Topic: Wrist Pain

I am a 16 year old oboist. Iam very involved with my instrument and love to be in bands and orchestras as well s performing pieces I just plain love. Lately I have been having problems with my wrists. It started out just as a little bit of pain, but now it hurts after a few minutes of playing. My doctor told me it is not carpal tunnel and to go to physical therapy. That worked for a little bit but has started to become less effective. I am wondering if anyone out there has had the same problem or knows what to do about it. It is starting to effect my playing!! If someone could please help it would be amazing.

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Re: Wrist Pain

My first word of advice is to Stop whatever it is you are doing when it starts to hurt.  Immediately.  You will only make things more difficult and painful (potentially long term debilitating) for you later if you play through the pain.

My second word of advice is to find someone that is a certified Alexander Technique instructor.  He or she will teach you about using your body in proper ways in order to avoid causing injury.  Very often I hear a musician with problems like yours say "It's the only thing that worked for me" about Alexander Technique and performance injury.  More times than not, overuse injury due to playing an instrument is almost always related to unnecessary tension in the body - not just in the hands and arms - and not improper hand position, although that can also be a factor.

Third, do you play with a neck strap?  I'm not an oboist, but I know many oboists play with neck straps and/or alternative right hand crutches (thumb rest) in order to better handle the weight of the instrument.

Finally, examine other aspects of your daily routine that might contribute to your pain.  Do you play video games?  Type a lot on the computer?  (get a natural keyboard!)  Play a sport like tennis that has a tendency towards stress injuries?  These are all things to consider.

This is a topic of special interest to me because my wife is a flute player who nearly had to drop out of college and did drop out of grad school as a result of tendonitis caused by her playing.  It was severely debilitating not just to her musical life, which came to an abrupt stop, but also to her regular life.  It was painful just for her to drive a car.  So much of her injury could have been prevented if she didn't play through the pain for two years before it got so bad she couldn't even hold her instrument up anymore.  Don't make that kind of mistake.  So don't play when it hurts, and really look into Alexander Technique.  There is registry of certified teachers online at http://www.alexandertech.org/teachers/FindTeachers.php

Last edited by Trent (2007-09-08 21:55:32)

M.M.A., D.M.A. University of Illinois at Urbana/Champaign: B.Mus. Lawrence University
Bassoon professor at University of Wisconsin Eau-Claire
Maker of the Little-Jake electric bassoon pickup and Weasel bassoon reeds

Re: Wrist Pain

Alexandra, I'll second Trent's comments about avoiding any activities that increase your pain. I think it's important to determine exactly what it is that causes or aggravates your pain, and precisely where the pain is located. Often the cause is NOT music-related, and so you might have to look critically into all the physical aspects of your life to see what activities may be causing your pain.

My first choice of practitioners would be your family physican or primary health counselor, whoever that might be. Make an appointment, telling the office staff that you are an instrumentalist (mention which instrument), and bring your oboe to the appointment. Watching you play can be very helpful in making an accurate diagnosis, and the practitioner can see whether you're playing with excesive muscle tension.

Your treatment will depend on the precise diagnosis of your problem. I can't expand on this further unless I know the diagnosis, so it's important to discuss this fully with your physician and learn what the treatment options are.  Be open with your healthcare providers and willing to proceed with treatment suggestions.

Hope this helps -- and good luck.

Dr. Bill

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: Wrist Pain

Physical Therapists can work wonders, also. I've got a chronic case of De Quervain's tenosynovitis (http://tinyurl.com/2jbzft) that has best been treated with physical therapy- I've had cortisone shots, which provide  temporary relief, but the treatment that my Physical Therapist provides (e-stim, ultrasound, deep massage, exercises, etc.) have kept the pain within reason.

Thanks, André! (My therapist!)

Note- You can only see a therapist with a prescription from a medical doctor, so start there first and the doctor will refer you to a qualified Physical Therapist. Look for physicians certified in such specialties as Physical Medicine and Rehabilitation, Orthopdic Hand Specialty, or Physiatry.

Last edited by arundonax (2007-09-13 19:53:54)

Paul Barrett
   -Principal Bassoonist, Honolulu Symphony
    -Lecturer in Bassoon, University of Hawaii

Re: Wrist Pain

Here is something we developed for young musicians on an intensive week-long course of orchestra playing - based on personal experiences of injury and remediation.

Neville


Christchurch Itinerant Teachers of Music
National Secondary Schools Symphony Orchestra

Avoiding Musicians’ Injuries

Many orchestral musicians, both young and old are experiencing serious postural problems which pose a long-term threat to their continued involvement in music performance. 

This summary is designed to alert players to potential problems and forestall them; to identify the risks from playing;  to prevent the onset of problems;  to identify the initial warning signs; 
to takeeffective “self-help” remedial action;  to seek professional help where necessary.

Risks mainly come from:
    the unnatural postures instruments require players to adopt (e.g. violinists’ left hand).
    long periods of static posture and muscular tension
    poor furniture,  poor posture,  weak musculature
   
Preventing the onset of problems:
    be physically fit - strong back and abs
    choose or adapt furniture for good support
    sit erect - maintain the lordosis (inward curves) in lower back and neck areas
    use a natural playing position - avoid sharp bends in joints such as wrist and neck
    use a support for heavy instruments
    change position from time to time
    relax muscles regularly
    adopt counter-stretches to dissipate tension during rests while playing

Warning signs:
    sore back, neck or shoulder
    pain in forearm or hand
    tingling sensation or numbness in hand
    weakness in hand or forearm

What is causing the problem?
most problems stem from split discs pinching nerves where they exit between the bony segments of the spine
another localised problem comes from muscular “poisoning”  which occurs when muscles held under tension, naturally generate toxins which cannot be flushed away because of restricted blood-flow.
less common is inflammation from overuse, restriction, or deterioration of the tendon sheaths extremely rarely, nodes or long-term injury of the tendons or joints may be due to arthritis or a traumatic injury or chronic OOS.

Self-help:
correct posture especially neck and lower back; reverse stretches; back strengthening exercises sit-ups with rolled newspaper under spine (move it progressively from neck to lower back); spinal rotations; yoga or physio postures such as “squares”, “wall locust”.

Professional Help:
    Find a good sports physiotherapist or preferably one who deals with musicians’ injuries.
    Avoid injections (cortisone, gold); surgery, invasive operations, pins,  etc.

Remember it took months to get into the state your are in - it may take at least a few weeks to correct old habits, restore split discs, strengthen your spine and regain your fitness. You will experience some mild pain from stretching and feel tightness initially down back of legs, in palms, arms, chest and back.
Do not continue if pain is severe or persists.  Listen to your body.  Work gently and increase over time.


Avoiding Musicians’ Injuries - Some Basic Postural Exercises:

    1. Arm Stretch
    Reach arms above head and interlock fingers
    As you exhale, soften shoulders and extend arms. Squeeze elbows together
    Exhale and push base of index finger up, pull base of little finger down.
    Exhale and become aware of the increased hollow in your low back.
    Tuck your bottom in and flatten the lower back. 
       Concentrate on making a hollow in your upper back (you may feel some pain between your shoulder blades). 
    Breathe freely while holding the pose.

    2. Wall Lean
    Stand 20 -3 cm away from the wall, feet parallel, knees straight but not locked.
Reach hands up wall as high as possible - hands spread wide.  Maintain contact with base of index finger and thumb.
    Lean into wall - you may even wish to rest your head against the wall.
    Tuck bottom in, flatten lower back so only upper back is leaning significantly into wall.
    Concentrate on small region between shoulder blades.
    Try to take your sternum (mid-chest) and upper back towards intersection of floor & wall.
    Breathe steadily.

    3. “Prayer” Square
Elbows quite close together on table or sill.  Clasp hands, palms together, up at right angles.
    Allow head to drop through.  Soften inner shoulders.  Roll out arms shoulders.
    Feet hip width apart. Knees straight but not hyper-extended.
    Push into base of big toe and roll out thighs.  Aim for right angle at hip.
    Lengthen body away from arms.  Begin to turn backside towards ceiling.
    Push away from wall and lengthen.  Aim to gain hollow in upper back.  Flatten lower back.
    Pull shoulders down and into lower back.
    Work through check-list again.  Hold pose for 10 -15 breaths.

    4.  Square Against Wall
    Similar to “prayer” square above.
    Place hands against wall around mid-chest height.  Middle finger vertical.
    Spread hands wide.  Push into base of index finger and thumb.
    Roll out shoulders.  Soften neck.
    Aim to make a right angle as for “prayer”  square.
    Lengthen the spine.  Backside towards ceiling.  Pull kneecaps up.

    5.  Wall Locust
    Lie on stomach face down on floor, feet flat against wall.
    Tighten backside and thighs.
    Interlock hands behind back and lift, arching back and reaching back towards heels.
    Do not rest hands on backside.  Press sacrum and backside downwards.
    Hold for 10 -6 seconds.  Breaths will be shorter and sharper in this position.

    6. Roll and Stretch
       Side lie, inner shoulders down, back straight, knees crooked, hips at 90 degrees to body and weight of top hip over bottom hip, arms out straight, palms matching, inner shoulders down.
Leading with head, leave lower arm on ground and take upper arm over to other side of body.
    quietly stretch for 20 breaths each side

Resources
Acc Booklets (free)
The Athletic Musician - Barbara Paull & Christine Harrison pub PAULLINK Toronto

Neville Forsythe
Christchurch New Zealand
Bassoonist / Teacher / Conductor

Re: Wrist Pain

Hello!
First of all it is necessary to learn the reason from what there is a pain in hands. Make three exercises.

1. Take the partiture, take in hands the oboe and read partiture with eyes, do not press keys.

2. Read with eyes the partiture and press necessary keys, without  sound.

3. Play this partiture.

Between these exercises have a rest. Analyse in what case there is a pain.
I hope, that it will help you.
I wish good luck.

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Re: Wrist Pain

I'd like to add a couple of observations and findings from my medical and musical experience --

Musculoskeletal pain from posural problems is usually from the affectedmuscles, tendons, and ligaments -- rarely from pinched nerves. Herniated discs that pinch on nerves in the neck and lower back are serious problems, to be sure, but in my experience are very uncommon in instrumentqalists.

Neville's suggestions for prevention are sound. I'd add the Alexander Technique as an excellent method to regain proper posture for playing (and for most of life's activities). It's crucial to relax those constantly-used muscles, whether or not there is a posture problem. I recommend taking a 5-minute break every 30 minutes, geeting away from your instrument and doing anything else but practicing (or reedworking).

Try to play relaxed -- that is, using only the muscles needed to get the job done -- can be a career-saver. Excessive tension in any muscle is counterproductive to playing at your best. It's not necessary to hold instruments with a death grip, nor to contract muscles on both sides of a limb simultaneously.

Finally, let your physicians and therapists know that you are a musicina -- bring your instrument to the appointment so they can watch you play it -- Seeing the problem is so much more effective than listening and trying to figure out what the patient is saying.

Bill

Dr. Bill Dawson, bassoonist and teacher
IDRS medical consultant
Past President, Performing Arts Medicine Assoc.
Author of "Fit as a Fiddle: The Musician's Guide to Playing Healthy"

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Re: Wrist Pain

I started having wrist problems when I was in middle school - mine was from a combination of playing oboe, cello, and doing gymnastics, as well as having excessive tension while playing my instruments.  I was diagnosed with tendonitis in both wrists - I spent a couple of (painful) years in various wrist braces, going to hand specialists, orthopedists, etc.

Eventually, I tried acupuncture, and it worked wonders!  I was skeptical at first and went, really, as a last resort because nothing else was working.  After about a month, the pain had drastically decreased.  I also used a support system (Mike Benthin's MUTS) to take the weight off of my right wrist.  I stopped using the support system after a couple of years, because I felt like I was becoming dependent on it - but if you want/have to keep playing, that's the way to go!  I didn't have a chance to really "take a break" and heal, so taking the weight off of my wrist was my only option, and things worked out fine.

Now, I use a harness (bari sax harness - Neotech) when I play English horn, and one of the "Etude" model thumbrests by Ton Kooiman.  Forrests Music carries them for about $30, and it distributes the weight of the oboe much more evenly on my hand.  I have small hands, and it also helps to position my right hand so that I don't have to stretch as much to reach the low C# and D# keys.

Hope this helps!  Good luck!

Leslie Godfrey
Leslieoboe@aol.com

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Re: Wrist Pain

Leslie's point is well made - I would always recommend using the least weight-bearing system whether it be a Muts for oboe or a seat strap combined with a shoulder sling - or a spike (together with re-formed crook) for bassoon.

The best treatment is preventative.

Neville

Last edited by NevilleForsythe (2007-09-16 04:51:57)

Neville Forsythe
Christchurch New Zealand
Bassoonist / Teacher / Conductor

Re: Wrist Pain

Hello guys this is my first post in this forum in my opinion best treat can be the physical therapy it is bit lengthy treatment but its quite good.............

http://www.marketplacewellnesscenter.com/2011/07/26/marketplace-physical-therapy-corona-gives-four-strategies-to-treat-osteoporosis/

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