Embouchure Dystonia: Mind Over Matter?

Dr. Peter Iltis is a Professor of Kinesiology and also a horn player.  After developing some serious embouchure issues Iltis was diagnosed with focal task specific dystonia of the embouchure and became interested in looking further into the subject.  Gordon College’s Faculty Forum invited him to give a presentation on embouchure dystonia and posted his lecture on YouTube.

The whole lecture lasts an hour, and unless you’re interested in learning a little about neuroanatomy and kinesiology you might want to skip around.  There are several highlights that I found particularly interesting or have comments about.

At about 20:40 into the video Iltis comments on the how classical musicians are found to be diagnosed with dystonia more often than in other musical styles.  He speculates that one of the reasons has to do with the exacting playing style of classical music, where the musician must repetitively trains playing passages to play them the same way every time.  In contrast, Iltis speculates that jazz musicians are free to do things differently, making them less prone to the repetitive training that makes one more prone to dystonia.

There may be an element to truth there, but I imagine there are other factors at play as well.  For example, I’ve found jazz musicians to be more open to using embouchure types that classical musicians tend to call “wrong.”  Many embouchure problems can be avoided by playing on the correct embouchure type (with the correct embouchure form for that type and the individual’s own variations) for the individual’s anatomy.  However, many classical musicians teach their students to play with a very rigid embouchure instructions that aren’t always correct for the individual player, or simply try to fix embouchure issues with breathing alone.  On the other hand, it might be that jazz musicians are getting dystonia at the same rate as classical musicians, but professional classical musicians may be more likely to visit a doctor and get a diagnosis.  Regardless, it’s an interesting trend and if true could provide some additional avenues to explore and compare the long term trends of pedagogical or musical practices.

One of the gems of his lecture, my opinion happens at 40:34.  Although Iltis glosses over this point here, I think the following statement from his slide show is important.

If heavy practice with improper technique [my emphasis] can lead to the “out of tune” processing of sensory and motor information, then why can’t the sensory-motor simply be returned somehow?

I don’t have the medical background to comment on neurological matters.  However, I do have a decent understanding of how embouchures function and I at least can comment on embouchure form.  In every case I’ve seen of serious embouchure dysfunction, frequently being diagnosed as “embouchure dystonia” by both medical professional and even sometimes by non-medical professionals, there always appeared to be some sort of embouchure type switching going on.  Iltis seems to be acknowledging that one of the causes of embouchure dystonia may happen to be “heavy practice with improper technique.”  The trouble is that an awful lot of musicians and teachers haven’t actually looked closely enough at brass embouchures to understand how the basic types function and how every individual has a unique embouchure that needs to fit the player’s anatomical features.

The video of Iltis’s embouchure looks familiar to some of the other cases of severe embouchure dysfunction I’ve documented.  The first look at his chops can be seen here.  The camera focuses on his embouchure a little high at first, you can’t get a good look at his chin as his hand gets in the way.  You can get a great look at the uncontrollable spasm he has in his left cheek (where the electrodes are attached).  The best look at his chops happens at around 57:19.  Take a look and see what you notice.

Again, I’m not qualified to comment on his medical diagnosis of dystonia, but in that short video excerpt I see several things that may be related to his symptoms.  First, notice his chin is disengaged from his jaw.  It bunches up a lot and it moves up and down as he plays.  This is something common with players with dysfunctional embouchures.  I also notice how his mouthpiece and lips bob around over his teeth quite a bit.  His jaw placement also moves around inconsistently.  Trying to type his embouchure is difficult because the direction of his embouchure motion is so inconsistent.  Particularly after he opens his mouth to take a break, his mouthpiece jerks around on his lips, trying to find the best place for that note.  As Jay Friedman might say, his embouchure is jumping off the elevator before it’s gotten to the floor.

As far as I can tell, none of the medical and musical experts on embouchure dystonia address these sort of issues  Perhaps they are unaware of these embouchure patterns in the first place or don’t feel it is relevant because the player was successful up to a certain point before running into troubles.  At the very least, I think these are important variables to consider and possibly get to the actual core of many player’s problems who may get diagnosed with embouchure dystonia.  That said, I’m not a medical professional and can only comment on embouchures issues, not neurological.

Thank you to Dr. Iltis for his willingness to share both his background and personal story and allow his lecture to be publicly accessible.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.