It is entitled Carpal Tunnel Syndrome: Explanation and Prevention. Although it is meant for the musician, it has pertinent information for anyone suffering from Carpal Tunnel Syndrome. Enjoy!
Dr. Timothy Jameson
Bayshore Chiropractic Holistic Health Center
Castro Valley, CA
510-582-5454
Carpal Tunnel Syndrome: Explanation and Prevention
by
Timothy J. Jameson, D.C., C.C.S.P.
Carpal Tunnel Syndrome (CTS) is a nemesis prevailing
throughout the musical professions. It has threatened and has
ended careers of many promising and well respected artists.
Education within the profession is of vital importance to
prevent the occurrence of this disease. This article will
explain why musicians are susceptible to developing CTS, the
causes of carpal tunnel syndrome, and finally, prevention of
these injuries.
What makes a musician susceptible to CTS? There are
numerous factors that all play an integral part. These injuries
are reported more in females than males. The numbers available
only tell us who reported the disease, not how many suffer from
the disease. This may be two totally different statistics.
There are many musicians who do not disclose their suffering in
fear of losing their jobs, especially if they are members of
orchestras where each position is sought after by many
applicants. We have learned that approximately 75% of symphony
musicians have suffered at some time in their career with a
musculoskeletal injury. Thus the prevalence is extremely high
within musicians. It has been suggested that people who are of
lesser build and have a smaller body frame are more susceptible
to injury due to the forces imposed upon the body by repetitious
movements. Symptoms usually result from a sudden increase of
practice time, a change of teachers, a change of instruments,
and long practice sessions without breaks. Smokers run a high
risk because of nicotine's constrictive affect on the blood
vessels. Anyone with underlying disease states such as
hypothyroidism, diabetes, fibromyalgia, rheumatoid or
osteoarthritis, blood vessel disease, and obesity, will be more
likely to develop CTS. Pregnant women tend to develop CTS
because of fluid retention, but the symptoms usually subside
once the pregnancy is over. Nonmusical professions such as
computer inputting or programming, and hobbies such as knitting
can lead the musician to CTS. Previous neck injury from a car
accident, from a bad fall, or from any trauma needs to be
evaluated. Previous shoulder injuries, such as dislocations are
important to note. A history of broken bones in the arm,
forearm, wrist, clavicle, shoulder blade can be a predisposing
factor. Finally, the particular instrument played by the
musician increases susceptibility. Violinists, violists,
guitarists, pianists, and percussionists are most at risk.
For those of you who are unfamiliar with CTS, the
following is a list of symptoms associated with the malady. CTS
leads to pain, numbness, tingling, and when at its worse,
weakness in the first three fingers of your hand. Symptoms can
occur in the forearm as well. Many sufferers complain of pain in
the hand or arm while sleeping. The person suffering from this
disease may experience difficulty holding the instrument,
clumsiness, drops objects such as glasses, and cannot grip well.
When it is severe, the artist loses complete use of his/her
hand, and will usually begin using the opposite hand to perform
daily activities.
It is my opinion that 80% to 90% of "carpal tunnel
syndrome" cases are not a direct result of median nerve
entrapment in the wrist. (This is the nerve that passes through
the small tunnel formed by the bones of the wrist and a
ligamentous covering). This is a controversial statement, but
my clinical experience has shown that most cases termed "CTS"
are a result of a combination of musculoskeletal and
neurological problems stemming from the wrist as well as in the
arms, shoulders, and neck regions. This is why it is necessary
to find a competant doctor who will investigate all these areas
to determine the extent of injury.
To explain how carpal tunnel syndrome develops, I
like to use the following analogy when explaining nerve flow
from the neck to the arms. Imagine the nerve in your arms are
like garden hoses, with water (energy) flowing at full pressure
when working properly. If you have arthritis in your neck,
previous whiplash injuries, misalignments of the spine, or
spinal curvature problems, this will cause a "kink" in the hose,
and decrease the flow of water (energy). This will lead to a
40% - 50% decrease of nerve flow to the arms and hands. The
nerves than pass under certain muscles that are tight and
constrictive, and the nerve flow may decrease to 30%. It gets
kinked as it passes through the carpal tunnel, leaving only 5%
or 10% of its normal energy, thus the numbness, tingling, and
weakness. This is why I state that performing surgery on the
wrist is usually not effective, since many times the problems
lie above that area.
A predisposing factor to this insult on the nervous
system is poor posture while playing the instrument. I will
not go too deeply into posture here due to space limitations.
Just keep in mind that when your mother told you to sit up
straight, it still applies while playing your musical
instrument! A hunched forward posture will create pressure on
the nerves traveling from the neck down through the shoulder.
This is especially important for the acoustic guitarist who
leans forward over the instrument while playing, and also the
pianist who leans forward to read sheet music. Inefficient use
and overuse of the hand and arm musculature while playing the
instrument is another major factor. How many of you keep a
pinkie pointed outward and extended while playing? How many of
you apply great amounts of pressure on to the fretboard or
keyboard with your fingers? How many guitarists put a
tremendous amount of pressure with their thumb on the neck of
the guitar, especially while playing bar cords? These aberrant
muscle actions lead to fatigue and soreness. Over a long period
of time, the body retains a somatic memory of these positions
and it becomes difficult to change them. This is where such
techniques as Feldenkreis and the Alexander Method come into
play.
How does the musician prevent these maladies from
occurring? The artist needs to use common sense and increase
his/her body awareness. Musicians are compared to athletes
because of the amount of training involved to play the
instrument, and the repetitive nature of the muscle movement.
The big difference is that athletes usually train with the
larger more powerful muscle groups. Musicians on the other
hand, need fine motor control of the smaller muscle groups of
the hands. Consider yourself an athlete preparing to train when
you pick up your instrument next time. Have you warmed up your
muscles adequately to "train"? Have you increased overall blood
flow and heart rate by performing some mild aerobic exercise?
Have you stretched the muscles in the arms, hands, and neck? If
you have not done these exercises, you are risking injury, just
as an athlete who runs a 100 meter race would if he/she did not
warm up beforehand.
The most important advice I can give is to take
breaks at least every 45 minutes. These breaks should be for 10
- 15 minutes in length and should include stretching and
self-massage on the arms, hands and shoulders. Become aware of
your body's needs. After you are done practicing, rehearsing,
or performing, don't just throw the instrument in the case and
leave. You need to cool down the muscles. Perform stretching
exercises and elongate the tightened muscle groups.
The more you as the musician become "in tune" with
your body, the better off you will be. Read books on
stretching, massage, and proper nutrition. Education,
prevention and maintenance are the keys to a pain free career.
Do not wait until symptoms arise to begin learning about
prevention. Start now - your musical career is depending upon
it!
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