Strange New Shoulder/Back Pain

November 5, 2008 at 10:50 PM ·

 Hi all,

I've been experiencing a strange shoulder pain lately.  It hurts where my right arm attaches to my shoulder on my back and I think it's muscle pain.  I've experienced pain since August, but it was minimal and only lately has it gotten bad.  When I'm playing violin, I have to rest about every 15 minutes, but it also hurts when I'm doing physical activity with that arm - especially pushing/pulling heavy things.  I don't know if this pain is a result of playing, but I first noticed it while playing.  You should also know that I haven't changed any practice habits; I only practice 1-2 hours per day.  I did, however, purchase a new instrument in January 2008.

Does anyone know what's wrong?  Any exercises would be helpful too.

Thanks,
Sydney

Replies (21)

November 5, 2008 at 11:10 PM ·

 Have you been able to see an orthopedic specialist? Bard has a conservatory, so they probably have contacts who specialize in musician's injuries. I'm sure there are good specialists in NY, but with luck you can find someone closer. If I were you I would not embark on an exercise or stretching program until I'd seen an orthopedist or physical therapist who works with violinists. 

I know several people will recommend Alexander Technique, which certainly won't hurt you, but you need to see a medical specialist for this injury, which has been going on now for several months. Could be that something about the new instrument (maybe a different chin rest) has created a change in your position that caused a biomechanical chain reaction. A good specialist will want you to bring the instrument to the appointment. Good luck!

November 5, 2008 at 11:19 PM ·

I had pain that sounds a lot like that- more or less under your shoulder blade? Like a toothache that won't go away? My doctor sent me to a physical therapist, who did a lot of work loosening things up in my back, neck, shoulder area, and had me do stretching and exercises with small weights. Possible source too much in one direction w/o developing opposing strength. Get to a doctor! :)  Sue

November 5, 2008 at 11:35 PM ·

The advice received is good.  You need to see an orthopedist, and this doctor will probably send you to a physical therapist.  These injuries tend to be what is called musculo-skeletal, and the cure is usually exercises to strengthen the muscles.  With the use of some anti-inflammatory meds and some exercises, this should go away.  At the same time, you should ask your teacher to evaluate your technique to make sure that there is not some flaw creating the problem. Good luck from someone who is a minor orthopedic catastrophe area!

November 6, 2008 at 01:07 AM ·

Indeed see an orthopedist. You could have a frayed rotator cuff. A physical therapist told me that this is actually an imbalance between  several muscles in the shoulder. I had a few weeks of PT and stayed of it for a week and it is gone. 

November 6, 2008 at 06:14 PM ·

Oh, no!  I was just thinking the other day, "I wish Sydney would check in so we would know whether to believe those Bard ads."  :-)  This is not what I was hoping to hear...

I echo the people who say, "Get to a physical therapist."  (You'll probably need a doctor's referral, based on how most insurance works.)  Glad you're resting rather than playing into and exacerbating the pain.

November 10, 2008 at 06:44 PM ·

Well, I went to the doctor!  Health Services (on campus) gave me some anti-inflammatory medication and told me not to play for a week.  I am going back on Wednesday to see a doctor whose second specialty is orthopedics and I will bring my violin.

November 10, 2008 at 11:48 PM ·

 I have my fingers crossed for you (which makes typing very difficult).

November 11, 2008 at 01:40 AM ·

Sounds like ratator cuff to this amateur doc. The initial three days are gone so maybe applying heat would help now.

November 11, 2008 at 04:55 PM ·

 Yucko. Hope it clears up soon. Hope you're otherwise having a good year!

November 12, 2008 at 02:27 AM ·

While I'm no dr, I did want to say I encountered a similar type of problem.  I got a different violin, larger than my last, and was fine for a month, and after that suddenly got lots of pain.  I went to see an orthopedist, who'd operated on that same shoulder (I agree with others--you should see an orthopedist).  He told me that often, when someone changes equipment (whether it's violin or sports or whatever the case may be) it can strain the rotator cuff and that one needs to do physical therapy to help strengthen it.  Of course, you may have something completely different which only a dr can tell you, but did want to let you know that you're not the only one who started having problems after changing equipment.  I hope it all ends up working out for you.

December 31, 2008 at 11:07 PM ·

Hi Sydney, I'm glad to hear you saw a doc and will be thinking good thoughts. 

As for other ideas for helpful pain management and so forth, I have found great benefit in seeing a chiropractor fairly regularly.  I was in a very bad car accident a few years back, and was terrified to consider back surgery.  With therapy, and my chiropractor, I managed to skirt the surgical route.  While I still suffer from bad back pain, and shoulder pain (torn rotator cuff from playing volleyball..not the violin), I might also recommend a product called Biofreeze - a topical treatment that I've used for years.  It's available in a gel, but now in a spray, which is much more convenient!  I don't have to wrap my arm around to my back and get it everywhere - the spray is easier - I do like this product, and it may help you in feeling some mild/moderate pain.  It seems these sorts of things do ebb and flow.  

Good luck!  :) Valerie

January 1, 2009 at 01:43 AM ·

I had a pain like that and found out I was kind of crooked all the time. After a minor injury, this crooked life made things so much worse and painful. Sitting crooked, talking on the phone with shoulder up while cradling the phone, driving in a slouch. Italways favored the same side and in the end, my back was out of line. While that didn't cause the initial pull at the beginning, it really made it worse very quickly. I also had numbness in addition to what you describe in my thumb and hands. I had to do everything really straight with a straight back for about 6 months and it helped a lot along with excercise and of course some tylenal 800. If you lift things, or push or pull heavy things make sure you line up your back, neck and head so they are all straight. This of course assumes it is just a muscle thing. Don't practice with your weight on one foot. Sleep with the right pillow as well, straight on your back which took a while to get use to. Try not to fall asleep slouching over as well. Good luck and I hope you feel better soon.

January 1, 2009 at 01:52 AM ·

Sydney,

Have you seen the orthopedist yet?  I just took my son, 14, to an orthopedist because his shoulder hurts when he gets his bowing elbow up to where it should be.  It turns out he has overlaxed ligaments.  While it can be a plus for playing sports (he's also a pitcher), it can be potentially not good because the ball joint in the shoulder moves around more and rubs against bone and causes pain and could ultimately dislocate.  The doc said about 10% of people with this condition end up having surgery but he thinks my son will get better with physical therapy.  He'll go twice a week for 6 weeks to strengthen surrounding muscles so that the ball won't move around so much.

I hope all is well with you, Sydney.

January 1, 2009 at 06:07 AM ·

Three cheers for J Kingston! In my experience, doctors don't know very much about this sort of thing. Osteopaths and Alexander Teachers are a better bet.

February 23, 2009 at 04:23 PM ·

I've been getting this pain 24 hours a day for the past few months, and when it got unbearably annoying I decided to take a break from playing violin. I started swimming in the meantime, and the pain has largely gone away - only to return whenever I pickup the violin (even for short amounts of time).

The orthopedist says that correcting my posture and reducing force employed by the bowing arm should help. So, my next experiment will be to see if consistent swimming (to balance out the back muscles on both sides) and consistent posture focus while playing will take away the pain.

I should probably try Buri's stretching suggestion also..

Lots of luck to everyone else experiencing this pain!

February 23, 2009 at 04:37 PM ·

So how are you doing several months later? Our medical board wants to know. We have all seen at least one Dr. show on TV so we're more than qualified to give medical advice.

February 23, 2009 at 11:13 PM ·

Greetings,

I`m not. I don`t have a licence.

Cheers,

Buri

February 24, 2009 at 12:25 AM ·

Hi,

I posted the below a long time ago in response to a similar discussion. 

I really do believe that in situations when orthopedists and neurologists are unable to find what's wrong, tension myositis syndrome (TMS) is often the culprit:

---------

This is going to sound unorthodox to a lot of people, but a doctor named John Sarno established a relatively famous and controversial theory many years ago that most chronic pain that people have is NOT caused by structural problems with their bodies--their bodies create the pain (through oxygen deprivation, it's believed). The idea is that when rage, fear, etc. in the unconscious reaches a certain point, the unconscious directs the brain to create pain (itching, etc.) as a distraction to prevent the undesirable feelings from surfacing. In particular, this tends to happen to people who are perfectionistic, insecure, competitive, and self-critical.
Most people actually get better just from accepting this diagnosis, and relatively quickly, at that.

There are lots of websites on this--search for Tension Myositis Syndrome.

Dr. Sarno has had better results with this than any type of medical doctor I've ever researched--over 80% of his patients who accept the theory are pain-free, again, usually pretty quickly.

Consider a number of studies that have determined that 1) people without back pain are just as likely to have bulging and herniated discs, etc. as people WITH back pain.

All this is very researchable. Look up books by John Sarno, and search the web for "tension myositis syndrome."

In my experience, his theory is correct. I've been a chronic pain sufferer numerous times, and have gotten better after accepting what he says is the true cause of the pain. Many thousands of people have.

In one such situation, I, and lots of orthopedists, neurologists, and physiatrists, were unable to explain the symptoms of severe pinched nerves that I was having.  Needless to say, there were no pinched nerves, and I got better when I realized and accepted that I had TMS.

Think about it--tons of young people are out thereweight-lifting, playing rough sports, etc., and many elderly people with some degree of arthritis are not in terrible pain. ESPECIALLY if you're relatively young and otherwise in good health, a structural reason for the pain does not make much sense, in most cases.

Again, I know this sounds unorthodox and controversial, but I believe it to be true, and I hope it helps people. [Flag?]

February 24, 2009 at 07:54 AM ·

Sydney -

How old are you again?  One of the things I've discovered over the years is that as your body changes things that worked easily and well for you in the past don't do so anymore.  Something as seemingly innocuous as gaining or losing 5 pounds can have have a tremendous impact in your physical activities, especially when playing an instrument.  Physical changes we all experience over a life-time can distrupt that delicate balance.  Somewhere betweeen the mid 20's to early 30's your body changes again.  Balance points start moving to different areas in your body, and you start to find that you aren't as flexible and relaxed as you once were. 

Add to any physiological changes with a change in instruments, and that disruption can be more pronounced.  An AT teacher in conjunction with a physical/occupational therapist should be helpful.  I hope that there aren't any other underlying causes to your pain other than normal changes & adjustements.

February 24, 2009 at 08:05 AM ·

1-2 hours per day is a lot of playing.  I'd be willing to bet that the pain is being caused by your neck muscles.  Your neck muscles are extremely underrated but they affect your whole backside.  They connect to your shoulder and run all the way down to your lower back.  Your playing posture may be producing muscle tension or even a pinched nerve.

I would highly recommend that you look into having a few sessions with an Alexandar Technique specialist and/or an acupressure massage therapist.  I would also stop practicing completely.  Pain is your body's way of saying stop.  There are other ways to stay in "playing shape" without actually playing.

February 24, 2009 at 09:19 AM ·

Hi Sydney:

Try this. Put your old chin and shoulder rests on the new fiddle and be sure you have it in the same position as the old one was.

If you have a video of your recent playing even if it is just practicing put it online. Maybe someone can see the problem.

It sounds to me like you may have a trigger point in the posterior rotator cuff. This is not serious if you have the right doctor and a good position of the fiddle on your left shoulder. The doc to see is a pain management spec. If he is any good he will be able to give you a trigger point injection which in my experience is almost without pain due to the local contained in it, and within a few days the pain should be dramatically reduced. After that it is up to you.

 What broke the cycle for me was learning to hold the instrument in a low position relative to the right shoulder, not the left. It is simple. Put the instrument on your shoulder and look in the mirror. Set it so that the curve of the shoulder rest is on the collar bone rather than over the shoulder, even though it looks like it should go on the shoulder. Judge this by comparing the height of the bridge to the right outer end of the collar bone. See vids of Oistrakh and Kogan on You Tube.

Your right upper arm should not go much over level if at all when you play on the G string. You should let the weight of the fiddle push down on the shoulder rest while the chin rest pushes up on your jawbone, and you put almost no pressure at all down on the chinrest. It hangs there by itself instead of you holding it. Do no fast playing at all until the pain is gone altogether. I've been through this and solved it by adapting the Russian bow method which involves pulling and pushing the bow rather than sweeping it crosswise with a side-to-side motion of your arm.

Last, check this advice with Dr Jay Azneer, who is a viol.com member and an avid player. I have been working with him for some time with regard to playing healthy and without strain. Write him and see what he suggests and whether what I and your other supporters have suggested sounds like it makes sense for you. When and if you look  for a local spec in pain management, usually anesthesiologists and physiatrists do this sort of thing.

Good luck and write back soon with progress report.

BJ Berman

 

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