Klarinet Archive - Posting 000413.txt from 1998/07

From: Lee Hickling <hickling@-----.Net>
Subj: RE: [kl] Tendonitis
Date: Thu, 16 Jul 1998 07:03:29 -0400

Dr. Goldman's advice to Jason Cable about his disabling pains and numbness
in his wrists and fingers in my opinion is very sound. I am not a
physician, but I was for years a science and medicine reporter for a large
newspaper chain, and when I began to develop symptoms like Jason's, but
less severe, I researched the problem in the medical literature, and took
several steps that so far have put an end to the problem.

However, as the doctor said
>I never diagnose over the net
and I seriously recommend that anyone regard medical advice from a musician
with the same skepticism he would have toward musical advice from a doctor.
The internet is not a reliable source for help with a health problem. (Even
many physicians are not qualified to diagnose and treat injuries of the
types athletes and musicians are prone to. You'd be surprised what great
gaps your doctor may have in his or her medical knowledge. Some are even
unfamiliar with the effects and side effects of drugs that they're
prescribing nearly every day - but that's another story.)

But back to the main subject - one step I took that was very helpful, since
I spend hours every day on the computer, was to arrange my keyboard and
monitor so there is no strain on my wrists. The keyboard should be 20 to 22
inches from the floor, so one's elbows are higher than one's wrists, and
the backs of one's hands are about level. It's the same position required
for playing the piano.

It was not necessary for me to change my posture when playing the clarinet,
because I was fortunate to have teachers who made me start right. But as a
teacher myself, I have been shocked by the number of clarinet students who
come to me with major problems with their posture, problems that court
carpal tunnel syndrome. It is essential to play with your elbows well away
from the body, so the wrists are not bent or twisted. The clarinet should
be held away from the body, at roughly a 40-degree angle, so it balances on
the ball of the right thumb and is steadied by the mouth, with the fingers
relieved of virtually all responsibility for supporting the instrument.
This is the classic position, taught for going on 200 years not because it
minimizes damage to the tendons that operate the fingers but because it
permits a freer and more supple finger technique. On the sax, or the larger
clarinets, one should fuss with the strap until the mouthpiece comes to the
lips without the slightest need to support the horn with one's hands. The
full weight of the instrument should be on the strap.

If a musician both holds the clarinet close to the body, putting the weight
of the instrument on the side of the thumb rather than the ball, holds his
or her wrists close to the body, so the wrists are bent at an angle, and
besides that spends much time on a computer with the keyboard so high that
it's necessary to bend the wrists to type, he or she is courting CTS.

Lee Hickling <hickling@-----.net>

What Dr. Stephen Goldman said was:
>It sounds like you have more than tendinitis. If what you describe as
>numbness is shooting, burning, or so-called pins-and-needles discomfort, you
>probably have something called carpal tunnel syndrome (CTS). If vigorously
>shaking your hands gives you prompt relief for a time, CTS is very likely.
>It's caused by one of the nerves going to your hand being compressed by a
>band of fibers that wraps around everyones wrists. The symptoms come and go,
>and occur at night (often waking you up) and during activities in which the
>wrists are held in flexion or extension, such as playing the clarinet or
>using a computer keyboard. IF you have this problem (I never diagnose over
>the net), a splint which keeps your wrist straight and is worn at night can
>be very helpful. Never have seen it used while playing the clarinet, but if
>it doesn't interfere with your dexterity it may help then. In severe cases
>there are other very good treatments, but they are more involved.
>The weakness you have (assuming it is true weakness and not just discomfort
>caused by numbness) is probably tendonitis and the ibuprofen should help the
>symptoms while you recuperate. A splint which keeps your wrist straight
and is worn >at night can be very helpful. Never have seen it used while
playing the clarinet, but >if it doesn't interfere with your dexterity it
may help then.

---------------------------------------------------------------------
For additional commands, e-mail: klarinet-help@-----.org
For other problems, e-mail: klarinet-owner@-----.org