Brass Embouchure Dystonia – What does a typical case tell us?

Let me start this post by making it very clear that I am not a medical professional. In no way should anyone use the information I’m posting to diagnose or treat a medical condition. My recommendation is to visit your doctor and get checked out, or get a referral to a specialist.

I’ve been thinking recently about some of the papers and articles that discuss brass embouchure dystonia. While I have written up before about helping musicians with embouchure dysfunction, I haven’t really written up a close look at what appears to be a typical situation. In his literature review and case study, Dr. Seth David Fletcher wrote a hypothetical case:

Consider the following scenario: a trombone player earns a seat in on of the nation’s premier orchestras. One day in rehearsal she notices that she cannot articulate some middle-register notes cleanly. The following week this difficulty recurs and is noticed by the conductor. Naturally, she increases her practice and focuses on the source of the problem. Unfortunately, she then develops an uncontrollable tremor in her embouchure when playing sustained tones. Over the course of the next few months her ability to play rapidly declines the the point that she is forced to stop playing.

Even though this case is hypothetical, it includes some characteristics that are noted as being common for brass musicians dealing with dystonia-like symptoms. It’s more common in men than women and the mean age of onset is 37 years old. Symptoms include lip lock, tremors and involuntary contractions in the embouchure muscles.

Jan Kagarice in a presentation for the International Trombone Festival in 2004 wrote more about typical cases (see Fletcher’s dissertation, p. 33 for the full chart). Personal traits include being a natural player, considered to be talented and successful, a perfectionist who practices a great deal, and naturally expressive and talented. The onset of the problem manifests in a change of playing sensation. Symptoms arise, and the case usually progresses along the pattern described above.

For my purposes, I’d like to consider the following descriptions that appear to be typical.

Common Patterns of Brass Musicians with Dystonia-Like Symptoms

  1. A natural musician who practices a lot, but who doesn’t typically need to address technique.
  2. An issue begins to manifest and the musician begins to diagnose and try to correct the issue through task-specific practice.
  3. The problem gets worse.

Some of the authors of the papers and articles use this typical pattern as evidence that because there is a correlation with task-specific practice, and by implication, perhaps the cause. I’m not so sure that this is accurate.

First, it’s worth noting that there is also correlation between being a “natural” player (who didn’t really need to be shown how to play correctly, just did) and the onset of a problem that they can’t practice their way out of. Secondly, when it comes to the task-specific instructions on the topic of brass embouchures, one thing that is worth noting is how contradictory a lot of the advice is. When a natural musician tries to eliminate a playing difficulty through task-specific practice, it’s worth looking at what specific tasks they are practicing and whether it actually makes corrections in the player’s embouchure technique. Particularly if a musician is a “natural” player they are unlikely to understand how to analyze their embouchure and how to make specific corrections.

Like others, I feel we should be helping players with embouchure dystonia in a wholistic manner, including emotionally and musically. However, I feel we’re missing some important clues by jumping directly to goal-oriented approaches to treating embouchure dystonia. The onset of the musician’s problems will typically manifest prior to the task-specific practice. The cause of the symptoms may be in the musician’s technique and the effect of trying to practice out of it incorrectly is what leads to the full blown breakdown. At the very least, teachers and therapists should be aware of brass embouchure types and be able to note type switching. How they choose to make necessary embouchure mechanics corrections is up to them, but they should understand what they should be accomplishing.

As I mentioned above, I’m not a medical professional and neurological disorders are out of my area of expertise. Brass embouchures mechanics, however, are in my wheelhouse. There are important variables that is being missed by many musicians and medical professionals who are working to treat embouchure dystonia. As I mentioned last month, there seems to be a movement in Europe to take a more objective and scientific approach to embouchure dysfunction. I hope that researchers, therapists, and music teachers in the U.S. will follow their lead.

Alex Marco

Hello David;
How do you know about: Is there any direct association between the inclination of the air inside the mouthpiece, as Paull Pollard argues, and the three positions of the embouchure?
Could it have any relationship the tipe of embochure betwen support up or support down in the pedal notes?
Thank you so much!



I don’t know exactly what Paul Pollard says about embouchure dystonia or embouchure malfunctioning in general, so I can’t comment on that. If you have a reference you can send me to, I’ll read it/listen to it and get back to you.

If I understand your questions correctly, the three basic embouchure types (as I prefer to describe different embouchures) are relevant, I feel, but the researchers who are investigating embouchure dystonia are pretty much unaware of them and don’t use them as a variable. When I have been able to study players with chronic embouchure problems (some minor and some in complete collapse of playing ability) I have always seen some element of the player’s embouchure form not working correctly for the embouchure type.

Maybe I’ll do a more thorough writeup of my hypothesis on embouchure dysfunction, but it hasn’t been researched or tested to my knowledge. The Rehabilitation and Music Conference that just happened in The Netherlands had a presentation on therapy for brass musicians with embouchure dysfunction. As best as I can tell, this is the first research into this topic that points out embouchure types and other characteristics of embouchure technique as useful for diagnosing and developing physical therapy for brass musicians.


Bruce Bevans

Hello David: I worked for years with Ms Kagarice. She is a very dedicated helper. However, with me, at least, she eschewed all talk of the embouchure, trying to get my embouchure (I am a classic Very High Placement, a IIIA as “Doc” called it. My progress was very slow. My main symptom was lip lock, but also a very stiff tongue and a very tight gut in the area of the solar plexis. I returned to my Air Force buddy, Doug Elliott, who immediately got me working on free buzzing. It has taken a long time, from 2012 until now. The point is, I lost all muscle tone in my embouchure! I feel as though now I am on my way, as I feel that I never had a properly developed embouchure. I remembered how my original teacher, Mr. John Coffey, retired bass trombonist of the Boston Symphony, showed me how to free buzz. He also was a High Placement player. That visual was the ticket! I still get anxious, my head shakes a bit due more to oxygen deprivation, but it soon subsides if I can get the initiative on the dystonia. You have an excellent grasp of the disorder, David! Keep up the good work! Your friend and supporter, Bruce Bevans.

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