Embouchure Dystonia Treatment – Some Questions and Criticisms

Unless you are one of my regular readers chances are that you’ve come to this post looking for advice about some severe embouchure dysfunction. While I hope the following can provide some helpful avenues to explore, my target audience here are more the music teachers out there who promote themselves as “chop docs” or purport to diagnose and/or treat what often gets called “embouchure dystonia.” For the purposes of this essay, I will be using the terms “embouchure dystonia” and “embouchure dysfunction” at times interchangeably. I will try to be specific with my language when possible, but keep in mind that what some folks call “embouchure dystonia” may not be a neurological disorder, but an issue of embouchure mechanics.

The National Institute of Neurological Disorders and Stroke define “dystonia” as:

…a disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. The movements may be painful, and some individuals with dystonia may have a tremor or other neurologic features. There are several different forms of dystonia that may affect only one muscle, groups of muscles, or muscles throughout the body. Some forms of dystonia are genetic but the cause for the majority of cases is not known.

More specifically relevant for brass players’ embouchures, the variety of dystonia that we need to understand is known as a “focal task specific dystonia.” Again, from the NINDS:

Task-specific dystonias are focal dystonias that tend to occur only when undertaking a particular repetitive activity.  Examples include writer’s cramp that affects the muscles of the hand and sometimes the forearm, and only occurs during handwriting.  Similar focal dystonias have also been called typist’s cramp, pianist’s cramp, and musician’s cramp. Musician’s dystonia is a term used to classify focal dystonias affecting musicians, specifically their ability to play an instrument or to perform. It can involve the hand in keyboard or string players, the mouth and lips in wind players, or the voice in singers.

Before I go further I need to clarify my background and thoughts on embouchure dystonia. As I always try to point out when discussing anything medical, I am not a medical professional and in no way am I qualified to diagnose or treat a neurological disorder. While I will attempt to describe some possible causes, or at least correlations, with severe embouchure dysfunction below, my thoughts and advice should in no way be considered valid medical advice. Always consult with a medical professional if you suspect a medical condition.

The Difference Between Music and Medicine

This leads me to my first criticism, music teachers who purport to diagnose and treat medical disorders. Stop it. While your intentions may be good and you may very well be helping folks suffering from embouchure dysfunction recover, there is potential to cause great harm. Call what you do what it is, embouchure troubleshooting. Unless you have had the medical training and licensing to legally treat and/or diagnose medical conditions you are skirting the line of practicing therapy or medicine without a license.

I mentioned potential harm. I will shortly argue that there are non-medical reasons why some brass players’ embouchures break down and cause symptoms consistent with focal task specific dystonia. Unless you have the qualifications to diagnose a medical condition your proclamation that a student coming to you for help with embouchure dysfunction has “embouchure dystonia” may cause that person to delay or avoid necessary medical treatment. If the student has Bell’s palsy or a mild stroke, for example, delaying a correct diagnosis and proper medical attention can ruin the student’s chance at making a complete recovery. Or it can lead to more serious complications beyond playing a brass instrument. Medical conditions like focal task specific dystonia do exist and should be treated under the supervision of a qualified professional.

Leave the medicine to the medical professionals and you should advise your students to seek medical attention, when appropriate.

Do Your Homework/Ignorance Is Not Bliss

It sometimes surprises me how ignorant the field of brass pedagogy as a whole is of embouchure form and function. There is definitely a culture of ignorance here that discourages brass musicians from learning to truly understand how their embouchure functions and put it into a larger context of how different brass players play differently. One of the most influential voices in encouraging players and teachers to remain blissfully unaware was Arnold Jacobs. Jacobs encouraged his students to, “Think product, not methodology” (Also Sprach Arnold Jacobs: A Developmental Guide for Brass Wind Musicians). Whether or not he actually intended this idea to be taken as such, many brass teachers have interpreted this to mean that one should never analyze brass technique.

Roger Rocco, a former student of Jacobs, has written on his blog that embouchure dystonia is caused in part by:

Focus on self awareness, self analysis, or the instrument.

He doesn’t cite any medical literature supporting this statement, nor does it align with what any reputable sources state about focal task specific dystonia. As the bulk of Rocco’s discussion on his blog related to embouchure dystonia is ideological and philosophical, I would question his statement here.

Another common, but misguided, approach to treating embouchure dysfunction is to assume that it is purely a result of overuse. Lucinda Lewis’s web site and books make this mistake. According to Lewis:

For the purpose of discussion here, embouchure overuse syndrome refers to any chronic embouchure-related playing problems which last for more than two weeks and includes any or all of the following:  lip pain, chronic lip swelling or bruising, numb, rubbery, or cardboard lips, recurring pressure-point abrasions, air-induced abrasions, lack of endurance, unfocused sound, lack of playing control, and chronic high-range problems.

 – Broken Embouchures, by Lucinda Lewis

What she has done here is taken virtually every embouchure issue and placed them under the umbrella as “embouchure overuse.” The problem is this not only oversimplifies the issue, but also prescribes a general treatment program that may not be relevant for the situation. Chronic high range problems can come from a variety of mechanical issues, many not related to overplaying. Abrasions on the lips can be exacerbated by twisting the lips up with the mouthpiece. Lip swelling and bruising can occur because the mouthpiece placement isn’t balanced correctly between the upper and lower lip. A particularly demanding playing period may be the proverbial straw that breaks the camel’s back, but incorrect mechanics are possibly behind the issues to start with.

It’s easy to find similar ideas throughout the musical literature, but sources that discourage embouchure analysis typically lack an accurate and complete discussion of brass embouchure mechanics. You can’t analyze something you don’t understand. What they miss is that if you are analyzing something incorrectly you’re going to have trouble making the needed corrections. Combine this with the pithy phrase that embouchure “analysis leads to paralysis” and you’re going to create a self-fulfilling prophecy. Do your homework first.

As a general field, brass pedagogy is largely ignorant of brass embouchure form and function. Some folks are willingly so and proud of it. Other folks are misguided. I like to think that most brass players and teachers simply have been ill-advised and with access to good information will be able to make more informed decisions about how to practice and teach embouchure development. Either way, actively discouraging people to avoid learning about reality is doing our brass students a serious disservice and you need to stop it.

The basic brass embouchure types as a topic is not all that difficult to comprehend. If you feel that having a general understanding of music theory is helpful for performing music (and I hope you don’t need to be convinced of that), then surely making a similar effort to understand brass embouchures better is well within your capabilities. Yes, there is a time and place for forgetting about brass technique, but don’t throw out the baby with the bathwater. You must make an effort to fully understand a topic before you dismiss it as unnecessary or wrong.

What You Need To Know About Brass Embouchures

In order to treat embouchure dysfunction you need to first understand embouchure form and function. Since there are many contrary ideas out there you will need to have the tools to place them into a proper context. I’ve written fairly extensively about this topic on this site, but I will go over some basic information in this post in order to better make my points. A good introduction to this topic, however, can be found here and a more complete one here.

If you look closely at brass players’ embouchures you will soon notice that every embouchure is different. This makes sense, since every player has different anatomical features. That said, you will also begin to notice that there are specific patterns in brass embouchures. Using two observable features of a functioning brass embouchure you can begin to categorize all brass embouchures into different types. These embouchure types are not practice methods or instructions, but rather describe observable characteristics that all brass embouchures have, whether or not the player is aware of them.

The first category to note is that of air stream direction. While many players are convinced that they blow the air straight down the shank of the mouthpiece, observation with a transparent mouthpiece shows otherwise. Virtually every successful brass player will place the mouthpiece so that one lip or another predominates inside the mouthpiece. When more upper lip is placed inside the mouthpiece the air stream passes the lips and gets blown in a downward direction. The reverse is true when more lower lip is placed inside, the air stream passes the lips and strikes the mouthpiece cup above the shank. Horn angle, while important to an individual’s embouchure, does not determine air stream direction, mouthpiece placement does.

These days brass embouchure air stream direction should be common knowledge, but it isn’t. This characteristic has been independently discovered and confirmed by a variety of sources and the literature is available in academic libraries and much of it is now freely accessible online. More importantly, it’s not that hard to see for yourself. The link I posted in the previous paragraph shows some photographs and videos and transparent brass mouthpieces are available and relatively cheap. If you’re helping players with severe embouchure dysfunction you need to be aware of air stream direction and whether or not your student’s embouchure is upstream, downstream, or switching between both. You will want to understand that not everyone plays with a mouthpiece placement that fit’s his or her anatomy and be aware that changing mouthpiece placement and air stream direction can help or hurt some players, sometimes in a dramatic fashion.

The other embouchure characteristic that is even less known about in the field as a whole is what I prefer to call an “embouchure motion.” Virtually every successful brass player, whether or not they are aware of it, will push and pull their mouthpiece and lips together as a single unit in an upward and downward direction along their teeth and gums while changing registers. The general direction and specific angle that this embouchure motion takes varies between players, but it appears to be an essential part of a well functioning embouchure. Some players will generally push the mouthpiece and lips up towards the nose as they ascend, while others will pull down. These basic patterns also correlate with an individual’s air stream direction. Upstream players will almost always pull down to ascend, while downstream players may either do the same or the reverse. Again, this phenomenon has been discovered and independently verified by different resources, but is still not widely known about.

Using these two basic embouchure characteristics alone it’s possible to categorize at least three basic brass embouchure types. Using other features, such as jaw position and horn angle, it’s possible (but probably unnecessarily complicated) to define even more brass embouchure types. If you’re helping players recover from severe embouchure dysfunction you should become aware of these basic brass embouchure types and learn how to spot them. These are important variables you need to consider.

Type Switching

While I haven’t seen as many cases of embouchure dystonia or embouchure dysfunction as some, every single case that I have looked closely at (and documented, in some cases) exhibits some form of embouchure type switching. A handful of these are players who probably should be playing with an upstream embouchure but for some reason aren’t, often due to advice from well-intentioned but ignorant teachers. More commonly, however, I see type switching between the two basic downstream embouchure types. If you look for these players’ embouchure motion you will be hard pressed to see if they are pulling down to ascend or pushing up. Sometimes they reverse the direction at a particular point in their range or they go too far with the embouchure motion at a certain point. Here’s an example from YouTube recorded by Joaquín Fabra, who believes that embouchure dystonia is a “behavioral” problem and treats dystonia as a psychological issue. Watching the video of that particular horn player you can see his embouchure motion changing directions.

Here’s another video recorded by Fabra that shows a trumpet player. Note how this player’s embouchure motion during the earlier part of the video shows his mouthpiece and lips bobbing around for almost every attack. Every time he plays a note he is trying to hit a moving target. Later in the video, the trumpet player is largely symptom free and you will be able to spot how much more consistent the embouchure motion is, particularly on the initial attacks of notes.

To the best of my knowledge, Fabra doesn’t even consider the player’s type switching. In his interview with Dave Stragg Fabra is quite clear that he feels embouchure dystonia is caused by an emotional condition and he avoids discussion of embouchure mechanics, even going so far as to imply that the embouchure analysis is partially responsible for the condition in the first place. Considering his apparent lack of understanding of the basic embouchure types, but the correction of type switching in many of his documented examples, I argue that Fabra’s approach would benefit from not merely treating the psychological results of severe embouchure dysfunction but consciously correcting embouchure mechanics.

Returning to Lucinda Lewis’s thoughts, she feels that a treatment program for embouchure dysfunction requires the brass musician returning to their embouchure form prior to the breakdown. In Broken Embouchures she wrote, “Fixing your embouchure means rehabilitating your mechanics back to their pre injury integrity.” (2005, p. 40). What is missing from her text, however, is any consideration if the pre-injury embouchure was malfunctioning in the first place. My favorite analogy for this is lifting heavy objects with your back. You can get away playing wrong for a while, particularly if you’re naturally strong. Keep lifting with your back over time, however, and you’re going to be more prone to injury. If you suffer from severe embouchure dysfunction and get better by returning to your old way of playing you should consider that you might just be getting better at playing wrong. Teachers need to be aware of their students’ embouchure type and overall embouchure form in order to eliminate type switching as the culprit to embouchure dysfunction. It can also help players correct type switching before it causes the breakdown in the first place.

Where To Go From Here

The bulk of my above rant is largely concerned with the lack of awareness among brass teachers and players of embouchure mechanics and our inability to put them into a proper context when troubleshooting embouchure dysfunction. If the field of brass pedagogy is dropping the ball here we can’t expect the medical community to be any better, and players suffering from embouchure dysfunction are perhaps not going to be well served by doctors and therapists treating embouchure dystonia. But beyond this issue, which will be corrected over time when more players become better educated on this topic, we need to start asking better questions about embouchure dystonia. Some of these questions can (and should) be objectively researched, but again, this needs to start at the level of the musical community, who are not only going to have a higher stake in this issue but also should have the necessary background in brass technique to better study brass embouchures.

But in order to do this better music educators need to take research methodology more seriously. To a certain degree, our lack of awareness of how to conduct research and interpret academic articles and papers is understandable. We are first and foremost artists and our primary concern should be musical expression. That said, critical thinking is a skill that pays off in dividends both in and out of music. It behooves all brass teachers, not just ones who specialize in treating embouchure dysfunction, to learn about cognitive bias, how to conduct original research, and how to search for accurate and quality information on musical topics. Once we have changed our culture of ignorance for one of critical thinking and awareness we can begin asking (and researching) questions that potentially lead to more effective treatment of embouchure dysfunction. Here are a few that I personally feel we should be asking.

  1. Are certain embouchure types more prone to severe embouchure dysfunction than others?
  2. What embouchure characteristics (e.g. embouchure type switching) correlate to embouchure dysfunction?
  3. Is embouchure type switching a cause of a specific neurological disorder that can be mapped in the brain or does the neurological issue cause the type switching?
  4. How often is a diagnosis of focal task specific dystonia of the embouchure really a result of type switching?
  5. Does conscious correction of embouchure type switching lead to improvement in embouchure dysfunction?
  6. Do programs that are successful in treating severe embouchure dystonia lead to a player correcting embouchure type switching, even if type switching is not a consideration of that program? If so, would conscious corrective procedures that encourage a player to avoid type switching better serve?
  7. Do mechanical issues related to embouchure type switching lead to the psychological troubles that brass musicians suffer from? If so, can making mechanical corrections lead to a reduction or elimination of the psychological issues?
  8. How can brass teachers helping players who suffer from severe embouchure dysfunction balance a treatment program to address both the mechanical issues related to embouchure type switching and the psychological issues related to inability to perform?

Leading To Open and Honest Communication

I have criticized some folks by name in this essay and elsewhere online before. In the past some of these teachers have taken this criticism personally, even though that is not my intention. Please note that I do my best to address ideas, not people as individuals. I also am very careful to try and qualify my opinions as much as possible to clarify when one of my ideas is based on objective evidence or mere speculation. Furthermore, I have been wrong before and will continue to be wrong again. One of the reasons I post my thoughts about this topic publicly is so that experts can point out the flaws in my reasoning.

The scientific method has been so successful due to its self correcting nature. Brass teachers helping players suffering from severe embouchure dysfunction need to follow this model more. This involves questioning each others’ ideas, challenging our own assumptions, and engaging in an open and honest debate with each other. Too often we view this as being impolite and forget that this is how advances are made. No single individual treating embouchure dystonia has all the right answers, no matter how successful their treatment program seems to be. The lone genius leading the way for everyone to follow is really just a myth. We are collectively a lot smarter than we are individually.

Advice For Suffering Players

If you made it through all this and you are a player suffering from severe embouchure dysfunction I want to conclude with my advice for you. I have had some success helping some folks with chop problems myself and I also know a handful of folks around the U.S. that I recommend, but if you want help you’ll probably have to travel to someone unless you happen to live in their area. Video consultations, while having potential, generally don’t lend themselves to diagnosing embouchure problems and the solutions.

There are brass teachers who are successful at helping folks with embouchure dysfunction who don’t demonstrate an awareness of embouchure types and how to correct type switching, but I typically would encourage a student to seek the help from someone more knowledgable. Ask questions. Furthermore, when you are looking for help I think it’s good to remember the Dunning/Kruger Effect. The more black and white a discussion of embouchure dysfunction is and the more sure of themselves they can help, I find the more likely their approach is going to be based on philosophy or analogy than objective reality. Treatment programs that are based in the “Harold Hill Think System” may be more likely to be successful in spite of, rather than because of what you learn. A second opinion may be a good idea, even if it seems to be working for you.

Then again, I may be wrong. Take the time to follow some of the resources and links I’ve posted here about brass embouchure function and dysfunction and judge for yourself. My goal here is to make brass teachers and players aware of the information that is available in order to place advice into a proper context, not scare anyone away from an opposing viewpoint. I welcome questions and criticisms to my own ideas and encourage you to leave them in the comments section below.

11 thoughts on “Embouchure Dystonia Treatment – Some Questions and Criticisms

  1. Hi Dave, just saw your post has been translated into Japanese, so here it goes on Spanish, we are a bunch of brass players here south of the US, and it’s really difficult to find quality information in our language, and very little musicians who can effectively understand English.

    A menos que seas uno de mis lectores regulares, es posible que hayas llegado hasta este post buscando consejos sobre alguna disfuncin severa de embocadura. Aunque espero que las siguientes lneas puedan provee algunos caminos tiles para explorar, mi audiencia objetivo son los maestros de msicos que se promueven como los “doctores del pitar” o que pretenden diagnosticar y/o tratar lo que con frecuencia se conoce como “distona de embocadura”. Para los propsitos de este trabajo, estar usando el trmino “distona de embocadura” y “disfuncin de embocadura” de manera intercambiada. Tratar de ser especfico con mi lenguaje tanto como sea posible, pero mantengan en la mente que lo que algunos llaman “distona de embocadura” puede no ser un desorden neurolgico, sino un problema de la mecnica de la embocadura.
    El Instituto Nacional de Trastornos Neurolgicos y Derrames (NINDS, siglas en ingls) define “distona” como:
    “un trastorno caracterizado por contracciones musculares involuntarias que causan movimientos lentos y repetitivo o posturas anormales. Los movimientos pueden ser dolorosos, y algunos individuos con distona pueden tener temblores u otras caractersticas neurolgicas. Hay distintas formas de distona que pueden afectar a un msculo, un grupo de msculos o musculos a lo largo del cuerpo. Algunas formas de distona son genticas pero la causa de la mayora de los causos es desconocida.”
    Especficamente ms relevante para las embocaduras de quienes tocan metal, la variedad de distona que necesitamos entender se conoce como “distona focal especfica de una actividad”, nuevamente, definida segn el NINDS:
    “las distonas especficas de una actividad son distonas focales que tieneden a ocurrir solo cuando se lleva a cabo repetidamente una actividad particular. Los ejemplos incluyen el calambre del escritor que afecta los musculos de la mano y ocasionalmente los del antebrazo, y solo ocurre durante la escritura. Distonas focales similares han sido llamadas calambres del mecangrafo, del pianista y del msico. La distona del msico es un trmino utilizado para clasificar las distonas focales que afectan a los msicos, especficamente su habilidad para tocar un instrumento o actuar. Puede involver las manos en los instrumentistas de cuerda o teclado, la boca y los labios en los de aliento, o la voz en los cantantes”

    Antes de continuar, necesito aclarar mi formacin y mis ideas sobre la distona de embocadura. Como siempre intento sealar al discutir algo mdico, no soy un profesional de la medicina y en ninguna manera estoy calificado para tratar un desorden neurolgico. Mientras intento describir algunas causas posibles, o por lo menos correlaciones, de las disfunciones severas de embocadura ms adelante, mis ideas y consejos no deben de ningn modo considerarse un consejo mdico vlido. Siempre debes consultar con un profesional mdico si sospechas de una condicin mdica.

    Esto me lleva a mi primer crtica, los maestros de msica que pretenden diagnosticar y tratar desrdenes mdicos. Detnganse. Mientras sus intenciones pueden ser buenas y quiz estn ayudando a personar a recuperarse de una disfuncin de embocadura, hay un riesgo de que se cause un gran dao. Llamen a lo que hacen lo que es, resolver problemas de embocadura. A menos que tengan el entrenamiento mdico y la licencia para legalmente tratar y/o diagnosticar condiciones mdicas, estn sobre la lnea de practicar terapias o medicina sin licencia.
    Mencion dao potencial. Brevemente dir que hay razones no-mdicas por las cuales algunas embocaduras se daan y provocan sntomas parecidos a la distona focal de embocadura. A menos que estn calificados para diagnosticar una condicin mdica, su proclamacin de que un estudiante que llega a ustedes tiene “distona de embocadura” puede causar que esa persona dilate o evite un tratamiento mdico necesario. Si el estudiante tien la parlisis de Bell o un derrame ligero, por ejemplo, postergar un diagnstico correcto con su atencin mdica correspondiente puede arruinar las oportunidades del estudiante de recuperarse por completo. O puede conducir a complicaciones ms serias que estn ms all de tocar un instrumento de metal. Las condiciones mdicas como distona focal especfica existen y deben ser tratadas bajo la supervisin de una persona calificada.
    Dejen la medicina a los profesionales y ustedes debern aconsejar a sus estudiantes a buscar atencin mdica, cuando sea apropiado.


    Algunas veces me sorprente lo ignorante que es el campo de la pedagoga de los metales de la forma y funcin de la embocadura. Hay definitivamente una cultura de ignorancia que evita que los msicos de metal aprendan a entender realmente como su embocadura funciona y poner en un contexto ms amplio como distintos msicos tocan de manera distinta. Una de las voces ms influyentes en hacer que los msicos y los maestros permanezcan dichosamente desprevenidos fue Arnold Jacobs. Jacobs alentaba a sus estudiantes a “pensar en el producto, no en la metodologa” (Also Sprach Arnold Jacobs: A Developmental Guide for Brass Wind Musicians/As hablaba Arnold Jacobs: Una gua para el desarrollo de msicos de aliento metal) Sea o no su intencin que su idea se tomase de esta manera, muchos maestros de metal han interpretado que esto significa que uno nunca debe analizar la tcnica de los metales.

    Roger Rocco, un antiguo estudiante de Jacobs, ha escrito en su blog que la distona de la embocadura es causada en parte por:
    “Enfocarse en la consciencia de s mismo, en el anlisis de s mismo, o del instrumento”

    l no cita ninguna fuente mdica que corrobore su declaracin, ni esto se alnea con lo que fuentes de buena reputacin declaran sobre la distona especfica. Como el mayor volumen de la discusin relacionada con distona focal del blog de Rocco es ideolgica y filosfica, pondra en cuestin su declaracin aqu.

    Otra aproximacin comn, pero mal guiada, es la de asumir que la disfuncin de embocadura es meramente un resultado de sobreuso. La pgina y libros de Lucinda Lewis cometen este error. De acuerdo a Lewis:

    Para el propsito de la discusin aqu, el sndrome del sobreuso de la embocadura se refiere a cualquier problema crnico relacionado con la embocadura que dure por ms de dos semanas e incluye cualquiera de los siguientes: dolor de labios, moretones o inflamacin crnica, entumecimiento, labios de cartn, abrasiones recurrentes en los puntos de presin, abrasiones inducidas por el aire, falta de aguante, sonido desenfocado, falta de control de tocar y problemas crnicos del registro agudo. – Broken Embouchures, de Lucinda Lewis.

    Lo que ella ha hecho aqu es tomar virtualmente cualquier problema de embocadura y lo ha colocado bajo la sombrilla de “sobreuso de la embocadura”. El problema no es solo que sobre-simplifique, pero adems prescribe un tratamiento general que puede no ser relevante para la situacin. Los problemas crnicos del registro agudo pueden venir de una variedad de problemas mecnicos, muchos de los cuales no se relacionan con el sobreuso. Las abrasiones de los labios pueden ser exacerbadas por retorcer los labios hacia arriba con la boquilla. El hinchamiento de los labios y los moretones pueden ocurrir porque la colocacin de la boquilla no est balanceada correctamente entre el labio superior y el inferior. Un periodo particularmente demandante de tocar puede ser la paja proverbial que rompe la espalda del camello, pero la mecnica incorrecta est atrs de los factores con los que se debe empezar.

    Es fcil encontrar ideas similares a lo largo de la literatura musical, pero las fuentes que descartan el anlisis de la embocadura a menudo carecen de una discusin completa y precisa de la mecnica de la embocadura. No puedes analizar algo que no entiendes. De lo que carecen es que si t analizas algo incorrectamente vas a tener problemas haciendo las correcciones necesarias.Si combinas esto con la lamentable frase de “anlisis lleva a parlisis” vas a tener una profeca que se autocumple. Haz tu tarea primero.

    Como un rea general, la pedagoga de los metales se lleva a cabo en gran parte ignorando la forma y funcin de la embocadura. Algunas personas lo hacen conscientemente y estn orgullosos de esos. Otros estn mal aconsejados. Me gusta pensar que la mayora de los msicos y maestros simplemente han recibido mala orientacin y que con un buen acceso a buena informacin podrn ser capaces de tomar decisiones ms informadas sobre cmo practicar y ensear el desarrollo de la embocadura. En ambos casos, activamente hacer que la gente evite aprender acerca de la realidad est haciendo un despropsito a nuestros estudiantes y debe ser detenido.

    Los tipos bsicos de embocadura no son un tema difcil de entender. Si sientes que tener una comprensin general de la teora musical es til para tocar msica (y espero que no tengas que ser convencido de eso), entonces, con seguridad, hacer un esfuerzo similar para entender las embocaduras est muy bien dentro de tu capacidad. S, existe un tiempo y un lugar para olvidarse de la tcnica de los metales, pero “no tires al beb con el agua de la baera”. Debes hacer un esfuerzo para entender completamente un tema antes de que lo descartes por ser innecesario o equivodado.


    Para tratar la disfuncin de embocadura, primero necesitas entender su forma y funcin. Al haber muchas ideas contrarias debes tener las herramientas para colocarlas en un contexto adecuado. He escrito bastante extensivamente sobre esto en este blog, pero continuare con alguna informacin bsica sobre esto en este post para puntualizar mejor.

    Si te fijas de cerca en la embocadura de los msicos pronto descubrirs que cada embocadura es distinta. Esto tiene sentido, pues cada msico tiene caractersticas anatmicas distintas. Habiendo dicho eso, tambin notars que existen algunos patrones especficos en las embocaduras. Usando dos caractersticas observables de una embocadura funcional puedes empezar a categorizarlas en distintos tipos. Estos tipos de embocadura no son mtodos de prctica o instrucciones, sino que describen caractersticas observables que todas las embocaduras tienen, estn o no conscientes de estas los instrumentistas.

    La primer categora es la de la *direccin del aire*. Mientras muschos msicos estn convencidos que soplan el aire hacia abajo de la boquilla, observar esto con una boquilla transparente muestra algo distinto. Virtualmente todos los msicos exitosos ponen la boquilla de modo que un labio o el otro predomine dentro de la boquilla. Cuando se coloca ms el labio superior dentro de la boquilla la corriente de aire toma una direccin hacia abajo (downstream) al pasar los labios. Lo contrario pasa cuando se coloca ms el labio dentro, el flujo de aire pasa los labios y choca la copa de la boquilla arriba del tubo (upstream). El ngulo del instrumento, a pesar de ser importante para la embocadura, no determina la direccin del aire; es la colocacin de la boquilla la determinante.

    En estos das la direccin del aire debera ser un conocimiento comn, pero no lo es. Esta caracterstica ha sido independientemente descubierta y confirmada por una variedad de fuentes y existen documentos disponibles en bibliotecas acadmicas y mucha informacin disponible gratuitamente en lnea. An ms importante, no es difcil darte cuenta por ti mismo. El *link* que poste en el prrafo previo muestra algunas fotos y videos y las boquillas transparentes no son difciles de conseguir ni caras. Si t ests ayudando a msicos con disfunciones severas debes de estar atento a la direccin del aire y a si la embocadura de tu alumno es upstream, downstream o alternan entre ambas. Querrs entender que no todos tocan con una embocadura que satisface su anatoma y deberas estar consciente de que cambiar la colocacin y el flujo de aire puede ayudar o lastimar a algunos, a veces de manera dramtica.

    La otra caracterstica de la embocadura que es an ms desconocida en el mbito es lo que me gusta llamar “motricidad de embocadura” (embouchure motion). Virtualmente todos los msicos de xitos, estn o no conscientes de esto, empujarn y jalarn la boquilla y los labios juntos como una unidad hacia arriba o hacia abajo a lo largo de sus dientes y encas al cambiar registros. La direccin general y el ngulo especfico que esta motricidad vara de msico en msico, pero se muestra como una parte esencial de una embocadura funcional. Algunos msicos por lo general empujan la boquilla y los labios hacia la nariz al subir el registro, mientras otros la jalan hacia abajo. Estos patrones bsicos tambien estn correlacionados con la direccin del aire del individuo. Los que tocan upstream casi siempre jalarn hacia abajo para ascender a los agudos, mientras que los downstream pueden hacer lo mismo o lo contrario. Otra vez, este fenmeno ha sido descubierto y verificado por distintas fuentes, pero an no est ampliamente divulgado.

    Usando estas dos caractersticas bsicas por s solas es posible categorizar tres tipos bsicos de embocadura por lo menos. Utilizando otras caractersticas, tales como la posicin de la mandbula y el ngulo del instrumento, es posible (aunque probable e innecesariamente complicado) definir an ms tipos de embocadura. Si t ests ayudando a los msicos a recuperarse de una disfuncin severa debers estr atento a estos tipos bsicos de embocadura y aprender a distinguirlos. Estas son variables importantes que debes considerar.


    Si bien no he visto muchos casos de distona o disfuncin de embocadura como tales, cada caso que he visto detenidamente *(y en algunas ocasiones, documentado)*, exhibe alguna forma de alternacin del tipo. Un puado de estos son msicos que probablemente debera estar tocando upstream y que por alguna razn no lo estn, a menudo por los consejos de un maestro bien intencionado pero sin pericia. An ms comn, sin embargo, veo alternacin entre ambas variantes downstream. Si miras la motricidad de embocadura tendrs dificultad para ver si estn jalando hacia abajo o empujando hacia arriba para ascender a los agudos. Algunas veces dan la vuelta a la direccin en un punto particular de su registro o van muy lejos con la motricidad de la embocadura en cierto punto. *aqu hay un ejemplo de youtube* grabado por Joaqu Fabra, quien cree que la distona es un problema conductual y quien trata a la distona como un problema psicolgico. Al mirar el video de este cornista puedes ver la motricidad de su embocadura alternar la direccin.

    *Aqu est otro video* de Joaqun Fabra que muestra a un trompetista. Observa como la motricidad del msico en la primer parte del video muestra boquilla y labios haciendo pucheros alrededor de casi cada ataque. Cada vez que toca una nota est intentando darle a un blanco movedizo. Ms adelante del video, el trompetista est casi carente de sntomas y podrs ver la consistencia en la motricidad de la embocadura, particularmente en el ataque inicial de las notas.

    A mi parecer, Fabra ni siquiera considera que el msico est alternando. En su *entrevista con Dave Stragg*, Fabra deja bastante claro que el percibe que la distona es causada por una condicin emocional y el evita la discusin de la mecnica de la embocadura, llegando incluso a dar a entender que el anlisis de la embocadura es parcialmente la causa de la condicin en primer lugar. Considerando su aparentemente carencia de entendimiento de los tipos bsicos de embocadura, pero la correccin de la alternacin, yo dira que la aproximacin de Fabra se vera beneficiada de no tratar meramente los resultados psicolgicos de la disfuncin severa, sino de corregir conscientemente la mecnica de la emocadura.

    Regresando a las ideas de Lucinda Lewis, ella siente que un programa de tratamiento de la disfuncin de embocadura requiere que el msico de metal regrese a la embocadura previa al colapso. En Embocaduras Rotas (Broken Embouchures) escribi, “Reparar tu embocadura quiere decir rehabilitar la mecnica a su integridad pre-dao” (2005, p.40). Lo que falta en su texto es, como sea, considerar si la embocadura pre-dao era funcional en primer lugar. Mi analoga favorita para esto es el levantar objetos pesados con la espalda. Puedes estar tocando mal por un rato, particularmente si eres fuerte. Pero si lo sigues haciendo sers ms propenso a lastimarte. Si sufres de una disfuncin severa y mejoras al regresar a tu embocadura previa debes considerar que quiz solo ests mejorando en tocar mal. Los maestros deben de estar atentos a la embocadura de sus estudiantes y a la forma general de la embocadura para poder eliminar los cambios de tipo que sean los culpables de una disfuncin. Tambin puede ayudar a los msicos a corregir el cambiar de tipo antes de que sto provoque un colapso, en primer lugar.


    La mayora de mi escrito aqu est dedicado a la falta de atencin a la mecnica de la embocadura por parte de los maestros y estudiantes de metales y a nuestra incapacidad de poner esto en un contexto adecuado al atender a la disfuncin de la embocadura. Si el campo de la pedagoga de los metales est aventando la toalla aqu no podemos esperar que la comunidad mdica tenga mejor desempeo y los msicos que sufren de la disfuncin quiz no vayan a ser bien atendidos por doctores y terapistas que traten la distona. Pero ms all de este problema, que ser corregido cuando ms msicos estn ms conscientes de este tema, necesitamos comenzar a hacer mejores preguntas sobre la distona de embocadura. Algunas de estas preguntas pueden (y deberan) ser investigadas objeticamente, pero nuevamente, esto necesita comenzar al nivel de la comunidad musical, quienes no solo tendran una participacin ms importante en este tema pero quienes tambin debern tener la formacin necesaria en la tcnica para mejorar las embocaduras.

    Pero para mejorar esto los educadores musicales necesitan tomar ms en serio la metodologa de la investigacin. Hata cierto grado, nuestra falta de consciencia de cmo llevar a cabo investigaciones e interpretar artculos acadmicos es entendible. Antes que todo somos artistas y nuestra preocupacin primaria debera ser la expresin musical. Habiendo dicho esto, el pensamiento crtico es tambin una capacidad que se remunera dentro y fuera de la msica. Corresponde a todos los maestros, no solo a aquellos que tratan la disfuncin, aprender a conducir investigacin, aprender sobre los sezgos cognitivos y cmo buscar informacin precisa y de calidad de temas musicales. Una vez que hayamos cambiado nuestra cultura de la ignorancia por una de prencamiento crtico y consciencia podremos comenzar a hacer preguntas (y a investigar) cuestiones que potencialmente dirijan hacia un tratamiento ms efectivo de la disfuncin de emocadura. Aqu hay algunas preguntas que personalmente creo debemos hacer:
    1. Son algunos tipos de embocadura ms propensos a la disfuncin?
    2. Qu caractersticas de embocadura (por ejemplo, cambio de motricidad de embocadura) pueden correlacionarse con la disfuncin de embocadura?
    3. Es el cambiar de tipo de embocadura una causa de transtornos neurolgicos especficos que pueda ser mapeada en el cerebro o es el problema neurolgico el que causa el cambio?
    4. Qu tan a menudo es un diagnstico de distona realmente el resultado de cambiar de tipo?
    5. Conduce la correccin consciente de la alternacin entre embocaduras a una mejora en la disfuncin?
    6. Conducen los programas que son existosos en tratar la disfuncin severa a correcciones de la alternacin entre embocaduras, an si la alternacin no est considerada en ese programa? De ser as, Serviran mejor los procedimientos que encaminan a un msico a evitar la alternacin?
    7. Llevan a problemas psicolgicos las fallas mecnicas relacionadas con la alternacin de embocadura? De ser as, puede lograrse una reduccin o eliminacin e los problemas psicolgicos a travs de correcciones mecnicas?
    8. Cmo pueden los maestros ayudar a los msicos que padecen disfuncin severa hacer un programa de tratamiento balanceado que ataque los problemas mecnicos relacionados con la embocadura y psicolgicos relacionados con la incapacidad para tocar?


    He criticado y nombrado a algunas personas aqu y tambin, previamente, en otras ocasiones en linea. Algunos de estos maestros han tomado esta crtica personalmente, an cuando esta no es mi intencin. Por favor, ntese que yo hago lo que puedo para enfocarme en las ideas, no en las personas como individuos. As tambin soy cuidadoso de probar y calificar mis opiniones tanto como sea posible ya sea de mis ideas est basada en evidencia objetiva o mera especulacin. Ms an, me he equivocado en el pasado y continuar cometiendo equivocaciones. Una de las razones por las cuales posteo mis pensamientos sobre este tpico pblicamente es para que los expertos puedan sealar las fallas en mi razonamiento.

    El mtodo cientfico ha sido tan exitoso debido a su naturaleza autocorrectiva. Los maestros de metales que ayuden a los msicos que padezcan una disfuncin severa necesitan seguir ms este mtodo. Esto involucra cuestionarse sobre las ideas de los otros, retando nuestras propios supuestos y comprometerse en un debate abierto y honesto con los dems. Muy a menudo vemos esto como descorts y nos olvidamos de que as es como se hace el progreso. Ningn individuo que trate a la distona tendr todas las respuestas, no importa qu tan exitoso sea su programa de tratamiento. El genio solitario que gua el camino para todos es solo un mito. Colectivamente somos mucho ms inteligentes de lo que somos individualmente.


    Si llegaste hasta aqu y eres un msico que padece disfuncin severa de embocadura quiero concluir con mi consejo para ti. He tenido xito en ayudar algunas personas con problemas al pitar y tambin s de un puado de amigos a lo largo de los EUA que puedo recomendar, pero si quieres ayuda probablemente tendrs que trasladarte a menos que vivas en su rea. Las consultas por video, a pesar de tener potencial, generalmente no se prestan a diagnosticar problemas de embocadura y a encontrar la solucin.

    Hay maestros que tienen xito en tratar problemas de disfuncin que no demuestran una consciencia de los tipos de embocadura y cmo corregir las alternaciones, pero yo por lo general animara a un estudiante a buscar ayuda de alguien ms reconocible. Hagan preguntas. Ms an, cuando buscas ayuda creo que es necesario tener en cuenta el efecto *Dunning/Kruger*: mientras ms blanco/negro se torne una discusin, ms probable es que se vuelva ena discusin filosfica que una realidad objetiva. Los programas de tratamiento que se basan en el *Sistema de Pensamiento de Harold Hill* tienen ms probabilidades de xito a pesar de, en vez de por lo que aprendas. Una segunda opinin puede ser una buena idea, an si aparentemente te est funcionando.

    Otra vez ms, puedo estar equivocado. Tmate tu tiempo para seguir los recursos y links que he posteado aqu sobre la funcin y disfuncin de embocadura y juzga por ti mismo. Mi objetivo aqu es conscientizar a los msicos y maestros de la informacin disponible para colocar los consejos en un contexto apropiado, no para espantar a las personas de un punto de vista opuesto. Le doy la bienvenida a preguntas y crticas a mis propias ideas y te invito a que las pongas en la seccin de comentarios de abajo.

  2. Dave: Excellent article. My neurologist diagnosed me as having dystonia. And, I am a Rienhardt student and friend of Doug Elliott. I have consulted with a person who has had success helping folks with embouchure dystonia. Given that true task specific dystonia has a neurological basis, basically, neurons in the ganglia region of the brain, seem to have wired together, sending a mass of tangled messages to the embouchure, causing involuntary muscle contractions. The only way out of this morass seems to be the phenomenon of Nuero-elasticity, similar to how stroke victims re-learn how to function again. It is slow work, not for the faint of heart. The frustrating part of this for me is that when I send corrective, technical commands, for example, “firm the corners,” or pull down to my left to descend,” the symptoms get WORSE. I have to hear the note I want, blow freely, and avoid all thoughts about the embouchure, to get results. Any thoughts of embouchure form or function, tighten my lips, making it impossible to get air out of the mouth. The aim is to, through thinking analogies, blowing freely through the mouthpiece, and other acts, to in a round about way, relax the embouchure, get the air flow going, and make a sound. Hence, the necessary avoidance of proper form and function for the time being, as coached by the most successful coaches of dystonia sufferers. It’s all about learning a new way of playing, albeit necessarily avoidant of the true characteristics of proper form and function, for now at least, to calm the errant neurological functions.

  3. Thanks for your insights, Bruce. I’ve heard other folks say that thinking about making physical corrections while playing makes their issues worse, regardless of whether they are having embouchure issues or are simply practicing to get better. Consciously thinking about your mechanics takes practice to do correctly. To the best of my knowledge no one has looked into whether players suffering from what is diagnosed as embouchure dystonia relearn better by not making the “technical commands.” It’s plausible that there’s something about the nature of focal task specific dystonia that makes this the most successful rehabilitation program.

    I also find it interesting that (according the my memory) players who run into issues with embouchure dystonia are more likely to have learned to play without thinking about embouchure mechanics in the first place (sometimes called “natural” players). I also find it plausible that for many of these players they played for a long time on improper embouchure mechanics and got away with it until their chops couldn’t take it any longer (statistically, this is more likely to happen when the player is in his or her 30s). And another question I’d like to see addressed is whether a player who has been, for example, type switching and his chops finally break down is actually setting up a neurological chain reaction that causes the dystonia or whether this is an entirely different situation from a medically diagnosed focal task specific dystonia of the embouchure.

  4. Dave: I agree with you, more study is needed. I am a classic Very High Placement player, downstream, of course. Frank Crisafulli was a hero of mine, who, by the way, sought out Don Reinhardt’s help when he type switched. I am experimenting with round about suggestions to my self, allowing correct form to happen when needed. The fact is, we have to allow the proper motion and have the corners lock down. No two ways about it. The suggestions of the practitioner I have consulted do work and promote relaxation, efficiency, and sound breathing.

  5. Muchas gracias E. Díazor, estaba pensando en hacer la traducción cuando he visto la suya. Of course many thanks also to the author. His article is a beam of light in a dark well. It has expressed and shaped semi-formed thoughts within me and haunting my head for years.

  6. David: I have revised my thinking as a result of thinking of doing one thing at a time. I am not inclined to go for a more relaxed embouchure any more, without the proper form, the sound suffers as does control. Well, Doc Reinhardt told me “only work on one mechanical correction at a time.” I agree with you even more now that I have had an additional 5 years of re-training under my belt. And Joakim Fabras, who has helped people regain playing ability, those with TSFD, encouraged me to take my “luggage” with me when I try to play in an ensemble: to remember those things that must happen for it to work: firm corners, as you say, “locked down,” easy breathe, a lot less than I was using, with minimal air pressure. I feel the arched tongue takes up most of the work of the air pressure, not a an overly tight solar plexis and abdominals. I would eagerly recommend fellow sufferers to consult with Doug Elliott. He is the one who got me back into basics taught by him and Doc. Thank you, David! Good work, as always.

  7. What helped me with “dystonia’ most was free buzzing, “walking into the horn” while free buzzing and lastly, “walking out” of the horn, maintaining the buzz. In and out. It is central to adopt free buzzing as your method.

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