Instrument Injuries: Fixing Musicians' Mouths

It's football season! But while we watch high school, college, and pro players put their bodies at risk for our entertainment, musicians on the sidelines are in danger of hurting themselves, too.

They march, blow, and jive, to energize crowds. But playing a brass instrument can be hard work. Just ask Stephen O'Connor.

A trumpet player since fifth grade, he's been in marching bands, stage pits and orchestras, practicing at least an hour each day.

"I love music, and I love the trumpet,” says Stephen O’Connor a trumpet player. “At this point, it's become like an extension of my body."

But all that playing caused muscle to weaken and scar in Stephen's lip. A big scare for this dedicated musician.

"I couldn't hit the notes,” explains O’Connor. “I couldn't hit them consistently."

Doctor Craig Vander Kolk sees about two brass instrument players every week with lip problems.

"I think every horn player has put his lip, or his embouchure, under stress," says Dr. Craig A. Vander Kolk. MD, Plastic Surgeon at Mercy Medical Center in Baltimore, MD.

He says over-use, not warming up and incorrect form are to blame. If the lip muscle is strained, he recommends rest, ice and alternating practice sessions with 20 to 30 minutes of rest. If the muscle scars, surgery is the best option.

"Because we need to actually cut that scar tissue out and bring the muscle back together,” explains Dr. Vander Kolk.

Stephen's lip before surgery was loose. Doctor Vander Kolk removed scar tissue and sewed the muscle back together. After a successful procedure and months of rehab Stephen is back to playing his horn.

"I wake up, and I've got music going through my head already," says O’Connor.

A young student, whose dream of a career in music is still very much alive.

Doctor Vander Kolk says musicians from all over come to his center, which has one of the only programs of its kind in the country. He also works closely with physical therapists and injury prevention specialists.

He tells us the worst instrument for lip injuries is the French horn, because it causes the most stress and pressure. The trumpet is next, and the trombone is also high on the list.

Instrument Injuries: Fixing Musicians' Mouths
REPORT #1937

MUSICIANS AND INJURIES: Although the extent of the problem has not been fully appreciated until recently, musicians are at risk of injury from playing their instruments. In fact, some orchestra studies estimated that between 40% and 76% of players have suffered at least one medical problem that was severe enough to affect their performance. It is also thought that many times musicians do not mention the symptoms of injuries such as pain in the upper limbs, shoulders, and back, loss of control, tingling, or weakness. The British Association for Performing Arts Medicine found that out of the number affected musicians; about 52% have musculoskeletal problems while the remaining 48% have concrete diagnoses including tendonitis, carpal tunnel syndrome, tennis elbow, various neuropathies and over-use syndrome. These problems are thought to be to due to, at least in part, the body/instrument interface, which is essentially the use of the body in relation to the instrument. (Source:

COMMON INJURIES: Certain injuries are seen more often in musicians. Some common injuries amongst musicians are strained or torn muscles, over-use syndrome from repetitive motions, joint pains, tendonitis, and carpal tunnel syndrome. It is important that if someone continues to experience pain or the pain is severe, they need to see a doctor.

HOW TO AVOID INJURY: There are some things musicians can do in order to prevent experiencing these injuries. These tips will help people keep on playing with less risk of injury:
When playing the instrument try to identify, avoid, and release inappropriate tensions. For some instruments mobilizing the shoulders, like with arm swings, can also be helpful to prevent tension.
* Warm up with light playing before jumping into a complicated or vigorous musical piece. Warming up the whole body, not just with the instrument, may also help.
* Adjust the instrument as needed to fit your body better. For example, the mouth-pieces on flutes can be changed to better fit the musician.
* Try to maintain good posture and alignment while playing, and for those who play guitar, keyboard, or anything with a bow string, make sure the hand and forearm are aligned properly.

For More Information, Contact:

Craig A. VanderKolk, M. D.
Professor of Plastic Surgery - Johns Hopkins
Associate Director - Plastic Surgery, Mercy Medical Center
(410) 332-9700

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