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#2188940 - 11/26/13 09:25 PM Lingering Tendonitis
Cole Stanford Offline
Junior Member

Registered: 11/26/13
Posts: 2
Hello, I'm a nineteen year old piano student who's having trouble with repetitive strain injuries. About two years ago, I began to notice a slight ache in my wrists when playing the piano and during physical exercise. Over the course of a few months, the pain spread so that my entire forearm would ache and "burn" after playing for as little as twenty minutes.

When a doctor told me five months ago that I had a minor case of tendonitis, I took an extended break from playing. I just recently restarted with a teacher who tells me that poor technique was the cause of my problems. For the first two weeks, the new techniques this teacher taught me did not cause any pain, but during practice today I encountered pain in my right thumb and in the base of the pinky coupled with a slight loss of mobility in the pinky and ring fingers. The soreness has persisted all day.

While my new playing habits do not exacerbate the pain in my forearms, they are still tender in certain places. I get twinges of pain when I do things such as lifting, pushing, or gripping objects. I can't do pushups due to wrist pain.

Has anyone experienced this before and can tell me when the aches in my forearms will go away? And what might be causing the thumb and pinky pain? I think I might be practicing too much too soon (around 3 hours a day during my third week of retraining).


Edited by Cole Stanford (11/26/13 09:28 PM)

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#2188956 - 11/26/13 10:39 PM Re: Lingering Tendonitis [Re: Cole Stanford]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
Hi Cole,

I'm very sorry to hear about your problems. Yes, RSIs associated with piano playing are very common. Piano World just put up an FAQ about them with advice about 1st Aid, various people's stories, the typical progression of symptoms, and some information about finding a doctor to work with. You can read it here:

http://www.pianoworld.com/forum/ubbthrea...tml#Post2129006

The kind of symptoms you report are usually indicative of someone who has not yet healed all the way. What kind of medical treatments have you received? Did you work with a physical therapist? If yes, how did they work with you? Have you tried any alternative or holistic modalities e.g. acupuncture, Rolfing, et cetera? Also, how did you respond to any of these approaches?

Also, you did not say what kind of approach or method your teacher uses in working with the injured. Can you give us some information about that? It will help us shape our answers.

Thanks, and I look forward to hearing from you soon!
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2188987 - 11/27/13 12:10 AM Re: Lingering Tendonitis [Re: Cole Stanford]
Derulux Offline
5000 Post Club Member

Registered: 06/06/05
Posts: 5321
Loc: Philadelphia
I very rarely do this, but.. "what he said." Greg's spot-on.

One other consideration: you mentioned different kinds of activities, like lifting, gripping, pushing, push-ups. Would it be fair to assume you workout pretty heavily? I bring this up because it is possible that things other than the piano could be the "initial" issue, and the piano has simply exacerbated the injury to the point that it is noticeable and you are, for the most part, experiencing difficulty continuing. Improper form while exercising, combined with improper technique at the piano, can certainly do quite a bit of damage.

Greg's mentioned a great way to go forward.. discussing what you're doing at the piano. There are many experts here who can help; Greg's one of them. If piano is eventually ruled out, or marginalized, you may want to take a look at some of those other activities to see if the injuries aren't compounded over more than one type of activity.
_________________________
Every day we are afforded a new chance. The problem with life is not that you run out of chances. In the end, what you run out of are days.

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#2188993 - 11/27/13 12:29 AM Re: Lingering Tendonitis [Re: laguna_greg]
Cole Stanford Offline
Junior Member

Registered: 11/26/13
Posts: 2
Thanks for directing me to that enlightening post!

As for medical treatments, I've been to two orthopedic doctors with experience in music-related injuries. They both agreed that I have tendonitis in the wrists and forearms as well as a minor case of ulnar nerve irritation in both arms. Fortunately I do not have RA or any nerve damage. I went to physical therapy for about three months which got rid of a lot of the superficial pain but didn't completely fix the deep forearm/wrist pain or the nerve pain. Neither of the doctors I have visited recommended a form of treatment beyond PT and rest, but I'd be willing to try acupuncture or some other kind of holistic healing.

The primary difference between my new teacher and my former instructor is in the emphasis on relaxed posture and efficient technique. My former teacher never taught me core technique concepts such as arm weight, so every passage required extraneous effort from the muscles of my hand and arm, leading to tense playing and a strained sound. My new teacher is showing me how to align my arms so that my entire arm weight rests on my fingertips. Now I'm playing in such a way that my energy travels from my shoulders all the way through my fingertips into the keys. I don't feel any of the forearm tension I felt with my former style of playing.

Also, I have not done any heavy arms workouts in over six months. In fact, I haven't done more than a couple push-ups over the past three months and I've ceased all freeweight exercises entirely.


Edited by Cole Stanford (11/27/13 12:54 AM)

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#2189199 - 11/27/13 12:57 PM Re: Lingering Tendonitis [Re: Cole Stanford]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
Hi Cole,

Thanks for the detailed answer. It's good to hear that you responded to your initial medical treatments. Some people don't, and then a good outcome can become elusive.

Orthodox medical approaches have their limits. They very often can take soft tissue only so far, so the next steps require a bit more imagination. Alternative modalities can be very helpful as a next step. It sounds like you've made some good progress, but are not yet completely healed. Further treatment can still be helpful if you find the right ones.

One thing you might consider is to find the very best PT you can to continue your work. It can't be just anybody; it has to be the very best practitioner you can find who has had lots of experience with RSI and consistently good outcomes. Their case histories should number well over 500, and they should have lots of experience working specifically with upper extremity RSI and especially in musicians. The best providers often can be excellent resources for information about alternative treatments, as well as help you quarterback, or manage, your treatment plan. When you go to speak with them, ask these questions and also if they can provide you with references from patients who had your problems and got better working with them.

A caveat: If you work with them, don't let them talk you into doing anything that hurts. They have a particular philosophy of treatment called "work hardening", and it is usually contraindicated in upper extremity RSI unless certain conditions are present e.g., atrophy/wasting, etc. Any exercises they give you should not cause any lasting or increasing discomfort. If it does, stop right away. "Working through he pain" is almost always a bad idea and can just make things worse.

And here's another idea. It's certain that you have some fibrotic scarring left from the initial acute injury. This is probably causing some residual dysfunction in the tissues, and possibly the circulation as well. It would be good to work on this directly using a form of myofascial therapy level IV, which the originator of the technique calls "active release". And the only good providers I've found of it are trained and certified. They can be found here:

http://www.activerelease.com/

You can find information about the treatment protocol, and there's a "find a provider" page. I've referred several hundred people to ART providers over the years, and with consistently good outcomes in most of the cases. The technique has undergone two large-scale trials with very good documented outcomes; both have been published in mainstream peer-reviewed journals. It works best when the injury is still in the early stages, but I think you'll find some help from it at this stage.

Another caveat: The best outcomes I've found with ART have been with MDs or chiropractors using it. If you decide to try it, you can call their headquarters in Colorado Springs to ask if they know of a successful provider in your area. If you're lucky, you could find a provider who is also an instructor in their institute. These providers are the most skilled and highly trained.

And here's yet another idea: Rolfing, yoga, and acupuncture have all been shown to be helpful with RSI when they are employed at the right stage of recovery. If you work with a yoga instructor, they must have ample experience working with people who are disabled or they will work you too hard.

Nobody can tell you how far along you can get in your recovery; I certainly can't. Beware of people who do. However, that doesn't mean you can't get better than you are right now.

I'm glad to hear you are happy with your teacher. I myself am trained in the Taubman method and was a teaching assistant at their institute for several years.

Let us know what you think about all this!


Edited by laguna_greg (11/27/13 01:01 PM)
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2189223 - 11/27/13 01:27 PM Re: Lingering Tendonitis [Re: Cole Stanford]
chopin_r_us Offline
500 Post Club Member

Registered: 09/17/10
Posts: 959
Loc: UK
2 cents: you may find it takes years to put into practice what your new teacher is showing you. Old habits die hard.

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#2189344 - 11/27/13 06:42 PM Re: Lingering Tendonitis [Re: Cole Stanford]
Louis Podesta Offline
500 Post Club Member

Registered: 02/05/13
Posts: 740
Once again, like Mark C., who seems to have given up on this type of thread, I take tremendous umbrage at Laguna Greg dispensing Physical Medicine advice on this website. For every so-called statement of fact that he makes, you could find at least a dozen to the contrary.

I have 62 year old spindly thin fingers, with a small hand, and a woman's wrist. In addition, I have psoriatic arthritis, and every bone, joint, ligament, and tendon in my body is in some stage of inflammation.

So, I have had to jump through all kinds of loops and hoops to get to where I am today at the piano. And, today, I had a great day.

I worked on a section of the Schumann Concerto, and it went okay, physically. Then, I worked on L'isle joyeuse for the rest of the afternoon, and it went very well.

Normally, I would not stress my hand in that fashion, but I broke it up with a soft practice of the Debussy Reverie. Where is any of that in Laguna Greg's playbook?

My point is that your hands are your hands, and your body is your body.

My coach is Thomas Mark, author of "What Every Pianist Needs To Know Abut The Body" www.pianomap.com, who Laguna Greg basically considers an amateur. However, he has taught me basic principles of Taubman, and Alexander Technique at the piano. And most importantly, he has taught me that one size does not fit all!

As has been suggested by another post, you need to look at how you treat not only hands during the day, but also the rest of your body. And, most of all, listen to your body, and it will eventually guide you to proper health, your hands, as well as the rest of it.

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#2189447 - 11/27/13 11:25 PM Re: Lingering Tendonitis [Re: Cole Stanford]
Jeff Clef Offline
4000 Post Club Member

Registered: 10/05/08
Posts: 4425
Loc: San Jose, CA
"...during practice today I encountered pain in my right thumb and in the base of the pinky coupled with a slight loss of mobility in the pinky and ring fingers. The soreness has persisted all day.

"...my forearms... are still tender in certain places. I get twinges of pain when I do things such as lifting, pushing, or gripping objects. I can't do pushups due to wrist pain.

"Has anyone experienced this before and can tell me when the aches in my forearms will go away? And what might be causing the thumb and pinky pain? I think I might be practicing too much too soon (around 3 hours a day ..."


Well, Cole, with an unhealed previous injury, I think three hours of practice a day very likely is too much. I admire your energy and dedication, but you are going to have to back way off this schedule if you are to expect any lasting improvement. The tendons are unforgiving and can take a long time to heal. However, exercise does promote healing, as long as you stop when you first encounter any discomfort--- way short of immobility and impairment, daylong soreness, and lasting pain in the digits. I believe that you are not listening to your body's signals, and are not stopping soon enough. We have pain for a good reason--- it prevents worse pain, if we heed the body's warning.

Injuries of this sort can end careers. You will have a long life ahead of you to play, but for the present it would be better for you to concentrate on patient healing, rest, and working with your orthopedics doc.

You are beyond the stage of common first-aid measures. Still, you might get some help from them. Ice packs--- applied to the forearm, not the hand--- for a few 15-20 minute sessions a day, can help both with pain and inflammation. Common over-the-counter NSAIDS like ibuprofen and naproxen sodium can give you some relief. Be sure you talk to your doc about it, and follow the package instructions; over-doing it, or doing it for too long, can open the door to other troubles. There are physical therapy methods for addressing scar tissue, but you would best learn them from a good PT, working according to your orthopedist's instructions.

One thing that helped me greatly, was getting a good-quality, stable and adjustable piano bench. A lot depends on maintaining a good seated posture when you play. If your teacher is accustomed to working with students with injuries, you will receive instruction about bench height and seated posture. I ended up with a Jansen bench http://www.pljansen.com/
after trying a couple of others. They are quite stable, and of excellent quality; there are some less expensive Chinese-made benches which cannot say as much. An unstable seat invites tension.

I wish you good luck. It seems that you are getting the right kind of medical attention and piano instruction, so if you can just follow through with what you have learned from these people, I think that, with time, you will come out in good shape.
_________________________
Clef


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#2189511 - 11/28/13 05:58 AM Re: Lingering Tendonitis [Re: Cole Stanford]
stores Offline
6000 Post Club Member

Registered: 12/28/09
Posts: 6648
Loc: Here, as opposed to there
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.
_________________________

"And if we look at the works of J.S. Bach — a benevolent god to which all musicians should offer a prayer to defend themselves against mediocrity... -Debussy

"It's ok if you disagree with me. I can't force you to be right."

♪ ≠ $


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#2189521 - 11/28/13 06:43 AM Re: Lingering Tendonitis [Re: Jeff Clef]
wr Offline
7000 Post Club Member

Registered: 11/23/07
Posts: 7892
Originally Posted By: Jeff Clef
Common over-the-counter NSAIDS like ibuprofen and naproxen sodium can give you some relief. Be sure you talk to your doc about it, and follow the package instructions; over-doing it, or doing it for too long, can open the door to other troubles.


Talking to your doc about it guarantees nothing. It was my doc who prescribed the mega-doses of NSAIDS that led to my developing a sensitivity to them and now I can't use them at all.

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#2189625 - 11/28/13 12:01 PM Re: Lingering Tendonitis [Re: stores]
Derulux Offline
5000 Post Club Member

Registered: 06/06/05
Posts: 5321
Loc: Philadelphia
Originally Posted By: stores
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.

Einstein was a hobbyist, whose career was "patent clerk". Are you saying E=mc^2 is wrong? wink
_________________________
Every day we are afforded a new chance. The problem with life is not that you run out of chances. In the end, what you run out of are days.

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#2189636 - 11/28/13 12:24 PM Re: Lingering Tendonitis [Re: stores]
Louis Podesta Offline
500 Post Club Member

Registered: 02/05/13
Posts: 740
Originally Posted By: stores
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.


Very well said.

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#2189644 - 11/28/13 12:48 PM Re: Lingering Tendonitis [Re: Derulux]
stalefleas Offline
Full Member

Registered: 08/16/13
Posts: 249
Originally Posted By: Derulux
Originally Posted By: stores
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.

Einstein was a hobbyist, whose career was "patent clerk". Are you saying E=mc^2 is wrong? wink


I think this idea is a little misrepresentative... Einstein was no hobbyist, we all have to pay the bills. I read that he liked his job because it was mindless enough that he could focus on physics while he was at work.

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#2189646 - 11/28/13 12:50 PM Re: Lingering Tendonitis [Re: Louis Podesta]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
Louis,

you're off topic. The OP seems quite happy with his teacher, who apparently has experience working with the injured. And it seems to be producing good results right now, and the approach, from what little he's said about it, seems sound. So leave him alone on that score.

I was just giving the same advice about post-injury medical intervention I give anyone who asks, not his technique. There is a very important place for that in recovery. If the tissues aren't healed enough to withstand the minimal stresses of of playing correctly, any injured person will re-injure themselves.

As much as I put a great deal of faith in Taubman's methods, I know from long experience that technical retraining is not a substitute for a good recovery. Taubman, Grindea, Marks, Alexander, Feldenkreis and many others swear that their technical approaches are wholly therapeutic and require little or no help from modern medicine. This is simply not true with a middle-stage RSI, which is what is being described here. In fact, the only way to fully recover from an injury like this is with a multi-disciplinary approach that starts off with orthodox medical intervention. Any injured person should go see a really good doctor first before they do anything else. The idea that your or any teacher can "teach you out of" an advancing and serious second-stage injury without any medical supervision is untrue, irresponsible, and dangerous. You have no business saying that.

I really don't understand you or your objections. On one thread, you praise me for my research and clinical experience in this area. And on other threads, you object if I say anything for no good reason. And you get pretty nasty about it too, which I think is way out of line.

As far as your teacher goes, I don't know what to say. To be clear, an "amateur" is one thing, and and "unknown quantity" is another. I don't know Mark's teaching, so I can't recommend it. He has published no research, so his methods and outcomes are a mystery. Taubman, on the other hand wrote quite a bit about it during her lifetime, and had her results scrutinized by several scientists as have a few of her best students. The results were compelling. My own methods have been put under the same scrutiny and produced similar results. Why on earth would I listen to you then? Or anyone else, for that matter? When your teacher does something similar by peer-review, I and many others will sit up and take notice.

Lastly, you don't raise any valid criticisms of what I suggested the OP do therapeutically. You just object that I say it, or anything at all. If you have any thing valid to say about that, then now's the time. Man up. Offer another therapeutic approach, one that has proven to be effective one way or another. You're not going to change my mind, or possibly anyone else's. But it will be fun to watch you try.


Edited by BB Player (11/29/13 10:07 AM)
Edit Reason: Ad hominem attack deleted
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2189648 - 11/28/13 12:56 PM Re: Lingering Tendonitis [Re: Cole Stanford]
stalefleas Offline
Full Member

Registered: 08/16/13
Posts: 249
Hooweee! gettin rowdy in here

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#2189653 - 11/28/13 01:00 PM Re: Lingering Tendonitis [Re: stalefleas]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
You ain't seen nothin' yet...
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2189667 - 11/28/13 01:24 PM Re: Lingering Tendonitis [Re: Cole Stanford]
chopin_r_us Offline
500 Post Club Member

Registered: 09/17/10
Posts: 959
Loc: UK
I also don't think much of Thomas Mark. I find his solutions for what is an extremely complicated mechanism to be rather simplistic.

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#2189704 - 11/28/13 03:41 PM Re: Lingering Tendonitis [Re: Cole Stanford]
jdw Offline
500 Post Club Member

Registered: 03/04/11
Posts: 997
Loc: Philadelphia, PA
The Taubman people I know all advise getting medical advice for injuries, along with retraining.

Personally, I think people with injuries are wise to look for all the advice they can get, including on the internet. Otherwise, they risk putting themselves in the hands of experts in one narrow field who may not be aware of other effective approaches. (Everyone has heard, surely, of surgeries that turn out to be ineffective or unnecessary.)

I think we might as well credit people with enough judgment to sift through the differing perspectives they'll get. (And if they haven't got the judgment to make intelligent choices, what does it matter where they seek advice? that'll be the least of their problems smile!)
_________________________
1989 Baldwin R
Currently working on:
Grieg, Papillon
Mozart, K 330
Brahms, Op. 118 no. 2

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#2189828 - 11/28/13 08:59 PM Re: Lingering Tendonitis [Re: Cole Stanford]
Ed McMorrow, RPT Offline
2000 Post Club Member

Registered: 12/09/12
Posts: 2192
Loc: Seattle, WA USA
Over my 40 years as a piano technician I have heard many pianists' discuss repetitive stress issues. Very few have been able to depend on MD's alone to help them. The number of physicians who would be able to diagnose and prescribe an effective treatment is small. Musicians must rely on casting a wide net to gain adequate insight into what would help them.

Making statements that experienced posters who have worked on these issues should not be given any credence because they are not medical professionals-is arrogant.
_________________________
In a seemingly infinite universe-infinite human creativity is-seemingly possible

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#2189838 - 11/28/13 09:21 PM Re: Lingering Tendonitis [Re: stalefleas]
Derulux Offline
5000 Post Club Member

Registered: 06/06/05
Posts: 5321
Loc: Philadelphia
Originally Posted By: stalefleas
Originally Posted By: Derulux
Originally Posted By: stores
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.

Einstein was a hobbyist, whose career was "patent clerk". Are you saying E=mc^2 is wrong? wink


I think this idea is a little misrepresentative... Einstein was no hobbyist, we all have to pay the bills. I read that he liked his job because it was mindless enough that he could focus on physics while he was at work.

Perhaps, but no less misrepresentative than the original. wink
_________________________
Every day we are afforded a new chance. The problem with life is not that you run out of chances. In the end, what you run out of are days.

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#2189844 - 11/28/13 09:36 PM Re: Lingering Tendonitis [Re: Derulux]
stores Offline
6000 Post Club Member

Registered: 12/28/09
Posts: 6648
Loc: Here, as opposed to there
Originally Posted By: Derulux
Originally Posted By: stores
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.

Einstein was a hobbyist, whose career was "patent clerk". Are you saying E=mc^2 is wrong? wink


Oh please.
_________________________

"And if we look at the works of J.S. Bach — a benevolent god to which all musicians should offer a prayer to defend themselves against mediocrity... -Debussy

"It's ok if you disagree with me. I can't force you to be right."

♪ ≠ $


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#2190244 - 11/29/13 07:47 PM Re: Lingering Tendonitis [Re: Cole Stanford]
Jeff Clef Offline
4000 Post Club Member

Registered: 10/05/08
Posts: 4425
Loc: San Jose, CA
I am sorry to see some of our members bringing their personal squabbles into this thread, which does nothing to help the young pianist who asked for help.

I am not a doctor, and hope my suggestions were not taken in that way--- I agree that giving (or taking) medical advice over a website is a risky business. It happens that I have had a lot of personal experience with this problem, including doctors, orthopedic specialists, physical therapists, medications, elastic wraps, thera-band, acupuncture, special training from piano teachers (well, one in particular) who were trained in working with students with injuries. And, MRIs, x-rays, exercises and stretches, steroid injections, more medications (including the advice to stop taking certain medications).

This is not a one-size-fits-all problem. I think the sensible advice for most people is, at first, the first-aid measures that anyone can do: rest, ice, NSAIDs if tolerated; awareness of seat, posture, and technique; and moderating the length of practice sessions.

Most people with a slight strain will not run to a doctor immediately--- I wouldn't, myself. But, if the problem doesn't yield or worsens, it is certainly appropriate to consult a doc--- and better sooner than too late. It seems to me that our young friend is at that point, and is already getting skilled help.

This does assume that the doc is qualified to help, and it's quite true that some are better than others. Like anything else, we have to shop with our eyes open. It is definitely my opinion, that anyone who consults a doctor, will get the best care if the doc knows about any medications that are already being taken. Otherwise, the patient might as well be putting his money through a shredder.

Any therapy or medicine has its risks, which have to be balanced against their possible benefit. Every patient should understand this. Personally, I have never heard a doc say, "Take huge doses of NSAIDs, or tylenol" ---except they add--- "if you want a new liver, a lingering death, or a perforated ulcer." Following the package instructions is really pretty important, and fixing the basic problem, if you can, is better than long-term medication use, even the most innocent over-the-counter product. Ask your own doc, to be sure... but I have never yet heard one say differently.

Anyway, good luck and good health to you, Cole Stanford. It would be nice to hear how it works out for you.
_________________________
Clef


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#2190275 - 11/29/13 09:08 PM Re: Lingering Tendonitis [Re: stores]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
Originally Posted By: stores
It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.


Stores:

The thing of it is, there is no place else to go. There are only 1 or 2 web sites I know of in the world that even present the idea that musicians even get injures from playing. The useful web sites that actually carry any information are geared towards industrial injuries, not musicians. And even in these few places, the information is so opaque that it is generally not helpful. The vast majority of doctors themselves by and large are also not trained in occ med/ind med, and their understanding of these conditions is quite limited. That includes orthopods who specialize in problems other than occupational ones. It's much, much harder to find a doctor who has any experience treating musicians. Music medicine is a new and still very small specialty, and hardly anybody does it. At this point, there are no books in print for the general public about the topic. I have a friend who's writing one, and it's supposed to be published this June. But again, she discusses industrial injuries, not music-related ones.

Jeff:

NSAIDs are the typical first-course of drug treatments recommended by physicians when tendinitis/tendinopathy is presented. Of those, naproxen is the most commonly prescribed. So you were not at all wrong to bring them up. As wr pointed out though, many people do not tolerate them well, not even the weaker over-the-counter strengths available now. The side effects can be very problematic.

NSAIDs work principally by reducing the edema, or swelling, at a cellular level. They are most effective relatively soon after onset. Since it's been so long since the injury began, I don't think it likely that a doctor would prescribe them unless they could find that the edema was still present.


Edited by laguna_greg (11/29/13 09:17 PM)
Edit Reason: changed name
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2190285 - 11/29/13 09:40 PM Re: Lingering Tendonitis [Re: Cole Stanford]
WaterfallMelody Offline
Junior Member

Registered: 11/10/11
Posts: 11
Hey Cole,

Let me say first that my advice is probably unlike anything else you're going to get on this issue. Additionally, my advice won't help in every case. In fact, all I really know is the advice worked for me, and the others with RSI who originally gave me this advice in the first place.

Also, I'll stress that it's very important to get legitimate medical advice, as others are saying.

For my personal experience, I suffered from "tendonitis" for almost two years. It started from writing on my computer, which I did for a living. Then, when I started playing piano, it exasperated it. I remember, one day, I had an "incident". I practiced the Fantasie-Impromptu at a speed I shouldn't have been practicing at for several hours.

Then I played a video game that required a lot of fast finger motion, for a few hours, after my hands were already tired.

When I finished, I realized I had a pain in my forearms I'd never had there before. It was a tingly/burning sensation, that made me feel very tender.

I thought it was a slight injury that would heal overtime. But after days, weeks, months, and finally years, I had NO CLUE what was going on. I tried resting, but it would always come back. And the more I learned about it, the worse it got.

It started as hand and forearm pain. But by the end, it was neck, shoulder, tricep/bicep pain, forearm pain, AND hand pain, all in one.

I read every book I could find on RSI, including trigger point therapy, "It's not carpal tunnel syndrome", and several others. Each promised to cure it and had me feeling hopeful, but all failed to deliver permanent relief.

It was incredibly stressful to me, because my pain wasn't going away... it was getting worse. And I didn't know if what I was doing every day was hurting it even more. I had no clue if I should just stay in my bed for six months to see if that would help, although if I did that, I'd be out on the streets!

Then, when things seemed their most hopeless, I got a very unlikely solution. I searched RSI on Amazon and sorted by reviews, which I had done in the past. This time though, I went past the first page, and found a book called "The Mindbody Prescription".

http://www.amazon.com/Mindbody-Prescript...words=mind+body

The book talks about how certain conditions, mainly back-pain and RSI, can be the result of emotional trauma, NOT an actual injury.

I also googled the book title + "RSI", and found this very helpful link:

http://podolsky.everybody.org/rsi/

(even Harvard has a portion of their RSI site that recommends it: http://www.rsi.deas.harvard.edu/mb_resources.html)

It sounds a bit out of left-field, but when I read this book, I felt everything coming together. I'd always wondered if it was just "all in my head", but since I didn't know if it was or not, I was too scared to just go about my day normally, as I didn't want to do permanent damage. This led to me babying my arms for two years, scared to do anything major with them (it even hurt to open doors).

The second I picked up this book and read the first chapter, I WAS CURED.

Yes, cured. After two years of pain, confusion and depression, within 5 minutes, I was CURED.

Now, it "came back" a few times, but by just reading the book, I was able to eliminate it every single time, within a matter of days. As of now, it's been close to six months since I read the book, and my hands/wrists/forearms/biceps/shoulders/neck all feel better than ever. wink

Once again, I stress you listen to advice of other posters and doctors especially over this. You may have a real physical injury.

However, as the Mind Body Prescription outlines, the body heals itself very quickly... even a broken femur only takes 2-3 months to heal. I was told that since tendonitis was related to tendons and nerves, it takes much longer to heal.

However, this claim was backed by no evidence, and I never read any success stories that I felt were helpful. Everything just left me more confused than I was before. Until I read the Mind Body Prescription.

Here's what I say. Maybe your condition is a physical injury. Or maybe it's like mine was: a mental/emotional issue.

I'd say regardless of what your condition is, reading the book can only help. If it doesn't help anything, and what he describes is far off from what you're really experiencing, it's likely you have a real injury and need to seek medical intervention.

However, if you're like me (and I do feel my case was relatively severe), reading the book will change your life. To be able to play piano pain free now is a gift that I took advantage of last time I had it, but it is one of the greatest gifts life has to offer, and I'm very grateful to have it back.


Edited by WaterfallMelody (11/29/13 09:41 PM)

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#2190438 - 11/30/13 07:38 AM Re: Lingering Tendonitis [Re: laguna_greg]
stores Offline
6000 Post Club Member

Registered: 12/28/09
Posts: 6648
Loc: Here, as opposed to there
Originally Posted By: laguna_greg




But again, she discusses industrial injuries, not music-related ones.



And this is the crux.
Mention that you have a cold to 100 different individuals and you'll get nearly 100 different remedies... none of them given by a medical professional. Why one would ask for medical advice on a piano forum populated by a membership that, in large part, consists of armchair quarterbacks is beyond me. I'm not singling anyone out and was not pointing my finger at you, specifically, greg, but I see this all the time on this site and I've never understood it.
_________________________

"And if we look at the works of J.S. Bach — a benevolent god to which all musicians should offer a prayer to defend themselves against mediocrity... -Debussy

"It's ok if you disagree with me. I can't force you to be right."

♪ ≠ $


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#2190513 - 11/30/13 11:25 AM Re: Lingering Tendonitis [Re: stores]
boo1234 Offline
500 Post Club Member

Registered: 05/06/09
Posts: 512
Originally Posted By: stores
Originally Posted By: laguna_greg




But again, she discusses industrial injuries, not music-related ones.



And this is the crux.
Mention that you have a cold to 100 different individuals and you'll get nearly 100 different remedies... none of them given by a medical professional. Why one would ask for medical advice on a piano forum populated by a membership that, in large part, consists of armchair quarterbacks is beyond me. I'm not singling anyone out and was not pointing my finger at you, specifically, greg, but I see this all the time on this site and I've never understood it.


I have to agree with Stores on this one. I am a physician and think that it is irresponsible to offer treatment advice to people you have never seen or only know online. Everyone is different and such advice should be limited to the OP's medical professionals. They might be allergic to NSAIDs or have some problem that would preclude them from taking them like kidney disease that they might not be aware of. There are too many possibilities to name, not to mention liability issues should something go wrong.

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#2190541 - 11/30/13 12:22 PM Re: Lingering Tendonitis [Re: boo1234]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
Boo,

You are not wrong, and your circumspection is appreciated. Which is why I end up telling people to go see a doctor all the time.

However, to leave the public in a vacuum of information is equally problematic. When you say you are worried about liability, I hear the voice of someone who pays malpractice insurance. Please understand, I am not criticizing that viewpoint! It's perfectly valid to think like that and, if this is a concern, then you should respect that limit.

But you must admit it's not very helpful. There is something of a balance between the two, and we all need to strike that point. Knowledge is power. Musicians' injuries are among the best-kept secrets on the planet. Not providing good information about them is actually helping create an environment where people get hurt and stay that way.

As far as NSAIDs go: is it wrong to discuss a standard treatment protocol? Most anybody going to see a doctor with this kind of complaint is usually going to get treated in the first round with RICE in early onset, and a splint and a pill with something more acute. Heck, that recommendation is even written in my very-second hand PDR; it's readily available everywhere. The AMA and the APTA both consider it good advice, so where's the liability? Anybody wanting to get prescription-strength NSAIDs, or something other than naproxen, will have to see a doc to get a Rx. So there's no liability there for anybody except the prescribing doctor. Anybody who goes out and takes boxes of Alleve while ignoring the label instructions takes the liability into their own hands. I don't see the liability issue is very applicable here for, who exactly? Certainly not the web host.

As far as discussing medical treatment in general; it sounds like the OP's providers are pretty much done with him and may have possibly even discharged him. With whom is he then supposed to discuss his continuing concerns? I agree, an internet chat room is a really dicey place to get advice about dating, let alone your health.

But as I said, there is no good place to get information about RSIs. The average MD is notoriously uninformed when it comes to them, and even the average orthopod has little or no experience working with musicians; they make their money replacing knees and hips, not treating soft-tissue injuries. And then, the outcomes from orthodox medical treatments are not often highly successful with musicians unless they follow a very sophisticated, multi-modality approach. I can think of eight places in this country where an injured musician can find that kind of help. Equally, I can think of several hundred where an injured musician might first go looking for help, but not find the kind that will do any good in the long run.

How are we going to find the necessary balance to discuss this well?


Edited by laguna_greg (11/30/13 12:25 PM)
Edit Reason: poor word choice
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2190606 - 11/30/13 03:58 PM Re: Lingering Tendonitis [Re: boo1234]
Louis Podesta Offline
500 Post Club Member

Registered: 02/05/13
Posts: 740
Originally Posted By: boo1234
Originally Posted By: stores
Originally Posted By: laguna_greg




But again, she discusses industrial injuries, not music-related ones.



And this is the crux.
Mention that you have a cold to 100 different individuals and you'll get nearly 100 different remedies... none of them given by a medical professional. Why one would ask for medical advice on a piano forum populated by a membership that, in large part, consists of armchair quarterbacks is beyond me. I'm not singling anyone out and was not pointing my finger at you, specifically, greg, but I see this all the time on this site and I've never understood it.


I have to agree with Stores on this one. I am a physician and think that it is irresponsible to offer treatment advice to people you have never seen or only know online. Everyone is different and such advice should be limited to the OP's medical professionals.


What the good doctor is saying is that, without actually seeing the patient in person, you don't have the faintest idea what is wrong with him. He could be making half of it up, or he could not be accurately describing his symptoms.

Unless something psychic is going on here, you are way out of line dispensing medical advice to a real person based on what you "think" is going on.

Before he died from prostate cancer, my father practiced medicine for 40 years, and not once did he have a patient come into his office and have his preliminary symptoms match up with the eventual diagnosis. It is the same with every other health professional, and you are not going to be the first person to do otherwise.

Suggesting that someone read a book or visit a website is one thing. Giving out specific diagnostic medical advice to someone who you personally know nothing about is, in a word, unethical!

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#2190651 - 11/30/13 06:18 PM Re: Lingering Tendonitis [Re: Louis Podesta]
laguna_greg Offline
1000 Post Club Member

Registered: 04/02/13
Posts: 1382
Loc: guess where in CA and WA
Louis,

"Giving out specific medical advice is another..."

Oh! So that's what you think is going on? None of us is treating anyone here. This is not treatment, or even diagnosis. Did you think it was? You couldn't have read these posts closely then.

What we ARE doing is discussing orthodox, standard protocols for treatment for a very specific problem, information that can be found anywhere on line and in reference books. The NSAIDs that are now the point of the discussion cannot even be had without a prescription, so we don't even have to worry about what someone's going to do with this information because they're going to have to see a doctor first just to get the drugs.

What the "good doctor" is suggesting, is, well, I don't really know what the doctor is suggesting. Nor do you. His post is a little unclear, which is why I wrote back asking for clarification.

To top it all off, the OP has been to see a doctor, has a diagnosis, and has undergone treatment with some success. They are not self-diagnosing.

Look, if this conversation freaks you out, you can always just ignore it.
_________________________
Laguna Greg

1919 Mason & Hamlin AA
1931 Bechstein C - now sold
http://www.triangleassociates-us.com/about_us (my day job)
http://en.wikipedia.org/wiki/Dorothy_Taubman (a recent article I wrote about one of my teachers)

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#2190773 - 11/30/13 11:20 PM Re: Lingering Tendonitis [Re: Cole Stanford]
Ed McMorrow, RPT Offline
2000 Post Club Member

Registered: 12/09/12
Posts: 2192
Loc: Seattle, WA USA
Isn't it ironic that some Physicians are interested in diagnosing the mortality of long dead musicians, and then some Physicians criticize musicians trying to learn about the way the human body responds to and can be injured by playing various instruments? Doctors are fun people too!
_________________________
In a seemingly infinite universe-infinite human creativity is-seemingly possible

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