Lip Injury (pain when playing)

[Benlafo]

For about two months, I have been experiencing sharp pain in my top lip when playing. I believe it started from playing too much too hard over a few days. It has been an incredibly frustrating problem to diagnose and rehabilitate, and I feel like it hasn't gotten better at all. I can still make a good sound, and my range isn't ruined, but the pain prevents me from playing too high or long. My teacher has offered a routine for me(that unfortunately does not seem to be helping much), but he cannot figure out what is wrong either. I can freebuzz for extended periods of time without any pain, but when I begin playing on the horn, the pain starts. If any of you have similar experiences or know any valuable resources, please help! This problem has made my life a lot harder and is causing a lot of stress for me.

[BurckhardtS]

You should take some time off and work with Doug Elliott. Likely, there's something really inefficient you have been doing with your playing that he could diagnose quickly and correct. Playing through it won't make it better, taking time off will just buy you time until it comes back and you correct whatever caused the injury in the first place.

[Wilktone]

I’ve had students who had similar things happen and their doctors weren’t able to recommend more than time off, but it’s good to get a professional opinion.

[SaigonSlide]

If it’s painful then you really need to NOT play until it’s feeling normal. Have you done that? How long have you rested it?

[paulyg]

Take time off. Then get a lesson with someone who know's what they're talking about.

I had a similar issue crop up almost a year and a half ago. It began as more of a general pain, but became localized over a couple months. I took ten weeks off in the early stages of the pandemic, and very slowly came back. A lesson with Doug was critical. I'm now back sounding pretty good, with a good range, and solid technique. I think another six months and I'll be back to "normal," though my playing has absolutely changed for the better.

In my case, I think I had been taking the wrong approach for a really long time, and REALLY leaning into it (does this sound familiar?). A few days of heavy playing shouldn't ruin you unless you're doing something wrong.

I can't stress enough the importance of getting a lesson with someone who knows EXACTLY what they're talking about. This is a very specific problem that is very distinct from what good teachers normally are experienced with. I talked to several teachers I respected, and the advice ranged from "I don't know" (the appropriate response if you really don't know) to "play through it" (f*** that noise). It sounds like your teacher is pushing you down that road- without very specific advice to actually fix the problem, you're just banging your head against the wall lips-first. You can probably count the people on one hand who are really qualified to pull you out of something like this if it doesn't get better on its own in a couple of days. Doug is one of them.

[Doug Elliott]

Injuries are generally caused by doing something wrong habitually, that you get away with for a while. Lots of players get really good at playing wrong.

[Benlafo]

Thank you all for your responses. I needed to hear a lot of this.

When the problem first happened, I had taken about 2 weeks off, and the pain came back after a few days of playing. I decided today that I am going to take more time off the horn. When I start playing again, I am going to see if I can get a lesson with Doug Elliot and try to slowly rehabilitate the problem with my embouchure. How long do you guys think I should take off the horn? I was going to try a month but I am afraid that might not be enough.

[Peacemate]

I don't think taking breaks will fix this. You should find what is wrong and change that, instead of hoping for it to go away. What if it comes back in 5 years? Actively changing is way better in that situation since you already know the solution and can be preventative.

[Doug Elliott]

It really depends entirely on what the cause is. I'm always in favor of fixing actual problems, not just hiding the symptoms.

Let me take a quick look at what you're doing and I'll advise what I think you should do. Skype or Zoom.

[kbryson]

Does it happen immediately or only after some time? I spent years combating a similar problem. The pain only came after 10 or 15 minutes of playing, and sometimes 10 or so minutes after I finished playing. Resting did not fix it. After visiting many specialists a chiropractor determined that the problem was due to a bunch of scar tissue that had formed in the embouchure muscles from overuse in thepast. It was solved by getting weekly deep tissue massages for about 2 months.

[Benlafo]

It seems to happen almost randomly but it definitely becomes more painful as my chops get tired. I have recently been experiencing a little bit of lip pain when not playing as well. It could definitely be scar tissue, that makes sense. I have been kind of hesitant to go to doctors, because both my general practitioner and dentist gave a quick look at it and said it looks and feels fine.

[Wilktone]

I have been kind of hesitant to go to doctors, because both my general practitioner and dentist gave a quick look at it and said it looks and feels fine.

You can always ask for a referral to get a second opinion, if it's painful enough that you feel it warrants. You might also bring your mouthpiece, or even your whole instrument, during your next visit so that you can show them exactly what you're doing that's causing the pain.

Of the two dentists at the office where I go one played trumpet in high school and the other still plays trumpet as an amateur. That's been helpful when I recently needed to get some caps put on my front lower teeth since they understood my concerns and were quite willing to work with me to get them as close to how the teeth were originally.

[Basbasun]

Go to the doctor!
I had a problem in my mouth, my dentist said it looked fine.
I went to a doctor who said it really was not fine at all. Also the problem was not easy for a dentist to see.
My dentist is a very good dentist.

[madelynstoklosa]

Did you ever figure out this issue? I’m going through something similar right now.

[tbdana]

You should take some time off and work with Doug Elliott.

I'm sorry, but I had to chuckle that it took only one post for someone to chime in with the universal solution to every problem ever encountered on this forum, lessons with Doug!

But to be serious, what you describe is a particular embouchure injury that can be quite serious if not treated properly. It's not quite dystonia, but it's related, and is a neurological issue. Rest, while necessary, won't fix it by itself. You need some expert guidance. I have a friend who has recently battled with this, and it began with exactly your symptoms.

I'm going to refer you to Lucinda Lewis. She's a French horn player who has become quite an expert in this area, and has helped many musicians, including a good friend of mine. Ms. Lewis has written a couple of books that I found fascinating and quite helpful. I had the beginnings of such injury, but managed to avoid it by using methods she shared with my friend. These are the books my friend lent me.

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My friend also had Zoom sessions with Ms. Lewis which helped diagnose and treat the condition. Perhaps the books alone will help you. But just know that she's available for in-person/Zoom help, too. You can find her website at http://www.embouchures.com/index.html.

Be patient. Recovery takes a long time.

[baileyman]

Pains inside muscles are often adhesions from a little scar tissue. Athletes work that stuff out all the time with different kinds of massage and stretches. I myself on my way back expanded my upper lip, which had apparently gotten bound up by internal adhesions the previous twenty years. The horn started to work at that point.

[Wilktone]

First, notice the original post went up Mon Feb 22, 2021. The OP posted 3 times on the forum, all in this topic. I don't know if he consulted with a medical professional or another teacher for help and what the results were, but after all that time something has happened, we just don't know.

I'm sorry, but I had to chuckle that it took only one post for someone to chime in with the universal solution to every problem ever encountered on this forum, lessons with Doug!

That speaks very highly of Doug's teaching that so many of us who have taken lessons with him have found them so helpful. And I guarantee that this "universal solution" is anything but universal - everything Doug has taught me about working with brass embouchures is all about finding out what works correctly for the individual. I think if you learned more about it your own opinions might change too.

But to be serious, what you describe is a particular embouchure injury that can be quite serious if not treated properly. It's not quite dystonia, but it's related, and is a neurological issue.

Where'd you get your medical degree?

But seriously, no matter how knowledgable one is, you can't diagnose something like this using text back and forth. We have no idea if the pain is neurological, an injury to the muscle, an ingrown hair, or whatever. It is likely to be something caused by playing incorrectly for your anatomy, but even that is just a guess that needs confirmation by seeing the student play. I'm not as confident as you about what the OP's difficulties are.

I'm going to refer you to Lucinda Lewis.

I have her two books and have had some communication with her in the past. She is very cagey about her research methodology and some of the claims she makes about it doesn't pass the sniff test. If Lewis's advice works for you, great. Personally, Doug is a better resource.

Dave

[jmholtfreter]

I experienced a similar lip malady back in the 80’s. I found what was causing it and rehabbed my condition, taught all of my students the technique which enabled them to develop high ranges without lip injury. Then I applied it as a lip therapy to brass players having the same embouchure pain with consistent, positive results. Presented the technique at the 1999 Michigan MEA Music Conference to over 100 attendees. Was very well received. Contact me at [email protected] for further details.

[timothy42b]

I have her two books and have had some communication with her in the past. She is very cagey about her research methodology and some of the claims she makes about it doesn't pass the sniff test. If Lewis's advice works for you, great. Personally, Doug is a better resource.

Dave

Old thread, but I had a thought.

She is a horn player. Much if not most of what I've read from horn teachers insist the only mouthpiece placement is 2/3 1/3, high placement. (excepting Farkas of course, who was a horn player)

If that is the case, any horn player not suited to that would be playing incorrectly. That implies horn players may be more at risk of embouchure failures. That might lead to more people studying apparent dystonias in horn players.

[Wilktone]

She is a horn player. Much if not most of what I've read from horn teachers insist the only mouthpiece placement is 2/3 1/3, high placement. (excepting Farkas of course, who was a horn player)

If that is the case, any horn player not suited to that would be playing incorrectly. That implies horn players may be more at risk of embouchure failures. That might lead to more people studying apparent dystonias in horn players.

I have read some article or paper a while back that surveyed brass instrumentalists diagnosed with embouchure dystonia. I don't recall the exact numbers, but without finding it again my recollection is that high brass tend to be more prone to this than low brass.

I believe you are correct, horn pedagogy almost universally recommend a mouthpiece placement that is typical for the "very high placement" or Reinhardt IIIA embouchure type. Because of this, many otherwise good horn players will give up or switch to a different instrument if they don't happen to be suited for a IIIA embouchure in the first place. I also think that this may make those players more prone to type switching and therefore to embouchure dysfunction. But this is also pretty common on all the brass instruments.

It's been a while since I read Lewis's books, but they are based on her concept of "embouchure overuse syndrome," which essentially implies that all embouchure dysfunction is related to overplaying. Her books contain very little description of how a well functioning embouchure works. Her stated goal is to have a musician return to the embouchure they were playing with before the dysfunction happened - regardless of whether that embouchure was the original cause of the injury or not. She also makes claims that I find hard to believe, thousands of test subjects and insinuation of scientific research - all without any documentation of research methodology or actual data. Personally, I didn't find much of anything useful for my own playing or teaching in her books. My suggestion for struggling players is to look elsewhere.

Dave

[tbdana]

Dave, she's not in the game of "fixing embouchures." She's in the business of curing overuse injuries. And she has, indeed, helped a great many professional musicians whose careers were at stake (as well as even more amateurs). Think of her as a physical therapist, not a trainer.

I won't out the professional players I know of who have benefitted from her help. But one was a guy who got me into the Hollywood Bowl Orchestra and who was and remains one of the best trombonists in L.A.

You might not want to dismiss what she does so easily. I think you're looking at it from a Reinhardt diagnostician's point of view. That's a pretty narrow focus. Try taking a few steps back and starting from a position of understanding that she doesn't do what you do. She does something else. Don't fall into the trap of, "when all you have is a hammer, everything looks like a nail."

I don't make endorsements of people very often. She is one I do endorse.

[JTeagarden]

Doug is really good at what he does, I came down to visit him years ago with a trombone section, and he helped three of us immediately, and lastingly (the 4th guy wasn't really a serious player and wasn't going to understand, let alone actually follow anyone's advice).

[Wilktone]

Think of her as a physical therapist, not a trainer.

In my opinion that makes it worse. Physical and occupational therapy require degrees and license.

When I help a player struggling with severe embouchure problems I'm very clear that I don't diagnose or treat medical conditions, the way a therapist or doctor is. I can help a player sort out their chops, nothing more, nothing less. There are other music teachers out there, like Lewis, who skirt the line about practicing therapy or medicine.

She's in the business of curing overuse injuries.

Curing injuries is out of my lane as a music teacher.

[Wilktone]

You might not want to dismiss what she does so easily. I think you're looking at it from a Reinhardt diagnostician's point of view. That's a pretty narrow focus. Try taking a few steps back and starting from a position of understanding that she doesn't do what you do. She does something else. Don't fall into the trap of, "when all you have is a hammer, everything looks like a nail."

I did feel that I should clarify a bit more and see if I can address your criticism here, Dana.

I'm reluctant to endorse Lewis less because of my background studying functioning brass embouchures academically and what I think she's got wrong regarding embouchure technique, although that certainly is an issue.

More important to me is that she does not follow the established protocols regarding her research and the claims she makes. She definitely throws down a veneer of science, but doesn't follow the scientific method. She hasn't published any of her methodology, yet claims thousands of test subjects. If so, she would be required to obtain Institutional Review Board approval in order to experiment on human test subjects and her methodology needs to be published, including the waver form her subjects signed. Data should also be published and peer reviewed. Controls need to be applied to avoid bias and proper statistical analysis done to provide an accurate look at what the data actually means.

She has chosen not to do all this.

For what it's worth, I'm not the only one who has pointed this out before. In Dr. David M. Steinhorn's review of her book in the scientific journal, Medical Problems of Performing Artists, he wrote:

"The book’s primary weakness is its anecdotal nature, relying pri-
marily on the author’s personal experience and testimonies of
colleagues and students. For the medically sophisticated reader,
there is a large amount of lay wisdom with a paucity of scientific
data regarding the various issues discussed. Although the book
is intended as documentary rather than prospective, hypothesis-
driven research, no effort has been made to quantify the inci-
dence of embouchure problems amongst various brass players,
the potential benefits of the exercises proposed, or the efficacy of
one approach over another."

Quod gratis asseritur, gratis negatur (What is asserted without evidence can be denied without evidence).

[tbdana]

Dave, it's not worth arguing about with you. She's not a doctor of some science whose career is in research, she's a french horn player who happened on a way to help people, when no one else is doing so. It's a shame that scientists won't or haven't done the research necessary to help people with embouchure dystonia. In the complete vacuum of definitive science on the subject, I can't fault a french horn player with a huge track record of success. You can. I won't.

You may now seize the last word if you like.

I'll just close by chuckling at researchers who completed a five-year study that determined that dogs do, in fact, feel emotions. This, of course, is something every dog owner in the world knows with certainty to the depths of their soul. I find it hilarious that these scientists think they've just made this huge discovery.

Same with the scientists who studied laughter and pronounced laughter as "an interrupted defense mechanism," as if they made a discovery. To me, the exercise was merely taxonomic, and my thought upon reading their paper was, "What a waste of time and money."

OTOH, scientists at CERN have recently made several important discoveries that move physics forward in dramatic ways. Today they discovered antimatter particles hundreds of times the size of the largest such particles predicted, which will likely upend our understanding of the universe right after the big bang.

Not all science is created equal. Not all people who are not scientists are charlatans. Just ask my dogs.

[timothy42b]

It's been a while since I read Lewis's books, but they are based on her concept of "embouchure overuse syndrome," which essentially implies that all embouchure dysfunction is related to overplaying. Her books contain very little description of how a well functioning embouchure works. Her stated goal is to have a musician return to the embouchure they were playing with before the dysfunction happened - regardless of whether that embouchure was the original cause of the injury or not.
Dave

This is also opposite to what I think the "dystonia" therapists recommend. Or the "yips" specialists in sports.

A classic case in golf would be Haney, who has been fairly successful in getting golf swings playable again, but not the same swing. In his own case he patiently learned a slightly biomechanically different swing from his previous one, to allow bad neurological habits to be replaced with different - not necessarily better.

Doug does the same thing with embouchure, but with an emphasis on better. However it's also different.

Laurie Frink? maybe? and a few others who are in the extreme relaxation camp are doing something similar, I think. They seek to replace an old approach with a new one. They believe it to be better, but in fact it may work mostly because it is different.