Unless you are one of my regular readers chances are that you’ve come to this post looking for advice about some severe embouchure dysfunction. While I hope the following can provide some helpful avenues to explore, my target audience here are more the music teachers out there who promote themselves as “chop docs” or purport to diagnose and/or treat what often gets called “embouchure dystonia.” For the purposes of this essay, I will be using the terms “embouchure dystonia” and “embouchure dysfunction” at times interchangeably. I will try to be specific with my language when possible, but keep in mind that what some folks call “embouchure dystonia” may not be a neurological disorder, but an issue of embouchure mechanics.
The National Institute of Neurological Disorders and Stroke define “dystonia” as:
…a disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. The movements may be painful, and some individuals with dystonia may have a tremor or other neurologic features. There are several different forms of dystonia that may affect only one muscle, groups of muscles, or muscles throughout the body. Some forms of dystonia are genetic but the cause for the majority of cases is not known.
More specifically relevant for brass players’ embouchures, the variety of dystonia that we need to understand is known as a “focal task specific dystonia.” Again, from the NINDS:
Task-specific dystonias are focal dystonias that tend to occur only when undertaking a particular repetitive activity. Examples include writer’s cramp that affects the muscles of the hand and sometimes the forearm, and only occurs during handwriting. Similar focal dystonias have also been called typist’s cramp, pianist’s cramp, and musician’s cramp. Musician’s dystonia is a term used to classify focal dystonias affecting musicians, specifically their ability to play an instrument or to perform. It can involve the hand in keyboard or string players, the mouth and lips in wind players, or the voice in singers.
Before I go further I need to clarify my background and thoughts on embouchure dystonia. As I always try to point out when discussing anything medical, I am not a medical professional and in no way am I qualified to diagnose or treat a neurological disorder. While I will attempt to describe some possible causes, or at least correlations, with severe embouchure dysfunction below, my thoughts and advice should in no way be considered valid medical advice. Always consult with a medical professional if you suspect a medical condition.
The Difference Between Music and Medicine
This leads me to my first criticism, music teachers who purport to diagnose and treat medical disorders. Stop it. While your intentions may be good and you may very well be helping folks suffering from embouchure dysfunction recover, there is potential to cause great harm. Call what you do what it is, embouchure troubleshooting. Unless you have had the medical training and licensing to legally treat and/or diagnose medical conditions you are skirting the line of practicing therapy or medicine without a license.
I mentioned potential harm. I will shortly argue that there are non-medical reasons why some brass players’ embouchures break down and cause symptoms consistent with focal task specific dystonia. Unless you have the qualifications to diagnose a medical condition your proclamation that a student coming to you for help with embouchure dysfunction has “embouchure dystonia” may cause that person to delay or avoid necessary medical treatment. If the student has Bell’s palsy or a mild stroke, for example, delaying a correct diagnosis and proper medical attention can ruin the student’s chance at making a complete recovery. Or it can lead to more serious complications beyond playing a brass instrument. Medical conditions like focal task specific dystonia do exist and should be treated under the supervision of a qualified professional.
Leave the medicine to the medical professionals and you should advise your students to seek medical attention, when appropriate.
Do Your Homework/Ignorance Is Not Bliss
It sometimes surprises me how ignorant the field of brass pedagogy as a whole is of embouchure form and function. There is definitely a culture of ignorance here that discourages brass musicians from learning to truly understand how their embouchure functions and put it into a larger context of how different brass players play differently. One of the most influential voices in encouraging players and teachers to remain blissfully unaware was Arnold Jacobs. Jacobs encouraged his students to, “Think product, not methodology” (Also Sprach Arnold Jacobs: A Developmental Guide for Brass Wind Musicians). Whether or not he actually intended this idea to be taken as such, many brass teachers have interpreted this to mean that one should never analyze brass technique.
Roger Rocco, a former student of Jacobs, has written on his blog that embouchure dystonia is caused in part by:
Focus on self awareness, self analysis, or the instrument.
He doesn’t cite any medical literature supporting this statement, nor does it align with what any reputable sources state about focal task specific dystonia. As the bulk of Rocco’s discussion on his blog related to embouchure dystonia is ideological and philosophical, I would question his statement here.
Another common, but misguided, approach to treating embouchure dysfunction is to assume that it is purely a result of overuse. Lucinda Lewis’s web site and books make this mistake. According to Lewis:
For the purpose of discussion here, embouchure overuse syndrome refers to any chronic embouchure-related playing problems which last for more than two weeks and includes any or all of the following: lip pain, chronic lip swelling or bruising, numb, rubbery, or cardboard lips, recurring pressure-point abrasions, air-induced abrasions, lack of endurance, unfocused sound, lack of playing control, and chronic high-range problems.
– Broken Embouchures, by Lucinda Lewis
What she has done here is taken virtually every embouchure issue and placed them under the umbrella as “embouchure overuse.” The problem is this not only oversimplifies the issue, but also prescribes a general treatment program that may not be relevant for the situation. Chronic high range problems can come from a variety of mechanical issues, many not related to overplaying. Abrasions on the lips can be exacerbated by twisting the lips up with the mouthpiece. Lip swelling and bruising can occur because the mouthpiece placement isn’t balanced correctly between the upper and lower lip. A particularly demanding playing period may be the proverbial straw that breaks the camel’s back, but incorrect mechanics are possibly behind the issues to start with.
It’s easy to find similar ideas throughout the musical literature, but sources that discourage embouchure analysis typically lack an accurate and complete discussion of brass embouchure mechanics. You can’t analyze something you don’t understand. What they miss is that if you are analyzing something incorrectly you’re going to have trouble making the needed corrections. Combine this with the pithy phrase that embouchure “analysis leads to paralysis” and you’re going to create a self-fulfilling prophecy. Do your homework first.
As a general field, brass pedagogy is largely ignorant of brass embouchure form and function. Some folks are willingly so and proud of it. Other folks are misguided. I like to think that most brass players and teachers simply have been ill-advised and with access to good information will be able to make more informed decisions about how to practice and teach embouchure development. Either way, actively discouraging people to avoid learning about reality is doing our brass students a serious disservice and you need to stop it.
The basic brass embouchure types as a topic is not all that difficult to comprehend. If you feel that having a general understanding of music theory is helpful for performing music (and I hope you don’t need to be convinced of that), then surely making a similar effort to understand brass embouchures better is well within your capabilities. Yes, there is a time and place for forgetting about brass technique, but don’t throw out the baby with the bathwater. You must make an effort to fully understand a topic before you dismiss it as unnecessary or wrong.
What You Need To Know About Brass Embouchures
In order to treat embouchure dysfunction you need to first understand embouchure form and function. Since there are many contrary ideas out there you will need to have the tools to place them into a proper context. I’ve written fairly extensively about this topic on this site, but I will go over some basic information in this post in order to better make my points. A good introduction to this topic, however, can be found here and a more complete one here.
If you look closely at brass players’ embouchures you will soon notice that every embouchure is different. This makes sense, since every player has different anatomical features. That said, you will also begin to notice that there are specific patterns in brass embouchures. Using two observable features of a functioning brass embouchure you can begin to categorize all brass embouchures into different types. These embouchure types are not practice methods or instructions, but rather describe observable characteristics that all brass embouchures have, whether or not the player is aware of them.
The first category to note is that of air stream direction. While many players are convinced that they blow the air straight down the shank of the mouthpiece, observation with a transparent mouthpiece shows otherwise. Virtually every successful brass player will place the mouthpiece so that one lip or another predominates inside the mouthpiece. When more upper lip is placed inside the mouthpiece the air stream passes the lips and gets blown in a downward direction. The reverse is true when more lower lip is placed inside, the air stream passes the lips and strikes the mouthpiece cup above the shank. Horn angle, while important to an individual’s embouchure, does not determine air stream direction, mouthpiece placement does.
These days brass embouchure air stream direction should be common knowledge, but it isn’t. This characteristic has been independently discovered and confirmed by a variety of sources and the literature is available in academic libraries and much of it is now freely accessible online. More importantly, it’s not that hard to see for yourself. The link I posted in the previous paragraph shows some photographs and videos and transparent brass mouthpieces are available and relatively cheap. If you’re helping players with severe embouchure dysfunction you need to be aware of air stream direction and whether or not your student’s embouchure is upstream, downstream, or switching between both. You will want to understand that not everyone plays with a mouthpiece placement that fit’s his or her anatomy and be aware that changing mouthpiece placement and air stream direction can help or hurt some players, sometimes in a dramatic fashion.
The other embouchure characteristic that is even less known about in the field as a whole is what I prefer to call an “embouchure motion.” Virtually every successful brass player, whether or not they are aware of it, will push and pull their mouthpiece and lips together as a single unit in an upward and downward direction along their teeth and gums while changing registers. The general direction and specific angle that this embouchure motion takes varies between players, but it appears to be an essential part of a well functioning embouchure. Some players will generally push the mouthpiece and lips up towards the nose as they ascend, while others will pull down. These basic patterns also correlate with an individual’s air stream direction. Upstream players will almost always pull down to ascend, while downstream players may either do the same or the reverse. Again, this phenomenon has been discovered and independently verified by different resources, but is still not widely known about.
Using these two basic embouchure characteristics alone it’s possible to categorize at least three basic brass embouchure types. Using other features, such as jaw position and horn angle, it’s possible (but probably unnecessarily complicated) to define even more brass embouchure types. If you’re helping players recover from severe embouchure dysfunction you should become aware of these basic brass embouchure types and learn how to spot them. These are important variables you need to consider.
While I haven’t seen as many cases of embouchure dystonia or embouchure dysfunction as some, every single case that I have looked closely at (and documented, in some cases) exhibits some form of embouchure type switching. A handful of these are players who probably should be playing with an upstream embouchure but for some reason aren’t, often due to advice from well-intentioned but ignorant teachers. More commonly, however, I see type switching between the two basic downstream embouchure types. If you look for these players’ embouchure motion you will be hard pressed to see if they are pulling down to ascend or pushing up. Sometimes they reverse the direction at a particular point in their range or they go too far with the embouchure motion at a certain point. Here’s an example from YouTube recorded by Joaquín Fabra, who believes that embouchure dystonia is a “behavioral” problem and treats dystonia as a psychological issue. Watching the video of that particular horn player you can see his embouchure motion changing directions.
Here’s another video recorded by Fabra that shows a trumpet player. Note how this player’s embouchure motion during the earlier part of the video shows his mouthpiece and lips bobbing around for almost every attack. Every time he plays a note he is trying to hit a moving target. Later in the video, the trumpet player is largely symptom free and you will be able to spot how much more consistent the embouchure motion is, particularly on the initial attacks of notes.
To the best of my knowledge, Fabra doesn’t even consider the player’s type switching. In his interview with Dave Stragg Fabra is quite clear that he feels embouchure dystonia is caused by an emotional condition and he avoids discussion of embouchure mechanics, even going so far as to imply that the embouchure analysis is partially responsible for the condition in the first place. Considering his apparent lack of understanding of the basic embouchure types, but the correction of type switching in many of his documented examples, I argue that Fabra’s approach would benefit from not merely treating the psychological results of severe embouchure dysfunction but consciously correcting embouchure mechanics.
Returning to Lucinda Lewis’s thoughts, she feels that a treatment program for embouchure dysfunction requires the brass musician returning to their embouchure form prior to the breakdown. In Broken Embouchures she wrote, “Fixing your embouchure means rehabilitating your mechanics back to their pre injury integrity.” (2005, p. 40). What is missing from her text, however, is any consideration if the pre-injury embouchure was malfunctioning in the first place. My favorite analogy for this is lifting heavy objects with your back. You can get away playing wrong for a while, particularly if you’re naturally strong. Keep lifting with your back over time, however, and you’re going to be more prone to injury. If you suffer from severe embouchure dysfunction and get better by returning to your old way of playing you should consider that you might just be getting better at playing wrong. Teachers need to be aware of their students’ embouchure type and overall embouchure form in order to eliminate type switching as the culprit to embouchure dysfunction. It can also help players correct type switching before it causes the breakdown in the first place.
Where To Go From Here
The bulk of my above rant is largely concerned with the lack of awareness among brass teachers and players of embouchure mechanics and our inability to put them into a proper context when troubleshooting embouchure dysfunction. If the field of brass pedagogy is dropping the ball here we can’t expect the medical community to be any better, and players suffering from embouchure dysfunction are perhaps not going to be well served by doctors and therapists treating embouchure dystonia. But beyond this issue, which will be corrected over time when more players become better educated on this topic, we need to start asking better questions about embouchure dystonia. Some of these questions can (and should) be objectively researched, but again, this needs to start at the level of the musical community, who are not only going to have a higher stake in this issue but also should have the necessary background in brass technique to better study brass embouchures.
But in order to do this better music educators need to take research methodology more seriously. To a certain degree, our lack of awareness of how to conduct research and interpret academic articles and papers is understandable. We are first and foremost artists and our primary concern should be musical expression. That said, critical thinking is a skill that pays off in dividends both in and out of music. It behooves all brass teachers, not just ones who specialize in treating embouchure dysfunction, to learn about cognitive bias, how to conduct original research, and how to search for accurate and quality information on musical topics. Once we have changed our culture of ignorance for one of critical thinking and awareness we can begin asking (and researching) questions that potentially lead to more effective treatment of embouchure dysfunction. Here are a few that I personally feel we should be asking.
- Are certain embouchure types more prone to severe embouchure dysfunction than others?
- What embouchure characteristics (e.g. embouchure type switching) correlate to embouchure dysfunction?
- Is embouchure type switching a cause of a specific neurological disorder that can be mapped in the brain or does the neurological issue cause the type switching?
- How often is a diagnosis of focal task specific dystonia of the embouchure really a result of type switching?
- Does conscious correction of embouchure type switching lead to improvement in embouchure dysfunction?
- Do programs that are successful in treating severe embouchure dystonia lead to a player correcting embouchure type switching, even if type switching is not a consideration of that program? If so, would conscious corrective procedures that encourage a player to avoid type switching better serve?
- Do mechanical issues related to embouchure type switching lead to the psychological troubles that brass musicians suffer from? If so, can making mechanical corrections lead to a reduction or elimination of the psychological issues?
- How can brass teachers helping players who suffer from severe embouchure dysfunction balance a treatment program to address both the mechanical issues related to embouchure type switching and the psychological issues related to inability to perform?
Leading To Open and Honest Communication
I have criticized some folks by name in this essay and elsewhere online before. In the past some of these teachers have taken this criticism personally, even though that is not my intention. Please note that I do my best to address ideas, not people as individuals. I also am very careful to try and qualify my opinions as much as possible to clarify when one of my ideas is based on objective evidence or mere speculation. Furthermore, I have been wrong before and will continue to be wrong again. One of the reasons I post my thoughts about this topic publicly is so that experts can point out the flaws in my reasoning.
The scientific method has been so successful due to its self correcting nature. Brass teachers helping players suffering from severe embouchure dysfunction need to follow this model more. This involves questioning each others’ ideas, challenging our own assumptions, and engaging in an open and honest debate with each other. Too often we view this as being impolite and forget that this is how advances are made. No single individual treating embouchure dystonia has all the right answers, no matter how successful their treatment program seems to be. The lone genius leading the way for everyone to follow is really just a myth. We are collectively a lot smarter than we are individually.
Advice For Suffering Players
If you made it through all this and you are a player suffering from severe embouchure dysfunction I want to conclude with my advice for you. I have had some success helping some folks with chop problems myself and I also know a handful of folks around the U.S. that I recommend, but if you want help you’ll probably have to travel to someone unless you happen to live in their area. Video consultations, while having potential, generally don’t lend themselves to diagnosing embouchure problems and the solutions.
There are brass teachers who are successful at helping folks with embouchure dysfunction who don’t demonstrate an awareness of embouchure types and how to correct type switching, but I typically would encourage a student to seek the help from someone more knowledgable. Ask questions. Furthermore, when you are looking for help I think it’s good to remember the Dunning/Kruger Effect. The more black and white a discussion of embouchure dysfunction is and the more sure of themselves they can help, I find the more likely their approach is going to be based on philosophy or analogy than objective reality. Treatment programs that are based in the “Harold Hill Think System” may be more likely to be successful in spite of, rather than because of what you learn. A second opinion may be a good idea, even if it seems to be working for you.
Then again, I may be wrong. Take the time to follow some of the resources and links I’ve posted here about brass embouchure function and dysfunction and judge for yourself. My goal here is to make brass teachers and players aware of the information that is available in order to place advice into a proper context, not scare anyone away from an opposing viewpoint. I welcome questions and criticisms to my own ideas and encourage you to leave them in the comments section below.