The Jawbone’s Connected ... A Case History

 

by Ros Walter (Feldenkrais Practitioner)

 

Stephen, aged 31, a jazz musician from Zimbabwe (saxophone, flute and guitar), was referred to me by a consultant at the British Performing Arts Medicine Clinic in June of 1991. By then he had spent three years consulting numerous local doctors, including three dentists and two neurologists.

Instead of reading the sheaf of letters and medical reports he handed me, I preferred him to tell me about his ‘problem’. This would give me an opportunity to make observations and form some impressions.

It all started in 1988. A composer and arranger, he had for some time allowed his sax playing to lapse in favour of the guitar. Totally out of practise, he then accepted an engagement to play the sax in a show requiring strenuous daily performances. Dissatisfied with his lack of power, he switched to a much harder mouthpiece (avoided by most players) to increase his tone, and ‘lost control’ of his mouth. His ‘lasting power’ deteriorated, and resting for two years did not help.

Although only the area around his mouth was swollen as he talked, his whole face seemed immobilised as if restricted by its outer skin, over-stretched and taut. His lower jaw was held far back and down, forcing him to look upwards at me. His upper lip was no more than a thin, tight line with a swelling above it. He fidgeted constantly as he sat on the working table, leaning first on one hand and then the other. Lying flat on his back proved no better. “I never could do it. They tell me to relax, but I don’t understand what they mean. I’ve never had a massage in my life, but I play competitive squash to keep fit.”

With Stephen lying on his back, I was able to make a number of observations about his general alignment. I noted that his head and upper body were well to the left of his pelvis and legs. At first his ankles were crossed, but he changed that, placing his feet very close together. He said he had been told that one leg was shorter — couldn’t remember which — and that he should wear a platform on his shoe. This ‘short leg’, I pointed out, could well be due to the left side of his pelvis being slightly raised, which in turn shortened the whole of that side while lengthening the right. To test this theory I suggested he shorten his left leg even more a few times, then lengthen it, noticing in both cases how the rest of him responded. Approaching it from the other end, I placed a ball diagonally above his head and asked him to reach for it. Repetition on each side reinforced his experience of how arms and legs shorten and lengthen. With his nervous system confused out of its habitual holding patterns, Stephen’s pelvis settled down horizontally and the rest of him fell into place. Both legs now matched! Meanwhile I felt how immobile his shoulder girdle was, and how rigid his pelvis and chest. His neck felt surprisingly free, but this proved to be relative. He said he had occasional lower back pain, but preferred to ignore it.

Stephen seemed very determined, ambitious and demanding of himself, with a very settled — even rigid — mode of thinking in one so young. Two instances illustrated this for me. Sitting in front of a mirror at the end of the lesson, he expressed great relief that a line above one eye which he had noticed in his reflection in a shop window, had mercifully vanished. “I’m young again,” he said. “I don’t want to get old.” I was surprised at the vehemence with which he said it, but when this sentiment was repeated a few times in subsequent lessons, it took on a different feel. It was as if he was running out of time for achieving the many goals he had set himself.

I also detected a somewhat self-limiting judgmental attitude when I asked: “What is your tongue doing?” during some exploratory jaw movements. “Nothing!” he exploded. “It just hangs in space. Thank goodness I’m not one of those people that has a tongue moving around outside his mouth when he stirs a pot.” I promptly suggested he do precisely that, to see what it felt like. He might after all be missing out on something! This set a tone that clearly intrigued him and by the following lesson he had decided to “stop being self-limiting,” and he also postponed his departure by a month!

Characteristically enough he demanded three lessons a week. “I’m a fast learner,” he said, sweeping aside my reservations. Stephen not only coped with such input, but practised between lessons with a most intelligent and rewarding understanding of the work we covered, making him a joy to teach.

Details of our work together would fill a fair-sized book. I propose to outline only the most interesting features in the remarkable progress Stephen made in his fourteen lessons with me.

Stephen’s main concern was his lower jaw which a childhood dentist thought protruded too much, and had ‘forced’ back, making him sleep with a pencil from upper palate to lower gum. It now juddered uncontrollably when playing the saxophone. (But interestingly enough, not the flute.) My priority, however, was to remind his pelvis and rib ‘cage’ (an iron one) how mobile and free they once were and could again become. Since the flexibility of one depended on the other and indeed on an equally free shoulder girdle, these were the areas I would focus on first as it was essential to lower the tonus in his whole body for the jaw to benefit. In each lesson I would give Stephen a Functional Integration lesson followed by an Awareness Through Movement sequence to reinforce it. This also gave him something specific to practise at home. Only after softening these areas did I concentrate on Stephen’s jaw. I suggested exploring a range of lower jaw positions: Still on his back, he would move his lower jaw up and down, his hand on his throat to enhance awareness of differences in sensation in that area. We called his habitual position B for basement, jaw forward with teeth parallel was G for ground floor and lower jaw forward of upper teeth, 1 for first floor! He showed surprising sensitivity so early on in his lessons by already feeling differences in his breathing in the different jaw positions — one affecting his stomach and the other ‘higher up’. I then noticed that he clenched his teeth in each position. To avoid this, we played with keeping teeth a finger-width apart behind closed lips. “Try keeping your teeth apart all the time,” I suggested. “Can you swallow without teeth touching?” Determined as ever he thought he could!

Stephen came to his next lesson able to tap out the rhythm of a folksong with his teeth, selecting different positions for different lengths of notes (quavers, crotchets or minims), quite effortlessly and with evident enjoyment! What’s more he had already understood an important principle of the Feldenkrais Method about experimenting with two or three options instead of sticking to one habitual way of doing anything. With a few seconds of mental rehearsal, Stephen could play any permutation he chose!

But he reported anxiously that “too many rides up and down the lift” had brought back some juddering accompanied by tingling in his lower arm. I advised him to stop striving and overworking. “Learn to play with these movements like a child,” I suggested. An FI to soften his chest (a likely cause of the tingling in his arm), settled him down. Noting the tight, thin line of his upper lip (as if permanently frozen into a flute embouchure), I gave Stephen an FI (Functional Integration lesson) to release tension in his facial muscles followed by an ATM (Awareness Through Movement lesson) in which he continued the process. With his own fingers inside his mouth, Stephen lay working the ‘clay’ of his rigid jowls and curling his lips inside out quite amenably. He was rewarded by the ability to vibrate his lips (Prrr!), then blow very loud raspberries at me! Patiently relearning the primal movement of sucking his thumb — with due attention to what his lips, tongue and stomach did — continued his renewed acquaintance with himself and had a most calming effect on him.

This continued in subsequent lessons, the time as always shared between FI and an ATM, one enhancing the other. Sometimes we would focus on his hands and feet — an area of major sensory significance. For example, he would interlace his fingers and toes, then reach to interlace toes with toes! He would lie on his back with arms by his sides, doing ‘The Bell’, a classic Feldenkrais lesson. This involves a gentle grasping movement (as if picking up a silk scarf) followed by letting gravity take the lower arm back to the table. Turning the raised hand to look at the scarf adds rotation of the lower arm and wrist, which I find invaluable.

By the end of this particular lesson, Stephen’s upper lip had become bow-shaped and full, even showing some inside lip: I suggested making dimples in each cheek our next goal. His jaw could now move through all three positions with closed lips; also, the angle of his head and neck had so changed that he could lie supine without a cushion under his head. And so we proceeded, focussing on one area at a time. To the jaw we added tongue and eyes, playing with breaking their habitual dependency on each other. Learning to move jaw left and eyes and tongue to the right — or permutations of these — proved exhausting! We tackled his ‘lazy right eye’ by closing the left one so that the right would have to work harder. “I can’t,” he said. “Alright then, close them both ... now open only the right eye ...”

This was followed by playing the same game with jaw, belly and sphincter muscles. “Tighten two of these without the third. Now tighten just one of your choice” I instructed. “Sing a loud vowel sound at the same time. Or a different one for each area! Sense your jaw as it changes shape with each vowel sound. Smile the left side of your jaw towards your left ear without screwing up your eyes. Increase your smile gradually using only the corner of your mouth. Compare the smile on the right...”

The importance of the eyes in regulating or inhibiting the movements of the body became a major learning experience for Stephen. This involved more games. “Wink with both eyes. Keep the left one shut and imagine the right one getting bigger. How big does it feel? A grape? Peach? Watermelon? Now imagine you’re watching a feather fall from the ceiling ... ” By the end of this lesson Stephen’s right eye was much larger than the left.

Stephen practised yawning deliberately to expand all his muscles more fully and take in mare oxygen. This brought our attention back to the tongue, that large, strong, under-used muscle. More games ensued, making Stephen’s tongue positively agile. “Pretend to lick an ice-cream cornet. Hold it against your lips. Now move it further away and reach for it with your tongue. Notice what the rest of your body is doing. Move the cornet more and more to one side for each lick. Notice what your neck needs to do.... Make a small circle in the air with the cornet, stopping to lick at certain points. Circle in the opposite direction and compare the ease and clarity. Listen to each movement you make with the same concentration as when listening to the sounds you would make on your instrument.” The pecking motion involved in licking an ice-cream, as well as singing a loud vowel sound or interlacing toes, all served to lower and loosen Stephen’ s chest.

We continued with: “Tap a rhythm with your tongue against your lower teeth. Now sing la la la to a rhythm on your upper palate. Vary the length of notes. Listen to them with one ear at a time. Compare the two ears. Notice whether you have chosen a high or low pitch for the sound. Vary that. Notice what your eyes do as you sing.”

We had now reached the third week. Stephen was generally more aware of how he did what he did and a lot more in control. It was time to integrate the work we had done into his playing. Initially we used the tenor recorder rather then the familiar saxophone with all its negative associations. To keep all blowing as unfamiliar and out of context as possible, Stephen would play lying flat on his back, with hands reversed or with his jaw in different positions. He also went onto all fours — even with the top of his head on the floor to allow him to experience his lower jaw hanging freely with gravity, pretending to blow with minimum effort,

Then Stephen graduated to the sax mouthpiece. Small and light to hold, he experimented with putting it into different parts of his mouth instead of returning to his former habit of using only the right corner. (for reasons he no longer remembered). Truly entering into the spirit of the work, he played the mouthpiece with both flute and sax embouchures, demonstrating a fundamental Feldenkrais principle : “If you know what you do, you can do what you want.”

By now he felt ready to tackle the dreaded sax itself. I noted instantly how hampered he appeared to be by the weight of the instrument hanging on its strap around his neck. This was making his head pull down so that he had to look upwards at me in the old, habitual way. Together we designed a harness with a strap across each shoulder, but in fact he was able to purchase something similar that same day.

Meanwhile, I suggested playing in a supine position (a different relationship with gravity) and with hands reversed. This unfamiliar approach to playing would, I hoped, be far removed from the habitual, and would serve as the vital ‘strange context’ that would reintroduce him to his instrument in a fun way. At the very least his hands would have different things to think about and his mind would be kept off past anxieties. It worked a treat!

Up on his hind legs again, Stephen was able to play with increasing confidence and finally with admirable abandon! I encouraged him to play ‘to the gallery,’ or ‘to the pit;’ to each side, over his shoulder, between his legs and behind himself. He could draw circles with his tailbone or navel or do a ‘belly dance’ while he played, noticing the role of his feet in supporting his whole body as well as his saxophone.

All past rigid notions of right or wrong ways of behaving appeared to have been erased by the sheer enjoyment of being able to move naturally with a free pelvis and chest and “with every part of his body pulling its relative weight.”

It was a very different young man who flew back to Zimbabwe to resume his career. In the notes he’d written for me, he said: “My mind is getting accustomed to focussing not only on movement, but on other aspects of life as well. I have come to realise that a musical career is a process to be played out in time and not a mad, desperate rush to achieve as quickly as possible.” He also felt that improving conscious control of his eyes had been the most important factor in his rehabilitation.
 
 

© Roselyn Walter