When a player is in top form, it is difficult for him to imagine that his embouchure could ever be in peril.  Most of us believe that chop problems happen to other players of lesser talent and experience; after all, great players have perfect technique, right?  Solid playing technique (playing mechanics) not only fuels great playing, it also protects a player's lips and face from the normal physical stresses of playing; however, there is one thing that can undermine even the best technique and cause playing to become painful and totally disabled--embouchure overuse.            

It begins innocently enough.  You've been doing heavy week of orchestral playing or had a demanding, all-day cast album recording of your Broadway show.  You've been practicing for a very important audition or spending long hours preparing for the premiere of a concerto.  Your lips have felt great throughout. Your playing has been free and easy--until one day, you pick up the horn, and nothing feels right.  Your lips feel thick and dead, and your chops seem completely out of shape.  You have no endurance.  You struggle to play in the high range, and you have lost your pinpoint control.  So you practice harder, but with each passing day, playing becomes more and more of a challenge, and the troublesome problems that now inhabit your playing respond to no amount of effort to overcome them.  A couple of weeks of this decline go by, and things just keep getting worse and worse.  Now you're in a real quandary. "I can't play," you say to yourself.  "How am I going to get through the next performance?"  You finally take a therapeutic holiday from playing for a week or two or three, but when you start playing again, nothing has changed.  It is just as difficult as it was when you stopped.  Welcome to the world of embouchure overuse syndrome.   

Few brass players understand the potentially devastating, long-term impact that overuse has on their embouchures. How and why can a strong, healthy embouchure deteriorate so quickly? It's actually quite simple to understand.  Four problems tend to hang on following overuse: significant lip swelling, lip pain, severe facial fatigue, and strange sensations that develop in the muzzle area of the face.  An embouchure simply cannot function normally or correctly in playing when it is impaired in this way--even though it may not initially feel terrible or be all that disabling. However, if a player continues to play on lips in this condition, he will unconsciously begin to compensate and adjust his embouchure to accommodate the playing problems caused by the presence of physical discomfort, swelling, and fatigue.  

All embouchure problems and lip injuries are related to a player's normal embouchure technique having become dysfunctional, almost always following a period of intense overuse. This dysfunction stems from the habit a player quickly develops of setting his embouchure cautiously (with too little structure and stability) as a reaction to the constant presence of pain, swelling, and fatigue. This "looser" setup allows the mouthpiece to irritate the lips and perpetuates the overall embouchure dysfunction and playing disability.   As the problem progresses, the acute injury phase--that began with overuse--is replaced by a chronic type of lip irritation that can be so painful at times, it actually feels like a serious injury.  This is the point at which overuse has evolved into embouchure overuse syndrome. 

There are other casualties of overuse syndrome. An embouchure which is chronically tired, sore, and impaired also cannot compete physically with normal air pressure. So it then becomes necessary for a player to reduce the intensity of his air control. This is one reason players who develop this syndrome complain that they feel no air support when they play. In addition, this loss of normal embouchure structure prevents a player's tongue from working efficiently. Fast tonguing is especially difficult.    

One of the more surprising and unique things about overuse syndrome is that rest has no effect on it.  You would naturally assume that hurting, swollen, tired lips would heal after a week or a month off.  In fact, there are players who have taken six months off only to face to the same physical issues and playing problems all over again.  Unfortunately, rest cannot reverse what is, for all intents and purposes, an embouchure change.  

As described above, in the painful aftermath of embouchure overuse, a player adopts a cautious and deferential way of setting his embouchure.  This might offer temporary relief to a player; however, as the discomfort, swelling, and playing problems persist, a player begins adjusting his embouchure mindlessly in search of reliable solutions to the things that are disabling his musicality.  Some players go so far as to try to move their mouthpieces to a more comfortable spot on their lips. Sadly, there is no such thing as a temporary or easily reversible embouchure adjustment. Even the tiniest physical adjustment one makes to his embouchure--consciously or unconsciously--has the impact of a major embouchure change. The result is an embouchure that has not only been stripped of its playing control and strength but that has become mechanically confused in the process.  In the final analysis, it is not difficult to understand why a therapeutic holiday from playing offers no lasting benefit to sufferers of overuse syndrome.

Chapter 2  Explaining the Mysteries

 Embouchure overuse syndrome is to an embouchure what tight shoes are to the feet.  If you wear shoes that don't fit your feet, your feet hurt, and you limp.  Embouchure overuse syndrome inflicts a stealth-like embouchure change on a player.  So by the time you have developed the full-blown syndrome, you are wearing a different embouchure when you play--one that doesn't fit you.  To reverse your playing disability and restore your comfort, you have to retrain your embouchure to function the way it did prior to your injury. 

Believe me when I tell you that there is no such thing as a permanent lip injury or an embouchure which cannot be fixed.  Embouchures do get injured, and that's neither a sign of incompetence nor weakness.  Perspective is important here.  You must accept the fact that you are an injured player, and your playing is not going to be as you want it for some time to come.  That is not a cause for panic but a simple reality you must digest with clinical objectivity.   

Phantom pains and inexplicable sensations in the lips and face are distractions which you have to sort through intellectually. It is almost predictable that every tiny twinge, irritation, or weakness you have noticed in your lips, mouth, or face have caused you to wonder whether something else is preventing you from playing--that if you could just fix it, your playing would miraculously recover. Sadly, that is just not the case; however, if a medical or dental problem was the predicate for your developing overuse syndrome, a resolution to the underlying condition is absolutely prerequisite to rehabilitating your embouchure.   In most cases, though, the odd twinge in a lip, weird pain here or there, or that strange sense of weakness you might have felt on one side of your face or the other are, individually or collectively, indicative of overuse syndrome.  To learn more about overuse-related symptoms, see Chapter 4 of Broken Embouchures.  It contains an explanation of the physical discomforts and playing problems that are associated with overuse syndrome.  

The lip injuries that brass players develop are rarely as serious as they feel. They are certainly not as significant as the trauma one would sustain by being punched in the mouth, for example.  In fact, brass injuries are more subtle and usually no more serious than an inflamed pressure point, which is a minor (albeit extremely painful) irritation of the tissue of the lips.  However, because the discomfort can be quite intense and does not respond to rest, players come to believe that their recalcitrant lip pain is a sign of muscle damage that requires surgical intervention to solve. Since more and more players are contemplating surgery, and in some cases, because of the information they find in my books, allow me to add a note of caution on this subject.  

I'm at a loss to know exactly what to say to a player when he tells me he has been advised to have surgery or thinks he needs it.  The reason is that I receive more letters of complaint from players about the failure of the surgery than I have received from players enthusiastically endorsing it.  Please don't misunderstand.  By failure, I do not mean this is an issue of malpractice. Repairing a tear of the obicularis oris (lip muscle) is quite a simple procedure. Dr. Simon McGrail (Canada) and Dr. Craig Vander Kolk (USA) are two fine surgeons who have consistently performed successful surgeries on brass players; however, it is important to understand that surgery only fixes the muscle.  It does not repair the underlying cause of the tear--or the lip pain--or the playing problems.  

Too often, players view this surgery as a cure all--that it will fully rejuvenate their playing after a slow and careful period of getting back into shape.  Unfortunately, when a year or more goes by, and a player finds himself still beset by lip pain and numerous playing woes, he assumes that his surgery was a failure.  Surgery isn't to blame here as much as the misguided, inflated expectations of the players who have it and, to a degree, the musical ignorance of the surgeons who perform it.  If a surgeon cannot understand the specific embouchure malfunction in playing that can stress the fibers of the orbicularis oris and cause them to separate, there is no way that surgeon can give a player-patient the kind of specific, post-surgical performance rehabilitation that is essential for full playing recovery. There is only one certainty in all of this:  with or without surgery, if a player fails to restore the structure, stability, and control of his embouchure in playing, neither his lip nor his playing will ever recover. 

I am often asked whether a player can fix his playing in spite of a torn muscle.  I think a better question is whether the obicularis oris can heal on its own without surgery.  If you are a sports fan, you know that one of the most common injuries among professional athletes is a muscle tear.  Surgery is almost never done to repair these injuries. Only when there is a severe, avulsed tear of a muscle is surgery required, but tears of this severity are rare. Most muscle injuries in sports are treated with rest and therapy.   So if you are contemplating lip surgery, you might first want to seek a second opinion from someone such as a sports medicine specialist who can give you another perspective about muscle injuries.  

Let us return to the issue of performance rehabilitation and the thing you need to know and the mindset you must adopt if you are to be successful. 

Embouchure overuse syndrome is, without a doubt, the most difficult of all the instrumental injuries to overcome.  The reason is that embouchure function in playing is so reliant upon feel--on sensation.  A player doesn't diagnose his embouchure problem by sight but by how it feels.  So it is not surprising that when a player's normal facial sensation is disrupted by chronic physical problems such as pain and swelling, he has no way of determining by feel what is wrong or how to fix it.   He just keeps adjusting things hoping to find something that works and feels right.

There is really only one thing a player has to do to fix his injured embouchure:  restore its structural integrity in playing.  Sound simple?  It could be, were it not for a couple of things which work against a player from the moment this problem takes hold.  Obviously, the sensory issue presents a real complication to playing and hastens an embouchure's decline just on its own, but compounding this problem is the degraded physical condition of a player's face.  An embouchure which is both uncomfortable and always tired and stressed tries to protect itself by shedding as much of the energy as it can from the muscles of a player's face.  It not only desires this more comfortable structure, it has become totally accustomed to it.  The fine muscle control which once made playing so easy for you has atrophied, and what remains is not even a shadow your normal embouchure.

Overuse sets into motion a chain reaction that culminates in a wholesale change in a player's embouchure technique. What you now have is no longer your old, healthy, reliable embouchure--the one you played on for so many years with complete comfort and confidence.  As things began to unravel, and nothing about playing felt normal, you urgently began adjusting your chops in an effort to find that familiar feeling and playing control you could always count on. Some of those adjustments were intentional.  Others were unconscious.   And then when all else failed, you tried changing equipment.   It's no wonder your embouchure has finally gotten to the point that it is physically confused and incapable of functioning the way it used to.  Well, your old embouchure hasn't gone far.  It still resides, totally intact, in the far reaches of you muscle memory.  Want to say hello?

You will need your mouthpiece for the following:

Blocked Buzzing

Stand in front of a mirror. Plug the end of your mouthpiece completely with a finger. Put your mouthpiece up to your lips exactly as though you were going to buzz a midrange note.  Begin blowing by tonguing a midrange note (In other words, don't just start blowing.  Start the note as you would to buzz or to play--by tonguing it).  Blow with a constant mezzo forte stream of air. (There should be absolutely no sound or air leakage from your lips or mouthpiece.)  Notice how firm and controlled your entire embouchure is and how your chin stretches down with considerable energy as you blow. Tongue a few notes with your mouthpiece blocked, and observe how still your face and throat are and how well your air works. This is your old embouchure structure.    

Let's do that again.  Block buzz in slow motion, and pay careful attention to how your embouchure physically prepares itself to block buzz.  Notice how your embouchure deploys considerable energy in your facial muscle in preparation to blow against the resistance.  When a player block buzzes, his embouchure prepares and sets itself with an intense, controlled structure, even before he begins to blow.  The normal level of embouchure stability generated by a healthy embouchure in playing is comparable to that generated by the embouchure for blocked buzzing. Embouchures that have developed overuse-related dysfunction actually deprogram themselves to set with this degree muscle energy and control.

When an injured player block buzzes, he does not feel mouthpiece pressure, lip pain, or the kind of facial fatigue that he experiences in playing. The reason is that even the most dysfunctional of embouchures configures mechanically correctly to block buzz. Your embouchure works correctly here not because you are blowing against resistance but because of how your facial muscles prepared and set themselves to block buzz. Compare this blocked-buzzing structure to how your embouchure currently configures itself to play. Do this with your instrument:

Watch yourself in a mirror.  Start on any comfortable midrange note, and play an octave scale up and down slowly. 

If you are like every injured player I have observed, you put the mouthpiece up to your lips and immediately began playing with little or no opportunity for adequate energy and control to be infused into the muscles of the embouchure to play comfortably or securely.  It is a certainty that your embouchure did not configure with the same, intense muscle control of blocked buzzing.

With your mouthpiece only:

Watch yourself in a mirror, and block buzz again.  Make sure that you start the note you are block buzzing with your tongue and not by blowing. You can see and feel how much more solid, firm, and controlled your embouchure is when you set to block buzz than it is when you set to play. 

Ever wonder why playing loudly has always felt so much more secure than playing softly?  It's because the embouchure has so much more grip and stability when it is set to play loudly. That's the key to blocked buzzing and how it can help you. Blocked buzzing offers you a window into correct embouchure function and gives you a quick and easy way of evoking your old, healthy embouchure structure.  It provides the best means with which to compare your current injury-prone embouchure structure with the one you so desperately want to get back. 

You can learn about blocked buzzing and embouchure rehabilitation in Broken Embouchures and Embouchure Rehabilitation.