More elbow pains...How fun!

[Lacrimosa]

Hello.
You’ve probably heard it a thousand times: I was learning Chopin’s Op. 25 No. 6 & Op 10 No 3 Etudes, when I developed this sharp pain in the fleshy areas to the left and right of the elbow (no pain in the back or fingers at all). Haven’t been able to play for about a year and an half.
  Well I know what you’re going to say cause I’ve heard it a hundred times: are you relaxed? are your hands in the right position? etc etc. This is actually a recurring ailment, and the first time I got it some eight years ago, I became so scared that from then on I became extremely meticulous about technique: practicing real slow and relaxing constantly. My teacher was in fact a student of some lady in France who wrote a book about piano technique (can’t recall her name though I’ve read her book, and various other books on technique), but he’s never seen anything wrong about my technique; just in case, I’ve gone to various other teachers, and they’ve seen nothing strange about the way I play (except that I’m too scared to play above forte anymore!). Moreover, I’ve seen monsters like Lazar Berman and Richter play, and they certainly were no more relaxed than I am!
  One question I have is, do maybe all pianists feel pain, yet continue playing; like football players? How possibly can Berman play those Etudes with such vigour and strength, when I hurt my arms playing those same Etudes in just slow motion and without going above forte?
  Doctor’s orders are to relax; don’t practice. Do you agree? I’ve rested for a year and a half, and it still hurts even if I try to do Hanon’s first study!
  Somebody told me about a breakthrough called PROLOTHERAPY, where a doctor injects an irritant solution into the affected joint, which triggers a healing response called sterile inflammation, which stimulates healing cells to make there way to the area; and then you go through some therapy. Has any body heard of this or tried it?
  One last question: I don’t have the money to go travel to Russia or whatever and learn the Alexander or Taubman techniques with some special teacher. Will some one just explain, in short, what they are all about (and I’m gonna be really pissed if you’re just gonna say the usual ‘relax, let the weight come from your shoulders, etc & etc’ nonsense I’ve been hearing (and following!) since I began playing!
  It's all so unfair!

Anyhow, thanks for reading.

[xvimbi]

Sorry to hear about your problems. I am not sure I understand exactly where your pain is, but it does sound very serious. If you are certain that your technique is fine, and you develop pain from the slightest pianistic activity, then there must really be something fundamentally wrong. You must have pain when you do other things as well. If so, keep a log of exactly what activities and motions cause that pain. If not, find out what pianistic motion is causing that pain. You need the log for visits to doctors. Your priority must be to get to the bottom of things and find out if your problem is muscular, neurological or structural in origin. Did you ever have an X-ray, or better yet, an MRI taken? If you complain long and loud enough, you may get an MRI (I say "may", because MRI's are very expensive, and doctors prescribe them only if absolutely necessary).

The Alexander or Taubman technique's will probably not help you right away, but may be useful in the long run. You don't have to travel to Russia. Dorothy Taubman is in the United States (https://www.taubman-institute.com/home.html), and the Alexander Technique originated in Australia. There are certified teachers all over the globe. Where do you live? Check out www.pianomap.com for a point of reference. There are email addresses where you can send your story to. Don't expect that they will tell you what's wrong with you, but they should be able to give you pointers as to where to start, because not many doctors are qualified to diagnose and/or treat pianistic injuries.

I would be very cautious with any method of treatment until you have found out what the root of your problem is. Then, I would first start with conventionel treatmentsm and if they don't work, try the more unconventional ones.

Regarding injuries in pianists: about 86% of all pianists are injured. Many pianists do play with injuries and risk having to give up the piani altogether. Glenn Gould, Sergei Rachmaninoff and Leon Fleisher are among the more prominent pianists with serious injuries. Ask around and take a poll. I have yet to find a single advanced pianist who does not have one or more problems that need attention.

Finally, what people were telling you about relaxation and balance is not nonsense. On the contrary, it is the correct way of going about things. It might just not have anything to do with your problem.

[Lacrimosa]

Thank you for such a thorough, caring, and intelligent response, xvimbi; much more intelligent than any of the three useless doctors I’ve been to. If you don’t mind, I’d like to tell you a bit more about the history of my ailment, and what my own diagnosis is.

The first time I got this pain some 8 years ago, I was using a real low chair at home; so I think what I got was Glengoulditis (I’m convinced, by the way, that the mysterious reason behind Gould’s ailment was his sitting so low at the keyboard). The pain was severe: it hurt just to raise my arms. Anyhow it went away with rest, so much so that I was soon playing Chopin Ballades.
  My fear is that, whatever happened that first time, something went wrong & stayed wrong, and it will continue to haunt me, even though I threw that confounded chair away long ago and now sit with hands even at the keyboard and am always relaxed. So I really don’t know what to do. I had x-rays, I don’t know what they were called, but they x-rayed my whole body; the only thing they found was a problem with my kidney!  
  What other activities bring the pain? Writing. I’m at a university, so I can’t stop writing, and that certainly brings the pain.
  Good grief! 86%! That’s like, everybody. Gould and Rachmaninoff and Fleisher are famous cases, but 86% means that almost everyone has a horror story to tell. I wish they would; it would be so helpful if all pianists would talk more openly about their ailments.

[xvimbi]

 My fear is that, whatever happened that first time, something went wrong & stayed wrong, and it will continue to haunt me, even though I threw that confounded chair away long ago and now sit with hands even at the keyboard and am always relaxed. So I really don’t know what to do. I had x-rays, I don’t know what they were called, but they x-rayed my whole body; the only thing they found was a problem with my kidney!  
  What other activities bring the pain? Writing. I’m at a university, so I can’t stop writing, and that certainly brings the pain.

Don't get too upset with the doctors. This is a difficult area, and their ignorance reflects the knowledge in the field. Collect the results of whatever tests they did on you, X-rays, your pain logbook and go from one doctor to the next. MRIs are most likely more revealing than X-rays. Raise hell to get them. Ask around if any of your pianist friends ever had anything similar. Send emails to those people I mentioned in my first post. Ask medical students, if there is a Medical School attached to your University. They often know specialists in the field.
Just don't despair! I hope your screen name is not a reflection of your state of mind

[Lacrimosa]

Thank you again, and also for those links. I will try not to lose hope, but you can imagine how depressing this is.

A very interesting forum you have here, by the way.

[stee]

Hi Lacrimosa

I can really relate to you.

I too had severe elbow pain when I was a student at the conservatory.  I was playing the Waldstein, the Symphonic Etudes, and Scriabin Etudes when both elbows just gave out.  The pain was horrible; no one believed how bad it was.  I rested for 2 years and when I started to play again, the pain came right back.

I tried cortisone injections, all kinds of relaxation exercises, massages--even dipping the elbows in hot wax!  I went to every doctor and therapist I could afford.  Nothing had lasting value.

I continued to play with the pain, masking  the discomfort with aspirin and arthritis medications.  My facility started to dwindle--slowly at first, and then quickly and dramatically.  I was now having a lot of trouble with my fingers.  They weren't painful (the pain was in my elbows), but they were becoming clumsy.  One finger stopped working properly--then another.

The new diagnosis was the worst:  I had developed focal dystonia--a paralyzing nerve disorder which left my fingers unresponsive to my brain commands.  You can probably imagine the psychological devastation I faced every day.   Playing the piano--at all-- was now totally out of the question.

I too had many reasons not to try Taubman technique and others.   It had been recommended to me years before.

Alas my story has a great ending:  I finally worked with Edna Golandsky, the leading teacher of Taubman technique (you can read about her at www.golandskyinstitute.org).   Because of Edna, I am playing again--defying the odds of dystonia--with much greater ease and comfort.   And yes the pain is gone.

Obviously I cannot tell you what your diagnosis is.    Nor am I trying to imply that elbow problems lead to dystonia.  This is simply my story.

But please get the help you need.  Now.  How I wish I had done so years ago when I first developed problems.  It would have saved me so much in the long run.

Best of luck.

[Lacrimosa]

Okay Stee, you've convinced me. I'lm going to call the Institute as soon as possible. Thank you so much, and I'm so glad to hear it worked for you!

[Lacrimosa]

Alright I emailed the institute, and they wrote back saying there are no teachers who specialise in Taubman technique anywhere near where I live. I'd have to travel, which I can't right now or even in the near future.

Do you think you could tell me a little more about what your teacher told you? What was her basic theory on arm position and weight; how long were you under Golandsky's guidance? Did she have some kind of study schedual made up for you? Even if your ailment was not the same thing as mine, I'd be interested in knowing what she said.

[stee]

Hi Lacrimosa

Obviously I have no idea what your circumstances are.  

I had used the same reason not to go to New York for my lessons.  It was a 4 hour trip for me and, as a typical musician, I really didn't have the funds.  

When I realized that I simply had no choice, I somehow found a way to make it work.  I have to tell you that it was, without exception, the best thing I ever did for myself.  

The knowledge and training I received literally changed my life--as a performer, musician and teacher.    Pianists from as far away as Europe, Israel, California and Hawaii would fly in for lessons.    

This is an important step and I understand everything you are going through.  I've been there...

Did you investigate both the Golandsky Institute and the Taubman Institute?

[Lacrimosa]

I have all intention of studying under a Taubman specialist some time in the future. Right now, however, to take a vacation from my university studies and spending money on a trip to foreign lands with dough I simply do not have appears to be out of the question.

Today was however quite productive, I think. Remember when I mentioned in my first post a treatment called prolotherapy. Well I was sceptical about it, but I found out that the doctor in my area who uses it is in fact a specialist at treating musicians and athletes. So I went to see him this morning, and I was blown away and how precise and intelligent his diagnosis was! At once he saw where the problem was (the other 3 doctors I’d gone to hadn’t a clue): He said my tendons are slightly torn, and that I’ve got pinched nerves; and he was even able to grab the exact nerve with his finger (ouch!). It wasn't a matter of bad technique, just overwork. He also said that my elbows were growing unnaturally sideways, and he compared his to mine, and the truth is they do protrude at a peculiar angle. He also said I was underweight and probably malnourished. So he recommended (in lieu of surgery) prolotherapy. I was like, no way, I don’t want you injecting my precious arms with some funky stuff. But he answered that the only thing he will be injecting is a tiny tiny amount of sugar (hardly a drug), which irritates the area and somehow stimulates the body to heal faster; the rest of the treatment is just therapy sessions of weight lifting. So if you really think about it, it’s a very natural way to heal & build back muscle. So I let him, and now I’ll need to go to therapy for like a couple months or something. He also told me to eat more meat & fish, and to buy this over-the-counter drink called ‘Amino Fluid’: it’s this disgusting thick protein drink ($14.00) of about 100 calories that body builders drink before & after working out to avoid injury, (so maybe all of you who play piano should ask your doctor about 'Amino Fluid' since, after all, playing Liszt and playing football aren’t much different)! He also said that all pianists should stretch before playing; I think it was something like: arm straight, palm up, and then bend your hand downward.  
  Well look, I’m no optimist. I know prolotheraphy sounds weird, but the doctor convinced me enough to try it and the fact is I have a recurring problem and it’s time to try something different. I dream of a time when my love/hate relationship with Mr Chopin will be one of just Love. Wish me luck & I’ll let you in on any changes good or bad that I notice.

[Swan]

Lacrimosa, I have been following your posts with interest. It would be devestating not to be able to play the piano.

I had not so much torn but stretched a tendon in my right wrist and couldn't play the piano without excruciating pain - just when I was putting a student through her grade 8 exam!

That was nearly a year ago now, and I still can't play octaves for very long without it hurting.  (I also have a small hand, which adds to the problem).

However I didn't do anything but allow it some rest, playing gentler pieces.

I hope your treatment works for you, and your story is as succesful as Stee's.  

[Lacrimosa]

Lacrimosa, I have been following your posts with interest.

I'm pleased to learn that this thread has been of some interest to you, Swan, & I hope it helps in some way (if just to comfort you!). I'm real sorry to hear about your wrist. Did it happen while practicing? Is it both wrists, or just one?

I’ll gladly be the class guinea pig for Prolotherapy (by the way, prolotherapy is used almost anywhere in the body, be it a back pain or a leg pain or any joint. It is also a treatment for osteoarthritis). Let me let you in on the latest developments.
  First day the doctor injected me in four different areas on each elbow. Though he injected directly into the areas that hurt, it was practically painless, like a pinch. Remember, he just injects glucose, or sugar. Immediately after the injections, my arms were in much greater pain than they were before. In fact, it was kind of hard to drive or lift anything! I was like, Doc I sure hope you know what you’re doing. He was like, yeah, it should hurt more.
  Day 2, pain was severe. It hurt just to move! I was real depressed & wanted to slit my wrist (after strangling the doctor, of course!)
  Day 3, pain reduced about 40%. It simply disappeared, yet still hurt more than before the injections.  
  Day 4, today, was my first therapy session. At the doctor’s office, they provided me with a personal trainer. First he laid me down and started stretching my arms and wrists and cracking my knuckles. This is done by in various ways and directions, like stretching the hand up and down. Then we moved to the weights, and he made me lift and pull ropes and stuff for about 45 minutes, everything in two sets of 10. When we were done my arms felt pretty healthy.
  Meanwhile, every day I have to drink that disgusting Amino Fuel, for protein supplement and muscle repair. Bad as it tastes, it wont upset your stomach. If this is helping me, I cannot tell.
  I don’t see the doctor himself again for another two weeks or so.

[Swan]

Lacrimosa,  I sure hope all the trouble you're going through benefits you in the end.  

I damaged my wrist trying to carry shopping bags that were too heavy for me.    It's just my right wrist.  The problem was aggravated the following month when once again I was carrying shopping bags - this time I thought they were much lighter.  So there you have it, probably the only woman in the world where shopping is dangerous to one's health!

[Lacrimosa]

Lacrimosa,  I sure hope all the trouble you're going through benefits you in the end.  

I damaged my wrist trying to carry shopping bags that were too heavy for me.    It's just my right wrist.  The problem was aggravated the following month when once again I was carrying shopping bags - this time I thought they were much lighter.  So there you have it, probably the only woman in the world where shopping is dangerous to one's health!

O, that's just awful! But it's nothing to be ashamed about, and I'm glad you brought up a very important point: practicing piano is not the only way you can hurt yourself! Pianists can never be to careful in day-to-day activites, and should care for their arms as though the were made of fragile glass. Allegedly the famous pianist Glenn Gould hurt himself during a mere handshake!  

Had you told me, Swan, that your wrist becomes only tired when doing octaves, I'd reckon it was a matter of poor technique. Yet that your wrist actually hurts is a different matter. It means your tendon never really healed. I know you're going to hate to hear this, but I think you should stop practicing (at least with that hand), and keep looking for some treatment or at least let it rest, becuase you're probably just aggravating the problem, which could be very dangerous! (Of course, you could also ask Stee about the Taubman method.)

[Saturn]

Allegedly the famous pianist Glenn Gould hurt himself during a mere handshake!

That's the story.  But is it really what happened?

[Swan]

but I think you should stop practicing (at least with that hand),  let it rest,

And that's the hard part, isn't it? But as they say, patience is a virtue.

[Lacrimosa]

That's the story.  But is it really what happened?

I mentioned it in jest; I find it highly unlikely (yet mind you, not impossible) that Gould got seriously injured by a handshake or pat on the shoulder or whatever it was. But given Gould's personality, I find it equally unlikely that he would lie; maybe he was just a hypocondriac. As I said before, I think the cause of Gould's pains were his sitting so low at the piano.
But the point I want to get across remains the same: if you're a pianist, you can never be too cautious with your hands in even the most routine activities like carrying groceries or yes, even shaking hands.