Repetitive Stress/Tendinitis--what should I do?

Irish Flute
1

It seems I have some repetitive stress/tendinits in my left arm and at times in both wrists. Probably from too much flute practice/playing (and picking up/throwing around/holding big babies, my 1 and 3 year olds). I’m bummed because it looks like I have to take a break from practicing/playing, but what’s my big hurry anyways?

I’m taking motrin and icing my arm as I write.

Has anyone else dealt with this? What remedies have worked best? I’m definitely worried it won’t get better; I’ve seen people never fully recover from RSS. :frowning:

Why is it the left hand/wrist that takes the brunt of the tough work? When learning guitar, I had funky left wrist/tendon stuff happening learning to play chords and bar chord on thick steel strings, using the left hand/wrist like never before. This should give me some comfort–I can play guitar now with no discomfort whatsoever, years later.

Jason

2

Had a good deal of this, seem to have escaped it now.
Some suggestions:

  1. Overuse is the likely culprit. Are you using
    a computer keyboard or doing anything else like that?
    Reduce such activity, if possible. Review your whole situation.

  2. Review your flute holding position. Check how bent
    your wrists are. See if there’s something you’re doing
    that’s contributing.

I described in an earlier thread how bopeps and moleskin
can get you a more stable and relaxed grip. Search
on ‘moleskin’ if you’re interested.

  1. Take three days off. Use an anti-inflammatory in
    reasonably high dosages.

Basically your approach to the flute and to the rest of your
activities will solve the problem.

3

the second your arms start to hurt, stop playing.

jim has good ideas.

i might suggest longer than three days. take a couple weeks off, seriously. listen to some music–work on your ear instead of your playing. if you devote the same amount of time on your ear as you do your playing, you will find a great improvement when you pick up your instrument. i had a lot of problems for a while, so i stopped playing for a couple months, and when i picked up my instruments again, i had a better, musical perspective.

i often find that tendon problems are posture problems as well as grip problems. if your posture is adding too much stress on your upper body when you play, that will translate to extra pressure in your tendons. i find working on my posture through yoga, pilates, running, or general exercise helps the tenseness in my upper body and arms. i find by having a better core you can fix a lot of upper body problems, especially after giving your upper body time to recover and loosen up.

one good suggestion is i have been given was to put your hands down at your sides, keep your hands relaxed, and try to replicate that finger position with your flute.

i have no authority on this, but i would bet t hat people with rss who never recover never radically change their posture, walking habits, how they use their upper arms, and how they use their necks. i would suspect that they just try to change how they use their wrists.

i try to do wrist stretches, such as they do in martial arts, as i find it helps when i am putting too much pressure on my tendons. i would say to be careful with these, though, because i dont know a lot about them and was shown how to do them by someone who knew what they were doing.

also, in addition to the icing you already are doing, i would say steaming hot baths help relax tense muscles. as you have kids, it would also be a good idea for your nerves!

4

take it seriously, I had a nightmare with tendonitis for two years not really understanding what was wrong. Get an ultrasound scan if you can and see what the actual damage is (my doctor completely mis-diagnosed the problem for ages before I got the scan).

do… get a wrist brace or two (you can get good sports braces with a metal support and velcro fittings). Look very carefully at what you do with computers if you use them at work - make sure you have keyboard and mouse pad wrist rests.

don’t… do nothing and think it will go away, it won’t if you carry on doing what you’re doing.

Good news is, mine is better after doing what I should have done two years earlier.

5

Yep I’ve had problems here too, from many years painting with heavy sprayguns. A factor that can make this worse is sleeping with your hands curled inwards, my doctor gave me plastic sleeves that kept my wrists straight at night… did they work? Well I dunno I got better anyhow! But at it’s worst you could hear the tendon moving in the wrist a sort of rubber on rubber sound… :astonished:

6

I had problems with RSI a few years ago. I think the real cause was heavy use of the computer keyboard, but the doctor told me to stop playing my recorder as well. I can’t remember how long it was for, but I think it was about three months, to give time for the damage to heal. He said I would probably always have a weakness (it was my right arm, btw). Laying off did the trick, but I have been careful ever since. Fortunately for me I did not have to rely on playing my instrument for my livelihood.

When I started to learn the flute, it seemed to be flaring up again, so I paid a lot of attention to my right hand hold. I think some of the trouble was I was bracing the flute against my pinkie. Anyway, I experimented with my right hand hold to find a more relaxed grip and also cut down on the playing. That seemed to resolve it, but I do have to be careful not to play for too long at a time, whether it is flute, recorder or concertina, all of which I play, or attempt to play.

Learning a new instrument does bring aches and pains because unfamiliar muscles are being used, and also we tend to grip the instrument too tightly because we are not yet confident about holding it. Mostly it goes away, but if it doesn’t don’t persist, do something about it.

I have a friend who runs a ceilidh band and plays melodeon. She was having problems in her left elbow, but because of the band’s commitments could not lay off and in the end had to have a steroid injection. She has been told, however that it is only a temporary measure and she will need to make some changes.

Geoff

Edited to correct grammatical error and to remove duplcate signature

7

Switch to one of these, which allow you to type with your wrists straight. You’ll adapt within an hour or two, and then never want to go back. Even my ex, who complained bitterly about the keyboard when she moved in, demanded her own when she moved out.

8

I found this Kinesis keyboard to be very helpful:
http://en.wikipedia.org/wiki/Kinesis_(keyboard)
This is a more radical approach than the MS Natural mentioned above. Just like the one above, it’ll take a day to adapt. After you get used to these keyboards, though, you’ll dislike standard keyboards. The Kinesis isn’t cheap, but you can buy them on eBay used.

I also used foot petals (to replace the shift, control and alt keys) when the problem was worst. The little finger is fairly weak, but we make it do a lot of work with a standard keyboard.

More recently I’ve been doing yoga to ensure that I stretch. It really helps loosen up my body.

You may also want to try a more ergonomic flutes. Casey Burns has a style with offset holes. (I.e., they aren’t all in a straight line.) It does make the reach easier.

9

To help remedy the hand and wrist symptons mentioned in this thread, in additional to the good suggestins already made, I recommend magnetic therapy. Magnetic bracelets are inexpensive and usually available at every larger drugstore and online from a number of sources.

I use magnetic bracelets myself, and I can attest to their efficacy. Prior to the bracelts becoming so readily available, I used to make bracelets, which I sold at health fairs and online. I have received enough feedback from my customers to become a believer in magnetic therapy. I have had the most success with bracelets that use strong magnets that have enough magnetic strength to make a noticable difference. Be careful with your magnetic gift cards, though, as your money may suddenly disappear.

10

I still wear a brace on my left wrist when I play, 3 years after my initial problems. Icing helped–20 minute sessions. I bought a wrap-around icing thing you put in the freezer. It helped greatly.

Make sure to wear the wrist braces at night. Many people tuck their hands under their heads to sleep–7-8 hours of stress.

My problem was caused by too much computer mousing.

Take it easy in your playing.

Good luck, Jeanie

11

Thanks one and all for the feedback. I’m trying to take a full break…can’t seem to do it yet :tantrum: —“SIR, PUT THE FLUTE DOWN–BACK AWAY FROM THE FLUTE.” Great suggestions and hope for the future.

Jason

12

i had an op 2 years ago for it .i am now 80% better so well worth it
mind you was off work for 6 weeks due to infection .

13

One thing which gets overlooked in the case of hand problems is the mental aspect. If an injury or recurring problem interferes with your doing something you love, like playing music, the tendency can be to freak out about it, to basically worry yourself into worse shape. I’ve had a couple of bouts of this sort of thing throught he years, including once when I had to give up playing acoustic guitar for over a year. At least, I thought I had to give up…

There are many, many resources to learn about this sort of problem. Many professional specialize in helping folks with hand difficulties, including physical therapists and chiropractors. While I’ll stop short of offering medical advice, my one big hint would be that many arm/hand problems seem to originate upstream. Start off with a massage! Can’t hurt. But most of all, realize that even bad cases of tendinitis or carpal tunnel syndrome get resolved over time. You will come back from this, probably sooner than you think. Best of luck,

Rob

p.s. Okay, second big hint: diet and general level of fitness can be a big part of this sort of problem, as can caffeine over-consumption. More info no doubt available on-line.

14

Ditto Rob. It wouldn’t hurt to evaluate your overall level of stress in general. My problems are mostly gone now, except for when I’ve worried about something at work or in personal life, or even beating myself up over how badly I’m playing.

Otherwise, and FWIW, the main things that helped me with my tendonitis were (1) working with an Alexander Technique teacher to rethink my physical approach to the instrument, and (2) strength training.

Good luck!

15

Sorry to hear about your tendonitis, Jason. A lot of good advice has been posted here, but the most important advice is to stop playing completely until you are pretty much pain free. I’ve had a couple of serious bouts with elbow tendonitis as a result of my other passion, rockclimbing, which nearly ended my climbing forever.

Tendonitis can be very stubborn and slow to heal once it really sets in, usually because we ignore the pain in order to continue doing what we love. Mine got so bad that I had to use my left had to open doors, use a mouse, and even pull up my zipper. The last time I had it, I finally went to my doctor who essentially told me to quit climbing and get into physical therapy before the tendonitis became chronic. When it gets bad enough, the last resort is surgery, and once the cutting starts, it’s a dice roll regarding the outcome. That got my attention, and I quit climbing for 6 months, and followed a strict elbow rehad program which included a lot of physical therapy.

I didn’t think it was going to go away and was getting very discouraged, but then, things suddenly turned the corner, and I healed completley and returned to climbing. My recovery regimen included: big does of anti-inflammatory drugs, icing daily, deep tissue massage (find the sorest spot and massage it deeply and thoroughly), ultrasound therapy, electro-stimulation, heat followed by ice, specific stretches, various exercises using small dumbbells, and squeezing exercises with increasingly more dense therapeutic putty.

Whenever I begin to sense it coming back now, I do the anti-inflammatories, ice, and massage, and monitor it very carefully. It seems like it is sometimes just lurking below the surface waiting to rear its ugly head, and it scares me, so I play it pretty safe now.

16

I use, and highly recommend, the Evoluent Vertical Mouse 3. Unlike other “ergonomic” mice, the Evoluent requires little to no time to adapt to, and is reasonably inexpensive.

17

I can’t remember for sure, but I think it might have been Oliver Sacks that made the comment that musicians are “athletes of the small muscles.” You wouldn’t just walk out your door and run ten miles without stretching before or after, so why would you play your instrument for four or five hours at a time without taking a break or stretching?

-When practicing, you shouldn’t play for more than an hour at a time. Yes, professional musicians do commonly practice for 8 hours a day, but they take frequent breaks throughout the day. When you start to feel even slight pain in your wrists, just stop. Never, ever try to “play through” it.

-Do you practice in front of a mirror? No? Start. Now. Here’s your perfect chance to unleash the narcissist within. When you do, don’t be surprised if you look at yourself and say, “Gee, I had no idea I looked so contorted and I was gripping my instrument to death.” Sit up straight and watch very carefully how you handle your instrument. Is there a lot of excess body movement? Are your fingers moving smoothly or not so much? When I’ve gone to workshops, I’ve seen so many earnest aspiring musicians contorted in hopelessly uncomfortable positions and gripping their instruments to death. I think a lot of this impulse stems from a subconscious desire to exert a feeling of “control” over your instrument. A lot of these people love playing, but many of them won’t be able to play at all in a few years if they keep doing what they’re doing…

-Here’s a handy exercise for you to do after practicing that I learned from a bagpiper/neurosurgeon: stand perfectly straight and stretch out both arms so that they are parallel to the floor. Lift your wrists until your hands are perpendicular to the floor. Hold for five seconds. Return to original position. Hold for five seconds. Make a fist. Hold for five seconds. Keeping your hands in a fist, move them down until they are close to perpendicular with the floor. Hold for five seconds. Repeat this exercise 10 times.

18

http://www.youtube.com/watch?v=SW_2l2CRU6o

19

-I’d suggest seeing a physician as some of the most effective medications are prescription rather than OTC medications. Moreover, a doctor may diagnose something unexpected but routine and easily addressed such as ganglion cysts of the hand, treated easily on an outpatient basis with minimal trauma.

–A relative froze up mechanically to a frightening degree from rheumatoid arthritis years back but has regained most mobility and some dexterity with use of the newest RA meds, some of which may be useful in treating overuse.

-I worked as a TIG welder for years and developed temporary hand and wrist numbness from the constant torch grip. It was alleviated by learning a new grip and alternating it with the standard position.

-Best wishes,
Brian

20

Will you say what the outpatient treatment is for
ganglion cysts of the hand/wrist?