Embouchure Overuse Syndrome in Brass Players

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.