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Does anyone have any advice on combatting tendonitis? I'm just recovering from a flare-up and have been off the piano for two weeks.

I thought some-one might have some tips on preventing a recurrence while still getting in plenty of practice. I practice about three hours a day usually, but when I'm having trouble with tendonitis my arms give out far more quickly. The bigger the piece, the harder it is to play without pain.

Any advice?

Nora, my performing career was destroyed by chronic teno-synovitis, CTS, and general inflammation. I can play, and when not aggravated, these maladies do not affect my technical ability, but I must severely limit my time at the keyboard and once aggravated, wait until the inflammation abates otherwise worsen it. Due to this I fashioned a career as a composer/arranger/teacher, because I'm never sure ahead of time when I can play at to what extent. very frustrating, but I've learned to cope with it (what other choice do I have, right?)
I've been to all types of doctors, and have no answers, but the first thing you should do is consult one because flare-ups can lead to a chronic problem.
First and foremost, I would suggest a visit to am A.R.T. therapist. If you've developed an entrapment and this is the cause of the problem, an A.R.T. therapist can release whatever the trigger is that's causing it:

http://www.google.com/search?gbv=2&...q=active+release+therapy&btnG=Search

This isn't only for back and lower body problems. Anywhere there is a tendon/nerve/soft tissue entrapment, or scar tissue, the technique qorks miraculously.

Hi Nora,
Rest, rest, rest. Chiropractic treatments where they use the ultrasound and electric stimulation helped me lots. I had it 5 years ago and thankfully have been O.K. since it cleared up, it took about 3 weeks.
Get this book:
"What every pianist needs to know about the body" by Thomas Mark, his website: www.pianomap.com
His book is invaluable to me. Posture, strengthening and relaxing muscles, on and on. It's an education.
GET BETTER SOON!!!!
What I have learned is that arm pain many times results from neck issues, torso issues, the idea of opening up your chest area when you play, etc. Check out the book

You may not be using an appropriate muscle coordination for 'big' pieces. That pianomap site looks interesting. Check out the videos here: http://www.youtube.com/isstip, notice how relaxed you can be and still make a big sound.

Hi Nora,

My heartfelt sympathies (or should that be empathy?) goes to you... I am similarly having to crawl along, playing just a bit here and there, in order to allow my tendons time to rest and recover from, thankfully, relatively mild tendonitis.

My teacher had to abandon her concert career, much as BJones outlines, for the same reasons - she had to refrain from playing entirely for a year, but is still fortunately able to teach and teach well!

She has recommended I use a homeopathic remedy for ligament / tendon injury in addition to plenty of rest of the impacted areas. The cream she recommends is based on poison ivy and is called Rhus Tox cream, after Rhus Toxicodendron. A company called Nelson's produce it in the UK and I understand it can be obtained in the US also. Basically you massage it into the hand, wrist, lower arm and elbow regions once or twice a day and it helps ease the problems of inflamed joints, ligaments and tendons. I am back able to play daily now provided I lay off the heavy octaves stuff until my technique improves, my arms are healed and my overall 'strength' is better.

I can heartily recommend it....

Thanks everybody for all the advice. I'm going to buy Thomas Mark's book immediately. I am resting and it seems to be getting better. I'm taking this very seriously. Still, it's driving me insane not being able to practice.

Do not rush back to practice if you're not 100% pain free. And even then, seek medical evaluation to eliminate the posibility of structural damage or abnormality being the cause before resuming normal practice.

This a controversial topic. My view on it is that this
so-called tendonitis condition is in the same category
as things like whiplash, tennis elbow, chronic fatigue
syndrome, carpal tunnel, neurasthenia, back problems,
migraines, etc., that is, conditions with
vague symptoms that are difficult
to treat. Ultimately, it seems, the only cure is
to stop whatever activity that seems to be causing
it, which makes me wonder if that is the whole
point, that is, the person doesn't like to do
the activity and is forcing himself to do it,
and eventually the mind/body finds a way to
shut the activity down by incapacitating the
person with a largely psychosomatic illness.

Dear Gyro,

Tendonitis is not a psychosomatic illness ... it is an RSI. And the OP should let us know what exactly are the symptoms coz there are different kinds of "tendinitis" ...

I could only imagine the flack that I would have taken as being a troll if I had posted this!

Having been an athlete (a power-bodybuilder) and pianist for most of my life, I can assure you that teno-synovitis related afflictions are not all in the victim's mind.

You need a specialist, an orthopedic hand specialist that deals with musicians, not your regular doctor. I have had the tenosinivitis you are talking about for many years and have seen numerous specialists. I know exactly what they are going to tell you...you will need to lay off till it heals to a significant degree...ibuprophen reduces inflamation...soaking in warm water and cool (not hot and cold)... gentle stretching...play in a way that minimizes recurrences (get a Taubman method teacher). Play a light action... play for only short periods with caution, without tension or stress... avoid percussing and fast reckless playing. I had ultra-sound, electric therapy, accupuncture, deep tissue massage (A.R.T. & Rolfing) and none helped. My own secret remedy is taking MSM (sulfar) tablets. 2 grams of MSM acts as an anti-inflamatory for up to 5 hours.

Ice water works best for me to take the edge off when really aggravated. I wonder if gluscosamine sulfate or chondrotin sulfate with work. MSM sounds like a good idea, I may try that.

I tried glucosamine chondroitin for tendinitis in both Achilles tendons from soccer. I didn't see results from it, but I may have already been too far gone when I started. For what it's worth, the sports-injuries specialist that I saw recommended rest, ibuprofen, and ice (along with wrapping my ankles before practice, but that doesn't help you ). I'd recommend talking to a doctor if you're having severe problems, though.

My problem is chronic and only piano playing, especially chording, aggravates this chronic problem. I've seen all the King's horsemen when it comes to doctors. None have any answers. I can shuffle cards all day and experience no other inflammatory symptoms from anything else other than playing. It' the stretching or movement of the fingers in that itself that cuase the problem and nobody has any answers.

You can lead a horse to water...

Saying something's "psychosomatic" is nice way of saying you don't understand it. If I "didn't like" playing the piano I hope I would have enough guts to say so and stop. On the contrary, my problem has resulted from over-practice, due to completely falling in love with a couple of pieces that are a bit difficult for my hands. Someone who has not had similar problems may not understand the enormous frustration involved. My biggest fear is having to stop, not being able to continue.

My symptoms are pretty simple--aching, shooting pains, etc. when I try to play the piano, lift heavy things, and so on. It's not severe yet by any means and seems to be clearing up--it's just, as my teacher tells me, not something to mess around with. I'm doing all of the things Jazz+ said to, except the MSM. I may try that. I especially appreciate BJones input--he has been very helpful.

I had NO luck at all with Gluscosamine or Chondrotin.

In my case (tenosinivitis), MSM (Methylsulfonylmethane) gives me temporary anti-inflamatory relief about like Ibuprofen does but without the intestinal bleeding I get from Ibuprofen.

I agree with the folks who suggested you see a doctor to assess this condition. A good chiropractor whom I have been seeing for my neck, back, and arms/hands for these past 8 years is wonderful. Please do not practice until you are pain-free.
I did strength training for my arm, which involved lifting a 3 pound weight 2 different ways.
Again, my chiropractor showed me how to do this, recommended therapy, when to use ice, heat, pain relievers, etc.
Please go see a professional, it's worth it.

I do understand, Nora--- I had to stop altogether for a while. Seeing a sports medicine doc (who is also a pianist) and a physical therapist (ditto) has helped significantly. A diagnosis, first of all, rest, prescribed exercises and stretches, and ice packs several times a day eventually helped. I also started working with a teacher who has specialized training in working with people with keyboard injuries, and that has made a big difference. The problem actually started with the way I sit, and the way I hold my spine, pelvis, and shoulders. That all works its way out to the arms and fingers.

I've been taking glucosamine/chondroitin for years, and I think it does help with some things, protecting the joints especially. But joint pain was not the problem.

Not all doctors, and not all teachers, have the specialized knowledge to know how to address the problem. But, keep trying: there are some who do. Ignoring the problem, or forcing yourself through the pain, could lead to an impairment that cannot be corrected.

I had to accept a setback in my progress as a musician and give up some of the momentum I had acquired. It was not easy to accept. But, in the meantime, there were other ways to learn about music that I could still do: listening, reading, going to concerts. It was through the last that I met someone who introduced me to my new teacher.

The original saying was, "You can lead a horticulture, but you can't make her think".

Heat should be rarely used when the afflicted area is inflamed/swollen.

Barb, I'm demonically strong. Been a power-bodybuilder since my late teens, and having well above average hand and arm strength has no bearing on my chronic teno-synovitis.
A stenghtening program may or may not offer a solution to the problem. It's worth a try though as in your case, in may be beneficial to alleviating the symptoms.

Shooting pain is not good. With all the problems I encounter with my hands directly caused by piano-playing, I've never experienced shooting pains. I get throbbing, swelling, stiffness, and discomfort. Shooting pains sounds to me as though this may be neurological in nature, perhaps an entrapment, much like sciatica for the lower body. Possibly a nerve conductivity test may be in order. Discomfort is one thing, but shooting pains is something that should be addressed by a neurologist or chiropractor (if you put your faith in chiropractic and have a great one).

Gyro, Congratulations on your good fortune for never having suffered any of these conditions! It's very easy to consider something psychosomatic if you've never experienced it yourself.

Actually, Gyro has a point. Science has proven that there is a very powerful mind/body connection in any illness and sometimes in injuries as well. I don't think Gyro is implying that repetitive stress injury is psychosomatic. He's just suggesting that there can be a mental component to susceptibility to injury. That mental component could just be mental tension caused by the fear of making an error or disappointing a teacher. The injury is real but the cause could be a combination of RSI and anxiety.

Nora-Kate,

I send my best wishes for your getting completely well.

I'm glad you received a recommendation to Dr. Thomas Carson Mark!

You are going to get a lot of benefit from researching his work! He has videos too, and his range of knowledge in his field of study is incredible. He incorporates at least 3 of the best "schools" of body study in his teachings. I either saw the videos on his website, or they are on youtube, I can't remember. I know I didn't buy them, they were readily available.

I hope to take a workshop of his in the future and I keep my eyes posted to his calendar. He is nearby in Portland, Oregon, about 2 1/2 hour drive south from me. I would even organize a workshop with his as feature if I could find enough interested pianists and teachers in my local area. I think that would be only a matter of getting the word out.

If anyone after reading his website and discovering his book(s) and videos would be interested in something closer in Puget Sound, maybe we could get together and create a happening.

www.pianomap.com

Betty

Thanks--it sounds like you really know what you're tslking about, and I appreciate the input. I'm looking at several options right now, so hopefully I'll get this cleared up soon.

This is the crux of the matter. The true cause of most pianist's problems. Repetitive pattern syndrome, and pianists aren't the only ones that fall prey to it. Typists (I shudder to say), asemblyline workers, carpenters who hammer all day or turn a screwdriver many times a day, archers, bowlers, etc., etc., anyone who overuses the same motion over and over is subject to tenosynovitis, trigger finger, and other soft tissue/neurological maladies all cause by this repetitive motion if they cross the threshold of their own tolerance level.

I sure do. I've lived with it everyday, for years. My love for the piano and need to express myself musically first hand, coupled with the fact that when I can play, my technical abilities are at the top of the pianistic spectrum, make this a very trying malady for me.
Working as an arranger, composer, muical director, and teacher keep me partially sane.

Here is my experience of tendonitis.

Some years ago I got tendonitis of the tendon attached to my thumb. This was following a lot of thumb work. The solution was to avoid twisting my hand when the thumb went under. Unfortunately that didn't cure the injury once I had it. I got a cortisone jab and it worked. Today I wouldn't do that as I think there are better solutions.

Recently I had a worse problem: Here’s a summary of my case, for anyone who’s interested.

I started getting mild symptoms of lateral epicondylitis 4 months ago. That's the same thing as tennis elbow, inflammation of the tendons where they join the elbow. In my case, the injured tendon is attached to the muscle that lifts fingers 3 & 4. It runs all the way from the fingers to the elbow.

I have stopped playing the piano and exercising for 4 months but that hasn’t cured the problem. If anything it has got worse.

The symptoms are variable. Simple actions like turning on a tap or tying a shoelace will trigger sensation, but inconsistently. The sensation is mild, it could hardly be described as pain. I could easily ignore it but it would then get worse. I don't feel anything if I play the piano but I know the piano caused it because the problem is in the forearm muscle which used to get stiff when I practised hard. Using resistance machines regularly in the gym may have contributed.

One thing that surprised me is that the injury is in the lifting, not the striking action. This is good news because you can reduce your lift and still play.

I tried all the recommended solutions.

A 2 week course of Ibuprofen prescribed by my doctor at maximum dose had absolutely no benefit.

Wearing an elbow brace seems to have no benefit.

Rubbing an ice cube on my forearm for a few minutes seems to help.

Avoiding doing anything at all with my right hand seems to help

I have had several sessions of massage treatment with a specialist, using ART (Active Release Therapy). This has achieved spectacular results, causing the symptoms to disappear completely immediately. Unfortunately the cure is temporary and the symptoms return within about a day even if I rest my arm.

I am hoping that these last 3 things, taken together with time will slowly cure it. I haven't done stretching exercises as recommended by some people. My specialist said this would aggravate the injury as it doesn't like any tension on the tendon.

Sending well wishes from here!
I hope you get better soon. This injury and healing process must be frustrating.
I had a similar result with taking ibuprofen....it didn't work at all for the pain and inflammation, at least it didn't seem too. Ice and heat did, though. The only thing the ibuprofen did for me was to give me an ulcer and lots of digestive issues. That was several years ago. I still can't take even one small dosage and have to stick to tylenol for pain meds.
Have you heard of this liquid stuff in a small bottle that you use with a dropper to dispense into your mouth? It's some new joint pain/muscle pain relief/healing product that I see advertised on TV all the time. Can't recall the name of the stuff though. Anybody tried any of this?

Hey guys! I took everyone's advice and went to see a doctor--actually someone in sports medicine--with excellent credentials. He said it is an over-use injury, caused by piano. The source of the problem is actually in my shoulders and back and is causing pain throughout my arms. Apparently I have rotar cuff tendinitis in my shoulder for one thing.

He's prescribed extensive physical therapy to relieve pain, strengthen my upper body muscles, and improve my balance and position at the piano. Apparently faulty posture and hand position, plus a lack of strength, have caused the problem. I'll be starting with a new teacher in the fall who is an expert on this kind of technique, so if I can get this cleared up now I should be fine.

I'm allowed to practice, but only for minimal amounts at first: thirty minutes one day, none the next, and slowly over several weeks building back up. He says I won't be pain-free for six or eight weeks, but with time and some changes in my playing we should get this fixed.

I'm relieved that it's nothing more serious, and anxious to get back to the piano. Thanks for all the advice.

Hfffoman, has your doctor mentioned physical therapy?

Has anyone ever said diagnoses is 9/10ths of the cure? Someone should. Congratulations.

A.R.T. does seem to be one of the only physical interventions that help (ice and no piano playing notwithstanding), but sadly, as soon as the playing resumes, so do the symptoms from mu experience.