Involuntary tremor-vibrato started - worried . . .

[vanderbagger]

In the last three weeks, I've developed an involuntary tremor on held notes, and I don't warm out of it. I'm concerned it may be the start of Parkinson's or another neurological issue. No, not a hypochondriac. I'm skipping a gig tonight because I can't hold a tuning Bb without my embrasure pulsating back and forth and the note quivering, not fast, but quite noticeable. Any information would be appreciated.

[Radar]

I was going to suggest the same thing Bloke did, take a break get some rest, make sure you're getting enough sleep, etc. If the problem persists or you see other symptoms then see a professional.

[Mark Horne]

I've had similar things happen to me both on tuba and french horn. One thing you might try is to switch to a mouthpiece with a different rim diameter and shape. For me it reduced or eliminated the quivering and eventually I could swith back to my original mouthpiece and play normally.

[Roger Lewis]

I've seen this happen with some students who were playing on mouthpieces that were just 'way too big for them. I agree with Bloke that rest will help the most but a change to a slightly smaller mouthpiece might also help.

Roger

[Rotaryclub]

How about some more information for us so we might be able to add or help better.

Is it in a particular note(s) or register?

Does it disappear when blowing strongly?

Is it worse as you get fatigued, or worse when nervous or on the spot?

Is it the same when playing a different horn (like an F tuba if you have one)?

Your age (if you wish)?


Past several years I often have something like that, on particular notes in certain situations (largely like those above). I attribute it to not having strong chops like I used to (too many kids, not enough practice). In recent years when going long stretches of good practice (building my chops up again) then this goes away. But I don't remember having it as a beginner without a strong embouchure so naturally I instantly I fear it's some neurological problem. Please keep us posted and good luck.

[Alex C]

I think you are playing on shallow breaths. Play and take particular attention to your inhalation; big, relaxed inspiration and fill the lungs quite full. Once you get air flowing again, I think you'll get a steady sound again.

Hint: don't play long tones until you get a good habit established. Right now, long tones will only scare you.

Been there.

[swillafew]

A trumpet colleague of mine is distressed about a loss of control of his embouchure. I know he attempts to play difficult literature without spending enough time on a systematic warmup. It inspired me just this week to ramp up my warm-up to the old "college try" level. If I had the OP's problem, I would rest a week or two, and then have a "do-over" on the fundamental exercises that have succeeded in the past.

[mjrctuba]

It sounds like the others posting to this thread have experience with this and it's definitely worth giving their tips a try. However, if you continue to be concerned about a medical condition (Parkinson's, focal dystonia, etc.), I strongly suggest that you make an appointment with a neurologist. More specifically, you would want to see a movement specialist.

Tubenet is a great resource for all things tuba, but it's not a great place to get medical advice.

I hope it's nothing and it goes away soon!

Good luck!

- Michael R. Cavitt

[MaryAnn]

There is a yahoo email group called embouchuredystonia. The archives are open to the public. By reading the archives you may be able to determine if you are headed down this path. If so, there are ways to circumvent having it get worse. There is a Facebook page on focal dystonia run by Jon Gorrie (I think) and he has apparently helped quite a few to fix themselves rather quickly. Even if it IS focal dystonia, I personally do not think a neurologist is of any help. All they do is drugs and surgery, neither of which work for embouchure dystonia. IF that is what is going on. If the two week rest and changing the cup size don't help, look at the yahoo site.

[vanderbagger]

Reply to Rotaryclub questions:
More in a particular note or register? Yes, in the middle register, tuning Bb, especially
Does it disappear when blowing strongly? Yes
Is it worse when fatigued or when nervous? Yes, when nervous especially I was going to play with a symphony that I respect highly and got very nervous and that's when I first noticed it. Had trouble playing the tuning note. Warmed up at home for the next symphony practice, and could hardly play a tuning Bb, so decided I couldn't go. I mostly play in a Bavarian band in a tourist town (Leavenworth, WA), and have very little problems there, but there are very few long tones in that music!
Same problem when playing different horn? Don't have any other horns.
Age? 68 Very good health and fitness.

Thank you all, this has been a great help.

[NDSPTuba]

I wouldn't worry about it being a neurological thing. When embouchure dystonia hit me ( as a Horn player ) it was sudden and catastrophic. One hard day of recording sessions and the next day a complete embouchure melt down. Couldn't even start a note. So it wasn't a come on slowly type of thing. Here is sit 15 years later and I STILL pick up the horn every now and then to "see" if I can play again. Nope.

[vanderbagger]

Update, it was an anxiety thing, nerves. I spoke to my doctor, he had me try propranolol, beta blocker, for gigs, a wonderful help. I have weened away from the beta blockers over a year or so by gaining confidence in the groups I play with, but it is good to know I have some in case I get into a new playing group situation.

[euphomate]

Dear old Arnold had some advice for anxiety-type issues, particularly performance nerves. Before playing - sitting quietly, long, slow, deep inhalations and exhalations, from memory count to six slow in and six slow out. A few repeats. I have this issue sometimes after longish spells of euphonium practice then switching back to tuba using the VB 24AW, so maybe the mouthpiece advice is valid. As is the need for solid, consistent full air support. The problem doesn't appear when I switch to euphonium from tuba.

[pjv]

A lot of great, sound advice here.

Seeing as nerves is also at work, consider adding a music group to your diet which is less stressful, lower key.

When I was finished with my studies I did a bit of playing on the streets in the summers (to pay the vacation!) It went a long way towards helping me resolve nerve issues. I was too busy having fun and entertaining the audience to notice what I was doing. I just had to trust that my experience and time spent practicing would support me "in my time of need", so to speak. The music my colleagues made came in through my ears and out through my tuba, you might say.
This philosophy still works for me today and allows me to concentrate on what I came for; making music.

[Rick Denney]

Many here know that I've been battling a tremor problem for some years--at least a dozen years and maybe longer.

2) Having an overly tense (heavy on diaphram *pressure*) air technique. Eventually this catches up to players causing shake possibly from the gut, but it can also cause shake at the embouchure. Also *nerves* will bring this on out in spades.

Oh, yes. But I believe the tenseness is just exacerbating symptoms of a problem that is there for other reasons.

As to whether it is what doctors call "essential tremor" versus the specific Parkinson's Disease, that requires a medical diagnosis. But here is a bit of what I have learned: Shaking for Parkinson's victims is called dyskinesia. With Parkinson's, it's a problem with L-dopa, which the portion of the brain responsible for same is not producting in sufficient quantities. Medications for Parkinson's patients try to restore the L-doba balance, but the medication protocols are difficult and require great precision. Also, the medication does nothing to slow the progression of Parkinson's. Generally, though, Parkinson's dyskinesia is related to muscles at rest, while essential tremor is related to muscles under tension. The lack of L-dopa and its effects are subliminal and happen when we aren't thinking about them, while essential tremor happens with muscles receiving our conscious attention for whatever reason. For me, tremor is related to the tension, and my doctor eliminated Parkinson's as a possibility instantly based on that distinction.

That's why the tension in the diaphragm can cause tremor in the gut. I will have tremor related to my diaphragm, my head, my jaw, my embouchure, and (sometimes) my hands, and all of them at different frequencies. There have been times when I could not sustain a buzz. Other times, I can control the "vibrato" only by resting my head against the tuba bell, which releases the muscles used to hold my head in place (or allows them to tense beyond the tremor threshold). Of course, the bell isn't in the right spot, and I have used my left hand to make a fist that I use to brace my head against the bell. I've considered coming up with something more permanent, or at least that doesn't require me to maintain the position of the instrument with my right thumb, but the goofiness of that has dissuaded me so far.

It's obvious to me that adrenalin (or something else released at the same time) makes it worse. Adrenalin is a stress hormone, and it can be released as a result of just about any stress, from a heavy weight-lifting workout to fear or anger. Excitement about the music is enough for me, as is solo or performance stress. I speak in public frequently (or did before COVID-19), so frequently that it no longer triggers stress. But in a meeting where I'm challenged enough to get a bit angry, the only tell (and it's a bad one) is that my head will shake side to side just a bit. On one occasion, that was interpreted as a disrespectful negative response that escalated the debate at the time--not good.

Propanolol subdues the production of adrenalin. But it has some side effects--it can lower blood pressure, which in me is not a good thing. My blood pressure and resting heart rate is already low and slow (typically 110/50 and in the low 40's in my current state of reasonable fitness), partly because of endurance training in my life, and partly because of genetics. I tried a drug (for an unrelated problem) that had the side effect of dropping my blood pressure, and the result was a trip to the ER after fainting in the bathroom one morning. A month later, I had another similar episode standing in line at the Houston airport, though I managed to avoid fainting, and thus the trip to the ER (I even made the flight). No more drugs that drop blood pressure for me.

Another treatment for adrenalin is a alcoholic drink. Doctors won't recommend this because they don't want to be responsible for those who have a problem and should not be drinking at all. But research shows that it works. I don't have a problem with alcohol--I do like bourbon and scotch but the bottles of each last well over a year and I enjoy them one finger at a time for taste--and a shot does help with the symptoms of essential tremor for about an hour, which is often long enough for the adrenalin-release signal to pass.

As to what causes it, I don't think anyone knows. But strategies fall into several categories: Avoid the adrenalin release in the first place through mental stress control, avoid the effects of the adrenalin chemically, and avoid the effects of the adrenalin through application of fundamentals that resist those effects. (I'm avoiding surgical techniques--not appropriate, it seems to me, unless one's livelihood or ability to manage living is at stake.) You've gotten advice in all three categories. Mental relaxation is a preventative, and for me that includes deep preparation (often only a pipedream), a long and slow private warmup, specific relaxation practices such as deep breathing and mental focus diversion. Propanolol and alcohol are in the chemical symptom control category.

And the advice to learn how to play without the tension that triggers the tremor is in the third category. For me, even sitting in the wrong chair can cause tension that causes tremor symptoms. But relaxing the gut is a challenge, and here's why: It's poor posture. I suffer from a back problem that couples with Piriformis Syndrome to cause significant discomfort. After some months of physical therapy (doctor ordered and highly qualified), I have learned that I must support my core and maintain a healthy back shape in daily life. What muscles do that? Precisely the muscles we should relax when playing. So, I have formed a habit of involuntarily using those muscles to support a proper back shape, and have to consciously relax them when sitting to play the tuba. Standing and playing the tuba has become very difficult for me as a result.

It may take some strategies in all three of those categories to keep it under control as long as possible.

For me, it has not been a steady onset of symptoms, but more like an ebb and flow, with the tides measured in years. For several years, it seems to get worse, and then for a while, it seems to be less of a problem. The changes have moved too slowly to correlate them with any specific life strategies. But this I know for sure: cutting out caffeine has had no effect at all in my case, despite that everyone around me thinks it does. When I was on my big weight-loss diet in 2018, I stopped drining all caffeine for months, and there was no effect at all on the tremor, nor any effect when I started drinking coffee again (I still drink diet colas only rarely compared to years past).

Most doctors think of essential tremor as being benign, but there is growing evidence that it is related to a body of movement disorders that might signal a greater correlation to more serious age-related dementia. When I read that, it got my attention! But all of that is still speculative, and the treatments those who are saying this are proposing are a bit out there. I'm sure of this: an aging population will see more of this, and worry about it more, which creates a market. The response to that market is not always legitimate, so when reviewing internet information and proposed treatments, one must be highly skeptical, particularly when common sales tactics are employed. Other musicians may be innocent purveyors of such treatments, being highly influenced by apparent correlation whether or not the correlation indicates causation. Truth to tell, doctors may not be much better.

Rick "always keeping an eye on this topic, as do a few others on Tubenet" Denney

[timothy42b]

Most doctors think of essential tremor as being benign, but there is growing evidence that it is related to a body of movement disorders that might signal a greater correlation to more serious age-related dementia.

A relative has Lewy Body Dementia. That includes some Parkinson's symptoms but normal drugs for Parkinson's makes it worse. There are a lot of scary things that can go wrong with our bodies, especially as we age.

[Rick Denney]

...unless I hadnt eaten and my blood sugar dropped before I got on stage...

Thanks for bringing that up--a very definite and important factor for me.

Again, though, I think low blood sugar, nervousness, etc., just exacerbate an underlying issue of tremor. To a certain extent, everyone suffers from that if the conditions are sufficiently extreme--even in my 30's I recall an episode where the TubaMeisters took a stage in an unusual situation and I got the shakes from nervousness. That happens to just about everybody at one time or another, and maybe more often for some.

It's just that, for me, the conditions no longer need to be extreme, or even noticeable, to trigger tremor. I don't have to feel particularly nervous, or stressed, or hungry. I'm none of those things in the practice room, but I have the problem there, too. Long, slow warmups help.

Anything we can do while the symptoms are minor or occasional in the realm of good habits--mental and physical--will help later on, but even then that might not be enough.

Rick "appreciating your PM, and will consider it" Denney

[Rick Denney]

Most doctors think of essential tremor as being benign, but there is growing evidence that it is related to a body of movement disorders that might signal a greater correlation to more serious age-related dementia.

A relative has Lewy Body Dementia. That includes some Parkinson's symptoms but normal drugs for Parkinson's makes it worse. There are a lot of scary things that can go wrong with our bodies, especially as we age.

I've just started reading about Lewy Bodies. Nothing to say, yet. My father in law suffered from that during his last several months.

Rick "getting old sucks, but it beats the alternative" Denney

[MaryAnn]

Well, a year ago I had a stachybotries exposure, and after that I have a minor tremor in my hands, sometimes there and sometimes not. This is NEVER considered by physicians of any type unless they have been forced to recognize it from personal experience themselves or someone close to them. I did not develop tremor from my previous exposures, which were not stachy. I had a lot of other things, but not tremor. Most people have no idea they are in mold exposure because it is usually hidden, and testing for it requires looking at specific inflammatory markers that are non-standard. However it causes brain damage, which I am intimately familiar with.