Peelu
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Registered: 6-5-2018
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Tendonitis: moving on
Dear all,
Although this is my first post, I have been getting a lot of information and general musical/cultural fodder from this forum, and I have been greatly
benefited from the articulate and in-depth discussions I have read on here.
Now, I wish my very first thread were about something more joyful, but as you've probably guessed, I have injured myself practicing, and am in need of
advice as to how best to keep going in my musical practice. For context: I am 26 and come from an academic background in the humanities, though I've
also studied music formally and less formally for most of my life. Beside the oud, I play/ed the gipsy jazz guitar, which is the Django-esque variety.
Before my injury I was playing in jazz band and was aiming to dedicating the next few years to my practice and maybe, maybe, getting to a
semi-professional level.
Six months ago I developed RSI when over-practicing what Joe Pass called 'tendonitis chords'. I stopped playing, saw a doctor, had physical therapy,
and got a full wrist/thumb splint. I stopped playing completely for 4 months, then resumed playing the oud very tentatively: no more than 1-2 hours a
day, stretching before and icing after, paying more attention to my body than I used to. The pain has returned, so I have decided to stop playing
indefinitely and resume wearing the splint. I'm obviously pretty torn up about it, but I would rather stop for a year than force it and develop more
permanent pain (I'm left-handed and play right-handed, so I now write as little as possible).
My broad question to this community is: have you ever gone through such injuries, and how have you dealt with the perspective having to put down the
instrument for a while, or, even, of never really being able to play like you used to? (I've read all sorts of horror stories, but I also still have
bear a running injury from my competitive days that never completely healed either, so I am trying to prepare myself for this possibility, too.)
Beyond the 'take time off the instrument to focus on theory' angle, I am looking at other instruments I might pick up without imposing the same strain
on my fretting hand. I've come across the Hindustani slide guitar , which exists under several variations such as the Hansa Veena or the Mohan Veena– they all share the obvious advantage
of being played with a slide, which eschews the left-hand strain associated with the oud, the guitar, the sarode, etc. As I understand it, they are
also capable of microtones, which is fairly appealing to any oud player.
I've also looked into picking up percussions, if only to improve my sense of rhythm while my hand heals. I find the Indian tabla particularly
appealing, and might look into this if my left allows it (I also shiver to think what tendonitis issues might arise from improper drumming
technique).
Anyway—apologies for the long read; I have tried to keep this as concise as possible. I really appreciate any testimonial or insight into this. Many
thanks!
P
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Jody Stecher
Oud Junkie
Posts: 1373
Registered: 11-5-2011
Location: California
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I have injured myself twice, both times on the right side. The episodes were 25 years apart and the injuries were unrelated. I got expert physical
therapy both times. In 1989 I went to a Feldenkrais practitioner and 25 years later I was treated by an skilled chiropractor. Both of them gave me
movements to do at home and advised me what to avoid doing. My active participation certainly helped get me well. In both cases I had to completely
rest the injured muscles for several months.
I can see how certain chord positions could cause tendonitis in the left hand. And I know from personal experience how an oud too big for my body can
injure my right shoulder. But how can you hurt yourself in the left hand playing oud? The strings are soft, the action is low and generally no
chords are played. I think the oud is safe for you.... BUT NOT YET. I would suggest leaving off doing anything with the injured hand until it is
fully healed. After that I expect you can play oud again. And guitar too.
There is no strain at all on the left hand playing sarode. But slide guitar or vicitra veena? I would be very wary. Look at the grip on the slides!
As for tabla, the left hand fingers move constantly and the hand opens and closes rapidly. I would be very cautious. Better to wait until you are
totally better and then go back to guitar and oud.
Have you considered playing string instruments left handed?
I hope some of this is of help.
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DavidJE
Oud Junkie
Posts: 265
Registered: 7-14-2013
Location: Vienna, Austria
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Sorry to hear about your injuries! I've had a few myself over the years (from non-music related activities) and I know they can be really
life-altering both physically and mentally.
I'm not a doctor, so take this with a bag of salt. First, 2 hours per day is a lot to be making small movements over and over again, every single
day. I know that many professional musicians and athletes practice for a lot more than that (as I have in the past), but a great many of professional
athletes destroy their bodies doing so and are a complete wreck after a relative few years. I bet it's not all that different with a fair number of
musicians. Our bodies just aren't designed to do the same thing over and over and over and over again. So for one thing, when you do try to get back
to playing I would start back with something like 10 minutes, gradually increase the time, and then never or rarely practice for more than one hour at
a time, but even inside of that hour you should be giving yourself breaks to shake out the tension, etc.. I don't always follow that advice, but I
tend to pay for it when I don't.
I've discovered that repetitive stress "injuries" start to appear from my oud playing *IF* I'm not doing other exercises. I try to go to the gym and
lift weights 3x each week (Mon, Wed, Fri). If I play a lot Friday afternoon, Saturday, and then Sunday, I'll notice pain starting to come into a
couple of places. But then when I go to the gym on Monday and work out, the pain works itself out. For my right wrist for example, where I get pain
if I am picking too much (hours a day, day after day), as soon as I do pull ups the pain goes away.
I also play shakuhachi/Japanese bamboo flute, and when I started with my flute teacher he had horrible tendonitis. He really couldn't type, and could
barely hold his flute. He had had it for years and it was completely debilitating. I told him about my experience going to the gym, and recommended
that instead of doing nothing at all (which is what he was doing), to try to exercise his arms using motions that didn't hurt...so to do weights to
strengthen everything up, but only with motions that do not cause pain/discomfort, and then to expand those motions so that everything is covered. He
tried that, it worked amazingly well, he actually got certified as a personal trainer (which I used to be many years ago), and his pain hasn't come
back.
So my very unofficial advice would be to take time off of playing until the pain is gone, but in the mean time do not do nothing (as Jody said), but
to work all the supporting muscles, or the muscles (requiring the tendons and ligaments) around the injury area, and to keep doing that even after the
pain is gone. I think that both physical and mental fitness is important for everyone, and especially for people who do the kind of things that we
do...and this requires exercise/work.
In the mean time, I would try to find or discover something else you enjoy. Take up a new hobby!
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Peelu
Oud Admirer
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Well, first off—many thanks for your thoughtful replies! You have given me a lot to work on. I think your suggestions to wait until my hand is
'fully' healed (if anything ever heals fully) are very sound. Regarding the 'doing nothing/doing something else with my fretting hand' conflict: I
will try and find a balance and keep my left hand not entirely inactive while listening to my body and any signs of pain.
Just a few follow-up questions, if I may:
Jody—do you mind if I ask where and how you injured yourself on the right side, and what instrument you were playing when you did (I know you are a
multi-instrumentalist, so this may be a more complex issue)? Out of curiosity (I shall not take this information as medical advice personally
delivered to me): what movements were you advised to perform/to avoid? I believe you are a professional musician with now a long and varied career.
Were you able, after months of complete rest, to go back to a level you were satisfied with? What changes did your injuries bring in the long run?
In the guitar world, and as I understand it, the great majority of injuries occur in the fretting hand. I have only read about pick-hand tendonitis
from one guitar teacher, Stephane Wembrel, who recommends specific warm-up exercises to avoid it (the gipsy jazz right hand technique is very, very
similar to that of the oud). I focused on oud precisely because of the properties you describe (low action, soft strings). Perhaps my posture was not
the best,though I do now pay better attention to wrist angle. I suspect I just started playing again too early. For what it's worth—give a jazz
player anything he or she can play chords on, and they will. One of the pieces I was working on when I decided to stop all practice again was Saïd Benmsafer's chord-rich Bint-al-Shalabiyah. I use my pinkie a lot, too, and that area was particularly painful. I must have upset my ulnar
nerve as well.
I am surprised to hear you say that sarode is light on the fingers—I remember reading that the high tension and general technique (making a steel
string resound, with your nails, on a metal fretboard) made it quite a straining instrument. What aspects or sarode-playing make you think otherwise?
Likewised, I just assumed that the slide technique of the various 'guitar' veenas or of the vichitra made playing far less intense for the left hand.
I realise that one must hold one's grip on the slide, but to me (perhaps mistakenly) this seems like nothing in comparison to the non-eucledian
voicings of jazz guitar (w/often the bass on the thumb), or the repeated pull-release-pull of the gipsy jazz 'pompe' technique. I also imagined that
the grip on a slide should conceivably be gentle, so that the wrist remain supple (and avoid injury). Again, I may be wrong, and I defer to your much
greater expertise. Regarding the tabla: you are obviously right. I was just looking for an excuse to pick up a new instrument.
I have actually considered learning left-handed. Have you done so, or know of someone who has? On the oud it would be 'easy'—I could use the same
instruments with the string order inverted, I suppose. One of my concerns remains that holding a risha with my left and the up/down motions would
still be painful as things are now.
DavidJE: thank you also for your advice. Interestingly, I came across the website of another shakuhachi-playing David, who goes into extensive details
as to how to avoid/heal injuries. Who knew the flute was so lethal?
http://www.japanshakuhachi.com/handcareformusic.html
You say something very interesting about strengthening other areas. Are you suggesting that strengthening other parts of the hand/arm/forearm not
directly related to the muscles stimulated by the oud/guitar/etc may act as support for practicing string instruments (if that makes sense)? If so, do
you have advice on what areas to look at?
Many, many thanks again!
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DavidJE
Oud Junkie
Posts: 265
Registered: 7-14-2013
Location: Vienna, Austria
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The longer shakuhachi are especially difficult to play without some contortions, and I think that probably contributes to shakuhachi related injuries.
I had seen that JapanShakuhachi.com site before, but forgot about it. As you can see, he also recommends strengthening the shoulders, arms, wrists,
and hands to prevent injury.
So, yes...everything in the body is connected, and muscles you might not THINK you are using may in fact come into play, at least in a supporting
role. I think there can be issues with overdeveloping certain muscles/structures too, which leads to a lack of balance, and that can also cause
injuries.
Musicians who practice a lot, especially if you have a desk job otherwise, can easily get out of balance, always holding the same postures, training
one "side" of the body and not the other, etc.. That's just not healthy, and over time it's going to cause problems. So I think we need
comprehensive physical training even more than the average person who may be a little more balanced by chance. Also, physical training has mental
health benefits, and will keep you mentally sharper for longer, etc..
In terms of where to look...there are so many ideas out there, but I think (and research certainly agrees) that everyone needs to be engaging in both
strength/resistance training and cardiovascular/aerobic training. You need to work every muscle in your body to keep your entire body functioning as
well as possible and for as long as possible. I can write out a work out routine...but it would just be one of many possibilities, and you really
need to figure out what works best for you. However, I do think it needs to be comprehensive. You want to avoid future injuries as much as "fixing"
current ones, and injuries can come from bad posture, over using certain postures, etc., etc...it's not just our hands and forearms that get stressed
when we practice.
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Brian Prunka
Oud Junkie
Posts: 2939
Registered: 1-30-2004
Location: Brooklyn, NY
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Mood: Stringish
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First things first:
Tendinitis is not as well-understood as people would like to believe. A lot of cases are based on assumptions and presuppositions; you have pain,
it's probably inflammation, repetitive motion can cause inflammation, etc. There is usually little evidence of actual physical inflammation and
symptoms seem to often persist when inflammation no longer is present. Inflammation can also be caused or exacerbated by diet and other factors,
including stress. A physical triggering event may be perpetuated by other factors after the initial musculoskeletal problem has been remedied.
Focusing strictly on the physical actions usually yields moderate relief at best. In my case, I had serious left hand pain much like you. It was not
as bad when playing oud as when playing guitar. Physical therapy, massage and exercise kept it under control, as well as limiting practice/playing,
but that was not satisfying, to put it mildly.
In the end, a combination of stress-reduction techniques and diet modification (I turned out to have a sensitivity to mushrooms) have created full
remission.
—
That said, when dealing with this I found the following helpful:
Many musicians mistakenly think that physical practice is the most important part of playing, when in reality ear training and mental conditioning are
of at least equal importance and often primary importance.
So you can do about 50-80% of your training without physically touching an instrument at all.
In addition, mental practice improves one's focus and intention with regard to performance, something with rote physical practice can actually hinder.
"Practice" is really training the mind to make the rapid, unconscious decisions necessary for performance. Muscle control is first and foremost mind
control—your mind moves the muscles, you're not really training the muscles when practicing music as much as training the mind to control your
muscles. This is something one can do to a large extent using your imagination, especially if you have basic experience.
When playing, a great deal of technique comes from aurally imagining what comes next and having the internalized the movements necessary to execute
the sound. So cultivating a vivid and accurate aural imagination and connecting that to the sound on the instrument gets you a long way.
This is why people who are very musical can often pick up a new instrument with relatively minimal exposure—they already have the aural/mental
skills and just need to connect them to the basic functioning of the new instrument.
Now, of course one does need to physically spend time with the instrument to perfect certain aspects. Things like building up callouses, muscle
strength, breath support, etc. all do require the physical interaction. But it is generally much less than we tend to assume.
I find that transcribing music without an instrument is extremely helpful. Since it's your writing hand that's the problem, you may not be able to
physically transcribe but you can mentally learn without an instrument.
----
This may not apply to you, but many people exert too much force when playing and do not learn to relax properly and use the minimum effort. Our
muscles initially tend to be nearly binary on/off in engagement, and we need to practice developing gradations of effort and control over them.
One thing you can do without risk is simply practicing gradations of effort in pressing down strings. Learning to use the weight of your hand/arm
rather than muscle contraction is very important.
In the fingering hand, you should be able to play oud without your thumb muscle contracting and gripping the neck (on guitar this is true largely as
well, but some chordal playing requires extra pressure).
In the picking hand, you should be able to use the natural springlike motion of rotation and gravity to do most of the work, with little or no muscle
tension.
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Jody Stecher
Oud Junkie
Posts: 1373
Registered: 11-5-2011
Location: California
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I'll try to answer your questions, Peelu. But first AMEN to what Brian has written. All of it.
I injured two of the four muscles that comprise the rotator cuff.
https://en.wikipedia.org/wiki/Rotator_cuff
The two muscles that were not injured were the ones involved in playing guitar so I was able to carry on doing that, so long as I used my left arm and
hand to lift my right arm over the guitar to reach the strings. If I tried that with my right arm on its own I probably would have fainted from the
pain.
The injury was caused by a combination of a stupid grip on the violin bow, a locked pelvis caused by sitting with my right ankle wrapped around the
leg of a chair when playing seated, and the constant lifting of the left shoulder to hold the violin between shoulder and chin. This tilt threw the
other (right) side out of balance which combined with the unskillful bow grip and obtaining all the bow stroke power from the shoulder and arm without
help from the area below the navel led to my injury.
I was advised to avoid doing what hurt. It was easy to tell!!!
After I recovered —yes, fully and totally — I taught myself to play violin properly. I did this standing on a mattress. Following the advice of
Kato Havas in one of her books I discovered how difficult it is to drop a violin while playing. She pointed out that many violin-related injuries are
caused by gripping the violin tightly and suggested that one of the causes of gripping was fear of dropping the violin while playing. She pointed out
how hard it was to actually drop it and suggested playing standing on a mattress and finding out just how loose one needed to be before the fiddle
dropped. I did drop it a few times and of course no harm was done landing on the mattress covered with bedding. I taught myself to play violin from
the very beginning once more, systematically and slowly, taking care to be aware of my body as I played. Did I regain the level of my past skill? I
bypassed it. Precise quantification would be difficult. I will say that I became considerably more than 3 times as good on this instrument as I was
before the injury.
But playing violin was never my principal performing instrument; hat has always been instruments played with a plectrum or the fingers of the right
hand. That was unaffected by the injury. But I did become more aware of my body as I played.
Most left hand guitar injuries I have seen have been caused by using the bizarre hand position taught to classical guitarists. Just thinking about
holding the hand that way without even pressing the strings is painful to my brain. I think I may have avoided left hand injury by using my finger
pads instead of the tips, by pressing only as hard as necessary, and especially by having a mobile thumb, never locking in any one position. Also I
started playing guitar at age 11 and so my fingers naturally spread out as I grew. Today if I splay out the fingers of my left hand there is a
straight line between thumb and pinky/ A 180 degree spread. The right hand doesn't go close to that.
A sarode that is well set up has low action near the nut. Above what would be the seventh fret on a fretted instrument it starts getting high. But the
tension of the strings is not much compared to a guitar. The wear and tear is entirely to the nails. Some have hard nails. Some get their nails
treated at the beauty parlor. I use natural nails but I tune to B instead of C or C sharp. That is to preserve my nails —to avoid grooves from
forming —not to avoid muscle pain. The danger to the body from the sarode is to the lower back. Also there are different schools or traditions as
to how to hold the instrument. Some of those who adhere to one of these always keep the right leg in front. After 5 years of practice their legs are
of unequal length and they cannot walk properly!
Yes there are left-hand oud players. Some reverse the stringing, some play with the instrument strung for right-handed playing and some commission
ouds to be specially built for lefty playing.
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Peelu
Oud Admirer
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Registered: 6-5-2018
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Many thanks to all three of you for taking the time to chime in; you also have given me a lot to think about. I will digest this information, take it
slowly, and go for a more internalized approach over the next few months... it's also very encouraging to see that you have overcome injuries
yourselves!
THank you again; I shall let you how I get on.
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