Preventing carpal tunnel (or wrist pain)

Subject: Preventing carpal tunnel (or wrist pain)
From: Johnhenry'shammer
Date: 14 Aug 06 - 05:31 AM

I just practiced (guitar) for about 4 hours straight and my wrist is pretty sore. It got me thinking about carpal tunnel syndrome and about how I've heard it can be caused by guitar playing. It also got me thinking about how I've heard that there are certain warmups you can do before you're about to play guitar that can prevent carpal tunnel (or at least help). Does anybody know any good ones that won't take up too much time?

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: The Fooles Troupe
Date: 14 Aug 06 - 05:47 AM

As a past sufferer, let me say this - if you do 4 hours 'cold' - without some months of gradually building up to such a lengthy period - there is no way that just a few minutes of warmups will prevent such injury.

You now will enjoy several months of MUCH REDUCED guitar practice sessions.

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: s&r
Date: 14 Aug 06 - 06:01 AM

Left wrist?

Get the guitar neck closer to your body, at about or just below shoulder level, not tilted so you can see the finger board. this gives a reasonably straight wrist, which minimises the likelihood of carpal tunnel problems.

Little and often is good for practice, and change the activity.

Stu

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: the lemonade lady
Date: 14 Aug 06 - 06:49 AM

Yes I know some excersises... Arm out stretched, palm down.Pull your fingers back towards your elbow and feel the stretch on the inside of your wrist. Then fingers down (limp wrist style) and push your fingers down and feel the stretch across the top of your wrist. Then shake out and relax. You may have tendonitis. I've had carpal tunnel problems after giving birth to numerous babies, and shaking cocktail shakers doesn't help at all. I get numb fingers but the feeling comes back if I dangle my arms and shrug my sholders.

Keep up the excersises, they really do work. Don't ask for surgery.

Sal

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Kaleea
Date: 14 Aug 06 - 02:25 PM

You might try having another guitarist observe your posture & playing position. Sometimes improperly holding one's hands or elbows, arms, neck & shoulders, etc. can bring about pain. I played Guitar for many years without pain until I was injured due to an auto accident & got carpal tunnel due to that.

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Stewart
Date: 14 Aug 06 - 05:06 PM

Or it might be arthritis in your hand (see other thread on arthritis). Learn your limitations live within them, and maintain good posture and wrist position. Also, see your doctor and a good physical therapist, quick!

Cheers, S. in Seattle

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: GUEST,mg
Date: 14 Aug 06 - 05:46 PM

Take off your wristwatch as much as possible. mg

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Cruiser
Date: 14 Aug 06 - 08:57 PM

As with any exercise, I find it is just as important to do cool down techniques after exercise as it is to warmup before exercise. Simple stretching will do. There are books on the subject for instrumentalists.

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: The Fooles Troupe
Date: 14 Aug 06 - 09:01 PM

In addition to what I said:

My episode seems to have been related to my Micro Motor Disorder - when writing, I lack fine motor control, so the bulk of the work is done by major muscles instead. Too much effort under stress, and the right arm went numb.

Posture is often implicated too - any repeated effort in which the joints are held for extended periods in positions other than a fairly 'neutral' position - i.e. in positions near the maximum travel of the joint, can do all sorts of things, including restricting blood flow, place pressure on nerves, cause cramp in muscles, etc. Forcing yourself to go on (no gain without pain stupidity!) when this starts will seriously aggravate things.

That is the reason for the 'traditional' 'Classical' body postures when playing 'traditional' 'Classical' instruments - many generations of experience, you see...

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: GUEST,Rowan
Date: 15 Aug 06 - 01:05 AM

The following applies to almost any type of physical exercise;
1   Before the activity, do a warmup (jogging is fine for outside activities but might seem a bit extreme for indoor ones),
2 After the warmup but before the activity, do a series of stretch exercises (for most instrumentalists, these would involve the whole body above the waist),
3 During a relatively sedentary activity, do what keyboard operators call "pause exercises" (general stretching and flexing of everything possible for about ten minutes) every 50 minutes or so,
4 After the activity, do a more extensive and pysically demanding series of stretch exercises, and
5 Finish up with a warmdown, usually more jogging and gentle flexing.

Most musicians I've known tend to be a bit disparaging about "keeping their fitness levels up" but, if you're going to use muscles seriously you've got to treat them properly, whether you're a guitarist, concertina player or a netballer (you can tell I coach my daughters' teams). The principles are the same whether you're working with gross motor or fine motor skills. All that's different is the particularities of movements you wish particular muscles to perform.

Another aspect that I recall from my IV judo days is the need to be able to relax muscles whenever they're not required. I'm sure other experts will tell you the same but Noel Hill (Anglo Concertina player) is the only other musician I've heard give the instruction "Your neck, shoulders and arms should be as relaxed as possible while you're playing!" All the muscular effort should be directed to only those muscles required to operate the mechanics of the instrument. This implies that you routinely use good posture.

I'm not a guitarist but I had a great opportunity to watch Andres Segovia play for a whole concert while I was only about 6' away and, untutored though I was, I could see that he wasted no effort supporting the instrument with fingers, wrist or arms. His posture was such that most of the instrument's weight was supported by his legs leaving all the effort of his arms and wrists directed purely at getting the music out of the instrument.

I hope this helps.

Cheers, Rowan.

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Don Firth
Date: 15 Aug 06 - 05:30 PM

Pour yourself a cuppa coffee or crack open a beer, prop your feet up and sit back and relax. Lotsa stuff here.

JHH, your persistence and dedication are truly admirable. However, I gather from what you've said in the other thread that you haven't been playing guitar for more than a few weeks. Four hours of practice at one shot is one helluva session, even for a concert artist who's been playing for years. A bit much for a relative beginner. You're doing something new with the muscles of your hands and fingers, and at this stage, it's definitely possible to overdo, to the detriment of those muscles. You need to build up their strength gradually. Like pumping iron, you need to start slowly and build your muscles up over time to avoid possible injury. Take the soreness as an alarm and rest your hands for a bit. A few days, at least. Then, restart, but take it easy. Since you seem to be dedicated to practicing (and that's a good thing! Some folkies act like practice is unnecessary and that if they practice it will compromise their ethnic purity. Phui!!), it would be a good idea to try to make that practice as productive and painless as possible.

I picked up a little book, about 24 pages, by classical guitar performer and teacher, Ricardo Iznaola, entitled simply On Practicing (© 2000 by Mel Bay Publications, Pacific, MO.). In it, Iznaola says the following:

           The purpose of good practice is to achieve specific goals, while focusing on continuous improvement in quality and ease of execution.

In short, decide ahead of time what you wish to accomplish and focus on that. Then he goes on to say:

           Traditionally, practicing has been undertaken, and its results evaluated, on a day-to-day basis. It is here proposed that the time-unit for practice be considered to be the week: distribute the materials to be practiced (exercises, etudes, repertoire) throughout the week, so that at the end of the week, everything has been covered.
           This way it is easier to control the amount of time devoted to particular areas, which needs more or less work, while at the same time avoiding the nagging feeling that there is not enough time to work on everything.
           The week should consist of six days only, with the seventh day of rest from practice (although you may play all you want that day!).
           For college-level professional students, no practice approach will produce results if done for less than an average of two to three hours a day. Practicing more than five to six hours, on the other hand, will begin to produce diminishing returns.
           Ideally, daily practice should be divided into three sessions, with sufficient resting time left in between sessions (certainly no less than 10 to 15 minute breaks). If any particular session should go beyond 60 minutes, then further breaks should be taken, but more brief in duration.
           An intelligent, flexible and consistent approach to the time allocated to practice will avoid a lot of possible problems related with injuries of the physical mechanism, stress symptoms, deterioration of technique, general health condition, lack of motivation, etc.
           Nothing bad happens if one doesn't practice for a couple of days. At the very early stages of development, some momentary loss of ability may be noticed, which is rapidly corrected once proper practice times are resumed.
           With regard to technical practice, such as exercises and etudes, it is wise to alternate the technical procedures used, so that some physical elements rest and rebuild, while others are worked out.
           In conclusion, remember that having six days a week as a time-unit of practice means that not everything has to be worked on every day!

Ricardo Iznaola was born in Cuba, but in addition to his concerts and recitals, I believe he is currently teaching in the music department of Denver University. He has written a couple of excellent instruction books on the guitar, one of which is Kitharologus : The Path to Virtuosity HERE ("Kitharologus" is Greek for "Guitar Book"). If you can play your way through that monster, there won't be much you can't do on the guitar. Another good thing to have is Scott Tennant's DVD Pumping Nylon. As the name implies, it's mostly a collection of "calisthenics for the guitar." Since Scott Tennant is a classical guitarist, it's put together with the classical guitar in mind, but most of what he shows will work well for any style of guitar playing.

One of the reasons that I keep recommending some acquaintance with classical guitar technique is not because I am some tight-assed classical guitar evangelist, but because what is now called "classical guitar technique" is the result of several hundred years of trial and error, keeping what works well, and discarding what doesn't. Considering the technical difficulty of many classical guitar solos, either written for the guitar originally or transcriptions from other instruments, classical guitar technique has to operated at the very cutting edge of what is technically possible for human hands. In short, it's the most efficient way of playing fingerstyle guitar. And this holds whether you play a nylon-string or a steel-string guitar, and whether you play classical, folk, country, jazz, rock, or whatever.

The main things that translate across all kinds of efficient and painless guitar playing are how you hold the guitar and the positions of your hands.

Almost all classical guitarists play sitting down, with the left foot on a foot stool about six inches in height, and place the waist of the guitar on the left thigh, with the neck angled up at about a 35^o angle—the tuning head at about eye level. The guitar is held in this position by its contact with the left leg and chest, and is "locked in" by the right forearm resting on the edge of the guitar. The whole point of this position is to hold the guitar securely, so that you don't have to support it with your hands. Your hands are going to have a lot to do without having to hold up the guitar too.

Lots of performers prefer to stand up, using a neck strap. This is fine, but the guitar should still be held at around a 35^o angle. This is to keep the fingerboard accessible to the left hand without bending the left wrist—which is asking for carpel tunnel syndrome!

The wrists, both right and left, should be held as straight as possible. I searched the internet for photos of guitarists holding a guitar in optimum playing position, and couldn't come up with much, but this one is pretty good. Clicky.

Eliot Fisk is a concert and recording artist and a former pupil of Andrés Segovia. Also, the photographs in Christopher Parkening's method book (Another clicky) are excellent. Parkening was also a student of Segovia's.

Anyway, notice how straight Eliot Fisk's wrists are. This is important. The strength and action of the fingers comes through leverage. Doing complicated things with your fingers while your wrists are curved more than just a little bit is mechanically unsound, and puts a lot of strain on the muscles and tendons of the hands and wrists.

Also, keep the left-hand fingers as light as possible. When fretting strings, use only as much pressure as is necessary to get a clear sound from the string. And when you're practicing, take frequent mini-breaks. Let your arm just hang from your shoulder, relax your hand, letting it go completely slack, and "shake out" any tension that remains. Do this a lot with both hands.

I hope some of this helps.

As Woody Guthrie says in one of his Talking Blues':

"Take it easy. But take it!"

Don Firth

P. S.   Some examples of superb guitar playing. Take note of the hand positions in all cases:   

My favorite woman classical guitarist. Busy fingers!
Here she is again. If I'm well practiced, I ve taken my vitamins, and I have a good tail-wind, I can actually play THIS.
I took a master class with this fellow in 1980 (not that I can do much of this sort of thing).
And this young lady is obviously pretty good.
And then there's this fellow. The hands aren't quite kosher from the classical viewpoint, but if The Doctor does it, it's right. It works. Note how relaxed his hands are and how smootly he does everything.

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: the lemonade lady
Date: 16 Aug 06 - 01:58 PM

or you could try standing on your head, singing 'Always look on the bright side of life' and sticking 2 pencils up your nose.

Sal

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Don Firth
Date: 16 Aug 06 - 02:13 PM

Gawd! Why didn't I think of that!??

Don Firth

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Cruiser
Date: 16 Aug 06 - 03:28 PM

That sure would have saved you a lot of typing Don.

Thanks for that detailed post.

Subject: RE: Preventing carpal tunnel (or wrist pain)
From: Scoville
Date: 17 Aug 06 - 12:47 PM

Thanks, Don.

Between having played music for 25 out of my 29 years, and having had several arm-stressing jobs, I find myself paying a lot of attention to my wrists.

I play standing up, but it's BECAUSE I can't keep the guitar in a comfortable position sitting down, and having it on a strap lets me get it just right. Probably depends on the size of the guitar and size of the musician, though. I also keep it hitched up just a bit high--a lot of the younger rock and C&W musicians around here seem to think it looks cool to have your guitar around your knees, but my left hand would break off if I did that for a extended period of time!

I avoid A and D chords like the plague because they make my hand cramp up after awhile if I'm playing fast. The capo is my friend. (Also, since I'm a woman and smaller/shorter-armed than most of the [male] guitarists I know, this lets me play just a little higher on the neck, which further reduces the need to bend my left wrist.)

My record for longest playing session is five hours, at a dance. My wrists were fine but the calluses on the fingertips of my left hand were long gone.