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Shoulder Pain

QUESTION:

I developed tendonitis from overuse of my right shoulder doing my cello practice --This was almost a year ago - -I have tried many things (chiro, phys therapy, pain relievers...) nothing has been successful.

I don't want to quit cello for life! Any ideas on possible remedies? Any resources on the Net that might help? I am not a fan of surgery - I hope it doesn't come down to that!

John Martindale

1. Charles Replies

Try the Alexander Technique. Type in these words (in a search engine?) and you will get lots of info on the subject. It is not a quick remedy but it will help."

2. Shannon Replies:

Every teacher will have their own thoughts on how to prevent tension as you play, but there isn't a single technique that can boast 100% success in eliminating these injuries in everyone who's given it a fair shot. Your problem may be your teacher (I'm assuming you're a student, sorry if you're not!) or perhaps in how well you listen to your teacher : - ) In which case a change of teacher or a change of heart would make a world of difference. Another thing to think about is how well you are taking care of yourself. There are a lot of theories out there about Repetitive Strain Injury. Fortunately, as computers are taking over the job industry, more people are winding up victims of RSI and are finally getting this problem the attention it needs for some solid research and treatments. Some of what these specialists are finding is pretty surprising and relates just as well to our feild as musicians as it does to those who work at a computer all day. BASIC factors such as diet and sleep impact your body's tolerance to strain enormously.

If you want a good, informative read on RSI, I recommend Repetitive Strain Injury, A Computer User's Guide by Emil Pascarelli, MD and Deborah Quilter. It is written for computer users, but the doctor who co authored actually has a clininc that specializes in helping musicians recover from RSI, as the injuries in these two fields are caused by similar motions. The book's ISBN if you want to order it is 0 - 471 - 59533 - 0 and is published by John Wiley & Sons, Inc.

Here are a few things you might want to consider if you haven't heard it already from one of your doctors. Basically what it boils down to is taking care of yourself. Being a musician is a lot like being an athlete in that along with the practice hours you put in, you MUST be willing to put in an equal amount of care for your fitness and nutrition. We depend on our bodies as an athlete depends on theirs and we HAVE to take care of it. Read on...

a) have you tried to isolate what the source of your pain is? I mean, is it possible you have a slight curviture of the spine, or some irregularities in skeletal structure (ribs, perhaps)? It sounds weird, but you won't believe what a good specialist can find just from a basic x-ray! If your chiropractor and physical therapist can't help you, go to someone who can, perhaps a hand specialist? In any case, basic irregularities or imbalances with your back, hips, ribs, neck, etc. can cause some muscles to tighten in your shoulders, chest, back, etc. that can lead to tendonitis and other strain injuries.

b) Diet and exercise can also have a lot to do with repetitive strain injuries. A high fat diet, a diet that isn't complete with all of the necessary vitamins (especially B vitamins), and a lifestyle that doesn't allow enough time for a proper exercise routine can all contribute to strain injuries like yours.

c) Basic habits and attitudes are also a culprit for some who suffer from strain injuries. Poor posture, chronic tension in your hands or your jaw or your shoulders, etc. are problems for obvious reasons. Also, if for some reason your cello is really stressing you out, or you're working at a job that is stressful or you just can't stand to be there, you are setting yourself up for some serious tension. Also if you drink excessively or smoke or you're not getting enough water or sleep, you may be aggravating your injury even more.

My advice to you is to stay away from surgury. Too many risks, too many unqualified or overanxious surgeons out there waiting for the unsuspecting RSI sufferer to come along. Those of you who support surgury as a viable solution for everybody (or if there are any hand surgeons out there reading this) can flame me personally for my frankness (don't clutter the message board on my account), but I've seen this happen too many times to apologize for my scepticism. For many, surgury may really be the only option left, but just because your doctor says so doesn't mean you should go out and get it without getting another opinion first! So, this may be the longest post in message board history, but I hope I opened some up some new vistas for you to explore. And I really do want you to read that book, it's a good read. Good luck!

3. Victor Sazer Replies

Shoulder injuries are high frequency problems among cellists. Improper use rather than overuse usually cause them. Turning your upper arm inward (pronating) or raising your shoulder as you play can damage your shoulder joint (rotator cuff). Cellists can be observed doing one or both of these things, particularly when playing on the A string.

The solution may be to change the way you sit, hold you cello and align and use your body when you play. I believe that the traditional way of holding the cello tends to induce the kind of problem you have. Cellists also have the highest incidence of back problems of any group of musicians and this too is largely caused by faulty sitting habits. The up side is that is quite simple to adopt more healthful ways of sitting and improve body use. When your body is properly balanced and aligned, you are able to address all of your strings without doing anything that can hurt you.

You might find some helpful information in New Directions in Cello Playing, subtitled How to Make Cello Playing Easier and Play Without Pain. You might also check out the interview that Tim Finholt did with me for some alternative ideas. It can be found on this ICS website.

4. Victor Sazer's Additional Comments

Another specific thing that can put a strain on your shoulder is leaning forward as you play. I don’t know whether you do this or not, but try the following experiment:

Raise and lower your arms while standing or sitting erect with both arms extended in front of your body. Then continue to raise and lower your arms as you lean your trunk forward. Do your arms feel heavier when you lean forward? Do you feel the strain on your shoulders as well?

This shows how important the alignment of your body is in preventing pain. In addition, when you lean forward your body is out of balance because you put some of your weight in front of your center of gravity. If you release your back and abdominal muscles while in this position, you will fall forward. So, leaning forward forces you to use (wasted) muscle power just to keep from falling forward. This creates uneeded tension before you even begin to play.

Some therepists tend to attribute all or most performance-related injury to overuse assuming that the way you play is the only way to do it. I think it is more accurate to charactarize the main cause of pain as improper use rather than overuse. Repetative motions can be one of many causes, but even these are not the same. There are significant variables in addition to the frequency of repeated movements. Vibrato is an example of repetative motion that actually releases stress rather than inducing it. By exploring alternatives you can find ways to feel better and play better.

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