Tendon Injury Overview

[powerbass]

Hello fellow TBers. I am a massage therapist, corrective exercise specialist and a bass player. I have read several posts about tendon pain and I thought I would make my own post about my experiences treating this condition. In general the diagnosis of tendonitis is often a default diagnosis w/out specific findings. itis means inflammation and in general inflammation is a short lived phase of healing as the result of an acute overload or tear in muscle/tendon/ligament tissue. The course of treatment: ice, rest, cortisone injections may help in the acute phase but long term, chronic tendon pain is usually from significant tearing and degeneration of the tendons without a significant inflammatory process. Tendonosis is the term applied to tendon degeneration and the course of treatment is very different depending on tendonosis or tendonitis. A lot of time and money will be wasted treating inflammation if the real issue is tearing and degeneration. If you have been experiencing significant tendon pain for longer than a month then I would have it checked out by the best physical therapists/MD/sports medicine doc etc. in your region. If any one is interested I can continue this thread w/ specific anatomy and self treatment techniques.

[EggnogJunkie]

This is interesting and relevant. Hope it doesn't get buried...

[Sundogue]

Very cool to have a therapist on board!

Between my chiropractor and my massage therapist, my tendinitis problems are completely gone.

Is there a therapist in the house?

[Commreman]

There have been a ton of threads on this topic in the last couple of months. Perhaps the mods can merge them and turn it into an ongoing "sticky." We as a community can all benefit from them, as tendinitis and wrist/hand injuries are a very real occupational hazard for us.

[Fergie Fulton]

Originally Posted by Commreman

There have been a ton of threads on this topic in the last couple of months. Perhaps the mods can merge them and turn it into an ongoing "sticky." We as a community can all benefit from them, as tendinitis and wrist/hand injuries are a very real occupational hazard for us.

+1 they are becoming more frequent the threads, but the advice is still the same. seek profesional medical help for problems. Lots of symptoms look and sound the same, but their diagnosis and treatment is and should be case specific.

[rygon]

ive just lateley started having theis problem in my left wrist. what options of self treatment besides bracing, ibuprofen, stretches, and ice are there?
the worst part is im only 15 and already getting problems...

[powerbass]

Originally Posted by Commreman

There have been a ton of threads on this topic in the last couple of months. Perhaps the mods can merge them and turn it into an ongoing "sticky." We as a community can all benefit from them, as tendinitis and wrist/hand injuries are a very real occupational hazard for us.

I agree an ongoing thread is a good idea that is why I made this post to see if there was some interest.

[powerbass]

Originally Posted by Fergie Fulton

+1 they are becoming more frequent the threads, but the advice is still the same. seek profesional medical help for problems. Lots of symptoms look and sound the same, but their diagnosis and treatment is and should be case specific.

Even medical pros don't agree on what is the best course of treatment for tendon pain - especially since many health folks still are operating on the inflammation (itis) model. Cortisone injections, rest and ice used to be the standard treatment. That approach is slowly changing now that there is a growing body of research that points in the tendonosis direction.

[powerbass]

Most tendon pain associated w/bass playing is a repetitive strain injury. This means that over a period of time the tendons become subjected to a level of stress that causes micro tearing/trauma. The natural healing process requires rest to repair damaged tissue. With prolonged repetitive practice, playing, gigging and work activities (computer, manual labor etc) the tendons are not allowed to repair adequately. These small tears happen often w/out a significant amount of inflammation - though inflammation may play a role though to a lesser degree. Eventually the tendon damage/tearing will breakdown completely causing a rupture or tearing away from the bony attachment - this is a severe case and is the last straw on the camels back and will require surgery to reattach the tendon. That is why it is important to address any pain early on before the damage is severe.

[powerbass]

In addition to the repetitive strain component of the tendon injury there is often many other factors that play a role in any injury: instrument set up, string tension, string height, the weight of the bass, shoulder, neck and wrist position, how much one plays/practices, how much recovery time is allowed between sessions, as well as subtle issues like how tight do you grip the neck/pick, how tense does your body get while playing and do you breathe calmly and smoothly while playing. Smoking decreases blood flow and poor nutrition means inadequate nutrient supply to promote healing. To completely address the injury reviewing all these things is important as well as therapy to the injured tissues. In my experience many therapists and health pros don't look at the big picture and address the multifactoral component

[Fergie Fulton]

Originally Posted by powerbass

In addition to the repetitive strain component of the tendon injury there is often many other factors that play a role in any injury: instrument set up, string tension, string height, the weight of the bass, shoulder, neck and wrist position, how much one plays/practices, how much recovery time is allowed between sessions, as well as subtle issues like how tight do you grip the neck/pick, how tense does your body get while playing and do you breathe calmly and smoothly while playing. Smoking decreases blood flow and poor nutrition means inadequate nutrient supply to promote healing. To completely address the injury reviewing all these things is important as well as therapy to the injured tissues. In my experience many therapists and health pros don't look at the big picture and address the multifactoral component

+1 and this is why proper diagnosis and treatment should be case specific.

[DeepSouth]

Great thread,

About 5 years ago I got a large cyst in the joint closest to my hand of my pointer finger on my fret hand. I had to stop playing for about a year and finally the knot went away. The cyst was caused from a technique I was trying on guitar using lots of slides up and down the fingerboard.

Anyway, I have not played guitar since then but my finger still to this days get inflamed if I play bass for more than about 45 min a day. It also get sore when it rains or the weather gets cold.

What could do that? Scare tissue around where the cyst was? I would go see a hand specialist but I'm self employed and have no insurance. Maybe I should just save up and go, I miss playing in bands

[Commreman]

Originally Posted by powerbass

Most tendon pain associated w/bass playing is a repetitive strain injury. This means that over a period of time the tendons become subjected to a level of stress that causes micro tearing/trauma. The natural healing process requires rest to repair damaged tissue. With prolonged repetitive practice, playing, gigging and work activities (computer, manual labor etc) the tendons are not allowed to repair adequately. These small tears happen often w/out a significant amount of inflammation - though inflammation may play a role though to a lesser degree. Eventually the tendon damage/tearing will breakdown completely causing a rupture or tearing away from the bony attachment - this is a severe case and is the last straw on the camels back and will require surgery to reattach the tendon. That is why it is important to address any pain early on before the damage is severe.

This is exactly what happened to me. I had surgery in January. It was no fun, and took a good 5 months to recover from fully!

[tearalong]

I think my injuries haven't been due to repetitive strain, but rather from not carrying my gear properly.
My preamp, compressor and power amp are in a rack unit with a handle that makes it convenient to carry with one hand, except it is way too heavy for one hand. Similarly my bass case has room for leads, tuner, music books as well as the bass.
The amp messed up my elbow and the bass case hurt my hand/wrist. I have finally worked out that saving a trip or 2 to my car to carry is not worth it.

[TheSuzie]

Another thing that is not publicized enough is the danger of major and frequently permanent tendon damage caused by fluoroquinolone antibiotics such as Levaquin, Cipro and many others of the same class. These antibiotics are known to cause tendon damage including rupture and to damage the tendon's ability to repair injury.

A black box warning has been issued for Levaquin by the FDA but only after Public Citizen filed a lawsuit. Many doctors are unaware of the warning or that the danger in reality extends to that whole class of antibiotics.

Fluoroquinolones were meant to be a last line of defense or dangerous infections but are handed out for many common infections more prudently treated with other classes of antibiotics. The fluoroquinolones are also suspected to cause a number of neurological side effects in some patients.


I'm editing this again to add a reference to this CNN story

http://www.cnn.com/2008/HEALTH/07/08...isk/index.html

Here is the beginning of the text:

FDA orders 'black box' label on some antibiotics

(CNN) -- The U.S. Food and Drug Administration Tuesday ordered the makers of certain antibiotics to add a "black box" label warning -- the FDA's strongest -- to alert patients of possible tendon ruptures and tendonitis.

"The new language will strengthen the existing warnings," said Dr. Edward Cox, director of the FDA's Office of Antimicrobial Products.

The FDA is requiring the label warnings and a medication guide for fluoroquinolone drugs, which include Cipro, Levaquin, Avelox, Noroxin and Floxin.

The consumer group Public Citizen asked the FDA in August 2006 to put the "black box" warning on Cipro and other fluoroquinolones, and also to warn doctors. Earlier this year, Public Citizen filed a lawsuit to force the FDA to take those actions.

Public Citizen said Tuesday it was "pleased" with the FDA's order but added "there is still more that the FDA must do."

"The FDA is silent on our request that it also send a warning letter to physicians clearly describing possible adverse reactions, such as tendon pain, so that patients can be switched to alternative treatments before tendons rupture," the group said. "We are troubled that the FDA is not doing everything within its power to prevent more people from needlessly suffering disabling tendon ruptures."

.................

For the rest go to the URL listed above

Peace,
S

[RAM]

I can see this being a great topic! There are a lot of debates about what proper technique is, and a lot of people with sloppy technique argue their still effective using such. What they fail to realize is not only is there a potential for lack of economy-of-motion, but also potential long-term health issues.

I'd bet you could write a book on the subject and not cover every major lesson you'd wish to impart!

If it were up to me, I'd also vote for this to be a sticky, and limited as to who could post to it so as to not raise arguments.

[rcarraher]

Originally Posted by powerbass

Hello fellow TBers. I am a massage therapist, corrective exercise specialist and a bass player. I have read several posts about tendon pain and I thought I would make my own post about my experiences treating this condition. In general the diagnosis of tendonitis is often a default diagnosis w/out specific findings. itis means inflammation and in general inflammation is a short lived phase of healing as the result of an acute overload or tear in muscle/tendon/ligament tissue. The course of treatment: ice, rest, cortisone injections may help in the acute phase but long term, chronic tendon pain is usually from significant tearing and degeneration of the tendons without a significant inflammatory process. Tendonosis is the term applied to tendon degeneration and the course of treatment is very different depending on tendonosis or tendonitis. A lot of time and money will be wasted treating inflammation if the real issue is tearing and degeneration. If you have been experiencing significant tendon pain for longer than a month then I would have it checked out by the best physical therapists/MD/sports medicine doc etc. in your region. If any one is interested I can continue this thread w/ specific anatomy and self treatment techniques.

Where were you 5 years ago when my right elbow went to hades in aunt Gertties purse? I had significant pain and popping in the right elbow. I had injured the elbow years before and they almost did surjery then, but decided to let it heal on its own, I told my PCP this. My PCP sent me to physical therapy, no x-ray, no MRI, no bone scan, and had the nerve to diagnosis carple tunnel, or more precisely, a repetitive motion injury.

I am a computer pro so do spend a lot of time on a keyboard, and when he heard I played bass, well, what else could it be (in his mind)? After nearly three months of ice, and PT it was worse. They finally sent me to a sports injury doc. I had an avulsion fracture (The tendon or ligament had torn away from the bone and took bone with it) a ruptured tendon, and serious bone chips floating around in there as well as a badly healed old fracture. So, basically all the PT did was run up my insurance and do more damage. All the ice and exercise in the world weren't going to help me.

[Fergie Fulton]

Originally Posted by rcarraher

Where were you 5 years ago when my right elbow went to hades in aunt Gertties purse? I had significant pain and popping in the right elbow. I had injured the elbow years before and they almost did surjery then, but decided to let it heal on its own, I told my PCP this. My PCP sent me to physical therapy, no x-ray, no MRI, no bone scan, and had the nerve to diagnosis carple tunnel, or more precisely, a repetitive motion injury.

I am a computer pro so do spend a lot of time on a keyboard, and when he heard I played bass, well, what else could it be (in his mind)? After nearly three months of ice, and PT it was worse. They finally sent me to a sports injury doc. I had an avulsion fracture (The tendon or ligament had torn away from the bone and took bone with it) a ruptured tendon, and serious bone chips floating around in there as well as a badly healed old fracture. So, basically all the PT did was run up my insurance and do more damage. All the ice and exercise in the world weren't going to help me.

Sorry to hear of your problems, what is the state of the injury now?