Lucinda Lewis  

The Greatly Misunderstood Subject of Embouchure Overuse and Embouchure Dysfunction Common in Brass

Lucinda Lewis
April 10, 2019

Over the last 25 years, performing arts medicine has become a recognized specialty. A number of clinics around the world treat the aches, pains, and injuries of performers. Unfortunately, while much is now known about the performance injuries of string players and pianists, brass players suffer a unique kind of performance injury that is not well understood by the music medicine community. As a result, brass players have to suffer lengthy, painful, and debilitating lip injuries with no hope of effective medical treatment.

The kind of embouchure injury/disability that most commonly affects brass players is embouchure overuse syndrome. Embouchure overuse syndrome begins as only a minor performance injury, but it quickly evolves into something far more problematic. Within days, it will musically cripple a brass player without his even knowing what has happened.

Embouchure overuse does cause initial injury to a player’s lips and face; but a disabling, residual cycle of injury persists for months and even years that is perpetuated by the erosion of the physical ability of the embouchure to function correctly in playing. A more detailed description of how embouchure overuse syndrome evolves and ultimately disables a brass player artistically appears later in this article.

Anecdotal Statistics

In the years that I have been writing about embouchure overuse and brass injuries, I have received thousands of emails, letters, and phone calls from desperate players seeking help. From the information that they shared with me about their respective injuries, interesting statistical patterns began to emerge.

In the first twelve years of my research, 3658 bona fide embouchure overuse injuries/playing disabilities were reported. Approximately 2/3 were from professional players. All had been suffering with ongoing playing-related lip pain and/or lip swelling, and developed serious playing problems, including loss of endurance, trouble playing in the high range, a lack of clarity in tone and in articulation, and a general sense of overall playing disability. 97% reported that the onset of their lip pain and playing problems had been preceded by a period of intense, physically demanding playing. 48% indicated their injury and playing problems had persisted for two years or more. 89% had consulted at least one physician and/or dentist. None had found any lasting medical solutions. Their physical discomfort, and playing problems continued even after medical treatment had concluded.

Interestingly enough, 75% had taken a therapeutic holiday from playing of at least 2 weeks. However, time off the instrument of any duration did not permanently resolve either physical or playing problems, all of which usually reappeared within two to three weeks of returning to the instrument.

Embouchure overuse is, by far, the number-one predicate for embouchure pain and dysfunction in brass players. To understand how overuse physically injures a brass player’s lips and face, you first must know a little about how the basic mechanical structure of the embouchure actually works in playing, and how it becomes damaged and disabled by an episode of overuse. By mechanical structure, I mean the trained physical system brass players employ to configure the facial muscles and lips into an embouchure.

Brass players aren’t generally taught specifically how the embouchure is supposed to work in playing. Embouchure technique is communicated through prompting from a teacher, such as, “Don’t puff out your cheeks.” “Keep your chin down.” “Don’t smile when you play.” “Keep your corners in.” So, brass players learn to shape the embouchure and to play in large part by rote, and by feel.

Without wanting to be indelicate, there is considerable similarity between how people in general configure their facial muscles to spit and how brass players organize their facial muscles into an embouchure. I don’t mean the sloppy kind of spitting baseball players are famous for, but rather the more aristocratic form we employ to remove, for example, a poppy seed roaming around on the tongue.

If a poppy seed is perched on the tip of your tongue, what does your face do to evict it?

First, the corners of your lips crimp together and snug themselves up against your teeth. Almost simultaneously, your chin stretches down, and the point of your upper lip and the center of your lower lip minutely stretch themselves apart. This creates a tiny little aperture through which you can propel a burst of air that will send that foreign object flying.

Some of the components of a spitting embouchure are essential to its successful operation. Try spitting with a relaxed chin or with the upper lip relaxed. Would that have been possible? Of course not. All components must work together, or the whole system is disabled.

In playing a brass instrument, the chin and lips use a similar physical mechanism to create a buzzing aperture. They work to shape and hold this aperture open in playing so that the surfaces of the upper and lower lips consistently have just enough clearance to be able to vibrate and function like the blades of a reed.

A brass embouchure is composed of a balanced system of mutually supporting systems, just as with that spitting mechanism. If one thing is not working, the whole system is impacted.

The function of the chin is so critical to the embouchure. Later in this article, I explain how an episode of overuse affects the basic mechanical structure of a player’s embouchure, causing him/her to lose the ability to control his chin in playing and setting into motion a painful and debilitating cycle injury.

Good mechanics are necessary to avoiding injury in just about any physical activity. For example, a baseball pitcher who drifts, drops his shoulder, or throws across his body puts tremendous stress and strain on his pitching arm and shoulder, and it also makes his pitches less effective. These are the kinds of mechanical problems pitching coaches watch for and try to correct as soon as possible. Just like athletes, brass players have to have sound physical playing mechanics if they are going to be successful and remain healthy.

A brass player’s playing mechanics, those highly trained, skilled physical systems that activate and control the embouchure in playing, not only help him/her perform, they protect the face, lips, and mouth from the physically intense pressures of playing, including mouthpiece pressure. Anything that impacts the normal function of a player’s embouchure for a long enough period, whether too much playing and overuse, or a medical or dental condition, will eventually cause his playing mechanics to deteriorate and fail, thus exposing the lips to repeated irritation.

Normal Performance-Related Fatigue

At the end of an average day of playing, which would consist of the amount and kind of playing one is used to, a player may experience mild lip puffiness and facial fatigue that disappear within a few hours. However, because the buzzing aperture is so tiny to begin with, any change in the physical contour of the lips from swelling can make playing very challenging.

In general, lip swelling is anathema to playing. Brass players describe it as “stiff lips,” because that’s how it feels. Swelling narrows the gap of the buzzing aperture, preventing the lips from vibrating freely. To overcome swelling in the lips, the facial muscles have to work just a little bit harder to stretch the buzzing aperture open enough so it then has room to vibrate. Even though the face has to work with more effort, under normal circumstances, the muscles are strong enough to handle the added burden.

However, after an episode of embouchure overuse, nothing is normal.

Embouchure Overuse

Embouchure overuse occurs when a player has engaged in an extreme amount or kind of physically demanding or stressful playing that is well beyond what he is accustomed to. Even a player who is playing at his peak and is in good physical playing shape can invite embouchure overuse syndrome after having to engage in several hours of very high, loud playing or from playing non-stop for a greater than normal duration. By overuse syndrome, I am referring to a set of symptoms and physical anomalies that occur which point specifically to—or are characteristic of—embouchure overuse. However, overuse of the embouchure is only one thing that can lead to overuse syndrome.

The physical impact on a player’s lips and face of embouchure overuse could be likened to what happens to the legs of a runner who is used to jogging 5 miles a day who suddenly decides to run a 26-mile marathon with no additional training. He may be in good enough physical shape to make it through the race, but his legs will feel weak, heavy, and like Jello by the time he reaches the finish line. The day after such a workout, this runner’s leg muscles will still feel weak and wobbly, and certainly won’t have the strength to run again anytime soon.

In embouchure overuse, the facial muscles are completely exhausted during a session of playing to the point where they can hardly function. As a result, a player’s lips are literally pummeled by the mouthpiece. Brass players say it’s like they’ve used a cookie cutter on their lips. The day after, a player’s face feels weak, dead, and heavy, and his lips are battered, swollen, and quite tender.

Hallmark Physical Symptoms of Embouchure Overuse

  • Extraordinary, unrelenting fatigue of the facial muscles

  • Pronounced lip swelling

  • Change in the normal sensation of the lips

  • Lips feel raw, tingly, and very sore

  • Significant playing disability

When he played third base for the St. Louis Cardinals, Terry Pendelton once said in an interview, “It’s really difficult for a ball player to know the difference between being hurt and being injured.”

That’s also true for brass players who routinely become accustomed to their minor lip discomforts recovering quickly. When a player has used his embouchure to the point of overuse, he certainly knows that his face feels worse than usual, but he has no idea that this is very different from anything he has previously encountered—that he isn’t just hurt—he is injured and things won’t recover quickly.

If a brass player continues to play while still suffering the lingering physical effects of overuse, he will likely end up with a long-term problem. Here is the most common evolution of embouchure overuse syndrome and how it transforms itself into a protracted playing disability.

Like that jogger’s legs following a marathon, in the aftermath of embouchure overuse, a brass player’s facial muscles are so exhausted and his lips so swollen, he can barely form an embouchure, much less perform. When a player has to get up the next day and play with these physical deficits, his weak facial muscles have to struggle against very, very swollen lips. Forcing already tired, overused muscles to work even harder prevents them from recovering. This extreme facial fatigue quickly hobbles a player’s basic mechanical structure and keeps it from functioning correctly. His lips are then entrapped between the unforgiving metal of his mouthpiece and a hard dental surface. Irritation and injury are inflicted to the lips again and again, causing the lips to swell in playing. The perpetual lip swelling overwhelms the severely fatigued facial muscles. The embouchure is rendered too physically impaired to work normally, at which point, his mechanics begin to break down. Thereafter, every time he plays, the lips sustain minor injury, and it doesn’t stop there. The lips and face get permanently stuck in this traumatized state.

Most Common, Protracted Playing Problems Following Embouchure Overuse

  • Total lack of playing endurance

  • Trouble starting notes

  • Constant feeling of being out of shape

  • Unfocused tone quality

  • Inability to play in the high range

  • Noticeable “increase” in mouthpiece pressure

  • Change in the normal sensation of the lips and face

  • Mouthpiece rim feels too thick and in the wrong place

  • Total mechanical confusion – “Nothing feels right”

In most cases, players who have suffered embouchure overuse just can’t stop playing, even though they might want or need to. One’s playing obligations often won’t allow for that; however, players naively believe that their tired, battered embouchures will heal by themselves. Unfortunately, as the days pass and things aren’t getting any better, players find themselves faced with a growing number of stubborn playing problems, including troublesome attacks, diminished endurance, inability to play in the upper range, unfocused tone quality, and an embouchure that feels totally weak and out of shape to them.

The constant playing-related facial fatigue and lip swelling soon begin to change the way a player physically feels his lips and face. His mouthpiece feels strange to him, as though the rim is suddenly much thicker and in the wrong place. He has lost all sense and memory of normal facial sensation. Even when he’s not playing, his lips tingle and his face feels like concrete.

As mentioned before, embouchure “feel” is very important to brass players. Brass players learn to play by feel; so they come to rely heavily upon their sensory perception to serve as a radar system that guides their playing. Therefore, anything that interferes with or masks the way a player feels his lips or face will certainly disrupt his playing and impair the normal function of his embouchure.

Many players with years of professional experience have related to me that while they were battling embouchure overuse syndrome, everything about playing seemed wrong to them. They couldn’t remember how their lips were supposed to feel or what the corners of their mouths were supposed to do in playing. How is it possible for highly trained, successful players to experience such profound mechanical confusion that they can’t even remember the most rudimentary things about playing?

One thing that is absolutely critical to the embouchure’s function is sensation. Sensation is important because a brass player needs the sensory feedback he gets from his lips, face, and mouth to serve as a navigational system for playing. Without that sensory feedback, a player’s muscle memory is effectively neutralized. Muscle memory is the amalgamation of the highly trained movement skills that control playing, which are programmed into a player’s muscles through years of training and deploy and operate automatically without thought.

In embouchure overuse syndrome, a player’s lips are inhabited by an indescribable flurry of sensory anomalies, a mischief perpetrated on the lips by a combination of facial fatigue and lip swelling, all of which ultimately handicap his muscle memory. The longer overuse syndrome prevents a player's embouchure from functioning normally, the more its basic mechanical structure deteriorates. It doesn’t take long before things become completely confused, and a player’s mechanics get totally screwed up, and then this injury cycle just keeps going and going.

The most visible physical symptom that telegraphs the damage inflicted to a brass player’s mechanics by embouchure overuse syndrome is seen in the chin as flexing or in the extreme, total buckling. When the chin loses the ability to function correctly in playing, a player is then faced with a lengthy, painful playing disability.

In the majority of cases, players don’t even know that their mechanics are collapsing. The presence of sensory anomalies, severe fatigue, loss of strength, pain, and swelling in overuse syndrome simply camouflage the mechanical link. It’s not surprising that a player has no idea what is happening. Unfortunately, this is the physical morass in which a player has to try to rehabilitate his playing mechanics.

I’ve come to learn how very fragile playing mechanics are. Usually, within a period of only a few days following overuse, the basic mechanical structure of a brass player’s embouchure will have degraded enough that it renders him physically injured and musically disabled.

This article began with the information that none of the brass players who had sought medical help for their lip injuries had found any medical solutions for their problems. It leaves a player totally frustrated and hopeless when not even a physician can offer any answers or advice.

Sorting out embouchure overuse syndrome can be a real challenge for any physician who is not familiar with this unique kind of performance injury. What complicates matters even further is that most brass players don’t know what has happened to them and find it incredibly difficult to describe their pain and playing disabilities to anyone who isn’t another brass player. In addition, unlike most other common performance-related injuries, such as carpal tunnel syndrome or tendonitis, which affect a musician even when he’s not playing, embouchure overuse syndrome is only painful and disabling to a brass player when he’s playing.

When a brass player tells a physician that he has no endurance, his lips are stiff and won’t vibrate, his high range is gone, his lips hurt and swell when he plays, and his face feels numb, he’s not exactly giving that physician the kind of symptoms covered in medical school. So it’s understandable why a doctor might be left scratching his head or put in the position of taking a shot in the dark and guessing. However, this jumble of playing symptoms points to embouchure overuse syndrome. The one thing these symptoms cannot clarify, though, is whether embouchure overuse was the underlying cause or whether something else set it off.

Clues To Overuse

A player who had been playing a lot or very heavily before his problem began, has developed embouchure overuse syndrome that is solely the result of physical overuse of the embouchure. Mechanical rehabilitation of the basic structure of the embouchure is the only thing that will break the injury cycle and restore healthy playing.

But lip swelling, facial fatigue, sensory anomalies, erosion of a player’s upper range, a greater awareness of mouthpiece pressure biting into the lips, and a general loss of technical control of the instrument, are all symptoms associated with embouchure overuse syndrome, regardless of the underlying predicate. If a medical or dental condition has caused a player to slide into overuse syndrome, obviously, that condition has to be addressed before the player can repair his embouchure.

Regardless of the cause, embouchure overuse syndrome cannot be cured medically. It only responds to mechanical rehabilitation, which a player has to undertake himself. Mechanical rehabilitation is an extremely frustrating process. Understandably, players want and need a speedy recovery to their playing; but if done correctly, within two to four weeks a player can break the cycle of injury and begin to repair his mechanics in earnest.


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