Wednesday, January 29, 2014

The latest in hand fashion, i.e. the other reason to see a physiotherapist

Winter is never a really happy time for my hands.  Not since I took a course of the antibiotic Ciprofloxacin about a dozen years ago, anyway.  I can't say for certain that the Cipro caused my arthritis, but it definitely caused arthritis symptoms while I was taking it. Following winters the aches and pains returned, but not usually to the degree I experienced while on or shortly after taking the medication.  My doctor actually thought I had fibromyalgia that year - the aches and pains as well as other symptoms - my messed up back full of "trigger points" and other symptoms probably caused by anemia, etc.

Actually, one of the first complaints I had was that it hurt to play my cello.  Stupid thing to tell the doctor, especially since there were other every day activities that were bothering me more - like pushing on those spring-loaded medicine cabinet doors, or writing with a pen.  "Well, you must be playing too much."  I knew that wasn't it - many, many people play hours a day and I was only maybe playing an hour a day.

But I also knew it wasn't supposed to hurt to play, and it never used to when I played multiple hours. I sought out a teacher to check my technique, to make sure I hadn't somewhere in my time off and coming back developed some unknown-to-me bad habits.  Nope.  But he had some great ideas for developing my technique further...

I learned that serious double stop work, double extensions, etc. only served to strain and aggravate my small (for a full sized cello) hands further.

My most painful joint now is the CMC - at the base of the thumb - the left thumb.  Curious, as that thumb has such a small role in left hand cello work in the neck positions, where the bulk of my playing is.  But the above mentioned strain and also some repetitive playing such as is common in a lot of orchestral playing causes an increase in tension in my hands which I suppose affects it.

The CMC joint seems to usually be one of the more commonly affected (by arthritis) joints, and I learned from the hand specialist (physiotherapist) that it is often the left one in right handed people, probably because it usually does the grunt work like holding the pot while the right hand washes, etc.

I am, however, now also developing pain in my right hand.  BUMMER!  The right thumb has a much bigger role in cello playing.  So far I think it has only been once that it actually bothered me to the point of having to put the bow down, but my practice has been much curtailed this season in order to rest the left hand.

After reading about splints for musicians in Playing (Less) Hurt by Janet Horvath, I wondered if something on my left thumb would help me. I first tried something my husband already had: a wrist splint.  But I modified the way I was wearing it to support the thumb.  Definitely helped, but was too bulky for cello playing, really.  I tried a few actual thumb splints before getting to the hand therapist, and none of them really worked for playing with, either.  The hand physio guy made me this:

Thermoplastic, molded on my hand, cooled to a very rigid, custom-made, splint. No, it doesn't work very well for playing the cello, but I'm told if I wear it to support the joint for other things, I may be able to play with a softer splint, or none at all.  This is the splint before tweaking.  It's a bit smaller on the back now with a shorter thumb.  I asked what I could do to keep my right hand from going down the same path, and have been promised another splint for that thumb.  Well, at the least, it might protect me from the over-enthusiastic hand shakers at church! :-)

I have been able to wear it for some of my teaching time, but found this softer "Thumsling" which provides a more modest support for the joint, but doesn't get in the way of playing as much as the rigid plastic or the bulkier wrist splint.

Wednesday, January 15, 2014

My aching back!

I mentioned back issues HERE several months ago.  I am happy to say that things have improved since then!  The aches improved with manual therapy (and tennis balls on the wall, and time on the floor at home) to relieve the muscle knots.  Stretching the pectorals have made a big difference in posture.  I had been working on that for months, but didn't see real improvement until my second physiotherapist gave me a bigger, better stretch.**  Combining that with the "Fix the Shoulder Blades" exercise as seen at, and trying to develop new habits...  big difference.  I had tried the shoulder blade exercise before without much success, probably due to the tight pectorals. helped me to understand why my neck was bothering me, even after physio treatment - or rather, even more after treatment. It seems to be slowly improving now.

I am not going to blame cello playing for all my issues (I have mild scoliosis, probably inherited from both parents!), but I think playing has contributed to the muscle imbalances.  Currently reading more about that in The Athletic Musician by physiotherapist Barbara Paull and violinist Christine Harrison.  Still on my reading list is The Musician as Athlete by cellist Dorothy Bishop.  Another good book about taking care of the musician's body is Playing (Less) Hurt by cellist Janet Horvath.***  Here is an interview where she offers advice for musicians:
 You might be at a place where videos and books can help, but if you are already aching I recommend also seeking the help of a good physiotherapist who does manual therapy - wish I had done so years ago!

Check back soon for my other reason to see a physiotherapist!

 **EDIT: The stretch worked very well for my muscles, but unfortunately was a bit too much for the nerves. When numbness and tingling developed in my hands I returned to the physiotherapist who had me change stretching techniques.
***EDIT: Another article which gives injury prevention advice: A Painful Melody: Repetetive Strain Injury Among Musicians.