Applying Norman Lu’s Hand Dystonia Retraining to Brass

By Dr. Logan Chopyk

May 25, 2026

Norman Lu has done a spectacular job researching and applying a neuroscience lens to musician’s dystonia retraining. His theory identifies the physical problem in the brain: an imbalance between excitatory neurons and inhibitory neurons in the M1 region of the brain for a given task.

His solution is Below or At Threshold Retraining (BATR), which consists of repetitions of playing or like-playing movements that can be done without triggering dystonic symptoms. Due to Spike Timing Dependent Neuroplasticity (STDP), repetitions of the movement which activate dystonic symptoms will result in increased excitatory neuron potential without increasing inhibitory neuron potential, leading to further imbalance in the movement. Whereas repetitions at or below the threshold for the dystonic symptom will result in a growth of the inhibitory neurons for that movement, resulting in greater inhibitory potential which is more capable of balancing the excitatory neurons. If done enough, this will 100% erase the dystonia.

For hand dystonia, like that of a pianist whose ring and pinky fingers curl uncontrollably during playing, it is fairly obvious when the dystonia symptoms occur. The mechanics of the hand and how they interface with piano technique is also obvious. Therefore, recovery via BATR can be straightforward.

However, brass playing presents unique challenges for BATR application due to respiratory system involvement, misguided and flawed pedagogy, inaccurate anatomical understanding, and technical misunderstanding due to the mystery of the invisible playing system.

The Respiratory System: The Central Lever

The most important component of any wind instrument (brass included) is the respiratory system. Breathing is directly connected to sympathetic and parasympathetic nervous system activation. It can be both consciously and unconsciously controlled; emotional states influence breathing and breathing influences emotional states. Therefore, breathing isn’t a simple movement—it is a central lever that dictates our moment-to-moment experience of life.

For better or for worse, breathing can be trained. In the case of brass pedagogy, educators often train young players to take big breaths. The problem with this is that a full relaxed diaphragmatic breath doesn’t carry the sensation of effort or fullness. This breath is characterized by a release of the lower back, abdomen, and pelvis in order to make room for the displacement of the guts that are below the diaphragm as the diaphragm contracts downward to create low pressure and therefore draw air into the lungs.

On the contrary, the sensation of effort and fullness comes from chest breathing—engaging muscles that tighten around the airway, lifting the sternum and raising the shoulders. Once these muscles are engaged during inhalation, it becomes impossible to play a brass instrument in an efficient way because the airways are blocked before playing is attempted. In every case of embouchure dystonia I have seen, runaway tension in the breathing has been a central symptom of the dystonia.

Pre-BATR: Gaining a Foothold in the Breath

So, how can we apply BATR to breathing? In most cases, it is not possible for the person to breathe without activating the dystonic symptoms. This requires tools that fall outside of Lu’s BATR. Inspired by my work with Jan Kagarice, I have mastered a number of techniques to get a foothold of ease in the breath:

• Anatomical Education: Breathing anatomy and technique must be understood, which is often the direct opposite of what the player believes. We release muscles to inhale, not suck and tank up. The diaphragm is not consciously controlled, and we cannot feel its muscular effort. Any sensations of effort indicate a chest breath or a misguided attempt to help the breath in ways that actually block breathing function.

• Flow State Activation: Making a dent in the dystonic breath is more easily done with a coach (like Jan Kagarice or me) because our coaching styles activate flow states. Flow states have been shown to increase brain plasticity by up to 400% and create an intrinsically motivating subjective experience. By creating an environment of extreme focus through constant focus cues and a moderately high level of challenge, we can consistently generate flow states.

• Deliberate Mistiming & Redirection of Awareness: If the dystonic breath is characterized by an automated number of ordered steps, we can subvert that pattern by changing the order of the steps. The timing cue is to release the muscles that engage at the start of the dystonic breath (often physically exaggerated by an upper body collapse). The player may need to pause their breath until they can send a release signal to the involved muscles. I recommend sending the release signal before letting air out as well.

• Sensation Replacement via Full Body Scans: The ability to be aware of sensations in the body is the currency of this step. With fine-tuned awareness, the player can manually release the muscles associated with the dystonic breath. Over the course of a week, doing many daily hours of breathing through the nose while laying down or sitting, the player may experience a breakthrough characterized by zero effort and relief from suffering. This sensation becomes the key for practicing healthy breathing in the future.

• Singing Through the Brass Instrument: In many cases, singing is still easy for the brass player with dystonia. By singing into the instrument (mouth on the mouthpiece and sound coming out the bell), we can observe and disarm many of the dystonic patterns that appear even though we are not playing the instrument (e.g., extreme breaths, blocking the air between notes or certain intervals, increased tension in the high register). This allows the player to maintain a musical connection and expect that actual playing should be similarly easy.

Once the player can breathe without dystonia, Lu’s BATR protocol can begin. They can practice it away from the instrument and while singing through the instrument as much as possible.

Brass Technique: The "Double Whammy"

Due to the invisible nature of the brass playing system, misconceptions and pedagogy based on misconceptions are abundant. As brass players hit technical ceilings, they may search for solutions and find harmful advice.

Lu notes that oftentimes changes in technique can be a catalyst in forming dystonia because the technical change weakens the neurological ability for the movement before the new technique can strengthen enough to allow the player to perform tasks they could before. This causes overreaching, which begins the process of runaway imbalance of excitatory over inhibitory neurons.

In brass playing, there is an added layer: the new technique may not align with the reality of how brass instruments and our bodies function. The player experiences a "double whammy" of neurological loss of ability from the technique change, plus the introduction of a faulty technique that makes it more difficult to play.

Therefore, the misconceptions of how brass instruments and embouchures function must be addressed before BATR can begin. Bad technique and dystonia become a single thing. The feeling of effort triggers a shutdown of the system. The brass player retraining from dystonia will be in disbelief with how easy it is to play when they are not engaging in the faulty techniques and dystonic patterns.

Freedom of the Air: A Unifying Concept

The freedom of the air is a unifying concept at any moment of the process. This is very complicated because there is a complex system of variables balancing on one another. A change made in one area will affect the other areas (all of which are felt and heard, not seen).

When the air is moving freely without tension, the embouchure will easily adjust. However, freeing the air necessitates the release of many variables piece by piece, including:

• Lip tension

• Tongue retreat

• Jaw tension

• Throat tension

• Chest tension

• Shoulder tension

Triggering dystonic movement in one cascades through the system and almost always shuts down the air. Without the airflow, there can be no resonance for the system to balance on.

Applying BATR to the Complex Brass System

How can we apply Lu’s BATR in this complex system? It relies on the total abandonment of what the player understands about how to play and how it feels to play. They must play with an overly released technique in the beginning in order to free the air, going from where they have commanding ease to areas of challenge:

1. Away From the Instrument: Move air freely in and out of the atmosphere. Move air easily through a boba straw, play a flute, blow a garden pinwheel, or blow on one’s hand easily.

2. Instrument Grip & Touch: Notice if holding the instrument activates symptoms. If so, begin holding the trombone with the right hand instead of the left. If the simple touch of the mouthpiece causes symptoms, repeatedly touching the mouthpiece to the lips can desensitize that response.

3. Inner Slide Assembly: Holding just the inner hand slide with the mouthpiece attached, move air freely through the long tube and expect a vibration to occur. This is very easy to achieve and an excellent initial BATR step.

4. Outer Slide Assembly: Attach the outer slide and play glissandi.

5. Bell Section & Full Assembly: Attach the bell section without the tuning slide, then finally assemble the instrument fully.

Execution Tactics:

• Timing Cues: Trick the brain by matching the sensation of freedom (like blowing through a straw) on more challenging steps. Use cues like “air goes before the mouthpiece touches” to preempt the dystonic sequence and cut out the 3–5 unhelpful steps the dystonia relies on.

• Air Volume: Play short notes if long notes are symptomatic. Less air usually leads to fewer symptoms, although it can be good to feel the freedom of a large airflow.

Conclusion: Retraining the Preparation

Getting to the point of being able to play a single short tone without dystonia may take weeks or months of retraining and learning. Because while pianists are retraining the act of playing, brass players are retraining the preparation of playing. Most of the problems occur before the moment of playing. It is the breath and the tension set up. This can happen while already playing if we have to play problematic intervals or directions because the dystonic preparation for the future notes are occurring.

Finally, when a player can play a single short note without dystonia, the complexity increases. Articulation, high and low range, and intervals all may require their own retraining. But in every case, free air and ease of sensation are the guides.