Common Health Problems for String Players

The following information details the most common health problems that string players encounter. Be sure to consult a doctor. Self-diagnosis can be very dangerous, and doctors have seen numerous examples of each of these ailments.

Tendonitis (also spelled tendinitis)

Definition: A tendon is a tough yet flexible band of fibrous tissue that connects your muscles to the bone. Tendons are denser and stiffer than muscles. Although this density makes tendons quite strong, the lack of elasticity and the constant pulling on the attachment to the bone makes tendons susceptible to a low level of tearing at the microscopic level. This tearing produces the inflamation and irritation known as tendonitis. Tendonitis is usually caused from excessive repetitive movement and overuse (e.g., playing a stringed instrument).
Symptoms: Achy pain, stiffness, and in some cases, burning surrounding the joint.
Treatment: Anti-inflammatory medications, icing, time away from the repetitive motions that caused the tendonitis, stretching (in particular, the more pliable muscle around the tendon, NOT the painful, inflamed area itself). Massage and ultrasound treatment are often used to break down the excess scar tissue that forms as the microscopic tears begin to heal on their own.
Websites:

• www.tendonitis.net
• www.orthopedics.about.com
• www.medical-research-studies.org/tendinitis.shtml
• www.musicianshealth.com

Carpal Tunnel Syndrome

Definition: At the base of the palm there is a tight canal or “tunnel” through which nine tendons and the Median Nerve must pass on their way from the forearm to the hands and fingers. This narrow passage is called the Carpal Tunnel. The Carpal Tunnel is snug and there is just enough room inside for the tendons and nerves that have to pass through. If anything takes up extra room, the nerve in the canal becomes constricted or “pinched.” The condition that results when the Median Nerve is being pinched is called Carpal Tunnel Syndrome (CTS). The most common cause of CTS is inflammation of the tendons within the tunnel, which is usually caused by excessive repetitive motion and overuse (e.g., playing a stringed instrument or typing on a computer keyboard).
Symptoms: Numbness and/or tingling in the hands and/or fingers. Shooting pains in the wrist or the forearm (in severe cases, traveling all the way to the shoulder, neck, chest, or even the foot). Difficulty clenching the fist or grasping small objects.
Treatment: Wrist braces, supports, and splints are often used to stabilize the area. Anti-inflammatory analgesics are also useful. Icing and time away from the instrument are commonly suggested. There is a surgery available for CTS called Carpal Tunnel Release. This is a last-resort option for musicians, because healing from the surgery can take a long time and results are not always satisfactory.

Tennis Elbow (Lateral epicondylitis)

Definition: Tennis elbow is the inflammation of the outer part of the elbow. It is caused by damage to the muscles, tendons, and ligaments around the elbow joint and forearm. This damage is usually caused by overuse.
Symptoms: Pain that increases with gripping and rotation of the wrist and forearm.
Treatment: Tennis elbow is usually treated with anti-inflammatory drugs and time away from the instrument; in particular, time away from the specific motions that cause the pain. Tennis elbow, like tendonitis and CTS, can often be prevented by warming up thoroughly and stretching the arm muscles regularly before practicing, while practicing, and after practicing.
Websites:

• www.tennis-elbow.net
  
• www.gadgetsreview.co.uk/tennis-elbow.htm

Focal Dystonia

Definition: Focal Dystonia of the hand is a neurological condition characterized by a loss in motor control of one or more fingers. A single muscle or group of muscles is involved; muscles in the hand and forearm tense and tighten, with the result of making the hand (or part of the hand) curl up or spring out. Sometimes called “writer’s cramp,” Focal Dystonia rarely affects violists, cellists, or bass players. Health professionals believe that these string players are not often affected because their fingers are spaced farther apart, allowing the brain to make clear delineations between them. Focal Dystonia usually affects the fingering hand, but there are cases of the bow arm being affected. Focal Dystonia is rarely seen in people younger than 30; however, there are also exceptions to this assumption. Focal Dystonia most often affects pianists, violinists, flutists, oboists, and guitar players. Because Focal Dystonia is a neurological disorder, traditional diagnostic tools used by physicians will not discover it. Uninformed doctors may tell you that you have psychological problems or that you are imagining your symptoms. Consult a doctor who specializes in musician injuries and is aware that Focal Dystonia exists and is extremely disabling.

Symptoms: Focal Dystonia sufferers may notice a sudden inability to perform a motion that was seemingly easy before. Perhaps the ring finger or pinky wants to curl into the palm of the hand instead of fall onto the string. The fingers may spring away from the hand as they are asked to be placed on the string. Vibrato may become difficult, especially on the ring and pinky fingers or on long notes or double-stops. In severe cases, the entire hand may recoil when placed near the instrument. Dystonia is very task-specific, and sufferers may discover that very few motions outside of playing their instruments are affected. Violinists may observe that when they hold their violin “guitar-style” or like a cello, the symptoms improve significantly. Usually relatively painless (physically), Focal Dystonia is a controversial and mysterious ailment.
Treatment: As of now, there is no cure for focal dystonia. Many treatment methods have been explored. There are brain/hand retraining programs available, as well as sensory retraining experiments (learning to read Braille with different fingers, exposing fingertips to various textural elements). Some doctors prescribe Artane, a controversial drug because of the intense side effects. Injections of Botox into the afflicted muscles in the arm are beneficial for some patients. The most successful form of treatment for Focal Dystonia seems to be learning to play the instrument in a different way, whether that be altering the hand position, learning a new vibrato, changing set-up and posture, or through a series of neurological “tricks:” visualization techniques and slight alterations in fingering and set-up that offset some of the symptoms temporarily. Because Focal Dystonia is a neurological disorder, taking time off of the instrument is rarely helpful, unless the patient is working on retraining specific muscle groups. If you are diagnosed with Focal Dystonia, talking to other “dystoniacs” can be very helpful; their “tricks” may help you stay functional and they may expose you to different fingering or bowing patterns that make your problem more manageable. The most important traits a dystonia patient can possess are patience and a willingness to experiment.
Websites:

• www.dystonia-foundation.org

• http://serendip.brynmawr.edu/bb/neuro/neuro01/web2/Blumenfeld.html

General Aches and Pains

Most violinists and violists practice standing up. Orchestra or chamber music rehearsals and concerts create a different series of challenges and potential problems. Long hours of playing while sitting in a chair that is the wrong height or positioned at the wrong angle can prompt intense shoulder and back pain. In addition, insufficient light can cause us to lean forward to see the music, placing stress on the lower back. Cellists may be required to use rockstops or chairs of a different height and shape than the ones to which they are accustomed. When preparing for an orchestra rehearsal, create time to ensure that you have a chair that works for you, that you have enough space to bow and move properly, that you have earplugs or shields if you need them, and that you have adequate light. Many orchestral musicians find that regular massages improve the quality of their symphonic experience. Again, stretching is a valuable resource. Find spots in the music to put down the instrument and rest the arms; breaks of only 30 seconds interspersed throughout the day can give you an immediate boost and allow you to increase your stamina.