Lucinda Lewis  

Embouchure Overuse Syndrome in Brass Players

Lucinda Lewis
February 28, 2019

Editor's Abstract (Click to Hide)

Lucinda Lewis, Principal Horn with the New Jersey Symphony and author of Broken Embouchures, explores the symptoms and treatment of embouchure overuse syndrome. She explains how the basic mechanical structure of the embouchure works while playing, and how it can become damaged and disabled by an episode of overuse.

Cindy lists the hallmark physical symptoms of embouchure overuse, and denotes the most common playing problems that result from overuse. One of the most important issues to consider is sensory feedback, which is critical to brass playing. Finally, she offers a list of clues that can indicate that you are developing embouchure overuse syndrome. The only treatment is mechanical rehabilitation, which can be frustrating but, if done correctly, can restore the embouchure to proper functioning.

- Ann Drinan
Embouchure overuse syndrome is the single most common performance injury suffered by brass players. It is an enigmatic, self-perpetuating injury syndrome that defies medical diagnosis and treatment. Its symptoms include lip pain, lip swelling, embouchure weakness, loss of technical control, lack of endurance, difficulty playing in the high range, and general playing disability. Overuse syndrome does not discriminate. It disables players of every level and accomplishment. While other things, such as a medical or dental condition, can cause a player to develop overuse syndrome, embouchure overuse is almost always the cause.

Embouchure overuse occurs when a player has played too many hours or with more intensity than he is accustomed 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. Once a player overuses his embouchure, it goes into a state of decline from which it cannot recover without a specific kind of performance rehabilitation. The reason is that the lip pain, lip swelling, and facial fatigue that follow a large quantity of playing simply prevent the embouchure from working normally. When a player's facial muscles are forced to work with greater effort, they get to the point where they physically can no longer set or hold the embouchure with any degree of normal muscle control or stability. In addition, when a player feels lip discomfort, his natural, unconscious instinct is to "lighten up" to protect his lips, and this reactive, protective mode gradually replaces his normal playing technique. It translates into the embouchure becoming too lax and loose to have enough structure in playing to protect a player's lips and be productive in playing. It also leads to constant irritation to the lips being inflicted during playing. If the embouchure lacks stability, a player's air control fails, and his tongue cannot work efficiently. Overuse also has a major impact on the normal sensation in a player's lips and face, which often feel numb or rubbery and make everything about playing feel strange and wrong. So it doesn't take long before one's healthy embouchure technique begins to degrade into a weak and unproductive system.

Another way of explaining how and why a strong, healthy embouchure can fail so quickly and dramatically is to analyze the effect pain has on the body. When we injure ourselves, the body suddenly kicks into an unconscious, high-sentry mode that engages in order to protect the injured area from further trauma. Sprain an ankle, and you limp. Cut your finger, and you automatically elevate it away from the other fingers to protect it.

The way the body reacts to embouchure pain and fatigue is to try to minimize the amount of stress on the muzzle area of the face that is generated in playing. Without even thinking about it, an injured player will "back off" the amount of tension in the muscles of his face because those muscles are tired and begging for mercy, and his lips hurt and are telling him to stop. This is one reason the embouchure feels totally uncontrollable in playing. In addition, when a player feels lip pain and facial weakness, he naturally assumes that he is "doing more damage". So it is no surprise that a player changes the way he plays to avoid putting less physical stress on his embouchure.

The impact that overuse inflicts long term on the embouchure is similar to the impact that wearing tight shoes has on one's feet. If you wear a pair of ill-fitting shoes, you are going to develop painful blisters on your toes and heels. If you stop wearing the shoes, your toes and heels will heal (just as a painful lip will heal with rest), but if you start wearing those shoes again, the blisters will return. You could go to a doctor to get the blisters treated, but that won't cure the problem. To cure the blisters permanently, you have to wear shoes that fit your feet. Similarly, the redundant irritation to a brass player's lips that follows overuse is the byproduct of playing technique that has become dysfunctional. To reverse the resulting pain playing problems, a player has to retrain his embouchure to function normally again in playing.

Yet one more casualty of this protective instinct is a player's air control. The lips and muscles of the face have to have physical integrity to resist an intense, focused column of air. In overuse syndrome the embouchure is always too tired, sore, and impaired to compete physically with normal air pressure. To accommodate the discomfort and weakness in the embouchure, an injured player "lightens up" and backs away from using a strong stream of air.

In the final analysis, embouchure overuse syndrome is perpetuated by a single, basic, underlying cause: how the facial/embouchure muscles prepare and set themselves to play. Healthy embouchures naturally and mindlessly set with an intense level of muscle control and facial stability. It is so highly trained and coordinated by the time a player reaches the level of a professional that it is often mistaken as easy and relaxed playing. In contrast, players who have developed embouchure overuse syndrome set deferentially to discomfort, weakness, and from a loss of confidence. That translates into the embouchure being set with too little grip, structure, control, and stability. It is this lack of structure which leads to severe playing problems and lip irritation and what must be retrained to restore playing.

To prevent embouchure overuse from developing into a protracted performance injury, players would be well advised to stop playing for at least a 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 things have recovered. Unfortunately, once the injury has evolved into the full-blown syndrome, performance rehabilitation is the only thing which will break the cycle of injury and restore playing.

A player suffering from overuse syndrome becomes totally confused about how his embouchure is supposed to feel and function in playing; however, there is a very easy way of demonstrating to an injured player how his embouchure worked in healthier days with a technique called blocked buzzing. Here is how it works:

Stand in front of a mirror, and block the end of your mouthpiece COMPLETELY with a finger. Put your mouthpiece on your lips as though you were going to buzz, and blow against the resistance. Blow with a constant mezzo forte stream of air (no air should leak from either your lips or mouthpiece). You can see and feel how your embouchure deploys a lot of muscle energy in preparation to blow against the resistance. Tongue slow, repeated notes while block buzzing. Notice how still and stable your face and throat remain as you do this. The normal level of embouchure stability that a healthy embouchure automatically and mindlessly generates for playing is comparable to that generated by the embouchure in blocked buzzing. An injured embouchure gradually loses its ability to generate and maintain this kind of firm structure in playing.

You probably noticed that your embouchure felt great when you blocked buzzed, even though you were using a lot of mouthpiece pressure. Mouthpiece pressure has no impact on a mechanically sound embouchure, and your embouchure works perfectly in blocked buzzing not because you are blowing against resistance but because of the way it physically prepared and set itself to block buzz. When a player block buzzes, his embouchure sets with the controlled muscle tension and structure of normal, healthy playing.

Embouchure rehabilitation generally takes many weeks to many months to complete. There is no set timetable because every player is different. The good news is: every embouchure injury is reversible.

Comments (Click to Hide)

Seeking help about an embouchure condition. Anyone out there with ideas please let me know. My problem is different, and I don't know if I should be worried or not.
I have played Trombone, Euphonium and Tuba for many years, and I'm 38 years old.
I just recently started playing French Horn to help out our local community band. I've discovered that there is a set of muscles in my cheeks that are being worked for the first time that were not used as much playing low brass. I've been playing Horn for about 3 months now, at least once a week. Within the last week, those muscles have become permanently sore, and hurt when I smile. I've heard of permanent injuries to the cheek muscles that put trumpet players out of business, so I thought I should be asking questions. I'm still able to play, but I don't know if I should lay off for a while, or what therapy is recommended.
If you have any advice, I'd be happy to hear it. If you know of someone I should talk with, please let me know.
Thanks so much,
Brian Bergman,
Astoria, Oregon
tubabug on February 10, 2019 at 6:37 PM
Hi Brian-

I think Cindy Lewis's ideas are good, but don't get too far ahead of yourself. You don't mention if you've taken any lessons from a horn player-- the horn is really drastically different from the low brass instruments you are accustomed to playing. I think the first step is to find a horn teacher in the area, perhaps someone who works primarily with beginners and explain your situation to them. In my experience, those are the teachers who know what to look for in an embouchure, and how to start a player off "right." They might be able to give you the minor tips you need for a healthy, functioning embouchure. You also don't mention if you are switching between the instruments on a weekly basis, which might create some sort of "chop confusion." While the large concepts are greatly the same (buzz and blow!) the mouthpieces are not. I am a horn player, and haven't ever played low brass instruments, but I think that you will have to think of a narrower stream of air than on the tuba and trombone. Just based on what you've written, I'm going to guess that you may be over-engaging your cheek muscles in an attempt to vibrate a larger portion of your embouchure to force "too much air" through the horn. I don't think you are broken by any means, but do proceed with caution. Good luck!

phillyhorn on February 12, 2019 at 10:46 AM
I need help on how to recover from my injury. I got it about a month and a half ago from a festival band. Since then I havent been able to take a serious break because of rehearsals and concerts. At this point my embouchure is pretty bad, to the point that air is leaking out between my corners and my embouchure. My range, which went up and a above a high c is now only up to an a flat. It also feels like I have a small indentation on the left side of my embouchure, probably from too much mouthpiece pressure. I know I need to equalize the mouthpiece on my lip, but I don't know what to do to get back into playing shape. I'm going to college next year for horn, and I'm terrified of having to start in the shape that I'm in. PLEASE help me.
dmarsh92 on June 21, 2019 at 9:48 AM

Please log in to comment: