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Lip Injuries & Trumpet Playing: An Unhappy Marriage

Coping with the physical demands of trumpet performance

Memo to trumpeters: Do your high notes seem flat? Not as bright as usual? Does your sound tremble or do you have trouble maintaining certain notes for a long time? Are your lips swollen and red after playing? Are they stiff and puffy after hitting those double high Cs? Do you suffer from chronic chops fatigue or pain in the lower lip? Do your lips feel rubbery or numb? Do you have a wooden-face feeling after playing? Do you have abrasions on the lip or in the mouth? Does air escape from the corners of your mouth while you play? Is your endurance shot? Do you have varicose veins, abrasions, lesions or tumors on the lips? Is your lip muscle stretched or torn?

While some of the problems inherent in trumpet playing might occur from accidental trauma (a punch in the mouth, an elbow to the chops during a pickup basketball game, a face-first fall off a bike), a large percentage of lip injuries are directly related to playing the instrument. Compressing flesh and muscle against metal for hours at a time can be a recipe for disaster. Tissue damage can occur if the mouthpiece is forced against the lips too hard or if one plays too long or with too much pressure without rest.

More serious lip damage can occur from overuse without warming up, as in Hubbard’s case. At the peak of his powers, no trumpeter on the planet played longer, higher and faster than Hub, and no one exuded as much confidence and swagger on the bandstand. But in 1992, Hub tore his lip one night in Switzerland during an ill-advised high-note cutting contest with Jon Faddis. Rather than practicing the three Rs (rest, recuperation, rehabilitation), Hubbard continued playing on his injured lip until it became infected. Following surgery, his once-legendary facility was tragically impaired. “It’s really something when you lose your chops like that,” Hubbard told me in a 2008 interview. “You feel like a motherless child.”

“With Freddie, I think it was just an abuse of the lip tissue,” says Faddis. “Back in the ’60s and ’70s, Freddie used to pick up the horn without warming up and he would just blow as long and as hard as he could. I used to do that too when I was young, like in my teens, but I wouldn’t even think about doing that now.”

Consider the case of another macho, over-achieving trumpeter who wrote the following entry on the forum: “To all the young high-note-seeking players out there. If you use bad form for long enough, you WILL hurt yourself. It’s just a matter of time. I know, I did it. My lip popped during a three-hour gig (two to three shows a day for eight days). Small mouthpiece, bad mechanics and … pop! There goes 25 years of investment and fun. I now just hang onto lower parts, still looking for the sweet spot, which is gone.”

More often than not, lip injuries in younger players occur because of poor technique. As Toronto surgeon Dr. Simon McGrail noted, “It’s not how long you play, it’s how you play. If your technique is not good, problems will begin.”

McGrail, a leading authority on lip injuries in brass players, is one of the few doctors in the world who has done corrective surgery to repair a rupture of the orbicularis oris (tear in the lip muscle), a condition also known as Satchmo’s Syndrome. (That term was coined several years ago by Dr. Jaime Planas of Barcelona, after he noted that Louis Armstrong suffered a similar rupture in 1935 which caused him to stop playing the trumpet for a year.) Satchmo’s Syndrome is actually more common among French horn players than it is among trombonists or trumpeters. In any case, it has destroyed careers. But Dr. McGrail has been able to surgically repair and rehabilitate even the most severe cases he’s encountered.

“What happens is that by attempting to play very strenuously-either too long or too high-without the proper musculature being engaged, it causes a thinning out of the lip,” explains trumpeter Brad Goode, a patient of Dr. McGrail’s. “When you continue stretching the lip muscle rather than contracting it when attempting to play high, then the lip muscle itself-which is a big oval-shaped muscle which encompasses both the top and the bottom lip-can herniate. And this leaves people unable to create a seal for air going into the mouthpiece, unable to control their sound, unable to hit the right notes.”

Goode is one of Dr. McGrail’s success stories. A Chicago native who has recorded for the Delmark, SteepleChase and Origin labels and is now a professor at the University of Colorado, he sustained a lip injury in 2001 that was so serious it almost ended his career. “I suffered a trauma to the lip after being slammed in the face by a door opening on me while I was practicing,” he explains. “The injury became more serious than it initially was because I mistreated it. My lip was swollen and people were telling me to ice it, but I iced it so much that I actually destroyed all the muscle tissue in my lip and basically turned my lip to mush so that I wasn’t able to play at all. You could almost say it was like a near frostbite kind of a thing that I had stupidly done to myself. I was pretty sure at that point that I would never play trumpet again, but I found Dr. McGrail, who not only does the surgery to correct Satchmo’s Syndrome but he has also invented a series of physical therapy exercises for the lip where you basically work your lip against your teeth. And in doing these exercises, I was able to rebuild my lip and go back to playing normal.”

Goode’s bizarre story has a happy ending in that his chops came back stronger than ever. “My technique hadn’t really ever been quite to where I had hoped it would be before the injury,” he says. “While I was recuperating with very little strength in my lip, I changed my technique and basically relearned to play. And when I did get the full strength back in my lip from doing Dr. McGrail’s lip exercises, I actually had an extra octave in my playing than I had before, which most people looked at in bewilderment and saw it as some kind of miracle. And it gave me a different career path. Since that time, I’ve been working as a lead trumpet player and people are calling me to go all over the place and play things that are too high for other people to play.”

Goode currently counsels trumpeters with severe lip injuries. As he explains, “Dr. McGrail has had a lot of his clients who are recovering from the surgery call me to get advice on how to do the exercises correctly. A lot of them had heard that I had some kind of serious injury and came back playing. So when I get calls all the time from people who have tears in their lip muscle or are experiencing chronic pain, I’m happy to talk to them.”

“I had nothing as severe as Freddie,” says trumpeter Terence Blanchard, who actually changed his embouchure while playing with Art Blakey’s Jazz Messengers to resolve a serious lip problem he was having. “For me, when I’m not playing as consistently, my corners are not as strong and firm as they should be, then I wind up pressing and I cut my top lip. And that can be pretty painful.”

“My first injury was getting my teeth chipped in an accident when I first started playing seriously in my last year of high school, when I was 17,” says Faddis, who is currently a full professor and director of jazz performance at the Conservatory of Music, Purchase College-SUNY. “I was playing basketball with an older sister and she accidentally threw me into a wall in the backyard, and that was my first accident because my teeth were knocked out. It didn’t change the sound so much but it changed the way it felt to me. And I felt like I would have to relearn everything I had been practicing for nine years, so I decided not to have the caps put on. And they’ve just spread as I’ve gotten older, that’s all.”

Faddis says that problems can occur with either the top lip or bottom lip. “It’s different for everyone. For me, it’s mostly the upper lip. But there are trumpet players who play with more pressure on their bottom lip. I think most orchestral players will play more evenly with pressure on the lips, and most jazz players, who may not have a teacher when they begin playing, may develop problems because they never were really taught the proper way to play. When you’re playing the trumpet and you have the mouthpiece going up there in all that very delicate tissue, things can happen. So you have to be prepared and not overdo it. You gotta play long tones, scales and get the lips vibrating and activated to do what they need to do when you start playing.

“And you can’t have tension coming into it when you play the trumpet,” Faddis continues. “Look at pictures of Miles when he played-he was very relaxed. Look at pictures of Dizzy in the late ’50s and early ’60s-he was playing very relaxed. So there has to be a certain amount of relaxation when one is playing, and you can’t force it. That’s the thing that I find most young trumpet players have a problem with. They force things and then nothing happens anymore. Their chops are exhausted. So with my students at Purchase, I try to give them exercises right from the first lesson that will prevent them from forcing in that way. But developing the chops takes time. You can’t abuse them-you have to rest, you have to treat them with kid gloves and it’ll be alright.”

Blanchard recommends not only warming up before a gig but also cooling down afterwards as a way of preventing chops problems. “It’s important to be as prepared as possible,” he says. “Practice as diligently as possible to alleviate any problems. But you have to warm up prior to playing, and one thing that works really well is to warm down after the show by playing long tones, scales and lip slurs. Because when you’re playing, you’re putting a lot of pressure on the embouchure, and it may get inflamed. And the warm down helps you to regain that pliability. I don’t do it as much as I used to but warming down after the show is always a good thing.”

Aside from Hubbard’s well-publicized lip problems and Armstrong’s bout with Satchmo’s Syndrome, Faddis reports that his mentor Dizzy Gillespie also suffered from serious lip problems throughout his career. “Dizzy had a long callus that extended from the bottom of his right nostril down to the top of his upper lip,” he says. “He used to pull his chops in and then the mouthpiece would fit right on that. Dizzy talked to me one time about having an ingrown hair, which is common amongst a lot of African-American males. But he had it right where the mouthpiece hits the lip. This was probably around 1950. So he went to a doctor and the doctor pulled out a hair out of his lip that was probably about a foot long. And when he told me that I thought about some of the recordings he was doing back then and thought, ‘Yeah, you can hear it,’ because he was struggling with the instrument then.”

Faddis’ own teacher, trumpeter Vince Penzarella, who just retired from the New York Philharmonic, struggled after suffering some extreme trauma to his lip in a car accident. “He had glass imbedded in his lip and so he had to relearn how to play the instrument after that,” says Faddis.

But then there are those rare trumpet players who have seemingly never struggled and avoided any serious lip injuries throughout their long careers. Says Faddis, “Doc Cheatham had chops that continued up until he passed away [at age 91]. Clark Terry still has unbelievable chops at age 88. And Snooky Young, who is 90 years old, also has a great set of chops. None of these guys had to back off of the trumpet, because they had a perfect embouchure. And I think you can attribute that to a lot of good and correct instruction along with some knowledge that they picked up along the way.”

Adds Blanchard, “Clark Terry is my idol. He’s the guy who has always maintained his flexibility and strength throughout his career. And I get a lot of these little tips through him. He’s the one who taught us all of this stuff.” Originally Published