Recovery after tendinitis treatment

[rachmaninova]

Hello!

I'd like to ask for your advise on a serious matter. I have a friend who suffered from several tendinitis (on the wrist and elbow). He stopped playing for quite a long time and was treated with physiotherapy. He's now going to re-start playing but he's worried that he'll mess up all the treatment with the wrong start. His teacher doesn't give him any help, unfortunately and I'm afraid I'll advise him wrong (since I haven't been through this problem).
What do you think he can do? Slow-motion scales? Exercises? For how long he should play on a daily basis?
Anything you have to say can help my friend.

Best regards,
Carla

[faulty_damper]

How did he get tendinitis?  If he got it from playing the piano, there's little he can do because he will have to relearn more effective methods of practice and playing.  If he got it from some other activity, then playing the piano may be fine.

[rachmaninova]

The one on the wrist was caused from playing the piano. He discovered he had a bad posture, didn't breathe properly during the playing and was always over-tensed. He's working on it.
The one on the elbow was caused by the same stress and some effort on moving furniture.

He suffered a lot with this problems, solved them temporarily, but they always returned to haunt him. This time, he's trying very hard not to do things wrong.

[rachfan]

One way to get tendinitis is to sit incorrectly at the piano.  The ergonomics of piano are no less important than the ergonomics of using a PC.  As you know, thousands of people a year end up in Workers Compensation health clinics for painful repetitive motion soft tissue injuries, because they ignored ergonomic principles while keyboarding at work.  Working at the piano can invite similar dangers.  So:

Your friend should be sitting on the front half of the bench only.

He should be sitting at a height such that when his feet are flat on the floor, thighs parallel to the floor and his lower legs are parallel with those of the bench, his thighs and lower legs should form a right angle.

Knees should be tucked 1 to 2 inches under the piano case enclosing the keyboard.  If the bench is at correct height, but it's a squeeze to get his knees under the case, then he should remove his shoes which will solve the problem.

The elbows and forearms should be level with the keyboard.  Elbows should not be up in the air above the keyboard or below the level of the keyboard, as both force-flex the wrists into unnatural positions.

Wrists should be neutral and naturally extended from the forearms.

Let me emphasize three things: 1) These are guidelines; 2) comfort is ergonically important too; and 3) everyone's body is a little different from the next person.  So your friend might have to adjust slightly one way or another.  One example: A pianist with long arms might have to sit just a bit farther away from the keyboard.   

Caution: At the first sign of pain, your friend should stop playing immediately.  Here are  a few relaxation techniques:

He should stand away from the piano and 1) dangle his arms freely while shaking and rotating his hands from the wrist (like turning door knobs rapidly).  Think of two loose ropes dangling freely in the wind.  2) Then swing the arms frontward and backward together from the shoulders like two clock pendulums.  3) Swing the arms crosswise in front of himself several times such that they from an X in front of his body as the moment of crossover.  Wait a few minutes before resuming playing again.

I hope this helps.

[rachmaninova]

Thank you, Rachfan!

He has been attending to Alexander technique classes and has been working on posture and positioning. He really had some issues to correct on that matter. He also started to workout in a gym (he was very unfit), lost some weight and is using some relaxation techniques (he used to play with a lot of tension). Everything you said is very important to his recovery and he is applying all those guidelines you gave me.

His problem is now on coming back to the piano and restart playing (taking care, of course, on the sitting, posture, breathing, relaxation, stretching, warming-up, etc). He doesn't know if he should start to study a new program or if he should start, for example, with scales played slowly and piano, or some technique exercices... And he doesn't know if he should start to play only for 10-20 minutes and gradually increasing the time of study.
He was away from the piano for a very long period (a little bit more than half a year), and is afraid of messing up all the hard work he had on this recovery.

I don't know if I explained this properly (I'm not fluent in english).

[thalberg]

He should try ART -- active release technique.  Find a provider at www.activerelease.com.  It will help tremendously with tendonitis.  Also have the doctor teach him hand stretches.

I always recommend this on tendonitis threads.

[rachmaninova]

Thalberg,

According to the site you gave me, ART would be perfect to help everyone who has this problems. Unfortunately, there isn't a provider in Portugal and the nearest providers are in the UK. It's such a pity that there isn't much help in my country for the "professional" musicians' diseases. The doctors aren't very sensible and always try to force them to an operation. There are only few physiotherapists who understand the hazards of being a musician. Also in the alternative medicine, the purpose is mostly the well-being (kind of a SPA), although there are exceptions. There is a new initiative of creating an Association for Musician's Health, but it's just on the beginning and only on the paper (if you know what I mean). It's better than nothing and I hope it brings to my country several experts on the matter.

Thank you very much for your help!