When Your Wrists Let You Down

[jweiss]

Well, since my day job deals with research on ligament/tendon injury and healing, I feel I can offer some suggestions:

1) go to the doctor. Get a referral to an orthopedist who specializes in carpal tunnel syndrome. A lot more is known now about the efficacy of various treatments than was known even 5 years ago. He/she will be able to determine the best treatment - NSAIDS, rehab, surgery, or a combination.

2) Advil - be careful with this stuff. Dosages for anti-inflammatory effects from Advil range from 600 - 1200 mg per day. Anything less and it's just acting as an analgesic. Doses high enough to produce anti-inflammatory effects are high enough to cause the majority of people to have side effects, and to cause stomach ulcers in others. There are MUCH more effective NSAIDS available with a prescription from your doctor that won't burn a hole in your gut.

3) TECHNIQUE - playing the bass requires very little effort if done right. Try this: Turn your amp way up. Try to determine the smallest amount of force that is necessary to fret a note with you left fingers. You will find that it is REALLY low. THAT is the level that you want to aim for. Do the same thing with your plucking fingers. Then, make sure that your wrist angles are not all jacked up. A teacher can help you with these aspects of your technique to minimize stress on your tendons.

Good news is that most cases of carpal tunnel can be treated effectively.

Good luck!

Jeff

 

[brandau]

I have the same thing going on. I play upright and electric and after years of playing almost every night I developed wrist tendonitis in my left wrist as well. I've been to every specialist dealing with the hand and wrist. I've researched and tried every method of treatment I could find(cortisone shots, electric currents, wrist brace, anti-inflamitories, physical therapy, alexander technique). Two things have worked!

1. Acupuncture- This was a last resort because I didn't know anything about it plus I really just didn't believe it would really do anything. It was amazing. After my first treatment I had full range of motion in my wrist and the pain was almost gone. I continued regular treatment for several weeks until the tendoitis was gone. Meanwhile I was still able to play and practice while I was being treated. I then did a monthly treatment just to keep things in check.

2. Deep Tissue Message- I recently had another flare up(my acupuncturist moved away) so I went to a friend whos a message therapist. It was really great. For one its not just your wrist thats the problem. Your forearm and back probably have all kinds of tension built up. Message releases all kinds of toxins and puts your mussels at rest so healing can take place. It really worked. Again it took several sessions, and was really intense.

Keep in mind that it probably took years for the tendonitis to set in, so it takes time to get ride of it. Then your always prone to get it again. Don't get depressed though because its something you can overcome. In someways its been a blessing because my form keeps getting better with every flare up. I play much more relaxed now too. Good luck! I feel your pain...literally

 

[sal4bass]

http://i196.photobucket.com/albums/aa296/nsmar4211/acuteafflciton/100_8687.jpg

You can see where/what I'm wearing in that pic ( don't ask about the face I'm making). Make sure it's tight enough to put a little bit of pressure on, the fabric type ones seem to work better than the terry cloth ones and aren't as hot. I had to get the ones from the tween section for a good fit- The one on my right wrist has happy bunny on it...... One day I'll remember to grab two of the same but oh well!

My bass teacher has one of those brace wrap things that he wears at times, looks just like a wrist band but neoprene, however he wears his almost up to his elbow on his forearm. Depends on which tendons are causing the issue perhaps? Or whether it's tendonitis or carpal tunnel?

So far, wearing the wrist things has prevented any major flareups (had a horrible bout with it when I first started playing, couldn't move my arm for 2 days... yeouch...). That and just laying off if I feel it flaring up and I can lay off for a day or two.


I dunno about the magnetic bracelets-gotta think having magnets near electronics isn't going to be good? Might also cause noise issues considering the magnets would be within inches of a pickup? Maybe for when you're not playing...

Ahhhh... now I see how you wear it. I am definitely going to try one out and appreciate you posting the pic for me. This is a great forum!

 

[sal4bass]

Well, since my day job deals with research on ligament/tendon injury and healing, I feel I can offer some suggestions:

1) go to the doctor. Get a referral to an orthopedist who specializes in carpal tunnel syndrome. A lot more is known now about the efficacy of various treatments than was known even 5 years ago. He/she will be able to determine the best treatment - NSAIDS, rehab, surgery, or a combination.

2) Advil - be careful with this stuff. Dosages for anti-inflammatory effects from Advil range from 600 - 1200 mg per day. Anything less and it's just acting as an analgesic. Doses high enough to produce anti-inflammatory effects are high enough to cause the majority of people to have side effects, and to cause stomach ulcers in others. There are MUCH more effective NSAIDS available with a prescription from your doctor that won't burn a hole in your gut.

3) TECHNIQUE - playing the bass requires very little effort if done right. Try this: Turn your amp way up. Try to determine the smallest amount of force that is necessary to fret a note with you left fingers. You will find that it is REALLY low. THAT is the level that you want to aim for. Do the same thing with your plucking fingers. Then, make sure that your wrist angles are not all jacked up. A teacher can help you with these aspects of your technique to minimize stress on your tendons.

Good news is that most cases of carpal tunnel can be treated effectively.

Good luck!

Jeff

Thanks Jeff. I have an appointment next Wednesday with a specialist so hopefully he can start to determine the best course of action for me.

I will try your suggested loud amp/least amount of force experiment.

My wrist is finally beginning to feel a little better after 3 days of tingling/hot sensations/soreness (but is still far from feeling "normal"). I am trying to decide if I should play the services this Sunday or sit it out. I'll make my decision by tomorrow evening.

 

[sal4bass]

I have the same thing going on. I play upright and electric and after years of playing almost every night I developed wrist tendonitis in my left wrist as well. I've been to every specialist dealing with the hand and wrist. I've researched and tried every method of treatment I could find(cortisone shots, electric currents, wrist brace, anti-inflamitories, physical therapy, alexander technique). Two things have worked!

1. Acupuncture- This was a last resort because I didn't know anything about it plus I really just didn't believe it would really do anything. It was amazing. After my first treatment I had full range of motion in my wrist and the pain was almost gone. I continued regular treatment for several weeks until the tendoitis was gone. Meanwhile I was still able to play and practice while I was being treated. I then did a monthly treatment just to keep things in check.

2. Deep Tissue Message- I recently had another flare up(my acupuncturist moved away) so I went to a friend whos a message therapist. It was really great. For one its not just your wrist thats the problem. Your forearm and back probably have all kinds of tension built up. Message releases all kinds of toxins and puts your mussels at rest so healing can take place. It really worked. Again it took several sessions, and was really intense.

Keep in mind that it probably took years for the tendonitis to set in, so it takes time to get ride of it. Then your always prone to get it again. Don't get depressed though because its something you can overcome. In someways its been a blessing because my form keeps getting better with every flare up. I play much more relaxed now too. Good luck! I feel your pain...literally

I have never used acupuncture but have a friend that swears by it. I have been reading that deep tissue massage and ultrasound treatments can be very effective at breaking down scar tissue. I appreciate your encouragement and I am viewing this as a process that hopefully has light at the end of the tunnel.

I just want to be able to reliably play my instrument again, and it sounds like there may be ways to make that happen. Thanks again for sharing your recovery experience from these problems.

 

[bassandbeyond]

All of the treatments suggested so far are certainly worth investigating, and it seems that each individual usually has to explore several avenues before finding the treatment that really works for him. At least you have been through this before and are wise enough to deal with it promptly.

I really do hope that you find the treatment or combination of things which will get you back in business on the bass, but if all else fails, remember that you can still express yourself musically through other instruments. Good luck!

 

[sal4bass]

All of the treatments suggested so far are certainly worth investigating, and it seems that each individual usually has to explore several avenues before finding the treatment that really works for him. At least you have been through this before and are wise enough to deal with it promptly.

I really do hope that you find the treatment or combination of things which will get you back in business on the bass, but if all else fails, remember that you can still express yourself musically through other instruments. Good luck!

Thanks Doug. I appreciate the well wishes. I'm hopeful to get something worked out, especially after reading the posts here. This is such a great forum (I just recently began to post) - what a fantastic resource. I wish the internet had been around when I got started in the early 70s.

BTW, I checked out your homepage - beautiful recordings.

 

[warwick.hoy]

I think it is worth mentioning, but may be a little presumptuous. If you are a smoker....quit.

I read an article in Bass Player mag many years ago about Repetitive Stress Injuries. In that article it said that smoking cuts the circulation to your extremities by up to %70.

Good blood flow is essential to keeping your hands and fingers warm, loose and I'm sure keeps that pesky scar tissue away.

It's a little thing that may not apply to you Sal4 but if you smoke (I smoke,....time to quit) consider giving it up.

 

[sal4bass]

I think it is worth mentioning, but may be a little presumptuous. If you are a smoker....quit.

I read an article in Bass Player mag many years ago about Repetitive Stress Injuries. In that article it said that smoking cuts the circulation to your extremities by up to %70.

Good blood flow is essential to keeping your hands and fingers warm, loose and I'm sure keeps that pesky scar tissue away.

It's a little thing that may not apply to you Sal4 but if you smoke (I smoke,....time to quit) consider giving it up.

warwick.hoy - Great tip - for a lot of reasons. I quit smoking about 22 years ago. But wow, here is yet another good reason for people to stop. I appreciate you bringing it to the discussion.

You know, I believe I actually remember that article in Bass Player where risks related to playing bass (like hearing issues and tendonitis) were discussed. It would have been one of the early issues IIRC.

 

[nsmar4211]

sal-You're welcome Sometimes it's hard to describe positioning!

May I recommend that you not play this Sunday? Your tendons haven't had enough time to recover, and since it's not a job type gig, no need to hurt yourself. Go to service and enjoy the message .

Something else to consider, are you playing sitting down or standing up? I know when I sit my wrist angle is different and I fatigue quicker than if I stand up. Even have to stand sometimes when doing the "guitars around the kitchen table" learning sessions we do so I don't get sore fast. If you're sitting, try standing, espically when learning new stuff because I'd be willing to be you're not even looking at your wrist angles when learning stuff .

Also also,have you seen a picture of yourself playing to make sure you're not holding your hands at awkward angles? Nothing like a picture .

 

[sal4bass]

sal-You're welcome Sometimes it's hard to describe positioning!

May I recommend that you not play this Sunday? Your tendons haven't had enough time to recover, and since it's not a job type gig, no need to hurt yourself. Go to service and enjoy the message .

Something else to consider, are you playing sitting down or standing up? I know when I sit my wrist angle is different and I fatigue quicker than if I stand up. Even have to stand sometimes when doing the "guitars around the kitchen table" learning sessions we do so I don't get sore fast. If you're sitting, try standing, espically when learning new stuff because I'd be willing to be you're not even looking at your wrist angles when learning stuff .

Also also,have you seen a picture of yourself playing to make sure you're not holding your hands at awkward angles? Nothing like a picture .

nsmar4211 - we must be on the same wavelength. Yes, I decided to not play tomorrow's practice and Sunday's services. It looks like I can take myself out of the musician rotation for three weeks pretty easily, so that should give my wrist some needed time to improve. My wrist is feeling better, I would guess it to be perhaps 50% back to normal, but is still weak and painful in certain positions.

Regarding my playing position, I always play standing up. I've always held my basses a bit higher than the average person does. But they are not high enough to equal my sitting position. Just for experimentation I tried them at various heights and found if I raise the position of my basses another couple of inches, my wrist stays much less bent in playing position (I won't actually try to play until the wrist is ready). So I need to fine-tune the strap settings for each bass.

Also, some require a longer reach and finger spacing (35" scale Peavey Cirrus 4-string) than others (34" scale G&L and Fenders). The most comfortable neck for me is on my MIM Active Jazz Deluxe. It is also a great sounding bass as it is modified with a BAII bridge, shielded cavities, upgraded heavy-duty wiring and battery connectors, and shimmed neck. I really enjoy playing it, so it may become my "rehab" bass. I may eventually consider trying a short scale bass as someone else suggested for when my wrist is feeling tender.

I have past shows on video I will watch to see how my wrist angles look. I can already tell that simply raising the bass positions should help reduce the bending of my wrist.

Thanks for taking time to think through this a bit more, I appreciate your willingness to offer thoughts on the matter. Hopefully incremental gains will add up to a manageable wrist situation.

 

[jsm81]

I knew this guy, when I was younger, that used to play his bass in almost an upright fashion. He was an older gentlemen with some sort of arthritis in his wrists. He would position his bass so that the center of the body would hang at about belt buckle level and he moved his strap of the horn to the neck heel. This would tilt the neck up so that it would almost be parallel with his body. He said he did it this way because then he could keep his fretting hand and forearm almost straight, which took a lot of strain off his wrist. This also allowed his plucking hand to stay aligned with his forearm also. I sometimes practice sitting down like that with the bass body stradled between my thighs. It's pretty comfortable and it does seem to relieve a lot of the stress off my wrists, when I've been playing long.

 

[sal4bass]

I knew this guy, when I was younger, that used to play his bass in almost an upright fashion. He was an older gentlemen with some sort of arthritis in his wrists. He would position his bass so that the center of the body would hang at about belt buckle level and he moved his strap of the horn to the neck heel. This would tilt the neck up so that it would almost be parallel with his body. He said he did it this way because then he could keep his fretting hand and forearm almost straight, which took a lot of strain off his wrist. This also allowed his plucking hand to stay aligned with his forearm also. I sometimes practice sitting down like that with the bass body stradled between my thighs. It's pretty comfortable and it does seem to relieve a lot of the stress off my wrists, when I've been playing long.

I saw a bassist on TV playing like that once. It looked really strange, and I thought he must have made the switch from upright and felt more comfortable playing electric in that manner. Maybe he was doing it to reduce strain on his wrists???

 

[randysmojo]

I had problems a couple of years ago. Sharp pains shooting through my forearm, my index, middle, and part of my ring finger went numb. I was loosing strength in my hand. I went to an Orthopedic specialist and had a nerve conductivity study done. Now first of, the nerve study sucks because they are sticking little needles in your hand, arm, and back of neck, wiggling them around to find the nerve, and shocking them with electricity to see how they react. They did detirmine carpel tunnel on my left hand. Last April I had sugery, and it has cleared up all the problems. My advice from experience, go to a doctor that is reputable. I wwas living in San Antonio, and went to the doctor that does work for the San Antonio Spurs. Second, give it plenty of time to heal and don't push it. It should take at least 6 months to heal up pretty good. I pushed it and started doing things after only a month or so , and my hand still hurts at times because it still has not healed up all the way. If you look online, it can take up to a year to heal all the way, unless you do something stupid like me and make the healing process take longer.

To agree with jweiss, the way you play can help alot. One guitar teacher told me that most people use way more muscle to play then they need to and wind up stressing muscles and joints and slowing themselves down. You have to learn economy of motion. Like the guitar player that is trying to play fast and picks up his shoulders. That isn't helping him. Just move your hand and push down the minimum you need to to get to the right spots and push the string down to the fret without buzz. Anything more is just hurting yourself. You'll be supprised how much speed and ability you can achieve if you learn proper posture and use economy of movement.

 

[sal4bass]

I had problems a couple of years ago. Sharp pains shooting through my forearm, my index, middle, and part of my ring finger went numb. I was loosing strength in my hand. I went to an Orthopedic specialist and had a nerve conductivity study done. Now first of, the nerve study sucks because they are sticking little needles in your hand, arm, and back of neck, wiggling them around to find the nerve, and shocking them with electricity to see how they react. They did detirmine carpel tunnel on my left hand. Last April I had sugery, and it has cleared up all the problems. My advice from experience, go to a doctor that is reputable. I wwas living in San Antonio, and went to the doctor that does work for the San Antonio Spurs. Second, give it plenty of time to heal and don't push it. It should take at least 6 months to heal up pretty good. I pushed it and started doing things after only a month or so , and my hand still hurts at times because it still has not healed up all the way. If you look online, it can take up to a year to heal all the way, unless you do something stupid like me and make the healing process take longer.

To agree with jweiss, the way you play can help alot. One guitar teacher told me that most people use way more muscle to play then they need to and wind up stressing muscles and joints and slowing themselves down. You have to learn economy of motion. Like the guitar player that is trying to play fast and picks up his shoulders. That isn't helping him. Just move your hand and push down the minimum you need to to get to the right spots and push the string down to the fret without buzz. Anything more is just hurting yourself. You'll be supprised how much speed and ability you can achieve if you learn proper posture and use economy of movement.

Great advice. Thanks for the post. I'm glad your hand is progressing well.

 

[sal4bass]

Update: This ordeal gets stranger with each chapter it seems. I went to my specialist appointment today - got there early to fill out paperwork and insurance forms. I quickly realized the office only had two staff on duty, the doc and an office receptionist. It turns out the practice uses a name nearly identical to a well-known practice in town, but is not affiliated with the well-known practice. (I thought they were). The receptionist appeared to be new and the Doc spent several minutes criticizing how she answered calls and how she processed patients at the window.

The exam room was DIRTY! I've never seen that in a physician practice before but the room appeared beat up (paint rubbed off walls by chairs and equipment carts), dark, dusty, and cluttered - not comforting. The Doc was cordial and tested my hands by asking me to hold them in certain positions while he tapped on my wrists as I explained my symptoms to him. He concluded that I have "early stage Carpal Tunnel Syndrome" and ordered an electromyogram [EMG] and nerve conduction studies. He seemed rushed and did not let me fully explain symptoms or how I hold my bass guitar for his professional input. I also tried to ask about various therapy options but he hurriedly said the first step is cortisone injections and if I don't get good recovery then immediate surgery. I am not opposed to either but felt he had a generic response without answering my questions about other treatment options. At checkout I learned they do not accept credit cards, and could not make change for my copay since they had no petty cash on hand. The Doc then asked me to OVERPAY my copay since they had no way to make change - promising to credit my account on a future visit. Luckily another patient had change. The Doc continued criticizing the receptionist for her phone methods in front of me. It was a really weird scene. I felt badly for her as you could tell she was trying her best and was embarrassed. At that point I had seen enough, and decided not to return for future treatment with this practice.

Once home, I called my family physician for a referral (which I should have done in the first place) and he recommended a different specialist group (well-known). They were able to get me in tomorrow for an appointment, so I will at least have a second opinion and hopefully a more interactive discussion about exam findings and treatment options.

BTW, my wrist is much better but still weak. All swelling is gone and nerve sensations have largely stopped. I haven’t played now for one week. Got a copy of “The Bass Players Guide to Injury Management” in the mail today. Looks like a very nice resource. I’m eager to play again but am going to wait until I learn more from the specialist and tests. I’ll update when I know more.

 

[lbanks]

I've been seeing a physical therapist for a while and it has helped. The exercises are a bit of a drag and its fairly expensive and has taken a while to see results... but it does work.

 

[sal4bass]

I've been seeing a physical therapist for a while and it has helped. The exercises are a bit of a drag and its fairly expensive and has taken a while to see results... but it does work.

Thanks Larry. That is encouraging to know.

 

[sal4bass]

Had my appointment with a second specialist today. This appointment was much more professional and informational. This Doc has experience working with musicians and as expected indicated I have two issues – chronic tendonitis and carpal tunnel. He stated the carpal tunnel is only about 25% of the problem in his estimation. I am getting swelling from the tendonitis that is inflaming the nerve, but the forearm and wrist pain is largely from my tendons. He took time to ask how I held my instruments and checked out my hands and wrists very carefully. Due to my good hand strength he does not recommend any surgical interventions. “You are really stuck in-between on this because the carpal tunnel is not advanced enough to get much relief from surgery but your tendonitis causes enough swelling to put pressure on the nerve causing your nerve symptoms and pain”.

My tendonitis is “chronic” meaning I will have to deal with it long-term. Now it is a case of learning to manage the tendonitis. Suggestions included changing the position of my basses to accommodate best wrist alignment, and finding bass guitars and setups that suit my wrists the best - hmmm. He stressed thorough warm-up and stretching exercises before and after playing. I am to strengthen my wrists with light reps of free weights (1/2-2 pounds) as tolerated to slowly build additional muscle support in wrists and forearms. Wrist and forearm wraps were recommended to experiment to see if any wrap positions help support tendons enough to reduce irritation of the sheaths while playing. Ice after playing is also an option when needed. Prescription strength Ibuprofen was prescribed to be taken as needed to stop the cycle of playing/swelling to the greatest extent possible.

If these non-invasive interventions fail after trying them over the next few weeks/months then cortisone shots would be the next step, but he sees no indication of serious damage related to carpal tunnel and views this as a case of learning to manage chronic tendonitis to avoid further injury.

I was cleared to begin playing again when I felt my wrists were up to it and he indicated he thought I could begin to play again right away if I was comfortable doing so. Bottom line (no pun intended) - I can probably get back to active playing once I learn to manage the tendonitis, but my wrists may never be like they were before I developed these problems.

This will likely be my last post for a while to this thread - at least until I see how these changes are working out for me. I may give my wrist a while longer before trying to play again just to make sure the inflammation has had time to settle down fully. I’ve read through much of “The Bassist’s Guide to Injury Management, Prevention, and Better Health” and it is full of great resources, and I recommend it highly to anyone who finds themselves with a playing-related injury.

Thanks to all who responded to this thread. I truly appreciate it.

 

[nysbob]

Reading this thread makes me appreciate how lucky I am having avoided these sorts of problems for 35 years.

I hope you find a regemin that works, Sal4.