This is the first in an intermittent series of articles about the physical challenges and medical issues experienced by players of brass instruments.
As you probably already know, players of any instrument may develop a physical or medical condition that on the one hand is directly related to their playing of the instrument and on the other hand adversely affects their ability to continue to perform at a previous high level. The case that is perhaps most widely known is that of Leon Fleisher, the classical, concert pianist, who developed a dystonia that affected his right hand at the height of his career. Dystonia is a neurologic problem that causes a part of the body, in this case the hand, to go into unusual postures that limit mobility and dexterity and can be painful. In Fleisher’s case, his dystonia forced him to play pieces written solely for the left hand and to spend most of his time teaching and conducting for the next 30 plus years. He did eventually, with multiple treatments, regain the ability to play with both hands, but his dystonia markedly affected his career.
Like Fleisher and some other musicians, brass players may also develop dystonias of various parts of their bodies. Similar to string, woodwind and percussion players, we may also develop a host of conditions that affect our musculoskeletal system. As is true with players of other instruments, these most often relate to how we sit or stand or hold our instruments while playing and can cause pain or decrease in the range of motion of the affected muscle or joint.
Unlike other musicians we also can develop problems that relate directly to our vibrating lips and their relationship to our teeth and to the mouthpiece that connects us to our horns. Even a player with perfect technique and a very strong embouchure may damage his lips or teeth while playing, especially after very long gigs or with prolonged high-range playing.
Even more significantly, unlike our non-wind musician colleagues, and even in comparison to non-brass, wind players, we play against significant pressure. Not just the psychological pressure that almost every musician experiences at some time prior to a performance, but the actual physical pressure that we must build up from our lungs in order to push air effectively into our horns through a very small space created by our embouchures. Some of the effect of this pressure is solely within our oropharynx (mouth and throat) and can produce small tears or even outpouchings of parts of the soft palate (pharynx) or in our voicebox (larynx). But more significantly, the pressure is dispersed widely in our bodies. There have been reports of transient loss of vision related to increases in the pressure within the eye; changes in the pressure in the inner ear that alter the structure of the balance mechanism and produce vertigo (a feeling of actually spinning, not just feeling woozy); alterations in blood pressure both high and low that may lead to headache or loss of consciousness; changes in the rhythm of the heart; increase in the pressure in the abdomen that can contribute to the production or worsening of abdominal or inguinal hernias (outpouchings of a part of the intestines through the muscle wall, but not the skin, of the abdomen or groin; and certainly most seriously and fortunately, extremely rarely, even a spontaneous hemorrhage between the brain and the skull.
I should not complete this brief survey of the maladies that may affect brass players without mentioning the risk of lung infections related to our intimate relationship with our horns. Blowing hot, moist air into a relatively enclosed, dark space is a perfect set up for the growth of bacteria, molds, and other infectious agents. There have been reports of everything from mild respiratory illness occurring more frequently in brass players than in other musicians to cases of far more serious illnesses leading to pneumonia and hospitalization. The short message here is: Always blow out and do not breath in through the mouthpiece when it is in the lead pipe.
I hope that this article has given you an understanding of why playing a brass instrument is truly not for wimps. There have been many articles written about the various subgroups of ailments and injuries that I have mentioned. If you are interested in a more detailed but short overview of the topic discussed here, I would recommend a paper written by Chesky and Devroop from North Texas State in Med Probl Perform Art 17:93–98, 2002.
Each of us players of trumpet, French horn, trombone, or the low brass of euphonium and tuba can experience any one or several of these issues. Some are more common in players of one brass instrument than another, but these problems collectively are quite common in all brass players. We all love what we do, but there is a potential price to pay for all this pleasure and from knowing that we are generally expected to be the loudest instruments in whatever group we play in even though we usually have a very small number of players in our section.
If you have enjoyed this brief overview, there is more to come. Over the course of several articles, I plan to delve in more detail into the various sub-issues mentioned here and hope that the information will give you insight into a symptom or problem that you may have experienced or might yet experience at some point during your playing career.
Dr. Louis Russo is a member of the trumpet section of the Bold City Brass.
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