Pain in hands

Irish Flute
1

Ok, so I had my wrists fixed so I’m physiologically normal now (mentally perhaps a different story). My problem is that I’ve been playing the flute again for a few weeks now. I’m now having pain in my hands. Mostly at the thumb joints but also running in between my fingers from the web back towards the top of the hand. Anyone else ever experienced this? I’m wondering if it’s just my body having to get used to playing flute again. I play with the “ideal” ergonomic position, little tension etc. Another possible cause I was thinking of is that I’m also having some shoulder/upper back pain. WOndering if it’s possible that the pain in my hands is related to what’s going on in the back and shoulders. I read a book recently that said upper body strength training can cause problems for string and flute players due to compression. Problem is that I have to do strength training to remain injury free at my job as well as being able to do the work. Discuss!

Oh, playing the fiddle still doesn’t bother them.

Thanks

2

please say more about how you hold the flute
and what your thumbs are doing. How werei
your wrists fixed. What’s ideal ergonomic position.

I do weight training, so do some others here,
partly to stay out of trouble playing music.
Unless you are doing something radical
I doubt that this is a problem.

Meanwhile suggest you stop playing for a bit.

More info, please.

3

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4

Thanks rh. Things have corresponded with the pain in the shoulders, though I haven’t tried reproducing things. I’m looking into getting a massage as well. I’ll re-read your psot when I have a bit more time and try some of that stuff.

I do have a book called “The Athletic Musician”. The physiotherapist that wrote it cautioned against conventional strength training, though she wasn’t specific. I think perhaps she was referring to body-building/Powerlifting type stuff.

I’d hate to have to stop after having stopped for 4 months previous to this.

5

Corin - this may be too simple, but are you tensing up when you play? I get pain in my thumbs and sometimes other joints when I’m tense and I usually don’t notice it until it’s hurting pretty good.

Eric

6

Corin, I’ve had hand pain similar to what you describe. I think it was worse in the beginning and with bigger-holed flutes. I don’t think it’s been an issue for some time now; I always attributed it to needing to strengthen and stretch the appropriate muscles and tendons in the hands. I’ve had a lot more of the neck/shoulder pain. That’s probably due to shoulders that have been injured a lot and spending too much time at my desk at work, as the pain’s been correlated with that.

7

Eric- I do stay pretty loose and relaxed. Hard to describe my position as Jim asked me too, but it has evolved out of all of the conventionally accepted wisdom geared towards not only simple system players but also Boehm. When I started playing about 6 years ago I had a lot of problems that went away from changing the position and being more relaxed.

Charlie- I never got around to writing a reply to your card, but I know what you mean about the fickleness of the beastie, and thanks for your good stewardship! I did have some disomfort similar to this when I started playing that flute. Just not the back/shoulder stuff. But they do seem to correspond chronoligically. It does feel like I have some knots in the shoulders and also some spots where there may be nerve compression. I sleep two nights a week in a bed that is very soft and uncomfortable compared to my own. When I get up certain points are more painful and the hands are just throbbing, so that may not be helping. Very frustrating to put it mildly.

8

Thanks for the “loan”, man – the Seery’s a damn nice stick. If the hand pain becomes really bothersome, you might try a small-holed flute for a bit. I used to get the pain playing the Schultz, which has quite a stretch, but seldom from playing the Bleazey, which is very comfortable.

9

Re: pain in your hands at night. I’ve been having carpal tunnel pain since August. (too much computer!) My doctor told me to to wear wrist braces at night. Often, people fold their wrists up under their heads while they sleep. Sleeping with the braces on definitely helps.

I’ve also been having to wear the braces when I play, which was a bit difficult to get used to, at first.

I’ve been going to a chiropractor to treat my wrists and my neck. The pain is related, he said. The pain has lessened but not gone away. Very frustrating! So far, though, I’ve not had numbness in my fingers, so that’s a plus.

Good luck with your problem. It’s frustrating, I know, to deal with such issues when you’re a musician.

Jeanie

10

My thumb joints hurt after I play a bit, and this was really a problem when I first picked up Jon’s blackwood flute. The pain has slowly decreased as I play the flute and get accustomed to it…

11

I got this link from my flute teacher. I believe I’ve posted it before but maybe it will help someone now as well.

Hand Care for Musicians

Carol

12

Me too it was from playing a lot of Mandolin (about 2-4 hours a day with at one hour a piece with no breaks). This does not sound like CTS no mention of the tingly thing and numbness which is really annoying. It might be the postion of your wrist while playing make sure it is mostly straight you could wear a brace while playing it wuoldn’t hurt (unless you have it on too tight :wink: ). You might just need to get used to the postion when I first got my Low Whistle I got a similar pain that you have it went away eventually. Are you using Piper’s Grip?

13

Find an Alexander Technique teacher and go to lessons with your instrument.
I have fairly bad tendonitis in my left hand from playing flute, and I find that it has a lot to do with my shoulders and back, and what I do with them when I play. In the meantime, I’ve found cranio-sacral therapy great for dealing with tendonitis in a short-term way (it has reversed the tendonitis a couple of times in about a month, even though I’ve still been playing) - but that isn’t dealing with the reason for the tendonitis, so I’ve just started Alexander Technique. Adjusting the way you play is the only long-term way to deal with playing-related injuries, sadly.
Good luck!
Deirdre

14

Thanks D, one problem seems to be the fact that the postions that keep the hands and wrists tension free cause tension in the back and shoulders. But, if I adjust the back and shoulders for better postitioning, it’s a bad position for my arms, hands and wrists. I wonder if I’m just oddly proportioned…I do have rather long arms compared to my trunk, and broad shoulders with narrow waist. I wonder if such a physique makes it more difficult to work within the confines of the flute.

15

I think you’ve gotten a lot of good suggestions, but I’ll add my 2¢. Or, my 1.23¢.

On ergonomics of playing . . . I also had the weird hand/wrist pain when I first started playing. As I paid close attention to how I was holding the flute, it got better, but as Eric mentioned, I underappreciated how tense my hands were. Now, they’re much better, even when holding a heavy and ergonomically crappy (==patent head) flute.

I think the problem mentioned about compression due to strength training. That physiotherapist is probably talking about thoracic outlet syndrome, or any of the various -tunnel syndromes, like cubital tunnel, carpal tunnel, and the like. I think physiotherapists WAY overcall thoracic outlet syndrome. They probably think doctors WAY undercall them. In my several years of giving anesthesia, and a couple years of doing anesthesia excludively for thoracic cases, I’ve given two anesthetics for the repair for thoracic outlet. Two. And during medical school, residency, and whatnot, I think I’ve seen the procedure three times. It’s just not that common, so I don’t think you’ve got a lot to worry about.

That sentiment would be HOTLY contested by PTs, probably. I’m cantankerous. I guess I’d say that you shouldn’t stop doing upper body strength training on the outside chance that you’ll have symptoms in your hands. If your bow arm isn’t bothered by fiddling, we’re probably talking about local phenomena in the hands and wrists, probably a combination of positioning and tension. Even though you’re sure they’re not involved, but they could play a role.

As for referred pain, musculoskeletal pain is almost invariably felt at the site of injury. The reason for referred pain, in basic terms, is that the sensor innervation of the viscera/internal organs is very different from that of the musculoskeletal system. Based on the spot on the (spinal) cord from which organ innervation arises, the brain sometimes interprets pain signals as coming from the musculoskeletal nerves from that area.

Whew, that’s probably confusing . . . let me see.

Sensory innervation of the heart comes from the bottom of the cervical cord/top of the thoracic cord. For the musculoskeletal/skin system, those nerves innervate . . . the arm and shoulder. So, when you’re having ischemic pain, like from a heart attack, it often feels like a crushing pain in the left arm. Likewise, a lot of people who’ve had gallbladder surgery have shoulder/upper back pain, because that’s where we tend to feel diaphragmatic irritation. The brain/body is just a heck of a lot better at localizing the limbs in general, and skin/bone/muscle pain than it is at figuring out what’s going on deep inside.

Maybe helpful . . . maybe not.

Stuart

16

OK, I can’t let this one go . . .

I’d have to say that if you’re much bigger than a smurf it’s quite difficult to work within the confines of most flutes.

Stuart

17

I have come to the conclusion that many of my neck / shoulder problems relate to my seating position while reading the Chiff & Fipple site on the damn computer ( aggravated by Myeloma related Polymyalgia !) so I must sign off now !!

18

Thanks Stuart. My knowledge of referred pain was more along the lines of the cardiac/gallbladder type as that’s more related to my role in medicine, loved those Dermatome charts! :stuck_out_tongue: . My expertise in Musculoskeletal stuff is more limited outside of trauma. You’re probably right about Physiotherapists and doctors vis a vis TOS. I’d like to believe there’s a middle ground. I just wasn’t sure if M.S. referred pain presentation had the same etiology as the others. Fascinating stuff, when I get sick of doing emergency medicine, I wouldn’t mind exploring sports medicine. Interestingly, my aunt, after doing anesthesia for years is now specializing in pain management. She does deal with this sort of thing, but entirely different etiologies, more folks with previous musculoskeletal injuries or degenerative disorders, so I hadn’t thought to pick her brain.

19

Ok, here’s a thought. Since the hand pain is worse in my right hand, I’ve developed a theory. This may also explain the shoulder/back pain. Due to some recent messing about with the UPs, I’ve been playing the flute with my right fingers perfectly straight, as one would for chanter playing. The thing I’m noticing in the last few days, is that this seems to produce more tension than having the fingers arched slightly. At least when playing the flute and holding my hand up in the air. I’m reluctant to attribute the back and shoulder pain to the UPs though, as it started a couple weeks after giving the set back to its owner for re-reeding. That and the fact that it’s intensified after playing the flute. What may be possible though, based on some experimentation I’m doing, is that the “correct” ergonomic playing position for the flute may not work for my body. Perhaps holding the flute lower with more angle is better as it seems to produce less tension everywhere. Who the hell know’s for that matter!