Carpal Tunnel / Tendinitis Problems

[jpdennis]

So, after a month of heavy practicing in February I develop problems with either carpal tunnel or tendinitis.  Either way, I have not been able to recoup orate so I am taking two weeks off piano.  Longer if need be.  I've been doing some research and apparently I have been using a bad technique by extending my arms too far out and so now I will try to get closer to the piano and have my elbows laying directly to my sides.  Also, move with my body when I have to go high or low on the keyboard.  I also might need an adjustable bench.

Yesterday, I got an hour table massage which helped but now I am back in pain again up and down my spine even.  I think some of it is stress because I am in the process of moving. The pain moves to different parts of my arms, shoulders, neck, and fingers.  Some middle back.  I'm considering going to see my doctor for a check up.

Any recommendations at all?

I am considering reading this book called the Art of Practicing.  I need to start stretching and doing some yoga before I play.  I studied 2 semesters in college (2009) and never had problems practicing two hours plus a day.  This past February 2013, I was maybe doing an hour or two at most a day.  Also, some of my compositions are very difficult and require some heavy stroking and triplet patterns.  I think my piece The Knight's Revenge killed my hands as well as the third movement of my piano sonata.  I will be honest I took a break from piano extensively in 2010 and some of 2011 after some health issues not related to piano I can't discuss on here.

Thank you for any ideas! 

-J.P.

[johnmar78]

JP, in any piano practice, you should seek for relaxzation BOTHr physical or mental process.
I dnt mean you flop your hands on piano.
These two factors works inconjunction with each otehr, if one fails you will get tension= injuries.
Right technique allows you practice go thru 4 hours straight without tensions but rather tired.
 I hope this helps.

[louispodesta]

You do not have Carpal Tunnel Syndrome or tendonitis, yet!  However, if you keep doing what you are doing, you will get there.

I say these things because if you go to a doctor, especially a hand surgeon, they will cut you open and basically ruin your piano career.   And, you will absolutely not be the first.

My coach, (I don't get paid for this) is Dr. Thomas Mark who is the author of "What Every Pianist Needs To Know About the Body."  It is an Alexander Techniqie analysis of how the human body relates to the piano.

Get yourself a copy, and if you don't want to pay for it, you can get it through your local library through Interlibrary Loan (for free).

In the meantime, you can visit Dr. Mark's website www.pianomap.com, which goes into an extensive discourse on this subject.

Calm down, and don't freak out.  Help is on the way, and that will come from your study of the problem and its eventual solution.

[nystul]

Your description of moving pain kind of sounds like a pinched nerve.  Might be a non-piano injury which is causing some of these symptoms (which could be triggered by sitting down to play the piano for example).  But that is just a guess.  Bottom line is if the pain is sharp and/or doesn't improve with rest you should probably be seeing a doctor.

[jpdennis]

Update!  Hi everyone thank you for all the good advice.  I went to see my doctor yesterday and he thinks it is a nerve problem.  Not necessarily from piano but stress in general.  So, I am checking out that website and boom right now louispodesta..,thank you!  I don't mine paying for a good book....my piano playing is so valuable to me.

I am taking 2 weeks no piano (doctors orders) and he's got me on an aspirin and muscle relaxer routine to help me sleep since I have not been sleeping good due to my back and neck pain when lying down.  He wants to send me to a specialist but I have no insurance so he will try this instead... I think it will work.

I did finally get some sleep but they were small increments for anywhere from an hour to 3-4.  I'm used to sleeping the whole night now.

[drazh]

hi
search for relaxation techniques in this forum.very helpful

[drazh]

You do not have Carpal Tunnel Syndrome or tendonitis, yet!  However, if you keep doing what you are doing, you will get there.

I say these things because if you go to a doctor, especially a hand surgeon, they will cut you open and basically ruin your piano career.   And, you will absolutely not be the first.



Calm down, and don't freak out.  Help is on the way, and that will come from your study of the problem and its eventual solution.

surgeons should have strong evidence of nerve entrapment to operate

[lloyd_cdb]

Surgeons often like to do what they know. It's usually best to see a general practitioner or specialist and THEN a surgeon. Going straight to a surgeon usually means you know somethings actually wrong, i.e. your shoulder won't stay together or your leg takes a 90 degree turn.

Regardless, that should be your first step anyway if it's that big of a concern. Relaxation techniques help, but if it's pain outside of when you are playing it's worth getting some professional attention.

[drazh]

Surgeons often like to do what they know. It's usually best to see a general practitioner or specialist and THEN a surgeon. Going straight to a surgeon usually means you know somethings actually wrong, i.e. your shoulder won't stay together or your leg takes a 90 degree turn.

And internists may delay a necessary surgery because they dont know surgery?
wrong.A qualified surgeon want to do the best option for specific patient.you know most doctors who do hand job are surgeon

[bronnestam]

In the meantime, you can visit Dr. Mark's website www.pianomap.com, which goes into an extensive discourse on this subject.

Thanks A MILLION for providing this link.
I dont' have the problems discussed in the topis of this thread, but I read it carefully anyway as I DO have severe problems with my hands right now and feared that I would have to rest for several weeks ... bad timing as I soon will have my first piano lesson in many decades, and now when I have found the motivation to practice - and to practice a lot - it is torture not being able to do that.

But I have had big problems with cramps in my hands when playing something fast and difficult. And after that pain that can last for hours and just was getting worse, especially in the joints of my thumb and 4th and 5th finger.

I followed the link and read that playing with "curled fingers" is a very bad thing to do. Well, when I started playing the piano, 36 years ago, I learnt that position on my very first lesson! Which meant that you had to keep your finger nails very short in order not to make "clac" sounds against the keys ... The reason this is bad is, according to Dr. Mark, that you have to make two contradicitve movements at the same time: bending the finger AND lifting it. (Try doing it while holding your hand right out in the air - you can feel that this is not very comfortable.) So he suggested a position with "naturally" curled fingers instead.

I thought  "great, so now I have to unlearn a habit that is 36 years old?" but it turned out to be easier than I feared - after all, this "naturally" curled position is what I use all the time when I type on the computer keyboard, just because nobody ever told me to do something else and it is, yes, the natural position.
So I tried to play the piano the same way and voilá! No cramps! No pain! I feel SO relieved right now.

Yes, you may call me stupid, as I did not figure this out by myself a very long time ago.

Still think I must be careful right now, though. I practice only short sessions at a time ...

[louispodesta]

I am a doctors son.  And, accordingly, I sing the praises (unlike the current trend) of great physicians.

However, I know of two people who have had hand surgery, my guitar teacher, and my former butcher.   The guitarist had four surgeries before he got wise, and my butcher was getting ready to have his fifth surgery the last time I inquired.

Absent a physical injury, there is no reason rehabilitation cannot cure hand problems.  If you are set on going to a doctor, then choose an osteopath.  They are not going to dope you up, and more importantly they are not going whittle on you with a surgical knife.

Oh, and I forgot the most important part, which is that hand surgeons cost a small fortune, and osteopaths don't.

[louispodesta]

I just typed the last post before reading your reply.   It is great that you were able to adapt to Dr. Mark's comments on curled fingers so rapidly.  Good for you.

Now, you need to get his book, which explains in detail, with photographs and drawings, exactly how your whole body must be in sync with the piano.

And, it is meant to be a primer that you keep by the piano to constantly check yourself.

I will give you a freebee that only Dr. Mark's personal students get and that is if something you are finding difficulty with at the piano does not improve in two days or so, then you are doing it wrong and you need to re-analyze the problem.

This stupid music school business of practicing something a thousand times will make it better over time, is just completely false.

Proper piano technique is not rocket science, it instead is bio-mechanics/physics.

[lloyd_cdb]

A qualified surgeon want to do the best option for specific patient.you know most doctors who do hand job are surgeon

Just like Louis, I am a doctor's son as well. My father is an oncologist and treats cancer for a living. He does lectures around the world to improve standards of care for each individual country. I went with him to Japan 2 years ago, and went to all the medical conferences and his teaching seminars. Japan's medical system in regards to cancer lacks general oncologists. They instead have surgeons that specialize in specific types of cancer. Their first instinct is to chop the cancer out of all their patients. They want to do the best thing for them, but they do what they know. My father went around presenting statistics in the different approach treatments of chemotherapy/radiology/surgery. They had absolutely no clue that they were doing things that were not in the best interest of their patient.

This is why I say to see a generalist before a specialist. I had surgery on my shoulder several years ago. Prior to the surgery, I saw a generalist who recommended physical therapy to me. I did it for 4 months and I didn't see an improvement. I then went to a surgeon and had my shoulder repaired. Was my 4 months wasted? Not at all. I'd much rather 'waste' those 4 months for the chance of avoiding the year that it took me to get back into normal shape. That being said, I'm probably going to have to go in for a second surgery after 7 years. On the flip side of that, years ago I was drunk and tried to punch my buddy in the face. I missed and clipped a wall with my thumb, pulled it back and tore a tendon in my wrist. My dad sent me to his friend who is an orthopedic surgeon. Before even inspecting it he had already checked his schedule to see if he could fit me in for surgery. Out of piano paranoia, I requested physical therapy and within 3 months I was perfectly fine.

(I know I lecture about medicine stuff regularly, I somewhat apologize. I just think the current criticism of medicine, which in most actuality is due to idiots coming in thinking they know how to treat themselves thanks to WebMD and... online forums... They subsequently sue because they didn't get an CT scan of a bruise. It's not exactly a surprise doctors cost a lot.)

[nyiregyhazi]

I followed the link and read that playing with "curled fingers" is a very bad thing to do. Well, when I started playing the piano, 36 years ago, I learnt that position on my very first lesson! Which meant that you had to keep your finger nails very short in order not to make "clac" sounds against the keys ... The reason this is bad is, according to Dr. Mark, that you have to make two contradicitve movements at the same time: bending the finger AND lifting it. (Try doing it while holding your hand right out in the air - you can feel that this is not very comfortable.) So he suggested a position with "naturally" curled fingers instead.

Thomas mark makes some good points in his book, but this one is shortsighted. This doesn't follow at all. I use both flat fingers and extremely curled ones and the idea that you have to lift is pure rubbish. He's failed to consider two points - keys have a lot of resistance to force which means you can even actively be pressing against them without depressing, if you do it sensitively (I actually consider feeling how to do this to be vital to any hope of good technique) . Secondly, you can both regulate your arm weight and use support of whichever finger played last to ensure that very curled fingers are in no danger of having to be lifted. They simply rest comfortably against keys, without coming close to moving them.

It's completely untrue to claim that you'd have no choice but to be actively lifting fingers to stop the keys going down. Thomas Mark is very good at understanding the body itself but he's much more inconsistent when he tells you how to actually play the piano. He took a single very specific error that can be made (or quite easily not made) and tried to speak for the possibilities with curved fingers in general. That's not a good way to go. I learned a lot from him about the body itself, but relatively little about how to play the piano. Much of what he says is stuff that actively held me back, when I'd previously heard the same from other teachers. He knows that flaccid relaxation is useless and so is tension. But he didn't help me achieve the specific useful activities that work and permit comfort. With curved fingers, you specifically need to get the knuckles high, know the corresponding lengthening action (and how to lighten the arm), which allows it to be perfectly healthy.

On the original topic, my most recent blog post has countless exercises which show you how to connect properly to the piano after playing a key without overworking your hand. When pianists are not properly used to this part, they have no hope in hell of actually producing sound with effective movements.

[louispodesta]

There seems to be some confusion over the term "curved fingers."  As a personal student of Thomas Mark, who is in my opinion the top technique teacher on the planet, I will attempt to illustrate what shape the finger should have.

Sitting in a chair, put both hands in your lap, and then slowly swing your right hand out to where it is perpendicular to your torso and parallel to the floor.  Just let you hand naturally hang off of the end of your wrist using natural gravity.

Then, maintaining that same weight balance, raise your hand to be directly in front of your face, with the thumb and forefinger facing you.  You will see and arch to the hand, and a slight curvature to the fingers.

That is the position you play with, and there should be absolutely no attempt to curl in the fingers while playing, even a chord.

When Thomas Mark gives his Octave Seminar, he teaches to always maintain this arch, even while playing chords.

After reading about your success with getting rid of your cramping, I remembered that I have had some minor cramping in my playing of the Mozart A Major Concerto.  When I put special focus once again on maintaining this normal position of the hand, the cramping disappeared.

And for the record, none of Dr. Mark's students are instructed to play or perform any special exercises to help establish the normal position or strength of the hand and fingers.  As he accurately points out in his book, the fingers of the hand are moved by muscles of the inner forearm.

I do not recommend that anyone use the special exercises referenced in the prior post.

[nyiregyhazi]

Sitting in a chair, put both hands in your lap, and then slowly swing your right hand out to where it is perpendicular to your torso and parallel to the floor.  Just let you hand naturally hang off of the end of your wrist using natural gravity.

1001 teachers will say thus, but it scarcely scratches the surface. Your hand doesn't automatically do that when you're keeping one or more keys depressed (as is the case in 99.9 percent of pianism). The question is what actions are used to achieve and keep that depressed state and whether they are applied suitably and efficiently. This is where it gets difficult. Knowing how to make the position in thin air is only the first 1 percent, if that, of maintaining it with low effort while actually playing. Also, you can be in that position with phenomenal wasted effort or you can be in one of many other positions (Eg near vertical fingers or very curved ones or totally flat ones) with minimal effort. When keeping keys down, it's a lot more complicated than this oversimplified comparison. My cited exercise go into the rest, beyond that first percent of feeling a relaxed but shaped hand (without having yet begun to use it for anything).

And for the record, none of Dr. Mark's students are instructed to play or perform any special exercises to help establish the normal position or strength of the hand and fingers.  As he accurately points out in his book, the fingers of the hand are moved by muscles of the inner forearm.

I do not recommend that anyone use the special exercises referenced in the prior post.

And you read them, did you? Based on your reference to developing strength, clearly not. The exercises are about ELIMINATING wasted efforts when actually keeping keys depressed (and learning how to distribute the small necessary muscular actions between hand and arm in a way that gives the greatest possible comfort and freedom). If you thought the word exercise only applies to strength exercises (and that you could hence get away with passing judgement on something you have not investigated) you've got the wrong end of the stick altogether. My exercises follow on from the one you gave above, but are also specific to what you need once you're actually playing - rather than merely exploring the body in isolation from the task that it must perform.

I read Thomas Mark's book before coming to the conclusion that there are many flaws in what he advises. I'd be interested in what he does in one on one teaching, but there are many flaws in what he attempts to rationalise and pass on about piano technique through words alone. I'd politely request that, likewise, you actually read my exercises and gain personal experience of them before making a blind request that others dismiss them.