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TENDINITIS PROBLEMS OF MUSICIANS - IDENTIFICATION, PREVENTION, TREATMENT
By Phil & Vivian Williams
WHAT IS TENDINITIS?
Tendinitis is a problem always lurking around the corner for string musicians. It can strike when
you least expect it. It is an inflammatory condition of a tendon, often at a joint, especially the
wrist, knee, or elbow. It is caused by tearing and abrasions of a tendon due to overwork under
conditions of high muscle stress. It is typically brought on by repeated controlled movements, and
is an occupational hazard of musicians, typists, carpenters, assembly line workers, tennis players,
and computer game nuts. "Tennis elbow", "carpenter's wrist", "Atari wrist", and carpal tunnel
syndrome are common forms of tendinitis.
Both of us have experienced and lived with tendinitis as musicians. Phil had to have his right
wrist operated on in 1983 for extensor tendinitis, and has been treated for tendinitis at the base of
the right thumb. Vivian has been treated for rotator cuff tendinitis in her shoulder and has
intermittent tendinitis problems with her right thumb and her left hand and wrist. The information
given here is from personal experience and advice given to us by doctors and therapists. Anyone
believing they may have tendinitis or experiencing the problems discussed below immediately
should see a doctor familiar with tendinitis and its treatment and start the course of treatment
recommended to them. Doctors with sports medicine experience often are knowledgeable about
tendinitis problems. Sports and instrument playing both require lots of physical movement and
conditioning and have similar muscle and tendon related problems.
There are different approaches to treatment ranging from rest and physical therapy to surgery. It
can be useful to talk to people who have had or are undergoing treatment for tendinitis, to identify
a medical practitioner with whom you can work.
Musicians often first experience tendinitis as a sharp pain located in one spot in the wrist, elbow,
or base of the thumb. It is characterized by a burning pain, sometimes only when the affected part
is moved in a certain way, or in more severe cases, continuous. Unlike simpler muscle strains, it
tends to persist for a long period of time. If not taken care of right away, it can develop into a
major problem involving months of intense pain and perhaps a total inability to play.
HOW TO PREVENT TENDINITIS
Warm up. Tendinitis can be avoided by warming up well before playing and by playing as
relaxed as possible. Warm up for at least ten minutes prior to playing, and preferably for half an
hour. The warm up is intended to get the tendons running smoothly and the muscles warm. It is
not designed to build strength, so simple, non-stressful movements such as flexing the wrist, arm,
and fingers are all that is needed. A light duty squeeze ball or exercise putty also works well as a
part of the routine. Some musicians warm up with Chinese Iron Ball Factory exercise balls. Use
simple exercises done on a regular basis to build up muscle strength for playing.
Grab a condensed soup can with your fingers, with the back of your hand up, and raise and lower
it about 20 times a day using only your wrist. Do arm strengthening weight lifting with fairly light
weights, like 3 or 4 pounds, on a regular basis each day. Just a few repeats of these exercises
each day gradually builds the muscles and helps prevent playing problems. Going gung ho with
lots of repeats can be harmful and result in the very condition you are trying to avoid.
If your fingers are cold before you have to play, immerse them in warm water
to increase circulation and relax them. We know from experience that going from
the cold outdoors in the winter to high intensity square dance playing with
no chance to get warm can result in tendinitis problems. Phil had this happen
to his right thumb from gripping the pick and playing the guitar.
Stretch. To help prevent wrist
area tendinitis, stretch your fingers out as far and hard as you can, then stretch
them a bit more, relax, and repeat a few times a day. Stretch your arms and
shoulders before playing, when taking a break from playing, or any time you
think about it.
Take breaks. Take frequent breaks
when you're playing. Don't practice for hours at a time if you're out of shape:
build up to it. Vivian's doctor told her of a violinist who habitually practiced
8 hours a day, and was unable to keep up this schedule for a few weeks. When
she resumed her practice schedule all at once, she developed rotator cuff tendinitis
in her left shoulder.
Guitar and mandolin players:
Guitars, mandolins, and other fretted instrument played with a pick have high
tendinitis potential. Watch how tightly you grip the pick. Too tight a grip
can strain the thumb muscles, resulting in tendinitis in your right thumb. If
you feel your wrist or arm start to tighten while playing, back off and try
to find a way to keep playing with the muscles relaxed. There are many muscles
in the arm and hand, and often you discover that you can use a set of muscles
you have never before been aware of. A tight grip on the instrument's neck with
the left hand, and pushing down hard on the frets, especially for chords, also
can result in muscle strain and accompanying tendinitis.
Fiddle players: Fiddle playing also has great tendinitis potential. If you remember how awkward
it felt to hold and play a fiddle when you were just beginning, you realize what an unnatural
position it is for the human body to get into! Tendinitis in the left or right wrist and thumb, in the
right elbow, and in the left shoulder are common problems for fiddlers. In most cases, these can
be avoided or relieved by warming up and doing stretching and muscle toning exercises. If you
haven't played for several days, don't start in by playing for hours all at once. Let your body break
in gradually! If you start feeling discomfort, take a break as soon as you can.
Julie Lyons Lieberman has published two videos and a book about using your
body correctly to play fiddle. The videos are The Instrumentalist's Guide
to Fitness, Health and Musicianship and The Violin In Motion: An Ergonomic
Approach to Playing For All Levels and Styles, and the book is You
Are Your Instrument: The Definitive Musician's Guide to Practice and Performance.
Take aspirin. Vivian's doctor made this recommendation, which seems to work: if you know
you're going to get into a situation, such as playing a dance, where you can't take a break when
you should, you might take an aspirin or other anti-inflammatory ahead of time, to ward off
trouble. You might even try taking aspirin after the gig, even if you aren't sore, because tendinitis
often doesn't show up for a couple of days.
HOW TO TREAT TENDINITIS
If you start feeling aches and pains, consult a doctor right away. DO NOT DELAY!
The longer you wait, the worse the condition gets, the longer it takes to recover,
and the less chance you have of making a complete recovery. Many doctors don't
know much about tendinitis, so find one who does. Standard treatments include
rest, immobilization with a splint, ice, and anti-inflammatory drugs such as
aspirin and ibuprofin. More drastic treatments include cortisone injections
and surgery. Don't let the doctor give you cortisone injections unless nothing
else works and you're desperate. Once your condition has been diagnosed, your
doctor may or may not be able to give you significant relief, but there are
lots of things you can do for yourself once you know what's wrong.
Anti-inflammatory drugs. The
simplest treatment is aspirin. Phil's doctor had him taking two 325 mg. (5 grain)
tablets every four hours day and night, and keeping it up for several weeks
during the acute phase. At these doses, you should take the enteric coated aspirin
that doesn't dissolve until after it gets past your stomach, to avoid irritating
the stomach lining. If the tendinitis really is acute, your doctor may have
to treat it with special anti-inflamatory drugs to knock the inflamation down
before beginning regular treatment.
Caution: Consult your doctor before taking this much aspirin. Make sure that you aren't allergic
to aspirin, or asthmatic, pregnant, taking other anti-inflammatory or blood-thinning medication,
and that you do not have ulcers. If your ears start ringing or you start to get dizzy, cut down the
dose until the side effects stop.
Ibuprofin (Motrin) will also cut down inflammation from tendinitis. Acetomenephin
(Tylenol) will not do the job, since it is just an analgesic (pain-killer),
not an anti-inflammatory.
Caution: Don't let your doctor
give you stronger anti-inflammatory drugs unless your condition doesn't respond
to milder drugs, since many prescription drugs have severe side effects. And
don't let your doctor give you cortisone shots unless you really need them to
knock out a bad inflammation, since they can actually damage muscle tissue.
Caution: Some powerful painkilling
drugs may mislead you into thinking that you are cured and therefore you can
resume normal activity. Phil had tendinitis in his wrist, and was prescribed
drugs which effectively killed the pain, without also being given proper therapeutic
treatment. As the pain levels were kept down, he continued to do things which
further exacerbated the condition, eventually leading to a chronic tendinitis
condition and surgery.
Ice. Another simple and effective
treatment is the use of ice. Apply ice for five or ten minutes at a time wherever
it hurts, especially after exercising the affected area. It may sound unpleasant,
but it does relieve inflammation.
Friction Massage. An effective
treatment which is more often known to physical therapists than to doctors is
friction massage. Have a therapist or other experienced person show you how
and where to do this. Basically, what you do is find the very sorest spot, dig
in with your fingertips and rub across the tendon. It hurts like crazy at first,
but feels better afterward. What it does is break up the scar tissue that is
preventing the tendon from sliding smoothly along its sheath, and this allows
proper healing. You might want to apply ice afterwards. Phil attributes his
ability to play today without pain (most of the time) to learning how to do
friction massage from a physical therapist who knew how to treat his condition,
and using it when the hint of a recurrence is felt.
Rest, immobilization, and splints.
The most effective treatment for tendinitis in the wrist or elbow involves reducing
stress on the tendon by means of rest, immobilization, or the use of a splint.
Splinting is a standard treatment for tendinitis in the wrist area. Sometimes
the problem can be controlled simply by wearing a splint at night. In general,
a useful rule to follow is "if it hurts, don't do it", or do it as
little as possible, since continued exercise aggravates the condition. A drastic
but relatively quick treatment is total immobilization of the affected joint
with a cast. This is not always practical. You can get some of the same benefits
by using a splint (possibly with a sling) part of the time. Splints are available
at most drug stores, and custom splints can be made on order from your doctor.
Caution: If the tendinitis is
in your shoulder, do not restrict the shoulder's motion, as you can develop
"frozen shoulder" which is much harder to deal with than tendinitis.
When Vivian developed tendinitis in her shoulder, her doctor warned her about
this. However, she had been so traumatized by Phil's recent tendinitis experience
that she stopped moving her arm whenever it hurt, and sure enough, by the time
the tendinitis was gone she could not raise her arm up above shoulder level.
It took months of physical therapy to get the shoulder unfrozen. Although it
may be painful, gentle stretching and reaching is not harmful and will help
you maintain mobility in your shoulder.
Caution: If you try to rest the
affected part by compensating with another part of your body, you can start
developing tendinitis in another place. When Phil developed tendinitis in his
right arm, he tried to rest it by using his left arm instead. Since he was not
accustomed to using his left arm for everything, he developed tendinitis in
his left arm as well. It is possible to compensate unconsciously. When Vivian's
shoulder tendinitis first developed, she took anti-inflammatory drugs to the
point where she didn't feel any pain except when she pushed her arm way back.
So one day she decided that the woodpile had to be re-stacked, and proceeded
to do so, without feeling any pain. The next day her biceps tendon ached badly.
Since her shoulder was weakened and out of balance, her upper arm was compensating
and developed its own tendinitis!
Braces. Most drug stores carry
various types of braces which give support to wrists, elbows and knees. They
can be useful in enabling you to use the joint without aggravating the inflammation.
A wraparound bandage can do the same thing.
Surgery. Surgery is a treatment
of last resort, but in exceptionally severe cases it may be the only way. It
is fairly common for carpal tunnel syndrome, which seems to be less responsive
to other treatments.
Minimizing stress. The real bottom line in preventing, relieving, or curing tendinitis is to minimize stress in your life. Tendinitis is more likely to plague you and to be more painful and slower to heal when you are under stress and tension. Whatever it takes to help you relax, give it a try, whether it is counseling, diet change, career change, meditation, massages, hot tubs, saunas, avoiding stressful situations, watching TV, or going on a Caribbean cruise.