Video: Collapsed and Puckered Embouchure with Dystonia

Haven't recorded a video in a really long time! Well, after a long duration of time of having very few symptoms, I of course get a day full of intense relapse symptoms. So I thought I'd record my relapse and also show what the symptoms look like on both a puckered, and on a collapsed embouchure.

So many people think that in order to overcome embouchure dystonia it requires a "fixing" of the embouchure setup by either puckering more, or loosening the embouchure more...and although less tension is key, it isn't the answer to overcoming embouchure dystonia. No matter what way I form my embouchure, I still deal with the symptoms, and I always have to adapt to them and try to iron out the contractions to an extent. But the symptoms are never 100% non-existent.

*I want to clarify that it is my left side that has the most visual symptoms (i.e. air leaks, uncontrollable rolled out lower lip on the side, and corner moving all over the place), and my right side that looks stable, yet it feels stiff and flacid at the same time, and my upper lip is raised up so much on that side. 

I tried to actually plan out my recording this time. The first thing I did was play a low excerpt with a collapsed embouchure/no tongue (i.e. air-attacks) zoomed in and then zoomed out. The second thing I did was play the same low excerpt with an extremely puckered embouchure (as puckered as my muscles would allow me) with tonguing, zoomed in and then zoomed out. Then I did the same with the higher register excerpt. 

Milestones: Played Horn in A Group for the First Time in Six Years!

A few months ago I received a message from a former UNI (Iowa) classmate of mine named Michael Conrad. He is the current Graduate Jazz Teaching Assistant at UNC (Colorado)...which is one of the schools I attended in my undergraduate studies. He had asked me to sub for the horn player in the UNC Jazz group he works with. 

At first I was a bit hesitant, but remembered how much I loved playing his compositions in my undergrad. Since then he's gone on to win numerous awards for his compositions. I informed him that I still was coping with dystonia and could play as long as it wasn't anything too crazy. He sent me PDF's of all the music to check and I told him it all looked doable, so I went ahead and took a huge step/leap of faith and drove up to Greeley to rehearse with them. 

I have to say it was one of the best experiences and decisions I've made this year! I was both excited and scared. But if anything, it proved that I have come a long ways with my embouchure dystonia, and that I must not ever give up. Right around the same time I received the news that I was selected as a participant in a research study on FTSED. Going to this rehearsal made me even more ecstatic for the upcoming research. 

I'm grateful to Michael for thinking of me even though I had not played the horn in a group since 2010, and for putting so much trust in my playing...even if it was just a rehearsal...I wanted to put my best foot forward. I also was very happy to see a former classmate at a former school I attended...it brought up a lot of memories and nostalgia from my horn playing days. Which is always an amazing feeling to remember!

PAMA Referral Listing

I am now listed on the PAMA website as a referral. I registered encase anyone needed someone to talk to about FTSED and having trouble finding information on the subject. Again, I'm only doing this for the purpose of leading others to information, research, and/or help with FTSED if they are diagnosed with it and are unsure of where to go/what to do.

Summer Vacation in Washington & 32nd Birthday!

A couple photos from vacation in early June for my birthday! Too many to post on here, but all-in-all it was the best trip taken. Spent a week in Seattle and Olympia visiting family and touring around.

Photo my boyfriend took while on our boat tour!

I met one of the Seattle Symphony tuba players.

Seattle Symphony Orchestra Concert at Benroya Hall where my twin sister use to perform with the Northwest Symphony Orchestra!

Garden of Glass

PMC

My boyfriend and I playing guitar and bass as usual.

Seattle Aquarium

While traveling to Bremerton via Ferry

Crab fishing in WestPort

EMP Museum

Watching an old classmate from UNC-Colorado, Robbie perform on trumpet in a jazz group in a Seattle club!

Happy Teacher!

A couple photos from throughout the year! I'm looking forward for fall to return and school to resume. Currently I'm assistant teaching at a Montessori school for the summer, but still missing my music students soooo much this summer.

Performance at Boulder Theater

Performance with CU Boulder Symphony at Denver Performing Arts Center

Setting up on stage at Boettcher Hall

Kinders get to try out trumpet for the first time!

My fabulous flutes and clarinets playing an arrangement of Great Gates in rehearsal with the strings for the first time!

One of my students performing at the school talent show. 

As program assistant during the fall, I was honored with the task of getting free tickets to the CSO's entire season for all our music students and staff throughout our 3 partner schools.

One of my trumpet students who moved onto advanced orchestra.

Being goofy

Some of me and my co-teachers kinder-violin students.

On the bus on the way to a CSO concert!

Oboist Alex Klein Returns to the Chicago Symphony Orchestra After Battling Hand Dystonia

It was so wonderful seeing some good news for once lately! Today I opened my browser to find news articles posted on Alex Klein returning to the CSO after stepping down in 1995 due to Focal Hand Dystonia. Here is the Chicago Classical Review Article over his new appointment in the orchestra! Congratulations Alex! This news brings so many of us hope and happiness. 

You're Never Alone

I had the greatest week! Last Sunday my friend and associate principal horn of the St. Louis Symphony visited Boulder to perform the Brahm's Horn Trio at the Boulder Bach Festival. My boyfriend and I went to watch his concert, and then Monday morning Thomas came and watched me teach kinder-violin at school. It meant a lot having him there, because none of my friends from out-of-state have seen me teach since I started my career, and not even my boyfriend has seen my teaching in action.

What I love most about this is that I realized in the last 3 years I've been able to see old friends more than I thought I would, and sometimes more than once. Every time a friend travels through Denver it's like time never passed between us.

I know everyone feels that way with friends, but for me it also brings back a reminder of my old self, my horn-playing self (basically when I felt like I had a definite fixed purpose or calling in life...not that teaching isn't, but the horn was my tool of expression...my voice). It gives me a sense of strength and confidence knowing that my past, my memories are not forgotten or faded inside after everything I've gone through....I guess I'm just happy that the fire burns even brighter inside me when I'm around friends.

I don't know if that makes. I feel relieved to have friends who get me and remain in contact despite the long distance, especially who have been supportive before I lost my ability, and after I lost my ability to play horn. I still can't believe time can go by so fast and yet, I feel as if yesterday I was playing my horn pursing my passion to be a horn professor.

I'm glad to have friends who continue to talk to me about horn playing and know that it's still a huge part of who I am and always will be, and who root me on to never give up hope. So often musician's with dystonia feel they lose a sense of themselves and who they are, and it is a huge struggle. In a way when I visit with friends I feel so much relief knowing that they had a equal impact and part in both my past and present (before I got dystonia, and after). I don't think they realize how important and meaningful that is to me that they've stuck around through thick and thin, and all the transformations my life has gone through.

Enough talking! I'm definitely rambling all over the place and not making sense. Here are some photos from the past week. I'm on vacation soon, and then participating in a research study on embouchure dystonia! But also happy to say I'll have more friends and relatives passing through during July and I'm excited for all the good things that happened and are to come. :-)

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.

Facebook Page: Living with Embouchure Dystonia & Other News

I got around to making a facebook page linked to my blog Living with Embouchure Dystonia. Hoping it will bring more awareness to the disorder.

I'm also excited to announce that I'll be participating in a research study on FTSED in the near future, and I'm currently working on publishing an article as well! I hope that in time I'll be able to share more details on my blog. Until then...thank you for stopping by, and hope to catch up soon. 

- Katie :)

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. 

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. 

Home Moments...

Home Life Moments. (Wish I could figure out how to make photo albums on blogger)...

New couch...

A drawing my best friend Lizzie drew for us to display in our new apartment!

Skyping with one of my best friends James!

Happy Halloween!

Our backyard squirrel taking a nap on the fence post...

Onion rings and beer..yum!

Enchiladas and beans...yum!

My boyfriend playing hockey...

Stroll in the park...

Chicken for dinner...yum!

My boyfriend in his new hockey uniform!

First bed bought ever...

Healthy shakes...yum!

On the wall of my organizations center...

Love of my life.

Practicing horn!

Favorite restaurant...

Beautiful view from West Denver

Golfing with my boyfriend...

Meeting with family...

Sitting in on a CMF orchestra rehearsal...

My favorite professional hornist watching his son play violin on pearl street!

My boyfriend playing bass