Embouchure Dystonia

I can't thank you enough, Dr-Mark, for taking time to offer so much valued advice.

Hi GeorgeB,
You're very welcome and I look forwards to reading about your smooth and steady recovery.

Richard III

Once I am playing again, I intend to take off the day following practice or tough gigs.

Okay, I'm going to say this again. If this is required, your approach to playing has something wrong with it. Please find a teacher who knows embouchure formation and go there. I've know many players who take lessons year after year and make slight improvements but the same faults continue. I think those teachers shouldn't be allowed to keep teaching. A teacher needs to to be able to say what the basic issue is that is holding you back.

tmd

@Richard-III said in Embouchure Dystonia:

@GeorgeB said in Embouchure Dystonia:

Once I am playing again, I intend to take off the day following practice or tough gigs.

Okay, I'm going to say this again. If this is required, your approach to playing has something wrong with it. Please find a teacher who knows embouchure formation and go there. I've know many players who take lessons year after year and make slight improvements but the same faults continue. I think those teachers shouldn't be allowed to keep teaching. A teacher needs to to be able to say what the basic issue is that is holding you back.

Richard, maybe I've misunderstood you. Are you saying, that if someone has the right fundamentals, he/she can play infinitely and without consequences?

Many of us have had tough gigs, where because of the needs of the moment, we overdid things, and needed a recovery day. I don't thinks this is due to a lack of fundamentals. And I don't think it's the result of bad teachers.

Mike

Dr GO

@tmd said in Embouchure Dystonia:

But based on what you shared, you're playing the trumpet beyond your normal abilities, and you are suffering negative consequences. You most likely have a soft tissue injury. Based on this, you need rest, you need to avoid the type of playing that caused this problem, and you need to work on exercises to refocus your embouchure.

Mike

I agree with Dr. Mike. I believe this is more of a tissue injury and not a permanent neuropathy. I refer you to this case report published in the medical literature;

I believe if you read the above case report this may parallel your presentation. The compression of the trigeminal nerve will cause this as a temporary set back:

The treatment by the authors in this case:

This would be my recommendation at this time. Do give us follow up as Dr. Mike and I will reassess your situation using time as our most reliable treatment option.

Dr GO

In addition, I refer you to this article that gives a very good differential diagnosis of lip dysfunctions in which Dystonia, thankfully is not as prevalent as other treatable etiologies.

This Table give you a comparison of the various conditions and their symptoms to the differential cause of embouchure dysfunction:

Finally, here is the proportion of all causes of non-ED and ED (with the percentage of ED among instrument types):

HOPE THE ABOVE ARTICLES HAVE BEEN HELPFUL

Richard III

@tmd said in Embouchure Dystonia:

@Richard-III said in Embouchure Dystonia:

@GeorgeB said in Embouchure Dystonia:

Once I am playing again, I intend to take off the day following practice or tough gigs.

Okay, I'm going to say this again. If this is required, your approach to playing has something wrong with it. Please find a teacher who knows embouchure formation and go there. I've know many players who take lessons year after year and make slight improvements but the same faults continue. I think those teachers shouldn't be allowed to keep teaching. A teacher needs to to be able to say what the basic issue is that is holding you back.

Richard, maybe I've misunderstood you. Are you saying, that if someone has the right fundamentals, he/she can play infinitely and without consequences?

Many of us have had tough gigs, where because of the needs of the moment, we overdid things, and needed a recovery day. I don't thinks this is due to a lack of fundamentals. And I don't think it's the result of bad teachers.

Mike

I think that anyone who can't make it past 45 minutes of playing has an issue. And if they go past that and play for 90 minutes are having prolonged issues days later. I get the tough gig problem resulting in feeling tired the next day. But damaged sounding embouchure from what was described doesn't sound reasonable. Does it to you?

tmd

@Richard-III said in Embouchure Dystonia:

I think that anyone who can't make it past 45 minutes of playing has an issue. And if they go past that and play for 90 minutes are having prolonged issues days later. I get the tough gig problem resulting in feeling tired the next day. But damaged sounding embouchure from what was described doesn't sound reasonable. Does it to you?

He played a double concert one night, and then tried to do his full practice session the next morning. Regardless of what he could be able to do, or should be able to do, he played well beyond what he normally does.

Mike

stumac

Been there and done that!

George I have started a chat with you as one 80 year old to another, perhaps I can give you some pointers that have fixed me.

Regards, Stuart.

GeorgeB

First I want to say that I have some good news. Following the advice of the doctor in our band, I have been applying an ice pack for 5 minutes three times a day. This morning I was able to play a soft low C to high C. Not pretty , but a sound just the same . Now I have laid down the trumpet for at least 2 weeks and will play nothing. After the rest period I will start rebuilding my embouchure.

As for the discussion about my endurance. Look, I am 83 and didn't play for 50 years before coming back in 2016. I could easily play 3 hours or more gigs in my younger days and I had good teaching to start. I followed that good teaching when I started playing again. In many way I can play better than when I was younger. But age affects endurance and if you are sensible (and I wasn't ) you will play within comfortable limits. I happen to play first trumpet ( not lead trumpet ) in a band that is a cut above most brass bands in this part of eastern Canada, so the material is demanding. But the band has allowed me to tailor my playing to my abilities without hurting myself. I caused this injury through my own stupidity.

And, Doc, thanks for those article. They are eye-opening for sure.

And thanks to everyone else, like Dr-Mark who also gave of this time to help me. Both doctors here knew what they were talking about, as did the doctor who plays in our band. I am on the way to recovery.

@tmd said in Embouchure Dystonia:

Richard, maybe I've misunderstood you. Are you saying, that if someone has the right fundamentals, he/she can play infinitely and without consequences?

I can perform all day long and have done several times but that is not indefinitely. Once I played from 10 in the morning to 8 that night. However, I'm pretty beat up at the end of the day (sides often cramp up) and the next day I'm pooped both physically and mentally. Using proper fundamentals are important in order to do something like that. It should be noted that I'm sore, but not damaged.
Knowing how to not force air into the horn and whenever I notice tension when I'm playing addressing it are paramount. One of the biggest loads of crap is when people say "You have to blow hard to play trumpet!" Here's something to try;
Hold the lightest paper you can find (toilet paper) and drape it over the bell of the horn where the sound comes out. Next, blow the loudest, highest note you can and see if the toilet paper moves. Guess what? Little to no movement so the idea of having to blow hard is just a bunch of malarkey. With that little experiment, one should begin to see that something else is at play and it's not accomplished by "forcing" air through the horn. Just this kernel of knowledge can increase a person's endurance like crazy if they are of the belief that one has to blow hard to play a trumpet. As for indefinitely, I don't even know of a piece of machinery that can run indefinitely. Maybe a nuclear sub?

@Richard-III said in Embouchure Dystonia:

I think that anyone who can't make it past 45 minutes of playing has an issue.

Hi Richard III,
I would think that what the person is playing and time behind the horn would factor in.
45 minutes of Paganini or Bach can reduce a person's lip to Jell-O if they are inexperienced or, they're just not use to the repertoire. If the person has no experience at a particular genre than the task at hand can become a real monster! When something becomes a monster, we often tighten up, begin to force the air, forget to take relaxed breaths, start using more mouthpiece pressure and the list goes on. Tension negatively affects endurance.

Richard III

@Dr-Mark said in Embouchure Dystonia:

@Richard-III said in Embouchure Dystonia:

I think that anyone who can't make it past 45 minutes of playing has an issue.

Hi Richard III,
I would think that what the person is playing and time behind the horn would factor in.
45 minutes of Paganini or Bach can reduce a person's lip to Jell-O if they are inexperienced or, they're just not use to the repertoire. If the person has no experience at a particular genre than the task at hand can become a real monster! When something becomes a monster, we often tighten up, begin to force the air, forget to take relaxed breaths, start using more mouthpiece pressure and the list goes on. Tension negatively affects endurance.

I think you are right on all points. I currently play in a section where at 60-90 minutes, the other players are starting to flap the lips to get feeling back. When I look around I see deep rings embedded in their lips. Sure signs that they are resorting to pressure to make it through the session. I always recommend the method that allowed me to not have that happen anymore, but I've never had anyone work on it. They just keep jamming the mouthpieces into their faces.

GeorgeB

Somewhere there is a misunderstanding on my not being able to play beyond 45 minutes. My practice sessions at home daily are 60 minutes in the morning and 60 minutes in the afternoon. But the 60 minutes includes rest time leaving an average of 45 ( possibly 50 ) minutes of actual horn on the face.

The 45 minute to 1 hour concerts we were doing for six weeks were never a problem. It is the 90 minutes we do during our regular weekly practice once a week. With those I sometimes start having to push hard ( probably too hard ) to get through. But I have never suffered an injury until last week's session, which happened to be the first 90 minute one I have had to play in more than 9 weeks. 45 Minutes is not a problem for me. I hope I have clarified things.

@GeorgeB said in Embouchure Dystonia:

But I have never suffered an injury until last week's session, which happened to be the first 90 minute one I have had to play in more than 9 weeks. 45 Minutes is not a problem for me. I hope I have clarified things.

Hi GeorgeB sez;
"But I have never suffered an injury until last week's session, which happened to be the first 90 minute one I have had to play in more than 9 weeks. 45 Minutes is not a problem for me. I hope I have clarified things."

I hope you're taking a break from trumpet and not trying to play for 45 minutes. Dr-GO posted some really good stuff on overuse injuries and the importance of taking a break away from the instrument to allow for recovery. Don't be one of those people that didn't listen to their bodies (and wise advice) and as a result, can no longer engage in their preferred activity.

GeorgeB

@Dr-Mark
No, sir, I am not touching the trumpet for two weeks. I was just trying to straighten out the misunderstanding where Richard III thought I said I couldn't play beyond 45 minutes. In my normal day to day playing, prior to the injury, 45 minutes is ( was ) not a problem.

Three doctors I respect have told me I needed rest, and believe me , Dr-Mark I am definitely taking that rest.

@GeorgeB
This isn't good news that you're resting, it's GREAT news that you're resting.
You'll be better than before.

GeorgeB

@Dr-Mark said in Embouchure Dystonia:

@GeorgeB
This isn't good news that you're resting, it's GREAT news that you're resting.
You'll be better than before.

I sincerely believe that, Dr-Mark. Thanks again for your help and encouragement.

Richard III

Good read and a very good site for musicians:

[link text](https://www.musicianswell.com/stories/2019/4/16/michael-atkinson-overuse-and-the-pitfalls-of-going-it-alone[link text](link url))

tmd

@Richard-III said in Embouchure Dystonia:

Good read and a very good site for musicians:

[link text](https://www.musicianswell.com/stories/2019/4/16/michael-atkinson-overuse-and-the-pitfalls-of-going-it-alone[link text](link url))

Thanks for sharing. Nice article.

Mike

Embouchure Dystonia

Hi GeorgeB sez; "But I have never suffered an injury until last week's session, which happened to be the first 90 minute one I have had to play in more than 9 weeks. 45 Minutes is not a problem for me. I hope I have clarified things."

Hi GeorgeB sez;
"But I have never suffered an injury until last week's session, which happened to be the first 90 minute one I have had to play in more than 9 weeks. 45 Minutes is not a problem for me. I hope I have clarified things."