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Embouchure Emergency
There are two kinds of disabling embouchure dilemmas related to overuse: acute and chronic. The acute version is defined by a sudden onset of disabling playing symptoms, such as lip swelling, extreme facial fatigue, lip pain, and a total loss of endurance and playing control. When such disabling symptoms don't go away and slowly degrade a player's ability to play comfortably over a period of weeks, months, or even years, a player is then suffering with a chronic problem known as embouchure overuse syndrome.
ACUTE
You can tell instantly when your embouchure is in trouble. You're in the middle of a rehearsal or performance and your face suddenly feels foreign and like it is totally out of shape. Your playing goes from feeling the best it ever has to feeling completely compromised and disabled. Your lips hurt, are severely swollen, and no long fit into your mouthpiece. Your cheeks feel weak and dead. Soft, sustained playing is next to impossible, and your endurance has dropped by 50%. You have lost all playing control. There is no greater stress on one's peace of mind than when this happens right before or during a performance. What do you do now?
The symptoms described above are symptoms of short-term overuse that have built up in an embouchure because of the close proximity between sessions of heavy, demanding playing. Often, there is little, if any, warning of this. Everything about playing goes from feeling totally normal to feeling completely weak and uncontrollable. When a player is presented with acute symptoms of embouchure overuse, how he reacts and deals with these symptoms may mean the difference between a problem that lasts for a few days or a protracted performance injury.
Overuse is one of those stealthy problems that comes on with almost no warning. Often, the only sign a player has is greater-than-normal "lip stiffness" and increased difficulty in getting his lips "warmed up". This is how lip swelling feels to a player. While a player can deal with lip pain (who hasn't played with painful, chapped lips) lip swelling poses the most trouble for a player. When the lip tissue that forms the buzzing aperture swells, it forces the facial muscles to have to work with greater effort. Why? Stand in front of a mirror, and form your embouchure as though you were going to free buzz loudly, and hold your embouchure in this position. Notice that the aperture in the center of your lips isn't very wide at all, so it doesn't take much swelling to impede the vibration of such a tiny opening. You will also notice how your facial muscles work together cooperatively to hold the aperture open. When the lips are swollen, the aperture narrows, and the lips cannot vibrate without a lot of air and a lot of physical effort (this is why soft playing is rendered so difficult), at which point, the facial muscles have to work doubly hard to stretch the aperture open enough that the lips can vibrate (and why it is so fatiguing to play loudly). Needless to say, this dramatically impacts a player's endurance and leaves his face feeling dead and like rubber. The important thing to understand here is the unconscious, protective instinct that the body deploys in reaction to lip discomfort and swelling and how this causes a player unwittingly to make changes in his embouchure and his playing.
As soon as a player feels lip discomfort, lip swelling, and severe facial fatigue, his body instantly reacts by putting his embouchure into full-blown injury mode. How this impacts playing isn't difficult to understand. The lip swelling and soreness that one experiences from overuse hang on for days and hamper the ability of the facial muscles to generate a normal, firm embouchure structure and also weaken their ability to sustain and control the opening of the buzzing aperture. As a result, a player begins making minor, unconscious adjustments to his embouchure in an effort to accommodate the playing problems that arise from the residual lip pain and swelling. The longer pain and swelling persist, the more the player is forced to accommodate them. It doesn't take long before these adjustments begin to make permanent changes to a player's embouchure. So, a player with new symptoms of overuse has to be proactive in taking steps to prevent these little adjustments from becoming the norm and locking in permanently.
The first step in dealing with the symptoms of acute overuse is treating the pain and swelling. One thing you will need is two small, refreezeable blue ice blocks--the kind you use in a sandwich bag or picnic cooler. Make sure you always have them frozen and ready for use. While Ibuprofen can help relieve or prevent some of symptoms of overuse, the most effective approach to addressing severe lip pain and swelling is heat and ice. After a playing session, especially when your lips feel particularly bruised and battered, take a washcloth, and saturate it with hot tap water--as hot as is comfortable. Stretch the moist, heated cloth across your face from below the eyes down. Wring it out and repeat. Do this for about five minutes, then take a frozen blue ice block from your freezer, and pat it on and off your lips. (Hold the block on your lips only as long as it is comfortable.) Do this for about 5 minutes. This will not cure your problem, but it will help prevent carry-over lip swelling and soreness.
The second step is to lighten your playing load. One way to do that is to save your playing bullets for the performance. Instead of doing your normal warm up, do a few minutes of blocked buzzing. (You will find information on how to do blocked buzzing at the bottom of the Overuse page.) If you have an instrument and/or mouthpiece that are individually or collectively easier to play, you might try using one or both of them until your playing has returned to normal. Another suggestion is to back off of the volume in tutti passages in rehearsals and performances and in any passage where you can lighten up a bit. Consider taking more breaths in a passage to give your lips a quick respite. As soon as you have a chance to take a day or two off, do. Continue to use heat/ice therapy, even on your days off. When you return to playing, don't allow any lingering, residual, strange sensations or lip discomforts to scare you or seduce you into making unnecessary changes to you playing.
All players experience a visceral reaction to an embouchure problem. Some players react by making dramatic physical and equipment changes which create more problems than they solve. Never move your mouthpiece location in reaction to pain. Doing so can create a problem that will take at least a year to get out of. Do not switch to a new mouthpiece with a different rim. If your old mouthpiece was previously comfortable and easy to play, it is not the cause of any problems you have recently encountered. The same holds true about your instrument. A new rim or mouthpiece and/or instrument can actually confuse and embouchure and make playing more difficult. Only change to equipment you are familiar with and comfortable playing. Never, never change the surface of your front teeth in an effort to fix an embouchure problem. Like moving a mouthpiece, changing the dental surface can cause a player to develop significant playing problems that can take months to undo. Remember, it was overuse which created this sudden chop problem, not your equipment or your teeth.
To prevent overuse from inflicting permanent, disabling changes to your playing mechanics--changes which would require performance rehabilitation to reverse--you need to know that your embouchure reacts to pain and swelling by reducing its "grip" and softening its structure. This is a habit you must short circuit before it takes hold. When a painful embouchure has to play, it automatically goes into injury mode and deploys a weaker, more flaccid structure than it previously engaged under more normal circumstances. If the embouchure structure your face generates to block buzz feels better and stronger than the structure your face currently generates to play, your playing embouchure is operating in injury mode. Blocked buzzing causes even the most injured of embouchures to function normally. Anytime your embouchure doesn't feel right, you can always see and feel your old, normal, intense playing structure by block buzzing. It is amazing that while a painful embouchure can function completely normally in blocked buzzing, it has difficulty functioning in playing.
CHRONIC
The primary symptoms of overuse syndrome are pain, swelling, fatigue, profound embouchure confusion, and performance disability. When you experience these symptoms for more than two weeks, your embouchure problems has evolved into the chronic stage of overuse.
Most players who experience daily lip pain and swelling and have no endurance when they play believe they have a permanent lip injury. They come to this conclusion because no amount of practicing and no amount of time off the instrument has cured their problem. What you need know is, overuse does not produce a typical injury, even in cases where intense pain is involved and muscle injuries develop. Lip pain and swelling are the result of a form of irritation which stems from structural and mechanical changes in a player's embouchure caused by overuse. As pointed out previously, the lip swelling and soreness that one experiences after a period of stressful playing tend to hang on days after and have the effect of preventing one's embouchure from functioning normally in playing, causing a player to accommodate those problems by making minor, unconscious adjustments to his embouchure. When these adjustments become the norm, they replace a player's natural, balanced playing mechanics with a dysfunctional system that irritates his lips.
Playing a brass instrument with injured, dysfunctional playing mechanics is like wearing tight shoes that pinch the toes and rub blisters on the heels. Tight shoes cause pain and cause you to limp. Dysfunctional playing mechanics put abnormal stress on the tissue of the lips and can cause pain, swelling, and, in the worst case scenario, tissue damage. Even with medical treatment, if you continue to wear those tight shoes, your toes and heels will be irritated and painful, and walking will be difficult. If you replace the tight shoes with a pair that fits, the blisters heel, and the pain and limp go away. When dysfunctional playing mechanics are restored to normal function, the tissue injury, lip pain, lip swelling, and playing problems all disappear; however, performance rehabilitation requires a player to adopt a different belief system which acknowledges the lip pain he has been experiencing is a symptom of his problem, not the cause. That is quite a leap for most players who believe if they could just fix the pain in their lip, their playing would miraculously recover. Unfortunately, wind instrumental performance injuries just don't work that way.
As recommended above, ice and heat therapy can be very helpful to a painful embouchure. Please see the recommendation above. Ultimately, the only way for a player disabled by overuse syndrome to get out of this problem permanently is to restore the structure and mechanical integrity of his embouchure through performance rehabilitation. |
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cinlewis@embouchures.com with questions or comments.
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