Bob Dylan can speak to the tragedy of overuse.
After nearly sixty years of playing his own guitar accompaniment onstage, the legendary folk musician sits placidly behind a piano, sparing his arthritic fingers from the abuse that is the frequent fate of excessive guitar playing.
On rare occasions, Dylan will step up to the microphone for a special rendition of “Simple Twist of Fate”– but only for a moment. Rumors of carpal tunnel and the pain from an aging injury keep his technical playing to a minimum.
The pain is real.
The wearing away of one of the more delicate parts of the body can be a physically and emotionally taxing event for anyone. Hand injuries are a concern for both young musicians as well as veteran players. If you are looking to extend your able-fingered years, you might have questions about your risks for injuries.
Keep reading to learn about the most common musician injuries and how you can work to prevent them.
Repetitive Strain Injuries
Some sources suggest that most professional guitar players play an average of 4-6 hours a day. This causes a great deal of stress on a player’s hands as the fingers. When fingers play the same strumming patterns, scales, licks, and sets for hours of performance time, they risk serious damage.
We consider this damage as an overuse injury. Musicians are deeply vulnerable to overuse and hand injuries after decades of strain and picking practice. Stress, tension, and repetitive motion all contribute to:
- Nerve damage
A repetitive strain or overuse injury occurs from repetitive trauma to a muscle, nerve, ligament, or tendon. This type of injury can be very painful and has the potential to accelerate fatigue. Loss of motor control can become a severe consequence of an untreated repetitive strain injury (RSI).
While musicians are prone to any amount of health conditions, they are a high-risk population for elbow, wrist, and hand injuries. Conditions like tendonitis, carpal and cubital tunnel syndrome, tenosynovitis, and arthritis are the most common culprits and can end or stall a musician’s career.
Osteoarthritis is a painful degenerative joint disease diagnosed by the breaking down of joint cartilage. With osteoarthritis, bones may grind together. This causes intense pain, loss of mobility, and stiffness in the morning or during bouts of inactivity.
Osteoarthritis is the most common kind of arthritis and one of the most common ailments to serious musicians. Performance-related musculoskeletal conditions like these can be avoided through proper technique and recovery. Because nutrition is a huge factor with any kind of arthritis, a diet of oily fish, dairy, leafy greens, and garlic can be particularly useful in combatting the risk of osteoarthritis early on.
When certain parts of the body move repetitively, the tendons can become inflamed under stress. Because it involves chronic inflammation, tendonitis can feel like fatigue, a dull ache, and even a sharp pain as the tendon becomes more inflamed.
Depending on how much they play and how their instrument is held, musicians most often feel the effects of tendonitis in their forearm or wrist. This condition can worsen under excess tension or poor technique.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a very common diagnosis for anyone who repetitively uses their hands and wrists. Anatomically speaking, the carpal tunnel is actually a throughline through which flexor tendons and the median nerve reach the fingers.
Just like any pinched nerve, carpal tunnel feels like throbbing pain or numbing pins and needles in the hands and fingers. It requires complete rest from the overuse that triggers the symptoms.
In severe cases, carpal tunnel is treated surgically with an Open Carpal Tunnel Release procedure to release the pressure and alleviate the nerve. The Hand Surgery Specialists of Texas offer a No-Stitch Carpal Tunnel Release for the right candidates. It’s a minimally invasive procedure that offers relief from the intense pain of this condition.
Cubital Tunnel Syndrome
Like carpal tunnel syndrome, cubital tunnel syndrome feels like a throbbing pain or intense pins and needles. This sensation is due to the pressure built up from inflammation. Rather than the hands and fingers, however, cubital tunnel syndrome affects the elbow and is caused by compression of the ulnar nerve.
The ulnar nerve runs from your neck down to your hand. Because it has such a long way to go, it is possible for this nerve to be constricted in multiple places. The most common location for compression, however, is within the inner elbow. When ulnar nerve compression occurs at the elbow, it is called “cubital tunnel syndrome.”
Because the ulnar nerve is a major nerve in the arm, it can be severely debilitating when pinched or inflamed. Surgery may be necessary to relieve the intensity of one’s symptoms.
Tenosynovitis or Trigger Finger
Tenosynovitis is the inflammation of the synovium– the fluid-filled sheath that is found surrounding the tendon. When the synovium is inflamed, it can tug on the natural formation of the fingers.
This sort of inflammation causes joint pain, swelling, and stiffness. This condition is especially devastating for musicians, as it can cause a semi-permanent deformity that curls the fingers back into the palm like a “trigger finger.”
Depending on the severity, tenosynovitis is sometimes treated with a surgery called tenolysis. This procedure corrects the tendon and allows your finger to move properly again.
Thoracic Outlet Syndrome
With thoracic outlet syndrome, one’s an intense amount of compression occurs in the space between your collarbone and your thoracic outlet (first rib). This compression typically involves blood vessels or nerves in that space.
Though this seems unlikely to interfere with your careful guitar picking, this kind of compression actually causes pain in the neck, shoulder, arm and can cause numbness in the fingers. Thoracic outlet syndrome can be triggered by:
- Poor posture
- Repetitive activity
These symptoms can be avoided with appropriate stretching habits, posture, and proper lifting.
How to Prevent Hand Injuries
It is possible to prevent hand injuries with the right amount of awareness and proper technique. Remember– your hands are your instrument. Maintaining healthy habits and taking care of your hands as if they are just as valuable as your trusted Stratocaster will keep you playing for years.
Body Posture and Awareness
Learning to recognize the limits of your body and how you react to pain is a great first step. Movement philosophies and activities like yoga, strength training, and Feldenkrais can bring awareness to your entire body and will keep you vigilant in your posture and playing.
Remember– there is never a good time for slouching or allowing poor posture during your performance. Bad habits are hard to break, and posture that brings additional tension to your practice will interfere with your technique and comfortability in the long run.
Healthy Warmup and Practice Habits
Every practice should begin with a thorough warmup routine. Not only is this a great habit for your physical well-being, but a good warmup will help you get in the right headspace for the task at hand.
Once you’re warmed up, remember to limit your practice session to a reasonable, healthy amount of time. It may be easier on your body to complete multiple, short practice sessions rather than one long, strenuous segment of time.
Stretching is a very effective method to combat tendonitis. Beyond warming up, there should be serious attention paid to all of the muscles in the body and how they contribute to your practice. Some beneficial stretches to incorporate every morning, night, and immediately before practice include:
- Standing tall and forward fold
- Forearm/wrist press
- Shoulder circles with open arm stretch
- Side-to-side neck stretch
- Downward dog and backbend
It’s important to acknowledge that the entire body plays a part in your performance– not just your hands. Because back injuries can be detrimental to any career, taking care of your core and paying close attention to some of the largest muscles in your body will help you to feel your best.
Many musicians experiencing pain or mobility restrictions find various types of therapies to dramatically improve their quality of life as well as their quality of performance.
Finding a supportive occupational therapist, physical therapist, or massage therapist can work wonders. Your fatigued muscles and joints with mobility issues will thank you.
There are additional therapies that can be performed at home. Ice and heat therapy, ointments, and self-induced massage therapy can help improve mild to moderate pain and discomfort.
Tools and Accessories
Tools can be a great way to make pain-free music practice a reality. Don’t be ashamed to use some popular accessories to assist with proper posture:
- A comfortable guitar strap to spread the weight out across your shoulder
- A mirror for practicing correct posture
- A comfortable chair for long practice sessions
- A dependable, serviced instrument to encourage ease of play
- A sleeping brace to keep the arm straight at night
- A daytime wrist brace to wear while playing
Remember– there is no harm in trying something out and deciding you don’t like it! If you find yourself uncomfortable with a new accessory, feel free to swap it out with something that works for you.
The Option for Hand Surgery
Sometimes, no amount of preventative measures can keep a serious musician from experiencing an injury in their lifetime. This is entirely normal and something that can be managed with the right treatment plan.
As a final resort, many musicians choose to proceed with surgery to relieve their pain and increase their mobility. If their non-surgical options aren’t working, they may turn to the right specialist for some much-needed relief.
If you experience any of the following, it may be time for surgical intervention:
- Daily tasks are becoming challenging or nearly impossible
- Your chronic overuse injury has caused a traumatic injury
- Pain is affecting your quality of life
- You have undiagnosed numbness or tingling
- Your range of motion is limited
If you have tried physical or occupational therapy, supportive braces and tools, anti-inflammatory drugs and still are struggling to enjoy a pain-free music career; a specialist can tell you what the best next steps may be. Depending on the diagnosis, possible hand surgeries include:
- Carpal tunnel surgery to release pressure on the nerves on the middle finger, forefinger, and thumb
- Cubital tunnel surgery to release pressure on the nerves on the outside of the hand
- Trigger finger surgery to widen the sheath and allow fluid tendon movement
- Dupuytren’s contracture surgery to release thick bands of tissue that make the fingers curl towards the palm
- Tendon repair
- Nerve repair
It’s best to seek a professional opinion before symptoms get worse. Many specific hand injuries like cubital tunnel syndrome can be confused with syndromes like carpal tunnel. Treatment will be different for each respective diagnosis.
Seek Minimally Invasive Treatment
With the right preventative measures and treatment, many musicians can continue on with their practice and performance routine without much of a hitch. This takes diligence and healthy technique.
For some, a surgical procedure may be necessary to make playing a real possibility. For extreme cases, hand surgery can bring normalcy back to one’s routine. Using a pencil or keyboard can feel comfortable again. For musicians, this kind of procedure can bring back one of the most important components of their life – the use of their instrument.
With hand injuries, it’s important to receive a proper diagnosis in order to begin rehabilitation. For minimally invasive diagnoses and treatment, book an online appointment with a hand surgery specialist.