Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians

Embouchure Overuse Syndrome in Brass Players

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    When a player is in top form, it is difficult for him to imagine that his embouchure could ever be in peril.  Most of us believe that chop problems happen to other players of lesser talent and experience; after all, great players have perfect technique, right?  Solid playing technique (playing mechanics) not only fuels great playing, it also protects a player’s lips and face from the normal physical stresses of playing; however, there is one thing that can undermine even the best technique and cause playing to become painful and totally disabled—embouchure overuse.     
    It begins innocently enough.  You’ve been doing a heavy week of orchestral playing or had a demanding, all-day cast album recording of your Broadway show.  You’ve been practicing for a very important audition or spending long hours preparing for the premiere of a concerto.  Your lips have felt great throughout. Your playing has been free and easy—until one day, you pick up the horn, and nothing feels right.  Your lips feel thick and dead, and your chops seem completely out of shape.  You have no endurance.  You struggle to play in the high range, and you have lost your pinpoint control.  So you practice harder, but with each passing day, playing becomes more and more of a challenge, and the troublesome problems that now inhabit your playing respond to no amount of effort to overcome them.  A couple of weeks of this decline go by, and things just keep getting worse and worse.  Now you’re in a real quandary. “I can’t play,” you say to yourself.  “How am I going to get through the next performance?”  You finally take a therapeutic holiday from playing for a week or two or three, but when you start playing again, nothing has changed.  It is just as difficult as it was when you stopped.  Welcome to the world of embouchure overuse syndrome.  
    How can a strong, healthy embouchure deteriorate so quickly?  By overusing it.  Few brass players understand the potentially devastating, long-term impact that overuse has on their embouchures. Four problems tend to hang on long after a period of overuse: lip swelling, lip pain, severe facial fatigue, and strange sensations that develop in the muzzle area of the face.  As soon as a player feels any sort of discomfort and/or unusual sensations in his lips, his body instinctively reacts to protect the painful area and instantly imposes changes to how his embouchure functions mechanically in playing.
    The difficult problem presented by embouchure overuse is that it causes a player's lips and face to remain physically weakened and symptomatic for days after the fact. When a player continues to play on an embouchure still impaired by overuse, he unconsciously makes mechanical adjustments in order to navigate the lingering symptoms, especially lip pain and swelling. The mechanical adjustments eventually overtake a player’s normal system of playing and become the new norm of how his embouchure functions from that point on.
    Unfortunately, these new compromised mechanics cannot produce a high level of playing, and the weaker system also exposes a player's lips to redundant physical abuse. It is a bit like what happens to a baseball pitcher who has thrown too many pitches. His shoulder becomes fatigued and sore. The next time he tries to pitch, he accommodates the lingering shoulder pain and weakness by changing his delivery, dropping his arm angle, and slinging the ball. It doesn't take long before the change in his pitching delivery locks itself in, replaces his former delivery, and then begins to affect his elbow comfort. His shoulder and elbow might heal with rest, but as soon as he starts to pitch again, the new, less mechanically sound delivery will cause him to develop the same discomfort in his shoulder and elbow. Once an embouchure becomes mechanically dysfunctional, a player experiences chronic, disabling playing problems, severe fatigue, and lip swelling and/or pain.
    The route from overuse to overuse syndrome is a speedy one.  The lingering presence of pain and swelling following overuse cause a player to develop the unconscious, reactive habit of setting his embouchure with a weaker, more flaccid structure. This "looser" setup allows normal mouthpiece pressure to bite into the lips and irritate the tissue, thus perpetuating the pain and swelling.   The problem then becomes circular: pain and swelling prevent a player from setting his embouchure with a normal, controlled structure; and the resultant lesser structure exposes the lips to irritation.  The lips and face are never quite able to recover, and every aspect of playing is affected.
    Players who develop overuse syndrome complain that they feel no air support when they play. That makes perfect sense.  An embouchure which is chronically tired, sore, and impaired cannot compete physically with normal air pressure. Instinctively, a player reduces the intensity of his air control in an unconscious effort to protect his ailing lips. In addition, this loss of normal embouchure structure prevents a player’s tongue from working efficiently. Fast tonguing and tonguing in the mid and low ranges become especially difficult.   
    One of the more surprising and unique things about overuse syndrome is that rest has no effect on it.  You would naturally assume that painful, swollen, tired lips would heal after a week or a month off.  In fact, there are players who have taken six months off only to face to the same physical issues and playing problems once playing is resumed.  Unfortunately, rest cannot reverse what is, for all intents and purposes, an unintended embouchure change.  A player suddenly finds himself dealing with an embouchure that has not only been stripped of its playing control and strength but that has become mechanically confused in the process.  In the final analysis, it is not difficult to understand why overuse becomes a quicksand into which a player can slide so completely unawares.
    All players who develop this syndrome experience the same symptoms, emotional distress, and playing problems.   In other words, embouchure overuse syndrome impacts every player the same, regardless of age or accomplishment.  

Embouchure Overuse Syndrome in Brass Players, © 2013, Lucinda Lewis

A native of Kansas City, Missouri, Lucinda Lewis began her musical studies at the age of 9. From 1964-68, she was a student of Kansas City Philharmonic hornist James Funkhouser. She entered the Manhattan School of Music in 1968, where she studied with Clarendon Van Norman, principal horn of the Metropolitan Opera Orchestra, and earned degrees of Bachelor and Masters of Music Performance. After three years in Israel, Lewis became the principal horn of the New Jersey Symphony Orchestra in 1977. She served as an officer and governing board member of the International Conference of Symphony and Opera Musicians (ICSOM) from 1990-2002.

In 2000, Lewis launched an informational web site for brass players, Embouchures.com. In 2002, she published Broken Embouchures, a book dealing with the overuse and performance-related injuries of brass players, and is a much sought-after expert in the treatment of such injuries. In June, 2005, she was invited to join the faculty of the Performing Arts Medical Association during their annual symposium in Aspen, Colorado.

Lucinda Lewis is also a successful artist and goldsmith. In 1968, she was awarded the National Gold Metal in sculpture and has exhibited her works throughout the United States. A successful jewelry designer, Lewis creates original intarcia (inlaid stones) designs set in gold and silver.

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