Focal Dystonia, it's challenges and how Stratos can help.

I was inspired to write this for several reasons, one of which was the serious damage to my lip caused by a fall from a collapsed stage. The resulting worries about playing again and making a living led to my own experience of Focal Dystonia. I have learned to play again and it has been a struggle, but I have learned much about FD and embouchure problems on the way and I’d like to share that with other brass players, particularly fellow members of the BTS.

Dystonia is uncontrollable muscle spasms caused by faulty signals from the brain. Focal refers to a condition affecting a precise area of the body, such as the lips and muscles supporting the embouchure. Experiencing FD is like dealing with a sat-nav that can’t understand your route is blocked. Progress cannot be made and frustration mounts. The sat-nav may even need to be turned off and the driver resort to basics (eyes and a map!) Similarly the FD sufferer returns to basics, or in medical terms, the brain’s cortical map needs untangling.

When a player visits me with FD the first thing I do is change the name of the condition. For some the mere mention of FD can amplify the problem, even triggering involuntary muscle movements, so when discussing their playing I try to use a different term, such as "the way you used to play" or "how you used to play". Typically an FD sufferer cannot control the lips as needed, so I start sessions with facial exercises, which look like gurning, followed by some gentle buzzing, using the Stratos system I have developed. I set the Stratos so the lips are hardly touching the mouthpiece. In that position, the brain does not register that an instrument is being played. This avoids the full contact on the lips which would have allowed the brain to associate the problem with the instrument, thus triggering a rejection of the mouthpiece. Playing with the much reduced weight on the lips is difficult but it cheats the brain so that the student does not produce and hear the heavily debilitating “bu bu bu” sound associated with the symptoms of FD. After a few repetitions of this exercise clearer notes begin to appear almost like magic.

This re-habilitation is about untangling or re-routing the cortical map and to achieve this I have created a series of mind and muscle distracting exercises.

One main aim is to help to build a new embouchure, accepting that the unpolished sounds the instrument might emit are part of the recovery process. The early unfocused sounds of a beginner are similar to sounds made by an FD sufferer. A beginner often takes time to achieve a good sound but does not shun or reject the instrument as they have no ‘history’ to compare their sound to. For experienced players, their ‘history’ and appreciation of a good sound increases their frustration when they cannot produce it. The situation nonetheless has to be faced. For me FD sufferers have to be treated almost like beginners, so that the embouchure problems producing this condition can be eradicated and progress made to playing again.

A tutor helping a player with FD needs significant depths of empathy and patience as success at any point in the recovery can be short-lived. Notes that were once stable can move and the whole process may need to be repeated from the beginning. Even when a smooth, even-toned note is being produced, FD can suddenly trigger an involuntary spasm, causing a squeak. However, as there will often have been a good quality note previously, I try to get the player to produce notes, in semi-tones, either side of the targeted good note. Repeating this extensively can achieve a new stability, controlled by a new muscle memory triggering messages to the brain.

 Recovery is partly about breaking what we might call ‘historic spasms’, that is, spasms arising from old ways of playing. One simple but effective exercise, for example, to start remedying this is, on the trombone, to play middle C in 6th and without changing pitch bring the slide to the 5th position C# 4th D, 3rd Eb etc. This exercise is carried out very calmly. Allow the notes to change by shortening the slide, like a glissando, keeping the lips in the same position, but keeping the same pitch throughout this exercise. If the symptom “bu bu bu” occurs simply start again on the C in 6th and work upwards as before.

Another exercise, using Stratos, is to set the chin-rest piston as far forward as possible, then encourage the player to reach forward with the lips and buzz towards the mouthpiece. This action will depress the chin-rest piston spring, closing the gap to the mouthpiece, and feel alien and different, but will cause no evidence of FD as ‘historic spasms’ will not be triggered. The exercise may be frustrating but it increases the blood and oxygen to the capillaries, strengthening the mouth muscles.

Maintain this exercise for a full minute then rest. Return the chin-rest turning clock-wise so it is just touching the chin. Then play a simple series of notes maintaining the forward reach of the chin. Results will vary, but I find that the player is playing with better support and in many cases without the “bu bu bu” effect.

Another strategy is for the player to go into unfamiliar areas, for example, striving to play an actual note on the instrument using the Stratos with the chin rest towards you in a ‘pushing you away’ position. This means the player must reach forward with the lips. Then, for example, play an arpeggio into the upper register, e.g. starting on middle Bb. The brain won't know what is happening and will not trigger the FD. Once some success has been achieved, reverse the process, working downwards from the higher notes of your arpeggio. Then try the same exercise on different slide positions, A, Ab, G etc.

Finally do not forget the usefulness of simple glissandos for keeping the same pitch, maintaining a steady air flow, but altering the note with the slide.

Whistling arpeggios is great and if you cannot whistle just copy the shape and blow. Not only does this firm up the oral chamber, but it encourages the "smiling” muscles to draw forwards towards the point of pitch. Do this exercise very slowly and deliberately, visualizing the travel of the tongue arching upwards for the higher whistled notes and then feel the tongue flatten as you descend the arpeggio.

Much of the published information on FD remains unclear about its causes. Many FD related problems are often caused by excessive pressure on the lips. It is possible that buzzing contributes a little to excessive pressure in these delicate areas, although buzzing is effective in keeping the capillaries open, allowing more blood into the lips. The Stratos will help to achieve this reduction in pressure on the lips a little at a time.

Once we’ve made a good start on producing a reasonable sound again, one good note, then we can proceed to rebuilding the embouchure properly. Avoiding old habits is central, but it often comes down to basics. Progress comes from patient concentration on producing a smooth airflow, correct posture of neck and body, comfortable handling of the instrument, and of course, effective breathing. I can recommend looking at the teaching of Kristian Steenstrupp, Professor of Trumpet at the Royal Academy of Music in Aarhus on this matter.

Anytime the player feels the progress is not favourable, I return to that one good note and start again. Anchoring that one good note is a rung on the ladder to eventual success.

Playing the ‘good note’ is also about restoring confidence and reminds us that the mental attitude to playing is as important as the physical issues associated with FD. The article in The Trombonist of Spring 2015 on the work of Professor Joachim Fabra and the experience of Ashley Horton looked at this and, as a busy professional player myself, making a living from being totally dependent on my ability to play, I can vouch for the anxiety and stress that ensues when that skill is taken away.

But we have to move on from such negativity. That attitude only sustains the collapse of the player’s skills and rejection of the instrument that is symptomatic of FD.

As I have tried to explain, and work out in my own experience, the way forward is to try to create different sensations that trick the brain and muscles into re-learning that what they are doing, i.e. enabling the player to play a note, is acceptable and ‘normal’ and not to be ‘rejected’, which is what the brain and muscles do in FD conditions. Even something as simple as wearing gloves, so the instrument feels totally different, can provide a new sensory experience, distracting the brain, and aid progress.

There are indeed alternative avenues and solutions. Rehabilitation of a player’s skills is like building a bypass around the main arterial road of everything the player has done. Like a bypass, the new road still gets us where we want to be - a happier playing experience. Recovery is possible if the player is patient and works diligently with the tutor.

I would be pleased to answer any questions about this difficult yet fascinating subject. I am confident that my approach is working and can offer hope to others anxious to return to playing. 

Marcus Reynolds