Wednesday, September 9, 2009

Musicians, Wrist Pain, and Carpal Tunnel...


...And joint pain...and ankle pain...


There are certain dangers to watch out for when playing any musical instrument, but especially drums. It's an instrument that requires alot from your joints in both the arms and legs. The constant impact with hard and varied sources isn't exactly a walk in the park for your body...add to that the repetitive motions that are required in long practice sessions and you have the recipe for potential injury.

I don't care how good your technique is, injuries can still happen...and all too often do. The problem is that way to many people are quick to point to Carpal Tunnel as being the culprit, when in many cases it's not.

The reason I wanted to take some time and talk about this is because about 2 years ago I thought I was going to have to stop playing. My wrist pain was getting pretty bad. Here I was a very schooled drummer, had spent years studying under some of the best hand technique guru's...and my wrists were killing me. Expensive doctors visits and surgery images flashed before my minds eye. Then I remembered an article I had read in Modern Drummer about wrist pain...I looked it up and there was my answer!


I'll be talking on this topic in three different posts...one will be an article and interview with one of the doctors (the one I went to), one will be my experience with the problem, and the last will be on how to avoid the problem altogether.


Below is a re-post of an article by Jennie Hoeft...you can find it here, or you can just keep reading...



A CURE FOR CARPAL TUNNEL SYNDROME?

BY JENNIE HOEFT

Stiff hands? Tingling fingers? Burning or numbness in the thumb and first three fingers?
Loss of speed, strength, or control?

You might…or might not…have carpal tunnel syndrome.

“Anyone who does a repeated motion long enough, without proper warm-up, stretching, and rest, will have a balance problem at some point. This imbalance has been fearfully named carpal tunnel syndrome,” says Dr Preston Wakefield. “ It has become the new melting pot diagnosis for all repetitive motion injuries from the fingertips to the shoulder.”
Preston (he prefers it to Dr.) claims that 90% of the carpal-claimers are incorrect in their diagnosis, that they actually have a very curable form of tendinitis/peripheral nerve entrapment.
And he cures them in 2-5 visits. Did you hear that? No more pain, no restricted movements, no drugs, no incisions, no braces…no way.

One year ago, George Lawrence, the drummer for Jo Dee Messina, couldn’t lift his suitcase. He couldn’t reach to the upper cupboard and lift down two dinner plates. His tingling arms kept him from sleeping, and the numbness and pain in his hands nearly cut his career in half. He came to Preston Wakefield as a last resort. He explains that his arm pain had been happening on and off for years, and then it became constant…not when he was playing, but when he went to lift anything, open a door, lift the trashcan…it was debilitating to his entire life. “I wore a brace for six months religiously, and nothing changed. Surgery was recommended, and I knew I had to investigate this new, non-invasive technique, before I looked for a new career”. After two visits, and daily homework of stretching and performing a couple of exercises, George is cured. “I sometimes feel a sense of tingle in my elbow, and it reminds me that I haven’t been doing my stretches.”

Trey Gray, the drummer for Faith Hill, known for his huge overhead left-hand back-beat, woke up one morning unable to raise his left arm. He had heard about Preston’s technique and now had no choice but to call him. Trey had relief within a few hours, but knows that his crazy style is the cause of his shoulder trauma, and that he if he doesn’t re-evaluate his motion, he will always have this potential for trouble.

Ron Ganaway, a serious session and touring drummer with Steve Wariner, took a few months off the road and then returned to an extra loud, extra long, extra demanding series of shows. For the first time in his lengthy recording/touring career, Ron felt a tingling in his forearms, and pain that would not go away. Ron thinks this tendinitis is about a lot of things… “The music is louder, the sticks are bigger, and the tours are fewer…so when I did go out, it was full out! Every drummer wants to kick the band, be the foundation, but there has to be finesse and control. If I could make one change in my past, present, and future playing, it would be to play relaxed…if the drummer doesn’t, no one else in the band will…and your body will suffer”. Ron sends every ailing musician he knows to Dr. Wakefield…“he freed all of that stuff up, and has given me an awareness of how to take care of my body before and after a show”.

What do these three professional, touring, recording, fabulous drummers have in common?

All three guys had pain, tingling, aching and numbness in their shoulders, arms, or hands.
All three guys thought they had carpal tunnel syndrome.
All three are clients of Dr. Preston Wakefield.
All three are playing pain-free, surgery-free, and drug-free

This miracle cure? ACTIVE RELEASE TECHNIQUESâ.

Dr. Preston Wakefield, a chiropractor and trained A.R.T.â therapist, has an office at The Club at Green Hills in Nashville, and is one of the only practitioners of Active Release Techniques âin the city. In thirty minutes, Dr. Wakefield observes what movement causes the pain, puts you on his table, and then puts the particular muscle through its’ range of motion. He is applying tension with his fingers, searching for the spots where the muscles are sticking together. Relief is immediate and lasting, if you do your homework. He is a forerunner in the healing industry as he focuses on the cause of the pain, not on masking the pain.

Dr. Wakefield grew up playing guitar and new first-hand about the possibility of repetitive motion injuries. He has transferred his love for music into an art of healing that does just that…heals.

A cure for carpal tunnel syndrome? Well, A.R.T. â is curing many of the same symptoms that are associated with CTS. As a working drummer myself, I was sensitive and curious about this new technique. As a personal trainer, I knew of the body’s natural ability to heal itself. I had to talk to Preston about this cutting edge approach to wellness, and his miraculous curing of Nashville’s finest drummers.
~~~~~~~~~~~~
Jennie: You’re passionate about your work? Please describe it, and why…

Preston: I was watching people fail all around me. They had to give up careers even after surgery and physical therapy. I knew there was a physical solution to these problems without knives and drugs and surgery…

Jennie: What kind of problems?

Preston: Repetitive injuries…like the strumming arm of a guitar player, the hat side of a drummer, the arms/hands of a keyboard player, anyone who does a motion over and over again. Our bodies are not designed to do this type of motion, and when we do, the muscles tend to stick to one another. Muscles rub on muscles, and build up this resistance to stretching.

Jennie: Because the muscles are swollen?

Preston: Not necessarily. Swelling can occur at the later stages of the syndrome, but the real culprit is the adhesions that form between the muscle groups. These adhesions limit the ability of a muscle to slide over adjacent muscles, ligaments and nerves. They create a tug-a-war in the muscles involved. The weird thing is that you might not know it is happening until you feel pain or tightness. This process can manifest over 20 years, but the predisposition has been there all along.

Jennie: Is this process inevitable?

Preston: I can’t say that every person who overuses a limb will get injured, but the probability greatly increases without some type of preventative measures. If you don’t do any maintenance on your car, over the years, it will break down. The same holds true for the human body.

Jennie: So…you wanted to find a non-invasive way to balance these injured muscles, and help the body heal itself?

Preston: Yes. In 1992, I was in chiropractor school, and read a paper in a sports chiropractic journal by Michael Leahy, D.C., an aeronautical engineer and chiropractor who was working with the Olympic athletes in Colorado Springs. He had developed a technique that helped these athletes with exertion and over-use injuries. The paper focused on repetitive injuries like carpal tunnel syndrome, why they happen, and how he was treating them. I knew I had found my healing technique. I called him immediately after reading the article, bought the tapes and began learning the Active Release Techniquesâ.

Jennie: What do Olympic athletes have to do with drummers?

Preston: Well, the similarities are more a function of how the human body heals soft tissue injuries. Athletes over-exert and damage muscles with a sudden force, like a muscle strain; musicians injure themselves over a longer period of time with repetitive motions. The body heals both of these injuries by forming scar tissue.

Jennie: So this over-use injury is not carpal tunnel syndrome?

Preston: 9 times out of 10…no.

Jennie: Then can you please explain what carpal tunnel syndrome is and why we are mistaken?

Preston: (smile). Yes. Carpal Tunnel Syndrome is inflammation and entrapment of the medial nerve in the carpal tunnel, (the tunnel formed by the carpal bone at the base of the hand). This medial nerve controls the thumb, index finger, and middle finger on the palm side of the hand. Numbness in these three fingers, or in the nerves leading to these fingers, could be caused by swelling and entrapment of that nerve in the carpal tunnel. Now, like a garden hose that is kinked, the block could be anywhere along the length of the hose. There are nine prime spots along the arm that may be causing this entrapment, and it is so much easier for insurance companies, surgeons and electro-diagnostic studies to all conclude that because there is no “water coming out of the hose” we better widen the tip. So, the surgeons then cut the carpal tunnel open to make room for the entrapped nerves.

Jennie: But they start at the base of the hand searching for the kink, and work their way up the arm, loosening and freeing the house of the medial nerve.

Preston: Right. Electro-diagnostic testing is performed to determine the time it takes for an impulse to travel down the nerve. If it takes longer than expected, the assumption of carpal tunnel syndrome is made. And then they work on “widening the tip”. When I was taking gross anatomy, and I knew I was going to be working on this injury, I did a lot of upper-extremity dissections, and there wasn’t a case that I had, (I know this is dead tissue), that I couldn’t fit three probes the size of pencils in the carpal tunnel, and still not touch the tendons and nerves. There is plenty of room in there! Plenty of room for all that stuff to move around…

Jennie: Unless the tendons or nerves are swollen?

Preston: Yes, unless they are swollen a little bit…but swelling goes down over time. But they want to go in and cut it! Here’s what we are finding out…that after five years, about 80% of the persons that have the surgery, have recurring symptoms, and they think that the tingling and pain are just a fact of life and go on...because they had the surgery. But most of the cases with these symptoms that I see, the entrapment is somewhere other than the carpal tunnel.

Jennie: And that is peripheral nerve entrapment?

Preston: Right. That is what is creating the numbness and tingling. But, the condition I see most often in musicians is tendinitis.

Jennie: Tell me what tendinitis is.

Preston: Tendinitis…inflammation of the tendon…and it is due to the muscles adhering to one another, and when you move the muscle, there is actually some adverse tension placed upon the tendon at the insertion onto the bone. You move this muscle, it tightens up, and it pulls on the tendon. Under normal conditions, the muscle is acting like a resilient, flexible elastic tube. When the muscle gets too tight, it develops a ropey texture, which increases the tension on the tendon, when the muscle is contracted

Jennie: And why are the muscles too tight? Over-use, not warmed up?

Preston: …and not stretched…this can take over 20 years to develop…scar tissue takes time to develop, and we don’t listen to our bodies, unless it is hurting. So the problem may be there for a while…we may have every excuse in the book… “I’ll play through it”, “It’ll go away”, “I don’t have any money”, or the biggest one… “I’m scared”.

Jennie: It IS scary!

Preston: Damn right...so don’t ignore it! This injury needs attention and awareness to heal.

Jennie: So you can tell by touching, whether the injury is carpal tunnel syndrome, or tendinitis?

Preston: Yes. No MRI’s, no x-rays, just some simple muscle testing and palpations of the injury, and I can get an accurate read on where the scar tissue has formed and is blocking the natural, easy flow of the movement.

Jennie: So, out of all the drummers you have seen here in Nashville, complaining of hand/arm dysfunction, how many of them have Carpal Tunnel Syndrome? (Preston has seen over 40 drummers in the last 3 years).

Preston: None.

Jennie: Some of your patients had already gone through the CTS surgery, even though they didn’t have Carpal Tunnel Syndrome?

Preston: Yes. I treated them after the surgery, when they still had symptoms. They are all right now. They didn’t have CTS in the first place.

Jennie: Yikes. These drummers that come to you, are complaining of what exactly?

Preston: Well, it is a general weird feeling in the hands or forearms…a tingling, and ache, sharp pains, maybe dull pains, throbbing, numbness, and lack of strength and gripping power.

Jennie: And describe a first visit please.

Preston: First… “Let me watch you play… bring a practice pad”, I’m concerned with what kind of grip you use…how much movement is generated in your forearms, hands and fingers when you hit, can you maintain that tempo for a long period of time, can you control the movements as your arms begin to fatigue, do you develop cramps in your thumbs? I’m not a drummer, but I do know about balance and efficiency of movement.

Jennie: And what are you learning about your patients?

Preston: They are using way too much effort to get a really loud sound, and they don’t have an efficient way of getting it! I suggest they visit an instructor who can help them with technique. I give them advice on how to treat their injury off the kit…stretching regimes, icing, and exercise…If the person responds to the treatment I am giving them, in two or three visits, the diagnosis is accurate. I’m not going to suggest spending big money on a bunch of tests if two or three of my treatments may cure the problem.

Jennie: So you watch them play, you feel the scar tissue in the injured arm, and then you use Active Release Techniquesâ to eliminate the problem.

Preston: Correct. I usually find that when using this technique, the problems go away.

Jennie: Say that again??!!!!

Preston: I believe the problems can be fixed!! I start at the origin of the pain, use A.R.T. â on the prime moving muscle, and then I release the antagonistic muscle, which is working just as hard. Then, if all else fails, we will trace the pain to the spine, and do some spinal manipulation…but I don’t usually need to.

Jennie: What else does the treatment include?

Preston: Ice, sometimes…stretching…absolutely…and some basic exercises for the rest of your dang life. You have a predisposition for this problem, and if you continue to do the same thing you did to bring this problem on, and not change anything…you are insane…doing the same thing and expecting different results…insane.

Jennie: Does anything else effect tendinitis?

Preston: Yes…things like cigarette smoking, too much alcohol, little or no aerobic activity, lack of sleep…all of these factors can contribute to a flare up.

Jennie: And stress?

Preston: Sure. The body’s natural response to stress is to tighten up, and the artioles (the blood carriers) do the same thing. So, not only are we demanding more work out of a muscle, we are asking it to work with less blood…that can lead to a compromising position. Stress is a major factor in developing tendinitis.

Jennie: So out of those 40 drummers, how many are healed?

Preston: 90% are okay, playing pain free. Some come by for a tune up every 6 weeks to 6 months, depending on how frequently they play and how often the stretch. I cannot emphasize the importance of daily and sometimes hourly stretching.

Jennie: And the other 10%?

Preston: They don’t stretch, or I should say, they don’t invest the mental energy it takes to develop necessary, preventative habits. So they stay within the box, wondering when they will get better. OR, the other 10% might need surgery or may have diabetes, hypothyroidism or some other disease that effects muscle and nerves. Active Release Techniquesâ is a great place to start but there is no one- treatment protocol that can cure every problem of muscle, tendons and nerves. Health problems are as unique as the people who have them. The important thing is to get checked out. My goal for every patient is to see me once…the body has a natural ability to heal itself and I am here to help align the muscles and the tendons to facilitate the healing. Then it is up to the patient to stretch, strengthen and retrain their muscles to move without strain or pain.

~~~~~~~~~~~

Jerry Kroon, Nashville’s legendary session drummer, is a new client of Prestons’. He tells a story of a professional pitching coach… “in life, we are blessed with a limited amount of pitches. It is our job to learn the proper technique that will most efficiently perform the throw.” Jerry noticed his arms tightening as the music in the studio changed from traditional country (stick in left hand, brush in right), to harder, rockin’ country, almost 70’s rock-n-roll… “we were self taught to get a sound, a feel…and we just didn’t develop the relaxed technique to pitch forever.” Jerry Kroon, master session drummer on over 30 gold and platinum records, can’t emphasize enough…IF YOU FEEL PAIN, TENSION, TINGLING, NUMBNESS…CHECK IT OUT RIGHT AWAY!!! You can change your posture, your technique, your kit set up…you can’t change your arms. “I hope Preston works for me…I’m going to give it my best.”

~~~~~~~~~~~~~

Musicians have a naturally high tolerance for pain. The nature of playing, (sometimes 8-10 hours a day, just to be competitive), can be a breeding ground for repetitive motion injuries. First, we hate that we are hurting (someone is right behind us who isn’t), we have egos that convince us that we can heal ourselves,
(we can, but an objective, learned pro may figure out the cause much quicker), and money and insurance are luxuries of more legit professions. Musicians have a dilemma…no sick days, no paid vacations, and a long line of hungry players willing and able to work. Injuries happen to all players, at all levels. It is important to address the tension, the tingling, the numbness, the aching, and the loss of speed or power immediately…take care of your body, and it will take care of you.

You can learn more about A.R.T. âor find a practitioner in your area, by checking out: http://www.activerelease.com/

Or contact Dr. Preston Wakefield at 3820 Cleghorn Ave. Nashville, TN 37215. http://www.prestonwakefield.com/

11 comments:

Flex protex said...

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Audiyo said...

@Flex...Thanks for the comment, no thanks for the ad.

I checked out your product and don't see much that anyone couldn't get from a bottle of Glucosomine and a good multivitamin...at a fourth of the cost. I'm a personal trainer as well as a musician and I've talked with alot of professionals about this particular issue. Your product is sketchy, overpriced, and not really a necessity. Not trying to hit you where it hurts, but if you post an ad on this blog without my consent it had better be for something reputable and useful...yours seems to be neither.

Dale Botha said...

Hi Stephen!

I'm very new to drumming and so I'm glad I found this now...I'm actually a waiter and carry massice weight with wrists and it's static and I'm developed small problems in the past and I've worked them out myself but this article demystifies the whole topic...I'm gonna be stretching now!!

Viagra said...

Great tips on how to ease the carpal tunnel!

Elliott Broidy said...

Shame. Great article.

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trevorbrace said...

I found your story about living through the pain to help others very inspiring! I unfortunately deal with carpal tunnel syndrome in my wrists from excessive time spent at my desk working. I was wondering if you had any ideas of how to permanently deal with the pain or how to better live with it? Right now I am using a brace that I bought off http://www.braceability.com/wrist-braces-wrist-supports-wrist-splints-hand-and-wrist-braces and it seems to do a very good job but I would like the pain to either subside more or to better mentally deal with the pain. Anyways I am excited to hear more in the future of your story and I hope that you continue to inspire all of those around you!
Have a GREAT Day!

Novak Jim said...

If you’ve a lot of pain then you shouldn’t use your wrist so much. You should use the extra water, eat bananas, use honey because it inflames in the whole body parts and try a physical therapy treatment.
physiotherapist bergen county , physical therapy bergen county

Skythia Haven said...

Some test can help you to determine if you have the signs of CTS. This maneuver can help you:
You rest your elbows on a flat surface such as a desk, with your elbows bent and your forearms up. You then flex your wrists, letting your hands hang down for about 60 seconds. If you feel tingling, numbness, or pain in the fingers within 60 seconds, you may have carpal tunnel syndrome.
Please visit on this site for further information.http://carpaltunnelhq.com/carpal-tunnel-symptoms/

tmtmedsource said...

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