- Dave Monette
ACQUIRED CERVICAL DYSTONIA AND RELATED ISSUES IN MUSIC PERFORMANCE—TREATMENT AND RECOVERY….
Updated: May 12
Over and over again, musicians who come to me for CST work have symptoms of acquired cervical dystonia.*
This involves repetitive stress from playing that most noticeably impacts the head and neck... but invariably ties into the shoulders, ribs, arms, hands, fingers, face... and more.
In CST and other holistic approaches, helping someone with upper body issues often starts with connections down into the pelvis, sacroiliac (SI), hips, legs, feet, etc... because all parts of us are connected!
The good news is that a comprehensive, full body treatment often leaves clients with more long lasting relief from their localized chronic symptoms - and helps them "full body" in standing taller, breathing easier and feeling lighter and more energized... often more so than they have felt in years. For musicians, the difference can be felt and heard in their first notes after even just one session.
When someone asks what separates the most accomplished players I work with from others, I often say that the best of the best play from, through and even beyond their entire physical body. Most players have not consciously experienced this... except perhaps in rare peak moments that they usually have not been able to repeat at will.
Playing full body (including all bodies; physical, mental, emotional, etc.) allows for the widest possible range of ease and expression. This is the ultimate goal in my CST work and in Energetics of Performance sessions.
CLICK PICTURE FOR THEO'S
VIDEO PLAYING DEMO AND TESTIMONIAL
ERIC FROM AUSTRALIA KINDLY OFFERS UP HIS EXPERIENCE...
Multi-instrumentalist Eric Budd recently visited from Melbourne, Australia. The symptoms he had been experiencing for years - and the relief he found during his Portland visit - are typical of those encountered by many clients with whom I work. With Eric's enthusiastic approval, here is a brief overview of our work together... which was typical of my work with others.
Our session goals were to help him relieve the chronic neck and arm pain he had had for years... and reduce or eliminate a chronic nerve impingement in his right arm.
Before the session, Eric's head was in both a forward saggital shift (picture on right) and a lateral (side) shift. The forward and lateral shifts impinged the ulnar, radial and median nerves at the base of his neck at C6, C7 and T1, causing nerve pain and numbness down his right arm into his fingers. The lateral (side) shift of his head - very common with many wind players - produced chronic tightness and pain in his right neck.
TYPICAL TRUMPETER'S LATERAL SHIFT
THESE ARE THE MUSCLES INVOLVED*
The two sessions Eric received were full-body Craniosacral Therapy (CST) work, with elements of Zero Balancing and neuromuscular re-education included as needed.
WHAT IS CRANIOSACRAL THERAPY?
CST has grown out of the practice of
osteopathy. The work is painless and extremely gentle... based in part on monitoring and subtle manipulation of the membranes, fluids and bones that surround, nourish and protect the brain and spine ( the central nervous system).
This full body, osteopathy-based work encourages the release of tension and habitual patterns of holding to allow for greater ease in functioning and mobility throughout the body. Areas of congestion or discomfort caused by injury, illness and/or the stresses of musical performance can be quickly assessed and effectively treated through CST.
TESTIMONIAL AFTER JUST TWO SESSIONS...
After returning home to Australia, Eric sent along the following note:
"For the first time in at least 25 years, I have NO pain in my right side neck. Nothing! Your table work has done something that chiropractic, massage, acupuncture, etc. couldn't or hadn't."
"It is truly fascinating to me, as there is no (apparent) manipulation, pain or strange sensations during the table work. It is more like your body is just being guided into the right place. It is still holding now, almost a week later. That is truly something! Awesome! Thanks again, Dave…"
WHAT CAUSES REPETITIVE STRESS IN MUSIC MAKING?
Somatic dysfunctions in the head, neck and other related areas can be caused by the repetitive stress of playing - exacerbated by the asymmetries in the body caused by the physical and acoustic properties of the instrument one plays.
Players develop unconscious
strategies of compensation in their bodies for both the demands required to physically hold and play their instruments - and to adjust in their bodies for the acoustic deficiencies inherent in their particular instrument. These compensations may (to varying degrees) serve them for years... or even decades... until they don't!
When these compensations stop working - and/or become to painful to maintain - players make the appointment and come visit our shop.
For many, the stress from these habitual compensations we all started subconsciously learning back in our musical primacy eventually catch up to us in the form of aches, pains and sometimes impinged nerves. This can cause discomfort, pain, swelling, numbness, loss of function, reduced range… and in some cases - if not addressed - a shortened career.
WHY DO PLAYERS JUST OFF THE TABLE IN OUR VIDEOS SEEM SO CALM?
A common benefit of CST is a rebalancing of the autonomic nervous system. This can lead to a heightened feeling of peaceful relaxation, expansion and integration... a similar experience to that which some musicians experience during peak performance situations.
MORE ON HEAD/NECK ISSUES
The two most common issues I find in clients are what Eric was experiencing. His head was pulled forward of his spine and tilted up - and was being pulled off center. This stressed the seventh (facial) cranial nerve, and nerves at the base of his neck going down his right arm.
With most trumpet players - even those not yet experiencing pain symptoms - the repetitive stress of playing almost invariably transposes the head over to the left of center, with the left shoulder raised up towards the ear and wedged in towards the neck.
Along with this, the A/C joint at the top of the shoulder is often stiff or immobile. Players often unconsciously tuck the left elbow into the ribs, accentuating the asymmetry and muscle strain. The scapula (shoulder blade) is often “stuck” to the ribs - which can eventually devolve into varying degrees of “frozen shoulder” issues. All this puts even more strain on the neck and head.
The physical symptoms players I work with often experience from the above issues include inflammation, pain, a feeling of fascial constriction (like one is wearing gloves that are too tight)... along with numbness in the shoulders, neck, arms, hands and fingers. Eventually if untreated, this can lead to numbness and loss of muscle control in their faces.
The seventh cranial nerve comes out of the brain stem and around to the face, providing motor control and sensory information to and from the muscles of facial expression. These are the muscles wind players use to form an embouchure!
Impingement of this complex nerve
can cause Bell's (facial) palsy - and the inability to play. I have already had two clients dealing with this issue. Both found immediate relief through our work together.
Forward saggital shift can cause constriction and pain in the neck, shoulders and down the arms into the hands. This is due to the stress it places on vertebrae C6, C7 and T1 at the base of the neck, where the nerves that control the hands and fingers originate.
It is likely not a coincidence that players experiencing these problems hold their heads well forward of their spines; with the back of the neck compressed and their chests collapsed.
The undesirable effects of this are often exacerbated by tilting the head up and back, which intensifies the feeling of compression and choking players with this condition often experience.
Of every 100 trumpet players who visit our shop, 99 of them bring their heads forward of their spine (and forward of the rest of their body!) to meet the mouthpiece as they bring their instruments up to play. This reflects both the tendency many of us have in "getting ahead of ourselves," and the habit of tightening up - raising the pitch center of our bodies by choking ourselves off at the throat.
THE LAST NOTE OF A BRASS PLAYER’S UPPER REGISTER...
... is when they have tilted their head so far up and back that they are choking!
This forward head shift is a common compensation with virtually all brass players who use conventional mouthpieces. Watch every tuba player you know lean forward in their chair and pivot their head up more and more as they ascend into the upper register.
Why do they all do this... and why do trumpet players also pivot their heads up as they play into the upper register?
These adjustments are unconscious body compensations for their traditional equipment, which plays flat in the upper register.
It is almost universal that the acoustic deficiencies of antiquated equipment reinforce the dis-integration of our mental body and thoughts from our physical body as we ascend into the upper register. If you doubt this, just think of the head trips (and endless equipment searches) many players experience over their upper register issues!
WE ARE THE MUSICAL INSTRUMENT... EVERY PART OF US... FROM HEAD TO TOE!
With the head, neck, shoulder and rib issues described above, there are invariably compensatory asymmetries all over the body that directly affect how we sound, feel and perform every time we pick up an instrument to play!
In trumpeters, there are often left side lesions (blocked areas with impaired movement) all up and down from head to toe. The hips and SI are often jammed, which can adversely impact the knee and/or ankle. With this, the pelvis is usually out of level, which can cause one leg to seem shorter. This in turn can produce a scoliosis (curve) in the spine that reinforces the cervical dystonia up in the neck, shoulders and head! (This also makes walking, standing and pretty much everything else in life much more difficult than it needs to be!).
COMMON KNEE ISSUES
In the knees, I often find medial or lateral shear lesions... often combined with the tibial plateau being a bit anterior to the condyles of the femur. In talking with clients who experience this, it seems they are sometimes hikers who like big elevation gains... or those who often take the stairs instead of elevators!
I had a client with a chronic anterior/lateral shear lesion in her right knee during my CST certification sessions. She had been an RN for 35 years. She told me I was the first practitioner to ever help her eliminate the pain in her knee. It just took a few minutes of gentle holding, subtle manipulation... and waiting. Her hips and SI was also jammed up, which was likely the cause of the knee issue. This all came around quickly as well. She checked in a week later to tell me the adjustment had held. Yes...!
YOU CAN HIT “RESET!”
In this work, gentle, full body, hands-on palpation sends a non-threatening message to the brain to release chronically tight muscles... which in turn, releases the bones that have been pulled out of place and have often pinched afflicted nerves. This work requires patience, and a gentle, informed touch in order to facilitate the desired release. My favorite part of every session is the waiting... followed by the connection and release!
For more on this, you can explore links to Dr. John Upledger, Dr. Moshe Feldenkrais, and you can read Dr. Norman Doidge’s excellent New York Times bestselling book, “The Brain’s Way of Healing.”
It’s fascinating to observe and treat the patterns of lesions and compensations we almost all carry in and through us around musical performance issues. And it’s so rewarding that often - even in just one session - players experience relief from symptoms they have endured for years.
This new freedom and enhanced body resonance they enjoy after a session allows them to make more music with less effort... and get the most out of the revoutionary equipment we make.
For more information or to schedule a session, just click the email link below to contact me directly.
Thanks for your interest in my work... and for taking the time to read this post!
*Cervical dystonia, also called in some medical circles spasmodic torticollis or torticollis, is the most common of the focal dystonias. In cervical dystonia, the muscles in the neck that control the position of the head are affected, causing the head to turn to one side or be pulled forward or backward. Sometimes the shoulder is pulled up.
I am so thankful for the pioneering work of visionaries such as Dr. Andrew Still, Dr. William Sutherland, Dr. Moshe Feldenkrais, Dr. John Upledger, Dr. Rollin Becker, Dr. Charlotte Weaver, Dr. James Jealous, Dr. Fritz Smith... among others. In my world, these hero's have led the way with their revolutionary, holistic approaches to helping others regenerate health beyond the realm of pharmaceuticals and conventional medicine. I look forward to the day when their work is considered conventional!