Steven Heitzer on Overuse

What was the nature of your injury and the circumstances surrounding it?

In August, 2016, I began taking a cholesterol-reducing medication Statin. My chops, especially with respect to range & endurance, began to gradually weaken. I didn’t make the connection between the medication and my weakening chops right away. Once I did, an entire month later, I discovered on the internet that two side effects of Statin are mild inflammation and muscle weakness. During this month, as my chops were struggling, I was playing challenging show music and resorted to using more and more pressure to get through gigs. I believe I damaged my upper lip muscles with excessive pressure and overuse. When I stopped the medication, my chops stopped continuing to weaken, but the damage was done and my playing did not recover as I had hoped. My upper lip felt thin, without adequate support for mouthpiece pressure. 

Did you see any doctors or specialists? 

I saw my GP and cardiologist (who had prescribed the Statin). Both were supportive of my discontinuing the medication. I saw a dermatologist about my upper lip, which had grown a small bump at the point of greatest mouthpiece pressure during my struggling month.  

I had my dermatologist remove the small bump on my upper lip. I also had, and continue to have, monthly acupuncture focused on my lip strength. 

Did you have to stop working? 

I did not get out of any work. Because this happened over the slower season of summer into the early fall, I was able to take short stints of rest, but never more than 4-5 days.

What were the greatest frustrations?  

There were a few: that discontinuing the medication never resulted in full recovery of my embouchure strength, that my high register was weak, that attacks were inconsistent, and that my endurance was diminished. I had taken sound-production for granted for forty years. I take nothing for granted anymore. My rehab became (and continues to be) the #1 focus of every day.

What seemed to help the most?

Two words: Lucinda Lewis! I managed to fake and hide through the fall of 2016, playing section trumpet parts or by dropping octaves when playing as solo trumpet on church gigs. I began a Lucinda Lewis rehab regimen on MLK day, 2017. By the summer of 2017, I was able to play again, but never the same as pre-injury. (I continue to do the rehab regimen EVERY day).  

Did you change your approach or technique at all?

Absolutely! I feel like the Lucinda Lewis rehab has changed my embouchure. I am much less dependent on upper lip strength, and much more focused on corner strength and bottom lip anchor. I am also hypervigilant about every note I play. 

Did you make any changes in your equipment?

Yes! At the time of the injury, I was playing 1.25 C mouthpieces (ACB, Greg Black, Stork). To get through any notes above the staff and have at least one gig’s worth of endurance, I switched to 3C & 3D sizes. Over the past two years since the injury, I have gradually moved back up to 1.5C & 1.5D. I am still not quite strong enough to return to my original sizes.

Did you make any lifestyle changes?

To deal with my cholesterol without the dreaded Statin, I have changed my diet to low carb and increased my weekly exercise.  

How did you structure your practice while rehabbing and rebuilding?

When I started the Lucinda Lewis routine, it took about an hour to do. It is designed for success, never hurts, and utilizes frequent icing sessions between sub-routines. I did it twice per day, once on Bb and once on C trumpet. As long as I could afford to avoid other, more difficult music to practice, I did. This became my life through the winter of 2017. Now the routine only takes me 45 minutes, and I do it first thing every morning, no matter how ridiculously early because of church gigs or early rehearsals. 

I’ve found that regaining trust in the body is tough. Have you experienced this? How did you regain that trust?

Wow! This is an amazing question. There were times when I’d play a two-and-a-half-hour afternoon rehearsal for an evening performance. I’d play fine (never great, but good enough) for the rehearsal, and return before the evening performance after a dinner break to re-warm up and NOTHING WOULD COME OUT OF MY HORN!!! OMG…the first few times I’d struggle to not panic. Fortunately, if I’d given myself a full half hour, and stayed calm, and did some breath attacks, lip bends, and simple slurs, I would be able to return to my pre-dinner break chops. So now I’ve learned to trust. 

Did you come to feel like “yourself” again?

To be honest, no. I think I’ll never be quite the same. I didn’t really start feeling like a good player again until about six months into the Lucinda Lewis routine. And I still had, and have occasional set-backs. But I am now able to play pretty much everything I was able to play before, as long as I maintain my daily routines, on-the-job vigilance, and focus on the music and my “corners.” What has not returned is my previous warmth of sound (because my equipment is still a little smaller than at my best playing years) and my endurance (I used to play 3-4 hour jobs…but not no mo!).

How has this changed you as a player?

I had to learn to give up waiting for my chops to feel "good.” They never feel "good,” at least not if I define "good" as how they felt before. (Now I almost always feel a little bit tired even when just starting the day). All that matters to me at this point in my process is how my chops are performing. I pay attention to sound rather than feel.

Also, I have a newfound appreciation for the days I play well. I never take sound production for granted. Even more than ever, I try to be a great musician, because I know I cannot be a great trumpeter. I try to make the most music with the skill set that I currently have at my disposal.

Were there any resources you found particularly helpful?

I spoke to several commercial players about overuse and rehab. It really was the Lucinda Lewis rehab that I owe my career to. I use ice more than ever, sometimes even during rehearsals/jobs, but almost always afterwards. I also think the Robinson Lip Renew is a helpful product. 

What advice might you have for someone facing an injury?

You are not alone. So many brass players deal with injuries and overuse issues. Find people you trust and ask for help. Find some rehab program to believe in and try it with due diligence. If it doesn’t seem to help, or it hurts along the way, don’t be afraid to try another program. There’s no one-size-fits-all solution. Trust yourself and find something that feels right and shows progress, albeit it SLOW progress!