doomed to tendinitis?

[JimmyTheSaint]

I suddenly developed really bad tendinitis in my left shoulder. The accompanying muscle spasm extends from my shoulder to my upper forearm, restricting the range of motion, and making my left arm almost completely unusable for everyday purposes and movements. The hell of it is that I can still play the bass with no problem because my upper left arm is fairly static while playing. In fact, it's precisely this static tension that causes the tendinitis. I have plenty of experience with types of tendinitis that prevent a wide range of activities but that still allow the root cause activity. And in this case, within a day or two of stopping playing bass, my problem reduced substantially, although it's still moderately debilitating. So there's no question that playing bass is the root cause.

My question here regards the inherent tension in bass technique: there is simply no way to eliminate a certain minimum of tension required to hold your left arm up, right? With the help of professionals, I've developed good techniques for other activities and instruments. With bass, I play short scale exclusively and always play sitting down attending closely to posture. I rest the bass on my left leg. In this position, my left arm doesn't support anything but its own weight. And still I've got the heartbreak of tendinitis. I can't put the bass on my right leg because putting it on my left is how I eliminated problems with my right arm. So it looks like my left arm simply cannot statically support its own weight over extended periods of time (while the fingers and hand move) without developing RSI. It looks to me like my body simply can't handle the bass's geometry--and I'm PISSED.

I'm out of ideas as to how to fix this. I mean, apparently I can continue to play bass, but at the cost of sacrificing my left arm for everything else. There's no way I'm going to live a one-armed life by choice. Before I commit to going all-keyboard (and if you heard my piano playing, you'd be pissed), are there any hail Mary ideas regarding bass?

[lowendgenerator]

Learn to play lefty?

[skychief]

you can have a harness cobbled for you that will support the bass AND your left arm---something that will shift the weight to your upper torso and/or waist. Your left arm can kinda hang from the neck and the tendonitis will no longer inhibit your playing the bass. A good physical therapist can help design one for you. Yah, it might look funky, but the only alternative i can see for you is to ditch the bass. Not a pretty sight.

[JimmyTheSaint]

Originally Posted by lowendgenerator

Learn to play lefty?

funnily enough, when I first started at 18 I realized I had a free choice between playing right or left handed. It would have made no difference as my right wrist, elbow, and shoulder have all proven equally prone to tendinitis.

The harness is truly a hail Mary--thanks. Believe it or not, I used to use an unsightly but functional harness to play the flute. Otherwise, the points of contact would make my left index finger and right thumb go numb. Then I discovered for sale the Flute Bo Peep, which worked great. I need a Bass Bo Peep.

[Fergie Fulton]

It sound like you have a rotator cuff issue a common agitator for tendinitis in that area.

Have you been diagnosed with tendinitis or is it tendonosis?

I only ask so to be clear about what is happening. The two are often confused in pronounciation with people beliving it is one and the same thing just said different.

There are some great straps and harnesses out there for bass including free stands that will support the instrument from the ground. i'm sure a search will bring up results that may interest you.

As for management, i sure you know the situation and i would hope have a regime in place that includes stretches, warm ups and warm downs and some ice treatments for good measure.

There are some good medical trials on the subject that are showing interesting results in trials one of which is Autologous Blood Injections, if you search on that term you may come up with some info that may interest you. Point of fact that trials need volunters, so there may be one near you that may consider you if your profile fits.

Below is an extract from a cyclist that used the treatment back in 2006. It was about this time that there were a lot of trials and as of yet i have still to read that it is a conclusive treatment, so i would assume trials are still on going.

Re: Autologous Blood Injections for patella tendonitis/tendonosis
« Reply #8 on: June 03, 2006, 01:01:44 PM »

--- Posted today on a cycling forum ---

I'm feeling rather smugly self satisfied after a nice ride around the Surrey Hills this morning. I did 40 or so miles in about 2hr 40mins, including the hill up to Newlands Corner in both directions - eg on the way out and on the way back. I used my granny ring but managed to stay in the saddle and spin my way up the climb without stopping.

Not impressive for many on here I know, but 9 months ago I thought I'd come to the end of my sporting life at the age of 37. With both knees crippled through Patellar Tendinosis I was barely able to walk. I knew that things had become desperate when I was unable to break into a trot fast enough to catch my 3 year old niece as she ran merrily toward a busy road. On a weekend trip to Venice last July my left knee gave way and buckled under me several times causing to me fall in such pain that passers by thought I was having a heart attack.

By the end of last summer I had lost so much muscle from my left quad that I could encircle my thigh with 2 hands, thumbs and fingers touching. I remember walking around a hosepipe lying flat on the lawn rather than trying to step over it.

In September I joined a clinical trial involving multiple 'autologous blood injections' directly into the fabric of both tendons below the knee cap, repeated over a 2 month period. Yes, this is/was as excruciatingly painful as it sounds! The treatment included a detailed 6 month rehab protocol which - if followed to the letter - gave a small chance of avoiding further injections. No more incentive needed believe me.

At the beginning of November I went back to the gym for the first time in 18 months. My first target was to complete 10 mins on an exercise bike set to minimum resistance. This was not a sure thing! Over time, the program gradually upped the loading on my tendons accompanied with a lot of stretching to cause the (hopefully) regenerating fibres to align themselves effectively and with the appropriate elasticity.

By the end of March I had recovered enough that my gym sessions looked like exercise not rehab, and I had begun to regain some aerobic fitness and lose some of the weight I'd inevitably added.

In April I was told that cycling (spinning not grinding) was a good low impact exercise to help me regain quad condition and fitness. So I went and bought myself a nice bike - Specialized Roubaix Expert Triple - with a granny ring. I hadn't owned / ridden a bike for about 15 years so this was all new to me.

After 6 or 7 weeks of shorter (upto 20m) flattish rides, I decided today to try a longer route and to include the nearest thing to a hill locally - Newlands corner.

Hence I am a slightly self satisified smug thing this morning!

I've posted this because there have been a few posts recently from people taking up cycling to lose weight or to recover from injuries. I thought that my story might offer some encouragement - specifically that real progress is possible within a timescale of months not years if you are determined.

Next goal for me is to complete a century ride by the end of this summer....

[Terracite]

Jimmy,

I'm not a doc or nothin, but from powerlifting, I do have real experience.

You need to talk to someone in person who knows what they are talking about.


Like Fergie was saying, tendonosis and tendonitis have very similar symptoms. But the cures for each are very different, and the wrong one will make it worse.

Also, the shoulder is very complex and can cause pain in lotsa ways. You need to know where the problem is. Could be moving muscles (front/side delts, lats/traps etc.) could be stabilizers (traps again, rear delts, or rotator cuff) and their associated ligaments. Maybe it's an arthitic condition?

Until you can see a PT, here's a couple ideas:
You've said you get better if you back off the bass for a few days. Often with tendonitis, you need to lay off whatever is causing the pain. Try a week or two. Seems like a long time, but not as long as quitting forever. If you have tendonosis, rest will make it worse.

If rest doesn't do it, then look at tendonosis. In this case you work out whatever is causing the pain with high rep low resistance exercises, and can hurt a little at first. But you have to know what to target, and this might take some experimenting. If you have tendonitis, doing extra movement will make it worse.

Could also be an arthitic condition, maybe a sprain, or other things too.

You can probably work through this, and there maybe a simple cure, but finding it through a forum is a bit of long shot.

Talk to a friend that is serious about weightlifting if PT's are not an option. Martial arts guys also love to talk about this stuff, and generally know their, um, stuff.

Good luck!

[JimmyTheSaint]

Thanks for all the well thought out advice. Due to the history and the symptoms, -itis is a virtual certainty. My follow-up appointment with the orthopedist is in a few days, and I'll sound him out about the possibility of -osis. His current plan is to blitz my shoulder with a week of total inactivity, two non-steroidal anti-inflammatories, and a muscle relaxant. I haven't treated this with drugs since two (non-bass related) cortisone shots in my wrists when I was 18. It's an orthopedist, not a chiropractor, hence the drugs, but chiropractors were also rather limited in the face of tendinitis. We'll see where I stand in a few days (I'm resisting the urge to "test").

Right-o on the weight training: working with chiropractor/sports physiologists we developed a routine that I've been using for about 13 years with no problems. I basically do the maximum weight possible without a spotter in conjunction with some isometrics for balance and chiropractic health. I've always been fanatical about good posture and weight training to protect against injury, which is what makes this tendinitis so frickin frustrating. In the last couple of weeks, I had to reduce my bench press from 160lbs. to 130lbs. because it had become excruciating around the middle of the motion. Shoulder press likewise needed to be reduced from 100lbs to 80lbs, but other than that I've been able to tough it out through the rest of my routine. Problem is, toughing it out only aggravates tendinitis. Even when the doctor advises against it, I plan to go back to weight training when I quit bass. The overall health benefit will be worth it if weight training only slows down the healing process rather than preventing it; my experience has always been that I can keep doing previous activities as long as I cut out the root cause, and within six months I'll be back to normal.

That's why the harness ideas won't help here: with my sitting/left leg technique, the left arm supports no weight but its own. The problem is that the left arm extends just far enough, and fretting a fingerboard requires just enough torsion that it inevitably results in an RSI for me. I just don't see any way to compensate for the bass's geometry. I think I'm on this board just looking for commiseration before I give my gear away. Waah. Happily, I never went and put a down payment on that short scale Alembic custom design I've always had in mind. Short scale options are so limited, and inexpensive Chinese imports (Flea and SX) have always sufficed, so I'll just give my gear to some students and retire from this board.

[powerbass]

Sounds like you have a good support system to help you figure this out. You may want to consult a bass teacher that has experience with injuries and proper technique. Healthy shoulders rely on good thoracic and cervical spine alignment - if you slump and round your shoulders while playing the rotator cuff and biceps tendon has to work even harder to stabilize and move the shoulder. While bench pressing and overhead pressing might be good exercises for healthy shoulders these exercises can create shoulder injuries - a well rounded shoulder strength training routine needs to include rotator cuff exercises as well as back (pulling) exercises. What I'm getting at is treating symptoms is a good thing, why injuries occur is another kettle of fish. If you don't resolve why this happened it will happen again.

[TomB]

I'm a rheumatoid arthritis sufferer, and tendinitis tends to come with the package. I've had long-term (if not permanent) success with judiciously-used cortisone shots administered by my rheumatologist. Is this the direction your orthopedist is headed? If so, I wouldn't be afraid to try it, at least once in the affected location (not more than twice, is my doc's belief). The pain (and swelling) is increased for about two weeks following the injection, so don't be misled; relief (in my circumstances anyway) has followed each time.

It may sound crazy, but try a longer scale bass as well, if you haven't lately. I recently discovered that most of my issues were actually aggravated by the short scale... not sure why, but I'm back to using only long-scale successfully. I know our circumstances are different, but what have you got to lose?

Best of luck!

[Steve Clark]

You may go through several RMTs trying to find the one that works for you but it's worth trying to find a good one. I had a similar issue and was heading for not playing at all because the pain on a gig was really intense especially on double bass gigs.

I see him regularly now and he keeps me playing through massage, acupuncture and whatever remedies he wants to try. Someone mentioned rotator cuff area and that where my issue is based but it can reach all the way down to fingers. At 45 I'm also making an effort to eat better and exercise more. Yoga has made a big difference in my life as well.

My arm has very mild flares from time to time but nothing like what I had before. He now works on the rest of shoulder and back.

[JimmyTheSaint]

All good suggestions of course, a lot of common sense. Yes, my upper body routine includes two more posterior and anterior deltoid exercises and two rotator exercises using Therabands. I should have mentioned that I don't depend on playing bass for a living, so that makes a big difference in what kind of course I'd actually pursue. A long exploratory process with an M.D. is a big time and money investment. And I've always been taught to fear cortisone shots due to the risk of inducing bone degeneration and arthritis. After I got the ones in my wrists at 18, I cut out the offending activity (wrist curls) permanently so that I'd never risk the need for more cortisone. If I was a pro athlete, sure, I'd live a life of cortisone and pain and then retire a zillionaire at 40 and laugh at any lingering disabilities all the way to the bank. As it stands, though, I have to put a premium on normal everyday use, and the continued ability to do maintenance weight training to maintain good health. If just plain old time off the bass cures this within a year, I think I'll be too gun shy to risk picking up the bass again because this time the tendinitis, weirdly, went from zero to 60 overnight. I may be able to play regular guitar because I rest that on my right leg, and with the shorter scale the left arm doesn't extend nearly as far. But that's not a whole lot of use since I suck on guitar.

[Indiana Mike]

I was told for ten years by doctors that my shoulder and arm pain was caused by muscle issues , tendinitis issues , arthritis , etc...and was told to learn to live with it ...

turns out it was nerve issues in my neck ...

had c6 & 7 fused , bone spurs removed and disk removed ... I haven't felt this good in years ...

Go see a GOOD doctor that will listen to you....

[JimmyTheSaint]

True enough: this orthopedist was one of those quick diagnosis types. I would think if my situation resists his advice that, being a traditional M.D., he'd soon order an MRI to see if there's any obvious physical damage of the kind you describe. My pattern does fit tendinitis better, and I can't say that the need for surgery (on my vertebrae, for God's sake!) would be a relief if the tendinitis was permanently avoided by simply cutting out the offending activity. It's good to hear that your situation worked out so well.

[fu22ba55]

Originally Posted by JimmyTheSaint

this orthopedist was one of those quick diagnosis types.

Dude, I'd get to a real doctor before you do anything rash (selling all your gear, etc..)

I'm > 40 and I've had a ton of muscle issues over the years in both arms.

I don't think tendinitis develops "suddenly". That's not its M.O.

Look into Frozen Shoulder, Impingement Syndrome, etc... that's what I had. Yours sounds like rotator cuff stuff, and bass playing is not the root cause... just making the problem worse.

Injections are a last resort and can do more harm than good. Long-term PT with therabands is the way to go. I had to do 6 months of PT twice a day to get usage of my arm back.

Go see a real orthopedist who specializes in sports, dance or music related issues, and get an MRI for sure.

Worst case, start playing standup. That'll get the left arm movin' a bit.

[JimmyTheSaint]

Right, it's the lack of movement in the upper left arm that causes the problem, I think, but no way I can play standing: Sitting was already the cure for other back and neck issues. Impingement does seem like a possibility. I'm not as familiar with rotator pain's characteristics. My sharp pain is totally localized under the anterior deltoid, accompanied by a muscle spasm down to my upper forearm. I thought rotator issues are felt toward the back not the front? I'll pin the doctor down at the next visit.

I told him the pain was in front, so it looks like the orthopedist is spending the first week having me take anti-inflammatories to see if it's really tendinitis or not. It's a very reasonable possibility because the muscle spasm accompanies the inflamed tendon as the body's way of immobilizing the inflamed area. Seeing as how the pain has lessened with rest and the medication, it looks like he's right. But I don't want to test the range of motion until I've completed the week of prescribed rest and meds.

Technically, you may be right about the root cause: I had a longstanding, on and off, but slight loss of range of motion for some time. Perhaps it's due to weight training and then the bass suddenly sent it off the charts. I think that still leaves me in the same position: bass will still cause an acute condition even if I cut out the weight training. And the weight training is necessary for long term health, so once again I'm stuck.

I should add: tendinitis has gone from zero to 60 for me before, in my wrists. Then, it was easy to pinpoint it to doing wrist curls. Yes, I'd been doing them for some time, but I had no pain or symptoms at all until one morning I woke up with an immobile wrist, which was just plain weird and scary. A few weeks later, the other wrist. No doubt the condition builds up over time, but my experience is that the perceived pain and loss of range of motion can suddenly manifest like some kind of evil magic.

[N.F.A.]

May I suggest finding a good medical massage therapist? I work as one part time, plus I teach it at a local massage school and can tell you that having someone work your muscles might relieve your problem. Doctors go with what they know/ are trained for. It is a rare one who knows the benefit of a good massage. Let me stress I am talking about a pain relief type therapist, not someone at a spa. Wish you lived closer...
PM me if you wish, I can give you some suggestions for stretches, etc.

[Ed Storer]

Cheap solution:

I had tendonitis in my right arm from playing golf. I purchased a $8 copper bracelet at the golf shop and wear it 24/7. The pain cleared in about 2 weeks. I've been wearing it for about 10 years and have occasional flare ups, but they seem to pass in a day or two.

Costs very little to try. No side effects - other than the easily washed green copper oxide when you sweat.

[JimmyTheSaint]

I've heard of the copper thing before, but I'd definitely go for the massage therapy first. My chiropractors also engaged in some massage therapy (for trigger points), and since then I've been able to fix my own trigger points (with a Thera Cane, if you know what that is). In fact, right now I seem to be quite clear of trigger points in the scapula area. If it's truly tendinitis, massage won't help, and in fact this orthopedist said not to massage it until my next visit. I get why you shouldn't massage an inflamed tendon, but I don't see why massage therapy wouldn't be appropriate for the rest of the arm's muscle spasm.

[JimmyTheSaint]

The one week rest/anti-inflammatory/muscle relaxant bomb improved things a bit, but on the return visit the doctor said the standard prescription around here is 100 days of inactivity. He also decided, after a couple of range of motion tests and an x-ray, that it's impingement just as fu22ba55 described above. In my case, that's basically inflammation of the shoulder tendon with the accompanying muscle spasm. He prescribed a non-steroid anti-inflammatory patch, which is better than eating lots of medicine, but I think that's just to cover the pain and doesn't speed up the recovery. We went over my weight lifting routine and because he agreed as to the health benefits of working out as opposed to total inactivity, he said just do whatever doesn't hurt, adjusting the load as necessary. Since weight training exercises are short and get all your attention, he agreed that it shouldn't be a problem as long as the exercise doesn't hurt.

But he particularly bummed out on the guitar playing since RSI-based damage is so much more sneaky and there's no identifiable moment of traumatic injury. He said to limit the bass playing to 30 minutes or less. To be realistic, that's practically a death sentence to my bass, and I think 30 minutes will still lead to problems over the long run, but I guess I won't liquidate just yet. I haven't touched the bass for 60 days, and I think I'll make that a full six months before I pick it up again. But with the 30 minutes or less limit--what I call the Domino Theory--it does look like I'm all but retired from bassing. I mean, even being careful I went from very slight symptoms to total debilitation overnight, and living with that kind of risk is a little too fearful.