My Struggle with Jaw, Neck, and Shoulder Pain

By Audrey Cupples


Preparing for tour

In 1995, I was getting ready to go on a Texas tour with “The President’s Own,” U.S. Marine Band. In preparation, we had rehearsals for three hours in the morning and 2 hours in the afternoon. After rehearsal, I would go home and teach lessons, playing with my students, then I’d practice. Towards the end of the first week, the week before we were to leave on tour, I noticed my embouchure was getting tired more quickly than usual. My jaw would start to open a bit and I’d start leaking air out of the corners of my mouth. I figured it was from the long hours of playing and decided to take it easy after rehearsals. Next, I noticed my neck was catching when I’d turn my head while pulling into traffic. It didn’t seem that bad, so I decided I was ok to go on tour. I really didn’t want to make someone else have to pack up and go on tour at the last second. This was a big mistake!

Tour Trouble

Our chop buster concerts were over two hours long, every night. That alone was a challenge, but we performed in inhibiting uniforms. The collars were stiff, tall, and cut so that it was very difficult to hold your neck up straight— the collar pushed your neck forward. They were heavy, and all the braiding pulled you forward. Put a saxophone around your neck, and you had a disaster waiting to happen. Adding insult to injury, each day, the bus rides were long and cramped, and carrying heavy luggage to your room, many times up stairs, was hard on your body. Sleeping on different beds and pillows every night didn’t help. I took 1600-2000mg of Ibuprofen at a time, and it didn’t touch the pain. It got to a point that the only time I wasn’t in sickening discomfort was when I was walking. Sitting or even laying down was painful. I could barely make it through dinner— I would get nauseous from the pain before I could finish eating. Concerts were rough to get through.

I decided it’d be a good idea to go to a masseuse. I thought maybe if I loosened my muscles, the pain would subside and I’d be able to play again with less pain. We were in the same place for 2 days, so I scheduled a massage for each day. The first day was pretty intense, and the masseuse said she could feel all the knots in my muscles. She worked on my shoulders, neck, and jaw. The next day I went back for my second massage. She touched my jaw and I jumped. I was so sore from the day before, she could barely touch me. She got out her electric gun and proceeded to work out my jaw muscles. This was not pleasant. That night at the concert, I could hardly hold an embouchure. I was in tears because I wasn’t sure I’d be able to play at all, and the sax section had a quartet soli in “Variations on a Theme by Paganinni.” I managed to play those 16 measures, but nothing else. Things were definitely getting out of hand.

Made it home, but now what?

I made it through the rest of tour, only playing the essential parts, but once I got home, even after resting a week, I couldn’t play. I had to figure out what was wrong and if it could be fixed. I had x-rays and saw many military doctors who were unknowledgeable about a musician’s life. The oral surgeon was the most understanding. He diagnosed me as having temporomandibular disorder, or TMD. He made me a night guard to wear when I slept. I still managed to grate my teeth even with that in my mouth. He made me a cover for my front top teeth to even out my bite while I played sax. One tooth is longer than the other, making my embouchure skewed. Something like that might have helped me when the injury started coming on, but I was in such bad shape, it really didn’t help. He suggested lifestyle changes and I made the appropriate adjustments. I cut out hard or chewy foods, I stopped sleeping on my stomach, I constantly checked myself to make sure I didn’t have my teeth touching during the day— my teeth were usually together unless I was talking or eating. He prescribed Flexeril— a muscle relaxant— and that helped a lot! I’d get really bad headaches, like a vice was squeezing my head. The only thing to knock them out was Flexeril. I’d take one at night, and the next morning my headache was gone, and my jaw, neck, and shoulders were so much more relaxed.

At the same time, I was seeing a civilian chiropractor I managed to find on my own. He had been a clarinet player in school and seemed to understand musician’s injuries. He took x-rays of my neck and found that the section that was supposed to be a “C” shape was straight from having a saxophone hanging around my neck for so many years. He worked at realigning my back, neck, jaw… body. After the first week, I felt some relief, and was able to move a little more freely. He used adjustments, moist heat, and electric stimulation to help relax and heal my injuries. He gave me a list of stretching and warm-up exercises to help me recover and to do before playing. Without his treatments, I don’t think I would have ever played again. The process was much slower than I would have liked, but every time I jumped the gun and tried to play too much, too fast, I’d take two steps backward.

The Marine Band was very supportive, never pressuring me to get back to work. They understood that my focus and energy needed to go into healing and working to play saxophone again. They even sent me, and a couple other injured colleagues, to a Musicians Health Workshop at Ithaca College in Ithaca, N.Y., which was very insightful. Two years after my first symptoms, I went on tour and made it the whole 52 days unscathed.

Staying Healthy

My jaw, neck, and shoulders have never quite been the same since my injury, and I need to remain vigilant with my preventative routine. Every night for 15-20 minutes, I use a moist heating wrap around my neck. I sleep on a pillow that keeps my head the correct angle and height to ensure no neck pain the next day. I never sleep on my stomach. I rarely chew gum. I don’t eat sour dough bread or tough steak. I play on much softer reeds than I used to. I can only practice tonguing sections or altissimo sections a little at a time— those techniques put a lot of stress on my jaw. I use Flexeril on the very sparse occasions that I get those bad headaches. I stretch before, during, and after practicing. I take breaks when I’m feeling tired or too tight. I’ve learned to LISTEN to my body.

Final Advice

If you’re having a similar problem, here’s some advice: 1) Stop playing your horn immediately, and go to a good chiropractor who understands what you do. I wish that I had immediately stopped playing and sought help. I might have prevented the permanent damage caused by my continued overuse of these injured muscles. 2) Stretching and warming up are very important. Take the time to work these into your practice schedule. 3) Yoga and meditation are great ways to relax your mind and body— and to help you focus during your practicing and performing. Anxiety doesn’t help if you have any tight muscle issues. 4) Sleep is another important factor. Make sure you’re getting 7-10 hours of good quality sleep pretty consistently. 5) Listen to your body!
From 1988 until her retirement in 2014, Audrey Cupples was the first and only woman saxophonist in “The President’s Own,” United States Marine Band.

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