Dealing with Injuries

Over the course of the last six months,

I have been dealing with early carpal tunnel as well as tendonitis in both of my wrists and hands. While this was caused by the mass amounts of typing I do at work, it still created a need to take over a month off from practicing my flute and weekly visits to a hand therapist for several months in an attempt to heal and alleviate the pain.

Luckily I never had any tingling in my fingers (a sure sign of nerve damage), but my driving factor to finally see an orthopedic doctor was my inability to control my fingers. I would be playing my flute or typing and my fingers would just not listen to me. They’d move around when I told them to, but not at all accurately. I’d try to play a scale quickly and my fingers would act like they were only getting half of an idea as to where to go. Nothing was working together as a whole and my coordination was shot. As you can imagine, for a flutist, this was very scary. My orthopedic doctor recommended me to a hand therapist and the slow and tedious recovery process began.

My therapist was amazing with giving me nerve stretches and tendon glides to aid in relieving my aches and pains and begin recovery from the constant battle against my own hands. As a flutist, my hands are very important to me. Losing coordination after over 20 years of building it up was not something I had any interest in doing. After a few visits, several ultrasounds and a lot of poking around, we decided that my coordination loss was due to friction and tension in my tendons rather than any kind of nerve damage (thank the flute gods!). This tension and friction was caused by more than just some inflammation in those tendons however. “The median nerve is the only nerve that passes through the carpal tunnel. Carpal tunnel syndrome is the disability that results from the median nerve being pressed in the carpal tunnel (1).” Tightening of the median and radial nerves also causes pressure to be placed on the carpal tunnel and surrounding tendons causing some loss of fine coordination. How did these nerves get so tight in the first place? Years and years of practicing and typing with a lot of tension in my muscles. My shoulders were never relaxed and my hands were constantly tensed up. Typing at fast speeds and playing thousands of lightning-fast notes while these muscles were crunching down on the nerves cause a lot of inflammation in the tendons.

The Median Nerve:

The median nerve runs from the base of your neck through your shoulder and down your bicep, forearm, and palm into your fingertips. It deals with coarse motor skills, but delivers the nerve impulses to the smaller nerves that dictate fine motor skills.

The Radial Nerve:

The radial nerve begins at the back of your neck, runs down the back of your shoulder, wraps around your bicep, travels through the side of your forearm and ends on the top of your thumb. While it is not itself in charge of fine motor skills, it delivers the impulses to the nerves that then run through the top of your hand and into the web between your thumb and index finger. My therapist was constantly asking me if my pain was in my palms or on the back of my hands. This was to differentiate between pain resulting from the median nerve or the radial nerve.

Differentiating between these dictated which stretches I needed to do to aid in recovery.

Moving forward when you’re in pain

Taking over a month off was more mentally taxing than I had imagined it would be. Getting over the mental hurdles of suddenly not being able to play a scale evenly and not being able to play that excerpt as fast were very difficult. I’ve been practicing again for a few months and I’m still trying to even out my fingers. Granted I can only practice 30-45 minutes a day for a few days a week and am still battling wrist and hand issues, but I’m finally able to see the improvements.

A few tips for physical recovery:

• Check the positions of your hands and angles of your wrists if you’re experiencing any pain while playing (for a more visual guide, please see my article “How to Hold Your Flute”).

  • For years I played with my left elbow up very high and this, I’m sure, only increased my chances of wrist pain down the road. I used to have pain in both wrists while practicing during undergrad and all it took was one professor to push my left elbow down. This eased the tension on that wrist as well as rolled my flute out a little, easing tension on my right wrist by moving the weight of the flute forward and creating a flatter plane across the top of my right hand.

• Remember to rest often and stretch constantly during practice sessions.

  • Stretches increase blood flow by easing tension in nerves so pressure is taken off the carpal tunnel

• Relax hands while playing and practicing.

  • Much like I type, I play the flute with a lot of tension in my arms and hands. Learning to relax the death grip will only help both with pain as well as technique. Tense muscles cannot move fingers evenly.

• Find ways to practice that don’t hurt; practice without your instrument

  • Listen to the music more than you would and practice finger patterns on a pen or pencil.

• Wear wrist braces at night to keep wrists straight (this one is doctor recommended, so see a doc if you think you need this).

  • Keeping your wrists straight for extended periods of time also increases blood flow and more blood in the tissue means better/faster healing.

• Kinesiology tape:

  • This was also prescribed by my doctor and shouldn’t be used until you know how to use it properly. Taping up tendons in very specific ways can help open up the carpal tunnel and aid in tendon movement by creating soft support.

• Slow down the typing at work.

  • As this is what caused the initial issues, it took a constant mental reminder to slow down my typing, relax my shoulders, arms, and wrists.

• Remember to constantly check in mirrors while I’m practicing to be sure my posture is correct.

  • check that shoulders are relaxed

  • make sure spine is straight and I’m not leaning off to the side

Tips for mental recovery:

Remembering that I was dealing with a health issue was very important. It wasn’t that I was a bad flutist and couldn’t play that passage. Having that constant pain took a lot of brain power to ignore; concentration that wasn’t being used on focusing on the notes in front of me and the technique needed to play it. Continually being afraid of that next shock of pain running through my wrists took away from my concentration and my desire to create something beautiful with the instrument in my hands and the music in front of me. If you’re dealing with pain while playing, it is very important to remember that it’s not your musicianship that is affecting the quality of your playing. It is both the physical and mental limitations of your injuries that is holding you back. Most importantly, remember that it’s not always permanent.

No one should be playing in pain. See a doctor if you notice continual pain outside of normal fatigue while practicing. Things can only get better when you don’t hurt.

Sources

1. Wikipedia. “Median Nerve.” Wikipedia.com. https://en.wikipedia.org/wiki/Median_nerve (accessed March 12, 2019).

2. Wikipedia. “Radial Nerve.” Wikipedia.com. https://en.wikipedia.org/wiki/Radial_nerve (accessed March 13, 2019).

3. Cluff, Jennifer. “Articles on Flute Pain Cures.” jennifercluff.com http://www.jennifercluff.com/deathgrip.htm (accessed March 13, 2019).