Tendonitis problems - Can I still play?

All topics musical, not specifically piano-related

Postby Dr. John Zeigler - PEP Ed » Wed Aug 18, 2004 8:10 am

This was a forum welcome message that has turned into a tendonitis topic. Rather than swim upstream, I've retitled the topic.



Edited By Dr. John Zeigler - PEP Editor on 1097077979
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Postby be-sharp » Wed Sep 22, 2004 3:13 pm

After 20 years of classical piano training, I have developed tendonitis in my wrists. Are my playing days over ??? What are my options???
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Postby Dr. Bill Leland » Wed Sep 22, 2004 5:11 pm

No, it doesn't mean your playing days are over, but you must be doing something wrong, unless there is a separate trauma, not related to piano, to blame. There is a whole branch of medicine devoted to medical problems of musicians, and practice/performing-related injuries are distressingly common among violists, violinists, clarinettists, and numerous others besides pianists. The most famous cases are those of Leon Fleisher and Gary Graffman, two world class pianists who had to quit (Fleisher is playing a limited schedule again after many years) due to overuse syndrome. I certainly can't diagnose what you have, but it sounds very much like the same thing--tendonitis is usually related to strain and overuse.

My suggestions are, first, to stop cold until you have a professional diagnosis and effective treatment; second, get different opinions about what you're doing when you practice that may be causing trouble. Are you practicing beyond the point of fatigue? Do your hands and arms exhibit a lot of tension when you play? Do you place your hands in awkward positions? Make exaggerated movements? We had a case of severe strain here at the University last year--it turned out that the girl's teacher was making her practice with weights on her wrists. Crazy! Playing has to be economical, fluid and natural. Hope this gets solved--you may need some time and patience to get to the bottom of it.

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Postby be-sharp » Thu Sep 23, 2004 7:16 am

Dr. Leland,
Thank you for your reply. I'm sure most of us enjoy the challenge of learning a new piece. I seem to practice with such passion that I probable do overdue it a bit. However, now that you mention it, I do seem to tense up in my arms, hands and wrist when I play.
Any suggestions on how to relax and still be in control?
Also, the proffesional diagnosis is Tendonitis. Two doctors have told me to stop playing the piano and find a new hobby. They are obviously not musicians. I miss playing and it has been a few years. Even as I type this note, I feel the uncomfortable feeling in my wrists.
Someone told me to try accupuncture. Do you know of this?
Thanks again.
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Postby Dr. Bill Leland » Thu Sep 23, 2004 9:46 am

Acupuncture has gradually gained more and more acceptance among the medical community as a viable therapy, and I can tell you that it certainly helped my wife with a tension problem in the neck. It wouldn't hurt to try it, even though--as with piano teachers and many other professionals--it's always a gamble to try and find a practitioner who really knows what he's doing.

From what you say I gather that the doctors feel the tendonitis was caused by piano, so you're probably right to be suspicious of tension in your playing habits. Whether temporarily or not, you're going to have to stop for now or you'll only make things worse. The worst thing you could do is try to "play through it"--that's what Graffman did, and finally the damage was permanent.

As for how to play relaxed, of course I can't teach you that in a couple of e-mails, but I can tell you this: when we play, our hands, arms and shoulders should act like the body of a professional dancer or athlete. The movements all have to be fluid, coordinated and economical; and economical means that both the degrees of effort and the distances of the hands' trajectories should be no more than necessary. When tension occurs we get three things: continued contraction and tension AFTER a movement has been completed; greater contraction than necessary to perform a task; and "parasitic movements", a term which medical people use to describe contractions of muscle groups other than the ones needed for a particular movement, like tightening the neck or hunching the shoulders. A common example is sticking the thumb out or holding up and tensing fingers that are not involved in, say, a trill.

You haven't mentioned whether or not you are currently taking lessons; if so, what does your teacher have to say about it?

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Postby 75-1095335090 » Thu Sep 23, 2004 11:09 am

I have a similar problem, but we're pretty sure it's not because of the way I play. I have tendonitis in my wrist, as well as the equivalent in my elbow (it's called something else), a problem with the carpal tunnel (not CTS... yet!) some scar tissue at the base of my thumb, and it's all inflammed... all in my right arm. Joy of joys.

Anyhow, I had gone to the doctor and he gave me anti-inflammatories (sp?) and said to wear a brace.

Neither one helped even a little bit, but then, he had only diagnosed the tendonitis in my wrist.

My massage therapist (after yelling at me for not going to her as soon as it started hurting) diagnosed the problem (it started in the elbow, and the wrist went because it was compensating for the hurt elbow). She said to ice it for five minutes in each spot every hour. She suggested keeping a tennis ball in the freezer and squeezing that from time to time.

She also showed me a stretching exercise that computer users should do, thinking that it might help, and it seems to be. You put your hands palm-down on a table, arms straight and lean forward a bit until you feel a bit of a stretch, then hold that for 30 seconds. Next, flip your hands around so that they are still palm-down but the fingers are pointing at you, arms straight, find where it's a stretch and hold it for 30 seconds.

Anyhow, the advice here is that you might want to consider seeing a massage therapist. Apparently they treat tendonitis all the time.
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Postby be-sharp » Thu Sep 23, 2004 4:30 pm

Dr. Leland,
As of about 5 years ago I stopped playing the piano due to the dull pain. Needless to say, I am not currently taking lessons though I miss it terribly. Most of my friends have pianos and when I do play (lightly) I can go for about 30 minutes before I feel the tendonitis kicking in.
Kittypaloozas mention about a massage therapist may be worth a try. The doctors told me there is nothing that can be done so I am glad to have heard from you both here on this site.
Thanks again.
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Postby Dr. Bill Leland » Thu Sep 23, 2004 5:09 pm

Thanks, K-P., for some valuable input. These problems can be major frustrations and aggravations, and I sincerely hope you can get yours solved. I had an awful time many years ago with what they called a "trapezial spasm"--the trapezius is the kite-shaped muscle that goes from the neck to the shoulder and down the spine, on both sides. Fortunately the problem turned out to be practicing hard with slumping posture (I was trying too hard to relax), and didn't go too far. Since then I've been careful to stay erect at the waist so that the shoulders can hang loosely without stretching those neck and back muscles out of shape.

Be-sharp, I didn't realize this started five years ago--when did you get opinions from the doctors? I can see where it's getting late now to solve this, but it's also hard for me to believe that tendonitis is incurable. Did they give you no treatment options, such as those KittyP suggests? Have you had xrays to be sure there isn't carpal tunnel syndrome? That would continue to cause friction in that tunnel where the nerves pass through. Don't give up! Keep us informed.

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Postby be-sharp » Fri Sep 24, 2004 7:39 am

Actually, they did not give any treatment options. Let's hear it for HMO's. They did take x-rays back then and, in a way, I wish it were carpal tunnel syndrome - there is a cure for that. The stretching exercises that K gave have me a bit concerned. I do want to explore their possibility though as I need to continue to express myself on the keyboard.
I am just starting to get back into playing after 5 years and the condition seems to be looming in the background.
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Postby 109-1089922742 » Fri Sep 24, 2004 2:39 pm

I experienced some pain last winter after i played for a while. A few things to keep in mind, first of all most doctors don't play piano or know anything about it, and a lot of times the tendonitis-overuse problem is misdiagnosed. More often then not the problem is mis-use, not overuse. Stoping playing or icing or whatnot might help a symptom but the problem will just come back. I looked into the Taubman method of playing, and have taken several lessons with a Taubman method specialist and it has helped a lot.

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Postby be-sharp » Fri Sep 24, 2004 4:18 pm

:D Matt,
I studied, for a while, with my cousin who is a music professer at CSU. The method that she taught had my hand position in an arch rather than the ole curved fingers/ level wrist. All of the musical passion came from the entire shoulders and arms as opposed to sitting still and having the fingers do all the work.
I visited the Taubman site (thanks to your post) yet still wonder if this technique is what I learned.
Can you elaborate on the Taubman Technique?
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Postby 109-1089922742 » Tue Sep 28, 2004 4:14 pm

Taubman method uses forearm rotation for its basis. The forearm rotates faster than any other movement the arm/hand can make. Its rather complicated to explain but i highly recommend taking some lessons from a Taubman specialist, it is real a different slant on playing and technique.
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Postby Wild Rose » Tue Oct 19, 2004 6:56 am

I suffered intense pain for over five years in hands and arms.

The one thing to remember about RSI (Repetive Stress/Strain Injury)
You CAN get better. You NEVER get over.

The best solution - never get it in the first place. I tend to come down on my students about improper back and hand positions like a load of bricks.

The things I found helpful were (and are)

Books:
It's not Carpal Tunnel Syndrome! by Suparna Damany and Jack Bellis
The Best book of the lot!!!
Aimed at computer users but the problems are much the same.

The Athletic Musician by Barbara Paull and Christine Harrison
Mostly about the spine, and what to do about it. Great Book!

Conquering Carpal Tunnel Syndrome by Sharon Butler
Mostly streaches and glides.

The Art of Practicing by Madeline Bruser.
Several methods are discussed as well as a great amount of other material.

Other Things:
ArmAid: A tool for deep massage of the arms and hands that you can do yourself when ever you need it. Worth the outlay!

There is a LIST for RSI suffers and one was being contiplated for musician/pianists. I was a member for a couple of years. It seems that piano mixed with computer/mouse is a particurly intense combination too often ending in one version or another of RSI.

Iceing helps.

Deep massage helps.

Lots of things "help".

But nothing is as good as simple awareness - and that is where so many of us fall down.
Pratice is what makes the impossible, possible
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Postby 81-1074658942 » Wed Oct 20, 2004 6:29 pm

Does anyone have any suggestions for what constitutes good posture at the piano? I have good posture at the piano, I sit quite straight and don't slouch, but I find that my right trapezoid muscle hurts when I play for a long time. Still trying to figure out why. The doctor said that I need to strengthen that muscle, which I'm working on, but is there anything I can do for the time being? The pain isn't bad and it isn't really consistent either, but I don't want anything to get worse here.
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Postby Wild Rose » Wed Oct 20, 2004 11:33 pm

Quidam - you should not be having any pain. Tired maybe but not pain.

When hand specialist Dr. Emil Pascarelli (who wrote "Repetitive Strain Injury" with Deborah Quilter) makes an examination it takes about 1 hr. and uses the equipment that is causing the problem. Bet your Dr. didn't do that.

Since getting to a real expert is probably not an option try to do it yourself. Ask yourself what movement that is causing the problem. It doesn't sound like a posture problem. Maybe accumulated tension. Maybe an arm movement. Maybe you lean a bit more on the right side - or the left.

You said "a long time". Any music teacher can tell you about students where this means "more then 10 min." If you mean more than that (and somehow I think you do :) ) - perhaps all you need to do is get up from the piano, have a glass of water, walk around a bit or streach and look out the window.
Pratice is what makes the impossible, possible
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