Jim Lyon
Mar-03-2004, 9:44am
First let me say I have been a dedicated lurker for years, and I want to thank Scott and all the rest of you! This IS a specatacular communinity, and I have learned so much from all of you. That being said, it's my turn to try to give something back.
In real life, I am a physical therapist. I am by no means an expert on CTS or repetitive strain injuries, but I do see people with these problems every day. Before I go too far I have to give the usual disclaimers: First, this is just an overview, and if you have hand/wrist problems, it is not necessarily CTS. Second, you need to remember free advice is worth what you paid for it, and if you have questions, you should seek the advice of a medical professional. As MandoJohnny has recommended look for a Dr. (typically an orthopedist or a physiatrist) or physical therapist who has a great deal of experience with neck and upper extremity problems. In the larger meetropolitan areas there are often folks who specialize in treating musicians, so ask around.
OK! CTS is by definition a problem with the median nerve, which runs through the carpal tunnel in the wrist. The median nerve specfically runs muscles in the fingers and thumb, and is responsible for the sensation in the thumb and the index, middle and 1/2 of the ring finger. Typically, symptoms will start with numbness and tingling in the hand and fingers, and can progress to pain in the wrist, hand and fingers as well as weakness in the hand. When it is severe, the numbness is fairly constant, and it can get to the point where the weakness is such that you are dropping things like a glass of water. If it gets to that point, do not ignore it! That means the nerve is compressed, and you probably need surgery. If you leave it alone you run the risk of permanent nerve damage.
The problem arises because the carpal tunnel is a very small space that has 8 tendons, an artery, a vein, and the median nerve running through it. The tunnel is made up of the 8 bones of the wrist along the bottom, and a thick carpal ligament across the top. (FYI, tendons are the part of the muscle that attaches to the bone, and ligaments are separate structures that attach bones to each other across joints) The numbness/tingling/pain/weakness come because the nerve is getting irritated in the tunnel. The irritation can be caused by the tendons rubbing against the nerve, or repeatedly using the wrist in poor postures, but most often a combination of the two. With prolonged irritation, you get swelling, which can compress the nerve, and over time you develop scar tissue, which does not go away. It is at that point you have a problem you have to manage continuously to keep it from getting worse.
Once you get it, can you get rid of it? Yes, but only if you catch it immediately, with the first onset of symptoms. But if you you've let it go for awhile (like me), then you probably have structural changes as I just described with the scar tissue. This is not reversible. That does not mean you are doomed! I have CTS from years of abusing my wrists, but I'm still able to play my mando, and I use my hands all day in my line of work.
You have to manage the problem continuously. It requires constant vigilance! There are several factors which contribute to the problem. In my opinion the single most important factor is it is not what you do, but how you go about doing it that has the greatest influence on whether you develop symptoms. You have to look at the postures you put your body into while you play the mando, type on the keyboard etc. A perfect example is the picture of Scott playing that piccolo mando. He is almost curled into a ball trying to finger that monster. If he were to play in that posture for hours/days/weeks, I guarantee he will develop symptoms, and not just CTS.
The best way to avoid CTS is to learn proper technique, and take frequent breaks. If you have CTS, you have to take care of it, you can't ignore it. I would agree with the advice of previous posters. I tried to look at the musicianshealth website stretches, but it wasn't working, so I can't give you my opinion on those stretches, but I'm sure those are good options, and I do recommend frequent stretch breaks. For example, if you are playing out, try to do a little stretching between each song. If you are working on a particularly difficult piece, and you find yourself in a similar Posture described above, stop every 10-15 minutes straighten up and stretch a little before getting back to it.
If you are having an acute exacerbation of the symptoms, you may need to back off the activities that bring on the symptoms for awhile. As to when to seek medical advice, I always tell people to start the process if they have experienced the symptoms for a week without any change, even if the symptoms are mild in nature. Most of these types of problems should start to improve within 7 days if they are simple problems.
As to mouse issues: pads, trackballs, "ergonomic" mouses all have their own sets of problems, and no single mouse is perfect for everyone. Again how you use it, and in what postures has a bigger effect. If you're not having any problems with your mouse, I'd leave it alone. As to vitamin B6, I have heard that it can be helpful, but I could not begin to recommend what doses to use.
Anyway sorry for being so long winded, but I firmly believe if you know your enemy, he can't screw you! Hopefully you find this helpful. I love this cafe!
Jim
In real life, I am a physical therapist. I am by no means an expert on CTS or repetitive strain injuries, but I do see people with these problems every day. Before I go too far I have to give the usual disclaimers: First, this is just an overview, and if you have hand/wrist problems, it is not necessarily CTS. Second, you need to remember free advice is worth what you paid for it, and if you have questions, you should seek the advice of a medical professional. As MandoJohnny has recommended look for a Dr. (typically an orthopedist or a physiatrist) or physical therapist who has a great deal of experience with neck and upper extremity problems. In the larger meetropolitan areas there are often folks who specialize in treating musicians, so ask around.
OK! CTS is by definition a problem with the median nerve, which runs through the carpal tunnel in the wrist. The median nerve specfically runs muscles in the fingers and thumb, and is responsible for the sensation in the thumb and the index, middle and 1/2 of the ring finger. Typically, symptoms will start with numbness and tingling in the hand and fingers, and can progress to pain in the wrist, hand and fingers as well as weakness in the hand. When it is severe, the numbness is fairly constant, and it can get to the point where the weakness is such that you are dropping things like a glass of water. If it gets to that point, do not ignore it! That means the nerve is compressed, and you probably need surgery. If you leave it alone you run the risk of permanent nerve damage.
The problem arises because the carpal tunnel is a very small space that has 8 tendons, an artery, a vein, and the median nerve running through it. The tunnel is made up of the 8 bones of the wrist along the bottom, and a thick carpal ligament across the top. (FYI, tendons are the part of the muscle that attaches to the bone, and ligaments are separate structures that attach bones to each other across joints) The numbness/tingling/pain/weakness come because the nerve is getting irritated in the tunnel. The irritation can be caused by the tendons rubbing against the nerve, or repeatedly using the wrist in poor postures, but most often a combination of the two. With prolonged irritation, you get swelling, which can compress the nerve, and over time you develop scar tissue, which does not go away. It is at that point you have a problem you have to manage continuously to keep it from getting worse.
Once you get it, can you get rid of it? Yes, but only if you catch it immediately, with the first onset of symptoms. But if you you've let it go for awhile (like me), then you probably have structural changes as I just described with the scar tissue. This is not reversible. That does not mean you are doomed! I have CTS from years of abusing my wrists, but I'm still able to play my mando, and I use my hands all day in my line of work.
You have to manage the problem continuously. It requires constant vigilance! There are several factors which contribute to the problem. In my opinion the single most important factor is it is not what you do, but how you go about doing it that has the greatest influence on whether you develop symptoms. You have to look at the postures you put your body into while you play the mando, type on the keyboard etc. A perfect example is the picture of Scott playing that piccolo mando. He is almost curled into a ball trying to finger that monster. If he were to play in that posture for hours/days/weeks, I guarantee he will develop symptoms, and not just CTS.
The best way to avoid CTS is to learn proper technique, and take frequent breaks. If you have CTS, you have to take care of it, you can't ignore it. I would agree with the advice of previous posters. I tried to look at the musicianshealth website stretches, but it wasn't working, so I can't give you my opinion on those stretches, but I'm sure those are good options, and I do recommend frequent stretch breaks. For example, if you are playing out, try to do a little stretching between each song. If you are working on a particularly difficult piece, and you find yourself in a similar Posture described above, stop every 10-15 minutes straighten up and stretch a little before getting back to it.
If you are having an acute exacerbation of the symptoms, you may need to back off the activities that bring on the symptoms for awhile. As to when to seek medical advice, I always tell people to start the process if they have experienced the symptoms for a week without any change, even if the symptoms are mild in nature. Most of these types of problems should start to improve within 7 days if they are simple problems.
As to mouse issues: pads, trackballs, "ergonomic" mouses all have their own sets of problems, and no single mouse is perfect for everyone. Again how you use it, and in what postures has a bigger effect. If you're not having any problems with your mouse, I'd leave it alone. As to vitamin B6, I have heard that it can be helpful, but I could not begin to recommend what doses to use.
Anyway sorry for being so long winded, but I firmly believe if you know your enemy, he can't screw you! Hopefully you find this helpful. I love this cafe!
Jim