Questions about overuse injuries, eliminating tension, etc.

[ngensewityposta]

Hello,

I have some questions about overuse injuries, eliminating tension, etc. Feel free to skip the back story and symptoms and see the questions below, if you like.

BACK STORY:

I'm a 33-year-old jazz pianist and I've been having some problems with tension and repetitive strain in my right arm and hand. I used to have a reasonably good technique, but I haven't worked on technique for over ten years. These days, I usually perform and practise only a moderate amount, with a decent amount of rest time in between: I usually have a couple of gigs a week, and I don't practise at home much unless I need to learn some new music. I recently went through a period in which I was performing and practising a lot. By the end of this period, I was playing with a lot of tension--presumably to make up for poor technique and muscle overuse. I was experiencing considerable tension in my right forearm and wrist, and discomfort in my right shoulder and even the right side of my upper back. At the last gig I was doing during this period, I even noticed myself holding my breath while I was playing to try to ‘force’ the notes to come out the way I wanted them to, which I’m not sure I have ever noticed myself doing in the past. I've been trying to take it easy for the last couple of months--I'm back to my light playing load--and the symptoms have mostly subsided, but I am still not quite back to normal.

REMAINING SYMPTOMS:

* Swelling, but no real pain, at the base of my right thumb, on the inside of my wrist (from Googling: the swelling is where the flexor carpi radialis tendon passes over/through the scaphoid/trapezium bones).

I noticed mild swelling here (with no pain) about eight or nine years ago and went to my GP as a precaution. He just told me to take ibuprofen to reduce the inflammation. I did that for a while and then forgot/stopped worrying about it. My self-diagnosis is that I have mild tendonitis in the flexor carpi radialis tendon, or tenosynovitis in the flexor capi radialis tendon sheath.

* Some tightness in the right hand in the muscle on the outside of the hand in between the thumb and the index finger (from Googling: the first dorsal interosseous muscle). It feels like there is a hard ‘cord’ running across the surface of this muscle. On the left hand, by comparison, there is just soft fleshy muscle.

A provisional self-diagnosis: fascial adhesion in the first dorsal interosseous muscle.

* My wrist cracks quite a lot and quite loudly when I move it around. I've had this symptom for a long time and just assumed that it was harmless, but I now think it could be a symptom of tendonitis.

* The whole area including my wrist and thumb just generally feels kind of stiff and a bit uncomfortable--not like my left arm/hand.

QUESTIONS:

- What kind of medical practitioner should I get to examine, and if necessary treat, these problems with my right hand/wrist/arm? General practitioner, physiotherapist, physical therapist, chiropractor, osteopath, hand surgeon, occupational therapist, physiatrist, massage therapist, neurologist, Hellerwork practitioner, ... ??

- What are the best ways of eliminating all of the remaining tension and discomfort in my right hand, wrist, and arm?

- What are the best ways of eliminating all unnecessary tension when playing the piano?

Any pointers to resources--articles, books, etc.--that you think might help me answer these questions would also be appreciated.

Thanks for reading!

[pianoplayer002]

Hey! In general, I'd say your medical questions are above pianostreets paygrade. However I've been interested in these kinds of problems for the last six years or so and would like to share some things I've learned:

QUESTIONS:

- What kind of medical practitioner should I get to examine, and if necessary treat, these problems with my right hand/wrist/arm? General practitioner, physiotherapist, physical therapist, chiropractor, osteopath, hand surgeon, occupational therapist, physiatrist, massage therapist, neurologist, Hellerwork practitioner, ... ??

First of all, surgery should very rarely have to be an option. Playing related physical problems tend to go away when technique is improved (becomes healthier). The goal is to feel good physically and not feeling any different after a practise session than before (no tension, pain, fatigue etc after practising).

Different kinds of physical therapies (massage etc) are good and can help you untangle your muscular knots, but they treat only the symptoms and not the cause. The cause is what you do with your body when you play. It's the habit of tensing stuff while doing playing movements that needs to be adressed.

- What are the best ways of eliminating all of the remaining tension and discomfort in my right hand, wrist, and arm?

- What are the best ways of eliminating all unnecessary tension when playing the piano?

This is really the same question. The tension goes away by practising playing without tension. Knowing how to do that is a whole other bag of potato chips.

It's of course not possible to diagnose what your technical issues are without watching you play. From reading your post it sounds like you have issues being tense in your right thumb. Any tension in the fingers or hand will often create tension all the way up the arm, shoulder, back etc. If you feel your right thumb with your left hand, is it stiff while you play? Does it resist any external force trying to move it around while holding down the key? Often pianists tense it even while not using it.

How's your wrist, can you move it around - up and down, left and right, move it in circles - with ease while holding down any key with any finger? If not, this is a good skill to start working on. It practically demands relaxation in every part of the playing mechanism, from fingers, hand, forearm, shoulder etc etc.

[ngensewityposta]

Hey! Thanks so much for the reply. Yes, I have definitely started to play with tension, and I plan to get some lessons with a good teacher to learn to eliminate it.

From reading your post it sounds like you have issues being tense in your right thumb. Any tension in the fingers or hand will often create tension all the way up the arm, shoulder, back etc. If you feel your right thumb with your left hand, is it stiff while you play? Does it resist any external force trying to move it around while holding down the key? Often pianists tense it even while not using it.

Yes! My own provisional diagnosis is that there is something going wrong with my right thumb. It has a tendency to tense up a bit even when I am using my other fingers, particularly my index finger, and especially when I'm playing fast. That is, the thumb muscle in my palm tends to contract a bit while I play, closing up my palm slightly. (I'll attach some pictures when I get a chance to show you what I mean.) This may be partly due to poor fingering when improvising, since I am often prone to avoid using my weak fourth and fifth fingers by crossing my thumb under more than I otherwise would in order to use my second and third fingers instead.

Do you have any advice on how to minimise this tension in my right thumb when I play?

How's your wrist, can you move it around - up and down, left and right, move it in circles - with ease while holding down any key with any finger? If not, this is a good skill to start working on. It practically demands relaxation in every part of the playing mechanism, from fingers, hand, forearm, shoulder etc etc.

I can move my wrist around with ease while holding down any key with any finger, although I'm pretty sure it tenses up when I play outside the practice room. I used to do some Brahms exercises which involved holding down one note and playing surrounding notes with the other fingers with a very exaggerated rotation of my wrists. I can do those exercises fine, but maybe I should start doing them regularly again.

Thanks again for the response.

[tjrob]

I had a similar but different problem -- in the late 80's I stopped playing due to right-arm problems. Around 2006 I started playing again, and for a while all was well, but I could feel my problem returning. At a party I happened to accompany a friend (who sings semi-professionally), and afterward struck up conversation with a woman who asked about my piano history, heard my tale, and then reached over and massaged a point in my back. I could immediately tell this was good. Turns out she is a Doctor of Osteopathy and I saw her twice professionally. She emphasized the need for good posture, not just at the piano but always. And she had me go to physical therapy for a few weeks, and showed me how to massage the key muscle end points in my back. Bottom line: my pain is gone, and has not returned for almost a decade. I am playing better than ever.

[ngensewityposta]

Thanks for the response! I'll keep the osteopath and physical therapist options in mind.