Embouchure Focal Dystonia

When the nerve connection breaks down.

When I recently visited John Ericson to discuss launching this website, he was ending a lesson with a student afflicted with focal dystonia. (He has written briefly about focal dystonia before.) I had an interesting discussion with this student and it opened my eyes to this debilitating medical condition.

I have perhaps seen this condition in several students, but at the time was not fully aware of the possibility that it might have been focal dystonia.

Dystonia is a neuro-muscular disorder that causes muscles in the body to contract or spasm. “Focal” dystonia is generalized to one region of the body. For musicians, it typically affects the specific area of the body that is used to play the instrument.

A failure to communicate

The connection between the specific muscles for playing and its corresponding area in the brain — for some unknown reason — short-circuits itself. Something goes awry with muscle memory.

It is not something that occurs overnight. According to a post at Chamber Music Today:

• Multiple parts of the body can be affected, or sometimes just one such as hands, arms, neck, face, eyes, or vocal cords;
• Symptoms are usually chronic and progressive;
• Varying degrees of disability and pain, from mild to severe, interfering with performing on your instrument;
• Affected body parts specifically are ones that are intensively utilized in your performing—ones that are the focus of intense attention, cognitive effort, and repetitive rehearsal.

Treatment

By all reports, it is incurable. Medications used to treat dystonia are generalized and temporary, and do not cure the condition.

Dianne Rhem, a National Public Radio personality that I regularly listen to, receives periodic shots of Botox directly into her vocal chords to help treat her spasmodic dysphonia. Sometimes this Botox treatment is prescribed for focal dystonia.

At Embouchure Dystonia, Joaquín Fabra suggests that Botox injections into the embouchure might ruin it forever.

This disorder is generally unknown among doctors, most of them have never seen a case and have no experience on this matter, generally they are cautious and sincerely admit they do not know the disorder, but others may dare to suggest botox which can ruin the embouchure forever.

Botox is, after all, a poisonous substance – a botulinum toxin. There may be some validity in Mr. Fabra’s assertion. How many Hollywood celebrities have we seen with plastic, frozen facial features from too many Botox treatments?

Trombone professor David Vining at Northern Arizona University in Flagstaff, Arizona recounts his experience with embouchure dystonia and his more holistic approach towards treatment.

This is what can be very puzzling about dystonia; it is not easily diagnosed and, at present, 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.

Adaptation and coping

Other musicians choose to adapt, as Billy McLaughlin did. Fortunately for him, switching hands was an option.

Other resources:

• http://www.youtube.com/user/davescragg
• http://www.dystonia-foundation.org/pages/musicians_with_dystonia/180.php