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Lip Injury??



 
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seanmc
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Location: pittsburgh, pa

PostPosted: Sun Jul 19, 2009 12:08 pm    Post subject: Lip Injury?? Reply with quote

Hey everyone- long time lurker, first time poster here.

I've read through a number of threads on this forum concerning lip injuries with great interest. I was hoping some members who have had experience with or encountered lip injuries could give me some advice about what I'm experiencing:

Quick back story- I studied the horn pretty seriously as a youth (I know that's a highly relative term) and by the end of high school had acquired a certain level of proficiency that was very happy with- great sound, easy playing, solid technique (enough at least to make all-state on the Halsey-Stevens), and a pretty consistent high F. Fast-forward 10 years and I can barely play a 3rd space C without everything falling apart. The decline was pretty gradual at first and I'd assumed it was just lack of time to practice, but it's clear that many bad habits and mechanical problems have crept in. For the past 5 years it's been endless starts and dead-ends, sometimes with a teacher, sometimes on my own. I don't need to be convinced of the merits of a teacher btw- I've got a great one right now and I've always been able to make more progress with one.

But I'm nervous that an injury might be what's preventing me from recovering further. There's what I can only describe as a "crease" on one side of my upper-lip, right under where the mouthpiece rests. It's partially on the inner lip, but curves around and is just visible on the outside when my mouth is closed. It's roughly 1/2 cm long and the skin immediately around it is a lighter shade- almost white. I can definitely feel a very small lump under the skin when I rub my finger across it as well.

It's only uncomfortable when I play, and it ends up feeling bruised and swollen almost immediately. And that's even while using what seems the bare-minimum mp pressure. I've tried taking weeks off and there's been no change. Could this be scar tissue? A cyst? Signs of a stretched or *gulp* torn lip muscle? I've read what parts of Broken Embouchures that I could find online and was thinking of purchasing the book. I've also read a little of Dr. Simon McGrail and his recommendations for rehabilitation. I've gotten the impression that if it is indeed an injury, it won't get any better with rest. Has anyone experienced this before?

I can remember a slight discomfort in the same place even back in high school. Once I had developed a consistent high range I immediately became lead in every local and school band and production and I was playing gigs around town. To say I overdid it would not be a stretch, and I wonder if this could be something I did to myself a long time ago that I'm just further aggravating now?

I would appreciate any advice or insights you all have. Similar experiences, links to other threads, etc.

Thanks!
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robertgrier
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PostPosted: Sun Jul 19, 2009 1:00 pm    Post subject: Reply with quote

You said there's a lump there. If it were myself, I would have it checked out by a doctor to see what it is. Even a very slight lump under the mpc would affect the lips ability to vibrate freely. What does your teacher say? From what you say about your early playing you couldn't have too many bad habits. Of course a lack of consistant playing and you can lose your lip really fast. Don't try a fix this yourself. Your teacher may have te experience needed to help you. Note: not all teachers can help with chop problems. Find out what the lump is and let us know. That's the first step.
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razeontherock
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PostPosted: Sun Jul 19, 2009 2:48 pm    Post subject: Reply with quote

While it sounds like scar tissue, scar tissue won't typically get tender or swell. Definitely treat this as potentially serious!
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TrumpetMD
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PostPosted: Sun Jul 19, 2009 3:41 pm    Post subject: Reply with quote

Hi seanmc,

Sorry to hear about the trouble you've been having. Let me make a couple comments as a physician. These are only general comments, since I've not seen you or examined you.

I believe what you are describing is a 1/2 cm linear lesion, starting from the inside of your upper lip and ending just in the red area of your lip, starting right where the mouthpiece rests, and is less colored than your normal skin. You think you've had it since high school. You also think that bad habits may have contributed to it. Let me know if I'm missing anything.

It sounds like scar tissue from a torn muscle or prior injury. It also could be something else. However, it really can't be diagnosed without someone taking a look at it and getting more history from you. So it definitely makes sense to get it checked out.

FWIW, razeontherock makes a good obsevation about scar tissue not swelling. But if the scar is serving as a source of irritation, the surrounding area could definitely swell.

Wayne Cameron had scar tissue from a ruptured lip muscle, which he had repaired by a plastic surgeon at Hopkins. He's in the Baltimore area, which isn't too far from Pittsburgh (http://waynecameron.com/teaching.html#chops).
Send him an email. He's happy to talk to people about his experience.
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Al Innella
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PostPosted: Sun Jul 19, 2009 4:13 pm    Post subject: Reply with quote

If it is scar tissue try moving it from the rim into the cup ,I had a very bad injury to my upper lip when I was in high school and had to change my mouthpiece placement to get the scar tissue in the cup and away from the rim ,that was back in 1967 and never had any problems with the change.
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TrumpetMD
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PostPosted: Sun Jul 19, 2009 5:46 pm    Post subject: Reply with quote

Al makes a great point. Assuming it is scar tissue, surgery is not the only option, and may not necessarily be the best option.
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Craig Swartz
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PostPosted: Tue Jul 21, 2009 6:25 am    Post subject: Reply with quote

Our tuba player actually had a small but painful cyst removed a few years back. It wasn't visible from the outside but it's removal has kept him playing probably 15 years longer so far than he may have been able to without the very minor surgery. Good luck.
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perspective
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PostPosted: Wed Jul 22, 2009 12:59 pm    Post subject: Reply with quote

Your experience demonstrates just how vitally important that tiny 10mm or so of flesh is to trumpet playing. The small physical change in just a part of your lip has altered the texture of it at that point, bringing about, as you have told us, a vast degradation in your abilities on the instrument.

Presumably the rest of you, lungs etc., perform the same as they ever did but, anything that interferes with that all important vibrating membrane that actually produces the sound then everthing else pales into insignificance. You are living proof of that.
Contrarywise, I'm convinced that there are those who have lip texture which is well suited to trumpet playing that is a fortunate "accident" of birth and been able to progress with the minimum of problems. We all know them, don't we ? Hardly ever practice, no warm up, no need to, safe in the knowledge that when the band starts they will handle everything just fine. Until then they just sit and push the buttons on their cell phones, casually waiting for the off..... no sweat.

Anyway, perhaps you could work on developing an embouchure to one side of the injury so that the hard scar and lump is outside the rim. It won't be easy because your lip muscles will not be accustomed to working in that way. But I have seen good players that play well off centre. However, whatever course of action you decide upon, good luck with it.
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seanmc
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PostPosted: Sat Jul 25, 2009 10:09 am    Post subject: Reply with quote

Just wanted to say thanks to all who posted. It's really great that a site like this is around and that you all are willing to share your advice/knowledge/experience- it's not like you just walk down the street and bump into someone who knows about tpt lip injuries.

I'm definitely going to seek medical advice about this. Seeing as how I don't have insurance, this is going to be a process, but it's worth it to me if I can continue playing comfortably in the future. I'll be sure to update this thread as I find out more in the hopes that it can be of help to others later.

With the aid of my teacher, I've figured out a lot of what I was doing wrong to exacerbate the problem. Whether it was the result of an injury or not, at some point in the past I was having trouble keeping the aperture open when I played and unconsciously switched to pinning my lips apart with pressure. This allowed me to retain the warmth and projection of my tone, but- well you can probably guess where that's landed me. It actually stumped a few teachers in the past who couldn't figure out how I kept a good sound but got tired after 20 minutes.

So, assuming I'll be able to eventually clear up the medical issues, there's a lot of work to do relearning the basics of tone production. First thing's first though- off to the doctor.
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perspective
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PostPosted: Mon Jul 27, 2009 12:40 am    Post subject: Reply with quote

So, assuming I'll be able to eventually clear up the medical issues, there's a lot of work to do relearning the basics of tone production. First thing's first though- off to the doctor.[/quote]

seanmc. If you are willing, of course, perhaps you would come back and let us know what your doctor has said about it. 'Hope it's nothing too serious.
Cheers.
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pied piper
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PostPosted: Mon Jul 27, 2009 1:21 am    Post subject: lip injury Reply with quote

It is difficult to asses your situation w/o seeing you or at the very least some pix of what your lip looks like before and after playing.

I had a very serious lip injury which led me to Lucinda Lewis and eventually Dr. McGrail. I had surgery to repair a rupture of my obicularis oris in 2003. Since then I've worked to better my playing and eliminate the cause(s) of the injury. I have also had many conversations with other brass players about whether or not they have an injury serious enough to warrant seeing Dr. McGrail and how to recover from that procedure. I will send you my email if you want to send some pix. From there we can SKYPE each other and observe what is going on and go from there.

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GenoValet
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PostPosted: Mon Jul 27, 2009 4:28 am    Post subject: Reply with quote

(1) See a doctor.
(2) My similar experience: http://www.trumpetherald.com/forum/viewtopic.php?t=62990&highlight=hernia

The good news is that it can heal 100%, but you must stop playing until you are certain it is gone, then start up slowly again.
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seanmc
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PostPosted: Thu Mar 18, 2010 8:00 am    Post subject: Reply with quote

just thought i'd update this thread after getting back from a trip to Toronto yesterday to see Dr. McGrail.

with the help of my teacher, i spent about 6 months trying to build a new embouchure that avoided the tender areas in the middle of my lip. playing off to the side brought instant improvement in tone, response, flexibility, etc. but i had to go so far over as to be literally playing out the side of my mouth. and even though the mp wasn't landing on any uncomfortable spots, the center of my lip STILL swelled up painfully every time after only 10 or 15 minutes of playing.

so i finally decided to see Dr. McGrail. it took him about 2 minutes of examining to tell me that i've got a torn lip muscle. so bad in fact that there's no muscle left in the center of my lip- it's just scar tissue. how i'm able to still play at all is baffling to me.

but what a relief it is to know what's wrong! for all these years i've been thinking that i needed to work on fundamentals, rebuild my mechanics, etc. but no amount of practice- no matter how careful- was going to rebuild the muscle. i really wish i'd known about the possibility of an injury like this earlier!

i'm definitely opting for the surgery. once i've gotten my finances in order i'll be making an appointment, and i'll be sure to update this thread with my progress.
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John Mohan
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PostPosted: Mon Mar 22, 2010 12:51 pm    Post subject: Reply with quote

Get a second opinion. Surgery might be required, but surgery is a very, very serious step with potential ramifications. How did the doctor determine you have a torn lip? Just by sight and feel?

He might well be right, and he probably is. But you should make sure probably is not just probably.

Best wishes,

John Mohan
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TrpPro
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PostPosted: Mon Mar 22, 2010 1:11 pm    Post subject: Re: Lip Injury?? Reply with quote

seanmc wrote:

It's only uncomfortable when I play, and it ends up feeling bruised and swollen almost immediately.

Have you experimented with placing the mouthpiece on a different place on the mouth that the lips will still respond to (off to one side or the other), completely off the spot that gets inflamed? You won't sound very good at first but if it's playable without causing the irritation to your lips this could be an option. Mendez developed three placements, so I'm told.
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John Mohan
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PostPosted: Tue Mar 23, 2010 12:57 pm    Post subject: Reply with quote

Hi again,

How much is the Surgery going to cost? If you have insurance, will it cover at least part of it?

Best wishes,

John
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seanmc
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PostPosted: Thu Apr 01, 2010 7:20 pm    Post subject: Re: Lip Injury?? Reply with quote

TrpPro wrote:
seanmc wrote:

It's only uncomfortable when I play, and it ends up feeling bruised and swollen almost immediately.

Have you experimented with placing the mouthpiece on a different place on the mouth that the lips will still respond to (off to one side or the other), completely off the spot that gets inflamed? You won't sound very good at first but if it's playable without causing the irritation to your lips this could be an option. Mendez developed three placements, so I'm told.


yeah, i spent about 6 months cultivating a pretty severe off-center placement. the problem is, i can't go over far enough to move the mp completely off the damaged tissue. i'd literally have the rim on my cheek if i tried.

and more importantly, i'm unable to create enough compression to produce a tone above a low C or D. for playing in the staff, it's a combination of pressure and pretty intense lower-lip compression. playing above the staff is impossible.

as i understand, this is consistent with a stretched or torn muscle, since the added length greatly weakens the muscle's strength.
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seanmc
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PostPosted: Thu Apr 01, 2010 7:34 pm    Post subject: Reply with quote

John Mohan wrote:
Get a second opinion. Surgery might be required, but surgery is a very, very serious step with potential ramifications. How did the doctor determine you have a torn lip? Just by sight and feel?

He might well be right, and he probably is. But you should make sure probably is not just probably.

Best wishes,

John Mohan


great advice, but at this point i'm planning on taking the plunge anyway. i'm not aware of too many doctors who are knowledgeable about these injuries, aside from the late dr. planas, dr. mcgrail, and possibly someone in baltimore? i could research the doctor in baltimore and head down there to get his take, but honestly i'm putting my trust in dr. mcgrail's experience. he did make the diagnosis by sight and feel- he actually felt along the muscle while i attempted to buzz. as i understand it, this is similar to the way a sports doctor might look for structural deficiencies in an athlete's muscle- appropriate since dr. mcgrail spent most of his earlier career in sports medicine.

i'm not expecting a miracle here, but playing the horn went from being the most enjoyable/fulfilling thing in my life to a constant source of anxiety and frustration in a few short years. this is sort of a last-ditch effort and i'm willing to make the personal sacrifice. already got a new & better-paying day job to pay for the procedure!
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bg
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PostPosted: Thu Apr 01, 2010 8:27 pm    Post subject: Reply with quote

Dr. McGrail is the best. I trust him, 100%.

Best wishes in your recovery. Feel free to PM.
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