1. Please take 30 seconds to register your free account to remove most ads, post topics, make friends, earn reward points at our store, and more!  
     
    TalkBass.com has been uniting the low end since 1998.  Join us! :)

Injury Recovery Recommendations

Discussion in 'Orchestral Technique [DB]' started by Tyler L, Jun 5, 2018.


  1. Tyler L

    Tyler L

    Aug 16, 2017
    Urbana, OH
    Hello All,
    Several months ago I was diagnosed with Cubital Tunnel Syndrome. After 2 months rest recovery and not playing to help avoid surgery, I have been cleared to start picking it back up. Because of my high metabolism, I had some mild muscle wasting in that period of time. Doctor says I should build up finger/hand/wrist strength before I go full-bore practicing again to prevent any new damage to the weakened fingers/hands/wrists. Does anyone have any recommendations? I saw these and thought they seemed cheap and helped with grip and reverse grip.

    https://www.amazon.com/Finger-Exerc...nger+strengthener&refinements=p_72:1248957011
     
  2. Chris Fitzgerald

    Chris Fitzgerald Student of Life Staff Member Administrator

    Oct 19, 2000
    Louisville, KY
    Not an orchestral player, but I am opposed to gripping/forearm exercises in general because I believe they they target as desirable all of the body habits I am trying to avoid as a bassist. This is only one perspective, but when I feel a burn in my hands or forearms after playing instead of my shoulders and back, my first thought is "I'm doing something wrong".

    Disclaimer - I'm not a doctor or an arco player, and this is only one individual perspective.
     
    Tyler L likes this.
  3. I too am not a doctor but was the OH&S representative in my ex-orchestra for nearly 10 years. My suggestions are -
    (1) For your hands obtain a soft rubber "stress" ball, have it in the palm of your hand, wrap fingers and thumb around it and squeeze all towards the center of the ball. Start with a few repetitions a couple of times a day and gradually build up.
    (2) Later you could add a stronger spring-type exerciser, again starting with a few reps and building up. The "Mummy Grip" advertised on the Amazon page that you give is the sort of thing but would be too brutal to start with.
    (3) If you have a short round piece of wood, something like a rolling pin, hold it out in front with both hands , knuckles up. There are two directions you can rotate the wood, alternating one wrist at a time. Start with a few reps and build up. Later you might tie a length of string to the wood and a small weight that you then raise and lower to add more resistance to the rotation.

    I would keep things fairly simple and build up slowly. You have to manage your recovery carefully. It should not take long to feel the strength returning. There are other hand and finger stretching exercises on the Net, both for strength and mobility, that I haven't checked out recently. Perhaps wait a little while before adding in lateral and rotating forearm (turning door knobs) and wrist (making circles) movements to avoid the risk of overworking and irritating things.

    I suggest that you also incorporate some gentle stretches before and after exercising to avoid stiffness. If you like I can PM you some material.

    Best wishes for a speedy recovery.
     
    Tyler L, Winoman and G-Z like this.
  4. LouisF

    LouisF Supporting Member

    Apr 21, 2003
    Los Angeles, CA
    I would (and have in my own recovery process) switch to synthetic core strings (Perlon/sensicore/Zyex, etc; Solo dominants at orchestra pitch etc); even steel/tungsten string strings like Corellis will be hard on your hands; if possible - transition to a bass with shorter string length and narrower upper bouts; whether you play French or German, shift your hold so that "arm weight" replaces "squeezing" the frog in your hand. I'm strictly amateur and nowhere Chris or David's level but after neck surgery 3 years ago (pins in 5 of 7 vertebrae) i was told to forget about playing. This week I have two concerts and three rehearsals. You'll get there.
     
  5. fu22ba55

    fu22ba55 Supporting Member

    Apr 16, 2009
    Deaf
    FlexEx bands from Amazon:

    https://www.amazon.com/FlexEx-Hand-...e=UTF8&qid=1528287194&sr=8-1&keywords=flex+ex

    After two doctors and one year of physical therapy NOT working, these things were the only thing that brought me back from carpal/cubital tunnel issues.

    Don't cheap out and use rubber bands. These have 3 different levels of resistance.

    Use twice a day. One long slow session to muscle exhaustion.

    Start with the weakest resistance for a few weeks until it no longer creates exhaustion, then switch to the stronger color.

    It took my about a year, but these were the only thing that worked for me.

    FlexEx.
     
    Tyler L likes this.
  6. s van order

    s van order

    Oct 4, 2012
    Delaware
    I deal with ulnar nerve irritation/impingement via cubital tunnel: quite severely 20 years ago and have to manage it ongoing on occasion to this day. So I feel for your situation. You "own" such soft tissue injuries when you get them so be prepared for a long term management approach. You can be successful. I am assuming it is your left arm in this reply. Playing cello as I do now requires a more acute left arm angle at elbow than the bass, and that lowers the bar to this trouble if I am not mindful. You might google up and download the pdf book by well-regarded musician doctor Richard Norris (he was my doc back then) which discusses a wide range of injuries including cubital tunnel. Once you start back you must go slowly, nerve irritation takes a long long time to abate, read his section on "work hardening." I even shadow played at first which is going thru the playing motion without the instrument to see if the motions aggravated the injury. Review your use of computer, your injury may be also related to that. Next, reviewing and correcting technique with a fine teacher, who will notice subtle things with your playing, is crucial. For example, if you vibrate with more muscle than momentum you can irritate the elbow. Or if you squeeze rather than sink weight into the fingerboard it can do it. Maybe change the arm angle to open the elbow joint a bit. Hiked shoulder can actually impinge the elbow nerve from above. Helping me stay in the music game are 1) look up ulnar nerve "glides" and watch a video or two, then check with doc or PT before trying. Do not do ones that really stretch the ulnar nerve (yikes) just glide it through a gentle range of motion. 2) I use the Theraband Flexbars (via Amazon, rubber, red one for for starting strengthening, green one for maintenance) to keep my forearm muscles toned and in range of motion. You should not need the tennis and golfers elbow exercises that the bars are well known for helping. Try instead the general strengthening exercises that come with them. They tone the forearms without adding bulk which I think is good for string playing. My doc said that playing the instrument would do the strengthening for finger flexors and extensors. Flexbars are to help the overall forearm. Good luck and keep us posted.
     
    Tyler L and Winoman like this.
  7. fu22ba55

    fu22ba55 Supporting Member

    Apr 16, 2009
    Deaf
    I agree with Chris 100% long-term (once your strength is back), but in the short term, I needed to get enough stability in my fingers to not re-injure myself.

    Don't worry too much about the squeezing muscles. You're not supposed to squeeze the neck anyway, and those muscles are much larger than the muscles that OPEN your grip. The squeezing muscles will take care of themselves with gentle practice.

    The reverse-grip muscles were way more important for me since they increase lateral stability. It's not about grip strength. It's about lateral stability.
     
    Tyler L likes this.
  8. LouisF

    LouisF Supporting Member

    Apr 21, 2003
    Los Angeles, CA
  9. Tyler L

    Tyler L

    Aug 16, 2017
    Urbana, OH
    Thank you all for your responses. I’m going to try to have an omni-response, so please bear with me.

    After reading everyone’s responses, it seems as though I am starting on the right path. I began trying to sit and play, but noticed that the angle of my elbow was much more acute than when I stood and play. To address this issue and one of the issues that many of you pointed out with squeezing my neck, I switched to an angled Robpin. It was absolutely strange at first, but it definitely helps “take the weight off” in an immensely helpful way.

    As fu22ba55 pointed out, I need to get my strength back. My left wrist is skeletal at this point and honestly quite frightening. Sometimes I’m unsure if the pain is caused by the muscle wasting or from genuine ulnar nerve pain. I’ll purchase those FlexEx’s that you recommended and work on the reverse grip. Any recommendations for reps or do you just reverse grip and hold for nth number of seconds?

    As far as strings are concerned, I’m currently using Evah Pirazzi Weichs so they a pretty light tension, in my opinion. I’d love to consider other options (if they are better), but strings are just downright expensive and my wife and I are not terribly well-to-do.

    S van order, I’ve been working on the nerve gliding exercises and that one stretch where you make circles with your thumb and index finger and make kind of a mask on your face. I avoid being in the public sphere when I do it to avoid concerned looks, but both the glides and the stretch really do help! I know that fu22ba55 said that they had bad luck with PT, but have you found it helpful? Even while learning the double, I found that sometimes it's good to have someone right there telling you what/how to do something to avoid (further) injury and I feel like PT could be in the same boat. But I also don't want to waste money if it doesn't help. I get such mixed reviews on methods that it’s so hard to wade through… Also, I was under the impression that the Flexbars only helped with tennis elbow, but after your recommendation, I now see that it helps a long list of issues. Thanks for the color recommendation as well. Saves me the research.

    My patience could also use a lesson, as I’ve been told that sometimes the best therapy is to put the instrument down for a period as well. Thank you all for the information and the encouragement and I’ll keep everyone updated. Hopefully this thread can be a resource for others struggling with recovering from this condition.
     
  10. LouisF

    LouisF Supporting Member

    Apr 21, 2003
    Los Angeles, CA
    Patience is the key. The hardest days are the ones when I want to (need to?) practice but (having learned to listen to my body) give myself permission to take the day off. Good luck.
    Louis
     
    Tyler L likes this.
  11. fu22ba55

    fu22ba55 Supporting Member

    Apr 16, 2009
    Deaf
    I did one set of reps, twice per day. (e.g. morning and night).

    I didn't hold the hand open for x seconds, just opened and closed carefully and slowly.

    Number of reps == until you fatigue--basically until you feel the back of your forearm burning a tiny bit. (Don't be a hero).

    I did the yellow band for a few weeks, then switched to the red band. Never used the blue (it was too much resistance), but I'll sometimes do red and yellow together to add resistance to the red band.

    The theory behind it is this:

    The gripping & squeezing muscles (inside of your forearm) are naturally much stronger and more developed than the "opening" muscles on the back of your forearm. So, with too much practice (or RSI), your "neutral" position slightly favors the squeezing position. Your squeezing muscles are too strong compared to your opening muscles. (Closing the tunnels in your wrist).

    If you work the "opening" muscles on the back of your forearm, then your resting position is more neutral, and the tunnels are free to open back up naturally. They only need to open up a tiny bit to relieve stress on the nerves.

    That's why I'd not worry so much about the squeezing muscles.

    ---

    Worked for me. I only use the FlexEx maybe once every two weeks or so now when I feel a little twinge of nerve pain coming back.
     
    s van order likes this.
  12. s van order

    s van order

    Oct 4, 2012
    Delaware
    Good point and advice on strengthening the finger extensors to correct flexor/extensor imbalance. I used rubber bands too.
     
  13. s van order

    s van order

    Oct 4, 2012
    Delaware
    To answer your questions etc: In hoops that mask on face stretch is "three goggles" lol. That is the more extreme end of the glide spectrum, stop if it causes symptoms and do not do too many. If you can do it without triggering lingering symptoms, that is a great sign. Some voltaren gel or even aspercreme rubbed into the ulnar groove helps me at times but do not rely on it. I found PTs knowledgeable about general recovering but not about musician challenges. Flexbars will help your general arm re-toning, much like the exercises I did with a PT, I do three sets of ten slowly: wrist externsor and flexor, pronation, supination, wrist adduction and abduction exercises that came with the flexbar. I do them still for maintenance. Be conservative to start. I tried a number of approaches before finding what works for me as outlined here. As others wrote, patience is the key, nerve irritation takes long long time to settle. I had to lay the bass down. 20 years later it still can stir up but I can manage it and still play. So will you.
     
    Tyler L likes this.
  14. Tyler L

    Tyler L

    Aug 16, 2017
    Urbana, OH
    Well, I'm around 4 or so days in now. Despite my achy hands and forearms, I'd say everyone's recommendations are already helping with my strength. But I noticed a major problem with standing up. I can feel the ulnar nerve rolling over the epicondyle and it makes a nasty pinging feeling in my arm when I move into in 4th position (Simandl) on the E and A strings. Knowing that's a recipe for further damage, I went back to sitting which prevents that issue, but gives me a new issue: my left arm is quite bent and I notice my arm getting numb from it. I'm not sure if it's just because I'm not used to holding my arm over my heart for extended periods of time, but the more likely conclusion is the Cubital, I think. Overall from the 15 minutes of practice I've been able to sustain, I've not met with any obvious residual consequences, but I'm feeling stuck between a rock and a hard place there. Maybe I just haven't given it enough time to heal? I'll check back in this weekend or so and let everyone know.
     
  15. s van order

    s van order

    Oct 4, 2012
    Delaware
    Hang in there. The more acute angle from sitting, like the cello position, will stretch the nerve more and numbness suggests residual nerve irritation. The nerve rolling over epicondyle might be from residual inflammation too. So, this suggests you need to ration your playing to manage symptoms, break up the practise sessions. But if the elbow angle is less acute standing up, and if you vibrate using weight amd momentum, without cranking the arm and elbow with muscle I'd hope it will be ok with time. Or can you get comfortable sitting yet finding a less acute arm angle? Use a mirror to watch what happens. Keep experimenting. Injuries like this force us to be a lot more body aware which in the long run can be an overall good. But it is max frustrating in recovery. You are doing great.
     
  16. fu22ba55

    fu22ba55 Supporting Member

    Apr 16, 2009
    Deaf
    My ulnar issue was 100% in my wrist, so I didn't have the ulnar pinging you mention (though I was able to unpleasantly trigger it in physical therapy at the elbow). I can't speak to that issue.

    But playing standing up was too painful for me. I had to play sitting down 100% for a solid year before I had the strength and stability in my wrist to both hold the bass and play it.

    It sucked carrying a stool everywhere, and I hated playing sitting down, but it worked for me. Now I never use the stool anymore and stand 100% of the time, or whenever possible.

    You'll need to find the sweet spot between sitting and standing... what angle & height of the bass work for you, just for the time being. I found playing in TP was much less painful (even when standing), so I focused on that whenever I needed a break from I - VI. I've never had an issue with TP endurance since.
     
  17. LouisF

    LouisF Supporting Member

    Apr 21, 2003
    Los Angeles, CA
    Alexander technique was a big help for me:
    The Alexander Technique: A Practical Lesson

    I basically think in terms of triangles and planes (If I could draw this would be much simpler): the neck of the bass/my shoulder/wrist form one triangle <\ - the bass/floor/my spine another l> - strings/bow arm/back a third />;

    On the good days when those three planes/triangles are centered, open, balanced and relaxed, I'm good to go for another 10K miles.
     
    Chris Fitzgerald likes this.
  18. Chris Fitzgerald

    Chris Fitzgerald Student of Life Staff Member Administrator

    Oct 19, 2000
    Louisville, KY
    As a seated player who strives to focus on transmitting energy from the core, I would try to look at the source. We often approach the issue as "My arm is bent at too tight an angle; how can I move my arm so that the angle is less at the elbow". In Jiu Jitsu and Aikido, issues of spacing are almost always approached from the opposite direction, as in "this spacing is unhealthy; how can I move my core/hips to the place where the spacing is safe?" If we look at approaching the bass the same way, it opens a lot of doors.

    For a seated player, the whole point is that the bass doesn't move, which means we have to move around the bass. If the elbow angle is too closed and the bass can't move, try pivoting your torso from the hip to keep a healthy elbow/wrist angle while moving up and down the neck. In other words, find a healthy elbow/wrist position at any point on the neck, and then move your body around that. Here's a link to a specific point in a posture video segment I did on this issue a few years ago that attempts to address the same issue.

    This is a lifelong learning process, but I think a healthy one. It's kind of like the bass equivalent of the old parental " lift with your legs, not with your back" (...or you could put an eye out! And for god's sake, don't run with a fork in your mouth!) cliche.
     
  19. I have been following each piece of advice above and notice that there is no mention of stretches that IMO are worth considering. I have been having some trouble with trigger finger developing in my second finger LH and have been on the net looking for exercises/stretches that will help me get past the clicking ( break in the smoothness of curling and straightening) and back to normal. My symtoms are worst after sleeping in my very comfortable armchair with my elbows resting on the arms, and when I wake up in the morning after sleeping with my arm bent and fingers curled up. Luckily my finger action and strength in forming notes are not affected (yet). As I read more I can't help notice similarities with Cubital Tunnel symtoms in that I feel my stiff second finger can relate right back through my forearm to compression of a nerve in the elbow or a need to do nerve and muscle stretches from my shoulder to my fingers. I found a site called Healthline.com that advocates eleven Trigger Finger exercises which may form possible alternatives to the advice above in your quest to increase mobility and strength.

    You might also try this as part of your warmup on the bass. Find a nice comfortable position, say Ist Position on the G string. Using nicely arched fingers and 1 2 4 fingering with the open G string there are six possible patterns of slurring the notes, 0 1 4 1 (G A B A) , 0 4 1 4, 0 1 2 1, 0 2 1 2, 0 2 4 2, 0 4 2 4. Play each pattern as even 8th notes, then dotted (dah dit-dah dit-dah, then reverse dotted (dit-dah dit-dah) with fingers rising and falling cleanly. Slowly build up the number of reps and possibly the speed.

    It was suggested very early in this thread that posting some pictures showing your standing and sitting positions with the bass and bow, taken both from the front and from the side, would help us give best advice.

    I agree with Chris' advice above, only differing from "the bass doesn't move", suggesting instead that you start by making yourself most comfortable, standing or sitting, then draw the bass towards you into playing position.

    Best wishes, DP
     
  20. wathaet

    wathaet

    May 27, 2007
    Do not forget about building the big muscles in your back, shoulders and arms. Go to the gym, start soft and build up muscle. As for squeezing muscle between thumb and index, it depends on the way you play. A few of my colleagues have an enourmous, very visible muscle there. I don't at all, so I either don't practise enough or I use my back muscles instead.

    I also recommend a string /setup that does not require deep right armweight for sound.
     
    Last edited: Jun 13, 2018 at 8:32 AM
    Phil Smith likes this.