My Recovery from Embouchure Dystonia

In May of 2002 I was diagnosed with focal dystonia of the embouchure. Dystonia is a neurologicalmovementdisordercharacterized by involuntary muscle contractions which force certain parts of the body into abnormal movements or postures. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords. My version of this dysfunction was deemed “focal” and “task-specific” meaning that it only affected my embouchure when playing trombone. This dysfunction is not life threatening but it is a chronic disorder and a prognosis is difficult to predict. At present there is no reliable medical cure for embouchure dystonia and nobody can be completely sure of what causes this mysterious condition.

My symptoms included an unnatural closure of the embouchure during various times when I played. The muscles would spasm and the tone would abruptly cut off causing a sort of “hiccup” in the music. Ends of notes would often suffer and my playing was generally rough and unreliable.  The problem started with chipped attacks on certain notes and progressed to affect more and more of the range of the instrument. Eventually the condition became debilitating enough that it was impossible to continue playing in public.

It should be noted that many musicians encounter some sort of physical or mental problem at some point in their careers. In fact, rare is the professional musician who has never encountered a difficulty along the way. Among the numerous possible ailments are repetitive strain injuries, performance anxiety, muscle tears and hearing loss. In some cases the problem may be remedied through medicine or surgery and in others there is simply no known medical treatment. With any of these problems it is important to understand the nature of the ailment in order to pursue an effective treatment plan; this is what can be very puzzling about dystonia because it is not easily diagnosed and there is no recommended medical course of treatment. This leaves the patient to find alternative non-medical avenues to rehabilitation.

My approach to this problem was exactly that – I aggressively sought non-medical options. Starting with a series of lessons in the Alexander Technique, I soon discovered an entire assortment of movement therapies which are largely unknown to musicians. The Alexander Technique lessons led me to a technique called Body Mapping, which I found so useful that I eventually became a certified teacher in this discipline. The other movement therapy which helped me to recover was Feldenkrais lessons. 

The benefits from the above mentioned movement therapies are too numerous to list. There is one principle, however, which emerged from these practices that turned out to be a particularly important key to my success; to retrain the embouchure, start with an understanding that you play trombone with the entire body, not just the embouchure.

F. M. Alexander called this Global Awareness and it includes the realization that tension in one part of the body can affect another part of the body. This concept can also be found in the teachings of one of our foremost pedagogues – Arnold Jacobs. When I finally understood and incorporated this idea into my own work my progress was facilitated greatly.

Another critical realization which made my rehabilitation possible was to identify the problem as originating in the brain. What this means is that to attempt to “make the muscles stronger” would have been the wrong approach because there was never any problem with weakness of the muscle tissue. The problem was with the messages sent by the brain, not with the tissue itself. This is a very common misunderstanding among those unfamiliar with dystonia – the assumption that the affected person overworked their muscles, played too long, played too high or some such situation. In my case, this was not what happened. It wasn’t what I played but how I played it.

Bearing this in mind, what I did was to change my approach to the instrument and what I was thinking as I played. A good example of this change (though not by any means the only example) is that I redefined the embouchure as an entity in motion which does not exist without air. Here is the distinction I made to retrain, which, incidentally, works very well for healthy players also:

The old, traditional definition of an embouchure is:

"the formation of the muscles around the lips and face used by brass players to produce a vibration."

The new definition that helped me recover is:

"An embouchure is a three-dimensional entity in motion created by the movement of air past lips to produce a vibration."

To the lay-person this may seem a subtle and inconsequential difference but to a brass player this is a profound distinction. 

Developing global awareness and overhauling my approach to trombone playing have taken years of relentless, gentle effort and lots of help from some very talented and compassionate people. When one is in the middle of this sort of condition it is very difficult (perhaps impossible) to think clearly and monitor the quality of one’s effort. I must stress that the effort of retraining is gentle and patient and to be gentle and patient is extremely difficult under these circumstances. Qualified professionals are needed to guide one through the process. For a list of the people who helped me, see the Thanks link.

I would be remiss for not mentioning one very important person in my retraining program – Jan Kagarice. While she is not affiliated with a particular movement therapy, Jan has become an expert in helping people retrain from dystonia.  She knows how to re-define our thoughts toward the new way of playing and is very talented at motivating her clients to continue on the right path.

To see a list of books and media which helped me to retrain from dystonia, please see the link titled Resources.