Personal Update: Visiting the Cleveland Clinic

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!

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.

That had not occurred to us, dude.

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.

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!