Questions and Answers for Classical Guitarists By: Brian Hayes
Many of us are already aware that the two main causes of wrist tendonitis for classical guitar players are: 1) overuse (practicing too much) and 2) misuse (poor technique, insufficient warm-up or trying to tackle pieces that are too difficult). In addition to these, though, there are certainly other factors that play a role in tendonitis. There’s still quite a bit that a classical player can do to help prevent the condition.
This article does not address the condition of carpal tunnel although there are some similarities between the two. The symptoms of carpal tunnel include numbness, tingling and pain in the wrist and usually affect guitarists who play with either wrist too arched.
I’ve been studying classical guitar for over ten years now but it wasn’t until I began studying pieces that were increasingly more difficult that I wound up having my first encounter with tendonitis. Between the orthopedic therapist I was seeing at the time and a prominent classical instructor in the area, I was receiving conflicting opinions as to the approach for treatment. After a month or two, the condition subsided and so I felt no need to think about it any further. I came down with a slight case of it again over the past couple of months and this time decided to take a more aggressive approach to my research. I began gathering any information I could from all of the classical players I knew. A friend referred me to a player who’d incurred an arm/hand injury in a car accident several years prior, which dramatically affected her ability to play. The orthopedic specialist who had treated her was Dr Bernard of the Jewett Clinic. An orthopedic hand specialist who had experience with classical players is exactly what I wanted so I went into his office not only with my condition but also with a whole list of questions. This doctor’s diagnosis, treatment and answers to my questions make up the bulk of the information you see here. I hope the results of this research will prove to be of good use to some of you.
Symptoms of Wrist Tendonitis
Beginning stage symptoms of tendonitis include aching pain and stiffness or a burning sensation. If a person is experiencing swelling, persisting pain, numbness, or spasms, they should see an orthopedic hand specialist right away since these are signs of a more serious case of tendonitis or other hand injury.
Wrist Tendonitis: a “Repetitive Motion Injury”
It is very important to understand that tendonitis is what is known as a “repetitive motion injury.” What this winds up meaning is that the more we vary our motion in what we practice, the more we decrease our chances of incurring tendonitis. Several players I’ve talked to who are familiar with these sorts of injuries say that Rasgueado (a flamenco technique) may be the very best thing for classical players to practice and make a part of their daily warm-up. Rasgueado works the extensor muscles/tendons, which are opposite of the flexor muscles/tendons that classical players use almost exclusively. I was also pleased to find out that I had something going for me in the fact that I play piano as a side-hobby. I found out that this also offers a variety of motion (in contrast to guitar) that is excellent for helping to decrease the risk of tendonitis. So the more diverse we are in the parts of the hand that we work, the lesser our chances of incurring any “repetitive motion injuries.”
Does Wrist Tendonitis Ever Go Away?
A player named Marty Freedman once told me that tendonitis never truly goes away once you get it and I’ve heard this teaching spread throughout many circles. This is completely untrue. Tendonitis is nothing more that an inflammation of the tendons. To me, saying that tendonitis will never go away is like saying that a sprained ankle will never go away.
Can Diet Be a Factor in Incurring Wrist Tendonitis?
Absolutely. When your intake of ‘bad fats’ (saturated) is too high and your intake of ‘good fats’ (omega 3 fatty acids) and anti-oxidants is too low, your body can go into what is called a “pro-inflammatory state.” A pro-inflammatory state is a predisposition to tendonitis (and to other inflammatory conditions like flu symptoms) brought on by conditions within the body, such as diet. Food allergies should also be considered as a possible cause of tendonitis since they have been known to contribute to the condition as well.
Treatment for Wrist Tendonitis
When I incurred tendonitis for the first time, my orthopedic therapist (not a doctor) prescribed for me that I should exercise my hand by working a lump of putty in addition to exercising with a spring-loaded, handheld device. When I mentioned this to one of the best classical guitar instructors in the area, he was shocked and said that I should, instead, do absolutely nothing with my hand except to rest it. What I wound up finding out is that it apparently depends on the specifics of the condition as to which is the proper treatment. Tendonitis is simply an inflammation of the tendons but depending on which tendons are affected and how badly, the treatment can vary. Only a specialist can determine this sort of thing.
No. After the symptoms have subsided, decrease your practice time by one half for the first week and by one quarter for the second week. After that, resume recommended routine. This is what I was told to me by the particular doctor that I saw.
Are There Any Over-the-Counter Supplements That Can Help Prevent the Condition?
Yes. The ones that were recommended to me (in order of importance) are: 1) Glucosamine-chondroitin 2) Vitamin B6 3) Omega 3 fatty acids and 4) Anti-oxidants (such as lipoic acid, coenzyme Q10, vitamin E and curcumin). Glucosamine-chondroitin helps to build cartilage and is often used for arthritic patients as well. I was told that a good brand of glucosamine-chondroitin is ‘Ostio Bi-flex’ which I found at K-Mart. B6 is supposed to help with neuro- transmitters. Omega 3 fatty acids and anti-oxidants (especially along with a decrease in saturated fats) help to reduce cytokine induction, which can cause the body to enter into a pro-inflammatory state. Salmon oil is an excellent source of omega 3 fatty acids although some are concerned of its possible content of heavy metals, such as mercury. Carlson’s Salmon Oil (sold at Chamberlin’s) is an excellent brand that guarantees no heavy metals in their product. Another supplement that many people are raving about is MSM. The doctor I saw said that there was no medical proof as to what MSM actually does for tendonitis.
Can Stress Brought On by Excessive Hours at the Computer Keyboard Increase My Risk of Incurring Tendonitis?
Yes, but only because typing at the computer keyboard alone is enough to bring about the condition. When typing at
the keyboard, never lay your wrists down but keep them elevated. Always sit up straight. It is also much better to learn how to type correctly, rather than being a “four-finger hen-pecker” as I have been. And as far as mice are concerned - The kind of mouse that is supposed to be the least stressful to the hand is a track-ball mouse that has the track-ball on top.
• Brian Hayes is a guitar instructor at a local Orlando music store who has been kind enough to share his experience with us.
• Of course, before following any health advise, check with your personal physician. This offering does not constitute an OAGS, Inc. endorsement for treatment.
