Adapting technique to medical issues

[bassybill]

I've just been diagnosed with something called Kienbock's disease, which is a bit of a downer to say the least. One website I found about this said that it makes Carpal Tunnel Syndrome seem like "a piece of cake".

At the moment I have a lot of pain, swelling and weakness in my right wrist and hand. These symptoms were all triggered by a bad fall at work and my right forearm is currently in a cast. But once I get past the prescribed rest period, I would like to get into some gentle exercises to hopefully enable me to keep playing.

I'd be really interested to hear from anyone else here who's had to adjust their playing in response to a medical condition. What did you find useful, how did you cope and what other tips have you got to offer?

Thanks for looking in.

[Soverntear]

After breaking my left wrist & scaphoid i waited till my physio said it was ok to start playing again. from there i took baby steps, infact im still taking baby steps 6 months after my cast is off. if the hand/wrist hurts after you start playing, stop playing. pick it up again later. one good way to look at it is if you physio says do stretchs 5 times a day, play bass 5 times a day (for lets say 15 min) untill you notice strength is returning.

Currently when i play more then 45 min at a time, I make sure I stretch out my wrists/fingers at some point during the session. nothing quite like a hand injury to make you take care of them.

[Ground Pounder]

Rest man, and if you need to be around musicians, be around them.

Injuries are terrible - I broke my left (fretting) hand as a teenager and didn't play for a long, long time because of it. But I stayed musical, stayed around musicians, and stayed around the instrument.

I also learned to play the harmonica a bit while I was at it.

The key is the rest, though. Stick with the PT regime, and talk to your therapist about when it's safe to jump back into a routine.

Good luck!

[bassybill]

Thanks, guys - sounds like solid advice all round. I agree about the being around musicians part. I met up with our trumpet player for a beer last night, and just chatting about the bands we play in and catching up with the musical news really made me feel positive about getting back into this in a determined (but sensible) way.

[WalterBush]

I was diagnosed with erythromelalgia a couple of years back after the accident that ended my electrician's career. For months, I couldn't even fold my own laundry for more than five minutes without painful swelling in my hands and feet. Any attempt at serious work (such as electrical work, or lifting PA cabs) resulted in my hands resembling Mickey Mouse's gloves, except red. I couldn't dance (I played in a cover band at the time, playing dance music) without painkillers thanks to my swelling feet, and even picking up my bass was painful.

Aside from spending a lot of time in prayer, I spent time learning an awful lot about bass setups. I bought the lightest strings I could find for each of my basses, dropped the action, and learned to play with a much, much lighter touch. The result has been that I'm a much better player with much better technique, and little in the way of stress on my hands. My feet still swell up if I'm on them too long, but the act of playing itself no longer triggers swelling since I changed my technique.

My condition's got better over the years, and I'm told it will go away completely with time as long as I don't aggravate it too often. The main thing for me was lightening my rig and making my basses easier to play. That, and completely relearning how to pluck and fret.

When I chopped my fingertip off in an industrial accident, it was a different deal. I was told to not touch an instrument for a month. Two weeks later, I was playing with the three fingers that were intact and trying to ignore the pain I was feeling. The result was again an improvement in my technique, and although my surgeon wasn't thrilled, I didn't tear my "new" fingertip off.

Don't take a diagnosis lying down. The minute you think of quitting or taking it easy, think of what you could do differently, even if it's just an exercise on paper. Keep playing when you can, back off temporarily when you can't.

[JimmyM]

never had to ocercome anything like that, but just wanted to say i hope you feel better, bill. hate to see one of the good ones get slowed down like this, but i got confidence in you...positive outlook is crucial.

[bassybill]

Hey, thanks Jimmy - I certainly agree about the positivity.

[Fergie Fulton]

Hi Bill sorry to hear of the problem, but i will ask if this diagnosis if confirmed as fact with the evidence to back it up.
You have what is called an Avascular Necrosis, the bone has died due to the blood supply failing, due to your injury if that is the case. Other things may complicate the condition of contribute to it.

Just make sure the diagnosis is correct, you must have confidence that this is indeed the case. Seach Avascular Necrosis also search for degenretive wrist conditions. Here is one link on the results of replacement surgury, use it to search for more examples of this procedure.

http://www.jbjs.org.uk/cgi/content/abstract/45-B/1/110

If it it is the Lunate bone for example that is affect seach for Avascular Necrosis of the Lunate. If not that bone use the link below to identify it and search using the bone name.

http://classes.kumc.edu/sah/resource...one/wrist.html

From what i know it seem that it can be fixed, so good luck.

[bassybill]

The X-rays that I saw certainly seem to back up the diagnosis. Lunate bone shows up whiter than normal and seems much reduced in size compared to a normal wrist. This hasn't been caused by the recent injury of course, but has taken place over years and years. The recent smack to the wrist has just triggered all the symptoms I'm struggling with now - swelling, pain, weakness of the whole right hand, lack of movement... even typing this out is more difficult than it should be.

[Fergie Fulton]

Originally Posted by bassybill

The X-rays that I saw certainly seem to back up the diagnosis. Lunate bone shows up whiter than normal and seems much reduced in size compared to a normal wrist. This hasn't been caused by the recent injury of course, but has taken place over years and years. The recent smack to the wrist has just triggered all the symptoms I'm struggling with now - swelling, pain, weakness of the whole right hand, lack of movement... even typing this out is more difficult than it should be.

Not to cast doubt but osteoporosis occurs when bone is broken down and not enough new bone material is made. Over time, bone is said to be lost because it's not being replaced. Bones become smaller and weaker and can easily break if someone with osteoporosis is injured this can show up as a whitening because the minerals needed to repace bone are deficient.
Again i do not know any of your medical history and i do not want to send you off on wild goose chases, but your symtoms for an Avascular Necrosis of the lunute would have been shown to you before the latest incident.
I do not wish to turn you in to a hypocondriact, but if it were me i would want to be sure for definate that this is the correct diagnosis, so i would ask some more questions (you may already have) to find out why this diagnosis is considered valid.
I appreciate the medical systems vary from country to country and this could be a costly process if you are paying for treatment, so you need to call it as you see it.
If you need any advice on re-hab towards the playing side drop me a PM and i'll see if i can help. Again sorry to hear and good luck.

[bassybill]

It's definitely something that's been brewing for a while, even though I was totally unaware of it until last week. But my reading up on this has confirmed that what the doc has said is undoubtedly right.

Anyway, back on topic... wrist exercises? Let's hear them.

[fdeck]

When you do get back on your horse, lighten up on the gear and get help moving it. I work with a lot of older guys, and it's just taken for granted that we help one another with gear.

[Fergie Fulton]

Any programme has to address the complete issue of hand use, you use your hands for more than just playing so there has to be a balance in what you do. I would look at what your hand does for you and how you use it in daily life. Sometimes player think they are exercising or playing correctly, but the hand use for that day may have left it weak and tired, impacting on them negatively in playing and exercise.
Stretching is always recommeded as are slow low impact moves.
Talk all this over with your physio people, tell them you play so they can understand the needs of your playing and address them... after they have got your wrist to an acceptable standard of fitness for daily life.
Drop me a PM if you want any futher info.

[bassybill]

UPDATE from a bassist who's feeling sorry for himself and wants some sympathy from his bass brothers and sisters.

Bad news from the hospital...

This hurts like hell, dammit!

[ausf]

I hear ya and feel your pain.

After about a year of getting back into playing I started developing numbness and tightness in my wrists. I thought it was the onset of carpal problems and concentrated on technique a bit more. It started to get worse with a burning in my wrists, thumbs would go numb and I realized I had a loss of sensation in my hands.

Turns out I have scar tissue ('that I wish you saw', sorry, RHCP reference) on my spinal cord that is causing a collection of fluid. The problem with my hands and bass playing was actually because of the way I was sitting. My cord has attached itself to the dura, so if I bend my neck or back too much it brings on symptoms. No solution short of surgery that has a very low success rate. So it's basically 'deal with it'.

So, I only playing standing up now. It actually helps if something else has set off symptoms, an hour or so and I feel better. It's kind of brought bass into a more prominent position in my life than it used to be, it's like physical therapy. It's also very weird, the more I practice the better I'm getting of course, but whether it's the strengthening of the fingers or the loss of sensation (or both), my hands are flying but it doesn't seem like they're mine. I just see two hands doing stuff they never could before, but effortlessly.

A lot of other things are associated with it, I don't get the normal feedback from my legs and can't feel my feet. So, except for not being able to jump around and bend my neck a lot on stage and stumbling a lot (or just plain falling over in the dark) I'm good to go. I'm 45, I'm not head banging or dealing with light shows anymore, so it's not really an issue. Although I'm not sure if anyone wants to watch Flea being covered by a guy leaning on a stool.

Long and short of it: you can overcome a lot by being creative and thinking it out. Find a PT or OT who is familiar with both your condition and what you want to do. Ask questions, get info and utmost, be patient. Don't get discouraged. Instead of falling into a funk, get yer ass up and play it.

If you have any questions, don't hesitate to PM or post 'em.

[mndean]

I have nerve damage in both arms. In each, my pinkie and third finger are somewhat numb and don't respond as quickly as they should (nerve tests show a delayed signal). It limits my ability to play fast. I can have surgery, but the surgery itself can cause nerve damage, may not work, so I passed on it twice. I have to learn to live with it and adapt. It shouldn't and hasn't been getting any worse, but there are moves that are totally out of the question no matter how hard I practice. I'm not discouraged, I just work right up to the edge of my speed. I may have to use nothing but quarter and eighth notes on really fast songs, but that's just the way it is. I'm not doing this as a profession - if I were, then I'd be discouraged.

[JimmyM]

dang bill, sorry. never had the cortisone shots but i hear they work really well short term. keep fighting, bro...hope it lets up.

[IvanMike]

woah i feel your pain.

big question (didn't read the injury thread yet) - you play righty or lefty?

If you play righty that's good news. My elbow injury was 11 months ago and is still screwy. Thankfully it's the right and i play righty. Still some ulnar nerve pain and numbness and general pain all the time and a bit worse when playing. First gig was ten days or so after the fall (ouch).

As long as you play right handed you can compensate for most anomalies, if you're doing upright it will be a lot harder, but a brace might help. Finger mobility is a bigger issue. does the condition screw with that?

good luck mate, and keep a postitive outlook. I was wigging my fingers post surgery to see how they were and when my wife fell asleep i snuck into the den an picked up the axe with my cast on to see if i could still play! (note - not a good idea )

[bassybill]

Just been having some attempt at practice - I'm okay at 120 bpm on eighth notes with a fairly light touch. Still, that's where all the money is, right?

I'm a righty and it's the right wrist that's damaged, btw. I agree, if it was the left I'd be royally screwed.

[IvanMike]

Originally Posted by bassybill

Just been having some attempt at practice - I'm okay at 120 bpm on eighth notes with a fairly light touch. Still, that's where all the money is, right?

I'm a righty and it's the right wrist that's damaged, btw. I agree, if it was the left I'd be royally screwed.

that is an understatement. Even though It's my elbow and not wrist, i never could have started playing (and maybe still would have issues) If it was my left. (Don't tell my doc, but after surgery # 2 I took the dressing off after a week to play a gig, and then carefully put it back on) -