EmbouchureHand Vocal Chord

Successful Cases: Focal Embouchure Dystonia

Instrument: Trombone
Time suffered before beginning the treatment: 9 years
Treatment duration: 8 weeks
Previous treatments:with other recognised Focal Dystonia therapies, Alexander Technique, Osteopathy and Physiotherapy…

Case History

I have change the name of this client to Juan to protect their privacy.

When Juan came to my office he had suffered from Focal Embouchure Dystonia for about 9 years. It occurred when he played the middle range of the trombone. It took the form of him being unable to tongue the notes in this range of the instrument. His tongue retracted backwards or moved too far forwards and past his lips and he was unable to bring his tongue to the exact place necessary to intonate the note.

This meant that he had left the classical brass groups that he was playing in and had limited his teaching capacities in the University that he worked in. He was able to continue to play in some of the groups that he played with because they required less precision and he was able to adapt his playing to be able to avoid tonguing in this range of the instrument.

He had tried many different and well known treatments over the years and whilst he had achieved some improvement he had resigned himself to live with his Focal Dystonia. When he heard about the work that I do he decided to give himself one last chance to heal it.

Treatment Focus

With Juan, I centred the process on the physiological sensations of the Focal Embouchure Dystonia. The central theme of the process is very individual to each client. Some clients need to focus initially on what triggered the onset of the Focal Dystonia. Others have such strong feelings associated with suffering from it that we need to begin the process with them. These individual differences have little meaning and what is important is to focus the process on the individual and unique needs of each person.

In the therapy I facilitate the client to “go inside” their brain to experience the erroneous neural connections that are causing their Focal Dystonia. As they do so they sometimes have flashbacks of difficult experiences that they have had, such as teachers, conductors or colleagues that have humiliated them, or punished and pressured them. Sometimes they are memories of experiences that aren´t directly related to playing their instrument, however, for some reason the clients brain has connected it to their muscle control. Other people just begin to experience the emotions that are related to the over stimulation of the muscles and then others only feel the physical sensations of the Dystonia.

Focal, without memories or emotions. Each of these experiences leads to the neuronal stimulation that enables the client’s brain to disconnect the erroneous connections and create new neuronal pathways to resolve the Focal Dystonia.

Juan was perhaps one of the most “text book cases” that I have had, if such a thing exists, in that he had all of these experiences.

Process of Resolution

En las primeras sesiones, muchas de las sensaciones difíciles que había sentido desde el comienzo de su Distonía Focal aparecieron. Eran sentimientos que incluían la desesperación de tener que tirar por la borda sus ambiciones y sueños como músico y la depresión que eso provocaba. También tuvo que esconder continuamente su Distonía Focal y eso estaba acompañado de los sentimientos de ser un fraude y del miedo de ser descubierto.

Cuando conectó dentro de su cerebro con estos sentimientos y su impacto en su Distonía Focal de la embocadura, los músculos comenzaron a soltarse y a regresar a estar bajo su control. También tuvo flashes de un profesor de trombón que era especialmente exigente y rígido. Se conectó profundamente a la auto-exigencia que él había aprendido de niño por su miedo de decepcionar a su profesor en las clases semanales que tenía con él. Además tuvo otros flashes de experiencias que en la superficie no tenían ninguna relación con tocar el trombón, sin embargo estaban subyacentes a la sobre-estimulación en su red neuronal. Incluían las regañinas que como niño le daban por ser demasiado alborotador y por hacer demasiado ruido. También tenía sentimientos de culpa por haberse mudado a una ciudad lejos de su madre para seguir con su carrera musical.

In the early sessions many of the difficult feelings that he had felt since the onset of the Focal Dystonia showed up. These were feelings such as the desperation he had in having to end his ambitions and dreams as a musician, the depression that followed this and the ongoing hiding of the Focal Dystonia and the feelings of being a fraud or fear of being found out that accompanied it.

As he connected in his brain to these feelings and their direct impact on his Focal Embouchure Dystonia the muscles began to release and return to being under his control. It also opened the door to him having flashes of a particularly demanding and rigid teacher. He deeply connected to the self-demanding that he learned as a child from his fear of disappointing this teacher in his weekly lessons. He also had other flashes of experiences that on the surface were unrelated to playing the trombone; however which were underlying the overstimulation of his neuronal network. They included being told off as a child for being too rowdy and for making too much noise, as well as the feelings of guilt for moving to a city in order to pursue his musical career that was a long way away from where his mother lived.

What was so clear with Juan; was that as he disconnected each of these memories from the neurons that control his muscle movement there was a direct relationship to the Focal Dystonia and he had an immediate return to his control over the correct functioning of his tongue.

As we stimulated the neuronal networks that were causing his Focal Embouchure Dystonia his brain was able to disconnect this intense overstimulation. Simultaneously I showed him how to activate the neuroplasticity of his brain in order to connect the fine motor skills of his tonguing to a place in his brain of deep calm and precision. He responded particularly well and his Focal Dystonia disappeared with spectacular ease and speed, in fact, in just 5 weeks he had almost completely recuperated from the Focal Dystonia.

What remained from point onwards was to recover the extremely fine level of technique that he had before the onset of the Focal Embouchure Dystonia. This last detail of the therapy simply required us to work through it with patience as it was stored in a deep part of the brain that is beyond our capacity to understand and analyse our experiences. However, this only required several sessions more of detailed and meticulous work.


I wanted to share Juan´s case with you because in his processing he directly experienced so many different levels of the erroneous neuronal connections that had caused his Focal Embouchure Dystonia. He localised the exact experiences, as well as the emotions with the erroneous connections that caused the physiological sensations of the Focal Dystonia.

It was a profound joy to have had the opportunity to accompany him to recover his great talent. He is a musician that has a natural style of playing the trombone with huge amounts of fun and energy. It saddened me to hear how the Focal Dystonia had robbed him of this. I have really enjoyed seeing him in concert since resolving his Focal Embouchure Dystonia with me and seeing him play with all his vivacity and vigour. It is inspiring to see how he captures the audience animating them with vibrancy and happiness.

Successful Cases: Focal Hand Dystonia

Instrument: Bass guitar
Time suffered before beginning the treatment: 1 year
Treatment duration: 18 weeks
Previous treatments: Osteopathy and Physiotherapy.

Case History

I have change the name of this client to David to protect their privacy.

David´s case is one of the more complex cases that I have treated. Even though he had suffered from Focal Hand Dystonia for only a year, it had developed extremely quickly and severely. It has spilt over into many everyday actions and he had almost constant pain and spasms throughout the whole day. This differs from most of the people who come to me to treat their Focal Hand Dystonia, which only appears when they begin to play their instrument. In addition his fingers curled tightly into his palm with extreme intensity in the moment that he picked his instrument up.

Treatment Focus

Therefore, I divided the work with David into 3 levels:

It was really no surprise to me that the causes of his Focal Hand Dystonia were an accumulation of highly stressful events experienced since early childhood. Amongst them were the demands and punishments of his first music teacher and his first music theory teacher who at 6 years old left him with a profound fear of making a mistake.

Phenomenologically, I have evidenced that the cause of Focal Dystonia is where the neuronal connections that control the fine motor skills of the musician are connected with high impact or stressful experiences. It seems that these experiences over stimulate the messages from the brain to the, in this case, movement of the fingers, causing the muscles create a “muscular vigilance” and a “withdrawal reflex” which leads them to become rigid and beyond the control of the musician.

The complicated aspect of curing Focal Dystonia is that these erroneous connections are located in the deepest parts of the brain which are beyond our awareness and our conscious control. This is the reason why it does not respond well to the traditional treatments such as muscular retraining. It is also the reason why it responds so well to deeper neuroplasticity and neurogenesis techniques, which are able to stimulate just these midbrain and brainstem areas.

Process of Resolution

In David´s case, the stressful events had three common themes, high levels of demanding perfectionism and feelings of guilt and fear. Interestingly, it is very common that people who have learned high levels of demanding perfectionism also respond to life events with feelings of guilt and fear. I was struck by a comment that David made to me early on in the treatment. He said “I am not permitted to make mistakes”.

He learned this level of demanding perfectionism from his first music teachers and from his family environment. He also has a personality that tends towards this way of approaching his music. Whilst it had motivated him to achieve world class ability on his instrument it had in the end taken away his ability to play.

Therefore, as well as curing his Focal Dystonia, I also showed him how to have a high level of ambition, excellence and precision as a musician with inner feelings of tranquility, openness, relaxation and enjoyment.

In the neuroplasticity part of the treatment David was able to have a direct experience of how the adverse events that he had experienced affected his hand. As I enabled him to connect to the neuronal nexuses that held these memories his hand entered into extreme levels of spasms and contractions. As he worked through the exercises that disconnected his hand from these memories it came into complete calm and relaxation and was able to regain complete control of his fingers once again.

David´s case is very interesting because in the sessions he was able to feel and see with so much awareness the connection between the events and his Focal Hand Dystonia. This meant that between the sessions he would often remember other events that he had otherwise forgotten. Therefore, although his was a highly complex case with many different highly adverse events that had occurred since his childhood, he was able to support his own healing process in a remarkable way by actively bringing all of them up to the surface so that we could effectively disconnect them from his fine motor skill neuronal nexuses.


It was a joy and very satisfying to work with David, not only because of his personal dedication to curing his Focal Hand Dystonia, but because he experienced so many other positive changes. He returned to finding new levels of enjoyment and satisfaction in playing his instrument, he felt calmness and wellbeing in his day to day instead of stress and strain and he said that his humour greatly improved. The frustration and bad humour that he often felt and expressed to his loved ones disappeared to such an extent that his little daughter even commented on it.