Carpal Tunnel Syndrome

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
Steve Langham
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Carpal Tunnel Syndrome

Post by Steve Langham » Tue Aug 18, 2015 4:47 am

I've recently been practising quite a lot and on Sunday night I had these strange feelings in my left hand, near the thumb pad, a bit of numbness, tingling and so on - and the symptons are a little better than Sunday today but it's clearly not quite right. I went to see a physio today and she reckons I have carpal tunnel, not an acute case but still...
I bit depressing and frustrating and so looks like my left hand will need plenty of rest at the moment maybe 4 weeks but who knows.

So, I'm trying to look on the bright side and think of ways I can still practice and do things that when I'm back playing again I will have improved in other areas - I'm a lower intermediate player (I was polishing the Sor Study Bm which probably did it, long periods of barre chords and not having enough breaks) and so I'm after suggestions of what I can do with only the right hand and in other areas.

I'm thinking the following, any feedback on these things or other options would be appreciated:
- Practice my right hand playing, tone/technique - I was thinking I can do this by:
- Guiliani 120 studies on open strings
- Some string crossing i,m - m,a etc up and down the strings on open strings
- Anything else?
- I could even start practisiing some basic tremelo stuff

- I've recently started doing a bit of basic sight reading, what do people think here? Maybe I could keep doing it but just with the right hand, make sure I'm plucking the correct strings? This worthwhile?

- I was thinking I could look over some scores of pieces I want to play and work through them in terms of learning the right hand fingerings and practice this? Not sure how that would go without the feedback of hitting the actual correct notes. What do people think?

Any thoughts would be great,

Thanks

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tormodg
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Re: Carpal Tunnel Syndrome

Post by tormodg » Tue Aug 18, 2015 6:45 am

Not good. Does it hurt every time you press the strings with your left hand? If not, maybe you should warm up thoroughly and play for 5-10 minutes and then do only right hand stuff.

This has been discussed before, maybe you can get some ideas from this old thread:
viewtopic.php?t=65216
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Alan Green
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Re: Carpal Tunnel Syndrome

Post by Alan Green » Tue Aug 18, 2015 6:52 am

chesl73 wrote: I went to see a physio today and she reckons I have carpal tunnel, note an acute case but still...
Take this very carefully - it might not be acute now, but if you continue the abuse of your hands in the same way it will become so. The good news is that you seem to have found out about it early.

This is a perfect opportunity to check lots of body position aspects - make sure your sitting position isn't adding to your discomfort (make sure your hips and knees are at right angles when you sit naturally, for example) , and pay some attention to the exact shape and position of your left arm. I try and achieve as straight a line as possible from my left elbow to my fret hand fingers so that the hand can come round the neck without any part of that arm being stretched or out of position. Use a mirror to check things; you may well be surprised how many things you've been ignoring over the years.

Now is also a good time to reassess your warmup routine. It's not all about speed; we subject our hands to all sorts of stretches and what do not always look like natural shapes and positions when we play. Finger placement, and correct fingering (not always what's on the score) also needs a bit of attention. I don't think it's too outrageous to suggest that very few of us warm up enough before we play; John Williams reckons he runs scales for about 20 minutes at the start of a 3-hour practise session when he has gigs coming up. Resources such as Pumping Nylon, or the 120, or the Bridges "Technique Builder" book provide heaps of right-hand exercises - they do not have to be played fast and when you do start to bring your left hand back into the equation then go back a level or two as part of all this due diligence.

And stop playing if something hurts - I know, we all ignore that one.

So, there is much you can do and it's not all doom and gloom; I'm on Methotrexate (a powerful drug) for rheumatoid arthritis (a condition which redefines what you understand by "intense pain") - I played a wedding reception last Saturday and a Cider Festival the following day. Don't give up.

Steve Langham
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Re: Carpal Tunnel Syndrome

Post by Steve Langham » Tue Aug 18, 2015 7:06 am

Alan Green wrote:
chesl73 wrote: I went to see a physio today and she reckons I have carpal tunnel, note an acute case but still...
Take this very carefully - it might not be acute now, but if you continue the abuse of your hands in the same way it will become so. The good news is that you seem to have found out about it early.
Thanks. With hindsight, I was overdoing it and didn't think that an injury would occur, it happens to other people, not to me!
I will certainly take it very carefully and will completely rest the left hand for as long as it takes and then as you say, will need to re-assess certain aspects of my technique and my approach to practicising.
I can concentrate on my right hand technique now for a while and improve things there at least so I'm not too downhearted about it, such is life, got to get on with it and try and make the best of it in other ways.

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Isabelle Frizac
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Re: Carpal Tunnel Syndrome

Post by Isabelle Frizac » Tue Aug 18, 2015 7:53 am

hello !

The carpal tunnel syndrome is a condition that does not heal, you need to know. :?

When the gene is large (tingling, paresthesia, pain at night), it must operate without delay. :cry:

I have myself been operated with both hands, and I play again with pleasure and without pain or discomfort. A true happiness. :D
I have 61 years, operations were performed in 2011 (right hand) and 2012 (left hand).

We must also learn to play progressively, with exercises to warm up, not to force, and take a break every 30 minutes.

I play the guitar and old instruments (lute, etc.) 3 or 4 hours a day.

:bye:
keep hope !
Bastien Burlot 2014" special anniversary" n°1, Pappalardo 1982, Antonio Ruiz Lopez 1974, and other instruments ...;-)

Steve Langham
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Re: Carpal Tunnel Syndrome

Post by Steve Langham » Tue Aug 18, 2015 9:13 am

My wife had it after the birth of our first child (this is quite common I hear) - her's was a lot worse than what I have and it took maybe 6 months but it did go,

I was hoping for some feedback on what I can do whilst it heals in terms of developing other aspects.

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bear
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Re: Carpal Tunnel Syndrome

Post by bear » Tue Aug 18, 2015 1:30 pm

[media]https://youtu.be/watch?v=B5goXA9MqCA[/media]

This worked for me without surgery. I started the first exercise in bed, lying on my L side pressing my R fingers against the mattress. The mattress has some "give" so it was a little easier at the start.
That was about 25 years ago, no problems since. I still do the exercise every now and then. I have always done push up on my knuckles and I started doing them with a normal hand position and this has also helped (after the CT exercises and the CT symptoms abated).
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OldC1guy
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Re: Carpal Tunnel Syndrome

Post by OldC1guy » Sun Aug 23, 2015 3:47 am

Guitar and old manual typewriters (an Underwood while I was in the Army) started the problem,over 50 years ago, but it finally required surgery in both wrists about 20 years ago. At that time obviously I was on a computer keyboard, which I still attack ferociously to my wife's displeasure, and I was playing 5 string banjo. So I had the surgery, one week for the left, and the right on the following week. I was "grounded" for a while, but the pain was gone. The one lingering problem is still a lack of some feeling in my fingers which causes me to drop things more easily. I've learned to live with that by focusing more on those movements to minimize the drops. The good news is the guitar does not cause any discomfort, and I play better than I ever did. I don't know if that helps, but get the condition verified and treated. It's not going to get better without treatment.
I bought my classical guitar before my first marriage. That didn’t last, but the guitar did; one of the few things she didn't get...

Jack Dawkins

Re: Carpal Tunnel Syndrome

Post by Jack Dawkins » Tue Aug 25, 2015 1:15 pm

chesl73 wrote:I've recently been practising quite a lot and on Sunday night I had these strange feelings in my left hand, near the thumb pad, a bit of numbness, tingling and so on - and the symptons are a little better than Sunday today but it's clearly not quite right. I went to see a physio today and she reckons I have carpal tunnel, not an acute case but still...
I bit depressing and frustrating and so looks like my left hand will need plenty of rest at the moment maybe 4 weeks but who knows.

So, I'm trying to look on the bright side and think of ways I can still practice and do things that when I'm back playing again I will have improved in other areas - I'm a lower intermediate player (I was polishing the Sor Study Bm which probably did it, long periods of barre chords and not having enough breaks) and so I'm after suggestions of what I can do with only the right hand and in other areas.

I'm thinking the following, any feedback on these things or other options would be appreciated:
- Practice my right hand playing, tone/technique - I was thinking I can do this by:
- Guiliani 120 studies on open strings
- Some string crossing i,m - m,a etc up and down the strings on open strings
- Anything else?
- I could even start practisiing some basic tremelo stuff

- I've recently started doing a bit of basic sight reading, what do people think here? Maybe I could keep doing it but just with the right hand, make sure I'm plucking the correct strings? This worthwhile?

- I was thinking I could look over some scores of pieces I want to play and work through them in terms of learning the right hand fingerings and practice this? Not sure how that would go without the feedback of hitting the actual correct notes. What do people think?

Any thoughts would be great,

Thanks
I'm in pretty much exactly the same situation and had the same thought about the Giuliani drills. I might tune to open G, so it doesn't sound so bad without the LH. I hadn't thought of just trying to learn the RH of pieces, but tbh that would require far more self-discipline than I have...

How about getting some drum scores and saying low E is bass drum, G is snare etc, and using it as practice for reading rhythms while keeping the RH in? I'm going to give that a try I think. Maybe put a scrunchie over the strings to make them more percussive.

I guess the other obvious things are ear training and theory, but like you I'm very open to suggestions.

So annoying...

Jack Dawkins

Re: Carpal Tunnel Syndrome

Post by Jack Dawkins » Tue Aug 25, 2015 1:19 pm

bear wrote:[media]https://youtu.be/watch?v=B5goXA9MqCA[/media]

This worked for me without surgery. I started the first exercise in bed, lying on my L side pressing my R fingers against the mattress. The mattress has some "give" so it was a little easier at the start.
That was about 25 years ago, no problems since. I still do the exercise every now and then. I have always done push up on my knuckles and I started doing them with a normal hand position and this has also helped (after the CT exercises and the CT symptoms abated).
Bear, did you do these exercises while you still had symptoms, or did you let them die down first? Mine are pretty mild - wanting to nip it in the bud - but I did read that bending the wrist back increases the pressure in the CT just as much as bending it forward, and I wouldn't want to make it worse.

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bear
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Re: Carpal Tunnel Syndrome

Post by bear » Tue Aug 25, 2015 6:26 pm

Jack Dawkins wrote:
bear wrote:[media]https://youtu.be/watch?v=B5goXA9MqCA[/media]

This worked for me without surgery. I started the first exercise in bed, lying on my L side pressing my R fingers against the mattress. The mattress has some "give" so it was a little easier at the start.
That was about 25 years ago, no problems since. I still do the exercise every now and then. I have always done push up on my knuckles and I started doing them with a normal hand position and this has also helped (after the CT exercises and the CT symptoms abated).
Bear, did you do these exercises while you still had symptoms, or did you let them die down first? Mine are pretty mild - wanting to nip it in the bud - but I did read that bending the wrist back increases the pressure in the CT just as much as bending it forward, and I wouldn't want to make it worse.
Yes, it was a little sensitive at first and I was not able to touch the heel of my hand to the mattress for awhile. This is akin to a stretching exercise. A little at a time. Don't try to get 100% on the first day. After you can do it on the mattress, then try the wall (okay, so it sounds obscene, but the advice is the same).
I have been symptom free for many years. Occasionally, I might feel some tightness especially after blacksmithing and I'll just do the exercise and I can feel the wrist open up and relax. The first exercise in the video is the one that I have always done. Go slow and if you do not experience any relief then I would get it checked out.
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2006 Michele Della Giustina Concert 10 string 650mm ce
2005 Jose Ramirez 4E 650mm ce
2005 Manuel Rodriguez Model C3F 650mm sp
2003 Manuel Rodriguez Model D 650mm ce

Jack Dawkins

Re: Carpal Tunnel Syndrome

Post by Jack Dawkins » Tue Aug 25, 2015 7:09 pm

Well it goes against the grain but I'll be sure to try the mattress first :lol:. Thanks for your advice.

I don't know if this relates to the OP, but I was coming out of the gym earlier and about to grab a 'recovery bar' when it occurred to me that they contain creatine, as does your thinking about maybe going to the gym a bit later shake, your en route pre-workout shake, your workout-workout shake... basically all the supplements that marketing victims - and I include myself in that - are known to take. Creatine causes water retention, water retention is thought to be behind the greater incidence of CTS in pregnant women. Think I will steer clear from now on.

Steve Langham
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Re: Carpal Tunnel Syndrome

Post by Steve Langham » Wed Aug 26, 2015 2:50 am

Jack Dawkins wrote:Well it goes against the grain but I'll be sure to try the mattress first :lol:. Thanks for your advice.

I don't know if this relates to the OP, but I was coming out of the gym earlier and about to grab a 'recovery bar' when it occurred to me that they contain creatine, as does your thinking about maybe going to the gym a bit later shake, your en route pre-workout shake, your workout-workout shake... basically all the supplements that marketing victims - and I include myself in that - are known to take. Creatine causes water retention, water retention is thought to be behind the greater incidence of CTS in pregnant women. Think I will steer clear from now on.
A week later the symptoms are a bit better but still not quite right. It's taking a lot of discipline but I'm just playing RH exercises with open strings and leaving the left hand off the neck. I'd rather try and rest for 3 - 4 weeks and get rid of it than jump back in and have it lingering around. It's quite mild so I'm hoping it won't take more than 3 - 4 weeks. The physio tells me that nerves are very slow to heal and it could take 3 months! All the muscles around my thumb are pretty tight and tender so definitely been overdoing a particular piece that had lots of barre chords and I've been pressing too hard with the thumb and not enough use of the arm. I think I need to re-think my left hand technique a bit and be more aware of tension along my arm, hand, thumb - I can feel many times when I'm playing that my left shoulder for example is a bit hunched up and not that relaxed.

I've been going through the Guiliani studies on open strings, pretty boring but I try and put that to one side and think of the value of it. I've also just been practising very slowly trying to keep the right hand fingers very independent so as one strikes and relaxes and returns back the other fingers do not move (much). I've also been doing some slow tremelo, starting that long journey.
I did actually take a fairly simple piece I like the sound of and learn the first 8 - 12 bars just with my RH, that is tough as you don't get any feedback on it. You have to know the piece and the melody of it very well in your head for this to work I find - as I play slowly the RH I sing in my head, or hum out loud the tune so that I can 'hear' how it sounds. It's hard work though.

I've been reading a bit on music theory and yesterday started a bit of ear training, listening to intervals etc which I am currently hopeless at so lots of room for improvement here (there is a very good app called 'complete ear trainer' on android I've just started to use).

None of the above is a satisfying substitute for actually playing normally but I'm forcing myself to be disciplined so that my longer term ability to play is not affected. Difficult though.

By the way, the physio told me, as per the youtube video above, that this is a good stretch to do as it stretches out the ligaments and nerve as the nerve comes from your spine to your neck and down your arm to your wrist/hand so this helps stretch this all out.

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Re: Carpal Tunnel Syndrome

Post by Philosopherguy » Wed Aug 26, 2015 4:17 am

Not to be a killjoy here. Did you ever get a proper diagnosis from a doctor who did more then just look at the outside of the skin? I don't think they diagnose carpal tunnel from a few days of discomfort in your hand. Guitar playing causes aches and pains when you are doing new things with your muscles and you overwork them; in the same way as your chest hurts if you start to bench press weights and don't regularly do so. Before going through all this and worrying yourself needlessly, it might be good to get a proper diagnosis. I'm sure the physio person is great. However, if that is the only person you are checking with it might be good to get a dr appointment.

From my understanding, I doubt doing barre's on the guitar would give you carpal tunnel unless you already had it and it was just aggravated. Guitar playing might be more likely to cause tendonitis. But, I am no doctor. Only a proper diagnosis can tell you what to do from here and how long to take off.

Maybe reevaluate your left hand technique to use less pressure and better accuracy?

Just a suggestion here! I hope you feel better soon. But, for what it's worth, my hand hurts when I play sometimes too. Sometimes it hurts for a week or more because i was working on something stressful and the muscles get sore and may even cause mild inflammation and all sorts of strange feelings. I just take it easy and relax and work on easier repetoire when this happens and it's all good. No one likes that feeling. But, it's life as you get older!

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Jack Dawkins

Re: Carpal Tunnel Syndrome

Post by Jack Dawkins » Wed Aug 26, 2015 8:17 am

chesl73 wrote:A week later the symptoms are a bit better but still not quite right. It's taking a lot of discipline but I'm just playing RH exercises with open strings and leaving the left hand off the neck. I'd rather try and rest for 3 - 4 weeks and get rid of it than jump back in and have it lingering around. It's quite mild so I'm hoping it won't take more than 3 - 4 weeks. The physio tells me that nerves are very slow to heal and it could take 3 months! All the muscles around my thumb are pretty tight and tender so definitely been overdoing a particular piece that had lots of barre chords and I've been pressing too hard with the thumb and not enough use of the arm. I think I need to re-think my left hand technique a bit and be more aware of tension along my arm, hand, thumb - I can feel many times when I'm playing that my left shoulder for example is a bit hunched up and not that relaxed.
Philosopherguy wrote:From my understanding, I doubt doing barre's on the guitar would give you carpal tunnel unless you already had it and it was just aggravated. Guitar playing might be more likely to cause tendonitis. But, I am no doctor. Only a proper diagnosis can tell you what to do from here and how long to take off.
3 months, ouch... I'll bear that in mind.

From the research I've done and thinking about what was I was doing when it first came on about a month ago, and when it flared up earlier in the week (having almost gone away but not quite), I think what sets it off is moving your fingers while your wrist is flexed to the point where this takes a lot of grunt - so I also doubt it was the bar chords. I'm sure any voluntary tension would make matters worse.

If you look online, the symptoms of CTS are quite different from tendonitis or DOMS, and while it would take a lot of googling to make you into a proper doctor, the tests they use are all described online and can mostly be done at home - so personally I think you can verify it yourself. If there's one thing that makes me sure, it's probably that I have numbness that gets worse at night.

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