In November, my lower lip started acting up: weakness, muscle spasms, etc. It’s been hard to figure out what exactly is going on with it, so I recently went to the Cleveland Clinic to see Dr. Richard Lederman, a world-renowned neurologist who’s written extensively on performance injuries, particularly embouchure problems in brass players.
Here’s what I found out!
Torn Lip Muscle? Maybe Not.
The doctor started by getting my full playing history, lip injuries, lip surgery, and everything else.
I’ve been concerned, of course, about whether I might have torn my lower lip muscle and might need another surgery. Dr. Lederman didn’t think so. He mentioned something curious, though: the concept of a torn orbicularis oris is controversial.
The facial surgeons at the Cleveland Clinic have been unable to document the phenomenon among brass players who’ve come into the clinic thinking that’s what’s wrong with them. Long story short, he didn’t think that was the issue.
Dr. Lederman then did a physical/neurological exam, including poking around my face with a safety pin. I reported a little dullness of sensation below the lower lip, where the injury is. He also watched me play, and noticed a bit of spasming or “flickering” of the lower lip on the right side, as I’d noticed when playing in front of a mirror.
He classified my condition as an “overuse injury,” a term he admitted was vague. He didn’t know exactly what’s going on, but he doesn’t think it’s focal dystonia (which is a great news, as dystonia can be a career ender). He doubts there’s muscle damage, and he thinks it will get better with time, though a full recovery could be a while. He suggested starting with short playing sessions and gradually extending them as the lower lip regains ability to function in the embouchure. He stressed playing up to the edge of fatigue, then taking a break.
The doctor also suggested doing an electromyography (or EMG), a test that measures the electrical activity in muscles to check for nerve or muscle damage. EMGs aren’t always able to detect slight damage, but the doctor recommended doing one in case anything did turn up in the results.
I was imagining a painless scan of some kind, but Dr. Lederman explained that an EMG is not really a painless scan: there’s this one part where they stick needles into your face. Normally, I’d have to wait weeks for an opening, but there was a chance the lab could squeeze me in this afternoon. He left the room to check.
A few minutes later, he opened the door and said “They’ll do it!”
“Yay,” I cried weakly.
The first stage wasn’t so bad: electrodes are affixed to the face, and an electrified little metal wand is used to touch various parts of the face, forcing the muscles to contract. The electrodes record the results. A little unpleasant, but not awful.
The second part was more than a little unpleasant: needle electrodes are inserted into various facial muscles. I will say that the needles were really tiny, and it wasn’t exquisitely painful. But I was not enjoying myself.
On the plus side, preliminary results were normal!
The overall news is good, for the following reasons:
- Dr. Lederman all but ruled out both focal dystonia and a torn lip muscle.
- I’ve got some experience with lip injuries, so I know how to rehab an injured embouchure.
But I’ve got some challenges, too:
- The good doctor didn’t have an exact diagnosis. It was great to have the worst-case scenarios ruled out, but he didn’t know exactly what the problem is, either.
- I’ve got a history of lip injuries, and I’ve got to figure out how to play differently so as to avoid them in the future. I’m working with Bobby Shew (via Skype) on improving my mechanics, with good results.
My immediate plan? Short practice sessions, careful tracking of how long I play each day, and a good mental attitude. My appointment was about ten days ago, and I’m already noticing improvement. Let’s keep it up!