Brass Embouchure Dystonia – What does a typical case tell us?

Let me start this post by making it very clear that I am not a medical professional. In no way should anyone use the information I’m posting to diagnose or treat a medical condition. My recommendation is to visit your doctor and get checked out, or get a referral to a specialist.

I’ve been thinking recently about some of the papers and articles that discuss brass embouchure dystonia. While I have written up before about helping musicians with embouchure dysfunction, I haven’t really written up a close look at what appears to be a typical situation. In his literature review and case study, Dr. Seth David Fletcher wrote a hypothetical case:

Consider the following scenario: a trombone player earns a seat in on of the nation’s premier orchestras. One day in rehearsal she notices that she cannot articulate some middle-register notes cleanly. The following week this difficulty recurs and is noticed by the conductor. Naturally, she increases her practice and focuses on the source of the problem. Unfortunately, she then develops an uncontrollable tremor in her embouchure when playing sustained tones. Over the course of the next few months her ability to play rapidly declines the the point that she is forced to stop playing.

Even though this case is hypothetical, it includes some characteristics that are noted as being common for brass musicians dealing with dystonia-like symptoms. It’s more common in men than women and the mean age of onset is 37 years old. Symptoms include lip lock, tremors and involuntary contractions in the embouchure muscles.

Jan Kagarice in a presentation for the International Trombone Festival in 2004 wrote more about typical cases (see Fletcher’s dissertation, p. 33 for the full chart). Personal traits include being a natural player, considered to be talented and successful, a perfectionist who practices a great deal, and naturally expressive and talented. The onset of the problem manifests in a change of playing sensation. Symptoms arise, and the case usually progresses along the pattern described above.

For my purposes, I’d like to consider the following descriptions that appear to be typical.

Common Patterns of Brass Musicians with Dystonia-Like Symptoms

  1. A natural musician who practices a lot, but who doesn’t typically need to address technique.
  2. An issue begins to manifest and the musician begins to diagnose and try to correct the issue through task-specific practice.
  3. The problem gets worse.

Some of the authors of the papers and articles use this typical pattern as evidence that because there is a correlation with task-specific practice, and by implication, perhaps the cause. I’m not so sure that this is accurate.

First, it’s worth noting that there is also correlation between being a “natural” player (who didn’t really need to be shown how to play correctly, just did) and the onset of a problem that they can’t practice their way out of. Secondly, when it comes to the task-specific instructions on the topic of brass embouchures, one thing that is worth noting is how contradictory a lot of the advice is. When a natural musician tries to eliminate a playing difficulty through task-specific practice, it’s worth looking at what specific tasks they are practicing and whether it actually makes corrections in the player’s embouchure technique. Particularly if a musician is a “natural” player they are unlikely to understand how to analyze their embouchure and how to make specific corrections.

Like others, I feel we should be helping players with embouchure dystonia in a wholistic manner, including emotionally and musically. However, I feel we’re missing some important clues by jumping directly to goal-oriented approaches to treating embouchure dystonia. The onset of the musician’s problems will typically manifest prior to the task-specific practice. The cause of the symptoms may be in the musician’s technique and the effect of trying to practice out of it incorrectly is what leads to the full blown breakdown. At the very least, teachers and therapists should be aware of brass embouchure types and be able to note type switching. How they choose to make necessary embouchure mechanics corrections is up to them, but they should understand what they should be accomplishing.

As I mentioned above, I’m not a medical professional and neurological disorders are out of my area of expertise. Brass embouchures mechanics, however, are in my wheelhouse. There are important variables that is being missed by many musicians and medical professionals who are working to treat embouchure dystonia. As I mentioned last month, there seems to be a movement in Europe to take a more objective and scientific approach to embouchure dysfunction. I hope that researchers, therapists, and music teachers in the U.S. will follow their lead.