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November/December 2004
Flatpick Magazine
DOES
PRACTICING HURT?
BY MARC DARROW, MD
How many guitarists
have altered their style
 of
playing from five fingered riff blazing virtuosos to simple chord
strumming rhythmists because of finger, hand, wrist and
elbow pain?
Certainly too many.
While, there are many articles devoted to preventive exercises,
stretching, warm-ups and other techniques to ensure the guitar player
can protect themselves from repetitive strain injury (RSI). This article
will focus on those guitarists whose skill and dexterity has been robbed
by painful fingers, hands, wrists, and elbows.
To no surprise, guitarists suffer from the same wear and tear injuries
that plague computer users and others who make a living or act as
hobbyists in activities involving the fingers. This injury is commonly
referred to as repetitive strain injury and is caused by tearing and
ripping in the connective tissue--especially the
ligaments.
Loose Ligaments, Slow Licks.
Ligaments are the connective tissues in our joints that, as their
descriptive name implies, connects the bones in a joints and hold them
in place, and gives the joints strength.
To make an obvious comparison, when ligaments are tight and strong, like
the new strings on a well tuned guitar, a beautiful sound is produced.
When the ligaments become weakened and loose because of overuse injury,
they become like the old, worn out strings--strings that have been
overstretched by constant tuning and playing, no longer hold their tune
and will no longer produce a beautiful sound, but rather, the "painful,"
sound of "wobbly" strings.
So it is with our ligaments, over playing without taking proper rest
periods and sufficient warm up, stretches out the ligaments making them
"wobbly." A cascade of pain then begins that lead some to give up on
playing altogether, or alter the style of play to slower, "less painful"
tunes.
Referred Pain
Why Your Arm Can Hurt From
Shoulder
To Finger
Pain from overplaying can start as an overuse injury in the shoulder as
inflammation,
bursitis, impingement syndromes. It can start in the elbow, in the
annular ligament that stabilizes
the two bones of the forearm, the ulna and the radius. Sometimes the
pain in the annular ligament can refer itself down into the thumb, wrist
and index and middle fingers, mimicking and sometimes leading to an
incorrect diagnosis of
carpal tunnel syndrome.
Regardless, wherever it starts it can quickly make your entire arm feel
as though it is injured.
How does this work? Referred pain is created by the
ligament laxity
around a joint, but, is felt at some distance from the injured joint. So
as explained above, elbow pain may be felt in the fingers, equally,
finger pain may be felt in the shoulders. As an example, the ligaments
in the wrist are injured and strumming the guitar is painful. Your body
compensates for this pain by constricting muscles and other tissues up
and down your arm in an attempt to stabilize the pain. This constant
"tensing," will in itself lead to "tender points," painful to the touch
spots within the muscle
What to Do?
If you are not already in pain, their are many preventive measures you
can take including stretching and warm up exercises, strengthening
exercises and other techniques that can be found in many references. The
focus of this article is for those players already in pain and altering
their style of play or not playing at all.
Surgery and Pain Medications
Surgery has its limitations, drawbacks and risks, as do
NSAIDS
(Non-steroidal anti-inflammatory medications) and pain killers.
Unfortunately, these treatments are usually the first and most popular
treatments prescribed. Surgery is especially aggressive and not the
choice of many patients because of the long recover time and possible
failure of the technique. When the surgery does fail, most doctors
resort to their one last option-sedating the patient with narcotic
medications.
Sugar Shots To Strengthen Ligaments
There are other treatments options available, conservative treatments
such as physical therapy and chiropractic care. There is also
Prolotherapy
which is becoming an increasing popular non-surgical alternative for
over use related injury.
The term "Prolotherapy" is short for "proliferation therapy."
Proliferation, of course, means "rapid production." What Prolotherapy
rapidly produces is
collagen,
the necessary protein building element of ligaments.
Continue>>>
Marc Darrow, M.D., is himself an
accomplished musician
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