embouchure damage and possible surgery

[holeypants]

I'd like the share with the trumpet community some chop problems I'm going through, in the hope that my story will be of some help to somebody experiencing similar troubles, either now or in the future.

This past spring, I was finishing up my M.M. at the University of New Mexico. I spent 1.5 - 2 hours on fundamentals every day (unless I had a extremely demanding gig that day), and I considered myself a strong player from an endurance and fundamentals standpoint. While I’m studying legit playing in school, I freelance pretty extensively as a jazz/commercial player. At the time, I was doing 3 sets of salsa or top-40 lead playing once or twice a weekend, and I was in great shape for it. Or so I thought.

On Friday, May 7th, 2010, I was playing lead trumpet with my top-40 band. Toward the end of the third set, during a particularly demanding chart, I felt a slight pinch on the left side of my upper lip. There was no lingering pain, and I was able to finish the set, but something just didn't feel right, and I could feel a “ball of flesh” in the middle of my top lip. I was pretty concerned right away.

I iced my chops for about 30 minutes when I got home, then went to bed.

The next morning morning, I tried to warm up as usual. I sounded like I usually do, my chops didn't hurt, and my range was not affected. However, the left side of my top lip felt squishy and weak, like there was less muscle there. After playing for about 20 minutes total, I was having trouble maintaining a firm embouchure. I put the horn away for the day and called a sub for the evening’s gig. I couldn’t remember the last time I played for only 20 minutes in a day.

On Monday morning, I called Dr. Simon McGrail and Dr. Craig Vander Kolk, two surgeons who have extensive experience repairing brass players’ lips. Dr. McGrail said “Come see me right away, and don’t play a note until you do.” Dr. Vander Kolk suggested I take some time off and see if things straightened themselves out. I decided to see if rest would help.

I took a month off, and it was the longest month of my life. When I started playing again, my lip didn’t feel like it had changed much – it still felt lumpy. After a couple of weeks of easy playing, though, I was sounding pretty good, and my lip felt stronger. I used Lucinda Lewis’ Broken Embouchures and Embouchure Rehabilitation extensively in my recovery, along with Caruso exercises, which I’ve always found extremely helpful. Since then, it’s been a roller coaster ride – a week or two of sounding great, followed by a hard gig and 5 days of barely being able to play for any length of time. Even when I’ve been happy with my playing since the injury, my top lip has still felt lumpy and abnormal, and my endurance is nowhere near where it was before the injury.

Despite being extremely careful, I’ve re-injured myself twice – once in early August, and most recently on Oct. 2. At this point, I’m tired of playing hurt, and I’m fairly sure there’s some structural damage – either a stretched or torn orbicularis oris muscle. I’ve canceled all upcoming gigs, and I’m making plans to see either Dr. McGrail or Dr. Vander Kolk in November (trying to figure out which one my health insurance will help with, if at all).

Since May, I've also spoken with several players who've gone through similar ordeals, and they've been extremely helpful. Even so, everyone's experience is unique, and there's no set process for dealing with an injury.

My main point is this – I didn’t see this coming. The only warning signs that I can recall were occasional sharp pains in the center of my lip in the weeks leading up to the injury, and I always heeded these pains by taking it easy for the rest of the day. I’m not a high-note jock, and I don’t beat my chops into the ground. For me, this was a bolt from the blue.

I have found it very helpful, though, to keep things in perspective: A lip injury for a working trumpet player is a major inconvenience with a lot of short- and mid-term consequences - there's no getting around that. Your life changes immediately, and in many ways.

However, even a severe chop injury is nothing like getting cancer, having your house burn down, or losing a loved one unexpectedly. Many people are met with far worse news than this every day, and I'm grateful for the fact that I'm still an incredibly lucky guy, despite this temporary setback. Counting my blessings, trite as it may sound, has been extremely therapeutic for me.

I’ll update you guys with my progress in the coming weeks. Thanks for reading, and take care of your chops!

Jonathan Vieker
_________________
Jonathan Vieker
The Lip Rip Blues
My ongoing recovery from a torn lip muscle, updated regularly!

[tptguy]

Jonathan, very sorry to hear of your setback. I know how frustrating it can be. I encourage you to call Jerry Callet in NY. He has worked wonders with hundreds of problems like this, including my own. He'll have you change your compression so your lips are no longer strained in the way they have been. It's just a phone call, so it really can't hurt. And, you may well find it a better-than-ever solution. And no surgery.

Best wishes, Kyle

PS - Jerry's contact info is on a sticky at top of Callet forum.

[TSUtrumpet]

Jonathan,

Brian is staying with me here in Tallahassee and told me about all of this. I'm sorry to hear it. I hope everything heals up soon. Keep me posted.

Dustin
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[Al Innella]

I did something similar to my bottom lip back in the mid 1970's. What helped me was changing the contour of my rim. I went from a standard rim to a semi-flat one. This gave my lip enough extra support and kept me playing without missing any gigs. Of course try to use as little pressure as you can.

[holeypants]

Update - 11/12/10

The injury has not improved, and in fact has gotten worse, with some sharp pains under rim of the mouthpiece. I've ceased playing completely to avoid aggravating it. Getting better at guitar, though!

Thanks to all who've expressed support, both through TH and otherwise. I'm flying to Toronto to see Dr. McGrail on Monday, and I'm excited to finally get some solid medical info on my injury.

If surgery is recommended, I'll have a very difficult decision to make. In the past several weeks, I've spoken with many players who've gone under the knife, and not always successfully. There's always a sizable risk that the surgery will not fix the problem.

It's a tough decision, and it's especially hard to know when to make the call, as one can always "give it a few more months" and see what rest will do. Of course, moderate rest (a month off in May and almost zero playing in October and November) has proven fruitless. If surgery is recommended, my only other option would seem to be long term rest - 6 months to a year (or more). While I'm willing to do take that much time off, there's no way to tell if it will work. I'm very interested to hear what Dr. McGrail has to say on the subject.

I'll have lots more info to post here in a few days. Stay tuned!
_________________
Jonathan Vieker
The Lip Rip Blues
My ongoing recovery from a torn lip muscle, updated regularly!

[PAB]

You might want to check out the books Broken Embouchures and Embouchure Rehabilitation by Lucinda Lewis. Find them, some excerpts and other info at www.embouchures.com

Good luck,

Ben

[holeypants]

[bg]

Dr. McGrail is the best. I saw him for a stretched muscle and over-icing damage I had caused in trying to treat a blow to my lip. As a result of the severe thinning I caused my tissue through this over-icing, I did his rehab exercises longer and more thoroughly than any of his patients. As a result, he often has people contact me with questions about the exercises.

While I did not have a playing injury, I have recommended him to many colleagues who have had torn lip muscles, and they have had good outcomes, providing they followed his advice.

Here is the most important issue for you:


If you have injured yourself playing, your embouchure formation is not allowing you to deal with the mouthpiece pressure. Many brass teachers teach fundamentals by suggesting their students think only of sound and air, and that they leave the embouchure passive. These same teachers often recommend minimizing mouthpiece pressure, rather than increasing embouchure strength.

I have heard from dozens of students who have torn their lip because they have no specific approach to embouchure strength/firmness. Many come from the same universities, repeatedly, schools whose trumpet professors often enjoy great reputations as orchestral gurus. The problem arises when the student attempts to play a strenuous gig or piece.

When people play "naturally", they either develop good embouchure habits or they do not. Those who do may enjoy great careers with no problems playing strenuous material. The problem arises when these people become teachers and they encounter students who don't have good technique. Not being aware of what it is that they, themselves, are doing, they can't help a student who has embouchure deficiencies.

So, Jonathan; Best of luck to you in your work with Dr. McGrail. I trust him
100%. When you do return to playing, you will need to change your technique, or you will be likely to hurt yourself again. An embouchure injury is not a one-time, freak accident. It is a symptom of a malformed embouchure being over-taxed. If your current teacher cannot explain how to develop a firm, stable embouchure, you will need to seek a teacher who is conversant in this knowledge.

Brad Goode
Associate Professor of Jazz Studies
University of Colorado
_________________
Brad Goode
www.bradgoode.com

[fraserhutch]

Sorry to hear about your pain, dude. I wish you well.
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[holeypants]

Good news - the muscle's stretched, not torn. No surgery!

Thanks again to all who've sent words of encouragement. I'll post a more comprehensive description of my visit with Dr. McGrail and my rehabilitation plans later this week, but right now, the wife and I are going to see Toronto!
_________________
Jonathan Vieker
The Lip Rip Blues
My ongoing recovery from a torn lip muscle, updated regularly!

[ExtraLargeBore]

[trumpetera]

Good news indeed!

There is a fabulous doctor in Stockholm-cant remember his name right now-, Sweden you should meet, should this not sort itself out, and also Bo Nilsson (famous trumpet teacher of Hardenberger and others), living just outside Malmö, southern Sweden.

Come stay here if you want to see them!
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[PAB]

That's great news! Glad to hear it.

Good luck with your rehab and enjoy Toronto.

Ben

[holeypants]

Okay - finally sat down to write an update.

After my trip to Toronto, I immediately began doing the exercises Dr. McGrail prescribed me. While I don't have his permission to share them publicly, I'll say that they're very strenuous, and they've already made a big difference in terms of pure strength and evening out the muscle tone in my upper lip.

They're available in full in Lucinda Lewis' book Broken Embouchures - a great read for any serious student of the instrument, and a must read for anyone who makes their living teaching or playing. If the trumpet is your career, I don't think you can afford not to familiarize yourself with the symptoms of embouchure overuse.

I've been quite happy with my progress thus far. The real challenge in all is this isn't just building up strength - that's fairly straightforward. It's retraining my chops to set with firmness (but not excess tension). During the months that I was playing injured, I developed a unconscious habit of setting with very little structure in my embouchure. I'm now focusing on setting my embouchure correctly, and replacing a bad habit takes a lot of time and patience.

The pain I had been feeling under the rim of the mouthpiece is much less apparent now, and I can play for longer periods of time without it setting in. When discomfort does rear its head, it's much less intense - more of a tickle than anything.

I'll keep updating this thread from time to time. I'm hoping to be close to full strength in a couple of months, but there's really no way to set a firm date - too many variables, and you can't rush this sort of thing. If it takes longer, I won't be disappointed - I'm just happy to be playing again.

Once more, I can't emphasize enough how helpful Lucinda Lewis has been, both through her books and emails back and forth. She's a fantastic resource.

Oh, and Toronto was awesome. It's a beautiful city with a great big-city perk: Lots of cheap, good food!
_________________
Jonathan Vieker
The Lip Rip Blues
My ongoing recovery from a torn lip muscle, updated regularly!

[holeypants]

Another update:

Thanks again to all of you who've sent messages of support or posted on this thread. TH is great place in many ways!

Recovery has been gradual and has taken longer than I'd hoped, but overall I'm quite happy with how things are going. One of the biggest challenges in rehabilitating an injured embouchure is that one does not experience the steady progress one is accustomed to in the practice room. Lucinda Lewis makes note of this in Broken Embouchures, and I've found that I'm no exception.

With a run-of-the-mill playing issue, one attacks the problem in the practice room and expects to see some results within a few days, if not a few minutes. While we all have periods of frustration on the horn, we serious students of the instrument expect to see consistent improvement in our playing. As Phil Collins says, "if you are not getting better at a noticeable pace, practicing is a waste of your time."

Recovering from an injury is a little different. There have been periods of up to two weeks when everything works and I feel like I'm finally out of the woods: I'm playing with no pain, my sound is sparkling, and endurance, though not where it was pre-injury, is clearly increasing. Two days later, I may find that nothing is working correctly and my nerve pain has returned. Although these "bad" periods are becoming shorter, fewer and further between, they're still endlessly frustrating.

As I reflect on my playing before getting hurt, I realize now that I was setting myself up for an injury like this. At various times I dealt with sore front teeth and sore lips, and when I got tired, the fatigue was always under the mouthpiece, not in my corners. I've been using James Stamp's material and general principles extensively in the past two months, and it has turned me around in terms of constructing a "puckered" or "forward" embouchure with firm corners and enough muscular support to handle the mouthpiece. A recent lesson with Brad Goode also opened my eyes in this regard. Now when I get tired, it's mainly my corners that feel it.

Again, my primary goal in maintaining this thread is to provide a good resource in the TH archives for anyone faced with an injury in the future. I'm also working on an article for the ITG Journal about this whole experience and the basics of embouchure damage, prevention and rehabilitation. If it's accepted, look for it in ITG about a year from now!
_________________
Jonathan Vieker
The Lip Rip Blues
My ongoing recovery from a torn lip muscle, updated regularly!

[txtrumpetguy]

This thread has been particularly informative, as I've been struggling with chop issues myself. I've been trying Lucinda's ideas with some success. Still working through the issue. Glad to hear that you're making progress.

[trptdoc]

Great topic and rational discussion. I am impressed with how often players with embochure problems become overwhelmed with the psychological trauma of not being able to play. Most can't believe it's due to overuse. Remaining logically focused on the underlying problem usually allows us to find the source and devlop a rehab program that works. No one soulution fits all. Finding the right exercises is similar to the rehab process necessary with other musculoskelatal problems. In over 40 years of teaching I have never had a student that had to have surgery. The fear of relapse often becomes a life long curse if not dealt with early. It sounds like the author of this thread has got it together.

D. Larry Miller,MD

[nyctrumpeter]

[KRossum]

sorry to hear about your problems, but thank you for sharing your progress.

all the best.
-Kelly
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www.krossum.com

[bilboinsa]

Jonathan:

So glad that you are on your way to recovery. Do you think that Lewis' book would be a good pre-injury strengthening routine?
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