Classical Guitar and Index finger impairment loss of dexterity

by Richard
(Wales, UK)

I play classical guitar and have been experiencing loss of dexterity for about 4 months. The problem is that fine motor control of the right hand index finger is impaired so that I have difficulty playing scales with the i m i fingering, and descending arpeggios. If I play a rag-time style accompaniment, the index finger doesn't quite obey in time and garbles my playing, although I can just about do it if I slow down.


There is no index finger or hand pain at all, but that is not the full picture. I have a chronic but slightly elusive forearm or arm strain of some kind - sometimes brought on by grabbing or holding an object, and especially when flexing the arm slightly off straight and against resistance - a bit like golfer's elbow.

I have identified two slightly tender areas. One is on upper side of the forearm, half way down from the elbow, but seemingly fairly "deep." This is the area in which, for a couple of years, I would feel pain in my daily practice when trying to play fast repetitive rest stroke excercises. I have been putting ice on this area daily for a while.

For whatever reason, the skin of the forearm in that area now has a permanent numbness.

The other tender area is on the underside of the forearm. If I flex the index finger and pinch my right forearm with my thumb on the underside about quarter of the way up from the wrist, there is a mild ache again fairly "deep" in the forearm.

I still play, but I'm trying to find a remedy.



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Joshua Answers:

Hi Richard.

1. What have you tried so far, as far as self care goes?

2. 4 months ago, did this come on fast, or slow?

3. Any history of anything like this previously?

4. History of car accident, boxing,
falling off a horse/down the stairs, etc? Injury?

5. No pain, that's good.

6. What's your Vitamin D level? Get it checked, asap. One of the symptoms of Vitamin D deficiency is reduced dexterity, muscle function, nerve function, balance, etc. Probably not the ONLY factor involved, but it may or may not be a sizeable factor.

7. Spots of tenderness, that makes sense. The tighter a muscle is, and the longer it's tight, the more tender it gets and the less optimally it function.

That's part of the whole Pain Causing Dynamic.

8.Tendonitis is a -dynamic-. It can look like a lot of different things, and it can change quickly or slowly over time.

See: What Is Tendonitis

9. At this point, it doesn't sound particularly hard to get rid of/reverse. It would be useful to learn how to make this pain go away, as that will be a skill you can use through the rest of your life/playing career.

10. I of course suggest my Reversing Guitar Tendonitis ebook, as it has a complete explanation and plan of attack.

11. Short of getting that, I'd definitely learn Process of Inflammation

and See: Magnesium for Tendonitis


More questions, more answers


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Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.

And, comments have a 3,000 character limit so you may have to comment twice.
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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Comments for Classical Guitar and Index finger impairment loss of dexterity

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Oct 30, 2016
Rating
starstarstarstarstar 		Trigger finger and DeQuervain's, same hand, classical guitarist.
by: Paul V

So I'm a podiatrist here in the great state of Texas and fairly serious classical guitarist, and some steel string.

Middle and ring finger on left hand are trying to trigger(mcpj); I never wake up with them locked, but if I try to make a medium to hard fist, one or both will lock.

The thumb tendinitis is a more recent development and is my main hindrance to practicing and playing at the present time. The problem is just on the ulnar side of the radial tubercle.

So my question is...do you have one book that we will give me what I need for both of these problems, or exactly what do you recommend that I purchase?

Thanks

Paul Valenza


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Joshua Comments:

Hi Paul.

I'd go with the Reversing DeQuervain's Tendonitis program.

DeQuervain's is just a fancy name for thumb tendonitis. The program will talk specifically about the thumb, but....the bulk of the physical self care is in the forearm on the muscles that attach to tendons that attach to fingers and thumb.

The progression towards trigger finger is a function of (lack of appropriate nutrition and too tight structures in the forearm[s]).

I don't have a 'trigger finger' program out yet (though I keep threatening to), but the bulk of it will be exactly what you find in the RDT program.

Said another way, it contains all the primary work you need to do.

It may or may not take care of the 'locking' after making a fist. No way to tell at the moment...it will help but we won't know how much until we see what your body does. If you're left with any 'locking', let me know and I'll make sure you get the specific how to do deal with whatever triggeryness is still in play (it depends on how much your tendon/tendon sheath has thickened and whether that's currently just swelling or actual new tissue growth/denseness).



See Related: A Classical Guitarist With DeQuervains and Trigger Finger Pain Relief And Playing Again


See Related: Classical Guitar Wrist Pain I Want To Play Professionally All My Life


Aug 09, 2015
Rating
starstarstarstarstar 		Guitar playing and flexor tendonitis maybe trigger finger
by: Joel

First, the site is an excellent resource, thank you very much. I play guitar probably more than I should, coupled that with some computer work and it is safe to say my hands are pretty beat.

About 2 1/2 years ago I was diagnosed with flexor tendonitis in my left hand, specifically in the index finger.

It never got to full blown trigger finger, but both the Dr. and OT said it was really close to that. I took time off, did therapy and it seemed to work, but not in a lasting way.

Went back to the Dr. and of course he could not wait to give me a cortisone shot. Two shots later and guess what? Yup it's back, except now it is also painful in the middle finger as well.

The pain is located mostly where the tendon sheath is located, above the palm, below the fingers. It is painful grabbing things like doorknobs.

I have tried ice dipping and that has eased the pain somewhat. My question is how often should I do the icing in the beginning? Everyday? ( it has been 2)

Also what will happen once I begin playing again? Thanks for your time.


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Joshua Comments:

Hi Joel.

1. Sounds like some chronic Tenosynovitis (tendonitis dynamic with some specific behaviors related to inflammed/irritated tendon sheath.


2. Yeah, Corticosteroid Injections aren't a fix.

At best it will temporarily reduce the process of inflammation.

Rest isn't a fix either.


3. Do the ice dipping as often as you're motivated to do. The more the merrier. Make sure to dip the entire hand/forearm up over the elbow, because while it hurts in that one spot, the entire structure is involved.

Ice dipping is very effective at what it's effective at, which is reducing inflammation and increasing circulation.

Read this entire thread, follow the links, come back with any questions you might then still have.


See Related: Pain 1 Year 4 Months Guitar RSI Help I Feel Frustrated
Mar 17, 2015
Rating
starstarstarstarstar 		tennis elbow for a year from playing the cello
by: Robyn

Hi!

I've played the cello ever since I was five (now eighteen) and for the past year i have been experiencing tendonitis on the top of both forearms.

At first the pain started in my left arm (started in the elbow, went to the wrist and shoulder, but calmed down after taking a short break from the cello) and after seeing a massage therapist (who treated me mainly with kinisio tape) the tendonitis moved to the right forearm as well.

I then saw an acupuncturist, but didn't go to enough appointments to really see a difference and then went to a physical therapist that seemed to be helping but after about six sessions, the exercises they prescribed began to flare up my ulnar nerve.

I've experienced tendonitis before this year and have been able to get rid of the pain in less than a week and continue to play the cello with no problems (I probably play anywhere from three to eight hours a day when there I don't have tendonitis, with the pain right now, I can't play any more than twenty minutes) but this time I haven't been able to rid it for a year now.

Besides the previous doctors and therapists I have seen, I have done icing, heating, advil, and stretching. The self help that I have done seems to help somewhat with the pain at the moment, but I still am not able to play and practice the cello to the extent I need to (I play professionally, and will be going to college to study as a music major).

More information... I participated in a CrossFit gym for about a year and a half now. At first the gym didn't interfere with music and when I started experiencing tendonitis I thought that CrossFit was helping the pain and getting blood into the arm, but now I don't think so anymore and have stopped lifting any kind of weights with my arms for about three weeks now and only run and do weights with my legs.

I feel at a loss right now so any advice you have will be greatly appreciated.

Thank you,
-Robyn


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Joshua Comments:

Hi Robyn.

You've done some things, and that helped for a while.

But the dynamic progressed, and now those things don't help.

Why? Because if you don't effectively target the primary causes, then the dynamic continues to progress.

Nutrition is a missing piece for you. Muscles etc can't respond adequately to certain self care without the right nutrition.

Not enough nutrition = limited ability to function.

Crossfit could/would help in that you get movement and blood flow, etc. But ultimately, not enough nutrition, chronic inflammation process, and too tight muscle and connective tissue results in ever increasing pain and problem.

It's all reversible, but it's going to take some smarts and some diligent self care.

Read this entire thread and follow the links in the original post/response, and then come back with questions and an update on what your symptoms are doing.
Sep 11, 2013
Rating
starstarstarstarstar 		Joshua Responds to Anastasia
by: The Tendonitis Expert

CONTINUED FROM LAST SECTION

On electric I don't feel any problems, but with acoustic it happens very often and I'm not a beginner anymore, so it's not a beginner problem.

Because I often have to go on-stage with an acoustic and I'm even expected to record album in studio (some songs will be acoustic), I don't really know how to solve that pain problem when playing it.

Should I completely transfer to electric guitar only, or is there any solution I can still play an acoustic and a violin without so much pain and tension?

Any advice would be appreciated as I just recently heard of such problems and I experience pain too.


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Joshua Comments:

That's awsome you're so musically skilled/versatile!

See: Wrist Tendonitis Symptoms for an explanation of the causes of various symptoms.

You are short on nutrition. And your Pain Causing Dynamic is such that you have a lot of chronic tightness and inflammation. Reverse those three factors and you're good to go.

Any of those factors (all of them working together, really) can cause pain, loss of strength, loss of dexterity.

It's been a bit since you submitted this but I'm guessing things haven't gotten better all by themselves.

Give me an update, and as always I suggest Reversing Guitar Tendonitis


Related: Wrist Tendonitis Guitar Player Fretting Hand

Related: Fret Hand Numbness From Playing Base Guitar Very Fast

Related: Palm Ringfinger And Pinky Pain From Playing Bass Guitar
Sep 11, 2013
Rating
starstarstarstarstar 		tense muscles, elbow pain, wrist pain, pinky problem - guitar question
by: Anastasia

I'm 22 years old, started my musical path with violin when 12. I play guitar for 3 years. First year I was self-taught, then I entered a private guitar school and played a dreadnaught electro-acoustic guitar for almost two full years, few months ago switched on electric. I'm now starting class 4 and am intermediate player.

Before I played synthesizer (2 years), cello (1 year and a half) and violin for around 6 years of music school, and guess that is where I first experienced pain.

As I play an electric guitar for few months now (quite good at it, especially solos), I don't experience as many problems as when I want to hold and play an acoustic.

I can't even hold it properly without pain, and not really play any barre chord on it without wrist pain. If I try to play a barre chord without pain, I have to lift up my thumb from holding the neck, otherwise it's just plain painful and I loose strength in my fingers holding the strings due to pain. I don't push strings too much, but just much as normally required.

On electric I have super light strings and low action so it doesn't hurt. On acoustic the action is normal for one, not high.

I also experience frequent pain in my elbow and have to drop the hand from time to time due to painful elbow and sometimes wrist. With the plucking hand I don't really have problems, it's my fretting hand that's the problem.

But the biggest problem is my pinky finger. I just can't coordinate it properly with chords. When I play solos, I only sometimes can't coordinate it properly or place it properly, but if I train the move, the problem goes away. While when I'm trying to play chords it often just won't move in the direction I want it, or it locks-up, or even becomes numb and like dead and I can't move it at all (once it happened on-stage with acoustic and I had to find solution to shape chords with other three fingers instead for some minute).

Some times my forearm muscles feel so tense that even simple stretching before playing does not solve the problem, but sometimes causes even more pain than if I weren't doing it. Solution... don't play acoustic for few days and pain goes away completely, but when I practice again, I still can't hold some chords without feeling tense.

I learned to take enough rest between practice and when I practice cca. 6 hours, I always rest for at least few minutes after every 45 minutes of playing and later go on again.

The problem is the pain in my wrists, elbows, pinky control/numbing, and pain when playing certain chords, especially on acoustic, because the action is higher than with electric guitar.
I have same problems when playing the violin too.
As to when the pain started... it started first when I was a violin player, in class 4, because of repetitive uncomfortable violin hold and finger posture. It went away when I was not playing it for two years, and when I played a bit more advanced acoustic guitar, it started again.

CONTINUED IN NEXT SECTION



Dec 06, 2012
Rating
starstarstarstarstar 		Joshua Comments - focal dystonia and gluten - Classical Guitar and Index finger impairment loss of dexterity
by: The Tendonitis Expert

Joshua Comments:

I in no way thought you were being antagonistic or anything close to an equivalent.

My main point was, that even though you've gone through the usual routes, "but by the same token I am wary of anyone who claims to have answers without properly researching the problem." the general assumption is that doctors etc have done all the research so if a problem still exists after time with doctors etc then there's nothing left to try and the problem is either uncurable or really is what they diagnosed.

I certainly can't diagnose anyone or know exactly what's going on in their bodies. Maybe dystonia is a real thing. Maybe it's a funciton of inadequate nutrition and physical factors like too tight muscle and connective tissue. Maybe a combination of both.

What I do know is that, in the context/arena of soft tissue problems that I deal with, hospital doctors reliably have little to no clue what they're talking about. Alternative medicine docs definitely perform better, IMHO.

What I do believe is ruling out the possible causes. You're serious about looking for results. I am too. And the reality is, regardless of the problem, on has to keep looking for answers/results until one finds them, and that may require trying lots of different things/looking for info in lots of different places.

In the hospital doctor world it takes an average of 10 years of doctor visits for a person to get diagnosed for Celiac disease, for instance (which should happen on the first visit if the doctors had any clue, again alternative docs are far better at that).

It's great that you went gluten free for a year (most people won't do that even when it's a clear cause of problem). That ruled out one factor (mostly). The problem is, if one doesn't put adequate nutrition into one's body then those factors don't get ruled out.

Maybe you did, maybe you didn't, I don't know. In my experience working with people though, my general statement that 'you didn't' is generally a really safe bet.

I greatly acknowledge your committment to help other musicians, and your personal desire to be able to play again.

I don't have answers per se, but my 2cents is that it's almost certain that more can be done to fine tune your self care in the hopes of reducing dystonia symptoms.

If it's -really- dystonia, then either you're out of luck, or symptoms can be reduced. But there's possibility that it's really just dystonia symptoms (just like carpal tunnel symptoms can exist without any actual problem with the carpal tunnel).

Along those lines, what is your Vitamin D level?
Dec 06, 2012
Rating
starstarstarstarstar 		Dystonia and gluten
by: Anonymous

Went gluten free for a year. Restricted sugar intake. Unfortunately, still no results. I do believe there are things that nutrition and physio can help, and I think that there has to be a time when we finally acknowledge that there are deeper issues.

No I don't believe that doctors have all the answers, in fact, I have many doubts regarding their practices, but buy the same token I am wary of anyone who claims to have answers without properly researching the problem.

I am sorry. I am not writing this to be antagonistic, but for a musician who is suffering this condition this is not a joke. This is not something which I take lightly. This condition has been known for decades to be a career killer and as one who is suffering from it and who has gone through the wholistic, alternative medicine, physio and clinical medicine routes, I want people to be aware that there is no easy fix.


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Joshua Comments:

"This condition has been known for decades to be a career killer"

I'm curious WHY it develops.

Nobody knows, as far as I can tell.
Dec 06, 2012
Rating
starstarstarstarstar 		Classical Guitar and Index finger impairment loss of dexterity
by: Richard

Many thanks to Anonymous. I have indeed read everything I can find about focal dystonia and sensorimotor retraining etc - many guitarists and medical experts have written helpfully on the subject.
I'm not entirely convinced that my problem is definitely within the focal dystonia zone but I don't discount it. I am by now able to detect a pain spot near the elbow in the deeper digital tendons and an occasional related ache when I do certain grasping actions - there's definitely a deep seated tendon damage, whatever else.
I'm playing less and playing less often but it isn't as if I had lost a great proficiency - it was just a "retirement ambition" to improve my playing. I still enjoy playing and I intend to keep on going. I also accept that this type of injury (or maybe dystonia if you like) needs a lot of time to heal - as well as ice-dips and the other things helpfully advised by Joshua. Let's persevere patiently.


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Joshua Comments:

Granted, weird issues like a random 'dystonia' are certainly a possiblity, but I'd ALWAYS first look at nutrition and muscle function/structure first.

Stuck tight muscle keeps a muscle from working in such a way that can look exactly like focal dystonia.
Dec 04, 2012
Rating
starstarstarstarstar 		Focal Dystonia
by: Anonymous

You might want to read about FOCAL DYSTONIA.

I had the same issues and after a couple of years in physio - chiro, massage, accupuncture, active release- and several different therapists along the way - it was suggested that the condition might be neurological.

Unfortunately, there is little you can do. I asked neurologists, homeopaths and researched many other avenues and the only thing to do is to retrain your brain.... I'm currently trying teach myself to play left-handed.

Sorry.



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Joshua Comments:

Thanks for bringing it up Anonymous.

Maybe there's little you can do, maybe not.

It is my opinion that if the neurologist etc don't know -why- 'focal dystonia' developed, then they don't have much right to say that there's nothing you can do about it.

As always, I'd make sure your nutrition is more than covered, and go off all gluten for a couple months to see what happens.
Aug 17, 2012
Rating
starstarstarstarstar 		Guitar tendonitis - right hand index finger problem
by: Richard

Hi Joshua,

Thanks for your detailed comments. In reply to your questions -

1. I have abandoned the right hand exercises that caused pain in the forearm, and I have been practising with less intensity, sometimes taking a few days off. I have also tried using an ice compress on the forearm.

2. I noticed the relative loss of dexterity around the time I began to ice the forearm and noticed the slight loss of feeling on the top side of the forearm just after that. I would say that this slight loss of dexterity came on fairly qickly, but it's a subtle thing.

3. The background has a few complications. I suspect that I have caused some more basic damage to the right arm while grappling with a broken up-and-over garage door early this year. There is a deep seated strain which reveals itself on certain movements, especially on a slight (say 10 degrees)flexing of the elbow joint against resistance. This golfer's elbow type damage responds to rest but is slow to mend. I suspect that the index finger flexor problem is something separate and specifically related to guitar playing. I had right hand nail problems for a couple of years during which I used false nails (particularly the m nail.) Although I now have a healthy set I have been unable to achieve the desired i m i rest stroke technique, and that is the area in which I have exercised to the point of strain. The m nail tends to catch - maybe it's the shape, or maybe the relative lengths of my fingers, or maybe it will just need more time and struggle. Last October on a guitar course, the tutor detected a lack of follow-through in my i m i strokes and after that I practiced an exaggerated follow-through exercise daily. At present I even have difficulty playing scales, especially with rest stroke. Maybe this is something I just have to go through. I'll keep playing anyway.

3. There is no other history of relevant accidents - I did in fact fall off a mountain bike last weekend. took a heavy blow in the rib-cage/kidney area and dislocated my left hand little finger, but the only relevance of this is that I'm having to take a complete rest from playing (and eveything else)!

5. Indeed the problem is really one of playing dexterity, not pain.

6 - 11. Many thanks for your suggestions which I'll pursue. I'll let you know how things develop.

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