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JG:
I thought I would add my thoughts here on focal dystonia of the embouchure.

As a previous poster noted, I have experienced focal dystonia of the embouchure, and managed to overcome it. In fact, many aspects of trumpet playing are now easier than before the dystonia set in.

Firstly, a brief clarification. We need to be careful when using the term “dystonia” as there are several, quite different types.

There is generalized dystonia, where a sufferer can experience uncontrollable muscular spasms in various parts of the body. This can be referred to as “focal dystonia” when it affects one specific part of the body.

Then we have what can be experienced by performing musicians, “Task Specific Focal Dystonia” – that is to say dystonia symptoms (uncontrollable muscle tremors, spasms, and other unwanted movement) only when carrying out a specific task – e.g. playing a brass instrument. In this case, the symptoms are only apparent when the task is attempted, and disappear as soon as the patient stops trying to attempt the task.

Task Specific Focal Dystonia in musicians (TSFD) is NOT a disease. It is a neuro–muscular condition with a root in the emotions or subconscious. In other words, although you may consciously wish to perform a task (e.g. form an embouchure and play a scale) you are stopped or blocked from doing so.

Before a person experiences TSFD the following elements seem to be prevalent, whether the player is aware of them on a conscious level or not:

• A “high achievement” mentality
• Stress – related to musical performance, or generalized
• Fear/Anxiety – related to musical performance, or generalized

The reason for this stoppage or blockage is to the best of my knowledge yet to be proven, but my best guess, based upon personal experience and studies of TSFD sufferers (both from a musical, psychological, and medical perspective) is this:

Subconsciously a TSFD sufferer has, over a period of time, learned to build a strong negative neuro–association with the act of playing

An example of the subconscious thought: “I will feel ashamed if I crack this tuning note”
This subconscious feeling can then develop to a real conscious fear, which in turn has physical implications.

We as human beings are hard–wired with certain physiological responses when we perceive a threatening situation – whether it be physically threatening (in the case of being physically attacked) or emotionally threatening (in the case of a perceived feeling of shame if cracking a tuning note – there are umpteen other examples such as giving solo recitals, speaking in public etc.)

Physiological responses can include a release of adrenalin, sweaty palms, tight breathing via a locked solar plexus, other muscular tension and so on. These physical symptoms can then create a feedback loop between the body and the mind/emotions. In other words, the physical responses we feel as a result of the fear actually make the fear worse. This puts us under further stress. We then learn to associate this stress with the specific task (playing a brass instrument).

What is often a pre–cursor to TSFD in brass players is “first note anxiety” or “fear of the first note” – that is, the inability to start a note without the aid of an external source such as metronome or conductor. Many TSFD sufferers reading this will no doubt recognize this symptom.

In time, and it can be a matter of several years, the above can create conflicting messages when attempting to play. For example, you say “I want to play C” and your subconscious says “I don’t want to play a C because this might happen, and then what will they all think of me if this happens, and then I’ll feel bad, so guess what…you’re *not* going to play a C”.

A mental tug–of–war ensues, until finally, the neural pathways responsible for forming an embouchure break down, your subconscious–turned–conscious fear wins, and you are unable to play as one side of your embouchure stops working, or your jaw grinds or shakes, or your fingers curl, or any other one of the common TSFD symptoms begins.

Luckily, due to neuro–plasticity, (the ability for other parts of our brain to take over functions in the case of damage), we are able to re–learn how to play, as I did.

However! This is only possible with a new approach to brass playing on a physical, psychological, and emotional level, so that we don’t just keep repeating the same destructive tug–of–war processes over and over again. It is quite a journey (to hell and back, some might say!) and one which is certainly avoidable, with the right guidance.