Tendonitis

[John Rosett]

I've developed a pretty bad case of tendonitis in my right arm. Taking large doses of ibuprophen seems to knock it back to a dull roar, but makes me sick, so I had to stop taking it. I don't have any medical insurance, so "traditional" medicine is out of the question (just the trip to the doctor for diagnosis cost almost $400!). It's not so bad when I'm playing electric guitar or dobro/lap steel, but playing mandolin hurts pretty bad. I'm definately not ready to give up the mandolin!
So I'd like to hear from anybody who's been through this kind of thing, and what you've had success with. I have a fiddler friend who's had success with accupressure, and I'm going to try that, but I'm open to anything. Thanks!

[Peter]

I had a similar problem some years back, tried ultrasound, heat treatment, electric stimulation swearing --- none of which worked.
Being a sceptic, I couldn't accept that sticking pins in my arm could possibly have any effect, but, in a bout of desperation, I went for the acupuncture treatment. The physio who treated me said that they had seen surprising results so I had nothing to lose.

In fact, after 4 treatments, with no discomfort during them, NO MORE PAIN.

I think I'm a believer!

Good luck with whatever you go with.

Peter

[Ken Sager]

Rest really helps with tendonitis. Ice does, too, especially if you can't stomach anti-inflammatory drugs.

Once you get your tendonitis controlled (I'm also a believer in acupuncture) you may also want to look at what you're doing differently on mandolin when playing other instruments doesn't hurt so bad. It'd be worth sitting with a teacher once or twice to get another set of eyes looking at your right hand mandolin technique. Just a thought.

Best wishes for a speedy recovery,
Ken

[John Flynn]

Two things that have helped me:

1. Lighten up: I have found that all pain related to playing the instrument has been related to my using too much tension somewhere and the tension is not always in the same spot as the pain. There is a lot of interconnectedness in the hand and arm.

2. Warm up: I like the stretches on the Musicians Health website. They are not an instant fix, but done regularly, they really work for me when I am having hand and arm pain.
http://www.musicianshealth.com/stretches.htm

[morgan]

My tendonitis is in my left arm, so its a different set of problems. I tried to battle through and it kept getting worse, so I eventually ended up taking a 4 or 5 month break from playing till it subsided. I've learned to manage it now and back off when it flares up slightly, so I haven't had to take any other long-term breaks. I also pay attention and try to identify non-musical activities (things that torque the wrist backward, like raking and pruning, are especially bad) that aggravate it.

I went to my doc when it happened, and he told me to rest, then brought me into his office and showed me his Bill Monroe screensaver. Turns out he's a lifelong guitar player that was taking up mando. The eight strings reach in many directions, I guess. I haven't tried any quote-unquote alternative remedies.

I gave up playing octave mando because it torqued my wrist too much, and when I'm sore I play my mandolinetto, which is a 13-inch scale with light strings, but none of that will help a right hand problem

I knew a guy who had to give up mando due to tendonitis but took up dobro and managed fine, so if the accupuncture doesn't give you a miracle cure perhaps you could take a mando break and play dobro for a while until it calms down.

[Timbofood]

I reaslly tore up my left elbow doing some leaded window "deconstruction". I had to stop playing for about 6 weeks and then do as little as I could at a gig. Very irritating but, The alternative ws not play and still be miserable. That took about 9 months to finally "go away" Don't push it if you can help it!

[John Rosett]

Thanks for the tips. I don't think that my pain is caused by playing, I think taht it's caused by my day job as a house painter. Johnny, you're dead on about the tension thing. I have worked really hard to loosen up my pick grip over the years, and keep my shoulders loose as well.
I think I'm going to check out an acupuncturist. Unfortunately, they're all closed on Fridays here. I'll have to wait til Monday.

[red7flag]

When I first started playing mandolin, I went way overboard, playing too much. I know this is hard for some of you to believe. After a week of almost non-stop playing I developed pain in my left hand that seemed to escalate when playing. My brother, who is the sceptic's sceptic told me about Glucosemine and Chondroitine. I did some follow up research that found that Chondroiton is not effective in blind tests. MSM another over the counter suppliment and Glucolsemine were both found effective. Since taking Glucosemine, I have not had a the problem since except in a minor way. I now take a Glucosemine and MSM combination daily. If you are having pain and are just starting, they recommend 3 tablets a day for the first month, then if the pain recedes cut back to one pill a day. The suppliment has not eliminated the problem, but made it manageable.
Tony

[homeslice]

I recently had a very discouraging battle with tendonitis. I took a week off of playing and followed a remedy that was posted on here by a user. Basically, you rotate from a hot pack to and ice pack in 2-3 minute intervals for about 15-20 minutes a day. Its very uncomfortable, but it worked. I also spoke with a doctor before this and he assured me that it was safe so you dont have to worry about doing more damage. I should mention though that my problem was in my hand and fingers. Since then I have also gained a mandolin with oversized frets and a radiused board which helped me tremendously. Still, I think this little regiment is worth a shot since it's free. Good luck and I hope you get free of this soon.

[Timbofood]

I've heard that one too but, can't bring myself to do it. The drag is I have heard lots of floks say that REALLY works well!

[siren_20]

Yikes. Tendonitis is scary, isn't it? I have a bit of experience here, so I'll try to share a few things...

I've battled tendonitis in my left arm for the last four years or so. Tendon injuries heal very slowly and in my case, the problem was rooted in a very inobvious area (blown ligament in my wrist gave rise to a ganglion cyst which caused carpal tunnel which caused tendonitis which dorked up my rotator cuff, ad nauseam...). I literally tried EVERYTHING there is to try for chronic tendonitis pain: prescription painkillers from my doctor, ibuprofen (or, as I came to call it, Vitamin I), castor oil packs, stretching exercises, chiropractors, cortizone shots (many in the wrist and elbow), taking flaxseed oil and amino acid complexes (I read a study that said taking an amino acid complex with L-Arginine helps tendons heal), Moxibustion (http://en.wikipedia.org/wiki/Moxibustion), massage therapy, lighter strings, lower action, and a whole host of other "remidies"...

The key is really finding (a) good pain relief, and (b) resolving the root cause of the problem, whether it's medical or technique-related. The best long-term pain relief I got was through physical therapy and acupuncture. The acupuncture loosens you up, and the physical therapy broke my initial pain "cycle" that left me barely able to function, think, or sleep (let alone play) for about four to six months.

Even if you are squeemish about needles, I really do recommend acupuncture. My acupuncturist actually used needles with me very seldom, and often in parts of my body other than the arm. You literally don't feel the needles AT ALL... I know it may be hard for some to believe, but you really don't feel a thing. And I HATE needles! I actually took a photo of the electroacupuncture setup she used most of the time (attached)... basically those are little suction cups that have electrodes in them that relax and sort of knead the muscles in the arm. Totally painless despite looking like some sort of torture device. After a couple of treatments, I really noticed a huge difference, both when I was playing and when I wasn't playing. I'd forgotten what "loose" really felt like, which led me to very consciously relax and re-relax all the time while playing.

Another thing: if you think that your injury may be related to some sort of repeated strain, you might want to consider investing in a wrist splint to wear while on the job. Keeping the wrist immobile will help things heal up sooner. If it's at the elbow, there are elbow bands that put pressure on the muscles and tendons near the elbow. I've used both with good results.

Bottom line, in my opinion? If you have pain, it's your body's way of telling you something is wrong. Stop playing for awhile and get checked out by a professional (whether it's a doctor, acupuncturist, physical therapist, chiropractor, whatever). Then, examine and re-examine your technique once you get the pain under control. A bit of caution now can potentially save you a lot of trouble down the road. Best wishes and I hope you can get back to picking at full strength soon!

[MandoSquirrel]

I've heard that one too but, can't bring myself to do it. The drag is I have heard lots of floks say that REALLY works well!
Well, if you'd rather suffer, feel free, just don't complain, if you won't try the remedies.

[Andrew Faltesek]

Hey everyone, new to the cafe...after a few decades desiring a mandolin, I finally purchased a Weber STE Prototype F, and have been enjoying playing it since February.
I had tendonitis and nerve impingement in my right arm from tons of scraping/painting on my home which put a big cramp on the guitar and mandolin playing. As you can see there are lots of techniques for relieving the pain, but as others have advised, you need to get at the root of the condition, as these problems arise from overstressing and repetative motion. Mandorose, are your trouble areas at the wrist, elbow, shoulder or a combination? One thing I learned is that our wonderful arms and hands are comprised of looser joints and bundles of nerves, muscles and tendons, and the connections extend all the way to the vertabrae in the neck. I recommend employing the least invasive measures and examination of your habits in working and playing to manage the stress on your arm. As has been mentioned, curing the pain will not solve the problem. Some ideas for doing this outside the expensive clinic...
Wrist: you need to back way off on the motion and stress. Try to quiet the movement and as hard as it is; this means not playing or subjecting it to work loads for a while. If you have a medical supply store in your area or can order it over the internet, obtain a wrist support such as are employed for carpel tunnel (nylon/velcro) and support your wrist in a neutral position. The more time the wrist is unstressed the better...use it while you are sleeping also. A cheaper alternative is to wrap your wrist area with a couple layers of gauze bandage (helps breathability), then overlay with cling bandage. Wrap the 2" cling over the wrist area a couple times but do not pull or stretch it much, then pass it between your thumb and 1st finger...adding a twist to reduce its width there. Then continue to wrap it down your wrist and forearm, overlapping to form a good support. It should not be tight, just enough stretch to provide support. This is a good disposable support you can employ when painting.
Arm and shoulder: If your work was similar to mine, you spend a lot of time stressing your arms in a position curved and extended forward. You need to again quiet the muscles and balance the work force. With your back straight and arms at your side, move your shoulders back and down towards your lower back, hold this position for 10-20 seconds, then relax. Repeat several times. Also relax your neck, and roll your head slowly to each shoulder stretching it slowly. Also roll your neck slowly all the way around. Elastic bands can also be purchased cheaply, and used to provide resistance in the opposite direction of your work loads. Wedge a folded length of band in a door or other support, and slowly pull the ends of the bands in each hand down to your sides as you face the door. Starting position should be with your hands extended straight out in front (adjust length of band to achieve this). Then slowly raise your arms to the starting position. The idea with all this is to provide stretching and relaxing in equal measure to your work load in the opposite direction. Ice/heat is good. Ibuprofin helps to reduce swelling...time your doses to occur after you have eaten and had something to drink (this helps to avoid sick feeling), use 400-600 mg doses, and it must be continued for a few days to be effective. Too high a dose can cause stomach bleeding, alcohol should be avoided during its use. Gradually work back into your work/mando efforts but back off at the first sign of symptoms developing. You need to take care of your arm so you do not develop a chronic problem.

[Fretbear]

Here is an easy thing to do that really helps; use your computer mouse with the trouble-free or less troublesome hand. If you use a laptop, get a mouse. I was starting to have pain in my right hand and wrist and started using a mouse with my left hand and it starts to feel natural very quickly and lets you rest your other hand. A gel-pad wrist rest is also good and of course, if something is hurting, give it a rest. If you try to "push through the pain" with tendonitis, you will regret it.

[Andrew Faltesek]

Fretbear is right...keyboard and mouse use is real bad on the wrist, and will set you back even if things have improved. Try to keep your shoulders pulled back and your arm bent and closer to your body. Try to arrange the desk for the best ergonomics, which usually are not very good. Oh, sorry for the long post! ...and no line breaks!

[Lane Pryce]

John, a counterforce strap will aid you considerably at work. However the only way to really treat the tendonitis and promote healing is by direct injection of a steroid into the inflamed tendon. Healing rates vary but count on several weeks after injection. An internist,family practice MD,PA or NP can accommodate your needs. Not too pricey either.
The stap can be purchased at a local pharmacy. Lp

[chirorehab]

Technique, proper posture, proper warm up and resting are all important factors...

I utilize an incredible technique called Active Release Technique (ART) with my patients with great results for these types of injuries.

For more information on ART or to find a provider in your area go to www.activerelease.com (http://activerelease.com)

Best of luck,

Eric

[siren_20]

However the only way to really treat the tendonitis and promote healing is by direct injection of a steroid into the inflamed tendon. Healing rates vary but count on several weeks after injection. An #internist,family practice MD,PA or NP can accommodate your needs. Not too pricey either.
Steroids are not the only way to treat tendonitis and promote healing. Not everyone responds well to local steroids like cortisone. A cortisone shot will typically involve an injection of a local anesthetic such as lidocaine followed by the actual steroid injection. Cortisone takes a good long while to be absorbed by your body and the short-term effects can be pretty gnarly. You can end up with a big lump o' steroids at the injection site that takes awhile to subside. In my case, this meant bruising and pain in an already painful area. I had several, both in the arm and in the wrist, and they hurt like a/an [insert your favorite expletive here]. After the swelling went down, I noticed no real effects even after two or three successive injections over the course of a few months. Several folks I've talked to who have had cortisone injections for tendonitis have had similar experiences in that steroid injections really did little to help the underlying problem and caused more painful problems in the short term.

That being said, I have heard of folks that have found good results from cortisone. If you go this route, I'd suggest finding a hand specialist, as they're a little more delicate and experienced with regard to doing these sorts of injections. Also be leery of anyone who wants to give you multiple injections in a relatively short period of time. Cortisone can actually weaken tendons if it's overused.

[Hal Loflin]

I had problems with my right wrist but not from playing mandolin. I am a golf professional by trade (club pro at a course south of Nashville) and that is where my problem came from.

From a golfer's perspective, the counter force strap works! But let me add another "snake oil" cure. I had seen PGA Tour pros wearing the bracelets with the magnets and had read that the reason that they use them is due to sore wrists and tendonitis. Soooooooo, I tried one and have been without pain since.

Hey, maybe we could come up with some magnetic bracelets with mandolins on them!!!

[Ivan Kelsall]

I suffer from 'trigger finger' in my left middle finger & a stiff 1st joint in my left first finger due to tendonitis .I've already had one op.for trigger finger in my left ring finger & left thumb & i don't want another one if i can avoid it. It wasn't so much the pain as the fact that it kept me from playing (Banjo) for over 3 months - ok,say it,that's a good thing !.
#My real point in this is,that even though both fingers are stiff,after about 10 minutes playing,they are as free as a bird - NO STIFFNESS !. How can that be ?.
#Since trigger finger is caused by a swelling in the finger tendon & tendonitis is caused by inflamation in the tendon,how come both seem to disappear after i begin practicing ?.It certainly can't be because the swelling & inflamation does ACTUALLY disappear,as after half an hour or so they are both painfully stiff once more. I can't explain it,neither can my Doc.,
# # # # # # # # # # # # # # # # Saska

[John Rosett]

I thought that I'd give a little update. First off, I went out and bought one of those "tennis elbow" braces-the kind with a little pillow thing to apply pressure. Man, that thing really helps me get through the work day without much pain. I checked out the Active Release Technique website that Eric (chirorehab) directed me to, and had an appointment with a local practitioner that I found there. Not only is he helping me feel better, he used to be a musical instrument repairman in Pt Angeles, WA. I've gotten a little financial help to pay for the treatments, and I think that he's going to be able to help me.
To top things off, I got a call on Friday from Donna Smith, a jazz singer that I've worked with over the years who lives in Missoula, MT. She's the singer on "I can't believe that you're in love with me" on my Myspace page. She has a very high-paying wedding at the end of the month, and the people getting married heard the CD I recorded with her and requested me! So I'm flying out to Montana at the end of the month to play with some really good friends.
I was pretty depressed when I originally posted, but I'm starting to feel alot better now!

[olgraypat]

Many excellent ideas. As someone with lots of aches and pains, I can verify help from the following (most of which have been mentioned above) listed in order of benefit:

1. The braces which you can buy at a pharmacy. If the problem is in your wrist area, the carpal tunnel braces used at night can help a lot.
2. Glucosamine/MSM
3. Accupuncture
4. Massage
5. Rest/well-designed exercise
6. Stretch before you play
7. Probably the best advice is don't try to play through it. Rest a while, and then do what you can. You can improve by doing things other than playing (learning scales/theory/ writing tab as you work out songs)

[siren_20]

Hey, that's great news! I'm really happy to hear that you've got a plan, and maybe a little bit of hope! I'm sure you'll be back picking at 100% soon.

[Andrew Faltesek]

Glad you are feeling better. Remember to employ the least invasive measures of treatment when possible, and try to reduce tension in your arm and in gripping the pick. I'm new to the mandolin; but it seems with all the fast picking and rapid switching/blending from melody picking to chording and chops and the like; requires a lot of concentration and diligence which promotes tension. Or I'm listening to too much Grisman and need to simplify!

[TonyP]

Hey, that's great news mandorose! It always hits home to hear another musician is having "mechanical" probs.. Personally, I find ibuprofen the lest effective over the long run. What they don't tell you is studies have found it actually affects the joint negatively in the long run, causing deterioration of the soft tissues. One thing not covered here which I was really happy that there was so many good responses about acupuncture and vitamins. But another one that's really good along with lots of vit. C, E, glucosamine/chrondroitan (I don't do MSM because of a study that showed a link to the dreaded E.D.!) is Pycnoginol. This stuff along with the others has done literally wonders for me. my deflated 2c.
Good luck and continued success.

[chirorehab]

I am glad that ART has been able to help you & things are looking up!

ART is an incredible, non-invasive technique, very well known by many professional athletes, runners, triathletes, weight lifters, and more. In fact, the chiropractor who developed the technique has completed in over 35 Ironman triathlons!

While it is not the answer for every problem, I have helped many patients avoid surgery for conditions like rotator cuff strains, tennis elbow, carpal tunnel syndrome, and back pain.

Like discovering the mandolin, utilizing ART has had a huge impact on my life!

Best of luck!

Eric
www.nelsonpilates.com (http://www.nelsonpilates.com)