Question re thumb pain

Posted by: lizcat

Question re thumb pain - 02/15/13 05:10 PM

I've experienced a very frustrating situation for about two months now.

I've been playing for about 8 months, and my progress is very slow, which is not a problem given my life with work, kids, etc. Around Xmas I was assigned "Carol of the Bells," which was challenging enough that I threw myself into practicing it for sessions that were longer than usual. I managed to cause pain in my wrists, index finger, and especially both thumbs. I'm sure it was due to my not-great technique--despite my teacher's instructions, I played with my fingers. I just couldn't grasp the whole concept of arm weight, etc.

My hands have since healed other than my thumbs. Most of the pain centers around the middle joints, with only occasional twinges at the base. Strangely, they don't hurt while I play, but they hurt afterwards and whenever I flex them. It's almost like they are slightly jammed or something.

I'm really trying to play using arm weight (I still have a very hard time grasping how to do this--teacher is very patient), and I do so for only 5 or 10 minutes at a time. I've given up "Carol of the Bells" for now and have returned to much easier pieces. But I wonder if my problem is that the thumbs never healed and whether I need to take an extended break. I dread doing this, as again, the whole process has been so slow to begin with. But I certainly do not want to give up this hobby, which I've waited literally my whole life to take up.

Any advice is welcome.
Posted by: Charles Cohen

Re: Question re thumb pain - 02/15/13 06:35 PM

First question, always:

. . . What does your teacher suggest?

The standard treatment is probably ice, and rest. Say, icing for 10-15 minutes before and after practice, and not using your painful thumbs for daily activities. Ultrasound treatments may also be useful. [You can buy ultrasound machines for home use, but should probably be trained by a physiotherapist before using one.]

. . . What have you been doing for the pain?

I have great respect for tendon pain. About 20 years ago, I developed a case of "squash elbow" (same as "tennis elbow"), that was so bad it was painful to lift a glass of water.

I switched to my off-hand (right, since I'm left-handed) for _everything_ -- eating, opening doors, etc. It was mostly healed in six months or a year.

If I over-use my left arm (and it doesn't take much), that 20-year-old injury still bites.

I suspect it's not just "playing with the fingers", but excess tension and rigidity in your hand, that caused the problem. Easy to break, slow to heal.

. Charles
Posted by: lizcat

Re: Question re thumb pain - 02/15/13 07:03 PM

Thank you so much for your reply, Charles.

My teacher is trying to help me relax...you're right that I have excess tension and rigidity in my hands as well as arms. He suggests sticking my elbow out (lifting from the elbows, not my forearm) and letting my arm drop, taking the notes as slowly as I can until I learn to use arm weight. The movement is sort of like birds moving their wings. He definitely stresses relaxation in general--very hard for me, especially since I'm tense about causing more injury. I'm not sure whether it's working, although as I mentioned, the rest of my hand/wrist pain went away. I'm just not sure whether I should continue this way or give my thumbs a complete rest from playing, and for how long. I can't completely rest them in "real life," as I have three young kids (thankfully, I don't have to lift anyone anymore at least).

I haven't really done anything for the pain. I tried deep massage of the areas on my own, which I think made things worse the next day. I was afraid if I took ibuprofen I would mask the pain and "allow myself" to go back to playing incorrectly. As I'm sure everyone can understand, it's very hard to stay away from the piano even when I know it's the cause of my injury. Ice is an excellent suggestion and one I hadn't yet tried.

Please let me know what you think.
Posted by: Sand Tiger

Re: Question re thumb pain - 02/15/13 07:17 PM

As Charles already wrote, rest and ice (or cold) are standard for minor discomfort. If discomfort crosses over to pain, it may be time to seek medical care. A day off here and there, and less practice time are examples of rest. If it crosses over to pain, time to take a few days or a week off.

Instead of ice, I use a cold metal water bottle. I also wear fingerless gloves when I play. Cold hands seem to make the problem worse, so I try to keep the hands warm. Another thing I do is soak my hands in warm water. Some use Epsom salts for the soak.
Posted by: JohnSprung

Re: Question re thumb pain - 02/15/13 08:02 PM

The obvious difference here is that we use our thumbs kinda sideways on the piano, and the fingers more straight on. There are so many variables here that I'd suggest finding a doctor who specialises in sports medicine.
Posted by: Charles Cohen

Re: Question re thumb pain - 02/16/13 12:51 AM

Originally Posted By: JohnSprung
The obvious difference here is that we use our thumbs kinda sideways on the piano, and the fingers more straight on. There are so many variables here that I'd suggest finding a doctor who specialises in sports medicine.


An excellent idea! There are even doctors who specialize in musicians' injuries, but they're hard to find.

Ibuprofen has a fair amount of anti-inflammatory effect (if you take it regularly), as well as being a painkiller. I've used a lot of it. You _know_ you've got an injury; there's no reason to remind yourself with extra pain.

The problem is to keep your intelligence riding herd over your desires.<g> "Too much practice" is a sure way to make things worse.

. Charles

PS -- I'm very wary of giving advice to others -- not enough letters after my name. My own experience may not match yours.
Posted by: Derulux

Re: Question re thumb pain - 02/16/13 07:13 AM

Couple ideas on this subject. First, everything you've read from the other posters is accurate, and I'll do my best not to rehash any of it. smile

Next, the particular location of the pain you described doesn't sound much to me like you caused the injury while playing the piano. As John said, you play the thumb sideways on the piano, so that particular joint should not be involved much in the playing. Unless you severely curl the thumb, which is a no-no. That could lead to a twisting injury, which could eventually tear ligaments in the joint. So, check that out when you sit at the keys.

It sounds very much to me like an inflammation injury. Most repetitive stress injuries are of this nature, so I'm not really suggesting anything profound. Rest and proper care (ice is a great suggestion) are the only way to heal such injuries. But I'm more concerned with the cause, since Charles and the others have suggested the former two therapies.

Has anything in your daily life changed significantly that could add additional stress? Sometimes, with these types of injuries, we associate the pain with the thing we are doing at the time, or the thing we were just doing, but the inflammation could have been caused hours before. If you're typing more on a keyboard, answering a phone for significantly longer periods, shoveling a driveway because of a recent snowstorm (northeast anyone?)... any of these things can lead to pain, and with enough aggravation, injury. Especially if, because of your technique, you're already prone to it, or are already causing lesser injury over time. So, give this a thought, too, while you're icing.
Posted by: lizcat

Re: Question re thumb pain - 02/16/13 08:05 AM

Thank you, everyone. I really appreciate the time and thought you put into these replies.

I can't think of anything that changed in my life outside of the extra practice before and around Christmas (I bought an easy carols book and was playing much more than usual). Even then, I knew my form was off, but I was getting the sounds I wanted so I kept it up.

I ordered the Thomas Marks book "What Every Pianist Needs to Know About the Body," and it arrived last night. It's really resonating with me, particularly since I've always had poor kinesthetic sense (as well as terrible posture). As I mentioned earlier, I have a hard time applying the notion of any movement beyond my fingers. Early on, Marks stresses that many "overuse" injuries are simply from playing incorrectly, which helps me realize why cutting down to even five minutes wasn't helping.

As for the position of my thumb, I know during those long practice sessions I was using it like a sideways hammer (flexing at the joint), and that's something I'm trying to correct with awareness.

I will be trying the suggestions here, particularly the ice. It's exactly what I've done in the past with sports injuries--not sure why I didn't translate the same ideas to this situation.

Thank you again.
Posted by: cirenosach

Re: Question re thumb pain - 02/16/13 10:28 PM

I have a very similar story, except it was my left pinky and playing electric bass. Sorry to say that I don't have a happy ending. After 20 months of rests, restarts, doctors, Advil, lessons, and books, I really just can't play for more than 15 minutes without problems. I'm 95% sure it's not technique. It's either physical or psychological.

Anyway, I've decided to put thing away for a while and try to learn to play the piano that Santa brought my daughter.

My advice: (1) figure out whatever it is that's hurting your thumb, (2) don't push through even minor pain but treat it as a signal to stop whatever you're doing asap, and (2) nail your technique. I'm not a pianist, but I suspect this means playing at a painfully slow pace.

Best of luck to you.
Posted by: spanishbuddha

Re: Question re thumb pain - 02/17/13 04:16 AM

I had a similar problem with both thumbs. No pain when playing but soreness around the joint afterwards. I used to ice both thumbs every evening. I never really figured out the exact motion causing it, but made greater effort to relax and play without tension, and either roll the whole hand or use arm weight rather than articulate the thumb. It took a few months, I kept on playing, but I no longer have sore thumbs.
Posted by: JimF

Re: Question re thumb pain - 02/17/13 07:37 AM

Thinking about what derulux wrote re other activities made me think of folks you see texting like mad with their thumbs.
Posted by: Derulux

Re: Question re thumb pain - 02/17/13 07:53 AM

Originally Posted By: JimF
Thinking about what derulux wrote re other activities made me think of folks you see texting like mad with their thumbs.

Aye, that can do it, too. It's not so much the pressing down with the thumb, but the gripping of the phone while doing it that will cause most of the issue. But certainly, something as simple as that can cause harm. Repeated stress injuries are buggers.. sometimes, something you added/took away six months ago (or longer) can cause the injury. Then, you tend to think it was something you started doing that same day, or even that week, that you first feel the pain. Almost never the case.

If you already have a stress injury, however minor, then something as simple as shoveling the driveway can exacerbate it. But for repetitive injuries, the damage was usually done quite a long time before you begin to feel it.
Posted by: lizcat

Re: Question re thumb pain - 02/17/13 12:11 PM

Some really good points here.

cirenosach--You bring up something I've suspected, that there's a psychological aspect to it as well. For one thing, the pain has been moving around--it's no longer in my joints but sort of showing up as twinges in tendons near my thumbs, and I haven't touched the piano in three days (nor done anything out of the very ordinary--no snow here!). I've experienced this "moving pain" before over the past few months. I had a very stressful Oct.-Nov., and the pain coincided with all that was occurring. At the very least, my stress over even approaching the piano absolutely causes me to tense up as I play--also, my stress over not "getting" the relaxation part. It's a vicious cycle, as I end up getting very frustrated and tense over the fact that I can't relax. smile

spanishbuddha--I started the icing yesterday based on what I've read here. I'm going to lay off playing again today and then ask my teacher tomorrow night to start from square one--technique only, as though I've never touched a piano before. (I started with a different teacher, which is where I originally picked up the incorrect playing that I can't seem to shake). We'd tried to move to easier pieces so I didn't have to worry so much about sight-reading, but I think we need to go further back than that. I really need to focus 100% on relaxation and technique and not think about notes or tempo or anything else for awhile.

JimF & Derulux--As it happens, I don't have texting on my phone--thankfully! However, I had similar injuries years ago when my kids were babies, so I know my thumbs are a weak spot. I agree that this had likely been building up for months.

Thank you again for all the good suggestions.
Posted by: Arghhh

Re: Question re thumb pain - 02/17/13 01:12 PM

You said this pain was similar to when you had little kids (picking them up) - is it the same? Check out information on de Quervain's. One link is here: de Quervain's info , or do a google search for it to find a page that better explains it to you.

I'm not saying what that's what you have, but it is something to read up on. And if it does seem likely, then eliminate the motions that it says cause it, such as pinching and grasping with the thumb. Neither of these are necessary in piano playing, but both of these are habits I've had to break.
Posted by: lizcat

Re: Question re thumb pain - 02/17/13 01:29 PM

Arghh--Yes, that's exactly what I had with the kids. I ended up getting two cortisone shots total, and the pain went away.

This pain is different. Very occasionally I feel the same sensation in terms of the tendon alongside my thumb feeling "weird," for lack of a better term, but when I do the thumb test for de Quervain's, I can tell it's not the problem here.

I should have clarified--from my experience with the kids, I know I'm prone to some sort of imbalance in that area. For example, when I was picking up babies, I was using my wrists rather than my arms--hence, the strain.

Thank you for this suggestion, however.
Posted by: Jean-Luc

Re: Question re thumb pain - 02/19/13 10:55 AM

Lizcat, I can do the De Quervain test without feeling any special pain and my De Quervain disease has been confirmed today through an ecography so I guess the test isn't 100% accurate.
After 8 months of pain, like you I started to think "it's in my head" and it's actually a relief to have a medical confirmation of an actual physical problem (at least you know how it can be treated and how much time it might last). You can also take steps to correct your technique (despite the fact that my teacher sees nothing wrong). Knowing what lurks in the dark is often better than imagining what could be smile
Posted by: lizcat

Re: Question re thumb pain - 02/19/13 05:55 PM

Jean-Luc, that's interesting. I hadn't even heard of that test for diagnostics--my old doctor just did the standard manipulative tests. Things appear to be improving for me after a few days of complete rest and some gentle massage and ice. However, I will definitely keep your post in mind, especially if I have to end up seeing a doctor. I'm sure it's a huge relief to have a diagnosis and treatment. Thank you.