More Thoughts on Dealing with Playing Injuries and the Stigma of Talking About It

We (musicians) have a lot more people coming out and talking about their injuries and issues these days, which is a good thing. Unfortunately, there is still a stigma that keeps many musicians from talking. I totally understand it. I lied and kept gigging until I just physically couldn’t play anymore. It was tough, because I didn’t have a full-time job, and these gigs comprised most of my income. I didn’t want to lose the gigs, so I just kept taking them. After each gig, my playing got worse, because I wasn’t focusing on good habits. I was just trying to figure out a quick fix to get me through the performance. I’d work on fixing the real problem later….except that the real problem ended up being too big to fix, because I kept putting it off.

I really wonder if things would be different if our society of musicians were more open about injuries (and dealing with illness). Would orchestras have a “Disabled List” and allow musicians the proper time to heal without worrying about pay? I don’t think it’s fair that athletes are allowed to go on the DL and receive high-quality medical attention, while musicians just have to figure it out on our own. We perform at a high level, get less time off, and we have to be way more accurate. Could you imagine a principal horn player of a major symphony only hitting 60% of the notes on the concert? Or having an accuracy rate of .250 out of 1.000? Our batting average has to be in the .900 range or we might lose our job. Some conductors won’t accept less than .999. It’s unreasonable, yet this is part of the reason why the orchestral profession is consistently ranked as one of the most stressful jobs. It also makes sense that a lot of orchestral musicians suffer from anxiety and health-related issues that stem from work. So many principal horn players have suffered heart attacks that it makes me never want to play principal in a professional orchestra.

I mean, if you’re a tenured member of a full-time orchestra and a member of the union, then you probably do get some benefits and paid-leave, but the majority of us do not have one of those full-time gigs. Most of us piece together a “full-time” salary by playing in several different regional orchestras and teaching. These jobs, unfortunately, do not offer paid-leave nor benefits, which leads to the big question: how would most of us afford to get help if something happened?

Sure, you probably qualify for Obamacare, but the insurance available through the Marketplace isn’t what it was when the program began, especially if you make a “livable wage.” The deductibles and premiums are so high that it’s almost not worth having insurance. Even the insurance that I have through my public school teaching job is awful. Each individual on my plan (me and my two kids) has to meet a $500 deductible on “sick” visits before the insurance even starts paying anything, and when it does start paying, it only covers 80%. This is why we’re switching back to my wife’s plan, even though it costs more, it’s better insurance.

Even if you could get help, where would you go? Are there doctors that specialize in helping musicians? Are there treatment options for focal dystonia? Is treatment available for those musicians that suffer from work-related anxiety and depression? Does each professional orchestra provide a medical staff to treat work-related injuries or illnesses? Does the orchestra pay the bill for any medical procedure required by its members? Does the orchestra employ massage therapists and chiropractors specialized in treating musicians?

Again, if we were professional athletes, the answer would be yes to all of these questions, but we’re just musicians. There’s all of this interest and money being thrown at sports medicine programs, but we don’t have a need for arts medicine. There isn’t a realistic need for people to help musicians with injuries, because there’s no money to be made in that venture. Musicians only bring sound to life, and aid in the effort to keep our culture alive. Music only makes people smarter and more equipped to handle all types of situations. Work ethic, problem solving, teamwork, listening skills, etc.

It just doesn’t make sense.

Although, even if we had help, would musicians talk and take advantage of it? Everyone is just so afraid to admit that something is wrong. We don’t want to fall further down the “call list,” because we have an injury or suffer from an illness, whether it be mental or physical. I finally started talking about my issues, because things really couldn’t get much worse. I had to hit rock-bottom…so, is that what it takes? Do musicians have to lose all hope before they will start talking about things? It shouldn’t be that way, and I hope that we can change it. We need to be more open and talk, because how are we going to find people that can help us? How are we going to warn and/or help younger musicians struggling with some of the same issues? We need open dialogue and a safe environment in which to express our needs and concerns.

I’m glad that people like Dr. Peter Iltis are working to understand more about focal task-specific dystonia. Dystonia in general seems to be more prevalent nowadays, not just with musicians, and if we have the technology and resources to solve the problem, then it needs to happen. Another society that I just discovered today is the Performing Arts Medicine Association. It was formed in 1989, and holds a yearly symposium in Colorado every summer. Obviously, there are people out there working to make things better for musicians, but it definitely isn’t common knowledge. I think we really need to make a lot of this information more readily available, and we also need to help musicians feel more comfortable about coming forward. We need to get rid of the stigma and start helping people, because we’re all in this together.

I definitely don’t have the answers, but I do have lots of questions. Hopefully, some of these questions will lead to answers…I’ll let you know if that happens.

Breath Attacks

As a younger horn player, I struggled with attacking first notes. I felt so much anxiety over missing the note that I would be unable to make a sound for a few seconds, then it would finally come out. Sometimes it would sputter, kind of like when you try to crank your car on a cold morning, and other times I would need to consciously relax myself and allow the air to move freely in order to produce a sound. I would blow, but my upper body was so tense that I wasn’t blowing enough air to make a sound. Unfortunately, this “hesitation” in my attacks resurfaced after my injury.

This problem seems to always prey on me when I have lost all confidence in myself and my abilities as a horn player. When the hesitations first started to occur, it was because I hadn’t built up enough confidence through positive experiences. I was also very afraid of putting myself out there (Remember that I am an introvert and that drawing attention to myself isn’t something that excites me). After the injury, I didn’t think that I would be able to play anymore, and my my embouchure setup felt foreign, which didn’t help my confidence. I didn’t know what note would come out, so I was afraid to play. I was also afraid, because I was really embarrassed of how I sounded. I knew how well I could play, and I didn’t want anyone else to know how bad things were, because I didn’t want anyone to think less of me. Again, I was linking my self worth to my current abilities as a player, which was not a healthy situation.

The way that I overcame both situations was a combination of diligent practice and the fortification/reparation of my mental state. I have already talked about how I’ve been working to change my mental fortitude, and I will continue to do so, but this particular post is meant to focus on a particular type of exercise that helped me along the way to overcome the hesitation, and anxiety, I felt before attacking a note. This particular exercise, or group of exercises, involved the use of breath attacks on a daily basis.

Breath attacks were a daily part of my routine during undergrad and grad school. I was introduced to the Caruso Method while struggling to become a horn player, and I used many of the exercises to help build my strength and endurance. I guess that I should credit these exercises for turning me into a “high” horn player, even though there isn’t such a thing any more. When I practiced the Caruso exercises regularly, I was able to comfortably play above a written c”’. I never really went through the whole book, because I just felt that the first two exercises achieved the goal, and everything else felt like overkill. Here are the Caruso exercises:

Breath Attacks - Caruso Style

Breath Attacks - Caruso Style - High

The catch is that you have to keep the mouthpiece on the face the whole time. Caruso gives you breaks to breath, but you breathe through the nose, either in or out. Don’t loosen the corners of your embouchure to let out air, because even that small change will lessen the benefits of the exercises. The first exercise should be done twice, I forgot to add the repeat sign. The second one, which obviously focuses on the high range, start at your own pace. Go as high as you can, until you either can’t play the note or have trouble with the slur. At this point, take the mouthpiece off of the face, rest a minute, and then try again. If you still falter on the second attempt, then it’s time to stop. If you’re successful, then keep going. At my best, I was able to play up to a written f”’. It wasn’t the prettiest sounding note, but it helped my confidence, and made play a written c”’ feel a lot easier to play.

Another breath attack exercise that I used to improve both accuracy and stability in the high range, is a short exercise that I received from Bob Pruzin. Pruzin was the Professor of Horn at The University of South Carolina for many years. I studied with him for a time, and he had a very specific way of doing things. Some things were great, and others were a little on the gimmicky side. This particular exercise really helped, and I’ve used it off and on ever since:

Breath Attacks - Pruzin Style

Play with a metronome and take the mouthpiece off of the face between each note, because you want each breath attack to simulate a first attack. I love doing breath attacks in the high range, because there is no room for mistakes. Your embouchure has to be set correctly for each note, which really helps one to feel the note. We can sometimes get away with not being perfect with the help of the tongue through articulations, but that’s not so with breath attacks. They help with accuracy, because, like I just mentioned, you really feel the note and get a better understanding of what needs to take place to perfectly and efficiently play each note throughout the range.

During my undergrad, when I was first afflicted by hesitation attacks, I worked on breath attacks using the Singer – Tone and Control Studies – Ex. 1. I would breath attack the first note, and then attack the following two. I would use a metronome, set anywhere from quarter = 60-72, and I would also take the mouthpiece off of the face between each attack, simulating a first attack each time. Here is a portion of the exercise:

Breath Attacks - Singer Style

You would follow the same chromatic pattern up to a written f” or g”. Then, do the same with the mid-low range, starting on e’ and working down chromatically to a written c. This helped a lot, but I also developed a similar exercise that challenges your ear and accuracy a little bit more:

Breath Attacks - Singer Style - Johnson Version

This is only a portion of the exercise. I start it on a written g’, and then the exercise works chromatically, alternating up and down, from this note, ending on a written g and g” respectively. It’s a great way to work on accuracy, and it will hopefully rid one of hesitation attacks as well.

Another exercise that I have used recently to build and maintain consistency in the pedal range is a version of the Pruzin breath attacks. It takes the same concept, but shifts the focus to the extreme low range. The goal is to get a really good, loud blast for each pedal note. If you can play the notes really loud, then you’re doing the right thing. I never worked on breath attacks in the pedal range until working with Bill Caballero. He suggested it, and it helped, so I’ve used it myself and in my teaching.

Breath Attacks - Low Horn Blast

I wish I could say that breath attacks will fix all of your problems, but they won’t. These exercises will help you through the process, but perfecting your attacks takes time. Work with a metronome, record and/or video yourself, play in front of people as much as possible, and believe in yourself. A lack of confidence is normally the prime suspect when dealing with hesitation attacks. It’s also a good idea to observe the amount of tension present when trying to start notes. Any amount of excess tension in the upper body will negatively affect one’s ability to play with ease. I know from experience. I would feel a lot of tension in my shoulders and neck, and my throat would tighten when trying to start notes. This would also affect my breathing. When starting a phrase, I would always take shallower breaths and be unable to to play through long phrases.

Stay positive and trust the process.

The Standley Routine

The unexpected passing of Gene Standley, dealt the community of Columbus, OH and the horn community in general, a huge blow. He served as Principal Horn of the Columbus Symphony for many years and was an all-around great horn player. I never met him or knew him personally, but his reputation was stellar. Thankfully, he (along with Stephen H. Hager) was able to leave us with a valuable piece of horn history, the practice routine developed by his father, Forrest Standley.

Forrest was Principal Horn of both the Dallas and Pittsburgh Symphonies, and he taught at Carnegie Mellon University for many years, teaching the likes of Dale Clevenger, Philip Myers, Howard Wall, Brice Andrus, and William Purvis. A pretty impressive resume. He developed his routine, known as the “Standley Routine,” after leaving the Pittsburgh Symphony due to “lip issues.” The Standley Routine is long, encompassing all twelve major and minor keys through different scale and lip slur exercises. If done from start to finish, it would take a player over one hour and thirty minutes to complete, per Forrest. The only other practice routine that even comes close to this one is the fabled “Heavy Routine” by Joseph Singer. Both routines require and develop an insane amount of endurance and traverse the full range of the horn.

Now, you might be wondering, “why is he talking about this practice routine on a blog dedicated to performance anxiety?” Well, I have been incorporating parts of the Standley routine into my warm-up lately, and it has helped me to regain some of the endurance that disappeared after my injury.

FS (Forrest Standley) recommends that one should start by playing only “some of the exercises every day” and gradually increase the number of exercises performed until one is able to play through the whole routine. As an alternative, he does mention that one could divide the routine into several different fifteen minute sessions done throughout the day.

The routine begins with an “attack exercise” similar to the “Tone and Control Studies” presented at the beginning of Joseph Singer’s Embouchure Building for Horn. The exercises that follow are divided into six different sections, with each consisting of two major and two minor scale patterns, two major scale arpeggios, each presented in three and four note lip slur patterns, an endurance exercise, and two major scale overtone series slurs. The only exception is that the sixth section does not contain an endurance exercise, but contains more of the overtone slurs.

In the past, I have played through this routine, front to back, in one sitting, and it is not an easy thing to do. The routine focuses on building endurance and flexibility, giving the player the confidence that he/she needs to play anything, in any range, and for as long as possible. For now, I have been incorporating a section of the Standley Routine into my normal warm-up each day. I’ll start by playing a couple of noodling patterns, do some harmonic lip slurs, several different lip trill/flexibility exercises, chromatic exercises in different octaves, play major scales two octaves, do one or two of the Basler lip slur exercises from his book, and then a section of the Standley Routine. It takes me over an hour, but I have felt an almost immediate difference in my endurance in the high register since starting this regimen.

There are plenty of wonderful warm-up routine books out there, and everyone tends to have their personal preference, but I do try to keep an open mind. I will always try something different, especially if it helps. If anyone out there is struggling with endurance issues, trying to come back from an injury like me, or hasn’t played in a long time, you might want to grab a copy of the Standley Routine. It will get you back into shape quickly, even if you’re modifying the routine a little, like me.

Disclaimer: Please be careful when first starting the Standley Routine. It is tough and doesn’t back away from the high range. It will help you get back into shape, but don’t hurt yourself trying to play too high or by trying to play through the whole thing during the first sitting. Be smart!

Embouchure Re-Training: Thoughts and Exercises

I thought that it might be a good idea to discuss and share some of the exercises that I tried while attempting to re-train my embouchure. Some exercises worked really well, and there were quite a few that did nothing. As a disclaimer, take the things that I will be saying at face value. I’m not here to discredit anyone either. What helped me may not work for you, and vice versa. Don’t just take my word, try it for yourself, and if it doesn’t work, reevaluate and move forward. One last thing before I begin, it would always be a good idea if you seek the help of a professional for guidance when dealing with these types of situations.

When my injury first occurred, there were two books that I read immediately: Broken Embouchures, by Lucinda Lewis, and The Balanced Embouchure, by Jeff Smiley. Both are great reads, and I would recommend them to any student or colleague. I have mentioned the Lewis book in a previous post, so I will discuss that one first.

Like I said, this is a good book to read for anyone that is going through an embouchure injury, or just a good text to have on hand in case you need it, for yourself or for a student. I enjoyed how Lewis included a lot of her own experience in the book, because I feel like the best tips will come from those who have experienced the same thing. The book contains information regarding any type of embouchure related injury, internal and external, and normally suggests a recommended treatment. It also shares words of encouragement, which is great, because this can be such a traumatizing experience. Lewis constantly reminds us that there will be good days and lots of bad days, but that vigilance and resisting the urge to panic will eventually lead to reward. I unfortunately kept panicking, and it took me way longer than it should have to get my correct embouchure back….more on that in a later post.

Lewis uses a technique called “Blocked Buzzing” to force the embouchure back into its natural setting. The companion manual, Embouchure Rehabilitation, contains step-by-step exercises that are supposed to help recreate the feeling and structure of one’s old/natural embouchure. This paragraph from the aforementioned manual should give a clear understanding of what “Blocked Buzzing” is and what it is supposed to accomplish:

Stand in front of a mirror. Plug the end of your mouthpiece completely with a finger. Put your mouthpiece up to your lips exactly as though you were going to buzz a midrange note. Begin blowing by tonguing the note. Blow with a constant mezzo forte stream of air. There should be absolutely no sound or air leakage from your lips or mouthpiece. Notice how firm and controlled your entire embouchure is and how your chin stretches down with considerable energy as you blow. Tongue a few notes with your mouthpiece blocked, and observe how still your face and throat are and how well your air works. Say hello to your old embouchure. (Embouchure Rehab, 10)

I was very hopeful when I first began using the exercises, and I believed that it would work. Unfortunately, it didn’t work for me. I could never do the “Blocked Buzzing” without having some form of air leakage. I attempted the exercises for a long period of time, several weeks, and I even would try them again periodically, but it just never really helped me regain my old embouchure. Now, this doesn’t mean that these exercises won’t work for someone else, so by all means, buy the book and try them out. The exercises did seem as if they would work, and they are well developed. Lewis has you trying to “Block Buzz” in different ranges and using different air speeds (dynamics) and continues the same type of formula with regular mouthpiece buzzing. The book and more about Lewis can be found on her website: www.embouchures.com.

Another embouchure technique that I tried was the Balanced Embouchure. I purchased the book, written by trumpet player Jeff Smiley, and I also got the horn-specific exercises put together by Valerie Wells. To try and put it simply, the Balanced Embouchure technique focuses mostly on full-range motion and allowing the embouchure to move freely if needed. It instructs one to not worry so much about keeping the chin flat or about maintaining an embouchure that looks uniform. If you play with a bunched chin, and it doesn’t affect your tone or ability to play in different registers, then don’t worry about it.

In order to gain full-range motion and unlock the capabilities of your embouchure, Smiley developed exercises that ask the player to use two very drastic and extreme types of embouchures: Roll-In (RI) and Roll-Out (RO). It sounds exactly like the words imply. The RI embouchure requires you to roll the lips all the way in and attempt to play, while the RO does the exact opposite. The RI exercises focus mostly on the extreme high range, while the RO focuses on the extreme low, pedal range. For example, there is an RI exercise that starts high and works its way down in the range, not allowing you to adjust your embouchure. It’s pretty tough to play with a good tone. Some exercises combine the two embouchures. One in particular jumps from a really high note to a low one, requiring the player to quickly adjust from an RI to setting to the RO, then back up again.

Smiley never suggests an embouchure change, you only use the RI and RO embouchures within the confines of the prescribed exercises. Once you finish the exercises, you play everything else with your normal embouchure setup. However, Smiley and others believe that one can enhance and strengthen an embouchure by using the RI/RO techniques on a daily basis. I know many people who have experienced great success through using this method. The most common side effects are better endurance, greater flexibility, and increased stability in the high range. For me, things felt good for about the first two weeks of working through the exercises. Then, my embouchure started to feel weird/unstable. I kept doing the exercises for a few more weeks, but stopped once my playing began to suffer.

For what it’s worth, I would be very cautious when attempting any type of exercise that requires you to manipulate your embouchure in a way that is not natural. I don’t know if BE hurt my embouchure, or if the damage had already been done and BE accelerated the process. I just know that my embouchure felt normal before starting BE. My endurance wasn’t as good as it once was, hence the reason for trying BE, but when I stopped doing the exercises, my embouchure felt completely different and didn’t feel normal again for quite some time. So, be careful and don’t just try something because it’s the hot new fad.

For the last section of this post, I will focus on the exercises and routines that did work and help me to regain my ability to play. First, I had to focus a lot on my breathing. I will probably write a longer post on the topic later, but I think that some of us might take our air capacity for granted when we are at the height of our playing abilities. I’m still working on using my air correctly, but I know that my sound and tone have improved tremendously since taking more time to focus on breathing.

One thing that I noticed right away was the fact that I was slouching a lot when playing. Before my injury, I was very much into the Alexander Technique and had great posture when I played, but when I was playing poorly, my posture mimicked how I sounded. That was step one, fix posture. Problem number two, and this was/is the bigger problem, was to address how my throat seemed to tighten/lock up when I attempted to play. This not only happened when I played in front of people, but also in practice, when I would be completely alone. To be honest, I’m not sure how I was able to overcome this issue, but when I changed my mindset, began to think more positively, and started playing in front of people again, I got better. Remember, I’ve been practicing a lot and working on specific exercises to get better, so this wasn’t some quick fix. Speaking of which, here are some of the particular exercises that I’ve worked on to get me back into shape:

For flexibility, I needed to work out the extremes of my range, high and low:

Basler – “Slurred Arpeggios”

Basler - Slurred Arpeggio

Basler – “Tongued Arpeggios”

Basler - Tongued Arpeggio

I also did a lot of work with lip trills, lip slurs, and different natural horn exercises to increase flexibility, endurance, and range, some of which are listed below:

Brophy – “Lip Slur Exercises 1-7”

Brophy - Lip Slurs

Frøydis – “Harp Flexie”

Froydis - Harp Flexie

Oscar Sala – “Natural Horn/Lip Slur Exercise”

Sala - Natural Horn-Lip Slur Exercise

Here are just a couple more exercises that I used to help with flexibility throughout the different ranges:

Caballero – “Slur Warm-Up”

Caballero - Lip Slur Warm-Up

“Low Horn Flexie”

Low Horn Flexie

These aren’t all of the exercises, but it at least gives you an idea of the things that I worked on. I still play through some of these exercises during my warm-up, but I have also graduated to different exercises that better meet my current needs. It was difficult to play through many of these drills at first, and some of them sounded rough, but I was definitely rewarded for my hard work. I wish that it hadn’t taken me so long to finally work through this stuff, but I think part of me was just afraid of sounding bad, especially around other people. Once I realized that this was the only way that I would get better and that my playing ability didn’t define me as a person, I felt relieved and free to do what needed to be done. I am very thankful that I can play well again, and I am excited for the future.

My Personal Experience with Embouchure Overuse Syndrome

As with any musician who has been in a similar situation, I never thought, never dreamed that this would happen to me. About five years ago, I suffered a playing injury that lingered for far too long. For roughly six months, I couldn’t play without feeling pain or a sense of mild discomfort in my upper lip. The injury happened during the second year of my DMA studies at West Virginia University, and I didn’t have time to wait around for it to heal. Now, I could still play at a very high level even though I was constantly feeling pain or discomfort. I performed principal on Mahler 1 and even won an orchestral audition while this was going on. Unfortunately, it lasted so long that I decided to start tinkering with my embouchure in order to attempt to relieve the discomfort. However, when the discomfort finally disappeared, the damage had already been done. My embouchure felt weak, and I didn’t have the same strength and endurance that I had enjoyed before, which led to even more tinkering. Thankfully, I was able to perform my final recital and finish my degree before my playing really started to deteriorate.

Due to my tinkering, I have endured a tumultuous relationship with the horn over the past few years. After finishing my DMA, I could still play pretty well, but I started having to work harder to keep things in check. My playing was no longer effortless, and this was due to my embouchure setup being completely wrong due to all of the changes that I had tried to make. I am one of those rare people that actually enjoys practicing, but for a while, I just didn’t even want to look at my horn. I began to practice less and my embouchure finally broke, which was not a fun experience. I even sold two of my previous instruments, because I just felt so depressed, and I didn’t believe that I would ever play again. It was rough, but for some reason, I couldn’t get away from it. I don’t think I ever had Focal Dystonia, but I do think that I changed my embouchure so frequently that I developed a severe case of Embouchure Overuse Syndrome. It was so bad that at one point I struggled to even produce a sound. I am pleased to say that my embouchure is currently back in its natural setting, but I’m still trying to gain back range and endurance.

This whole ordeal has created mental scars that have produced a level of performance anxiety that I have never felt before. I will admit that I struggled with anxiety for many years, even during my doctoral studies, but the level of anxiety that I have felt during performances over the last two years has truly left me handicapped. I think we all have dealt with the adverse effects of “dry mouth” and adrenaline, but this has been much worse. I don’t think I even suffer from dry mouth anymore. On the contrary, my body just completely shuts down. I’ll try to attack a note and nothing will happen. Loud stuff accompanied by other brass instruments is usually fine, but heaven forbid I have to play an exposed passage at piano.

These are issues that I will continue to work through, and I hope that I will be able to share thoughts and insights that might be of value to others along the way. I just have to keep practicing and remember that even the smallest steps forward equal progress.

Dr. J