Hand Injury not improving

[neil argonaut]

Before this year, I had never been bothered by hand injuries, but just in case was always cautious, warming up well and stretching fingers before playing, plus trying to be careful about technique, grip, etc.
However, late this summer, I started to get pains in my hand and wrist, and had to massively cut down the amount I played (which previously varied between 5-10 hours a day). I was quite sure this would solve things, but it didn't seem to help, so I've more or less stopped playing completely now for about 6 weeks, hard as that has been. I was given various pieces of advice, ranging from "just play through it" to "gradually start playing again a bit more each day" to "rest completely till symptoms are totally gone, then wait another 2 weeks". As I rely on music as my only source of income, and I've got enough money to get me through a few more months, I thought it wise to rest completely, quite sure this would solve things.
However:
It seems like with every week without playing, things get worse rather than better, and my hands are in a lot more pain than when I gave up playing. I'm willing to give it as long as needed (up to 3 or 4 months after which I'll run out of money) but if they're going to get worse anyway for a while, I wonder if I'm as well playing. I tried reading through many threads on tendonitis etc, but can't find any cases where it doesn't improve with rest - anyone else had this experience, or got advice?

[verbs4us]

Sounds like you might need a professional diagnostic work-up to rule out nasty things. One cheap thing to try if you haven't: ice. 20 minutes, three times/day. Ice calms inflammation and sets up conditions for the body to heal itself. I have used it for strains, sprains, tendonitis and other soft-tissue injury. If the cause of the problem is indeed just soft tissue, ice may be both pallative and curative over time. Try it for 10 days and see what happens. Tendons take a ridiculously long time to heal and the older you are, the longer the healing time. I'm 56 and a minor Achilles strain took almost three months to clear.

[neil argonaut]

I'm 33 so hopefully young enough for it not to take too long
Unfortunately ice isn't an option as I don't have a freezer (though give it a few more weeks and I could probably find some outside!). Thanks for the advice anyway, though.
Well I've been to a doctor already (luckily I live in a country where medical care and medicine is entirely free), and he said he thinks it's tendovinitus, and referred me to a physiotherapist, but that might not be for another month or two.
Another thing I've heard about is Rolfing and similar techniques, but not sure how much this works or whether it's just a bit of a new age con.
I've also got a powerball, but not sure whether using that or resting totally is better.

[nickster60]

Neil I am not sure how old you are but if you approaching middle age this is just a preview of things to come. I have had hand issues for along time. I had severe carpal tunnel for along time. I went to the doctor and they found I had a thyroid condition(carpal tunnel is side effect). I just lived with it for along time, I wish I had went to the doctor sooner. If you work with your hands and play instruments it is just a matter of time before the hands give you trouble.Make a visit to the doctor and see what they come up with. For my other aches and pains I use Advil.

[UsuallyPickin]

Man I know what you are talking about. I take Naproxen Sodium ( Aleve ). Which has a long list of side effects so tread carefully. It helps relieve the symptoms of pain and inflammation but it won't make it go away. Tendonitis is a condition not a disease. Weather effects it ... nobody knows why. I don't know if it can be taken with Ibuprophen ( Advil ) but it can be taken with Acetymenephin ( Tylenol ). Plants from the Nightshade family ( tomatos , potatos ) are said by some to effect tendomitis and arthritis patients. I play as much as I am able. I warm up by running my hands under hot water and stretching. I try not to over grip the mandolin or whatever I am playing. And when my left hand starts hurting I stop playing for awhile. Stopping altogether does tend to leave me with more pain and less range of motion..... Luck.. R/

[neil argonaut]

nickster, i'm 33 so hopefully middle age is a good wee bit away yet; yeah I've been to the doctor, he referred me to physio, still waiting for that.
Usuallypicking - well it has got much colder over past week or two, so maybe I am getting better but it's been balanced out by that. Do tomatoes and potatoes make it worse or better? I tend to avoid drugs whenever possible, and am not as bothered about the symptoms, i e putting up with a bit of pain, but more scared by them being a sign of underlying stuff; so I try to avoid anything that kills the pain as then I'll be unaware when my body is warning me not to play. did try ibuprofen for inflammation but didn't seem to make much difference.
Edited to add: So Usuallypicking, you suggest not resting completely, but keep playing a bit?

Obviously I maybe want to hear that kind of advice as I'm dying to get playing again even 30 mins a day, but I wouldn't want to if it sets back full recovery.

[JeffD]

but more scared by them being a sign of underlying stuff; so I try to avoid anything that kills the pain as then I'll be unaware when my body is warning me not to play..

I had hand and wrist pain after playing for about 30 minutes. Turned out to be undiagnosed diabetes. Once my blood sugar was corrected the pain was gone. Not abated, or less - totally gone, like a light switch. Do get it checked out. You are right to be thinking of the underlying stuff.

[Timmando]

I would stop with the powerball, rolfiing is a deep tissue massage, I had it done, once, and it causes pain, so I stopped. I would also cut out all diet sodas as the fake sugars are questionable in relation to fibromyalgia, pain in tendons and joints. While you are at it, cut out sugar period, as it is related to diabetes which can lead to joint issues. You are pretty young to be having health issues, but then I know a 15 year old who has and gets just about everything. I would think your problem is specific to overworking that part of your body. Let it rest completely, except for normal usage (ie, don't put your arm in a sling). Do the physio that is upcoming and for heavens sake...get a freezer!

Also, ibuprofen and other anti-inflammatories work better after you take them for awhile. In other words, once the inflammation is under control, the pills will help keep it under control, they will not solve the problem. If inflammation is beyond the bodies ability to control it normally, a cortisone injection can help bring it down to the point where the body can take over. You might try a cortisone injection into the area of pain. A doctor will mix the steroid with painkiller, and if the pain goes away immediately after the shot, he knows he hit the right spot with the steroid. Cortisone injections worked with tennis elbow that I had, from playing guitar.

[neil argonaut]

Well I only started with the powerball because it bills itsself as being good for rsi, tennis elbow, tendonitis rehab etc. I can't imagine it being something like diabetes as aside from music-related injuries (to voice, ears and hands in varying degrees) I'm quite ridiculously healthy. And don't worry, I never drink any kind of soda, but especially avoid diet stuff. and don't really eat stuff with sugar either.
I'm not even totally convinced it is inflammation, could just be pulled muscles, wear and tear, or something else, don't know.
And the freezer isn't really an option, there really is no room in my kitchen, unless I got rid of my tape player, and that ain't gonna happen!
Thanks for all the advice, folks.

[Folkmusician.com]

I started having issues with my hands in my 20's. Between playing, riding motorcycles and bicycles, computer usage, and then some hard labor thrown in, it was just too much. The single biggest cause was actually sleeping and posture. I found that my sleeping positions was irritating it, then any usage at all was too much. The same with posture, How I have my hands and sit throughout the day make a big difference. Lastly, lifting and gripping heavy things. If I pickup something heavy enough to stress my hands, I can feel it for the rest of the day. At that point it will be minor, but if I then go and play for a couple of hours and go for a bike ride, I have set it off. In my case, I did have to give up most of my playing time. That is my trade off for getting to work on instruments for a living.

I can't over emphasize the damage done sleeping. It took years for me to be conscious of this at night and adjust my hand positions. When sitting, driving, etc... I move my hands around until I find a very relaxed position. This may or may not work for you, but at least be aware.

[Timbofood]

Sounds pretty miserable, what has the physio had to say or did I miss that?
I was a pall bearer for a buddies mom and the casket was unimaginably heavy, tore the blazes out of the tendons on my left hand, pain for months, finally eased up but, it was a long time. I still have trouble with from time to time.
Pay attention to your doctor on how to handle it, share info if you so desire.
Best wishes for better musical health.

[Timmando]

"Well I only started with the powerball because it bills itsself as being good for rsi, tennis elbow, tendonitis rehab etc."

Don't believe everything they say in advertisements...doesn't sound like you are at the rehab stage yet, you still have to find and fix the problem, then rehab afterwards.

[neil argonaut]

Timbofood - thanks for the wishes; I'm still waiting to see the physio, but might be another month or so till I'm top of the queue.
Robert - hadn't thought of that; don't think I'm sleeping with it in a bad position but will look into it. Also, hadn't really thought of cycling, I travel everywhere by bicycle, and probably average about an hour or two each day on it, though wasn't using it at all when the injury happened as I was traveling, and amn't using it much at the moment as I'm not going to practices, sessions, busking etc.

[jaycat]

I've gotta think repetitive use of any body part for up to 10 hrs. a day is gonna crash and burn sooner or later.

I've had great luck with cortisone shots too. After you feel better, take it easier with the playing, or alternate with some other instrument that puts demands on different muscles.

"Dr. J."

[Polecat]

I too wish you a speedy and hopefully complete recovery. For the past ten or so years, I've had recurring problems due to arthritis (I'm 50), and have had to accept that some things I used to be able to play are now no longer possible - I hope for your sake, that it won't come to that. No doubt, you're aware of it, but the inflammation of your tendons is not a syndrome but a symptom, in order to tackle the problem, you need to find the cause (if this is possible). Jaycat may be right, your problems may be some form of "repetitive strain syndrome" and you need to change your practice regime, but if possible, it's worth pursuing every avenue available (x-rays, blood tests...) to try to get to the root of the problem.
As regards treating the symptoms, I've had luck with low-dose radiation therapy to reduce the pain.
For the record, I'm not a doctor so this is an unqualified opinion. Once again I wish you all the best.

[neil argonaut]

yeah, thanks, I am trying to solve syndrome and not symptoms; annoying as it is, I would quite willingly put up with any pain i've got just now for ever if I could keep playing like before, and not get any worse. It's not the pain that annoys me, but what it means, so I'll pass on the radiation therapy.

[Mike Arakelian]

Robert raises a very good point about the position of your hands and arms while sleeping. Several months ago I was diagnosed with a mild case of Carpal Tunnel, and one of the important things the doctor recommended was wearing a wrist brace when I go to bed at night. The brace prevents you from sleeping with your wrist in a position that could put tension on it. I also wear it whenever I feel any pain or discomfort, and it always helps. In addition, the doctor told me never to put my elbows on a desk or table and then lean on them. Again, it puts tension in the wrong places. I doubt that doing these two things will solve your problem, but they certainly won't hurt any and may help some. I'm happy to say that I'm almost 100% again! and hope you get that way too. Good luck!

[mandroid]

so, no power tools involved? that's a relief ..

[bratsche]

Robert raises a very good point about the position of your hands and arms while sleeping. Several months ago I was diagnosed with a mild case of Carpal Tunnel, and one of the important things the doctor recommended was wearing a wrist brace when I go to bed at night. The brace prevents you from sleeping with your wrist in a position that could put tension on it.

Unfortunately I toss around a lot in my sleep, and I know (from impressions they sometimes leave on other parts of my body) that I roll over onto my hands a lot, which explains why I often wake up with either numbness or stiffness in them. But also, unfortunately, any type of brace or wrap would prevent me from getting a good night's sleep... I know, I've tried it. Fortunately, though, my hands always return to normal once I get up. So far, anyway.

bratsche

[Pete Martin]

Read all you can about RSI http://rsi.unl.edu/music.html

[Tom Wright]

My worst case of tendonitis was when I was 30, after intensive practice for auditions. It was cured by a steady regimen of ibuprofen ( I saw an orthopedic guy---he prescribed the new drug, Motrin).

It can easily keep happening even without playing mandolin. If the tendons are inflamed enough they keep rubbing, and keep themselves irritated. All inflammation-reducing strategies are helpful including ice. But regarding the anti-inflammatories, I was old by the pharmacist back then that one should take it with food for better absorption (and stomach protection), and that it took a couple of weeks to build up the blood levels and the effective inflammation reduction. Then you stay on it for a few weeks. Problem solved, never came back. But it takes time and deliberate attention to reducing the inflammation.

[Stephen Perry]

Rolfing. I had 11 sessions, then 10 of Core Structural (lower angle version of the same), and a good deal of other work. Made a tremendous difference. For hands, the work on my forearms did wonders.

Ergonomics. For everything. Retraining my movement habits was difficult and works great.

Ice water. Dipping my hands in ice water helps a great deal.

Diet. Gianna changed her diet and mine with it. Much less, few preservatives, very little gluten, very little salt, very little sugar. Ginger. I think this might be the main thing. She lost 70 lbs, I lost 20. And no pain in my hands.

All that helped. I can even play the piano again, after over a decade off.

[neil argonaut]

Thanks again to everyone for so many suggestions and resources. Stephen, so the Rolfing definitely helped for playing injuries? I might have to try and seek out a practitioner. As far as ergonomics, I've been thinking of checking out the Alexander technique after reading more through following links from the website Pete suggested (which I'd recommend anyone checking who hasn't already); and tomorrow I'll look for a wrist support and try sleeping in it.

[verbs4us]

Meil--All non-steroidal anti-inflammatories (Motrin, Advil, generic ibuprofen, Naproxen) have gastric side-effects. There is a gel form, available in the States as Voltaren, that side-steps these side effects because it goes from the skin to the inflammation, bypassing the gut and the rest of the circulatory system. Might ask a doc about it.

[neil argonaut]

yeah I've got some of the gel stuff.