A Conversation with Jen Montone
Angela Bilger: I seem to remember something about a car accident, but why don’t you tell me from the beginning what happened with your jaw.
Jen Montone: So, it was in October of 2004, and I in the car with my sister, she was driving, and I had my feet up on the dashboard, which is brilliant. Not brilliant. Don’t do that. Funny, my mom had told me for years not to do that, but I still did. But anyway, that had more to do with my back problem later, less to do with my jaw. So, I was leaning and turning my head and talking to her, and we were rear ended – not even very hard – but it was enough that my jaw slid all the way to the right. So, everything on the left side got stretched and displaced, and everything on the right side got compressed and tense and hard. I took a couple weeks off, then tried to come back to work in November, because I was still untenured, but it was way too soon. I played for a week or so, but had sharp, shooting pain in my jaw. So, then I started talking with colleagues and found an oral-facial chiropractor/physical therapist, a guy named Clayton Scaggs, who now co-runs the Central Institute for Human Performance in St. Louis. He was really brilliant. He works with athletes, and is specialized in these kinds of injuries, so he was my main doctor for this. He also ended up being a resource for me in that he had acupuncture in-house and a massage therapist he recommended, and also a cranial-sacral chiropractor, who was helpful in this case, because our hips and our jaw are both on rotators, so if you injure one, the other gets hurt too (which probably explains at least part of my eventual back injury). So, I ended up seeing Dr. Skaggs three times a week for about six months. It was a very regular regimen of that, plus a massage once a week for the first three months or so, and then acupuncture once a week for the last three months or so, chiropractors and an osteopath who put me on Celebrex which worked well for the inflammation.
So, in the jaw, there are the masseter, temporalis, lateral and medial pterygoid muscles which were relevant in my injury. The masseter is the lower jaw/chin muscle, and when I had pain playing low or loud or sustained, it was the masseter muscle that was affected. When I played high and stopped or muted it was the temporalis muscle, which is your temple muscle, and it goes all the way up like a hand, from your TMJ into your head. So, if I had sharp shooting pain up the top, I knew it was the temporalis muscle. If I had aching pain on the sides, it was the masseter. And the one that got really jacked up for me was the lateral pterygoid which is a little muscle that goes straight down, and then there’s a medial pterygoid, and they create a T in the middle of your cheek. So, if you have jaw pain, TMJ is a very easy one because there are doctors that are TMJ specialists. But if it seems to be not near your ear but somewhere else, there are those four muscles that might be affected, and there are PT exercises to deal with all of them. So, what he did for the temporalis was an exercise (that you can do yourself) where you put your fingers in the middle of your cheek and separate them out: one moving up, one moving down, to gently, slowly, carefully stretch the jaw muscles: stretching one hands’ fingers up toward your temple and moving your other hands’ fingers down toward the masseter, and that stretched out the temporalis and small muscles. For the masseter, he had me work on strengthening the bottom of the jaw with an exercise (which you can also do at home) where I put my tongue on the roof of my mouth and then opened my jaw very slowly and held it for a couple seconds, then closed it slowly;it engages the floor of your jaw. It seems to me the same idea as every other PT exercise – strengthen the big muscles so that the little muscles around it can relax and stop freaking out. So, that was to get the lateral and medial pterygoid (the T muscles in the middle of my cheek) to calm down. The exercises are easy and innocuous enough that I’m guessing you can do them on your own. But you can go to a physical therapist who deals with oral/facial issues, and it’s a huge resource. It took a long time. I’d say I started back to work in May. Between early spring and May, I had a very specialized practice routine, which I can talk about.
AB: So, you were out from October through May.
JM: Yes, a pretty long time.
AB: And how much of that were you not able to play at all?
JM: A lot of it. When I went back in November, and there was sharp, shooting pain in my temporalis muscle, maybe because I was doing a lot of high playing, it scared me. I thought I was having a brain aneurism or something. So, I went to see Dr. Scaggs and my regular doctor and this osteopath, and they all thought that playing seemed to be a bad idea and recommended that I stop playing for the time being. Then I heard about a doctor named Richard Lederman at the Cleveland Clinic. He’s the head of the Center for Performing Artists there, and a neurologist. What I heard about him was that he dealt with a lot of musicians who have tendonitis and other injuries – about 1,000 different musicians was the number I heard about him from a friend of mine there. So, he deals a lot with tendonitis, and some people who have dystonia will go to him and sometimes he’ll send them on to a dystonia specialist. He referred my student to a member of the performing artists team who helped her heal. So, he refers if he’s not likely to be the lead expert, but he sees a lot of chop and hand cases, and all things neurological. I saw him around January of that year, and what he did first was he put electrodes all over my face and jaw, and hooked me to a monitor, and I played for him.
AB: A biofeedback machine?
JM: Exactly. He figured out, whatever I did, whatever register I was in, what happened in the musculature. This is how we found that the high register got the temporalis going, the low got the masseter going, and everything else got the little muscles. Based on that, he helped me formulate a plan for coming back and recovering. The plan was very intelligent and worked well. He suggested I stay off the horn until March and then start back playing five minutes a day between middle C and middle G, just soft and easy. This created an interesting opportunity, though it was pretty brutal at first, because I would play my five minutes a day and then I would cry for about ten minutes after that. It was just awful. [laughing]
AB: Yes, this is sounding very familiar!
JM: It felt like just the worst thing ever. He then recommended that after a few weeks, I add one more half step orone minute each day. So, it was an excruciatingly slow intro back into playing, but it was conservative, effective, and then eventually, I started wondering: Okay, so, in this six-minute session, between middle C and A, what are the aspects of horn playing at work here? So, okay, maybe first, taking a nice relaxed breath. Then having a relaxed attack that is either timed and tongued, perhaps, or just air attack based on how my lips respond. So, you’re working on inhale into exhale on the air attack, and the coordination of that with rhythm and movement on the tongue attack. Then I’d focus on the smoothness between one note and the next, connecting a couple notes, then three notes in a row, then connecting with some musical direction, then articulation, then rhythm, then dynamic control, then sound quality, then musical expression, then style, then confidence. So, how I rebuilt ended up truly informing how I now play and teach. The process for me was actually really great, because I don’t know that I was doing things very intentionally before. I think I did a lot just off instinct and body memory. So, I think this whole thing made me a more conscious and problem-solving player and teacher.
So, that buildup on time and notes was what I was doing in months five through eight of the recovery process, and I started slowly work-hardening – easing back into work – in mid-May. We just had a couple weeks left and some opera. So, I played with an assistant (it was Larry Strieby), and he was willing to play everything that was high and low and loud, and I just played the soft solos in the middle registers. I think by that point I could go up from low A to an E at the top of the staff, so that’s what I played, and he played everything else. Even within a solo we alternated sometimes, which I’m sure sounded ridiculous, but by that point, it was important for me to be in the chair. And he’s one of the world’s most compassionate colleagues, so he was like, “yeah, this is funny, but that’s totally fine, let’s do it.” There were some solos in Strauss Four Last Songs that I remember sharing with him. But it was so important for me to be able to play a little bit with people. It was amazing of him, and I think it really helped my recovery. And I continued that process of expanding through the summer, which St. Louis has off, so I was teaching, didn’t take any gigs, but was just practicing diligently.
Then, the Philly audition was the next October, and by that point I could play high, but I still couldn’t play pedal notes. The first time I played pedal B-flat or C was at the audition. Both sounded god-awful. Heldenleben and Till. Those two excerpts in particular were like…aachh. It still hurt quite a lot. So, a year after the accident, there were still those sharp, shooting pains in my masseter if I played pedals. But I could play high pretty well, so I think my temporalis had healed quite a bit, my medial and lateral pterygoid muscles were healed. I continued going as slowly as I could and trying to be really conscious, and tried to figure out what is causing what, and seeing what I can do to bypass it, and seeing if I can develop and progress in one direction while being mindful to not overdo it in any way that hurts. This is the interesting skill set that one learns from an injury, you know, being very realistic and very in-the-moment about what is actually happening and what you are capable of at that moment. The challenge, I think, is not getting in your head about, “oh I should be able to do this,” or, “I could do it yesterday, why isn’t it working today,” or, you know, “why is this happening?” There’s a huge mental component, obviously – and an emotional component – that’s maybe bigger than the technical aspect of it.
AB: Yes, which brings me to a big question for me, personally: how do you develop trust in your body again. How do you get over that hurdle? I mean, part of it is a matter of time, right? But once you are on the edge of being able to do something, or think you could, how do you teach your body to know again that you can do it, and not to approach it with a sense of fear? What was that process like for you?
JM: Okay, so, that is a great question and a huge topic! I had a later injury to my back which is very recent. It was two years ago now. That injury had an even greater mental challenge to it. The jaw injury was helped quite a lot by how many practitioners I was going to – the fact that I was doing something for it every day. I knew I was doing everything I could for it, and if that wasn’t enough, then, you know…. I think that’s how I do a lot of things. Whenever I ‘m feeling insecure about anything, if I throw the book at it, if I do research on it and I figure out every single way anyone’s ever thought to deal with it, and then I do everything, it’s like, come on, if that’s not enough, then I guess it wasn’t meant to be. So, I think there’s that, if you’re that type of person. I’ve never been as good at the zen/sit-with-it-and-trust approach. It’s just not my bag, which is funny studying with Julie [Landsman] and being friends with you, because you’re both better at it, way better about it than I am, and that was the challenge of my back recently – there was less to do for it.
For the jaw, I think it was the “have a plan, stick with it, read up on it out the wazoo, go see a million practitioners, have them all tell you what to do and trust in their guidance” approach. That was a lot of it for me. Then the fact that the pain started to subside over time was a big thing. Also, I’m antsy when I’m not working, so I ended up doing a lot of other things. Actually, St. Louis Symphony was locked out for a couple months and I ended up doing the website for the musicians, and I was part of the team that was doing interviews and other things. Also, I did a lot of wallpapering and finishing decks and doing a lot of sports. I filled my time as much as I could and tried to be an overall healthier person. I did a lot of yoga and meditation during that time. There are these great meditation resources on the Kripalu website, Kripalu being the yoga center in Lenox, Massachusetts. They have a great website with books and CD and DVD sets on yoga and meditation, and the one that became my favorite was one by Jack Kornfield called A Path With Heart.
AB: Yes, he has a book by the same name and I love it.
JM: I used his lava lamp meditation, and it’s on my website (here’s my PR moment!) which is jenmontone.com. I ended up using this meditation quite a lot. You fill your body with liquid light, whatever color you want. Maybe the painful parts, or hurt or scared parts are red, and then you imagine your hands being white and healing and loving and you breathe in and out through your nose until you feel the red parts and feel the white parts and feel the self-healing spirit inside yourself. I do it lying down, and sometimes I’ll do it with students that are injured or terrified, because this field is just so hard on your psyche sometimes – wonderful and hard. So yes, lying down is nice, and in the dark, closing your eyes, and scanning your body. If the body part your scanning is healthy – if your hand is over your heart and you know you have a loving and giving, caring heart – you can draw strength from that area into your hands and put it towards your jaw or your lips or your belly which has fear in it. It’s kind of like a big sister/little sister, big brother/little brother kind of self-healing, and I love the whole spirit of this meditation, which is similar to the metta meditation – “May I be healthy, may I be at peace. May [insert name] be healthy and at peace, etc.” Those are powerful forces, I think, and there’s a lot farther one can go, but those are at least gateway meditations to loving-kindness, self-healing, self-loving, self-accepting, self-trusting, and trusting in the greater universe to be part of the spirit that helps us heal. And trusting in our own power of loving others and helping them to heal. So, I started some of that when I was going through my jaw injury, and that was the name of the game the last two years while trying to get back to playing after my back injury. Because of my injury, I was experiencing quivers from weakness in my core. That, when you start hearing quivers in your own body and in your own sound, feeling it in your body, hearing it in your own sound, that was even more terrifying for my psyche than the jaw pain, so this focus on loving-kindness has been more important and bigger in my mind the past couple years. It’s a very beautiful place to put your mind when you’re trying to do something as expressive as play French horn.
AB: Right. Okay, I’m going to cry now.
JM: [laughing] And to that point – the expressive part of what we do being more important than the technical part of what we do, the giving and loving and sharing aspect of it – I think that is key in an injury, because an injury makes you feel weak and scared and imperfect – and, of course, we are allof those things – but the giving and the loving that we can do with our teaching and our speaking and our playing is the strongest part of us. So then, when I play with my expressive soul instead of my fearful self, I can hear and feel an unbelievable difference, and I’ve noticed with the back injury that when I sit there and I wait fearfully to hear the quiver, feel the weakness inside my core, there it is. If, however, I think about what I want and who I’m speaking to – you know, the grandma in the back row, or the couple having trouble coming to a concert as part of working things out, the loving, human connections and how every solo can be a story and a message – if I get my mind set there – when I’m performing, especially, but also when I’m practicing – if I try to create the story, then the loving spirit that’s coming from my intention is healing to me also. It feeds me and helps me to trust that the art form is bigger, and that the intention of love is bigger than any challenge we face. So, I’m working on that [laughing]. Those are my challenges.
AB: Beautiful.
I’ve think you’ve covered so well so many of my questions regarding the jaw. Do you just want to talk about the back injury, and what exactly happened?
JM: Sure. So first off, I think it runs in my family. My mom knocked out her back (that’s what we called it), and my sister then did also. My mom did it by picking me up when I was a baby, so I grew up with her having a back injury my entire life. My sister did it in college playing soccer, and my uncle and cousin had it also, so I think it’s hereditary. I think we all have a slightly smaller-than-normal spinal cord. And then age and normal everyday things aggravate things, and horn-playing and kids didn’t help! You know when discs slip out of place, it’s like a hot dog in a hot dog bun – they start blocking the nerves in your spine, and you feel pain. Almost everyone has it happen to a certain extent as they get older, just from the realities of life. I had problems with both the L4/L5 and the L5/S1 discs in the lower lumbar, and it was always on my left side. In college and in my young professional life, I would feel excruciating pain for a couple days and then I’d go to my doctor and he’d give me pain killers, and I’d just lie around for a couple days and it would slip right back in and I’d be fine. But it started getting more frequent after coming to Philly and since I had kids, and I think I wasn’t particularly mindful of how I was picking things up. I learned a lot that would have been very helpful had I done some more research on it. As much as I threw the book at the jaw injury, I think with the back injury I just thought, “oh, that’s just something people have,” and I wasn’t as proactive to prevent the eventual huge injury and surgery that later occurred. That was sort of foolish as I look back on it, because I probably could have helped myself out quite a lot. The movements to avoid are called “BLT”s – bending, lifting and twisting. Anytime you bend and you have a slipped disc or a hurt back, you’re aggravating it. Same with lifting and twisting, especially if you twist while lifting, or twist while bending. It’s way worse when you do two together. It was a semi-chronic thing for me that was slowly becoming more frequent.
So, this very extreme episode two years ago started when I was out of town with my family. My youngest son was about two at the time and he was throwing a tantrum at a playground, so I bent down, lifted him up, and twisted and plopped him in his stroller. So, I bend, lift, and twist at the same time and, all of a sudden, I thought, “oh my God, OW.” That was in April of 2016. And my back had been out in December and January, so it had been happening every couple months at that point, but this was the final straw. So, I went to my doctor, and got painkillers. Didn’t work. He suggested a physical therapist, so I started doing physical therapy, but I didn’t stop living my life, doing everything pretty much like I normally do, so it accelerated very rapidly. I was still playing, and we did Rite of Spring, Mahler 2, etc., and we went on tour to Asia with Bruckner 4, so it was heavy playing for how much pain I was in. I had brought the kids on tour, and was pushing the double stroller and carrying the suitcases around. I didn’t know enough to be as cautious of my body as I should have been at that point. That would be the one thing I would do differently – take it easy more. I was pretty heavily medicated on pain killers, so I think that almost masked the escalation. Incidentally, it turns out there was a reason why heavy playing was helping to accelerate the already formed injury: I found out later that there is intrathoracic or intrathecal pressure, in the form of fluid, that builds up in our spine when we play. Playing soft is a little bit better than loud, but only mouthpiece buzzing doesn’t have that intrathecal pressure inside your body.
So, my injury all came to a head in August, which is when my surgery happened, then I went to see Dr. Lederman again in October, and he explained the fluid buildup and helped me develop a plan for coming back to playing. He suggested waiting for what felt like a crazy long time. I wanted to go back to playing immediately. I was so antsy. But he thought I would probably not be back to normal playing until April or May, and he was spot-on. That was when I started to feel like myself again. So, that was another year-long injury. I tried a little earlier, which he said it was okay if I mouthpiece buzzed or played very lightly, but not to expect much from myself, and again, that was accurate. I came back to work in January, and it was definitely too early for me to be healed at all. I still had a lot of weakness in the muscles. I didn’t feel as confident, either; my nerves were perhaps at a lifetime high. Probably because I sensed that I was still physically weaker than you want to be when playing our particular instrument. It was a fascinating dilemma, but it also improved with time. I think the muscles around my spine were so busy dealing with my discs going out, that they just weren’t able to be used for horn playing, and were still very weak for about six to eight months after my surgery in August.
AB: So, let’s back up and talk about the surgery, because that was a big deal.
JM: So, yes, this particular episode of back pain that started in that April of 2016 got worse through the orchestra tour, and in June and July when we were in Vail and Saratoga Springs. I had seen the Rothman specialists in Philadelphia in May. They have different levels you progress through, so there was the physical therapy level, but I was already seeing a physical therapist, so I went on to the level where you do cortisone shots. So, I did cortisone shots in May and June, but they didn’t help. They said the next level would be an MRI to see if surgery is indicated, but I was leaving town, so I did the MRI in Vail. The doctor said that, at that point, my discs were slipped out to the extent of blocking my spine 60%, which explained the pain. She said if I kept going with the PT, I might be able to avoid surgery, but that I might want to start thinking about it.
So, then in late July we went home, and I saw a surgeon in Philly at Rothman. He basically said the same thing and he said, “yeah, I understand you want to beat the clock. If you can, that’s great. I’m a doctor, I understand that fighter mentality! But you’re probably going to want to look at September for surgery.” He said at this point most people would be begging him for surgery just to get the discs out. Again, I should have paid more attention. I had numbness down my leg at that point, and he said that’s normal, and numbness in the foot is normal. But if you get numbness in your groin/pelvic-region, that means the nerves are being squished to the point that you could start losing the ability to control your bladder and your legs. At that point you have something called cauda equina and that means your spine is 100% blocked and your nerves are pinned and you have to have emergency surgery within twenty-four hours, or extreme things like incontinence and paralysis can happen. So, on August 18, I woke up bizarrely numb in my trunk, so my family and I rushed to Philly from Saratoga. I was going to go to Albany for the surgery, but my Rothman doctor wasn’t sure who they had on call in the ER, and it’s better if it’s an orthopedic specialist, so they suggested I come to Philly. They just bypassed all the normal pre-op stuff and rushed me in. They did a laminectomy where they grind down your bones and then a discectomy where they take out the discs that were blocking. It was totally successful. I’m completely fine, and everything’s normal. I mean, doctors are really, really good at what they do! It was super scary for that five-hour drive from Saratoga to Philly, but they said as long as I got there within that twenty-four hour window of time, it was fine. Even when something extreme and scary like that happens, so often they take care of it – if you can get the care you need when you need it. So, I’m so relieved to say, it was scary, but I’m totally fine.
So then, it was a lot of very slow PT to recover from that. They ask you, “does heat work better, does ice work better?” It’s good to figure out which one works best for you. I found a heating wrap that was good. It was just from Rite Aid – nice and warm around my whole lower torso, and I figured out that lying on the floor with my legs up on an ottoman so my legs form an L shape is a good lying-down position for my back. And my physical therapist showed me some exercises that worked in that position. A lot of them originate from that position anyway, so now whenever my back gets achy at all, I just do those exercises, then lie with my heating wrap in that position and that works great. It’s like, I don’t know, your low register, or something – there’s a personal way that it works very well for different people. Problems manifest in personal ways and so do solutions.
I know a lot of horn players with back troubles, and I think playing exacerbates it, but obviously, it’s what we do.
AB: Do you have things that you do now after extensive playing to counter the exertion of horn playing?
JM: I do, and that’s been an interesting thing beyond the mental and emotional stuff that we just talked about – just the physicality of it all. I did find during that time that it was all about figuring out how much exertion can my back take. I still can’t pick up my kids for instance, and I stopped doing any kind of pushing of the stroller or lifting anything heavy. On any given day, for a while if I really desperately wanted to wear high heels for something, I couldn’t then sit down for a long period of time, and I certainly couldn’t play French horn. There were certain very clear things that hurt my back. Playing loud or long was one of them, picking anything up, sitting for long periods of time, standing long periods without walking, any of those things would make it worse. If I did one of those things, I would usually be okay if I did my PT exercises right after, and I would be conscious not to do any more of whatever was aggravating it, and would lie down with the heating pad and my feet up on an ottoman for a while. Celebrex has also been very helpful.
The PT exercises generally involve the Pilates concept of “navel to spine,” so, engaging your core inward and then doing something very gentle like opening your knees or sliding your foot along the floor. It’s basically strengthening the different muscles on the front and back of your spine, and I think those core-strengthening exercises are standard for a lot of injuries. And now I‘m on to very gentle yoga and I’ll do some Pilates Hundreds broken up. It takes a long time. I’m still building my core strength back up, and I try to do it as mindfully as I can. I started to do a little too much yoga in one week and I felt it in my back and had to tell myself, “OK, easy tiger, take a step back and only do one sun salutation a day and one set of hundreds.” So it’s a constant readjusting of what you think you can do. And you cross the line, jump over the line, and then you have to step back. I’ve been using assistant a lot the past year or two, and generally it has been playing loud or sustained that aggravates my back. During my very slowly escalating injury (over a number of years) and then recovery, I would notice that my torso might quiver or I’d feel like the muscles were “tapping out” on strength if I crescendoed and ascended at the same time, for example. That was a personal observation, that there was a definite correlation also between how I must support when I play standing or off the leg, and the way that the muscles surrounding my spine just didn’t seem to have the strength to support that kind of playing. I thought I was going crazy, wondering why that would happen. I had no idea it was related to the periodic and increasing back pain I was experiencing. In that way, the increased body-understanding from the injury has been a huge relief, and as my back has healed, and my core strengthens around my spine, it all improves, and that’s been incredibly exciting to me! Life manifests in our playing in ways we have no way of knowing. It’s fascinating.
AB: Okay, I know we’re short on time. You’ve given so much advice through what you’ve already said, but is there any other piece of advice might you have for somebody going through an injury?
JM: I would say that the resources are there both in internet form and maybe book form (but definitely on the internet), and in terms of doctors and physical therapists who know what they’re doing medically. I think the connecting of the dots between the instrumental part of it and the medical part of it – there aren’t that many performing arts institutes and performing arts doctors, but there are some. I’m trying to compile a list on my own website of the ones who are out there. But when I google “performing arts institutes” there are some within driving distance of pretty much anywhere in the U.S. So, those doctors like Richard Lederman – he just happened to be the one I’d heard of first – those people can be the ones to connect the dots between what your doctor is telling you and what you do on the instrument. Those types of resources, the “connector people” are important ones to find in order to tie it together.
Also, I think regarding the subject of trust and faith and hope – I do believe that if we are trying the best we can and have that persevering spirit of “I’m going to give this everything, because it is everything to me, and I will try everything I possibly can and I won’t give up until I have tried absolutely everything” – usually, with the time that it takes to heal most injuries, it will heal before our perseverance will give out. I mean, obviously, there are special cases that are more difficult, like dystonia and certain chop injuries. But, depending on the seriousness of the injury, especially with other parts of the body that are not your lips, many things can and do heal, and you might just have to give it the time and give it the faith, and either distract yourself or “proactive it”, which is what I did the first time, or go into the realm of yoga and meditation and loving-kindness, and something in there will feed your soul while you’re going through it.
I do find that so many musicians have gone through something. Almost every professional has gone through some injury or some period of time where they thought that maybe this was it, and that maybe they weren’t going to be able to play anymore, and the vast majority of them are doing just fine. So, I hang onto that. And I do think I’m a better player and a better teacher after these injuries. You know, I know I’m learning a ton. It’s a fascinating thing – it just might be part of our profession because of how physical it is, what we do, and how physical life is, and stuff happens. I think if we can see it as part of the process of being a musician, I think it can be less scary that way.
AB: It’s just part of it.
JM: It’s part of it for the vast majority of us. But we learn from it, and we support each other, and that’s a big part too. You’re talking to so many people who have had injuries, and there is so much loving, compassionate advice out there. Even if you take one hundredth of the advice out there, you feel supported by it. It’s a beautiful community that way.
AB: Hear, hear! That’s wonderful, Jen. Thank you.
JM: May we all be happy and healthy!
You can learn more about Jen and visit her page of resources and videos on her website www.jenmontone.com.