Some Interesting Ideas on Focal Dystonia

[tubapress]

Over the years a number of brass musicians at the very top of our field have been diagnosed with Focal Dystonia of the lip. In many cases, this has ended careers.

I stumbled across a VERY interesting thread on this topic via the Trombone Forum tonight that I thought I would share with the Tubenet community. There are some very good posts in this thread dating from 2008 including some personal stories and an excellent posting by Doug Elliott. I truly believe that in many cases the diagnosis is just plain incorrect and that the condition can be reversed in some cases to varying degrees.

Have a read via the link below:

Focal (Embouchure) Dystonia

[Doug Elliott]

I will quote my TTF post (from April 15, 2008):

I have been aware of embouchures and paid attention to lots of players' chops (whether they know it or not) for a long time. Believe it or not, I've attended every ITW (now ITF) since 1974 with the exception of 1989 (in England) when I was in Air Force Basic Training. I've also attended several International Tuba-Euphonium workshops and other brass clinics in that time, so I've seen a lot of players in action.

I won't mention names, but I had noticed one the players who has since stopped playing, before he had any problems. Several more I saw when they were starting to have problems. Every one of them was switching embouchure types in different ranges - not uncommon at all in the general brass-playing population, but potentially disastrous to someone in a demanding professional position.

I firmly believe that most, if not all, cases of "focal dystonia" in brass players, are originally caused by incorrect form that could have been corrected at almost any point. Bad form, or using multiple embouchure types, can work well with no apparent problems for a long time. But just like lifting with your back instead of your legs, eventually you injure structures that aren't strong enough to take that kind of abuse. Using good form would have prevented the problem from ever happening. And the solution is to learn what good form actually is, and start doing it.

As Sam says, and I believe Jan's approach addresses, the emotional impact of a breakdown is a major factor if not the hardest one to overcome.

There are certainly medical and neurological issues that can affect playing, but in my opinion, these breakdowns in professional players should mostly be looked at as symptoms of an embouchure form issue, not a medical problem. And I think it's completely preventable.

[NDSPTuba]

Doug,

Focal dystonia ended my professional horn player career. I do know after reading about embouchure types, that I definitely switched embouchure types for the mid/low range. I've since tried to use a correct embouchure type when playing the horn, but my shakes and quivers are pretty severe in the mid range. Do you think that one can recover once focal dystonia has set in, if you concentrate on using a proper embouchure type? I get the impression from your post that you may think once the damage is done your done.

[tubapress]

Before you go any farther, check out Dave Scragg's YouTube channel which features a series if interviews with Joaquin Fabra. Fabra suffered from focal dystonia himself for 7 years and rehabbed himself. He is known to have helped scads of players recover from dystonia. Certainly, it is at least worth a viewing! Fabra believes that dystonia is reversible in many cases. It has to do with first rescuing the person, not the musician. Watch and you'll see what I mean.

Doug: if you've seen these videos, I'd live to hear your thoughts.

[Doug Elliott]

It is entirely possible to correct the "damage" but usually there are multiple issues to address; it's not as simple as "trying to use the correct embouchure type" unless you thoroughly understand what that means and a lot of details that are also very important.

The longer someone has been making the wrong stuff work, the harder it is to learn ANYTHING different. Deeply ingrained 30, 40, or 50 year habits and beliefs can be very difficult to erase.

[dwaskew]

I can speak to this, as I had a dma student who came in dealing with FD. (and if we're really going to be correct, the appropriate terminology is Embouchure Specific Focal Dystonia) He came from two very well known teachers who have had many students do well in the professional playing and teaching arenas--good solid instruction from them all the way around--bottom line, over a period of 4 years here, he went from basically not being able to generate any sound to giving solid degree recitals and is currently teaching at the college level. (and believe me, he has a firm grasp on "correct playing" so his students are likely getting some of the best instruction going....) He worked with Jan Kagarice some, at the outset, and then it was pretty much the two of us. There is no magic bullet for this, and I agree with Doug that changing "embouchure" while playing is a culprit, and also with the thought that the emotional side of this is probably equally hard to overcome as the physical. I expect that the older one is the harder it would be to come out of it.

D. AsKew

[bilmac]

So, what are we saying? Is it a physical complaint with a physical cure or something else which we are reluctant to put a different label on?

[Dan Schultz]

I don't have any experience with Focal Dystonia but always find these types of discussions interesting. I attended the 'Outer Banks Tuba Retreat' two years ago and one of the clinicians was Dr. Richard Cox. He spoke a bit about Focal Dystonia and may be a good resource for information. He's on Facebook and I also notice that there is a Facebook Forum about it. The email I have for Dr. Cox is r-bcox@ix.netcom.com" target="_blank" target="_blank

[tubapress]

So, what are we saying? Is it a physical complaint with a physical cure or something else which we are reluctant to put a different label on?

My take on this is that it is not quite that cut and dried. There are emotional and psychological aspects to this condition, which in many cases are more prevalent than any physical issues. The body may simply be reacting to those aspects. As Dr. Joaquin Fabra states in the videos I referenced earlier, "we have to save the person before we save the musician".

I encourage you to check out the videos. It is incredibly enlightening!

[dwaskew]

My take on this is that it is not quite that cut and dried. There are emotional and psychological aspects to this condition, which in many cases are more prevalent than any physical issues. The body may simply be reacting to those aspects.

This is exactly the case. it's in no way shape or form cut & dried. Some may have a true dystonia, like a symptom from a stroke, that truly the synapses are not firing correctly or the pathways are somehow blocked or broken. Some may have muscular failure from incorrectly playing/wrong use/overuse, even. (most likely a combination of all) add that in to the way we can wrap our identity into what we do (as opposed to who we are) and a failure to continue to do what we do results in losing who we are. That can be incredibly demoralizing.

In reading my previous post on this, I realize it could've come across as incredibly self-serving--didn't mean it that way--my student did the work, I guided, but he did the work. we problem-solved, he learned how to do things correctly based upon what worked, and his knowledge of pedagogy, his prior abilities of what should go on, not any one thing that I said or had him do. anyone who winds up being side-lined with this type of issue will go about things in a similar manner in hopes of coming out of it--there is no guide book, no anti-biotic, no cast to put on.

dwa