Playing clarinet with wrist tendonitis or thumb tendonitis

by Rebecca
(Chicago, IL, US)



I am a senior in highschool and play clarinet in the band.

I've been playing it for, well... a really long time.

I believe I have wrist tendonitis (haven't had it diagnosed, but my symptoms match the description).

I first noticed an issue last year when I picked my clarinet up before school started, after a long summer's rest. I played a long time and noticed a slight pain at the very base of my thumb, with a slight jab when I stopped, which then went away.

I thought nothing of it, until our Christmas concert was approaching and I was practicing a lot, which brought the ache back. Then, a day or two before the concert we played badminton in gym (Bad. Bad bad bad. No doubt I wasn't playing properly). I couldn't hold up my clarinet. The pressure of the thumbrest both hurt and caused my thumb to shake uncontrollably.

After that the problem seemed to disappear except for an occasional spasm along my thumb and wrist when I play for a long period of time.

The weakness surfaced again only once, right before a competition (though that I got through fine- I have a feeling it had as much to do with nerves as the tendonitis).

However, this year I have noticed that same spasm, which again happens as soon as I remove the pressure from the thumbrest, shoots once, and is gone, and generally after prolonged playing.

It is nowhere near as bad, but I don't want the problem I had last year coming back.

So I guess the questions would be these:

First, that this really is tendonitis and not something else. The pain originates from where my thumb connects with my wrist, and I seem to have the other symptoms... but I may very well be wrong.

Second, I know I need to try that bone broth thing, but what else can I do to alleviate/ reverse this? Should I try doing things with my thumbrest?

I do have something to improve my finger and wrist strength, but when and how often should
I use it? (whether or not it helps this- I need to improve that anyway)



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Joshua Answers:


Hi Rebecca.

1. Do you think that you have Wrist Tendonitis, or Thumb Tendonitis?

2. Do you have pain in your wrist, or just pain at the base of your thumb? Or is it at your wrist under your thumb?

3. Describe the symptoms in more detail, please.


Answer those questions to give me a better idea of what's going on.

I don't know if you have Tendonitis, but you definitely have a tendonitis dynamic.

Meaning, muscles that are getting tighter, connective tissue that is getting more constrictive, Process of Inflammation, and a nervous system that is freaking out about it and going overboard trying to protect you....with more tightness and pain sensation.


Probably we just need to deal with the inflammation and spasm. I bet you're just in a dynamic where the nervous system is going bonkers and -thinks- that you are getting hurt. This is consistent with spasm and shooting pain.

Probably we'll look at some Magnesium supplementation, and do get a crock pot and get some Bone Broth going.

My main curiosity is what exactly is going on with the pain. Constant, or more shooting and then is gone?

(Also, you're under 18, so please make sure you have a parent type take a look at this.)


Joshua Answers:


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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Oct 06, 2009
Rating
starstarstarstarstar 		PART 2 - Answering the questions - Playing clarinet with wrist tendonitis or thumb tendonitis
by: Rebecca

Thanks!

I have had people look at it and my parents do know about it.

The pain is mostly in my wrist under the thumb, where that bone connects with my wrist, continuing through some of it. Mainly in that one spot, though.

Now that I'm asked I'm not really sure which it might be, or be like, or if it is actually tendonitis.

It starts as a general ache that I hardly notice. It's when I finally relax my hand that I get a really bad shooting pain, which almost seems to 'reset' it, though sometimes it still aches a bit afterwards.

Sometimes with that slight ache my hand gets tired, though I've not had the weakness for some time.

So no, the pain isn't really constant.








Oct 06, 2009
Rating
starstarstarstarstar 		PART 3 - Playing clarinet with wrist tendonitis or thumb tendonitis
by: The Tendonitis Expert

Joshua Comments:

Hey Rebecca.

Check out this page on two different ways to think about Tendonitis. There Are Two Tendonitis Types

In short, you can have pain and actual tendon wear and tear damage, or you can just have pain. They both feel essentially the same.

My main message is that the damage isn't the problem so much as the dynamic that exists before and after tendonitis damage.

Which is, too tight muscles, constrictive connective tissue, and inflammation.

My guess with you, as you are young etc, is that you don't have tendonitis per se.

I bet you that what you have is:

You used your thumb too much for too long in too short a period of time. Your nervous system freaked out because it thought there was danger. The structure is thrown into an acute pain and tightness dynamic.

The benefits of youth settle it all down pretty quickly, but you're basically left with a hot button, a spot in your muscle that is too tight, and when used too much in a specific manner like playing clarinet, fires off a message to the nervous system that causes it to throw the mechanism towards pain again.

Left to it's own devices, it is predictable that it won't just go away back to normal. We can 'fix' it, though. Not that big a deal.

Like the shooting pain, it feels bad, but that's just it. It feels bad, but you're not broken or anything, your body just went a weird direction and we need to steer it back to working 'right'.

By the way, that shooting pain that feels like it resets...that's kind of what it is doing. I like to think about it like a submarine sending out a ping to get a picture of the ocean around it.

An electrical charge fires off, likely accompanied by muscle clenching in a spasm, that sends an echo through the nervous system. Possibly it's not finding much bad to report, so the nervous system tells it to settle down.

But, right there around your thumb/wrist, you have a Pain Causing Dynamic that we need to deal with.

And muscle that is too tight, for too long, fatigues VERY quickly.


So, thanks for making sure your parents have seen this, and, before we move on, does this all make sense? Any questions about any of this?
Oct 08, 2009
Rating
starstarstarstarstar 		PART 4 - I get it! - Playing clarinet with wrist tendonitis or thumb tendonitis
by: Anonymous

Yes, this does make a LOT of sense.

I must say, I really apreeciate they way you describe it, because now I think I have a much better idea of what's going on.

So no, I don't think I really have any questions about that.

Thanks again.


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Joshua Comments:

Excellent.

You're welcome. Now, no more thank yous. Get better is thanks enough.

Moving on.

I wonder if you have a trigger point.

Essentially, a trigger point is a little tiny bit of muscle stuck in spasm. This sends off information and chemical constantly, causing everything around it to get 'worse'.

Probably I should have you do what is described on the How To Reduce Inflammation page.

You can if you want. It's a good idea.

But for right now, my main suggestion is to do two things.

1. Increase your Magnesium intake. Read the Magnesium for Tendonitis page.

Then, at the bottom of that is a link to my Kerri's Magnesium Dosage which will describe what and how.



2.
Start rubbing your thumb pad muscles.

First, you are going to explore. Get in there with your other hand/thumb/knuckles, etc. See what hurts. See what is tight. See what isn't. Go exploring in all the tissue all around. Feel the bones and their angles and grooves and such.

See if you can feel where muscle turns to tendon, then where tendon connects to bone.

While you do this, you will find tight, painful bands in the muscle.

Exploring those, you will likely find hot spots.

Right now your primary form of self care is to get in there and rub all that. Circles, across the fibers, squeezing like a sponge, chipping away at hard spots, etc.

You can even to static pressure, meaning not moving/not changing pressure. If you find one of those hot spots, stick it and hold it for a minute or so.

Sometimes when you do that, it will 'explode' in a fast spasm, then release and relax. That's fun to experience.


Ultimately, you're going to get in there until you turn the 'dry, crunchy sponge' into 'soft, squishy sponge.

Towards the dry crunchy end of the spectrum, things hurt and don't work well.

Towards the soft, squishy end of the spectrum, there is no pain and things work great.

Do this 10 times a day, for 3 minutes each, for 3 days, then update me.

You can spend more time in the wrist/forearm area if you are really motivated to get out of pain. Also, it would be smart to ice dip at least several/many times a day.

Having said that, if the thumb pad muscles really don't hurt, explore elsewhere until you find what does.

Again, does that make sense? It's not a magic bullet, but it works, and I think it's your primary need at the moment.

Get to it.



Jan 10, 2015
Rating
starstarstarstarstar 		Wrist Tendonitis Affecting Ability to Use Mouse and Play Clarinet
by: Alexander S.

Hello Joshua,

Thanks for taking the time to read about my current tendonitis issues and answer my questions (I’m 31 years old). I am writing you now because my symptoms have not subsided after several months of treatment, and I would like your expert opinion based on my unique symptoms.

The initial injury occurred in March 2014 while on vacation. My brother and I decided to spend the week playing computer games. This is an activity I do occasionally for perhaps 2 – 3 hours at most.

However, on this occasion, we played about 6-8 hours daily for nearly a week. This activity involved a lot of repetitive mouse clicking. Additionally, my ergonomic setup was not my usual, and I was situated on a dining room table with my arm propped up too high.

After the 5th or 6th day, I developed a burning/numbing sensation in my forearm extensor muscles close to the elbow. I eased back on mouse use over the last two or three days. However, the damage must have been done, and it was at that point that I started noticing that whenever I moved my wrist up or down or twisted it, there was a cracking/snapping sensation. It did not really hurt but was obviously an indication that something was not right. I’m sure what I did was cause tendonitis. I never experienced any bruising or swelling that I know of, though the affected areas were warmer to the touch.

Here is a more detailed description of the symptoms I experienced back in March and still experience now. When I flex my wrist up or down, I almost always get snapping in my wrist on the extensor side. The snapping sensation is usually on the pinky side. In fact, I constantly have the urge to grasp and press down on my ulna at the wrist on the extensor side, which usually causes a small snap and seems to pop it back into place (only a slight movement).

Sometimes the snapping occurs along the entire length of the extensor side of my forearm, like a rubber band being snapped, but it is mostly felt at the site of the original numbness, closer to the elbow. I should note that I have absolutely no symptoms on the flexor side of my arm or wrist, though a massage therapist did say that those muscles were tight, and I have no pain at all at my elbow, though it does occasionally pop/crack.

After about two months of rest, the symptoms did not go away, so I went looking for more information and found your website. I have also had work done by a deep tissue/medical massage therapist a few times.

You will probably not be surprised to hear that resting does not help. I recently took two weeks off, and did not use a computer at all. Within one minute of returning to work and using the mouse, the snapping and discomfort started up again. What makes it better is not using a mouse while using one makes it worse.

Here is another observation about my right arm tendonitis. From doing the self massage on my right arm I have noticed that there is a band of tissue that runs perpendicular to my extensor muscles at the site of the original numbness from overuse (2-3 inches from the elbow). I pointed it out to my massage therapist, and she said it was a ligament. I asked her if it could be scar tissue, and she replied that it was not. What concerns me is that I cannot find this same band of tissue on my left arm, so I suspect that it might be scar tissue (especially since it is at the site of overuse from mouse clicking). However, I have been unable to break it up after much self massage and going to a massage therapist. I suspect that this tissue may be the cause of my muscle tightness which is leading to my wrist and forearm cracking/popping.

I think this muscle tightness is also causing some issues with my clarinet playing, and I would appreciate any feedback you have in this area. In normal use of my hand, I don’t feel any restriction in motion or function other than the heat/aching from the snapping. However, playing clarinet is a different matter. No matter how much I practice, I have a finger hitch on my right hand when trying to play scales smoothly.

I have been playing clarinet for 15 years, and this issue only started after the incident in March. I am sure this is related to the muscle restriction in my arm, and no amount of practicing or massaging (up to this point) is fixing it. If it helps you in your assessment, here is a description of how my fingers are currently functioning on my right hand: I am unable to quickly and smoothly place down the following fingers one after the other on the clarinet tone holes: index, middle, ring, pinky. The hitch normally starts when I try to place down the middle finger. Oddly enough, I can place down the following sequence of fingers smoothly and effortlessly: middle, index, ring, then pinky. To be clear, this hitch is minute at best and only evident when I am playing scales very quickly, but it feels like my right arm is restricted and cannot play freely.

I am sure that clarinet playing is not the source of the problem (the computer mouse was), but because playing clarinet uses so many arm muscles, the symptoms do surface. When I play, I am constantly having to shake my wrist to release tension build up, and often my whole arm will crack/pop up to and including the shoulder. This does not hurt, but I need to do it to release the tension I feel in my wist and forearm.

Thank you and I look forward to reading your response.

Regards,
Alex Schlesinger


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Joshua Comments:

Hi Alex.

1. You are correct. :) I am not surprised that Rest didn't help.

2. The clarinet and the playing video games are both innocent of being 'the cause'.

It doesn't matter what motion is, it matters how healthy your body is and how well it is functioning.

The 'Cause' is progressively too tight muscles and connective tissue, inflammation process, and nutritional insufficiency.

The actions we perform can shape how and where we hurt, but the actions don't 'cause' the pain. THe pain is a result of the body performing poorer and poorer.


3. That 'snapping' is due to too tight muscle and connective tissue compressing the joints, and trying to pull them out of whack.

Joints are supposed to 'float' some. But can't when compressed and pulled, thus you feel that urge to press and do something about it.

Imagine how your body has been trying to play clarinet and video games with constantly compressed joints and constantly too tight muscles etc.

It's a downward spiral and Pain Causing Dynamic.


See Related: Injured Woodwinds Musician Who Needs Help With SHooting Wrist And Arm Pain"


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