Klarinet Archive - Posting 000343.txt from 1998/02

From: Neil Leupold <nleupold@-----.edu>
Subj: Re: tendonitis
Date: Fri, 6 Feb 1998 21:40:05 -0500

On Fri, 6 Feb 1998 Bafra@-----.com wrote:

> And if you take ibuprofen, it only "masks" the pain; doesn't cure it...
> You won't feel pain but the dammage will still be there.

This statement is partially false and must be corrected. The "true"
part is that ibuprofen does not cure tendonitis. This is correct.
What is false (and more important to address) is the notion that
ibuprofen masks the pain which is caused by the malady. This is
incorrect. Ibuprofen is a well-known and widely recommended
anti-inflammatory agent, used for many different problems. When
used in the treatment of tendonitis, the effect is to diminish
the level of inflammation which arises from inflamed tissue in
the affected area (i.e.; the arms and wrists). When the drug
takes effect, the inflammation is alleviated, and the pain
decreases. The pain is caused by the inflammation, thus the
cessation of the pain is not brought about by the ibuprofen,
but is a happy by-product of the drug's effect on the inflammation.
Hopefully all of this makes sense. It's important to under-
stand, because something which we sometimes ignore is the fact
that the body can sometimes work against itself and mitigate
a problem rather than work naturally to solve it. Swollen
and/or inflamed tissue tends to swell and/or inflame further,
rather than diminish, if left untreated by external means. If
we help the body by decreasing the inflammation, the body
responds by beginning the natural internal healing process.
Also (and this should not be under-estimated either), when
pain is diminished, we tend to relax psychologically and
emotionally, which can be a major factor in our prospects
toward healing.

All of this having been said, I'll offer my own thoughts on
how best to approach the issue of tendonitis. I've had it
too, just like many others, and what I did worked for me.
First, I did take ibuprofen, and the pain was diminished.
Some may balk at this next part, but I made a trip to my
local chiropractor and had him "open up" my wrist by re-
lieving any tension which might be caused by rigid bones.
He pops some bones, loosens up the motion, and elongates
the whole area so that there is no undue friction or con-
striction anywhere along the pathway from the upper arm
to the tips of the fingers. After leaving his office, I
was very careful not to compress my hand or wrist against
any surface which might cause any locking up of bones and/
or tissue. This "loose" and opened-up feeling was a relaxed
one, and I focused on it in order to memorize how it felt.
I moved my wrist up and down, gingerly, slowly, to encourage
this freedom of motion. I never moved to the point of causing
pain or discomfort.

After having my arm and wrist "prepared" (i.e.; relieved of
unnecessary internal restriction of motion), it was a matter
of letting my body do its job. I decreased my practice regimen
quite a bit, and when I did practice, I always took several ibuprofen
pills before playing a single note. And then, when I played, I
made a special effort to ensure that the relaxed and painless
feeling I had when I left the chiropractor's office remained
in effect. The moment pain began to creep in, I knew that
inflammation was occurring, and then it was time to put the
instrument away for the time being. I doubt I would have
been able to play for five minutes without inciting the
inflammation -- if I had not taken ibuprofen before-hand.
As it stood, I could put in 30 minutes or more before the
problem re-asserted itself.

Ultimately, I began skipping a day or two of practice at a
time -- not because the pain was greater, but because I knew
that the more respite I gave the affected area, the greater
chance my body would have to relax and heal. I continued to
take ibuprofen daily, even on the days when I did not practice,
in order to protect against inflammation being caused by other
activities beyond playing clarinet (i.e.; typing, carrying
heavy objects, writing, etc.). Practice sessions were
merely for maintenance, not for directed study or growth.

There was something I didn't try, but in the beginning I
was desperate for action to heal the problem, so I called
Ricardo Morales and discussed his own problems with tendonitis.
He's had special braces on both wrists, as well as a neckstrap,
over the course of his career. He saw several chiropractors,
orthopedic surgeons, and physical therapists in an attempt
to fix the problem and maybe get rid of the braces and
neckstrap. He finally landed on a hand-held vibro-massage
unit that could be strapped to one hand and rubbed along
the arm and wrist that are in pain. It's a plug-in electric
device, and he claimed that it went appreciable distance
toward relaxing his upper arms when used on a regular
basis. I think he may also have iced and warmed the
areas in conjunction with this massage treatment. But
the truth, as he admitted, was that the means for healing
are not as important as understanding the cause. If
there's something wrong and you figure out what's causing
it, you can work to eliminate that cause permanently. If
we just keep re-aggravating the problem and then use the
same "cure" over and over again, then there is likely to be
permanent irreversible damage over time (which will ultimately
fail to respond to the original treatment). Ricardo said, as
I knew he would, that the issue is one of relaxation. In some
cases, this may very well also involve correction of a habit
which induces tension. This can be related to posture or
hand position, or any number of other possible culprits.
Sometimes it is simply a matter of paying attention to the
arm/wrist and making sure it's relaxed when holding and
playing the instrument. I didn't buy the massage unit
that Ricardo recommended, but I knew what he was getting
at, and he was also the one who suggested that I see a
chiropractor if I thought it might help. His point was
that there are innumerable approaches to aiding in the
healing process, but the end-game is to relieve the cause
of the pain, and then eliminate the cause of the problem.
It takes some open-mindedness and foresight to recognize
that many physical problems we have are our own fault.
We need to take responsibility for that when it applies.

In response to the issue concerning neckstraps and braces,
it is as simple as "do what works". There is no longer the
stigma about wearing a neckstrap as there used to be. If
Ricardo wears one without shame, so can you. If it's a
debate between "embarrassment" and prevention/elimination
of pain, choose the latter option. Many players now wear
neckstraps purely as a preventive measure. They've never
had tendonitis or carpal tunnel syndrome, and they don't
want it. It's not a matter of fashion or social acceptability.
It's a matter of doing whatever it takes to enable painless
and comfortably happy clarinet playing. And the really nice
thing is that straps and braces are relatively inexpensive.
It doesn't get much better than that.

Best of luck to you,
Neil

   
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