The Flute May be Metal, but You Are Not.

(click on image to enlarge) 

 

On one of the flute discussion boards this week, an amateur flutist wrote of their embouchure problems and search for a cure for them. In the interest of pointing out the flashing red lights that he/she speaks of, the warning signs that you are about to incur a “musician's injury”, I have paraphrased the parts of their description that jump right out at me, in order to answer, here on my blog. If you have been injured you JUMP at the chance to save others. So hopefully my rapid response is understandable.
Another flute professional, J. Brahms has also given permission for a reprint of his questions about this injury-journey and his clarifying questions for those on it. (see below)

See what you think. Comments welcome.

The Flute May be Metal, but You Are Not.
or
'No Pain No Gain' is the Puritanical Path to Injury

 The flutist “G” writes:
I have been playing flute for almost sixty-five years and have enjoyed playing Baroque chamber music in my middle age with an amateur ensemble. However for all those decades I never played any high register (not required in Baroque).
When I did restart flute seriously, I signed up for a challenging Chamber Music Summer Program, where some of the contemporary music required super-high-register C#4 and D4 and, of course, having no experience with these notes, I drilled myself on them, without much success.
After my super-high-note drills, I found I had completely lost my lowest notes: D, C# and C.
No sound came out.
By the time I got to the actual summer course, it was hit and miss on the low notes; most often nothing came out, but other days, for some reason, I could play them.
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Jen:
Highest C# and D4 are known to require the uncovering of the embouchure hole so that the lower lip covers only one quarter of the blow hole. (see article)
This is a tricky new and somewhat advanced flute embouchure procedure that takes some trial and error and lots of previously developed flexibility of the lips.

Perhaps you were using another more forceful way to obtain the super high fourth octave notes?

Many people just stiffen up their embouchure, and blow really hard from the lungs, but that doesn't work over time, as it is a civil-war between one set of muscles and the other, with no increase in aiming accuracy. A flawed method all around. So sorry you got caught up in it. A teacher would have advised against this as it leads to injury due to the constrictions and counter-tensions.
And of course, the high notes sound dreadful too.

Is that what you were doing? That alone could have been the birth of this problem.

Also, without lessons during all those decades, and with only mid-range (low/med. octaves) musical demands it's possible that your embouchure solidified into a very narrow range of motion from thirty years with no high notes (or no instruction on the best way to approach high notes).

I've seen students solidify their unfortunately now non-flexible embouchure through only missing one year of lessons and they then have to retrain for two years to get back to the place prior to their newest bad habit. So forty or more years without helpful coaching from an up-to-date teacher might also have caused you to solidify a poor neck position, or tight shoulders, or any number of “tight” methods that are  inflexible.
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G continues:
Perhaps this all stems from three years ago when I signed up for the chamber music program at a nearby College.  This upcoming goal forced me to up my practice time considerably in just a few short months, and to try to regain my facility with high notes.  One day, a few months into my high note attempts, the lowest notes ceased to speak altogether.
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Jen: This is a very typical problem in any intermediate flute player who's just finished practicing the highest octaves. Almost everyone has difficulty returning to low C immediately, especially without instruction about how to release tension in the embouchure so that the lips can “remember” their low register position. Even if you had been following the advice of a good teacher in gradually increasing your range, you can encounter this phenomenon where for a moment, your lips forget where the low register is.
In musician's injury stories, this is typically the time frame in which the injury becomes serious because the person is driving themselves too hard to meet a hugely challenging goal that is frighteningly close.
They don't warm up, they play too much per session, they play too many hours per day, and they don't apply easy “release tension” remedies, but just keep pushing and pushing and repeating and repeating with maximum tension, fear and fatigue.
I've done it. These are some of the flashing red lights that tend to lead directly to injury.
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G continues: After the summer chamber music ended, I visited an acupuncturist to see about curing my embouchure problems,  and although my high-low conflict has eased somewhat, I still have other difficulties with my musculature.
I had an autumn appointment at a medical facility for the Performing Arts where I obtained some input and advice about going forward. That fall I also began taking private lessons.
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Jen: Was the private teacher aware of the scope of the possible injuries and did they have any idea how to advise you? Were they very experienced? Did you present with the specific problems? What remedy did they offer?
I know that when I am presented with a person who has not taken lessons for decades (or who had never taken lessons but was self-taught) it can take two years of simple rebuilding from the ground up to give them the full spectrum of abilities; built on a secure skill set that is layered very gradually.
The worst thing to do would be to let them continue with all their physical habits of tension and give them difficult repertoire. (the WORST!)
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G continues: For three years I’ve been quite frustrated about my not-too-great high register, and my lips feel “stiff” and I cannot play expressively. I expected that after a few months of playing again, all this would come back.
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Jen: No, it's not that easy. If you are in your 70s, and these are your first few flute lessons since the 1960s, then a lot has changed about our understanding about “how to teach the flute.” And of course, none of us remembers techniques we never repeated in the intervening years.
Plus methodology has truly changed in flute teaching.

The most informed teachers would take a look at your flute playing, and gradually break it down into areas that can be re-trained in a more wholistic way. But building up that trust can take a year to develop the relationship. So it's a 2-3 yr. commitment to learn all the new things that have been developed in the decades since you last studied, and the education level is much higher now among qualified teachers.
Injury prevention is very important; be sure to choose a teacher who knows about it.
Not all teachers are equally adept. Go to a specialist teacher if you can.

So far, your problem description reminds me of very typical issue of a flute player whose lower jaw is thrust forward at the hinges and lips are too tight and unyeilding.
Jaw position can affect "stiffness" overall because the jaw hinge is being stressed by thrusting forward of the lower jaw and pinches facial nerves over time causing a numbness or inflexibility of the nerves and sensors around the lips.
You could be injuring the nerves further by continuing to play in your old manner.
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G continues: One example of the stiffness in my lips is that I am unable to do that Trevor Wye pitch bending exercise where you play a note and bend it very sharp and bend it very flat.
The note just stayed the same pitch. I could not bend it.
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Jen: This is also typical of someone whose jaw is thrust forward and lips are too tight across the teeth instead of jaw open and lips "pooched forward" to give multiple angles of airstream. A fundamental looser embouchure is the kind of retraining in the new way that a good teacher will help you with over several years of lessons. You can't just "remember" how to loosen, without step-wise techniques and a coach to spot what you're doing.
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G continues: But just the other day, I was suddenly able to bend the notes as per Wye note-bending.
Maybe I'm recovering? But my lips still feel “stiff” and after practicing, they really tingle as well.
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Jen: This tingling is a true sign of danger, and is also typical of someone whose jaw is thrust forward. If you look in the mirror and see that you're trying to make your lower teeth jut forward to create an embouchure, and then hold that jutted position with jaw tension, then this might indeed be the cause of embouchure problems. The tension at the jaw hinge is pinching the nerves that travel to the lower face, and this pinching impinges the nerves and blood flow. This tingling is your body telling you to stop doing whatever you're doing. It's a warning that injury is imminent. Sadly, folks don't read “preventing musician's injuries” articles that list these warning signs until they are already injured. At the first sign of discomfort, tension or tingling, you must STOP.
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G writes:  I usually surmised that tingling and stiffness were a good symptom of hard physical
 effort.  But I was puzzled that those sensations would persist, even when not practicing or playing.
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Jen: Please take note: Rant incoming.

Pain is not an indicator of "good hard work" but instead it is an indicator of misaligned body-use and wasted effort through tensing one part of the body against another. For some Puritanical, self-denying, try-harder, break-yourself, righteous insanity reason "No pain no gain" entered the human lexicon long before anyone realized that your body uses pain to warn you that, in the case of sports, you are ripping and tearing your own muscle tissue or damaging joints or compressing nerves so hard that they can't function at capacity. In musicians, it is these creepy feelings of the suddenly protesting nerves that are screaming for you to STOP what you're doing; it can be pain, numbness, buzzing, warm-cold, but it feels odd and creepy. This is your body saying to your brain “NO, please please stop what you're doing!”. So let's modernize, and agree that we can't let this saying continue.
Note:
Pain* means “no.”
No means stop.
This is your body speaking.
______________________
*Pain can also include: weird sensation, loss of sensation, any discomfort however mild,  any strange feeling you didn't have before that seems to linger, and unintended movements that are occurring by themselves without you having a choice.
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G continues: The chamber music summer program did contain multiple C#4s (ultra-high C#s) so when I did finally get them to come out, again, I lost my lowest register notes.
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Jen: If the repertoire required multiple high C#s then I would question the repertoire. What work was that? It's a horrible note on the flute, and much better on piccolo. Who is the composer???? Why did the flute teacher at the chamber music program put YOU on these passages, who had never played in the fourth octave before?
In the repertoire, there are only a handful of flute pieces that actually require this note, so I don't think the composer is doing anyone any favours by writing multiples of them.
Sorry to rant; but good grief. Not for amateurs.
You might HURT them, composer dear.
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G: Finally I had to stop playing altogether for eight weeks or more.
I went to Acupuncture to see if that would help.
======================
Jen: I wonder how the Acupuncturist could possibly understand about a musician's injury without knowing how the musician continues to injure themselves? When I go to Rolfing or Massage, I take my flute and show them the body position. (my injury is neck-shoulder-arm). But they don't fully understand it like a musician's injury expert would. So I wonder if you're seeking the correct therapy.
Also, regarding the lowest footjoint notes on the flute: Besides the fact that these two notes are difficult for anyone if they are not fully warmed up and there is a procedure for loosening the embouchure, you do not mention whether your flute been checked by any other player to find out whether the low C and D come out for them? You could have a leaky Eb pad! The C key could be bent. There could be a shrunken cork or shrunken pad. Has the flute been checked over?
What if a small leak in the F or E key is destroying the tone of all notes that are below them?
Have the flute tested by your teacher, and send feedback, please.
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G: After two Acupuncture appointments, I got my low notes back (they're still not great) and the practitioner suggested that maybe my lips had been in spasm. I tend to agree.
 The doctor at the musician's injury center suspected that the problem was not dystonia, or I would not be able to play the low notes at all.  The doctor filmed my highest C#4 and D4 attempts and discovered that air was coming out the sides of my mouth. So it was decided I should play it safe and limit my practicing to ten minutes a day only, until there is some recovery.
====================
Jen: I have recently seen a performing doubler who, only on flute, spasms in the lips continually from dystonia (from over-use, over-practice, and overly-tight-embouchure and jaw) and they could get ALL the notes of the flute, but they had a constant fast jaw spasm at the same time.
So I don't think dystonia is fully ruled out, as it could develop if the pressure is not taken off your impinged nerves and overly tight muscles.  Dystonia can creep up on you. This doubler I met had no idea that the tremors were not entirely normal. (Note: I found the link to the flutist's embouchure dystonia AFTER writing this blog post. In the flutist's embouchure dystonia article she realized that it was using slow air speed and shallow breathing and that was what caused her to over-work her embouchure. Very important point for flutists returning after a hiatus - use your air, not the tightening of your lips to hold notes up.).

The original problem could have even started with a very typical situation: You have an old flute that needs the pads fixed and then suddenly it is played many more hours than previously despite not being repaired. The fluteplayer presses harder to get clear tone. This finger pressure would be followed by creeping wrist, arm and shoulder tension from pushing the keys down too hard, and this would be followed by neck and jaw tension, rapidly causing deterioration of abilities by setting the goals too high and too fast and then relentlessly repeating wrong motions. The combination of all these things usually leads to increased injury, which is when the body finally says "Stop".

I'm truly surprised to hear that there was air coming out the sides of your mouth and you didn't know until you were filmed at the doctor's office.  You did not look in a mirror at any time during your previous practicing? Your teacher didn't have you check your embouchure in a mirror?
If so: What does your teacher say when she/he sees you play high register now?

My brain is telling me that your neck is uncomfortably twisted, your jaw is thrust forward, and you are therefore cutting off sensation to your lips through sheer tension. But of course, without a film of you playing, I'm just guessing.

I would also be curious whether you're standing full height to practice with the right height of music stand and whether you're craning your neck to see the music? I have had several students in their 60s whose problems begin with leaking pads, and the wrong eye-glasses. It's unbelievable what can go wrong if no one coaches you and notices these things.

I even had a student admit that they actually practiced sitting down with their sheetmusic on a kitchen table, in dim light, with their elbow resting on the table. What?????
This is how to CAUSE an injury.
But the student just hadn't adapted to the idea of purchasing a real music stand.
Again: What?????
I'll save my rant on that. ha.
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G:  The improvement has been fairly steady since the acupuncture visits and I do feel that the  stiffness and tingling that I mistakenly attributed to good results of hard  physical practice were actually muscular spasms.
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Jen: So perhaps your belief in "trying REALLY hard" is what caused the problem to escalate? You didn't know that obtaining the right technique from a skilled teacher was the faster way to gain proficiency?

 In fact my rant about "pain does not mean gain" might be correct, in that you over-did it because of the belief in "good hard practice", which is erroneous.  I'm so sorry that this one faulty message caused you to over-do it.

However,  now that you have been advised by the specialist doctor to accomplish your progressive recovery in only ten minutes per day, are you really creating a better focus, simpler plan, and less repetition of "too tense" ways of doing things? Are you getting professional assistance to design your practice program?
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G:  my 10 minute regimen each day consists of playing a C  scale or a D scale (starting on low C#), with each note followed by a  whistle tone on that note.  I only use whistle tones on the highest C# and D.  That takes most of my 10 minutes.
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Jen: Sorry: But who designed this warmup? If your new teacher did, do they advise it to be your warmup???

It's a bit too complex, in my opinion, because as you ascend the scale you are tensing, and when you whistle tone, you are loosening. So it's tense-loose-tense-loose-tense-loose-tense-loose.
I've never heard of a warmup like this.

Did your teacher give you this? Can I talk to them??  :>)

And why C or D scale? (I use descending chromatic, myself beginning with first octave B to Bb a la Wye longtones when I am out of practice).

And why begin on the lowest notes of the flute, instead of the middle, where beginning is easier?
There are much better warmups that really WARM not stress.
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G:  Then after my scale warmup, I practice a particularly tricky couple of lines in a Bach trio sonata. It's one with a lot of odd jumps.
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Jen: This sounds like too much too soon. An easy warmup should be followed by flowing melodies that are stepwise, not leaping.
Leaping difficult intervals along with Bach's insane demands for flute (not easy) in terms of lip and jaw tension, is not a good idea, especially if you're trying not to hurt your lips or jaw, I would not start with this, I would leave this until I was fully retrained and recovered.
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G: Finally, I run through a movement or two of a Telemann Fantasia with the focus on the architecture of the musical phrases and its construction.
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Jen: Again, in my very strong opinion (ha ha! :>) this is far too difficult a practice routine for someone who is recovering and needs to be deeply retraining to avoid tension. Bach with large leaps, and Telemann Fantasias are true showpieces. They are not skill-building gradual warmups that re-train the body to easier and more fluid ways. I would not advise this plan at all for someone recovering from an injury. But that's just me. Your own teacher may be better informed as to how seriously you are injured.
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 G: I do allow myself complete chamber music sessions every week and duets at my flute lesson,
 which I have begun again, after a halting them since last year.
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Jen: I personally would find it very taxing to play duets and chamber music sessions, if I was injured to this extent, with the need for basic embouchure relaxing, gradual embouchure skill building and more relaxing warmups overall. Without those skills, and without being fully warmed up, I would strain myself trying to play suddenly in a duet or chamber piece without stopping , with my fellow musicians requiring me to keep playing no matter what tension I may be experiencing.

So I couldn't help but jump on the computer here, rant a wee bit, and just state that a lot of warning lights are going off for me, as I too injured myself in similar ways in my 20s. And I wasn't working alone!!! I had teachers there to spot me.  (The knowledge of injury prevention was just not prevalent when I trained.)

 If you add tension to the fatigue of the body in its seventh decade, slower to heal, and easier to damage , and then put the whole thing in the pressure cooker of performing at too high a level of expectation and possibly fear of failing to make the grade, then you have a pot that's about to boil over. There is a great deal to consider here.
Let's breathe and think.

Also:  Take note of the interesting similar thoughts of a colleague who also responded with a certain level of helpfulness and panic from recognition of the danger signs.
See below for thoughts from flutist Jonathan Brahms who has given me permission to add his questions to "G"  to my blog. Comments welcome everybody!
I have written to G and await a reply so we can sort this out and all of us benefit.
Best,
Jen
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Date:    Mon, 25 Sep 2017 1
From:    Jonathan Brahms

 Thank you for this detailed description of your situation as you describe it to us.
I am responding in detail because I am personally acquainted with several highly-accomplished professional flutists who lost their ability to play, either temporarily or permanently, for one reason or another.

 Been There: I have had a close brush or two with it myself, so I am delighted that you were able to heal and continue to play (as I was), for it appears that you went all the way to the brink of losing your embouchure permanently, but not over it.

 The demands of music-making and our own artistic ideals, aspirations and ambition often lead us to engage in extreme behavior, which is often destructive.

 I am sorry that you went through this ordeal, which is sometimes brought on by the circumstances of performance frameworks (both amateur and professional) and other times as a result of decisions made by the player.

 You have described the process of your cure (the "after" situation), however, I am curious as to what you did exactly (the "before") in terms of practicing to bring about the situation in which you were unable to play as before.

 Specifically:
 Which composition did you work on that summer that contained fourth octave pitches (C#4)?

 How much time had you practiced on a fairly regular basis before you chose to "considerably up your practice time" and how much time did you practice as part of that campaign?

 Did you break up your practicing into short sessions or you did you do it all at once?

 Did your practicing (before and during) consist of a healthy blend of scales, arpeggios, études, articulation, dynamic and sound exercises? Did you emphasize any particular element/s?

 Did you spend a lot of time playing long tones, especially in the upper reaches of the instrument?

 Did you work on playing louder/softer in any or all parts of the range?

 Did you attempt to play with a dark, cutting, oboe-like sound in the low notes?

 Did you ignore warning signs such as twinges in the embouchure muscles or a wave of heat going through the embouchure?

 Did you make your practicing changes on your own, without the guidance of a teacher?

 Do you play the piccolo?

 Did you discuss what you had been doing during the summer with your new private teacher after the summer?

 Thanks for your contribution to this extremely important subject.

 Jonathan Brahms
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Best, Jen