nerve damage - potential causes and effects on playing

[CeeCee_C]

Earlier this week, I saw a hand therapist specializing in problems specific to string musicians due to concerns about the lack of independence of the fingers on my left hand.

Apparently, activities requiring that the base of ones hands be flat on a table (computer use), which cause the fingers/arm to go numb (leaning ones head on ones hand) or that produce strong and/or lengthy periods of vibration to the hands (tool use, motorcycle riding, etc.) can damage the fragile nerves controlling the fingers.

I seem to have sustained nerve damage, due to long term exposure to all of the above. This is a primary cause of my inability to keep my fingers close to the fretboard when not actively being used.

The therapist gave me exercises with which to start and suggested that I see a local therapist for other exercises as i progress. It's tedious and may be a lengthy recovery process.

So this is a cautionary message, suggesting that you consider all the things that you do which might interfere with your playing.

To some, this may seem like a justification or rationale for lack of diligence. I see it as an explanation for why all my careful practice and hand position control have yielded little in the way of improvements to accuracy and speed.

Just thought I'd pass this along.

I'm doing these exercises for two one hour sessions each day. So if your opinion is that I should buckle down rather than making excuses, please do me the courtesy of not sharing that opinion with me.

Thanks,

[peterk]

Thank you for posting your experience with the hand/finger nerve damage......I hope your hand motor abilities improve nicely with time and regular therapy.
Acute or chronic hand tendonits, and nerve damage are afflictions of many string players, the violin/viola community seems to be particularly vulnerable to it perhaps partly due to that old (European school) "8 hrs of daily practice" maxim.
A good reminder to us all to play/practice wisely and in moderation, and the older we get, the harder it obviously becomes to recover from a hand injury of the sort.

[Bertram Henze]

I can confirm that computer use thingie to some extent, and I have made neccessary changes:

- I have exchanged the mouse for a trackball; doing the clicks with your thumb is almost like picking.
- I don't rest my wrists when typing - this very moment my elbows rest on the chair's armrests; making sure that the keyboard is lower than my elbows, or else the tension would just move elsewhere.

[Al Bergstein]

I also use a cheap timer to force a 1 minute stand up and walk around break every ten minutes. It takes discipline but once you are used to it, it does help. Maybe use a hand gripper exerciser at that one minute break? The Apple touch pad is another good way to get the hands off the keyboard. But it raises other issues.

[Bill Lemerise]

A guitarist recommended that I get "the negative" after play/practice. Stretching b/4 and after any physical activity is essential. What is play/ practice but intense localized physical activity? I also lift light weights to relieve my pickers elbow.

[Mike Scott]

I have had a similar problem and wore a splint on my elbow for a month or so which alleviated the issue. Another thing was getting deep tissue massage on my forearms-about once a month. It hurts like crazy but at least for me really helps. Others I have talked to swear by acupuncture too. In addition to your exercises you may want to give these alternatives a try. Oh, and good luck with the recovery.

[marcodamusician]

handmaster plus should be used by all musicians. We've discussed it before. It prevents most of these problems from occurring.

http://www.handmasterplus.com/

[marcodamusician]

If you scroll to the bottom of this page, Doc Zac: the inventor of the Handmaster Plus, discusses how the product can benefit a guitarist and why a person playing an guitar, mandolin, ukulele, etc. should have the Handmaster Pro.

http://doczac.blogspot.ca/

[bmac]

During a period of terrible health roughly twelve years ago I took up serious mando playing in part as therapy and in part to do something I always wanted to do and I figured this was my last chance. The tingling sensation in my fingers and fingertips was quite bothersome for maybe a year or two. With time and three hours per day playing I eventually overcame the tingling and I can now play any number of hours without the slightest tingle. So I guess I would attribute the loss of the tinglies to vigorous use of the left hand fingers as well as diet, which has been quite strict. Although I have some disabilities from that period, blindness and some brain damage, I am probably healthier than I have been since my 40s. I just turned 80 and I don't feel a day over 79..... But seriously I did a complete recovery from them for whatever reason.

[Pete Martin]

A good source of information for all musicians is the page

Musicians and Injuries



Also some of you may want to take a look at my "Mandolin Basics" videos. These things were taught me by a wonderful Performing Arts Medical Assn doctor when I was going through overuse injuries. They are here:

http://www.petimarpress.com/mandolin...%20videos.html

[Bernie Daniel]

Earlier this week, I saw a hand therapist specializing in problems specific to string musicians due to concerns about the lack of independence of the fingers on my left hand.

Apparently, activities requiring that the base of ones hands be flat on a table (computer use), which cause the fingers/arm to go numb (leaning ones head on ones hand) or that produce strong and/or lengthy periods of vibration to the hands (tool use, motorcycle riding, etc.) can damage the fragile nerves controlling the fingers.

I seem to have sustained nerve damage, due to long term exposure to all of the above. This is a primary cause of my inability to keep my fingers close to the fretboard when not actively being used.

The therapist gave me exercises with which to start and suggested that I see a local therapist for other exercises as i progress. It's tedious and may be a lengthy recovery process.

So this is a cautionary message, suggesting that you consider all the things that you do which might interfere with your playing.

To some, this may seem like a justification or rationale for lack of diligence. I see it as an explanation for why all my careful practice and hand position control have yielded little in the way of improvements to accuracy and speed.

Just thought I'd pass this along.

I'm doing these exercises for two one hour sessions each day. So if your opinion is that I should buckle down rather than making excuses, please do me the courtesy of not sharing that opinion with me. Thanks,

Thanks for the warnings. Well a physician specializing in hand issues related to string musicians is a new one to me -- interesting.

But I worked for some years a research scientist at the National Institute for Occupational Health and Safety (i.e., NIOSH not OSHA) and while I ran a toxicology lab one of my good friends at the Institute was doing research on occupational vibrational hand/nerve injuries.

If your problem is vibration related (e.g., long hours on a Harley or something else) then perhaps you are experiencing some degree of hand-arm vibration injury Vibration injuries occur frequently in multiple occupations and industries, e.g. in automotive repair shops, construction work, engineering, even tools like dentist's drills can cause issues believe it or not.

Of course as your doc may have told you sometimes these injuries can involve permanent nerve damage -- hopefully you are not at that point yet. So it's nothing to fool around with. The common designation is Hand-Arm Vibration Syndrome (or HAVS) and the best course of diagnosis and assessment is done using various methods of tactilometry using different stressing imparted at various vibration frequencies/intensities. Maybe you've had these tests?

As disease HAVS manifests in either neurological, vascular or even muscular damage - or more typically some combination of those.

Do you have numbness or lasting tingling sensations after you ride your bike or do whatever? This indicates neurological impairment if you act to modify your behavior soon enough it will mostly go away but if the individual persists over time with whatever is causing the stress the sensation will become permanent and also motor function will start to be impacted -- the continual dropping of items because your grip gives way for no reason or unexpectedly is a common symptom. Affected individuals may find themselves unexpectedly having a glass or a cup just slip out of their hand while trying to drink at a restaurant for example. (hopefully just water not good beer!).

The vascular aspect typically involves damage to the small vessels (capillaries) in the hand and fingers and it presents as spontaneous vassal constrictions or more accurately spasms of the vessel walls - this causes white areas or blanching. This symptom can be misdiagnosed as a form of auto-immune issues like Raynard's syndrome or maybe even scleroderma. I am not as familiar with the muscular problems as I do not think they are as common because the represent more advance disease states and I don't think it is easy to separate out what is true muscular impairment from neurological anyway as it presents the same way -- weak, unreliable grip for example.

I expect mandolinist this might result in an inability to maintain adequate grip on the pick for example or an inability to press down on the frets is a controlled and even manner?

But is your doc really sure you have nerve damage per se or worse irreversible nerve damage? Because I think you would have to spend long time on a bike to produce that kind of issue? Besides computers and bikes what other vibrational stress are you doing on a regular basis. Oft times of course this issue is only temporary and goes way after a few days. This summer I spent about a week using a powerful vibrating sander and did start to get all the symptoms of nerve damage -- and I was concerned -- but I rested my hands and did simple therapies like gripping a rubber ball and gentle stretching exercises and within about a week I was back to normal.

Hopefully, rest and simple exercise will work for you. You look to be fairly young so I expect that you are not dealing with super-imposed issues of arthritis? If so, there are many things you can do to minimize that aspect of it -- good luck!

[marcodamusician]

As I mentioned folks, by a handmaster plus. Doc Zac researched this issue for years because he plays the guitar himself. He knows exactly what muscles need to be exercise. Three simple exercises strengthen all of the muscle in the hands and forearms. It's not even that expensive. The only thing I've had to buy recently are more bands and I don't buy them often at all. Even then, it's worth it because not only does using his product strengthen the hands but it also stimulates collagen production which keeps our hands looking younger. I figured that out after a month of using his product when my hands started to look younger.

[Bernie Daniel]

As I mentioned folks, by a handmaster plus. Doc Zac researched this issue for years because he plays the guitar himself. He knows exactly what muscles need to be exercise. Three simple exercises strengthen all of the muscle in the hands and forearms. It's not even that expensive. The only thing I've had to buy recently are more bands and I don't buy them often at all. Even then, it's worth it because not only does using his product strengthen the hands but it also stimulates collagen production which keeps our hands looking younger. I figured that out after a month of using his product when my hands started to look younger.

I am sure that is a good device and it might be useful here. It looks interesting.

However the OP implied that she possibly incurred some level of nerve damage from activities other than playing a musical instrument -- and she implies part of it might be serious or irreversible (not sure about that?).

But if this is the case there is a need to see a qualified occupational hand specialist first (sounds like she has done that) and get a full assessment including quantitative/qualitative testing to measure the degree of impairment and the seriousness of the damage.

Doing all the right exercises for musician may not be adequate or even advisable in some cases if the damage has occurred out of the realm of stress associated with overdoing it playing an instrument. Unfortunately not all hand injuries can be dealt with by exercise alone and doing the wrong thing may compound the problem.

[Pasha Alden]

Best of luck with the injury to your hand. Hope it recovers fully and you can pick up the mandolin with renewed gusto and huge enthusiasm and have oodles of fun!

[Pasha Alden]

Everything in moderation - even too much of a good thing can be bad? Oh dear that is not a contradiction in terms. All the same let us remember to be good to our hands when practicing.

Happpy playing all and To the op hope the hand heals well.

[Pasha Alden]

At Bart Well done and happy playing!
Though I guess we all need to watch the way we use the left hand during our practice sessions.

[marcodamusician]

Well let's hope that one doctor's diagnosis is completely different from another.

[TheBlindBard]

After reading this thread, I realized I do all of those things not recomended frequently: resting head on hand in the "thinker," pose, typing on a keyboard.
You guys have got me a little worried for the future now. Maybe that's why I haven't ascended to virtuosic levels of playing yet dispite my playing practice :D

[Jim]

It is important to keep trying to move the body part, that may be limited by nerve damage, in the way you want it to move. Re-routing of nerve signals around the damaged nerves is one way the body does this but it won't unless you keep trying. Stretching, exercises, diet, are all good things , but, if you want your little finger to move move quickly and accurately then that is what you need to be attempting to do. By all means also try not to pinch the nerves in your neck,elbow and wrist too.

[Bernie Daniel]

...You guys have got me a little worried for the future now. Maybe that's why I haven't ascended to virtuosic levels of playing yet dispite my playing practice :D

No, now you should be relieved, because now we have an EXCUSE for not being virtuosos! LOL!

[Bernie Daniel]

It is important to keep trying to move the body part, that may be limited by nerve damage, in the way you want it to move. Re-routing of nerve signals around the damaged nerves is one way the body does this but it won't unless you keep trying. Stretching, exercises, diet, are all good things , but, if you want your little finger to move move quickly and accurately then that is what you need to be attempting to do. By all means also try not to pinch the nerves in your neck,elbow and wrist too.

Some merit to that IMO - -but there are limitations and cautions.

If you have underlying issues such as joint arthritis its probably a zero sum game because extra motion acerbates that problem.

I have don't have nerve damage but I do have hereditary degenerative arthritis in my hands. I am trying to stabilize it with antioxidants -- I drink a blended concoction of fruits (bannana, strawberry, blueberry and whatever else is in season) with ground flax seed (2 tablespoons), evening primrose oil (1.3 gm), omega-3-acid ethyl esters (1 gm), alpha-tocopherol (1 gm; =vit. E); and citric acid (1.5 gm; =vit. C) with half cup low fat milk each morning. Lately I've added Anatabloc (anatabine) 8 mg twice a day. It will never reverse the process of course but it does reduce the inflammation and so they probably slow it down. You do what you can.

[JeffD]

Any therapist that specializes in problems specific to musicians is a great resources. I met a physical therapist for a college orchestra. They understand not only the particular mechanics of playing music, but also the relationship we have with those activities. When "just stop doing that" won't do.

Hope things improve.

[Jim Ferguson]

Good luck CeeCee.........you are doing the right thing seeking the advice of a competent provider.........here's hoping that despite the disorder you will find ways to enjoy your mando....:-)
Peace,

[marcodamusician]

I'm with Jim on this CeeCee. I hope all works out for you. Let's hope the second opinion determines it's not nerve damage and the other doctor was wrong.

[bratsche]

I too wish you all the best in your quest for good and lasting hand health, CeeCee!

Doc Zac researched this issue for years because he plays the guitar himself. He knows exactly what muscles need to be exercise. Three simple exercises strengthen all of the muscle in the hands and forearms. It's not even that expensive.

I looked at his site, and only saw the exercise of opening the hand and closing the hand. What are the other two? (unless opening and closing counts as two ) Do you use the medium tension one? I've squeezed a ball before for exercise, now I see I need to add rubber bands to get all of the muscles. Or else get one of these, I guess... we'll see. I wonder how much difference there is in the different tensions.

bratsche