Wrist health and exercise

July 27, 2017, 7:12 AM · This post is a two parter.

Fisrt, I believe that an important key to being even a successful violinist and an effective teacher is staying healthy, so I like to stay rather active. I do cardio and such but every time I try doing any kind of strength training I end up aggravating my tendonitis. What exercises do you guys do to stay in good health that are safe for your wrists?

I've heard yoga is good and safe, any experience with yoga?

Second, for people like me with seemingly weak wrists, what kind of doctor should I see to target the issue? I've seen my GP and he just gives the text book advice on tendonitis.

Replies (15)

July 27, 2017, 7:47 AM · The exercise literature/advice that I've seen says cardio and large muscle exercise is appropriate for "general health" maintenance. Recent research suggests that interval exercises (slow,fast,slow,fast) are more effective for general health than other styles.

I do a lot of squats, dead lifts, stair climbing, push ups, pull ups, and curls.

If curls hurt your wrist, try holding dumbbells vertically and use less weight with more repetitions. If pull ups hurt your wrists, don't do them. The rest of the above mentioned exercises don't involve tension in the wrists.

July 27, 2017, 7:59 AM · yoga puts a lot of pressure on the wrists - in your situation I wouldn't recommend it.
July 27, 2017, 8:31 AM · i started swimming a little every day, it seems like a very gentle way to slowly build up some overall strength in the whole body. I tried it earlier in somewhat hot water, but my current experience is that cold water is the best.

I also have some issues with my left arm/wrist/index finger, but i hope its mainly because of excessive overuse and that it will get better in time. Doing some short practice sessions around 10-20 minutes instead of hour long sessions.

About yoga. There is some very gentle excercises for the arms/finger/wrists that i can recommend.

You can find such program in a book like this:

https://www.amazon.com/Yoga-Tantra-Meditation-Daily-Life/dp/099733780X

"yoga puts a lot of pressure on the wrists... "
is a rough generalisation. Some yoga postures do, but alot of other dont, but naturally you should be very aware of what you are doing.

July 27, 2017, 8:34 AM · Yoga can be good for your wrist, but it can hurt your wrist if you're not careful. It might be possible to explain your situation before class, and a good yoga teacher should take that into account and adjust accordingly. It may be that you have some muscle imbalance, and maybe you should find a physical therapist that specializes in working with athletes, and see if they have some insight for you.
July 27, 2017, 8:53 AM · "What exercises do you guys do to stay in good health that are safe for your wrists?"

Daily walks + workouts with weights. The key is moderation and balance. Avoid over-training. The muscle groups you work directly in a given strength session should have at least 48 hours of rest before you hit them directly again.

In music practice, over-drilling on studies like Sevcik or Schradieck can cause problems. I take them in small doses and intersperse them with vibrato exercises or alternative movements that let the hand relax -- similar to the way I rest for 1 minute between strength exercises. See here for my own experience of dealing with tendinitis:

http://www.violinist.com/blog/jimtc/201410/16241/

July 30, 2017, 4:32 AM · Lot's of good advice, here.

Also, replace dumbells with weighted wrist bands.

Edited: July 30, 2017, 6:21 AM · I like the concept of "Kinetic chain" described in this book:
https://www.amazon.ca/Exercises-Shoulder-Hand-Release-Kinetic-ebook/dp/B008DM2OQ0

From my personal experience (long and painful recovery from left elbow injury), proper timing and proportion of rest, massage (trigger point release), stretching and strengthening during recovery process is of utmost importance.
It learned it hard way thati:
1. it does not make sense to stretch if you have muscle knots - this puts harmful pressure on already injured tendons.
2. it does not make sense to strengthen your muscles if you are unable to stretch them properly
3. tendons do not heal as fast as muscles; it appears that medical community still has a very vague idea how tendons heal. They also tend to heal creating x (crossed) instead of = (parallel) threads, resulting in weaker structure which is prone to re-injury. One has to massage them gently in a proper way to help the threads grow in a natural parallel fashion (like a small thread in a rope).
4. proper nutrition and hydration is very important
5. proper warmup before violin practice is very important

The challenge is finding an expert who knows the above aspects of healing process. Most of the people I met knew 1 or 2 and are prone to mechanical and compartmental approach to human body. The proper ratio and timing of massage, stretching and strengthening will depend on type and extent of injury and has to be designed for each client.

July 30, 2017, 5:49 AM · For a violinist's purposes I'd replace dumbbells with a more realistic (and cheaper) couple of tins of beans. You don't actually need anything heavier and you can exercise with them before you eat the contents.

I've heard lots of pros and cons concerning yoga, and for me the cons outweigh the pros. In my opinion, far more useful for the violinist, and any musician if it comes to that, is the Alexander Technique when taught by someone who knows what they're doing. My violin teacher didn't often specifically refer to AT as such, but I realised as time went on that it underpinned all her technical teaching.

July 31, 2017, 9:54 AM · Trevor, I think that yoga is really great for you as long as you don't go in with a competitive or goal-oriented mindset, unless your goal is 'listen to your body and don't push yourself through pain'. A lot of people hurt themselves by not paying attention to what feels good to them and by fixating on the next feat they have to conquer.

I second the Alexander Technique recommendation.

August 9, 2017, 8:46 PM · The last thing someone with tendinitis needs to do is start blindly hitting weights. I haven't read all of the posts above, but the kind of doctor you see is one that works in orthopedics generally. i.e. orthopedic surgeon. Yes it is appropriate to see an orthopedic surgeon without having any intention or need to get surgery.

It's taken me 4 months to somewhat recover from my tendinitis issues. I have both lateral and medial epicondylitis that extended throughout the forearm and to the wrist and hand. For the first 2 months of only seeing a primary care my symptoms were awful and I was almost incapable of signing my name. Not until I saw an ortho that prescribed a new round of medications, intensive physical therapy, ice/heat treatments, extreme caution/rest of the arm, etc. did I finally start to get some relief from my symptoms.

Best thing you can do is try to stay flexible and build strength. Even basic stretches like wrist flexions can help significantly if you do them regularly before/throughout/after, really whenever it starts to feel tight, should help to prevent injury. Start small with building strength. Keep everything slow, we aren't trying to lift as much as possible just trying to keep healthy. Good form, good breathing, slow movements, and a wide range of motion. Do only the weight you can handle and if you catch yourself with bad form then lower the weight a bit and build up to it.

Here are a couple exercises you can do at home that I do regularly at pt. Wrist curls, bicep curls, rolled towel gripping (or any hand/finger grip strengthener, towels are just readily available to everyone), and always remember to stretch.

If you're getting pain on a daily basis from simple tasks, that's something serious. If your current doctor isn't helping you through that then you may want to ask if he can recommend a specialist.

Edited: August 10, 2017, 3:06 AM · I have had tendonitis for over 20 years ; it started when I began to learn to play guitar. Nothing I do has ever been able to get rid of it so I have just learned to live with it. The violin is not as bad as the guitar as long as I limit myself to one hour per day.

Anything I ever did to 'strengthen' the hand or wrist just made things worse so I do not believe that will help you.

What does help with pain and healing is heat so 10 to 15 minutes each day for each wrist in hot water. NEVER use ice or cold water : I found this only makes things worse. Always keep your hands warm by wearing gloves if you go outside in cold weather (which is not really a problem where I live). A good massage therapist can work wonders for all sorts of problems but the big problem is finding somebody who knows what they are doing.

Edited: August 10, 2017, 4:00 AM · I second Bailey's recommendation to get a referral from your GP to an orthopedic surgeon and to ignore well-meaning advice from amateur doctors to lift weights and such. Also an experienced physical therapist can show you the right exercises to do that will help you strengthen your wrists without hurting yourself. Again, your GP can write you a prescription for PT ("diagnose and treat") and if you have decent insurance it should be covered.
August 10, 2017, 5:54 AM · Perhaps things are very different in the US (I hope so) but I have never heard of anybody being successfully treated for tendonitis with surgery. I have also found most GP's and physio therapists to be of very little use in this area.

August 10, 2017, 7:31 AM · From my personal experience I know that the function of everything extending from one's shoulder starts in the brain and travels through the nerves between the cervical vertebrae and every joint on down to the fingertips. Problems anywhere along that chain can manifest in difficulties and even paralysis.

Be sure that location(s) and causes of your problem are clearly understood before trying to treat them.

20 years ago after I saved a few dollars replacing my Apple computer's mouse with an off-brand mouse that lact the same ergonomic shape by a millimeter os so; as a result my right shoulder function was destroyed to the extent that I could not throw a ball as well as my (then) 4 year old grandson. Fortunately it did not affect my violin playing.

Edited: August 10, 2017, 5:40 PM · My physical therapy experience was great. And seeing an orthopedic surgeon has no direct implication to surgery. A surgeon is still a doctor.

Seriously though, hitting the gym while suffering from tendinitis like symptoms is probably the worst thing you can do. You may as well sever the arm and move on at that point. Especially doing lifts like deadlifts and pull ups... You need targeted exercises that you can focus on control, stability, and form with. The more muscle groups involved, the more difficult it is to maintain decent form.

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