Tendinitis and College

July 28, 2016 at 03:17 PM · I am 18 years old and have been playing the violin for 12 years now. About 8 months ago when I was practicing for an audition my hands gradually started to cramp up and get harder and harder to move. I pushed through it and was able to deal with it until about May. In May I had around 12 performances with my school orchestra, playing with my school choir, multiple times in church, private lesson performances, weddings, etc. My hands and wrists were constantly aching and the pain traveled up to my elbow. I finally went to the doctor and was diagnosed with tendinitis in both hands and up to my elbows. I took a break for a couple of weeks but the big issue is that I am going to start college and my major in violin performance really soon. I have to get ensemble audition material learned and perfected and it is really hard to even play for 10 minutes at a time.

I have been working on Bach's Chaconne for awhile now and can't seem to make much progress because of the pain and it's so frustrating to have this problem. I really don't want to change my major but I just don't know what to do.

Also does anyone have any ideas why I would have gotten the tendinitis? Is there an aspect of technique that could be done wrong which would cause this?

Replies (24)

July 28, 2016 at 04:16 PM · Ask you doctor for a Physical Therapy consult. The Physical Therapist can evaluate what is going on and prescribe exercises and stretches to help. The tendonitis will take a while to heal, and every time you practice too long or irritate the injury, it will make the recovery time even longer! If the doctor prescribed antinflammatory medication, take it as ordered for as long as ordered. Ice, heat, rest, and the Physical Therapist will help.

I would say that figuring out whether it was overuse or a mechanical/form issue is most important to help minimize the possibility that it will recur. No reason to change your major yet.

July 28, 2016 at 04:48 PM · Until you get help from a physical therapist (and look for one with experience helping violinists), you need to REST. If you can't play for ten minutes, then you're significantly damaged. You need to stop playing entirely. It's already late July, and you're starting a performance degree in less than a month? If I were you, I'd call up your undergrad institution and ask whether you can defer your admission -- for a year. You might lose your housing deposit, but that's a small price to pay.

I have seen this before -- young person plays the violin well, so even as they're preparing their senior recitals or college auditions, they get invited to play in the school musical orchestra, and performances at church, and so on. And a lot of that extra time is spent playing relatively easy music sitting down, so you start to get sloppy about paying attention to posture, hand positions. Mild fatigue turns into serious fatigue and then pain. As you go forward, in addition to being more mindful, you have to learn to say "no" to many of these "opportunities" because your body can only take so much.

July 28, 2016 at 04:58 PM · From my painful 6 months experience with recent injury (diagnosed as golfer's elbow on my left arm), I learned a few things.... and if I had to pick one keyword, that would be - BALANCE.

Our body is able to compensate quite a lot during distress, probably due our built-in capability to survive, but is amazingly unable to stop (wrongly) compensating and enduring dis-balance over a long time. Add the lack of bodily awareness and the things get worse.

Muscles, tendons and nerves have to work in perfect harmony in order to do their job. Once they are kicked out of balance, we spend more energy to perform basis movements and, if we repeat them often enough, the injury is only a mater of time.

Because of your age, your recovery could be shorter, but the same principles apply. You need to find a team of highly knowledgeable specialists passionate in helping musicians or people who engage in sports recover.

Your wining team:

1. Sport medicine doctor - to establish a proper diagnose and instruct # 2 on physical therapy

2. Physiotherapist - follows the instruction from #1 and reports back on progress

3. Nutritionist - provides advice on proper nutrition

4. Massage therapist, specialized in trigger point release - may be needed after #2's goals are reached, but the pain (due to muscle knots) persists

5. Violin teacher aware of challenges and injuries; if your teacher is unable to help, ask for 2nd opinion

Unfortunately, it takes time and a bit of luck to find them and, when injured, the time is of essence. A good professional will offer you explanation of causes of the injury and justification of steps to recover. If you do not see immediate progress in symptom relief, keep searching for better expert. ( For example an inexperienced physiotherapist can give you wrong exercises and in fact make things worse. )

Avoid anti-inflammatory drugs (if you can), because they will give you a false impression that the pain is gone and you are good to play, while the cause of the injury is still present. If the inflammation is indeed confirmed, use natural anti-inflammatory food such as curcumin (turmeric) paste. It address the inflammation only, not the pain, so you will be in the know.

What is essential, and the most difficult thing to do is to stop playing long enough to allow your body to regain balance and heal. From your post I understand that you are under time pressure, but you need to be warned that, if you pass certain threshold of injury, your career as a violinist will be over. Also, please note that, at least as far as I could find, tendons take long time to recover, because of relatively limited blood supply. (Right now, it seems that the process of tendon healing is a bit of mystery in medical community.)

Once you stop playing, it is only a beginning of a long way to recover, along which you will have to re-learn many things, including proper posture, warm-up routine, how to properly stretch.

You will have to release tension in certain muscles and possibly also strengthen certain muscle groups to regain balance. If the balance is not regained, chances of re-injury are high.

Once you are out of pain and have regained balance without instrument, it is essential to re-visit the way you hold the instrument and perform movements in order to stay balanced.

If you happen to be in Canada, send me a personal message and I will be glad to refer you to people who helped me recover.

July 28, 2016 at 06:54 PM · I don't want to work against Rocky's suggestion of turmeric as a home remedy for inflammation, because it sounds like he has had positive personal experience with that. Turmeric seems to be relatively safe in terms of side effects unless you're diabetic, pregnant, hemophiliac, etc. My strong recommendation, however, is that you follow the advice of your physician when it comes to medication. And if you are using turmeric, be sure to tell your physician that you are doing so. I'm always suspicious of herbal remedies that claim to be useful for treating dozens upon dozens of different conditions ranging from arthritis to liver cancer to depression to leprosy. Kind of just sounds a little too good to be true.

July 28, 2016 at 06:59 PM · Paul, I can not agree more. This is a public forum and all advice is given in best intention and based on personal experience. I hope that OP will listen to her physician and her body. The challenge with turmeric is zero retention, so it has to be taken with other ingredients in order to stay in the body long enough.

July 28, 2016 at 07:34 PM · Thank you so much for your advice everyone. I'm thinking that my main problem was that I never really warmed up I just jumped into the hard stuff. My violin teacher wasn't supportive at all so I don't have a teacher at the moment. I'm going to schedule some physical therapy asap and see where to go from there. Thanks again!

July 28, 2016 at 09:23 PM · I agree that you will probably want to defer your admission for a full year. For severe tendinitis, you are going to be spending weeks in recovery at the very least, during which it might be advisable to not play at all. I agree that whatever PT you do should be with someone who is experienced in working with violinists.

It's also vital that you modify your technique so that this doesn't happen again. Injury is career-destroying for violinists.

July 28, 2016 at 10:52 PM · Agree with previous poster’s recommendation to pinpoint the cause of the problem -- e.g., overuse or mechanical/form issue. This helped me deal with two cases of tendinitis.

No idea, from what you wrote, if there could be other physical activities contributing to your problem. In my case, I was working out 4-5 days a week for almost 5 months without a break. Then tendinitis in one elbow made it painful to execute cable flyes or dumbbell flyes or triceps push-downs. It wasn’t a matter of form but overuse and not enough rest. I ended up taking three rest weeks and recovered. Now I take a rest week after 6 weeks of working out.

On violin-playing and wrist tendinitis: See my experience from a few years ago:

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

July 29, 2016 at 01:13 AM · I have had tendonitis in the left wrist for over 20 years. My experience is that once you have it then it never goes away. Things may be different in the US because you have access to many specialists who specialise in musicians' injuries.

Rocky's advice is good : stop playing for a while. You really have to do this. Do not take any medication which simply masks the pain ; that is not the way forward.

You can try physiotherapists but my experience with them was that they are useless. They were unable to help with my tendonitis, frozen shoulder or back problems. You may have better trained physios in the US. Massage can help a lot of you can find a good massage therapist : A Chinese massage therapist cured my frozen shoulder in one 30 minute (painful) session ! Nobody else seemed to have a clue what to do about it.

Do have a plan B. Tendonitis is not an easy fix so you do need to explore other options at college. It is time to rest and think.

July 29, 2016 at 03:30 PM · McKenna,

2 of my 3 violin teachers had similar problems, except that the tendonitis occurred while they were in their college program. Both took a year off to recover. Tendon injuries are not like muscle strain. Because they have no blood supply, tendons take 8 to 10 months to heal. You should stop playing. More playing will cause more injury at this point. I have been there myself - I just caused more damage by pushing my playing.

During time off, find a different teacher who has special knowledge of relaxed stance, relaxed technique, and the daily exercises to get and reinforce relaxed playing. In short, your current teacher, "hot housed" you without instructing proper technique to make a career on the violin. Your technique flaws create so much muscle tension, sustained for thousands of hours, that tendon injury has occurred. Get a new teacher. You will start over again, so learn proper, sustainable technique this time around. The good news is you can learn faster, but face it, you will be relearning. IMO, physical therapists are a waste of time and money. They know nothing about violin technique and cannot address the problems your practice style has gotten you into.

Most likely, somewhere around 7, 8, 9 months, you can play a few minutes (5 to 15) without pain. Nine months after my own tendon injury (years ago), I started with 5 minutes a day and over the course of a month, gradually worked up to 1 hour without pain. Practice with your new teacher and spend time on the exercises to re-enforce relaxed playing - no tension anywhere.

If you are, or can be, near Rochester, NY, I can put you in touch with an excellent teacher who can teach proper relaxed technique. Best of luck. This is tough for you, but I know 2 fantastic violinists who recovered and made good careers after the same problems. I also recovered and learned relaxed technique, so that makes 3, but I am a non-professional violinist.

July 29, 2016 at 03:54 PM · ... regarding the critique of physical therapists; it is well deserved and there are people around who simply should not be allowed to practice. My experience is that 50% of them are useless or even harmful, while a few of them are excellent. Even the best of them have limitations, and that is why I think that one needs a team of experts. Proper diagnostics is extremely important; there are many steps in differential diagnostics and the same set of symptoms occur for 2 or 3 completely different causes. Moreover, there are only a few who indeed know what muscles are involved in violin playing and how to regain optimal functioning after the injury.

Another trend is to use "syndrome" to bulk label injuries, such as tennis elbow, golfer's elbow, RSI, etc. While convenient for inter-professional communication, it has inherited weaknesses in diagnostics, treatment and post-intervention.

July 29, 2016 at 04:45 PM · Rocky,

Tennis elbow and Golfer's elbow are not "syndrome" dx as you suggest. Tennis elbow is inflammation of the lateral tendons, thus called Lateral Epicondylitis. Golfer's Elbow is the opposite, the inflammation of the medial tendons, thus Medial Epicondylitis.

ALso, I disagree with your assertion regarding the use of anti-inflammatory medications. You are confusing the analgesic effects with the anti-inflammatory effects. The understanding is that you will follow instructions and not play, even if the pain is lessened. Sometimes anti-inflammatory medications are good things. Sometimes players need Steroid injections to decrease the inflamation, just like athletes.

July 29, 2016 at 05:51 PM · Duane,

No, I am not confusing the analgesic effects with the anti-inflammatory effects. Pain is there for a reason - your body is telling that something is wrong and you should pay attention to it. Inflammation, if proven, is there for a reason too.

You can take NSAID for 7 days and then are supposed to go back to your doctor who typically knows nothing about this type of injury, but will chant the RICE mantra again. I abstained from playing for 4 months, with a few rounds of NSAID, which beside of temporary pain relief did not help at all. They may threat some parts of the symptom, but do not address the root cause of the problem.

Having said that, I am not a doctor and have already agreed with Paul that one should listen to their doctor first.

The challenge is that, some of us, after listening to our doctor and exhausting conventional healing methods with limited or no success, have to keep searching for healing where it is available. Trust me, it is not fun to be in pain for 6 months, not knowing if you will ever play music again!

Once healed, I feel it is my duty to share experience and minimize the suffering of others who are in the same boat.

I do not want to open a discussion about the whole paradigm of contemporary medicine here - I have been surprised on how ineffective it is in treating relatively common injury. At the end of the day, the OP will travel the similar path and draw her own conclusions. My only wish is that her suffering will be shorter and less painful than mine.

July 30, 2016 at 12:55 AM · I would have to agree with everything Rocky has said. It is extremely unlikely that doctors will be able to offer any help at all ; most of them will just reach for the prescription book. It is going to take McKenna a while to find the right person to help her.

I would like to add that I have found that ice makes tendonitis worse by increasing the pain and doing very little to help it heal. I have found that heat is much better : water bottles or soaking in a bucket of hot water.

I still think that the first port of call here is a good Chinese massage therapist.

July 30, 2016 at 01:41 AM · Heat can make inflammation worse. Cold decreases inflammation. Basics from Nursing School and first aid.

July 30, 2016 at 02:06 AM · When I had rotator-cuff tendinitis they advised me to take long, hot showers with the water-stream directed at my shoulder -- and not to use cold.

July 30, 2016 at 02:41 PM · McKenna -- go back to your doctor. Go back to your doctor. Go back to your doctor. Clear?

July 30, 2016 at 02:53 PM · “I’m thinking that my main problem was that I never really warmed up I just jumped into the hard stuff.”

OP: Yes -- that’s one habit you should definitely break.

Warming up is something I do religiously -- about 20 minutes per session. First, right after tuning, I hit a short series of basic finger gymnastics along the lines of Schradieck, left hand only, 3rd position, equal time on each string -- E-A-D-G, in that order. This takes 1-2 minutes.

Next come vibrato exercises, 3rd position, on E-A-D-G, equal time to each finger, full bows: 2-3 minutes.

Then I move down to 1st position, to open up the left hand still more, and repeat these routines. I take left-hand drills like Schradieck or Sevcik or Dancla in small doses and then -- very important -- intersperse them with vibrato exercises and brief pauses to stretch out both arms and both hands -- a definite aid to avoiding cramps.

There’s more to my 20-minute warm-up, but I’m sure you get the idea. Bottom line for me: No “hard stuff” -- e.g., 3-octsave scales, etudes, repertoire -- till after 20 minutes, when I’m thoroughly warmed up.

July 30, 2016 at 06:02 PM · I'm thinking that the OP's problem goes well beyond the lack of a proper warm-up. That level of tendinitis in both arms suggests a level of tension and improper muscle-use that needs to be carefully looked at by a teacher, preferably one that also does Alexander Technique.

July 30, 2016 at 11:41 PM · I thought I'd chime in as a physical therapist of 16 years, as well as a violinist. A couple of months ago I played solo (Introduction and Rondo Capriccioso) with an orchestra, to give y'all an idea of where I am musically. I've worked in all kinds of medical settings, including general outpatient pain and surgery clinics, as well as private practice treating many violinists and other musicians.

I don't give specific medical advice about anyone's situation without a physical therapy evaluation in person, so please consult with your local medical practitioners. Here is a referral source for those who work with musicians: http://artsmed.org/referrals

I thought I would just spill a few thoughts about pain, healing, and physical therapy. You can agree, or not. :)

The things that basic physical therapy approaches are good at are: strengthen what's weak, stretch/loosen what's tight, and facilitate the body's natural healing process. Nearly all PT's come to the profession via an interest in athletics and/or the sciences, so very few have any idea what instrument study entails. Most will approach you as if you were an athlete, or a desk worker - for some problems this is OK, but for most it's best to also seek help from a musicians' specialist.

Unless a person has a specific finding of, for example, a muscle tear, a herniated disk, or just had a surgery, a physical therapy prescription from a doctor usually gives us very little information. It's up to us to exercise our judgment, and report back to the doctor what we're doing. For the most part doctors are not trying to be physical therapy specialists telling us exactly what to do - they know that's our job.

Years ago, I found that the Alexander Technique (http://www.alexandertechnique.com/) helped to fill in the missing links, for me, of HOW we as complex, brainy beings use our bodies, and how we can work with repetitive, unconscious habits (the source of overuse and persistent problems). I became a qualified teacher as a result. I think there are many very useful approaches to this same idea, and though Alexander has been life-changing for me and many others, it's not the only "path to enlightenment". :)

I personally have found that for a lot of musicians in pain, some common findings that I work with are a lot of neural tension (David Butler is a PT who has done a lot of work in this area), and a lot of fascial restrictions. The term "tendinitis" is seen by many nowadays to be outdated, and many say a better description for the process of overuse pain is tendinosis, micro-damage which isn't so much overt inflammation as more degeneration and poor blood flow. There are MANY reasons for pain in a particular location than tendinosis, however.

Usually overuse problems occur with a change in hours at the instrument, a change in equipment, or a change in technique. Most often the first one.

Most important to healing, however, is a person's mindset. People who heal well - physically, and otherwise - have several characteristics I wish I could impart to everyone:

- Willingness to accept the need for a change in habits, to see pain as a welcomed warning sign instead of an annoying interruption to getting back to exactly the status quo

- A respect for pain, resting and modifying as recommended - but not a fear of it

- Willingness to actively participate in healing by actually doing recommended exercises, sleeping and eating right, gaining perspective, using intuition, taking care of mental and spiritual health

- Being willing to make changes in equipment as necessary, but not to expect equipment to do the awareness or thinking for them

- Being willing to change musical practice habits during healing time to include going back to simple basics, honing listening skills, honing kinesthetic awareness, questioning what one thinks are "givens", singing, moving to music - always looking for new and creative approaches to problem solving.

I could go on forever, but I won't. Thank you to the OP for seeking help before things got worse!

August 1, 2016 at 12:52 AM · Thank you so much everyone! I am going to a hand therapist suggested by my doctor in acouple of days and am going to decide after that (probably based on what they notice and say) if I should just do GE's the first year of college or if I might be able to still major in violin performance right off the bat. I really don't want to wait a year, but it's probably a smarter option :(. And Diane, thanks especially for the comments on how a persons mindset should be while healing. I definitely need to work on a few of them. Thanks again everyone!

August 2, 2016 at 10:23 AM · What about instrument setup?

I had a milder form of all this when borrowing a heavy, long viola with a dull tone, and high-tension strings far too high off the fingerboard. With the effort to liven the sound with more vibrato, and the combination of extended arm plus a more tense pinky gave me Viola Elbow. Three months complete rest, and back to my own viola! (15-3/4" body with a 14"string length..)

August 27, 2016 at 01:46 PM · I have discovered this warm-up routine and thought others may benefit from it:

https://www.youtube.com/watch?v=5M2Kj-iBXPc

It is a bit complex to remember, but is relatively short and very effective.

August 27, 2016 at 09:48 PM · Get to an Alexander Technique class, if you have access to one. Tension and overuse is a major cause of tendinitis.Playing relaxed is important when playing the violin. Especially when you start into advanced technique. If there is an Alexander teacher in your area, I would highly recommend one. An Alexander person with violin experience would be the best. Good luck.

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