A Trumpet Player on Chops, Injury Prevention, and Recovery

What were the nature and circumstances of the injury?

I would describe it as two injuries. The first was overuse and some bruising, then nerve damage by continuing to play on the injury. I was in my first (and only) semester of doctoral work while juggling freelancing, teaching, and auditions.

I had reached a point a little past midway in the semester where my chops were pretty banged up. I had jumped into a DMA after being out of school for over twelve years, and had developed some bruising in the center of the chops as well as daily swelling. I was progressively becoming tighter in the corners to make things work, and daily practice was becoming shorter and shorter.  

I knew something was wrong as this point and I needed some time off. However, being back in school complicated the situation. I had talked to my teacher and he refused to grant me any time off during the initial part of the injury, and in fact insisted that I play through it. (I also had consulted with a well-known injury ‘guru’ who had the same advice). After about two weeks of limping along I reached a major tipping point. I was playing through a flow study etude and reached an ‘e’ at the top of the staff and it sounded like I had a water key stuck open. It was only on that note and I couldn’t play higher. I tried a few times and each time the results were the same. 

At that point, I knew I was in a serious hole, but didn’t yet know how deep it was. I had decided to put the trumpet away and was going to take some time off regardless of the school outcome. However, while having a cup of warm soup that same night, the right side of my embouchure went numb. I ended up with one side of my face always feeling like it was in a cramp, with dull pain and some numbness. It did not respond to rest (weeks or months) and basically seemed permanent. 

I decided pretty quickly to seek some medical advice.  I had talked to a few “specialists” and they had all been wrong – and even compounded the problem. I believe the issue is that they could only view someone else’s injury through their own personal experience and tried to shoehorn my injury to fit their injury story. Given the trouble I’d already had with my teacher I felt the need to document the problem as well. 

While there clearly isn’t enough information about musician injuries available, I was able to piece together a plan from a few articles in the International Trumpet Guild journal and by talking with a few medical specialists over the phone.  I went to a local plastic surgeon (paying out of pocket) to make sure nothing was torn, then used my internal medicine doctor to coordinate from there. 

I eventually had a localized MRI done (again having to pay cash) and consulted with a neurologist. Keep in mind it took months for these appointments to play out. By the time I met with the neurologist, four or five months had passed since my first physical exam. 

By the time I’d had the MRI, anything that had been damaged was healed to the point where the MRI wouldn’t show it. At that point I met with a neurologist for a nerve conduction test, but after consulting with him, we decided to move forward without the test. (He had played music in high school, and like many of the doctors, he was fascinated and sympathetic to my situation). The MRI had shown that I wasn’t going to make anything worse and was essentially healed, despite still having pain and tightness. The numbness, also, had mostly resolved. So, I was playing a bit at the time of this appointment with the neurologist, and he had some helpful insights. He gave me a common-sense timeline and general guidance, but his major point was that since I was playing, and could cover the normal range and had some dynamic control, that the playing itself could offer a better sense of how my muscles and nerves were doing than a rather painful nerve test. The nerves will either heal in ‘x’ time or not, so as long as you keep the swelling under control there isn’t much risk of further injury. Those comments were a sort of “aha” moment. I began viewing things like how soft I could play as an objective measurement of recovery. 

 

What therapeutic at-home treatments did you try?

I used heat, ice, meds, playing large mouthpieces (tuba, trombone, and baritone), Dr. Simon McGrail’s lip exercises, massage with an electric toothbrush, etc. Nothing seemed to make any difference. 

 

Did you have to stop working?

The injury happened at a pivotal point, right when things were finally starting to come together. I did a few gigs here or there about ten months after the injury, but the repercussions were long-lasting.  I probably went back to gigging too soon and had many ups and downs. I played well enough to make up an incomplete for my first semester of my DMA (almost a year later) but had no confidence in going back to school, gradually lost most of my local work and my part time college teaching gig. 
 

What were the greatest frustrations?

Chronic pain in a small muscle on one side of the face; also, the first few months of playing again when I sounded like a different person.  
 

What seemed to help the most?

The single biggest help was Jim Thompson’s buzzing basics book. I had been playing again (mainly out of frustration) while teaching. I found that even with the injury, chronic pain, and time off, I could still play the standard high school repertoire – the things we regard as “characteristic” of trumpet (I find this interesting, but that’s another story).  I had studied with one of Jim’s colleagues in Atlanta, and while I hadn’t used that book in those lessons, I was familiar with the book and its concepts. I had assigned the first four exercises to a high school student of mine and would play along while the student would buzz/play each exercise. I would only play the exercises on the trumpet, as the chops were unable to buzz a mouthpiece. Assigning these to a student gave me a weekly appointment to play when it was the last thing I wanted to do.

In Thompson’s book he describes a sensation you get when you are playing well – most people I’ve talked to seem scared of it – it’s this tingling you get from doing the exercises. It has to do with relaxation and blood flow and maybe a few other things. While doing the exercises, I found that sensation again, and in doing them I’d get a momentary release from the chronic pain and tightness on the right side of my face. Practicing these exercises became a daily ritual, simply to give myself a break from pain. However, there was always a line. Too much or too little and my chops would hurt again. There are other exercises that can accomplish this, but for me, the Thompson book was the one I used most consistently for that purpose. After Thompson, I moved to Stamp which was very helpful. I still use it.

One other issue that has been hard for people to understand is that the pain from my injury was constant. Nearly all the general advice I got was “stop playing if you have pain.” But what do you do if you have pain that doesn’t respond to rest?!  Unfortunately, pain tends to be the last warning sign you get from your body. At some point, you have to reprogram the body’s response to that area.  

Did you make any changes or tweaks to your technique?

I did make some changes in technique, but it was more about going back to what really works in playing the trumpet – things that I had gotten away from. I think some injuries can come as a bolt out of the blue, but for most people you are talking about the slow change of mechanics as a result of playing too much. I mentioned studying with one of Jim’s former ASO colleagues. I was fortunate to study with this gentleman when I was transitioning from being a jazz player to playing classical. Most people would study with him for high-level audition coaching. I, on the other hand, essentially got Trumpet 101 from him, and since I was in my early twenties, I could remember and understand it a bit better than a high school kid might. So, I had a wealth of information from lessons with him and some other fine teachers to fall back on. I did modify things a bit, though. 

One interesting thing I will mention is that I relied very heavily on play-a-long type things for retraining. I would stream videos from Play With A Pro and ArtistWorks over my HDTV and sound system. I played and buzzed with these exercises hundreds of times. I also used Tom Rolfs' Flow Study CD quite a bit. Having an aural model was extremely important.

Did you make any changes in your equipment?

I went through many different mouthpieces, larger and smaller to deal with the swelling. I found student horns easier to play at first and did the first few months of playing on an old student Yamaha cornet. So far it remains the only time I have ever found a student model easier to play than a pro model. Afterwards, I was still having lots of tightness in the same injured corner of my face but it would come and go for weeks at a time. I traced some of that to equipment issues.  I was fighting my Yamaha Chicago C, sold that and got one of the NYII models used. It is a big horn, maybe bigger than I should play, but it doesn’t hurt my face and sounds good. I play a slightly smaller rim now but consistently play a larger cup, throat, and backbore combination (B cup 24/24).

 

If you had to take time off and rebuild, how did you structure your practice in rebuilding? 

Obviously, a big topic. Much of this will come back to the issue of acute vs. chronic injury. I came up with entire routines to address and work around various issues. The short version is you probably want to do just one session per day for a while if you are getting swelling because playing on swollen chops changes your mechanics. Once you can do about an hour and a half a day, think about dividing that time into two sessions with the 2nd session being much later in the day and simply another warm up. For embouchure rebuilding I think Stamp and Thompson are probably the best books out there.
 

I have found that regaining trust in the body is no small task. If this was an issue for you, how did you work through it? 

Again, lots of playing along with recordings. I find playing jazz tunes with Jamey Aebersold recordings (and those of great singers) particularly helpful, but it needs to be done in a way that will transfer to your normal style of playing (the centering of the notes, limiting vibrato, sustaining the phrases, etc.). The mental side can be the most difficult and I didn’t spend enough time working through that side of recovery. As a result, I do have pretty bad nerves that pop up from time to time. If I had to do it over, I would spend some time playing for free in retirement homes or churches – very low pressure situations where I could play in front of people but it be as little or as much as I would like. I have to wonder if regaining complete trust is even possible. Once you have an awareness of how wrong things can go, and how easily it can happen, it’s hard to block that out.

Did you come to feel like “yourself” again? If so, how long did it take?

I still don’t really feel like myself. Somedays I feel better than before, some days not. It has been four years, and I still keep at it. The injury area will still feel tight sometimes after tough weeks or sessions. I have gotten much better at learning to calm it back down.

Has this injury changed you as a player?

There are a lot of gigs and pieces I would be hesitant to play if called. It takes a long time to refill the tank to have the reserves one would have had before. 

What other resources did you find particularly helpful during your recovery and rehab? 

It is changing a bit, but there is a serious lack of resources out there. If we were baseball players we’d have a tight script of what to do, who to see, and how to proceed. There need to be more doctors able to address the needs of musicians. I did find a podcast interview with New York Philharmonic trombonist Colin Williams that I found very helpful even though his injury was different than mine.

Do you have any general advice to those going through an injury?

In general, most injuries are going to be a combination of several things. Probably some tightness in the breathing or chops, or excessive pressure in addition to playing too much. It is rare for these things to come out of the blue, and under-recovery is just as important a concept to understand as overtraining. Also, teachers need to seriously examine how they teach. Piling on tons of work and having a student “make it” says more about the student than the teacher. Remember, at the end of the day, no one knows your chops better than you do.