Diagnosing injury is hard.

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
uptempo
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Diagnosing injury is hard.

Post by uptempo » Wed Sep 14, 2016 3:12 pm

Hi All

I thought I might add a new topic in addition to a previous topic where I noted that I believed I might have CTS.

It is now five month since developing the issue and it has not resolved. I have been to chiropractors and physiotherapists (hand specialist physios) and massage therapists and I have had various 'guesses' made at my issue. Some think it is CTS whilst others say it is thoracic outlet syndrome or a cervical spine problem.

I am now at the point where I finally got to see a consultant orthopedic surgeon who has ruled out thoracic outlet syndrome and is thinking that I have CTS in both hands. I have just had nerve conduction studies performed (uncomfortable) and i am waiting on results, but the consultant did say that they may not be conclusive and perhaps more investigations will have to be administered. I have had a lot of blood tests and they all come back fine. I got so bad with the symptoms that I started to have panic attacks in the night and sleep has been terrible for a few months. I am having further blood tests but I don't thing they will be abnormal. I eat a truly healthy diet - don't drink or smoke and consume water regularly.

Now then, I want to state an opinion; and that is that that it is dangerous to try and self-diagnose from forums and by following such things as stretching routines that may simply not be right for any particular medical issue. For example I have certainly made my condition worse through performing so called 'nerve flossing' stretches and this has resulted in very irritated nerves all over my body. I would therefore urge anyone with a issue that is not resolving to get to the right medical practitioners on the case as soon as possible. For me that is going to mean x rays and scans and I wish I had done this sooner - put simply - in challenging cases of injury I feel that it needs more than a therapists best guess and I for one have felt like a bit of a guinea pig for some time.

At the moment I am so down with it all that I am doubting if I will ever play again - the symptoms I have are very painful at times and holding things like phones and bags is uncomfortable.
"Never believe what an artist says, only what they do" - Walter Sickert

celestemcc
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Re: Diagnosing injury is hard.

Post by celestemcc » Wed Sep 14, 2016 4:17 pm

Oh gosh, so sorry to hear. A dear friend developed severe arthritis made worse by playing contrabassoon. She finally got a proper diagnosis from a specialist, and surgery, and recovered very well. Keep up hope!
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Jack Douglas
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Re: Diagnosing injury is hard.

Post by Jack Douglas » Wed Sep 14, 2016 8:15 pm

Hi Uptempo,
I'm very sorry for all you have been burdened with, but thank you for reminding all of us that injuries to our hands are best diagnosed and treated by specialists in the medical field. I wish you a positive outcome and hope you will keep us informed of your recovery!
Jack
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uptempo
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Re: Diagnosing injury is hard.

Post by uptempo » Thu Sep 15, 2016 2:58 pm

Thanks

To a certain degree I believe that some injuries will, given time, resolve. But what I have learned is that trying to diagnose injuries is fraught with danger, not least because I feel that it is easy to imagine what could be wrong in too simplistic terms.

As an example, and possibly related to my posture overall; I started performing some lower limb stretches thinking I was stretching the muscles when in fact it turns out I was stretching nerves. This only became apparent when I visited a physio who declared I had adverse neural tension and that I was "neurally tight". He explained (and it has been verified by a consultant) that nerves do not take kindly to overstretching and moreover an overstretched nerve in one part of the body often causes issues in remote areas of the body making diagnosis quite problematic. I guess what I am saying is that it appears that 'things' are connected in ways that we don't often understand and we can therefore be easily led to believe (via internet diagnosis) that what is wrong is a dead certain when in fact it turns out to be so different.

Also, I would like to add my bit about so called 'nerve flossing'. Please, whatever you do, consult a therapist of repute before you embark on any nerve flossing exercises. I learned much to my cost that when you overdo them - either my repetition or by intensity - you can cause some nasty and lasting nerve irritation.

As for my case. Well, who knows what is going to happen. All I know is that my hands and arms are - for want of a better word 'wrecked' and at the moment I can't see the wood for the trees. I can still type and use a computer but it is not comfortable. :cry:
"Never believe what an artist says, only what they do" - Walter Sickert

uptempo
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Re: Diagnosing injury is hard.

Post by uptempo » Mon Sep 26, 2016 2:26 pm

Thought I would update this:

I just got back from the consultant who has said that my nerve conduction tests were negative - meaning that there is no evidence of Carpal Tunnel or in fact any nerve issues. He said my tests were more than normal. He has ordered an MRI scan of my neck -particularly C6 and C7 discs - to check for a pinched nerve or other structural anomalies but he seemed fairly convinced they will be normal too based on my symptoms.

He is leaning towards a diagnosis of unspecified repetitive strain injury and is hinting that I have simply overdone it on the guitar and computer. This is further compounded by postural issues and the fact that I am a self proclaimed tense person because I suffer from anxiety and a lot of tension in the whole body.

It's frustrating because I can't see a way out of this mess. I am playing again, albeit in small bursts and with great attention to relaxation. Maybe in time this will resolve but the enjoyment of playing is somewhat diminished.

If I get a normal MRI scan I think I will invest in a good therapist to help me with my posture because, as previously mentioned, I do feel that I have made matters worse by experimenting with all kinds of stretches that I have either seen on the internet or have been directed to my non medical professionals.
"Never believe what an artist says, only what they do" - Walter Sickert

ipso facto
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Re: Diagnosing injury is hard.

Post by ipso facto » Mon Sep 26, 2016 3:44 pm

Yeah, but diagnosing injury is often hard even for professionals, and in my experience you end up experimenting even if you go that route. The experimentation is probably a bit more focused, of course.

You must be aware of the Alexander Technique already - from the sound of things I think it might be helpful.

I think it is normal to have some strange sensations in the hands if you play even a couple of hours a day.

ronjazz
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Re: Diagnosing injury is hard.

Post by ronjazz » Mon Sep 26, 2016 11:28 pm

Sounds like Alexander technique could be very useful for you.
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uptempo
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Re: Diagnosing injury is hard.

Post by uptempo » Tue Sep 27, 2016 10:44 am

Thanks for the replies.

I guess at least I will know that I have been tested for pretty much everything possible and that I can start to make sense of what happens when you allow tension, poor posture and so forth go unchecked for years on end. Put simply the body will rebel until something is done. I suppose some musicians will get away with it forever, but my research indicates that a very large percentage of musicians sustain quite serious RSI injuries at some point. I believe that a study was conducted in Australia of professional orchestral musicians and that the percentage of those who admitted to playing in pain was something like 70 percent.

At the moment I am playing in very small chunks and with as much relaxation as I can muster. Strangely enough I am enjoying this approach because it is allowing me to be very slow and detailed about how I play. What I am finding is that it is so incredibly easy to allow tension into the playing - not only because of challenging sections and individual bars, but in a general sense as well.

My first injury signs were a weak 'nervy' right hand 'm' finger and it soon got worse. I am now certain that I was playing with far too much force on the strings and that really it is best (for me at least) to start from a position of lightness and learn to increase the volume when I choose (yes I know it's called dynamics). In essence I think I have tried to muscle my way through music - not a good idea.

I will look into the Alexander technique as well. I am aware of it but need to investigate further.
"Never believe what an artist says, only what they do" - Walter Sickert

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Michael.N.
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Re: Diagnosing injury is hard.

Post by Michael.N. » Tue Sep 27, 2016 2:24 pm

Uptempo. I've had more injuries than anyone! Your description of 'tense', 'poor posture' etc. describes me exactly. I can play for two to three months, then I have to lay off for 8 months whilst I recover. The last episode (numb hands) started early January, I didn't feel fit to do anything (let alone guitar playing) for some 5 months. Any activity that I tried seemed to make matters worse. I've had electric shocks (obviously nerve problem), concrete shoulders, wrist pain, hand pain. Thankfully not all at once! Over a couple of decades though. Lengthy bouts of not playing at all, in some cases for years.
Try Alexander (I haven't). You should also do some type of yoga exercise but I can't possibly say whether you should do these in your current physical being. You may have to wait until your condition improves or go to see a specialist and ask them if it's OK to do those type of exercises.
A real common problem for guitarists is the shoulders. We tend to 'fold ourselves' around the instrument, shoulders push forward. Once you start doing that it becomes the 'normal' position. In fact anything else will feel wrong to you. That's what they term a bad habit and can lead to all manner of problems. Practicing doesn't make you better it makes you worse, as the tension becomes more severe. It's a cycle that I've been through many times.
The one exercise that really does seem to be helping me is 'wall angels'. I knew about the exercise several years ago but being a lazy t*** I rarely did them. Now on the advice of a physio I do them several times per day. They were extremely difficult for me to do, still are. I cannot really get my hands fully back to the wall. Things are certainly taking a turn for the better but it's going to take much longer to undo years of poor posture.
I do both of these exercises.

https://www.youtube.com/watch?v=_O0BDba57Lg

https://www.youtube.com/watch?v=LT_dFRnmdGs
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Blador
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Re: Diagnosing injury is hard.

Post by Blador » Wed Sep 28, 2016 2:41 am

Uptempo
Problems with neural dynamics and the symptoms that ensue (numbness, pain, odd and unusual sensations) can be capricious to treat, but not impossible. I hope things are improving for you.

I have 'skin in the game', so if you want to discuss anything over a private message, feel free.
Blaise

uptempo
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Re: Diagnosing injury is hard.

Post by uptempo » Wed Sep 28, 2016 7:05 am

Thanks for the replies.

Michael - Thanks for these videos. I am performing something similar and will run these by my consultant when I see him in a few weeks. I do feel thought that bad posture is behind much of this, because like you, I know that there is an issue with forward head carrigage.

Blador - thanks for the offer - PM on it's way.
"Never believe what an artist says, only what they do" - Walter Sickert

UKsteve
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Re: Diagnosing injury is hard.

Post by UKsteve » Wed Sep 28, 2016 8:40 am

uptempo wrote:Now then, I want to state an opinion; and that is that that it is dangerous to try and self-diagnose from forums and by following such things as stretching routines that may simply not be right for any particular medical issue.
Self-diagnosis is foolish and potentially dangerous unless you are medically trained. That's obvious. Attempting to do so from internet forums, where opinions are from unqualified people who are unregulated, is downright stupid. For example, "stretching routines" in certain circumstances can exacerbate problems and occasionally cause irreversible nerve damage.

I am medically trained and some of the stuff I have read in the "off-topic" sections of forums over the years frankly beggars belief.

If you have a problem, go see a person medically qualified to address the issue who can talk to you, examine you, and investigate you properly.

uptempo
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Re: Diagnosing injury is hard.

Post by uptempo » Wed Sep 28, 2016 3:34 pm

Hi Steve

I do in fact feel foolish that I have indeed tried to diagnose myself only to make matters worse before visiting and consulting various medical professional. I am almost certain that some of the exercises I have performed - especially nerve stretches, or flossing - have made matters worse.

Hopefully, I am now getting somewhere with the professionals although I must say that the consultant I am seeing (extremely well regarded surgeon) is not finding anything wrong with me. This suggest to me that it is muscular and tendons in nature and this is what he is alluding to with his assessment of me.
"Never believe what an artist says, only what they do" - Walter Sickert

uptempo
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Re: Diagnosing injury is hard.

Post by uptempo » Mon Oct 31, 2016 5:01 pm

Update:

I'm at a loss.

I have had a full MRI scan of head and neck and there are no issues of concern save a tiny bit of arthritis in a place that would not cause any nerve sensations. My consultant has, after two sets of Nerve Conduction Studies, ruled out any of the 'tunnel syndromes' or other entrapment of nerves. He has ruled out Thoracic Outlet Syndrome. I am currently having physio from a very experienced guy who has worked with Olympians and orchestral musicians and he feels that my issue is largely posture related - both at the computer and the guitar.

For me, I think I have ulnar nerve irritation because the classic pinky and ring fingers are stiff. Both my hands are now affected to the point where I simply can't play and even typing this is not pleasant.

I have seen a Neurologist who can't find anything wrong and all my blood tests (extensive) have shown nothing untoward.

I have now been discharged as a patient and told there is nothing that can be done for me except perhaps total rest - which I am now undertaking.

I do have an anxiety disorder though and I am getting used to the notion that this is the real issue. Recently I have experienced numerous panic attacks whereby my arms and legs were awash with an overwhelming sensation of numbness and a frozen like sensation. I have had a professional explain to me that this is classic panic disorder and is the body being flooded with adrenalin. I do find it hard to believe that this may the cause of RSI but in the absence of any other explanation I have to accept that this is probably the case.

For the time being my guitar playing has stopped, which is making me pretty depressed.
"Never believe what an artist says, only what they do" - Walter Sickert

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pogmoor
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Re: Diagnosing injury is hard.

Post by pogmoor » Mon Oct 31, 2016 6:15 pm

uptempo wrote:For the time being my guitar playing has stopped, which is making me pretty depressed.
Very sorry to hear it - it sounds like you've had a really grueling time :(
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