Endless Wrists Problem which ruined my life

July 26, 2019, 5:29 PM · Hello

When you have 1 free minute, I kindly ask you for an opinion on my problem that has ruined my life.

My problem is perhaps impossible to solve given that I have never achieved results from 1995 to the present.
Until 1995 (when I was 18) I used to play 6-8 hours a day every day, both the violin and the guitar, but then I had a problem with both my wrists, apparently because of too much playing. Since then I have never basically played again because of the huge pain I have had in my wrists if I play,
which obviously has completely ruined my career and my life.
Sorry for my english, I am from Italy.

At first the problem was just a little bit of a nuisance and a little stiffening in the wrists.
In the stupidity of 18 years old I continued to play many hours every day even though I was realizing that the problem
was getting worse and worse and after about 6 months later without a single day of rest from playing the problem exploded.
Until that moment I had been playing for about 5 years.

I have been visited by a huge number of doctors, orthopedists, hand experts, surgeons, physiotherapists, osteopaths for these almost 25 years.
I have tried many therapies in the past, absolute zero improvement ever.
According to the exams (several MRIs, echographies, X-Rays, electromyography, rheumatic blood tests), nothing is abnormal and no one has been able to give me a diagnosis with certainty, even after so long!

The pain occurs only on the upper band of the wrists, exclusively there, without hitting the fingers or the hand or the forearm.
No tingling or involuntary movements (dystonia has been excluded). No strange posture of the hands / wrists.

No longer playing the situation has normalized, I can do all the basic things in life (eating, driving, using the computer) without problems/pains. But if I do something more complicated, like even simply carrying an heavy bag, the pain appears. If I play, the pain explodes absurdly.

What is very strange is that even if I do have some nuisance while playing few minutes (15-20 mins, not more),
the real pain explodes all of a sudden only after 24/48 hours and is so extreme that I must rest about 10 days
before 'playing' again very few minutes.
In other words I basically can't play at all.

I have done endless research on the subject since 1995 and the most probable thing seems to be that the tendons have degenerated when at the time I played too much and didn't give them time to recover, but I am not completely sure.
In this case it would be a degenerative tendinosis,
not a simple tendonitis which is 'only' an inflammation.
It seems that a degenerative tendinosis is not seen by exams like MRI because it happens at a microscopic level.

If you have ideas on how to improve I am really looking forward to your answers and if by miracle I improved I would be more than happy to reward with anything you want, really anything. Otherwise I am already so humiliated and depressed after 24 years of this mess that I guess I am gonna die because of it sooner or later.

Thank you in advance

Rocco


Replies (63)

July 26, 2019, 6:03 PM · Well, that's depressing.

I just lather some Rub-A535 on my wrist when it flares up and it's fine. But I guess you would have tried creams already...

July 26, 2019, 8:02 PM · Have you seen a physician that specializes in rehab medicine for musicians?
July 26, 2019, 9:58 PM · Also maybe talk to someone who teaches Alexander Technique?
Edited: July 27, 2019, 2:24 AM · I never heard of tendinosis until now, this was very informative, and scary:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/

I would start taking collagen supplements (they are popular these days in the US, so easily available), and find a doctor who knows how to treat tendinosis, as the treatment seems to be opposite that of tendonitis.

And since it's long term, if you get pain from simple lifting, you are a long way from healed at this point, and avoiding what causes pain would seem to be really important as reinjuring things keeps it going forever.

In the short term I would stop pushing, back off from anything that causes pain at all, for at least 100 days (as in the article), then start very gentle physical therapy, at least that's what I got out of the article.

I have had injuries that took a decade or two to heal (a quadricep got torn in my right leg), I was unable to ride a bike for 10 years, now I can, but have to be careful not to over do it, and it was a long time to build back up to riding at all. But I will never be a competitive cyclist, I accept that, and have moved on to things I can do.

Along similar lines, my wrists limit how much I can play in a day, my theory of ceasing to play and resting if any pain occurs, limits me to about 2 hours per day max. And it is better if I play 10-15 minutes, rest for 45 min, and do it again. If I tried to play 2 hrs straight it would kill my wrists in no time.

Reading that article makes me want to take collagen supplements right now.

Edit: And allow me to express sympathy, best wishes, and I hope you find a way that works for you.

Edited: July 27, 2019, 8:21 AM · If you have not already, explore alternative medicine, such as acupuncture and Ayurveda. I am surprised that doctors could not find anything. I do remember one of fellow amateur musicians, who is a doctor telling me that there are circumstances when pain exists without visible changes in tissue. Keep in mind that the source of pain may originate elsewhere and that the root cause may not be in your wrist at all.
Edited: July 27, 2019, 9:39 AM · Not sure if this might be your condition, but if so you might follow the suggestions regarding rest and exercises in this article.
https://www.medicalnewstoday.com/articles/320914.php

Also, my partner who has a different condition that affects her tendons finds that Benadryl helps promote better healing (too complicated, but seems to help the collagen organize better during healing).

Unfortunately, you may be fighting a losing battle if playing musical instruments causes that much pain. Have you considered a wind instrument which might not tax your wrist so much?

July 27, 2019, 4:06 PM · Have you considered Multiple Sclerosis? It's basically a form of auto-immune disease where your body attacks your nerve sheathings as well as other CNS components. Google it and see if any of the symptoms match up.
July 28, 2019, 12:42 PM · Have you contacted
PAMA?
Edited: July 30, 2019, 6:21 PM · Attention ~ Rocco Pensa URGENT/ TIME SENSITIVE JULY 28, 2019 ~

Concert Artist Pupil/Carrier of the Heifetz-Milstein Legacy of Violin Playing

Firstly, accept my sympathies regarding what has been & continues to be a devastating & traumatic state of affairs due to an as yet unknown authentic medical & psychological prescription of either a drug or P.T., to begin a true healing of your wrists diagnosed as tendinosis ~

Not being a medical schooled Doctor, I do know a great deal about natural
Physical Bowing in tandem w/the physique of the human body, & especially
so after private invited 3 & 1/2 years studies with The Master of Bowing, N.
Milstein, whom I was introduced to through my first mentor, Jascha Heifetz!

Once ensconced in the ambiance of Nathan Milstein's World of Sound, rare Colour's of intonation, musical overviews and Milstein Bowing technique, I realised (despite success as a Concert Artist) my playing could be greatly &
realistically uplifted to the highest plateau of artistry in the Unaccompanied
Sonatas & Partitas of Bach for Violin, vis a vie Bowing I watched just 3 feet
away whilst Nathan Milstein would demonstrate What Could Be Possible w/
his uncanny & natural bowing technique/s! Due to a dramatic change over
2 years, my Bow Arm was assured of a Lifetime longevity, which in spite of
a lovely Franco - Belgium tradition of Bowing would liberate my playing so as to be enabled to actually reproduce musical-technical ideas in my head
which until my meeting & playing Bach's Chaconne for Milstein, & invitation
right there to study with him, would Never have happened!! Rocco, I've.got
a feeling I can help you because I sense your bowing was misguidedly but
well intended taught very early on with (what I call) a "Straight Bow Idea" &
this IS Contrary to ALL physical structure of The Curved in a Quarter Moon
Shaped Bridge, which if lain Flat atop the Table of the Violin you will see its
Arc as being a quarter Moon curve lying Down! What, you may think/ ask /does this have to do with your pain & a Bow Arm??! EVERYTHING!! And Milstein's Mastery of Bowing was in complete natural sync with the curved Bridge vis a vie his Bowing Motion & Sway of his body all Together w/Bow as opposed to the Right Arm (not Wrist, Elbow, Forearm which is bloody Nuts/dangerous) Idea of Most Teacher's Todo El Mundo, who have Never been enabled to play 3 strings at a Time nor 4 Strings at a Time due to lack of use of the *Shoulder controlling The Bow Strokes!! And much of bowing is Brushed, Not bounced or with fancy French adjectives (i.e., Sautille, etc.) but I Know What To Do As A Result of almost 4 Years tutoring sometimes 4 or even 5 hours a day by Nathan Milstein!! This IS The First Part of Your Road to Health Restoration of Those Wrists, including the Left Wrist which emulates whatever the Bow Arm is doing. There IS HOPE for YOU, but I'm Not an acclaimed American Hand/Wrist Surgeon, but on Tuesday, Julio 30, 2019, I will visit my amigo/ grande Dr. Daniel Nagel, of Northwestern University Hospital, whom I've now known for over Ten Years, & speak with him for The Future Care of my own hands (which are good) but as we age, our hands & every part of the Body requires expert getting-older care +wise advice re exercise or simple treatments for what can ail us. I had No Idea of your Post here on Violinist.com website until yesterday, but after thinking much about your Great Plight & So Much Suffering, I decided to write to you & ask if I can show your Article here to Dr. Daniel Nagel on Tuesday afternoon, 30, July, 2019, to see What He Says & hopefully shows a real interest in helping you?

Knowing from your comments of your deep Love of Music & playing both the Violin & Guitar, starting out brilliantly & practising w/Joie di vie intensity,
*I realise for your Soul to Live, you Must Find a Solution to be again able to
practise & Play without injury to your Wrists. Yet, my Gut Instinct tells me
your Wrists are greatly injured but by False Bowing w/the bloody 'Straight
Bow' Idea taught All Over The World by good willed Teachers yet almost All haven't any idea of Rounded Bowing Technique which one can parallel to
The Greatest Tennis Pro's, as Rafael Nadal's Serve from The Shoulder & to a lesser degree, his great friend/rival Roger Federer! Great Serves in Tennis = Great Violinist Bow Arms!! This obsession of 98% of Violin, Viola, Violoncello & Basso Teacher's that you Must Have a Straight Bow IS NUTS CRAZY!! I don't Think Nathan Milstein was Crazy; Milstein was a natural Genius of The Bow! (& Left Hand plus Uncanny Musicality, Sound, Colour , deep in-the-center of the Note Intonation + variances of a C# to a D Flat & There Is A Vast Difference, plus A Century More of 'Milsteinianna')

Enough Writing: If you read this, & watch my great Mentor/Friend, Milstein
in his Last Recital in Stockholm, in his 4th Movement Allegro of the Bach
Unaccompanied Third Sonata in C Major, & can SLOW MOTION it up, you
will see Milstein's extraordinary rounded circled bowing w/ practically NO
WRIST, COMING FROM THE SHOULDER & WHEN COMING UNDER, AS OLYMPIC SWIMMER'S GO IN A RACE TO SAVE NANO SECONDS OFF THE TIME, THEY SOMERSAULT UNDER THE WATER ONCE THE WALL IS REACHED GOING UNDER & COME BACK UP ON THE WATER TO KEEP SWIMMING AT MAXIMUM SPEED THEN REPEAT IT AT THE OTHER END OF THE POOL, AGAIN TO SHAVE OFF TIME. THE**DOWN BOW FROM THE BOW FROG TO TIP MUST GO UNDER OUR OWN IMAGINED WATER TO THEN BOW BACK UP (V) & BRUSHING IT BACK UP BRUSHED, AS ONE BRUSHES ONE'S HAIR. I'll SHOW YOU IF DR. NAGEL HAS INTEREST TO MEDICALLY SEE YOU BUT SOON AS HE LEAVES HIS PRACTISE AUGUST 30, 2019 ~ (ALL ARE UPSET AS HE'S GREAT & VERY BOOKED, BUT I CAN PLEAD YOUR CASE.)

I'll await your Time Sensitive Response! My Partner is Italian born & if you
Must, you might ring on Monday Night at 6:45 PM, Chicago Time, to my Studio, as I must know if you have interest in my showing your Post to Dr. Nagel, by Monday evening my time, which is 7 hours earlier than Rome Time. Are you in Rome or Venezia or Florence or Pietrasanta!? It may be best to Email me by going on here to www.violinist.com to Teachers or go straight to **my Bio on here ~

** https://www.violinist.com/directory/bio.cfm?member=Milstein

My full musical Biography is there with Studio Tel # y Email, but Not Email saying 'golden ... ' No, just one (lower case) that gives full name@*****.com

Okay, Rocco!! Let me hear either way from you if interested! My Tuesday appointment is for 3:00 PM, Chicago Time.

With Musical Greetings from Chicago ~

Edited: July 30, 2019, 6:57 AM · Thank you to all answers.

In order of appearance:
@Cotton Mather yes tried many creams already
@Lydia Leong yes tried many physicians including some specialized for musicians
@Dawson Weber I have considered it, but not tried yet
@Kurt Hutchison I have tried collagen supplements, no improvement at all, how did you heal from the quadricep issue ? very long rest only ?
@Rocky MilankovI have tried acupuncture, no improvement, didn't try Ayurveda. I have considered that the source of pain may originate elsewhere, yes, for example the pain exploding 2 days after playing really makes me wonder, but still couldn't find an explanation, much less a solution.
@Beverly Harris it's surely not a De Quervain's tenosynovitis, no issue with the thumb. Still researching on Benadryl. I have considered other instruments but the depression never made me try hehe....
@Erik Williams symptoms don't match up with MS, I only have pain after a mechanical stress
@Bud Scott no, never contacted PAMA, should I ?
@Elisabeth Matesky yes if you like you can obviously show my post to anyone who you think might help, thank you


July 29, 2019, 12:56 PM · Rocco, you say nothing of lessons or teachers before you were 18.
Were your 6-8 hours a day, and are your continued attempts, with relaxed hands or very tense hands?
Edited: July 29, 2019, 2:33 PM · @Gordon Shumway ~

A Superb Question, Gordon!! I begin to conclude all responding here assumed Mr. Pensa's early training/beginnings were excellently guided
& professionally supervised ... We really have very little to go on & it seems strange to me he doesn't respond to the names of either of my Violin Mentor's or express interest in anything I set down, which one Never has done before, online, excepting to accepted/vetted online violin pupil's ~

Hopefully, he will choose to respond to your 2 question's ??

With best musical wishes to you & all on this discussion for such caring ~

Elisabeth Matesky

Edited: July 30, 2019, 6:57 AM · @Gordon Shumway Well I was doing relaxing exercises but some days I was literally playing morning afternoon evening night, so even more than those 8 hours I mentioned, probably too much, and above all I didn't rest at all when the problem started and was getting worse and worse. I continued to play for about 6 months until my wrists 'literally collapsed and I couldn't materially go on', so if it's really a degenerative tendinosis it's probably as extreme as possible, infact I never improved after so many years and so many attempts. Since then I have tried to play many times with relaxed hands, as relaxed as possible, but it doesn't help at all.

@Elisabeth Matesky I appreciate your support but May I ask you to relax a little bit ? I answered all questions, including yours, if I missed something it's because I got confused by your extremely long and confusing comment and I was also a little bit hurt by your exuberance, there's nothing here to be exuberant or happy about, actually the precise opposite, I have tried to solve my problem basically every day of my life since 1995 and I am obviously extremely tired depressed and hopeless, often I feel like I am going to faint or die any day and I don't know why it hasn't happened yet, the musician already died that day

Edited: July 30, 2019, 1:49 AM · Perhaps a good test might be for you to see if you can play the piano. But relaxed and for no more than 30 minutes a day, or even less. Don't be ambitious about it.
Anxiety may be your biggest enemy.
Edited: July 30, 2019, 7:37 AM · Hi Rocco, I'm not a medical professional, and I don't know if you've pursued this already (sounds like you've done a ton of things), but if your situation is tendinosis related, you might want to take a look at providers of Active Release Technique (ART) -- which can address tendinosis and the degeneration associated with it. I know someone who found no benefit from standard medical professionals/specialists (even musician specific), rest (utterly useless, since there was no inflammation, except at the very beginning, and rest did nothing to break up adhesions/fascia), occupational therapy, etc., and this method finally worked for her. You can find people certified in ART at activerelease.com -- and a quick look indicates there are some in Italy. ART has many different areas of certification, so I would look for a provider with numerous certifications and experience, and particularly in upper extremities. I don't know if this will help you, but if you haven't tried it, it might be worth considering. Wishing you the very best!
July 30, 2019, 1:02 PM · '@Bud Scott no, never contacted PAMA, should I ?/' Yes.
July 30, 2019, 2:42 PM · Rocco, your "feeling like you're going to faint or die any day" comment suggests that there may be something going on here beyond a problem with your hands. Have you seen a chronic pain specialist and been evaluated for chronic pain syndromes such as fibromyalgia?
July 30, 2019, 3:42 PM · Rocco, I'm just posting in support of you -- to note that I do not feel that there has been anything wrong with your attitude or responses in this thread, contrary to Elizabeth Matesky's assertions.
Edited: July 30, 2019, 5:27 PM · This has all been a very fascinating and absurd, but I think this thread illustrates the limits of this website's medical knowledge and advice-giving. Good luck on your quest, Rocco, it seems like a truly frustrating experience.

This may seem unrelated, but I have had good luck with therapy before in getting a chance to find new ways to look at some of my long-standing issues and patterns. If you have never done it before, you may find it comforting to have someone to hear you out about the toll this has taken on you. I'd recommend it to anyone, in any case.

Edited: July 30, 2019, 6:35 PM · @Lydia Leong ~

Truly distressed by your post above essentially criticizing my good willed response to Rocco Pensa, unknown to me until viewing his Article of most desperate angst & plea for advice & help, I wrote out of over 45 years of teaching w/much experience, to try guiding him (due to a sixth sense) that his terrible Wrist Pains were quite possibly from faulty bowing & left hand usage in the Very Beginning of his playing & wondrously plus 6 to 8 hour practising days, truly unknowingly injuring The Root Site Cause of pain in his initial violin approach, later to boomerang back with intolerable physical upper Wrist bands of Pains ~

My efforts to describe the circular bowing techniques passed on to me by Nathan Milstein, & in trying to parallel it to motions of Olympic Swimmer's, was obviously Gravely misunderstood by Rocco. Never, Lydia, did I laugh nor dismiss his suffering of over 25 Years or think anything but thoughts of wishing to offer help & in so doing, asked his compliance with my sharing his Article & description of such seriously debilitating ills, with an acclaimed Hand/Wrist Dr. & Surgeon here ~ Mr. Pensa responded in the affirmative. His sudden cruel/abusive remarks insinuating I laughed at his pain, are not only seriously misguided but completely incorrect and deeply hurtful to me as a person, professional violinist & a teacher with his words, '.. and I was also a little bit hurt by your exuberance, there's nothing here to be happy or exuberant about. ..." If this is his response to my offer to help him & asap, plus certainty of relaxed bowing techniques proven by my mentor's & my pupil's around the globe, then there is no reason to participate on such a discussion ~

Troubled by your 'Support post' I've just seen & beyond my understanding, I now have reason to not share any ideas of either of my Mentor's again if they are mocked & thought of as laughing at other's pain/s ~

You know what, dear Lydia ~ it's best to 'Let Go and Let God' ...

Warm affection,

Elisabeth

Edited: July 31, 2019, 7:33 AM · @Gordon Shumway You mean try with the piano to search for a new instrument to play or to have some information on the wrists?
I did play it sometimes during these 25 years, it's gentler on the wrists and I like it a little bit but I still feel so frustrated because of no string instrument that I dropped it.
@Sean Gillia I have considered ART and it's a good advice, Among several phisycians I have already been treated by a fascia/adhesion expert who used a different but still very similar approach to ART, the treatment was extremely painful but no improvement. I may try also ART even tough it should be very similar as I said.
@Bud Scott ok, thank you, I just emailed PAMA.
@Lydia Leong well I absolutely see what you mean and it's a good advice but I think 'the anxiety and depression' I have is just a normal consequence of this endless nightmare, a friend of mine calls it a dante's circle of hell, it's just that a 24/7/365 torture. Still your thought is absoutely sensible, infact I have considered it many times, but I do have pain only in the wrists and only after a mechanical stress.
@Christian Lesniak well all the answers have been very supportive and I have apprecied them all very much, some good people trying to help others is the only good part of this 24year nightmare. The problem is not that this website's medical knowledge is limited but that very likely there's no solution to my problem. If it's really a degenerative tendinosis there's basically no solution to it, I have done endless research on it and read all the medical trials. There's some hope with the use of exosomes, which is basically stem cells 2.0, there's some evidence that these exosomes have some magical effects on tendons/ligaments but there are issues on the safety side and FDA approval of this approach is still many years away.
Edited: July 31, 2019, 8:44 AM · "@Gordon Shumway You mean try with the piano to search for a new instrument to play or to have some information on the wrists?
I did play it sometimes during these 25 years, it's gentler on the wrists and I like it a little bit but I still feel so frustrated because of no string instrument that I dropped it."

My idea was that if you were hyper-ambitious on the violin, that might have made you tense, whereas on an instrument on which you have no ambition, you might play in a more relaxed manner. Piano because I know the instrument (and of course you get to exercise the left hand) and I had good teachers who were adamant about the value of being relaxed.

Edited: July 31, 2019, 8:47 AM · Rocco-

With compassion and respect, I think you should see a psychiatrist or psychologist.

We all have the bodies we have, and learning to be happy with what we have, limitations and all, is more important than accomplishing any particular skill.

I have deep concern for you when I read "'the anxiety and depression' I have is just a normal consequence of this endless nightmare, a friend of mine calls it a dante's circle of hell, it's just that a 24/7/365 torture."

The anxiety and depression is neither normal nor necessary. The "torture" you describe is a psychological malady.

People live happy lives with many kinds of physical limitations. You can, too, but I think you need to treat your psychology first because your hands will likely never be capable of playing the instruments that you want to play. Nevertheless, you can be happy and fulfilled in your life.

Edited: July 31, 2019, 12:57 PM · Well, to me your own diagnosis of having some kind of degenerative tendinosis seems quite probable.

It hasnt ruined your life, it has just ruined your ability to play. Those are two different things.

Very likely your desire to try to play intermittantly only makes it worse.. you have seen all the experts there are, so the only thing to do is to face the fact that you cannot play anymore. Dont waste your money on any more experts or any medicine some people in the internet recommend, you have done enough. If you continue to put more of your energy to this thing, it will only harm you.

Life isnt fair, I know, having been born with a difficult tendon-problem which gives me a lot of pain and limits what I can do.

What I would do in your situation is to devote some time to tell young players to listen to their body and not play crazy hours, many peolpel warn of tha dangers but not everyone listens, but they might, if the story came from a bad example.

Edited: August 1, 2019, 9:29 AM · @Gordon Shumway I absolutely was hyper-ambitious on the violin and guitar, that's why I am still searching for a solution after 24 years
@George Huhn What happened to me can't be fixed psychologically by clicking a button or by taking a pill. Among the 1000 therapies I tried for the wrists, I also tried a pill advised by a psychologist/psychiatrist, not only it didn't make me feel better but it made me feel much worse, I don't need that stuff, my 'depression' is not a disease but only a physiological unhappiness because of the trauma/accident which can't be fixed, music apart I already live a good life, I like sports and eat very healthy.
@Maria Lammi I am not a guy who gives up and I am not going to give up searching for a solution
August 1, 2019, 7:08 AM · My brother used to know a weight-lifter. He broke his foot or his leg.
As the doctor was applying plaster to it he deliberately kept flexing his ankle and leg so that his foot would be mobile inside the plaster and he could continue to weightlift. I don't know the outcome of the story, but I'm guessing it wasn't good.
August 1, 2019, 11:56 AM · why are you mentioning that ?
August 1, 2019, 12:08 PM · I worry that your approach is similar to his.
August 1, 2019, 12:17 PM · why ? I am not playing at all
August 1, 2019, 12:39 PM · Rocco-- You have already done about all you can by going to specialist MD's. You will not likely find better advice here. I had another kind of joint problem when much younger that wrecked any possibility of a career as a mainstream classical violinist, so I can sympathize, but can't help. I re-trained for a non-music job. After about 20 years the condition "burned out" and I returned to playing, but it was too late to become a first-rate pro. Your story sounds like an example of Over-Training. The sports trainers and MD's that work with expensive pro athletes know that the best schedule is to alternate heavy and light work-out days. The two occupational groups that have Not learned that lesson yet are the military and musicians. The other cause of problems would be incorrect (for you) form and ergonomics. After a long period of rest and therapy you might be able to return to the violin, but start over at the very beginning with a teacher that really understands posture, form, and motions. We are not designed to play the violin. I am always a little suspect when a teacher uses the word "Natural" to describe their methods.
--"Doctor, doctor, it hurts when I do this." Answer; "Don't do that."
August 1, 2019, 5:33 PM · At risk of adding to the many non-professional diagnoses here, do you know if it's definitely tendonitis?

I too have had to stop playing due to wrist problems in both hands, which were initially viewed as rsi tendonitis because that's how it presented. Then it became carpel tunnel syndrome, which was great because something concrete can be done about that.

However some time into organising that operation I twisted by back gardening an was literally flat for month, unable to even sit without pain. At that point CAT scans showed I have compressed discs in my back which allow my spine to 'sit' on certain nerves. Before they got to the 'spear behind my shoulder blade' stage they had been causing the wrongly diagnosed wrist problems.

The biggest contributor this has been playing violin with a raised left shoulder and tension in both hands (why did none of my teachers stop me? I don't let any of my students get away with it). I now have to learn to play differently and I have to be to be very careful about what I choose to do: Viola is out. Orchestra is out (I can't practice enough to keep up). Hiking trails are totally out. Lots of computer at work means no violin practice but maybe a little cello or piano. Getting a lift instead of catching the bus, even with the inch-thick padding on my pack bhind me, means an extra 15 mins of holding a violin. Gardening means I can forget playing or sitting at a computer that day and maybe the next. If I decide to attend a festival and play all day, I'll be on my back between sets and probably the next day, and there will be no housecleaning for a week or more (Not even washing up, if it's not school holidays)...

This sounds aweful but they're the choices I have to make in order to keep playing. Ex I teach violin, which keeps the music going at least, and I have a back up plan for if it gets worse - I'm long-term saving for a tenor viola da gamba because the bowing style seems to be much more gentle on my specific injuries. If you're into early music that might be worth looking into because it doesn't do the unweildy twists of your left arm (even done right, outs not a natural movement) and it seems much easier wrist-wise on the right wrist. Someone here who plays both might be able to verify this ...?


August 1, 2019, 5:33 PM · At risk of adding to the many non-professional diagnoses here, do you know if it's definitely tendonitis?

I too have had to stop playing due to wrist problems in both hands, which were initially viewed as rsi tendonitis because that's how it presented. Then it became carpel tunnel syndrome, which was great because something concrete can be done about that.

However some time into organising that operation I twisted by back gardening an was literally flat for month, unable to even sit without pain. At that point CAT scans showed I have compressed discs in my back which allow my spine to 'sit' on certain nerves. Before they got to the 'spear behind my shoulder blade' stage they had been causing the wrongly diagnosed wrist problems.

The biggest contributor this has been playing violin with a raised left shoulder and tension in both hands (why did none of my teachers stop me? I don't let any of my students get away with it). I now have to learn to play differently and I have to be to be very careful about what I choose to do: Viola is out. Orchestra is out (I can't practice enough to keep up). Hiking trails are totally out. Lots of computer at work means no violin practice but maybe a little cello or piano. Getting a lift instead of catching the bus, even with the inch-thick padding on my pack bhind me, means an extra 15 mins of holding a violin. Gardening means I can forget playing or sitting at a computer that day and maybe the next. If I decide to attend a festival and play all day, I'll be on my back between sets and probably the next day, and there will be no housecleaning for a week or more (Not even washing up, if it's not school holidays)...

This sounds aweful but they're the choices I have to make in order to keep playing. Ex I teach violin, which keeps the music going at least, and I have a back up plan for if it gets worse - I'm long-term saving for a tenor viola da gamba because the bowing style seems to be much more gentle on my specific injuries. If you're into early music that might be worth looking into because it doesn't do the unweildy twists of your left arm (even done right, outs not a natural movement) and it seems much easier wrist-wise on the right wrist. Someone here who plays both might be able to verify this ...?


August 2, 2019, 8:42 AM · Interesting story.
No, I am not 100% sure it's a degenerative tendinosis, it's just the most probable diagnosis.
Having exactly the same problem/pain on both wrists does make me wonder if there's something going on elsewhere, like shoulders or the neck or the back but I don't have pain sitting at all and many phisycians checked them and found nothing wrong.
Edited: August 2, 2019, 11:02 AM · On the psychological front, is it just a psychological unhapiness in the context of a healthy life (as you suggest in one post) or is it humiliation, being depressed and torture (as you state in others)? The question is whether they are as extreme as you've made it to be in certain posts or is it a milder manageable form? An important distinction: The latter is manageable , the former is a black hole difficult to get out of without help.

Freud: "But you will see for yourself that much has been gained if we succeed in turning your hysterical misery into common unhappiness."


August 2, 2019, 1:12 PM · The body and the mind are more interlinked than most of us want to acknowledge. It's not unusual for someone who has been injured and then become depressed, or otherwise distressed, to experience continuing pain or loss of function even after any structural damage has healed. I have no idea if this is what happened to the OP, of course.
If I were you, Rocco, and I'd exhausted what the medical specialists have to offer, I'd look for someone who does Alexander technique or another body mapping discipline. You'll probably also need to work with a second professional with expertise in functional pain disorders. Treatment is not going to come in the form of a pill; unfortunately, it's not that easy.
Edited: August 4, 2019, 7:15 AM · @joel quivey Thank you for the support

@tammuz kolenyo well it's both, I feel very humiliated and depressed for the inability to play at all since 1995, kind of a black hole yes, but at the same time I have been able to manage it, mainly cause I have done everything I could to find a solution, it seems there's no solution at all so it's not my fault, if it's really a degenerative tendinosis science doesn't know how it works and there's no cure, my fault was when I detroyed the wrists yes, a stupid 18yo

@Jocelyn Marrow Thank you, Alexander technique is one of the few things I haven't tried, when I have enough mental stength I will try, I am currently trying another therapy

August 4, 2019, 2:11 PM · Hi Rocco - I am sorry you have been going through this for so long.

In addition to the excellent advice to see a musician-oriented medical professional, I would second both recommendations for acupuncture and a psychologist/psychiatrist/therapist who specializes in working with somatic therapies.

August 4, 2019, 3:15 PM · Acupuncture is pure quackery that has no basis in science. Controlled clinical trials comparing acupuncture with sham-acupuncture showed no difference in outcomes. Decades of work and over 3000 clinical trials have shown that acupuncture doesn't work for anything.

August 4, 2019, 4:01 PM · Sorry George, I can't let this go.

Acupuncture has been listed as an approved medical device by the FDA since 1996.

In fact, decades of work has shown it is not "pure quackery" and the scientific consensus is that it has been shown to be of some benefit in certain conditions.

Why are you espousing a viewpoint that can be shown to be untrue with a cursory review of the subject?

Edited: August 4, 2019, 4:17 PM · Why? Because acupuncture is pure quackery. There is no such thing as "meridians." I believe in science. You can believe whatever you want.

https://sciencebasedmedicine.org/acupuncture-doesnt-work/

August 4, 2019, 4:20 PM · I read your reference. It is a rant.

Just don't present your opinion as fact.

Edited: August 4, 2019, 4:40 PM · The "rant" is from highly-respected peer-reviewed scientific journal. That is not opinion, that is fact. But arguing with proponents of quack treatments like acupuncture is like arguing with creationists, climate change deniers, and anti-vaxers. But I hope that pointing out that acupuncture is quackery will save some people like Rocco their time, pain, and money. That's a fact.

The Journal:

"ANESTHESIA & ANALGESIA is the "Gold Standard in Anesthesiology," and provides the practice-oriented, clinical research you need to keep current and provide optimal care to your patients. Each monthly issue brings you peer reviewed articles on the latest advances in drugs, preoperative preparation, patient monitoring, pain management, pathophysiology, and many other timely topics.

ANESTHESIA & ANALGESIA is the official journal of the International Anesthesia Research Society and all members receive the journal as a benefit of membership."

https://sciencebasedmedicine.org/acupuncture-doesnt-work/

August 4, 2019, 5:15 PM · Your evidence is based on one article from a couple of anesthesiologists.

There is a compelling body of evidence from multiple sources to suggest otherwise.

I'll let the readers of this forum, including Rocco, make up their own minds about your blanket statement, "Acupuncture is quackery".

August 4, 2019, 7:32 PM · "Acupuncture is not supported by any good research, which is clear to people who actually read the fine print.

And that’s not a surprise, because we’re talking about a healing system that rests on a belief in auras: an alleged “energy” in and around the body that no one can actually detect.15 Or — if not an energy system — some biological version of them that remains as elusive as physical evidence of ghosts, UFOs, or bigfoot.

https://www.painscience.com/articles/acupuncture-for-pain.php

August 4, 2019, 8:08 PM · Hey Tammuz,

If you're gonna throw shade and belittle me, you should at least have the mental capacity to put in the end quotation marks.

August 4, 2019, 9:58 PM · Why would you assume that I was belittling you? Has nothing to do with your person.
August 4, 2019, 11:32 PM · Sorry.
My mistake.
I apologize, tammuz.

Rocco, sorry to hijack your thread.

I'll have no more comments here.

August 5, 2019, 11:58 AM · NIH has detailed information on acupuncture, indicating mixed scientific evidence: LINK

My father is a physician who also trained in acupuncture, specifically focused on the evidence-based use cases and methods. He does not believe any of the BS about Chi and whatnot.

I had very severe pain and tendinitis in my left arm after a sports injury damaged the ligament in my elbow when I was a child. Cortisone provided minor relief (mostly the painkiller that comes with the shot more than the cortisone itself, I think) but acupuncture provided significant pain relief for hours afterwards. (I don't think it was a placebo effect as I wasn't expecting it to work at all.)

I would try it once, preferably administered by a physician (some sports medicine doctors are trained), before writing it off.

August 5, 2019, 1:38 PM · Lydia, I don't have a dog in this fight, but my understanding of the placebo effect is that you don't actually have to believe that something is going to work to benefit by it.
August 6, 2019, 3:54 PM · I'm not here to convince anyone that acupuncture does or does not work, I've read most of the linked article, and have had acupuncture on and off for a variety of issues over the past 5-ish years. I don't know why I'm taking the time to respond to this given the last time I tried to respond to a thread that covered a non-conventional medical topic...

My opinion is that for some things acupuncture is great, and others not so much (to the extent that no effect is felt/realized). The body is a complex system, and when different avenues for healing/relief/whatever you want to call it fail to help for whatever reason, I think it is not unreasonable to seek other measures of comfort if one can afford it and if it does not compromise one's values/beliefs/integrity (including those to remain or not within the evidence-based medical model).

For the health things that acupuncture has helped with, well, I'm grateful it exists. It is by no means a cure-all and it has its limitations, like any other therapy out there. It's not going to "undo" damage within my body any more than swallowing a bunch of pills will "cure" back pain, tendonitis or migraines. I figure, all this is damage control - it's simply a matter of the method of damage control one chooses to pursue.

Lungs have been punctured by those who practice so-called "dry needling" (aka anyone practicing acupuncture without a license or proper training of no less than somewhere around 200-300hrs for MDs.) NB: non-medical doctors need at least 1,500 hours of training to be licensed acupuncturists in most US states; mea culpa all of these training numbers vary by state.

Modern acupuncture programs can be rooted in both biomedical and traditional medicines (see: PCOM's program, it is basically a pre-med program with acupuncture licensing training).

Acupuncture is believed to stimulate the CNS and activate blood circulation. That's not a big leap of logic: stick a needle in the body and the nervous and circulatory system responds. So sham acupuncture WILL do something, but will it do something specific as consistently with a custom chosen acupuncture point? Seems the entire medical community is still debating this...

Lastly: if you don't want to spend a lot of money having acupuncture done (I agree, it can be very expensive depending on where you live), community acupuncture is a good and rather affordable option. Many community acupuncture clinics offer a sliding scale fee.

August 6, 2019, 4:38 PM · Rocco, this isn't "traditional" medicine, either, but I highly encourage you to read about the work of the late Dr. John Sarno.

He talked about how the pain, often severe, that folks often feel (very commonly back pain) is not the direct result of a structural problem, but is created by the brain as a distraction mechanism, an effective one.

This saved my life, and the life of other musicians I've talked to.

Please let me know if you'd like more information.

Dr. Sarno is one of the most famous doctors who has explored this, and the link to one of his books is below.

Best wishes,
Andy

https://www.amazon.com/Mindbody-Prescription-Healing-Body-Pain/dp/0446675156/ref=asc_df_0446675156/?tag=hyprod-20&linkCode=df0&hvadid=312065696873&hvpos=1o2&hvnetw=g&hvrand=7801921095344056500&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9067609&hvtargid=pla-433805425883&psc=1&tag=&ref=&adgrpid=61316180399&hvpone=&hvptwo=&hvadid=312065696873&hvpos=1o2&hvnetw=g&hvrand=7801921095344056500&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9067609&hvtargid=pla-433805425883

August 7, 2019, 8:09 AM · @Andrew Holland
Could you please describe in detail what exactly you and your friends did to improve ?

I read Sarno's book some years ago and tried to write about a list of issues as advised, but really no improvement at all.

August 7, 2019, 10:01 AM · Dear Rocco,

Please direct-message me and let me know on here after you do. Sometimes I don’t seem to receive them.

Thanks

August 7, 2019, 10:36 AM · there seems to be no way to send you a private message from your profile page
https://www.violinist.com/directory/bio.cfm?member=andy989

can you write here ?

August 9, 2019, 8:27 AM · Hello Rocco, I will write very soon.

My best,
Andy

Edited: August 11, 2019, 9:57 AM · I will wait..

What makes me wonder is why my pain explodes in the wrists 1-2 days after playing

It behaves like DOMS pain that everybody has for example after going to the gym.
Delayed onset muscle soreness (DOMS) is the pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise. DOMS typically lasts between 3 and 5 days. The pain, which can range from mild to severe, usually occurs 1 or 2 days after the exercise.

In my case the pain is so severe after 1-2 days that it lasts up to 10 days.

Maybe I have some kind of muscle damage already before playing and after playing the damage gets so extreme that pain explodes like doms in 1-2 days?
but if so why it hasn't healed after so many years ?

August 11, 2019, 5:32 PM · Rocco, I read your topic before there were any replies whatsoever, and the first thing that came to my mind was recommending Sarno.

But I just didn’t know where to begin.

When I noticed Andrew’s post, how receptive you seemed to it, and the fact that you had already read the book before, I was super relieved.

Your latest reply, especially the last paragraph, is what encouraged me to chime in.

I think you are on the right track: Keep questioning your symptom(s).

Your pain is real, but it just doesn’t make any sense. If it were a physical injury (like a sprain), it would’ve healed years and years ago.

Sure, when you first got pain when you were about 18 in 1995, that was due to overuse. Playing 8 hours a day; that’s normal. It happens to everyone at one point or another. Whether it’s from computer use, a new hobby, preparing for a marathon, lifting a lot of stuff because you’re moving to a new city, etc.

But there’s no way you injured yourself permanently. That’s not how the body works. Even if you broke your arm back then, it would’ve healed for decades by now.

Nevertheless, your current pain is 100% real. There is no doubt about that. But the cause is psychological. I suggest forgetting about the microscopic level tendinosis thingy; thinking about that definitely won’t be helpful.

So to in order to recover from this, you should resume your physical activities (playing the violin, carrying heavy things if you have to). And while doing those things, try to think psychological. Not physical. Emotional. Not structural.

Have you tried that already? It’s far more useful than writing down your issues which you mentioned in one of your posts. In my eyes, that’s just a preliminary exercise to help you shift your thoughts in the right direction.

Looking forward to your reply.

Edited: August 11, 2019, 9:17 PM · Dear Rocco,

Sorry for the delay.

Here is my story, and how it relates to the work made famous by Dr. Sarno.

I had pain in both arms and shoulders between the ages of 20 and 25. I am 37 now.

It started with a forearm injury at the gym (at least I assume it was a real injury). I pulled a muscle and it quickly healed, but never completely. I never stopped going to the gym for more than a few days and never stopped using the arm. After a few months, the pain wouldn't heal, no matter what I did. I wound up having two surgeries, which relieved the initial location and sensation of the pain, but also, at this time, something new was happening.

The pain began to extend down the full left arm, from shoulder to fingers, and then started in the right arm. So I now had pain in both arms.

Over about 4 years, I might have seen about 3 dozen orthopedists, neurologists, physiatrists, physical therapists, and chiropractors. Electromyograms came out normal. MRIs showed a few abnormalities, like loose bodies, but they didn’t seem to explain the pain. These specialists all had different theories, including thoracic outlet syndrome, but no treatment consistently helped.

With the thoracic outlet syndrome treatment, for example (lots of stretches), I would feel 50% better, but then quickly back to where I was before, seemingly without rhyme or reason. I was extremely frustrated and felt defeated for a long time.

I had exposure to Dr. Sarno’s books earlier, also starting at about age 20, after I had other pain that didn’t make sense. His books had helped with other pain that arose. I’d strained my neck while doing a stretch for the alleged thoracic outlet syndrome that wouldn’t heal, for example, and considering the possibility that the pain was a distraction made the neck pain go away very quickly.

It didn’t occur to me for a few years that the same could be happening with my arms – the pain was too severe, and had been around too long. I don’t remember exactly what happened at age 25 that had led me to consider that the chronic arm pain might not be due to a structural cause, but it hit me one day, and I actually became very depressed, not happy.

I really had trouble believing, with such severe and chronic pain, that the brain could be responsible, or that there might not be a structural explanation.

Many of us are taught that the body is extremely fragile and that things like repetitive motion injuries can pop up at any time and seemingly without reason.

I actually went to see a cognitive behavioral specialist to help open myself up to the idea of Sarno’s work (he didn’t necessarily subscribe to it – he was just trying to be helpful and open), even though it had helped me before – I wanted to believe so-called tension myositis syndrome (TMS) was the cause of my pain, but just couldn’t.

What really helped me get better, after becoming somewhat receptive to the idea of the pain being a distraction, was to test it out – ONLY after becoming receptive to the idea, I would try a push-up, and notice that even if the pain flared, the sensation was inconsistent with what a push-up might cause.

When our brain causes pain, inconsistencies seem to arise that aren’t present when a structural injury is responsible for the pain. And so I was testing this theory.

Within a week or two, I was doing lots of pushups. The pain took a few weeks to fully go away.

In the years since, I’ve had other injuries, and the pattern of pain persisting after the injury should have healed continued. Almost every time this happened, even if it took awhile for me to realize what was happening, the brain seemed to be responsible, and when I realized and accepted what was happening, and challenged the pain through continuing normal activity (when I felt ready), I prevailed.

I realize that many people will have a hard time accepting this story.
But I do suspect that I am not the only one this happens to, and I am grateful that I didn’t lose full use of my arms for more than 5 years.

I hope my story will help others.

Let me know if I can help you any further.

August 12, 2019, 12:17 AM · Andrew, you seem to be describing CRPS Complex Regional Pain Syndrome.which is basically apain that it kept up in the brain allthought the cause of the pain heals. Usually it starts with injure but then the brain sort of picks up the sensation of pain and continues it even though the cause has vanished. I have no knowledge of the book you describe but CPRS is a known medical condition.

The thing is we must not mix it up with ”real” structural pain. I do think that some people are more prone to CRPS than others and it is very difficult for them to know when the pain is ccoming from the brain and when it is injury.

But the fact that there is CRPS diagnosis we should not attribute every pain to be caused by the brains. Now, if a person gets wrist pain from playing the violin, then the person obviously should not be playing the violin. It is just common sense. Violin playing is a very extreme thing to do and not a necessity of life.

However one does get a feeling from the ops post that there are other issues involved, not only the injury and he might benefit from quite another view on his wrist. Mindfullness and changing how one deals with pain are good things and may bring also a sort of acceptance that life doesnt often go as we wished it would go and there are others doors opening when some doors close. It is far easier to let go of the pain once the fact that playing a violin is not a goal, is accepted.

And here we also come to very deep question, which are cultural too. If a person has been taught that he or she can burst through every wall if he just tries hard enough, then it is very hard to forgive oneself when a wall that is too high comes in front of him. And rather than just ttrying forever one should try to go around the obstacle to another room instead the one one was trying to get into and find all the happy things that are there :)

Edited: August 14, 2019, 8:18 AM · @Addison Wyman and Andrew Holland
Maybe I have TMS but I have already tried to resume physical activities and trying to think I have no injuries but it doesn't help at all. Maybe I am doing something wrong but all I have tried about TMS/Sarno completely failed as all the other therapies :///
Edited: August 17, 2019, 1:06 PM · I’ve very recently (and still trying to recover) gone through grave symptoms, quite physical ones, that are suspected to be psychosomatic. This is, i recognize a strong possibility, if not probability in my case. However, there is also the possibility that the medical field has not uncovered all there is in terms of human pathology and ailments and mystery still lurks as in ailments such as chronic fatigue syndrome, some vestibular disorders, various pains, etc.
There might well be foundation to postulate that the state of mind might translate into some physically manifest disorders and certainly exacerbate others, but to exclusively postulate anxiety\depressions as the origin of ailments as a principle sounds like an unscientific way of jumping to conclusions.
The truth of the matter is neurologists and the like cannot always identify the problem. And even if they can, sometimes they cannot give always give a cure.
I say this not to exclude the power of psychosomatic effects, but one can only arrive to this conclusion by eliminating everything else which is possible and by a clearly present psychiatric disorder displayed by the patient (anxiety, depressions, bipolarité, etc)

What complicates things further is that sometimes The psychiatric disorder results from the physical suffering (and possibly reinforcing them; this is very clear in vestibular disorders for example) ...so sometimes it is difficult to identify which comes first, the physical or the psychiatric when aiming for a psychosomatic diagnosis. This is why really one should exclude other things first.

August 17, 2019, 2:26 PM · Maria Lamni speaks about CRPS. I too think it would be worth looking into this. After a severe broken right wrist over 25 years ago and a long casting I developed what was then called RSD....same symptoms...new name. After much physical therapy and occupational therapy and stellate ganglion blocks,I was able to play again. Then two years ago I broke the left wrist and manifested the same problem. The physician didn't believe me when I told him I had RSD before. He didn't cast me correctly or take the possibility under consideration. I again had to deal with the stiffness and pain. After almost a year and sixty plus PT and OT appointments plus following the at home exercises daily, I was able to play again. It sounds like you are needing more information.
I am copying one site below for more on subject, but there are hundreds to read. It is often overlooked by physicians. At least bring it up with the medical community you work with and research it on line.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
Best to you in your journey.
Edited: August 17, 2019, 9:22 PM · Tammuz, what Addison, I and probably also Maria are referring to here is not the result of an unusual amount of anxiety, or depression, or anything else. The theory is that the brain is simply trying to prevent what’s unconscious from becoming conscious. This is postulated to affect a wide variety of people - not necessarily those with apparent anxiety or depression. The aim is to prevent what can happen, for example, when you sit for a moment and let your mind wander. If one is in pain, those original unpleasant thoughts and feelings are less likely to surface because one is distracted.

I hope you find solutions for your symptoms.

Rocco, let me know if you’d like to talk about my experience with TMS more, and I will write the site administrator to figure out how we can get in touch.


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