playing into my daily activities. My friend Thomas Jostlein the associate principal of the St. Louis Symphony is here in Boulder for the CMF festival and wanted to see where I was at playing-wise with my disorder. I'm VERY picky about who I play for because it requires a deeper understanding of the complexity of what I'm dealing with (a combination of injuries and disorder), and also an unorthodox approach vs standard lesson approach when giving advice or suggestions. But I trust him as a mentor.

The best thing is that I feel like I've contacted my inner horn geek again...which I've missed a lot! hahaha! It's therapeutic in a way feeling like I'm included in the horn playing world even if it's just talking to another horn player. Even better, one who isn't afraid of my disorder and is genuinely interested.

Many years ago when starting my (horn performance) grad school audition process by visiting campuses, the University of Illinois (Champagne-Urbana) was on my scheduled list. After visiting Thomas, I realized I favored his horn pedagogy and approach to music best out of any other schools, so U of IL became my top choice for schools to apply for. I liked that he wasn't like other typical professors; lost in technique or standard methods of solving playing issues, nor taught by the textbook....he had a unique and innovative approach due to his former teacher, Arnold Jacobs' influence. However, grad school on horn never happened due to my injury and then disorder. However, I consider him one of the best horn players of our time (if you haven't heard him, you need to...he really needs to make a solo recording), so it means a lot knowing he believes that I'll make a full recovery and has been supportive of all the hard work I've done to rehabilitate.

 I also had some of my closest friends in Colorado this summer! I went and visited my friend James at the Aspen music festival. He use to play principal clarinet in the orchestra I was in, and we played in a woodwind quintet together. My best friend Lizzie, also from my undergrad, visited me in Denver. She's working on promoting her artwork and trying to make it as a solo artist. I know she will because she has such a diverse set of skills!

For the first time in MANY years I felt complete....like myself again. Just being around people who get me, who have known me throughout my music endeavors and all the challenges, changes, and growth in life...it brought me a sense of relief being around what feels like family. My friends are family...even if I'm not the best at keeping up, I would do anything for the few close friends I have. Even my own family (except my twin sister) hasn't attended any of my concerts, recitals, performances, or tours after I left high school.

Music has always provided the family, support, and sense of purpose I strived for and needed. Even if I could play, it wouldn't mean as much if I didn't have others to share my pursuit of music with. I miss performing with friends, people that I love, and sharing good memories. No, the performance world is not always pretty, there can be drama, but in the end when I look back, it's my friends I miss the most. I proudly watch them grow into professional musicians, already establishing their names and professions. And while I wish I could share in the same things, I can't complain too much....it brings me tremendous joy seeing them shine and accomplish their dreams.

On a completely different note and change of subject, I'm in a committed relationship; something that is a huge milestone. It's taken a lot of courage on my part, but so far I feel like my heart has healed a lot and I'm ready to see the world through a more positive lens again and embrace whatever comes my way without fear.

I'm still learning how to let go of control and to not fear the worst, but I've come a long ways since then. In a way I felt like all these wonderful reunions with musicians I admire and friends I care deeply about, was a gift from God as a reminder of who I am, that everything that's happened in the past, all that I've accomplished, the gift of music I was given....it wasn't all for nothing, and it really did happen. I really could play. Just when I thought the former me was dead and gone, I was reminded that passion and fire inside is still alive. I just needed a jolt to wake me up again. I honestly haven't felt this alive in a very long time, and I'm grateful for it. I can daydream about the future and look forward to every day with the faith that my talent and skills will serve a purpose again.

31st Birthday Blog!

Finally making some time to update my blog. It's my 31st birthday today and I wanted to write! First off, thank you to everyone who contacted me this year, for those who have driven all the way to visit, and for the phone calls and e-mails! I hope I have been of some help and support. It has moved me to see others speaking up about what they are dealing with and sharing their own research and findings too.

This summer I am working on writing an article over FTSED, and a lecture/presentation to give at possible conferences this coming year. It is a lot to undertake and a bit overwhelming because I'm of course not a medical professional, but just a musician who can only share their experience with FTSED. However, I think it is important to not only make others aware of injuries through writing...but to speak about FTSED, music performance-related injuries, and resources out loud. It needs to be brought up not just at conferences, but around peers, and especially in schools where advanced musicians are training.

On a personal note, I have unfortunately experienced a lack of motivation to write lately, mainly because of my recent diagnosis of TMJ. The fact that I have another hurdle to overcome makes me frustrated. I don't know whether or not the TMJ is a result of trying to rehabilitate on my horn with a dysfunctional embouchure for the last couple years, OR if it has always been an underlying issue creeping up on me overtime and caused the damage and dystonia.

At least when I was dealing with my nerves flaring up and my dystonia symptoms setting off, I could manage it and still play/rehabilitate. But with TMJ now it's almost impossible to play my horn due to overwhelming pain, or even try...and that is what has thrown me into this slump. I still have hope that someway, somehow, I'll be able to afford medical care later on (probably not until I graduate) and get the jaw splint/guard.

Despite feeling down I have a lot to look forward to! One of my favorite professional horn players will be in Boulder playing principal horn with the Colorado Music Festival. During my undergraduate studies I had planned on going on to study with him for graduate school while he was teaching in Illinois at the time. However, I ended up with dystonia, and he ended up taking a job with an orchestra. So we haven't seen each other since 2010!

I think being around a horn player that I admire so much will be therapeutic for me and remind me of my roots and bring back some life to me. With FTSED, after so long of not playing with a group or being able to play your instrument, you begin to forget who you were...it's almost like a long lost memory...but every now-and-then, that passion that you felt for your instrument comes back at unpredictable times (at times it can be a happy feeling, and other times a sad feeling); it could happen while sitting at a coffee shop and your favorite horn concerto comes on the radio. Or when I am walking to a class and hear an orchestra rehearsing in a concert hall, or coming across an old photo of myself playing horn.

I've been missing horn playing more and more lately. I do feel no matter how much progress you make in rehabilitation, you go through not only physical relapses, but emotional too, but they become less intense over time. For instance, right now I am feeling down, but it is a bittersweet feeling. I am glad to look back on the past, but I am not devastated over it...just like missing a loved one...you think of all the good memories and think, "I sure do miss them, but I know they're still here with me in the little moments like this." I still hold faith all these years later that I will beat this embouchure dystonia!

Not to get off track. I'm also working out a lot this summer. Time to get in shape! I started a new job not long ago and am still involved in concierge work. I can't explain how much this area of work has helped me to get where I am today...even if it's not what I love, I do enjoy it and getting to know the people who travel through. I also have one year left at CU and I've worked SO HARD, I can't wait to graduate!!!

If anyone wants to share any links of interest related to performing arts related injuries, please feel free to comment or send me an e-mail. I'll gladly share! Thank you again for all those who have kept up with me over the years, and I will write more soon.

- Katie

Month of May Links of Interest

I haven't written a blog in a long time! I've been so busy. My summer feels like it won't begin until July. I'll be back soon to update with more!

The first link is by Round Earth Publishing over head/neck/upper body pain.
The second is an article in Peabody's Magazine of Fall of 2009 over musician injuries.
I'm pretty sure I already have this link on here, but just encase: Embouchure Dystonia Ireland
A recent and wonderfully written and well informed post by Wilktone over FTSED diagnosis and treatment and criticism.
An Altenmuller article: From Embouchure Problems to Embouchure Dystonia? A survey of self-reported embouchure disorders in 585 professional orchestra brass players.
An article by Fruscht over Embouchure Dystonia.  
A flute player starting to document their journey through a blog too.

My Academic Year (Photos)

Well. It's been a busy school year! I'm almost done....5 weeks left. Whew! I just wanted to share some photos I've took throughout the year. It's been extremely challenging yet rewarding; 3 deaths in my life, lost my job, lost my car for a while, and way too much drama, on top of full-time work and full-time school, but on the positive side a scholarship, plenty of opportunities to teach, make friends, and let go of my past. This summer I'll be focusing a lot on work, getting in shape, and preparing for presentations over musician injuries. Cheers to my first year at CU, and looking forward to summer soon!

Learning/Practicing Timpani

Outside Macky Auditorium

Teaching a trombone sectional on Holst Suite



Macky Auditorium



Hiking in the Flatirons

More hiking....

My nametag from the school of education.

Macky Auditorium

Downtown Boulder

Pearl Street

Snowfall on CU campus

My bus pass and ID...I was so excited to receive these!

More snowfall on campus

More snowfall on campus...

Saying goodbye to some kids moving away from graduate family housing! My roommate and I always played basketball and football with them during the summer.

More campus photos...

We were learning how to do basic colorgaurd during Marching Band Techniques class.

Saying goodbye to the children moving away from graduate family housing. My roommate and I played basketball and football with them all summer. We miss them very much!!! :'(

The hour before my very first conducting experience. Dvorak Wind Serenade.

My first Music Educators Journal! I open it up and there's my high school band director Dr. Burrack.

Fireworks at Farrand Field

At an elementary school in Denver visiting my roommates mom's music class! I taught them about brass and introduced them to the horn and trombone.

Walking home....

More walks....

Conducting high school band on Halloween

More snowfall outside...

Teaching flute basics

Teaching solfege / hand signs.

Working on subdivision charts with a high school trombone section

More conducting....

More conducting photos

Katie Berglof: My Neuromuscular Dentistry Results

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Since writing my last blog post, I recently underwent Neuromuscular Dentistry tests within the last two months on my jaw, muscles, and nerves. With as much pain as I'm in, I'm not surprised they found that my joint was messed up. Apparently my right side jaw joint is severely compressed, it should be positioned down and forward from where it currently rests, my spine is not curved in the back of my neck like it should be, my masseter muscle is not activating, and my bite is too deep and misaligned.  The right side of my face is in more excruciating pain than my left, and I have to massage and pop the joint back in place with my hand whenever I'm practicing instruments; horn, clarinet, flute, sax, etc.

My doctor has prescribed that I do not resort to undergoing surgery, and instead have a professional neuromuscular orthotic (dental splint) to realign my jaw first and position it back to where it should be. They would track my improvement using CMS (Jaw Tracking), and use Sonography, Electromyography, TENS, diagnostic casts, and diagnostic photographs; all as part of my treatment, testing, and tracking of progress.

They are confident this will help me tremendously because they had me undergo a TENS test and wear a splint  during one of my four hour visits and retested the readings on my bite, jaw movement, and strength, and it showed drastic improvement in my clench and motion. My face even felt relieved for almost a week after that.  I also believe this is the source of my problems, as most of my pain is coming from my joint area. I also wanted to share this research study over FTSED (Embouchure Dystonia) and dental splints: Three cases of Focal Embouchure Dystonia: Classifications and Successful Therapy using a Dental Splint.

I'm planning on using insurance from work to help with reducing the price of undergoing this. I'm not sure when I'll be able to afford it, but hoping someway, somehow, things will work out.

Katie Berglof: Updates on my Jaw

 

This painting resonated with me more than I can put into words; as it visually captures what I consider the amount of pain my jaw is currently in or feels like. I previously wrote about how I was going to get the right side of my jaw checked out this coming summer because I felt like something was causing problems at the back corner of my jaw. Some minor pain started to set in that area a little over a year ago, and it wasn't so bad, except it set off my nerves and then the pain was not tolerable. My whole face started to feel like it was on fire. So instead of waiting until summer, I took all the money I had saved up and put it towards a doctor/dentist; someone who specializes in both oral care and facial pain.

 

I had just enough to pay off a couple of visits, but my first visit was a couple weeks ago to do routine tests. They did a full scan of my skull and an x-ray and nerve conduction. What's interesting is they found that the joint on my right side has a severe compression. They can't tell if it's because of a tooth nearby that's also causing problems or other factors, so they're doing more tests. All they've told me is that it's this compression which is causing all the pain and that one of the bones in my joint have deformed due to being rubbed up against so much. I asked if it was TMJ, and they have to find out what else may be contributing to it. I'm going in this coming Friday for more tests on my muscle weakness, motion, and nerves.

 

Part of me is worried....I keep thinking, "Why is my jaw so messed up! It's one thing after another. Always." It's extremely stressful having to play secondary instruments for classes (i.e. flute, sax, trumpet) and no one understands. I constantly have to remind them I'm in pain. Luckily I do have a couple people around that are going through similar things, and/or understand. 

 

Despite the frustration, I do feel better knowing I might actually find the true source of my dystonia and nerve damage. It would make sense that it comes from deep within my jaw, but as to why it's happening, or how, that's for me to find out hopefully soon. I am optimistic! It's so hard to find the source of everything that's going wrong with my face, but at least there are more signs leading to what's going on, and they're more obvious. Praying that everything works out.

 

I am hoping that a jaw replacement is not required, or surgery, but we'll see. I honestly will do whatever it takes to not be in pain and to regain control over my facial movements and sensations.

 

- Katie Berglof



TMJ Animation Images

I don't have much time to write, but want to say I came across this wonderful resource while looking up information on compressed joints. It's animation showing what normal jaw looks like in movement, a locked jaw, a popping/clicking jaw, and a dislocated jaw.

You can find the link here: Rich Hirschinger: Diplomate American Board of Oral Facial Pain (TMJ animated images)

Truman Blogspot Article: Mentalis Strain

Truman Orthodontics Link: Orthognathic Surgery, Skeletal Discrepancies, and Mentalis Strain
I found this very informative and amazing blog over orthodontics. This particular post is over Mentalis Strain (chin muscle formation problems). I feel like it gives an extraordinary example of mentalis strain. Take a look! A huge transformation is shown! #knowyourface:)

Updates: Welcome to 2015!!!

I though I'd write a more personal blog post for this....

Soooo...where to begin? It's been crazy! The last five months have been a whirlwind of great changes and challenges. I started my studies at CU, which are pretty intense. I haven't stepped foot in a classroom for YEARS, so I was in a for a big surprise. I've been teaching A LOT; high school, middle school, and elementary music levels, including all my other studies and work at the same time. I'm a part of NAfME, and selected to teach in the CU MSE program this Spring, and received a scholarship which has helped out tremendously.

I've made many friends, love the city, and love everything I've been learning. I've also been working on preparing a lecture for next academic year over musician injuries and disorders/ musician health. I've been very fortunate to have friends, colleagues, and some professors who are supportive and helping me organize this. I'm also hoping to present at some of the music education conferences.

Despite having not much time to write for my blog, things are good with my dystonia. The pain in the right side of my face has subdued, yet I will still have another x-ray and MRI scan of that area to check for arthritis, etc. any other problems that may be occurring just encase. That will happen over the summer.

I've been very fortunate to have many musicians who are struggling with dystonia or an injury contact me! Thank you for all the helpful resources sent, your stories, questions, and support. I'm glad we are in it together, and I know we all are fighting a hard battle to overcome this huge setback. It's inspiring to see so many people willing to open up about what they are going through, what they have learned, and reaching out to others. I swear, it's been a huge movement, and I'm just extremely thrilled and overcome with joy knowing the awareness of musician's dystonia is heightened more so now than ever. I've seen a huge flux in my blog views; reaching 30,000+ ...which is both exciting and embarrassing for me at the same time....I'm extremely honored and humbled. If you were all here, and if I could afford it, I'd buy all a beer! (or wine...or something great!) hehehe

This year should be a huge one for me, and I'm looking forward to it, no matter how exhausted I am....I can't even begin to explain how happy I am doing what I love!!! Cheers to a wonderful year and may miracles and blessings continue to flow our way! Have hope, and see in yourself what you see in others; we all have the potential to accomplish something great, one step at a time, even if it goes unnoticed!

Pathways in Focal Embouchure Dystonia by Dr. Denton Thomas

I've been busy as usual and didn't find time to update my blog for all of December! I found this handout online written by Dr. Thomas, so thought I'd share it and post it for December. Dr. Thomas hails from Melbourne currently, and previously from UT-Austin.

I'm so happy to see professionals writing about this neurological disorder, spreading the knowledge and backing it up with research study. Thank you for contributing your work and passion about this area of musician injuries/disorders Dr. Denton Thomas!

http://www.dentonlt.com/sites/default/files/webfm/fdresearch/ITF2010-LectureHandout.pdf

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

Jerald Harscher: The Poised Guitarist

I wanted to share Jerald Harscher's fantastic website on my blog. I had always been meaning to and now just got around to it! You can find his website at: The Poised Guitarist. He is a wonderful person to chat with and very kind, so please contact him if want to know more!

Jerald is a guitarist who has helped many (MANY) musician's with hand-related injuries and Focal Task-Specific Hand Dystonia. He can help you lessen tension in your playing and guide you throughout recovery. He knows a great deal about body mapping which I believe is essential to a musician overcoming any type of injury, and for prevention in general.

If you are looking for information, resources, help, and knowledge on anything hand-related within music, please contact him! He is a great resource. Check out his forthcoming book, videos and information. It is even helpful for brass players to read his writings over the hand/arm movement. Sometimes we use a heavy amount of tension in our grip on our instrument which can sometimes transfer and/or add extra pressure on our embouchure via the arm force.

Quantification of Instability of Tone Production in Embouchure Dystonia

Quantification of Instability of Tone Production in Embouchure Dystonia Link
I finally have a quick moment to update my blog. Right now I just wanted to share another article I came across! A really great read which discusses how hand dystonia can be objectively assessed, yet it is extremely difficult to do with embouchure dystonia. This research shows a possible way of measuring embouchure dystonia through the frequency of a note being played.

Roger Frisch Undergoes Deep Brain Stimulation

I just wanted to share this video! Roger Frisch, concertmaster of the Minnesota Orchestra underwent brain surgery to overcome his essential tremors. I'm so happy it helped him overcome them completely! Essential tremors and dystonic tremors both have no known source of cause. As well, they both involve misfiring signals from the brain.

However, essential tremors are much different than dystonia. Essential tremors are usually in just the hand, arm, and fingers (mostly all at once) and are a constant tremor (even when not playing their instrument). Whereas Focal task-specific dystonia, the tremors are set off by a specific motion or movement or task initiated (in other words they only happen when a person is playing their instrument), and the tremors are irregular or sporadic. Essential tremors usually develop in older age, and dystonia usually occurs in young adults 25 and up.

There are many people with general types of dystonia who undergo brain surgery, but not many musicians who do due to the difficulty stated below...it's not easy to find out how to correct the tremors or where the signal is coming from when the musician is not playing their instrument. In this case, he has essential tremors and was able to play his instrument during surgery. I can't imagine! I don't think I could ever be brave enough, nor afford it.