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The following article is adapted from an upcoming book by Lucinda Lewis entitled Broken Embouchures, An Owner's Manual and Repair Guide.
Permission to print it here, given by Lucinda.
You've always played in comfort and with confidence. You never had to worry about the way your lips felt. Oh yes, there were days when you overdid it, and your chops had to pay the price the next day for that excess. But they always came back with maybe a little more Chap Stick® and a longer warm up.
Then, one day, something
is different. Your embouchure feels detached from your face. Your
air control seems out of sync with the rest of your playing. You test note
after note just hoping to find the "sweet spot," but the rim of your mouthpiece
feels as though it is twice as thick and in the wrong place. Your
cheek muscles have a strange, heavy sensation that you can feel even when
you're not playing. Your usually reliable chops feel more like cardboard
than living, breathing tissue.
Or--
Perhaps you have noticed
lip pain more and more when you play. You're finding it increasingly
difficult to play high notes securely, and you suffer with lip fatigue
almost as soon as you pick up the horn. You've increased your
practice, but nothing seems to improve your endurance. Your playing
confidence gradually slips away, and you are left performing on experience
alone. You cannot understand why your lip begins to hurt almost as
soon as you start to play. You've taken time away from the instrument or
tried warming up more carefully. Nothing seems to help.
Or--
Maybe, you have developed an inexplicable weakness in one side of your mouth or an uncontrollable spasm in your lip. You can no longer seal one corner. Air and saliva bubble through when you try to blow. You go to doctor after doctor, using your playing symptoms as a vehicle for describing your condition. Bell's palsy, a tumor in the mouth or on the lip, physical impairment caused by a dental mishap, or some other medical or dental condition can suddenly make playing a nightmare. Where does one turn to find an answer--to get a proper diagnosis? What are the chances for a complete recovery?
A description of an embouchure
problem, playing injury, or medically related chop predicament pales in
comparison to experiencing any of these dilemmas. Nothing can adequately
describe the emotions which overwhelm a player beleaguered by embouchure
pain or a chop problem which won't go away. Whether
it's an embouchure malaise, medical condition, or a playing injury,
the player is truly playing-disabled. Artistry is imprisoned by painful
or uncooperative chops, and there is a screaming ego raging to be freed.
Sleepless nights are followed by every waking hour being devoted to trying to find a solution--an
answer. Mental and physical fatigue become the norm. Mouthpiece
pressure begins to supplant air control, and over-practicing develops into
chronic muscle fatigue. It soon becomes impossible to distinguish how
it sounds from how it feels. All he hopes for is a quick remedy
so that he can put miles of distance between himself and this problem and
never has to think about it
again. If wishing alone could only provide a cure!
Because most players perceive their embouchure problem as a sudden event, it is not uncommon for them to infer a medical condition from the physical symptoms they experience, symptoms which almost always include some sort of localized lip discomfort, swelling, and/or general embouchure weakness. The presence of pain, swelling, and lacking endurance usually send a player on a lengthy odyssey in search of a medical explanation with the expectation that a cure will provide an instant solution for his embouchure woes.
Certainly, there are a number of medical or dental conditions, allergies, or traumatic injuries which can negatively impact a player's embouchure mechanism. Notable among the more common medical conditions which imprison an embouchure are Bell's palsy and neurological anomalies like focal (occupational) dystonia. Sometimes an embouchure can even act as a weathervane of a more serious medical condition. Kidney disorders, for example, often cause tissue swelling which a player may first notice in his lips.
However, physical disorders actually serve as the basis of very few chop problems. All embouchure problems, whether medically related or not, result from a change in a player's playing mechanics. I refer to the non-medical variety of these as playing-mechanics-related embouchure syndromes [PMRES].
Our playing mechanics are, for all intents and purposes, made up of a balanced system of mutually supporting systems. Each of us compresses our embouchure muscles differently. We make individual uses of the corners of our mouths, cheeks, upper and lower lips, chin muscles, tongue positions, apertures of the lips, throat, and oral cavity, and we all have slight variations in our approaches to air control. There are millions of different possibilities and combinations--as many as there are players. Yes, there are some basic embouchure mechanisms which are common to all good embouchures; however, playing is largely an individualistic activity. No two players employ the exact same method or embouchure mechanism.
When players notices any change in the response or feel of their embouchures, they begin adjusting and compensating unconsciously. When our lips don't feel comfortable, we just calibrate our playing to fit the demand. Sometimes playing isn't easy, but we still have to crank it out, comfortable or not. Perhaps it is through our ability to be musical chameleons, capable of adjusting to any playing situation or problem, that we lose our capacity to judge the soundness of our own playing mechanics or to understand exactly how and what we are adjusting to.
Players are rarely aware of any change in their chop mechanics. Such changes are usually not dramatic and have a stealth-like quality. It doesn't take a significant change in a player's mechanics for him eventually to experience playing problems. As his embouchure mechanism gradually becomes uncoordinated and out of sync, he begins to notice minor, intermittent playing difficulties off and on over a period of time until, one day, he notices that his technical control of the instrument is no longer as reliable as it once was. He later feels a sense that his lips are always stiff, swollen, or rubbery and lacking sensation, and has trouble getting his lips to loosen, even with a long, thoughtful warm up. He suffers with endurance and high range problems. His sound becomes hollow and airy. His lips fatigue easily and don't recover quickly. He is ultimately plagued by chronic, nagging lip discomfort.
While embouchure malaises and playing injuries result from a change in a player's playing mechanics, such changes should not be confused with lacking ability, accomplishment, or work ethic--quite the contrary. To understand better how healthy embouchure mechanics can change and evolve into an embouchure problem or playing injury, one first has to examine one of the primary causes of such changes, chronic lip fatigue.
Chronic lip fatigue is quite often found in the over-achieving player or in one who has to play many rehearsals and performances within a short period of time. It can also affect a player preparing for an important performance or audition. The most notable symptom of chronic lip fatigue is stiff cardboard lips. A player will also experience lip bruising and swelling.
Playing several hours a day--day after day--saps the muscles of their strength, especially if the player is not used to such heavy playing. It doesn't take many days of this abuse for the lip muscles finally to succumb. With each successive day, the lips fatigue more quickly. Soon, there is a loss of control and flexibility. The lips begin to feel unresponsive--like rubber or cardboard. For the player who is preparing for an important performance or audition, panic sets in. His first reaction is to practice harder. The harder he works, the less success he has and the more panicked he becomes.
He doesn't realize that his problems are being caused by tired muscles and swollen lip tissue which simply will not perform as well. Swollen lip tissue closes the buzzing aperture of a player's lip, preventing the lip from vibrating easily, and fatigued chop muscles no longer have the strength and energy to pull open a buzzing aperture impeded by swelling.
Of course, we are trained as musicians to believe that practice makes perfect� that the more we play, the stronger we become. Who among us hasn't tried to polish our act to such perfection or make his chops extra "strong" that the performance is ultimately compromised by stiff, swollen, unresponsive lips?
Unfortunately, few players understand the cumulative effects heavy playing schedules have on their chop health, their concentration, and ultimately on their playing mechanics. Busy playing schedules make for weary embouchure muscles and swollen lip tissue which have to be forced to work with greater mouthpiece pressure, volume, and lip compression. When a player's regular embouchure system is frequently being replaced by a more forced, unnatural system, it won't take long for his mechanics to change. Doing this over an extended period of time can have serious, long-term implications on one's embouchure health.
Playing Injuries
Playing injuries to brass players lips are not all that well understood either by players or the medical community. Most players interpret lip pain and injury as being the natural result of the physical stresses of playing, and many ignore the symptoms of pain far too long. Playing injuries almost always begin as some kind of a simple, PMRES. When lip pain becomes a daily problem for more than a month, a playing injury is indicated.
Three kinds of playing injuries can occur to a player's obicularis oris (lip muscle), hot spots, stretches, and tears (also know as Satchmo's syndrome). All three injuries are related and, therefore, have very similar symptoms. Different players suffer these conditions differently. Therefore, the following descriptions of physical and playing symptoms are those generally described by players who have had experience with them.
Chronic hot spots are actually an early sign of mechanical problems, resulting in recurring damage to the lip. They are an indication of a lip muscle which is beginning to stretch or tear in a specific location. Hot spots are first felt >as a localized area of pain on either the upper or lower lip directly under the rim of the mouthpiece. The tender spot does not begin to hurt until after the player has played for a while and ceases to hurt when he stops. Recurring localized lip pain, lacking endurance, and difficulty playing in the high range are the most common playing symptoms of a hot spot.
A stretched lip muscle is a more advanced form of a hot spot and is also accompanied by chronic playing discomfort [which the player suffers as soon as he begins playing], as well as lacking endurance, and difficulty playing in the high range. A player can sometimes feel a divot in or thinning of the lip tissue where the muscle is stretched.
A torn lip muscle, the severest form of muscle damage, has almost the identical symptoms of a stretched muscle, but the overall impact on playing is much more dramatic. A player will experience a lack of seal when playing (air escaping from the lip in the area of the tear) and will often suffer some kind of constant lip discomfort even when he is not playing. A player may feel a "balling up" in the tissue of the area around the muscle tear itself.
The only time a stretch or tear of the obicularis oris is not the direct result of faulty playing mechanics occurs when a player's lip is pinched between the mouthpiece and a protruding tooth. This kind of playing injury happens over a number of years and results from repetitive stress on a localized area of the lip, causing the lip muscle first to stretch and later to tear.
There are reported cases of sudden tears to the lip muscle which occur during strenuous playing or using a very thin, sharp-rimmed mouthpiece one is not used to. This sudden tearing is sometimes felt as a "snap" or "pop" in the muscle followed by chronic lip pain, weakness, lacking endurance, lack of seal, and problems playing in the high range. Highly motivated young students often fall victim to sudden tears of the lip muscle when they over practice or try to master their high ranges too quickly.
Trumpet and French horn players
are the most common sufferers of hot spots,
stretched, or torn lip muscles because of the smaller surface area
covered by the mouthpiece and the greater amount of physical pressure applied
to lips.
But no brass player is exempt from injury.
Stretched or torn lip muscles
can only be diagnosed with certainty with an MRI
capable of imagining tiny areas of damage. Torn muscles can be
surgically repaired but will only be overcome and prevented by improved playing
mechanics.
Dealing with Embouchure Malaises, Lip Pain, and Playing Injuries
Players are largely unaware of how their chops feel until they stop working properly or begin to hurt. When a player notes a difference in the strong, familiar, secure, comfortable embouchure sensations he has always enjoyed in the past, the cause is a change in his playing mechanics. Most players can't believe their chop problem could be caused by something so simple--so obvious. But such changes can occur from mindless playing, bad habits, chronic muscle fatigue, lip swelling and bruising, or from an underlying medical or dental condition which has caused a player to defer to pain or weakness.
Players should seek
medical advice for any unusual symptoms. While embouchure malaises and lip pain are mechanically related, it is necessary
to determine whether a medical condition or allergy is the root cause
of the change in a player's embouchure mechanics. Players should also
know how their bodies react to all medications they take. Many medications can
cause fluid retention and therefore lip swelling. So, it is important to
read all package inserts which accompany the medications or to ask your doctor or pharmacist
for a list of the drug's side effects.
Brass players have a wonderful
built in alarm system which can alert them to
mechanical problems and chop injuries: chronic fatigue, stiffness,
swelling, and pain--and in that order. The first three are early warning
signs. The fourth should be considered a kick in the tush to get your attention.
If you are suffering from all four at the same time and for an extended period
of time, you probably have a playing injury.
Without a doubt, chronic, recurring lip pain is an indication of damage to the lip. Players have to understand, once the pain becomes chronic, the ball has been set into motion for a serious, debilitating lip injury. They also have to understand that "fixing" the lip is not going to be easy. While resting the lip and allowing it to heal is essential, returning to playing with the same flawed mechanics which caused the damage in the first place will only cause a player to re-injure himself. Correcting one's own playing mechanics, which have always operated at a subconscious level, is a very lengthy, frustrating, and frightening project. But it's something that only the player can do himself. Only a player knows how his lip feels and how his embouchure responds in playing, and only a player can calibrate the muscle systems which comprise his personal embouchure mechanism.
Embouchure problems and playing injuries present a great mystery to brass players. No one can begin to understand what it's like to play and perform in pain or with a dysfunctional embouchure unless he has personally experienced it. Unfortunately, it is within a confused, emotional prison that a player is faced with figuring out what's not right and how to fix what he cannot figure out. And it's not made any easier when one's career and livelihood is on the line.
Broken Embouchures is intended
to help afflicted players sort out the mechanical and/or medical causes of their embouchure problems, to inform
them about various embouchure therapies and techniques for solving embouchure
problems, and to help them find a way out of the emotional black hole
their chop dilemma has created for them. It offers specifics of how
to handle an embouchure problem and includes anecdotal information from professional
brass players, interviews with instrument makers, repairmen, and mouthpiece
makers, medical information from physicians, dentists, and other therapists,
legal advice from attorneys, advice from experts in disability insurance
and workmen's compensation, and commentary from union officials.
It's the kind of information which has been so lacking in the discussion of music medicine
in general and non-existent as it applies to the problems of brass players.
Hopefully, this book will begin to fill that void.