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Embouchure overuse syndrome: Information
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During the last 20 years, I have received over 5000 e-mails and letters from players of all ages and accomplishments who were seeking information and help for a painful embouchure problem. Here are two typical letters.
"About six months ago I was very stiff from an excessive amount of practicing the day before. The next two days I continued to play as usual. The third day, my sound was full of air, and I had no ability to play softly. I took three days off and tried to play again. After playing for two days, it was obvious that something was still very wrong. I decided to take the last month of the season off, canceling all sorts of solo concerts as well. It was all pretty embarrassing and upsetting. It's been over two weeks that I haven't touched my horn. I thought in another week that I would try buzzing. There is still a prominent scar on the inside of my top lip." ******************** "A few years ago while preparing for an audition, I suffered a small injury, which didn't seem important at the time, and it didn't stop me from doing the audition. The injury, as opposed to the ones mentioned in your articles, was not on the lip, but rather in my left cheek. A couple of months later, doing excessive playing after being out of shape, it got worse, and this time it was there to stay. I limped along for almost a year, until I decided to take time off, and I was out for some 6 months, until I found a good masseur, who did rigorous facial massages, and encouraged me to go back to playing. Previous to that I had seen many doctors and therapists around here, and they couldn't do anything for me. There wasn't even an exact diagnosis to be found, but rather vague descriptions like "pulled muscle in cheek", "facial injury", etc. The therapy helped, and I have been able to keep playing, although my endurance and flexibility has suffered. But due to the nature of my job, in spite of occasional aches and pains, I have been able to keep my standard of playing. Also, the experience, although unpleasant, has taught me a lot of things that have made me a better player and teacher. But I still have many doubts and questions about this problem, and once again I am facing a heavy season with lots of Bruckner and Mahler coming up, and there is always a voice in the back of my head asking whether or not I'll be OK this time."
This is how most players describe the onset of embouchure overuse syndrome. When a player plays too much, even if he is in the best physical shape and in top form, four problems tend to hang on: chronic minor lip swelling, lip discomfort/irritation, severe facial fatigue, and strange sensations, including a dull feeing in the lips, that develop in the muzzle area of the face. Unfortunately, the embouchure 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. When a player continues to play on lips in this condition, he will eventually begin to compensate and adjust his playing to accommodate the minor physical problems that overuse has caused. This leads to developing a habit of setting the embouchure deferentially to pain and fatigue, with less energy and control of the muscles, which is the exact opposite of how a good, healthy embouchure functions in playing. This looser setup is what disables playing, invites embouchure confusion, and lead to chronic and painful lip irritation. Of course, players who fervently believes that a lot of physically demanding playing is good for embouchure strength won't usually stop playing when their chops begin to complain. After all, we've all done it before with no lingering consequences, right? Where the real problem begins is the day following such a strenuous workout, when a player picks up his instrument and expects to reap the fruits of his previous day's labors. He starts playing and finds that his chop muscles have still not completely recovered, and the bruising and swelling has also not subsided. His chops feel weak, stiff, puffy, and sore, notes won't speak easily, he can't play soft dynamics, and his high notes are strained and difficult. After a few days of the frustrating technical problems that won't seem to go away, a player often tries to "practice" his way out of this predicament. Of course, what he doesn't realize is the more hours he plays, the more weary his embouchure muscles become. With each passing day, a more significant kind of muscle fatigue evolves, and he begins experiencing a thick, heavy, dull wooden-face feeling. He loses even more of his high range, endurance, and technical control. At this point, panic begins to set in. Ideally, brass players should try to avoid "chop busting" playing. Unfortunately, as we all know, that isn't always possible. Any player who has had an unusually strenuous day or week of playing should try to take a day or two off or reserve his chop strength and conserve his energy as much as possible both during and after the period of physically demanding services. An exhausting day of practicing should be followed by a day of rest or only a light amount of playing the next day. For the player who has developed full-blown embouchure overuse syndrome, performance rehabilitation is the only means by which playing comfort and integrity can be restored. ******************** I also occasionally receive letters from players who have developed embouchure dystonia.
"I was wondering if you had any information that could help me? I am a trombone player and have very rapid fatigue (my chops tire after 5 min) and have developed an involuntary wiggling in my orbicularis oris [lip] muscle when I play. This causes me to leak air and not be able to play longer than 15 minutes at a time at the most. I have been experiencing the symptoms for over a year now, and have pretty much been forced to stop playing. I have never had any endurance problems or physical health problems before this started. I used to be able to play for hours with no noticeable fatigue. I have had an MRI and an EMG which were both normal. A neurologist diagnosed me with a focal dystonia; however, a respected performing arts physician disagreed with that diagnosis and attributed my problems to tension and psychological stress. He prescribed psychotherapy and speech therapy. I have been doing bio-feedback and therapy without any noticeable difference. I was wondering if you have heard of psychological causes being a factor or if you have any other opinions regarding my situation? Is there anyone else you can refer me to?"
Unfortunately, not all doctors are capable of diagnosing embouchure dystonia in brass players, because not all cases of embouchure dystonia are alike. Some players feel one corner of a lip pulling up when they play, while others experience jaw clenching or lip trembling. Most often, the entire range of the player is not affected. The dystonic symptoms only appear in a particular range, while tonguing, slurring or playing certain notes or patterns of notes. If you are suffering with any sorts of strange symptoms, you need to consult with a neurologist who is a movement disorder specialist. For more information, see dystonia. If you are a professional musician who has been diagnosed with a dystonia and who is a member of the American Federation of Musicians, you could be eligible to received disability benefits through the AFM-EP Fund. For more information, visit afm.org.
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