Repetitive Stress Injuries: Temporarily Side-lined

Some aspects of pain are a natural byproduct of learning an instrument and are to be expected.  For stringed instrument players building calluses on the finger tips is an excellent example of this.  You practice until you’re uncomfortable, then stop and try again later.  Eventually your fingers grow accustomed to the sensation of working the strings and you build sufficient callus on the each finger to no longer have an issue with it.  Working unfamiliar muscles can result in lactic acid buildup which brings a different sort of discomfort, but one that most folks who have exercised are familiar with.   Stretching is vital to avoid many injuries, but it is also an area that is not addressed very often in the learning process.  Most of the time it comes up when an injury is either forming or has already manifested itself.

I have been having some issues with might right elbow that indicate that I probably have a repetitive stress injury that is impacting the ulnar nerve.  It seems to be a bass-centric injury in that the worst symptoms arise when I’ve been working with the bass as opposed to the guitar.  I’ve concluded that the ergonomics of my guitar playing are different than my bass playing.  One of my doctors agrees, and after noting the worsening of the symptoms, she stated that I should take an extended break from bass playing before the symptoms became even worse and started impacting my guitar playing as well.  She also advocated finding a good physical therapist to get me started on the road to recovery.  While this area is not her primary area of expertise, she is no stranger to RSIs as she has been dealing with her own for several years now.

So this has left me with a definite dilemma, as I am active in three bands as the bassist.  All three expect rehearsals and one is a semi regular three set a night band.  It was during the most recent gig with that one that I came to the realization that the problem needed to be dealt with in one way or another.  We were performing in a local watering hole and about half way through the second set the pain started in my elbow, followed by numbness and prickling running down my forearm.  If it had been my left arm I would have worried about my heart, but it was my right and not radiating from the shoulder.  By the end of the second set I was in significant pain and my right hand was starting to go numb in the ring finger and little finger.  The situation simply worsened through the third set, but I grunted my way through it; not necessarily the best decision health wise, but I made it through the gig.

If this had been a one-time occurrence I would have left it at that, but this has actually been building for some time now.  I have been having pain in the elbow there for some time and bouts of prickling and numbness running down my arm in that area that has come and gone.  I’d mentioned the prickling in passing to my PCP when I had my annual physical, but she was more concerned with some other things at that point and it was an “oh yeah, almost forgot about it,” comment on my part.  Given that my current symptoms are basically classic for some variation of tennis elbow, I’m fairly confident that I know what’s going on and my other doctor was in agreement with my assessment.  The treatment options that I have found thus far are pretty simple: rest, icing, and anti-inflammatories.  Severe cases might require surgery, which I would like to avoid.

I’ve also been exploring different positioning, moving from a five string to a four in order to change alignment, shifting strap lengths and instrument angles, and paying close attention to how my right arm responds to the changes.  I’ve been trying to move my elbow position as soon as I get any pain twinges or start feeling the prickling numbness occurring.  I traded my Carvin SB5000 five string for a Carvin Bunny Brunel BB70 four string, hoping that the difference in body shape, weight and less elbow travel to hit the low string would help.  I’m also trying to consciously play as lightly as I can with my right hand; trying to avoid digging in and working the muscles any harder than necessary.  Thus far the difference hasn’t provided any significant relief and I’m looking at another three set bass gig looming on the not so distant horizon.  The pain is under control, but the numbness and prickling are very much affected by how long I’m on the instrument at any given time.

So, I’ve started making my band members aware of my situation and have let them know that it is in all likelihood going to result in my having to take an extended break from performing on the bass.  I really don’t want this to get worse, particularly since I still can play guitar symptom free for the most part.  Thus I’m left with some pretty limited options.  We’ll see how it goes.



Being Mindful of the Physical Aspects of Music Making

One of the things I really love about playing a musical instrument is how it feels, the actual tactile experience. I particularly enjoy the feeling of fat strings under my fingers, which is one of the major reasons why I’m drawn to nylon strings. I love the breadth of the two-inch fingerboard combined with the feel of high-tension nylon strings. They’re nice and round, comfortable to push down, and visually pleasing as well. I don’t like the feel of carbon fiber trebles; they’re thinner than standard classical strings and bite into the fingers differently. Bass strings are also lovely combined with the wider fingerboard of the five string the texture and string response feels oh so good.

Playing brings a welcome tactile experience. There’s something about running up and down the fingerboard, the mechanics of the fingers meeting the strings and the clean order of solid technique being put to use. I don’t enjoy playing sloppily because it feels wrong. I’ve been trained, and trained well. I spent time developing clean playing habits, and while they’ve changed over the years due to working in different genres and the requirements thereof, my hands know the difference. Good technique inevitably feels better than bad technique, and good sound comes from good technique.

The longer I go without playing, the worse my hands feel. I’ve reached the point and the age where my hands start to stiffen and feel uncomfortable when I haven’t been playing regularly. The joints start to ache, and my palms and forearms start to feel crampy. Stretching helps somewhat, but what really makes the difference is spending a couple hours or more running the fret board, moving strings, and sending sound into the air. Doing, in this case, is far better than resting. Inevitably after working through some time on the instrument, my hands feel better, and so does the rest of me, especially when I focus on how it feels to play.

Focusing on the tactile experience also brings about healthier playing practices. There should be a sense of flow and order to the process of making the strings sing. The only physical tension that should be present is the amount needed to push down the string, initiate and maintain a clean sound. I have a tendency to carry a lot of tension in my body, particularly in my back, shoulders and neck. I also have scoliosis, which gives a pain response to tension in these areas. When I focus on the tactile process, I attempt to not only focus on the feeling of the strings under my fingers, but also on my body’s sense of relaxation. I try to keep my back, neck and shoulders as relaxed as I can, playing with as light a touch as I can while still maintaining a sense of dynamic response within the music. Musical tension might be present, but physical tension should be dismissed.

Relaxation promotes musicality, flow, and good health. Tension creates dissonance, pain and fatigue. At some point we all experience this, and we will still reach a point where we’re tired even when we’ve been maintaining a relaxed state. I have found that when tension starts to come into play my abilities decline dramatically. What was easy before now becomes difficult. My hands start to throttle the guitar or bass neck, while my shoulders start climbing toward my ears. Before long my abilities to deal with faster passages declines and emotional communication becomes static. Mistakes start multiplying and frustration escalates. By the end of the session, whether it is a gig, rehearsal or practice, I’m achy and ready for some ibuprofen. If it was a gig usually the next day is pretty physically brutal between the back pain and fatigue, often combined with a tension-induced headache. Tension also radically increases the likelihood of a repetitive stress injury that can sideline a musician for weeks. Been there, done that, don’t need to go there again!

Being mindful when playing makes a huge difference in being able to maintain a state of physical relaxation. The tactile experience should be pleasing, and when tensions starts to ratchet up being aware of the tactile experience’s divergence from pleasure to stress should be a signal. Granted, sometimes we do experience discomfort that requires working through as anyone who has ever played a steel strung acoustic guitar knows. It is necessary to build calluses in order to be able to play the instrument, and it is also necessary to train the muscles. In this case your hands and forearms are athletes and as such need to work out, stretch, recover and do it all over again to build strength and endurance. Athletes themselves seek flow, tension and release, as well as awareness of the physical process and tactile experience. They draw from this to enhance their performance, as should musicians. I can feel it, how about you?

Being Mindful in Life and Music

It’s under two days until Christmas and the gift shopping was just completed this morning.  For us that’s truly squeaking it in; we like to be done at least a week before hand but the past couple of years have been quite last minute.  I guess that this is at least in part due to being busy people.  My wife works full time in a demanding position at the University of Chicago, and spends close to three hours a day commuting.  She gets up super early so she get her mileage in running before work, so she ends up going to bed at the same time as our twelve year old daughter.  I’m usually filling my time chasing my three careers (writing, teaching, and music making) around in circles, so it’s not unusual to have a gig, two or three evening rehearsals, a day-time rehearsal and various other aspects eating up time.  We are the multi-tasking task force between the two of us, and then my daughter has her  after school activities as well.  I have more time to simply be than my wife does, but when I do it’s usually at the expense of something I should have been occupied with.

I’m working my way toward adopting an eastern religion, Buddhism, and I’m fairly certain that I’ll end up there, but some things have to change in order for me to get there.  One of these is mindfulness.  I’m struggling with the Buddhist concept of the mind; it’s not super difficult but it’s also not exactly straightforward, so the mindfulness I’m attempting at this point is being aware of what I’m doing or not doing.  This might seem like a simple matter, but I can just about guarantee that most people aren’t fully aware of what they’re doing when they’re doing it.  For example, when I practiced scales a long time ago I was painfully aware of what I was trying to do with my fingers, but once I had the pattern locked in it became an automated process, and still is to this day.  I think this is how most of us really run scales, by rote and in a programmed sequence.  We don’t think about where the whole or half steps are, or even what the key signature is because we’ve linked our entire concentration on one aspect of the process:  where our fingers go.

Once we have locked in the physical process and can run up and down at varying speeds, our focus, if we have one, is perfecting our accuracy and increasing our speed.  We might reach a point where we figure we have mastered the process, and run these lines up and down with fluidity, but we’ve also, more often than naught, gone onto autopilot, particularly guitarists because for us the patterns are often either the same or a simple variation thereof.  Once we have the patterns a key change is just a matter of shifting the pattern to a higher or lower point on the neck, so we don’t really have to think about it.  While we think we’ve gained mastery we’ve actually missed a huge part of the train, the actual notes that construct the scale and the actual music that a scale can be.  If we are truly mindful, then we are turning our awareness toward the construction of the scale, we are taking the time to be aware of the note names and relationships as we move through them, and we are being aware of our physical state of existence in this moment of the note, where we’re carrying tension, how we’re breathing, our bodies’ relationship with the physical process and the emotional tension and release we are invoking in the entire process.  The entire practice of scales becomes exercise of the complete physical process paired with the theoretical relationships and then crowned by the emotional expression of the music itself.  Now we are being mindful, as well as growing into a better understanding of what we are doing in those moments.

An aspect of mindfulness that I find very appealing is that it is aimed at being in the moment.  This means that your focus is locked into what you are doing, thinking or what ever it is right now and you are giving this moment in your life your full attention.  You are being the best you that you can be in that moment and giving your best to that moment.  For instance, if I have a performance and I walk out on stage with my guitar, then that is where I need to be mentally, physically and emotionally.  Lives are complicated; I know mine is.  I spend a good deal of time worrying about things, some of which I have the power to change but most of which I don’t.  Most of the things I’m worried about aren’t going to change during the time I’m performing and worrying about them isn’t going to change the outcome either way.  The worry is a distraction from actually living.  The performance is part of really living and is something I have the power to prepare for and execute.  This is where mindfulness comes into play as well, because we are living right now.  We can make plans for our futures, and should, but what really makes the difference is what we do in the moment.

Mindfulness is something that doesn’t come easily to me.  Part of this is due to my ADD causing a certain amount of mental flitting around.  It’s difficult to sit and run scales even without going into the deeper aspects of what I’m actually learning and doing.  My brain has a tendency to ricochet and ping pong around even when I am maintaining a guise of being focused which is one of the reasons that I’ve been writing essays for the past two years, to help train myself to maintain a focused train of thought and chase it to a logical conclusion.  The essay format helps me enter a somewhat mindful state, as did the five paragraph operations order in the military.  Through mindfulness I hope to start finding my path, and to elevate my awareness of who I am through what I do.  I hope to become a better person through it, a more focused person, a more empathetic person and a better musician as I work my way along.