Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

Filtering by Tag: overuse syndrome

There's Nothing Wrong with You- Working with Injury-Shaming in Music

Sometimes, despite all of your best intentions, your body doesn't cooperate.  It may be a repetitive stress injury, an immune response, tendonitis, migraines, the diagnosis of a disease, genetics, or the result of a trauma such as a car or bike accident.  You may have been eating well, sleeping enough, moving, taking your vitamins, and getting regular massages, but sometimes, things go astray and it can be hard to pinpoint how or why.  What then ensues is a series of self-destructive thoughts, such as how will I take that audition? How will I finish the semester?  What about this upcoming concert?  Will I be able to have a career? And so on.  Sometimes, a small injury can quickly escalate to a mental crisis in a matter of minutes, courtesy to your self-inflicted stress, and then the views of those around you only make things worse.  What do I mean exactly by that?

When one is suffering an performance-related injury, the automatic assumption by many administrators and teachers is that the way you play is wrong.  There's something wrong with your setup.  There's something wrong with your habits.  There's something wrong with you. I have been guilty of this thought, but I see it most frequently in academic settings and music festivals.  Here are some of the other classic responses from administrators:

Other people in this orchestra aren't hurt, why are you?

You're only doing this for attention, it can't be that bad.

Play through it, you've got important concerts coming up.

Why now?  You've been fine all year, and now you're hurt?  You have to fulfill your requirements or you won't pass.

The tricky thing with the human body is that everyone is wildly different.  There are certain basic movements that are unsafe for most bodies, and there are many things that are safe for most bodies, but musical training lives mostly in the "in-between" realm.  The truth is that music is a REPETITIVE action, and any repeated/semi-static position has mobility and stability risks of huge proportions!  Here's a great quote from Katy Bowman on this: "The problem is the repetition of stillness, not the position you're in while doing it." 

What often then occurs is a battle of school administration, faculty, medical professionals and students in trying to "get out" of certain commitments.  The counterattack is often ugly, and students are in a shaming crossfire between administrative requirements and personal pain.   Here's one of Brene Brown's TED talks on shame: "Shame...is this web of unobtainable, conflicting, competing expectations about who we’re supposed to be. And it’s a straight-jacket."

So here are some of my propositions:

1. Let's all acknowledge (musicians, teachers, school administrators, schedulers, festival managers!) that classical music and the practice of all music has musculoskeletal risk.  We expect students, colleagues and musicians to practice or play for 4-6 hours a day, without injury EVER.  (If we asked an athlete to train 4-6 hours a day and never get injured, there might be some major problems, right?)

2. It's not usually safe to play more than six hours a day, and any festival or administrator that makes you or your students feel badly about going into the injury threshold zone is full of &%$#.  Young musicians may be able to bounce back more quickly than older musicians, but they may also have less body awareness and be unaware of when they've played too much or how they feel.

3.  Let's stop institutionalized injury-shaming.  Really.  If someone is truly working with an overuse injury, don't punish them by emphasizing how much school orchestra they have to make up, or putting them in a demoralizing educational situation.  Come up with a better solution to make up the hours.    When I was at conservatory, the "injured" often had to play in the freshman orchestra, in the back of the section, or play the most undesirable concert or concerts.  Talk about a shaming experience!  Maybe it makes more sense for them to be in rehearsal with a score and write a paper on what's going on in rehearsal, and what the ensemble issues are.  Have students go to a conducting class instead.  There are TONS of ways to become a better orchestra musician and fulfill an academic credit that don't rely on playing in orchestra.  Musicians already deal with the fear of "not being good enough" and putting students in a depressing situation doesn't help morale.  (In addition, don't continue punishing students after they've been injured and healed.)

4.  While there are things we can all do to be healthier and have a more tension-free setup, a student's setup is probably not totally wrong.  That's placing a value judgment on a habit, technique, or learned movement, which can be a dangerous mental place to live.  (I've had this crisis through the lens of intonation...I'm doing everything wrong, I'm a terrible person...blah blah blah)  Sometimes a student is doing something in a non-efficient way, but rarely is a motion, movement, or setup inherently wrong.  (High heels, smoking, and rhythmic/pitch inaccuracies can be the exception.)

5.  Sometimes the area of pain is not actually causing the pain.  Someone might be having a wrist/elbow issue, but the problem is the tension in the trapezius.  Or someone is having back pain, but is really having ankle and knee instability. We can't just put a band-aid fix on things without looking at the whole person, and that means everything from walking and sitting to sleeping and purse holding.

6. Let's be open to change as teachers and musicians.  Sports medicine is far ahead of arts medicine in terms of understanding the body, yet few musicians receive any of that valuable insight.  Be open to changing how you teach, how you play, and how you move in your life.  Seek other opinions if you can't help your student.

7.  Be a professional.  The excuse I often heard at music school was, "If this was a professional orchestra, then..." If schools want to be professional incubation zones, then treat students as professionals.  In a professional orchestra or ensemble, there are constraints as to how much rehearsal time a day is allow, and if a member has an injury, they're generally given protection to prevent the loss of their job. They're not generally seen as a pariah or a liar.  At a school, that means there should be accountability for conductors with regards rehearsal time and break time amounts, halfway decent chairs, and consistent policies for injury management.

7. If someone has been injured in the past, don't hold it against them, as though they may be hurt again.  Here's a great quote from Gramophone:

Whereas athletes who have injuries are treated and then expected to rise once again to the top of their game once healed, a previously injured musician is often considered unreliable physically, and doubt remains in the mind of industry leaders. Why is injury accepted, treated and supported in the sports world, yet so shaming and unacceptable in the music world?

8.  Let's acknowledge that everyone's body is different, and that some people may be immune to injury more than others.  It may have to do with the size of your frame, how muscular your are, your genetics, the size of your instrument, which side is dominant, etc.  Rather than seeing an injured person as "weak," "poorly taught," or "wrong," we can begin to change the stigma of overuse injury, illness, and recovery.


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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