Embouchure overuse occurs when a player has played too many hours or with more intensity than he is used to, e.g., preparing for an audition or solo performance, a week of playing heavy orchestral repertoire, a long day of playing very high jazz charts, etc.  Severe, lingering facial fatigue and substantial lip swelling are the two predominant physical indicators. While other things, such as a medical or dental condition can cause a player to develop overuse syndrome, more often than not, physical overuse of the embouchure is usually the underlying factor in developing this devastating performance injury. 

The facial fatigue and lip swelling persist long after the episode of overuse.  This not only complicates playing, it also prevents a player from feeling his face and lips normally and quickly begins to cripple his embouchure. Within only a few days, a player's mechanics will have deteriorated to the point that they can hardly function, and thereafter, every time he plays, minor but painful irritation is inflicted to his lips.  Not even a lengthy layoff from the instrument will remedy Overuse Syndrome.

Players should stop playing for at least  day or two after physically overusing their embouchures.  If that’s not possible, they should play carefully and only when absolutely necessary--no lengthy warm ups or other non-essential playing until the face has recovered.  Unfortunately, once the injury has evolved into the full-blown syndrome, mechanical rehabilitation is the only thing which will break the cycle of injury and restore one’s ability to play.

Mechanical rehabilitation requires a player to retrain the basic structure of the embouchure. In other words, training the chin to stabilize in playing, and reacquiring the strength and ability to deploy and sustain the correct amount of tension in all the muscles of the embouchure. Players who develop overuse syndrome unconsciously try to "protect" their injured, tired faces by backing away from using the amount of tension required in the facial muscles for playing. That is certainly understandable. Their lips are constantly swollen and their facial muscles profoundly fatigued; but if there's not enough tension and resistance in a player's embouchure, a player has no playing control, endurance, or high range, and his air control also cannot function.

Because injured players literally cannot feel their lips and faces normally, they have no way of being able to ascertain, by feel, what their embouchures are doing. The most effective way I have found to retrain a broken embouchure is to have players consciously configure their embouchures with more energy in the muscles.  I prompt them to set the embouchure with a slow, simple sequence of physical mechanisms that is used each time.  This allows the muscle to strengthen around a specific pattern that the mind can control and replicate. Short, practice sessions allow a player to strengthen his embouchure without further irritating his already tender face.  Injured players have to be discouraged from practicing for long periods. Weak embouchure muscles can only be coaxed into configuring correctly for a few seconds at a time.  Overly fatiguing the face with too much playing will only exacerbate and protract the injury syndrome.
 
A practice session consist of playing for limited segments of time, during which a player concentrates on making his embouchure work as correctly as he possibly can. This is not an easy task by any means when dealing with muscles that are weak and confused.  Five minutes of intense effort is followed by ten or fifteen minutes of rest.  This routine should be done for only one hour total early in the day and can be done once again a few hours later.  Players must avoid playing to the point of lip swelling.  A damaged embouchure cannot work or be made to work correctly when lip swelling is present.  As the embouchure strengthens, playing time can be added, and rest time can be shortened. For those who are interested, Broken Embouchures contains a series of rehabilitation exercises.

A very typical problem I see in injured players is the inability to stabilize the chin in playing.  It won't take long following  overuse for a player's chin to flex, twitch or collapse in playing.  The photos below are from The Art of Brass Playing by Philip Farkas.

   

Bunching or collapsing chin         Correct downward-stretching chin 

The chin serves as the primary support structure of the embouchure which helps sustain the opening of the buzzing aperture.  In order to restore playing and comfort, the chin has to be retrained to function correctly in playing.

The other tendency I see frequently in injured players is relaxing the embouchure between notes. The throat often tries to help physically by "gulping" closed from note to note. Again, this is part of the body's way of trying to protect a player's sore, tired face; but if a player is to break the cycle of injury caused by overuse, this protective inclination has to be overcome.

There is no single time frame for recovery from overuse syndrome that can be applied to all players. When deadlines inflict themselves on this process or a player has become so emotionally injured by his playing disability, rehabilitation is sometimes more lengthy and difficult. In most cases, though, it is quite possible for a player to break the cycle of injury within two to four weeks.  While complete playing recovery takes longer, it is a much easier process when there is no discomfort complicating things.

The single most frequently asked question I field from injured players is, "Can you recommend a physician who treats brass player's lip injuries?" I am sorry to say the answer is NO.  While music medicine has advanced considerably over the years, and more and more is understood about the performance injuries of string players and pianists, music medicine specialists continue to be completely dumbfounded by brass injuries.  The reason for their confusion is quite understandable.  The performance injuries that string players and pianist tend to suffer are also quite common in the general population. It's no wonder, therefore, that much more is known about these injuries, and the treatment protocols for them have evolved and improved. 
 
On the other hand, brass  injuries are specific and unique to brass players.  Unlike tendonitis or carpal tunnel syndrome, each of which is painful and troublesome all the time, brass player's lip injuries are only painful and troublesome in playing and do not otherwise impede the normal function of a player's lips and face.    It is impossible for a physician to make sense of an injury which is physically excruciating for a player but can't be seen with the eye, felt, or identified by medical imaging (CT, MRI, ultrasound, angiography or plain x-rays) and whose primary symptoms are lip swelling / pain, lack of playing endurance, trouble playing in the high range, loss of playing control, unfocused tone quality, and general playing disability. What physicians and players have to understand is that this disabling, residual cycle of injury is perpetuated by the erosion of the physical ability of the embouchure to configure and function correctly in playing.  No medical treatment can cure damaged playing mechanics.

Many players come to believe that they have injured their lip muscles so severely that surgery is required, and surgery will allow them to recover their playing completely after recovery.  It is quite a shock when that does not turn out to be the case.  Dr. Simon McGrail, a well-known surgeon who has performed reconstructive lip surgery on brass players, always tells his brass patients that the underlying cause of their injuries is failed "playing technique" that requires a return to the basics of playing.  In other words, surgery only repairs the lip, not the playing.

Overuse syndrome is one of the most painful, emotionally wrenching experiences a brass player can endure.  I know that well, as I was one of the walking wounded.  The good news is that the playing disabilities caused by overuse are totally fixable.  Unfortunately, however, there are some players for whom the process of rehabilitation is so daunting and frustrating that they eventually give up.  That depresses me to no end because I know that with the right physical approach, overuse syndrome can be successfully overcome. 
 
I've always made myself available to injured players who get stuck in the physical morass of a lip injury and want to come to New York to see me.  I have a standing policy of not accepting money from these chop-weary players.  I want them to understand that there is no economic incentive in the assistance and advice I offer.  So I hope that before any player  frustrated by overuse syndrome makes a life decision to quit playing, he or she will first contact me at the e-mail address below.  For more information about scheduling a video consultation with me, please click on the picture icon in the left column under the Video Consultation heading.

A more extensive explanation of embouchure overuse syndrome can be found in Broken Embouchures.