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.
You can instantly tell 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, lip swelling poses the most trouble for a player. When the lip tissue which forms the buzzing aperture swells, it forces the facial muscles 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. 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 cooperatively to hold the aperture open. When the lips are swollen, the aperture narrows, and the lips cannot vibrate without a lot of air speed 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 all of these untoward symptoms and how this can lead a player unwittingly into make changes in his embouchure and his playing.
As soon as a player feels lip discomfort, lip swelling, and severe facial fatigue, his body instinctively 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 hangs on for days and hamper the ability of the facial muscles to generate a normal, firm embouchure structure. 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 encode themselves into a player's embouchure and replace his healthy structure. 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 themselves in permanently.
The most important step in dealing with the more constant symptoms of overuse—pain and swelling—is moist heat and ice therapy. For the ice therapy, you will need two small, refreezeable blue ice blocks—the kind you use in a sandwich bag or picnic cooler. The advantage of the blue blocks is they don’t melt; they stay ice cold for a very long time; they don’t drip; and you can put them directly on your lips without wrapping them in a cloth. Make sure you always have them frozen and ready for use.
Another consideration is lightening your playing load. Save your playing bullets for the performance. Instead of doing your normal warm up, do a few minutes of blocked buzzing. If you have an instrument and/or mouthpiece that is easier to play, you might try using one or both of them until your playing has returned to normal. You might find it helpful to back off of the volume in tutti passages whenever possible. As soon as you have a chance to take a day or two off, do. Continue to use the moist heat/ice therapy, even on your days off. The visceral reaction to an embouchure problem players experience often causes them to undertake dramatic changes in how they play and what they play on. Never move your mouthpiece location in reaction to pain. Doing so will cause you an embouchure dilemma that can many, many months to undo. Do not switch to a new mouthpiece with a different rim that you are unused to. If your old mouthpiece was previously comfortable and easy to play, it is not the cause of any playing issues you have recently encountered. The same holds true about your instrument. An unfamiliar, new instrument can actually confuse an embouchure with a different blowing resistance and make playing much more difficult in the long run. Therefore, only change to equipment you are familiar with and are comfortable playing. Above all, never, never change the surface of your front teeth in an effort to fix a dysfunctional embouchure. Changing the dental surface can cause a player to develop significant sensory confusion and playing problems that will take considerable time to undo. Remember, it was overuse which created this sudden chop problem, not your equipment or your teeth.
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, overuse has evolved into the overuse syndrome.
Most players who experience chronic lip pain and swelling and have no endurance when they play become convinced they have a "permanent" injury. They arrive at this conclusion because no amount of practicing and no amount of time off the instrument has cured their problem. It is important to understand that overuse does not produce a typical injury, even in cases where intense pain is involved and muscle injuries might 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. As pointed out previously, the lip swelling and soreness that one experiences after a period of stressful playing tend to hang on days after the fact and prevent one's embouchure from functioning normally. A player unconsciously accommodates the growing playing problems with mechanical adjustments in the way he plays. When these adjustments become the norm, they replace a player's natural, balanced playing mechanics with a dysfunctional system that cannot protect his lips from the physical rigors of playing. This is why one's lips never completely recover from overuse.