A few days ago I posted an hour-long lecture video by Dr. Peter Iltis that spells out some of his research and personal experience with embouchure dystonia.
This is a very complicated condition involving many factors that fall on a sliding scale, both physical and psychological.
Previously in “Embouchure Focal Dystonia” I wrote:
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.
Here are a few highlights from Dr. Iltis‘ lecture-video (with minute/second timings):
With general dystonia the cases are fairly rare, something like 11 to 430 cases per million, but with musicians and task-specific dystonia, this figure is more like 1 in 100.
We see video examples of generalized, focal and task-specific dystonia.
When muscles that are not involved in the task-at-hand start contracting uncontrollably, this is called co-contraction. These are symptoms of what Dr. Iltis specifies as task-specific dystonia.
The condition creeps in over time and it is not something that kicks in overnight.
Dr. Iltis relates a personal story of how he started to notice extra pulling in his facial muscles over a 4-month period. When demonstrating playing techniques for students his face would form into a grimace and his students, he noticed, would look away.
Who gets dystonia?
Who gets task-specific dystonia?
- Males predominate 4 to 1
- Ages mid 30’s to early 40’s
- Family history may relate
- It is specific to each instrument and the task involved to play it
- It affects mainly classical musicians. Dr. Iltis postulates that there may be a connection to repetitive practice techniques; perfectionism and anxiety may be contributing factors
- Piano, guitar, violin, flute and clarinet players are more commonly affected
- Some people may be physically or mentally predisposed towards the condition
26:00 – 35:00
Looking into the neuro-scientific literature, Dr. Iltis looks at brain function and brain structure. The concept of maladaptive brain plasticity was particularly interesting to myself.
He describes dystonia as something akin to electrical overload – the connection between the brain and the muscles cranks out too much energy and it overloads the muscles. In some cases the brain incorrectly maps fine motor control to a larger group of muscles.
The term geste antogoniste (sensory tricking) is introduced – a method of touching the face as a means to calm muscle spasms. This is something that I have unwittingly done myself with success, not to self-treat dystonia but rather to calm some incidental muscle twitches during a recent embouchure change.
Dr. Iltis discusses splinting and his own personal methods for calming his tremors. His dystonia is sensory-related:
- lip buzzing – no tremors
- mouthpiece buzzing – some tremors
- horn playing – significant tremors
Video examples of Dr. Iltis and his condition.
Claims for a cure?
One final thought for players seeking counsel in diagnosing and treating this condition would be this – I would be very skeptical of any teacher (or doctor for that matter) that asserts a cure.
At this date, Botox injections and other oral medications are for the most part ineffective. (38:00)
As musicians have become very aware of this condition in recent years, Dr. Iltis suggests that it might be over-diagnosed. While he does point to some general techniques that helped him to alleviate his symptoms, he ends his lecture stating quite flatly that he still struggles with the condition on a daily basis.
Thankfully we have people in this field like Dr. Iltis who are able to disseminate fact from fiction in such an articulate and honest manner.
Authentic diagnosis is something that only a medical expert in the field is qualified to do. While visualization, mental discipline, medication and sensory-tricking techniques may indeed help to alleviate symptoms, a reliable, one-size-fits-all cure does not exist at this time.