 The Clarinet BBoard
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Author: Ben
Date: 2004-02-06 05:30
I am having no comparable problems with my left arm, hand, and fingers, but I seem to consistently have problems with my right, in spite of the use of a BG neck strap.
In particular, the muscles in the forearm between the elbow and wrist and right below the knuckles in the hand are almost consistently sore/tired, even when not playing for a while. Also, my fingers seem to be getting stiffer and noticeably harder to move quickly with a smooth/fluid motion, in comparison to my left hand/fingers. Using the computer to type, or practicing for long stretches also seems to aggravate this, even when I take frequent rests and stretch before and after... I am also right handed.
I have tried Motrin, Aspirin, Tylenol, heat, cold, massage, and all of these are at best a temporary relief. Right now I am taking a couple days rest, and that seems to be helping some, but I feel like I cannot do that too much, as I am preparing for some important auditions and concerts in the near future.
It seems that in spite of stretching, and trying to frequently rest when I am practicing, I must still be practicing incorrectly and/or for too long a duration.
Any suggestions to make sure won’t be an ongoing or worsening problem?
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Author: Ben
Date: 2004-02-06 05:35
Also, even if it takes another day or longer, would it be best to wait until all the soreness and consistent muscle fatigue has dissipated before I resume practice?
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Author: sfalexi
Date: 2004-02-06 06:43
Have you seen a doctor? If it gets aggravated while typing or other "finger" activities then it's probably not a problem relates solely to clarinet. They may be able to tell you if all is well with your tendons, or if you're developing carpal tunnel, or the like.
And my philosophy is, if it really bothers you, take as long as needed to heal. God forbid you try to practice too much without the proper rest and do more damage that is harder to heal (or worse, maybe even permanent damage!)
Alexi
US Army Japan Band
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Author: EEBaum
Date: 2004-02-06 06:45
There's a lot of pressure on your right hand regardless, especially your right thumb. I'd recommend seeing a doctor. At the very least, you could try one of those wrist gloves to help relieve the strain. Repetitive Stress injuries can be nasty... be careful!
-Alex
www.mostlydifferent.com
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Author: Hank Lehrer
Date: 2004-02-06 11:46
Hi Ben,
Right handed, correct. We had a couple of long discussions about this very thing last year. You might be able to find the string and there was a lot of good dialogue.
I suffered (notice suffered) from the same thing but the computer mouse seemed to be the culprit (I spend too many hours each day at the screen but it is a major part of my work so...). One thing that really helped me was to switch to a trackball that you can operate with your thumb.
Seeing a doctor is an important thing to do. Aleve is the only thing that really helps me (but my knee and right shoulder pain - some assorted old sports injuries - is controlled as well).
Remember RICE. Rest, Ice, Compression, and Elevation are the standard cures for most such injuries (and you obviosuly have an injury).
HRL
PS Check the internet for information on lateral and medial epicondylitis.
Post Edited (2004-02-06 13:53)
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Author: David Peacham
Date: 2004-02-06 13:22
If the mouse is the culprit, operate it with your left hand. I am right-handed, but have always found it easier to use the mouse with my left. Apart from feeling more natural, it leaves my right hand free to pick up a pencil. I don't even swap the buttons: I operate the main (left) button with my middle finger and the secondary (right) button with my first finger.
A medical check-up is obviously an essential first step to rule out the possibility of disease. But my experience of medics is that they are useless at treating muscle injuries. For that, go to an osteopath.
As for checking the internet for information on "lateral and medial epicondylitis" - in your place, I'd get the problem diagnosed first. The problem with medical dictionaries, or their electronic equivalent, is that once you start reading them you start believing you have every disease under the sun ... I sneezed, must be bubonic plague.
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If there are so many people on this board unwilling or unable to have a civil and balanced discussion about important issues, then I shan't bother to post here any more.
To the great relief of many of you, no doubt.
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Author: Hank Lehrer
Date: 2004-02-06 13:55
Hi David,
Notice that I suggested seeing a doctor in the body of my message. The internet suggestion was as a PS.
I think an informed patient is a better patient for any physician. When I visit with my doctor about any ailments, if I can somewhat "speak the language" that saves him having to explain simple things to me. Then we can then concentrate on the cures.
There have been several times that what I gotten from the doctor was affirmation of something I suspected. However, we are talking about physics in this situation; plain levers and forces. An ergonomics engineer might be a good consult as well (but after seeing the doctor, of course).
HRL
PS Here is the link http://test.woodwind.org/clarinet/BBoard/read.html?f=1&i=125893&t=125465 for the earlier discussion.
Post Edited (2004-02-06 14:09)
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Author: Don Berger
Date: 2004-02-06 13:55
Have you considered that your thumbrest [is it located too low ??] might be contributing to your problems? This is a frequent topic for discussion here, the two solutions being relocation and/or an adjustable. Luck, Don
Thanx, Mark, Don
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Author: Ben
Date: 2004-02-06 15:14
I have a Buffet prestige, and the thumb rest is as high as possible. I have also seen doctors in the past, and the only things they have suggested is to rest, ice/heat the sore areas, and pop some pills. I have done this, but it still seems to be an ongoing problem. I think most of the drugs only obviscate the pain, making it possible to injure myself more while on them! Also, I think most of these doctors are not musicians, or musicians who play a lot, so I am doubtful for how much they can understand my problems first hand. However, the doctors I have seen have all been General Practitioners. So, perhaps there is a type of specialist that would be more helpful to see.
P.S. I am not interest in surgery. I have heard too many horror stories about musicians who have done this and only had it complicate/worsen their difficulties.
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Author: David Peacham
Date: 2004-02-06 16:18
The reason I suggested seeing a doctor first is to be sure that this really is a muscular strain problem rather than a disease. If it is arthritis, gout, or a nervous system problem, then RICE will not help. If the problem has changed in nature, or become a lot worse, since you last saw a doctor, I would see a doctor again. I don't know where you live; in England it can be difficult to get a specialist appointment, even privately, without a GP reference.
Once you have established with the help of some expert advice (not a medical dictionary or indeed a BBoard) that it is definitely a strain/injury problem, then I would suggest visiting an osteopath. Alexander Technique might also be beneficial, but is unlikely to cure an acute condition.
I would not assume that putting the thumbrest high is necessarily the best thing to do. I have mine, on a Concerto, adjusted pretty well as low as possible!
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If there are so many people on this board unwilling or unable to have a civil and balanced discussion about important issues, then I shan't bother to post here any more.
To the great relief of many of you, no doubt.
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Author: cujo
Date: 2004-02-06 23:57
It most likely is the thumb rest.
Hold your hand out in front of you in a very relaxed fashion. You will see your thumb lines up with your index finger(hopefully-if not see a doctor).
Now move your thumb very slightly to line up with your middle finger. You will notice now the thumb and some hand muscles have a little tension. Now imagine holding that tension while moving all your fingers for a few hours with a little wieght also being supported. That is how almost all clarinets are designed.
I know adjustable thumbs rest help alot. But a thumb rest that can line up your index finger with your thumb is the very best. For my clarinet I put mine upside down and bent the ends(with proper tools) and glued a little cork. Very cheap and fairly effective.
For a professional job what you can do is take it to a good repair person and have the thumb rest moved up and fill the old holes.
If your thumb rest is already straight with your anatomy and you still have problems I really suggest a doctor. The carpal tunnel can be fixed to a degree but it is much better to avoid with a proper thumb rest position.
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Author: ken
Date: 2004-02-07 00:27
Here are some random thoughts tackling the issue from a different angle. Excluding a physical malady, and focusing only on tension and pain in the right arm, hand and thumb, the culprit could be incorrect thumb position.
Depending on your current equipment have you first considered "lightening" the raw weight of your horn, (i.e. combining a lighter barrel and bell)? Going with lighter joints might take just enough weight off to reduce and/or alleviate the problem entirely, or at least cut it back a size. Another possible solution might be trying a new arm-hand-thumb position method. Nothing too drastic, just select minor fundamental changes that more efficiently re-distributes weight and concentration of finger movement.
For consideration, below is the arm-hand-thumb method I teach and been using for 18 years. The basic concept is to reduce and limit movement from the tips of the nails to the shoulder blade channeling/forcing all energy and technique into and between the 1st and 2nd knuckles ... this is where the REAL technique lives. All are welcome to freely use it and pass it on (or take it down the road and dump it).
Routine:
Sit in an upright playing position on the edge of the chair with the backbone at a 90-degree angle and feet flat on the floor. Take 3-4 deep breaths, and exhale while maintaining posture. With right arm hanging straight down at the side, grasp (Bb or A) horn in the left hand at the barrel, in the play-ready position and gently resting the bottom of the bell on the top of the “right” kneecap. Lift the right arm upward bending at the elbow 45 to 60 degrees and in a ready position to receive the bore and thumb rest. Tilt the horn back toward the right hand but not making contact with it. Stop and hold the horn keeping the thumb rest approximately 2 inches in front of the right hand. Now, keep the bended arm motionless, allow the right hand from the wrist to fingertips hang limp. Give it 5 or 6 good shakes to relax and relieve any stiffness again let it hang freely.
At this point, you should notice three (3) things, 1) the forefinger and thumb is in a natural state resembling a semi-squashed or backwards “C”. 2) If you shook the hand correctly and maintained position it appears about parallel to the torso. 3) The thumb is in the 9 o'clock position. Now, keeping the thumb motionless, slightly bend or "cup" all 4 fingers slightly inward from the 2nd knuckle down forming a more rounded backwards “C” (visualize bending your fingers just enough to suspend but cover the right lower joint 3 ring keys). Now, continue by raising the wrist upward slowly so the back of the hand is straight/parallel with the forearm. Now, the right hand and thumb should be in the 10 o’clock position, back of hand and arm parallel and in a totally relaxed and natural position ready to receive the thumb rest (wrong or unnatural position is cocked inward with back of hand and wrist at 9 o'clock position simulating a claw).
With the left hand, now slowly guide the horn "into" the right hand as if you are slipping on a glove. Rest and place the 1st joint of the thumb squarely under the thumb rest (relatively to anatomy) at the most “top and inside left” corner. Rest the right top pad of the right thumb slightly touching the bore. Maintaining this position use the “left” hand to toggle or make minor adjustments so the fingertips and pinkie cover the ring keys and bottom right joint 4 cluster keys. Familiarize yourself with the new hand position and try to achieve an "in the pocket" feel. Now, wiggle all four right hand fingers but concentrating on restricting any extraneous movement, and limited to the top big knuckles down to fingertips. If done correctly, the only other movement should be the forearm muscles twitching.
Lastly, rest the right pinkie on top and "between" the Ab/F//Eb/C lower right joint cluster keys. Be sure to maintain the fingertips in the same natural cupped position.
Exercises:
I'm a strong advocate of practicing tremolos in daily routine for mastering technique and producing the fastest, most accurate and noticeable results. Here are a few basic right hand tremolo exercises to help develop the technique and re-train the fingers (the 1st exercise might take several tries but will come with patience and perseverance; remember, slow to perfection, fast to excel). Exercise 1: Sit in front of a floor-sized mirror (or a larger compact pocket-sized used for embouchure work) to monitor progress. Use a metronome (set to 1/4=80 tongued or slurred). Play a 5th of an F major scale from low F natural to C natural and back down. Repeat X5. Focus on keeping the "whole" right side of the body (shoulder blade down to top of 1st knuckles) as motionless as possible (be certain to raise the fingertips high enough to avoid flattened pitch). After mastering the technique at the slower tempo increase gradually 4 to 6 metronome clicks to 1/4=144-152. Exercise 2: Play chromatically, (1/4=80 tongued or slurred) from right side low Gb/F# to C using both middle/forked fingerings (repeat as in exercise 1). Exercise 3: Strengthen the pinkie with right side (only) tremolos slow to fast. Play low E to G to F to G to F# to G to Ab to G etc; rotate patterns, clockwise, counter clockwise and in an “X” pattern. Basic stuff to some, yea, but boy does it work. I all but guarantee if one adds these exercises and 15 minutes to their routine 5 days a week they won't recognize themselves inside 3 months, and that's fast progress for anyone. Enjoy! v/r Ken
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Author: cujo
Date: 2004-02-07 00:59
Also I forgot spring tension could be a factor. Having a lighter spring tension will do the job with less effort and fend off the carpal tunnel longer.
Also how you play too. Some players play with thier fingers flat on the tone holes others bend thier fingers. Playing with flat fingers makes it easier to play and causes less stress.
If you cant play with fingers flat without air leaking the rings need to be adjusted lower and properly(make sure you have a good repair person). Also other keys can be lowered or raised to cause less stress.
Many instruments are set up wrong with tensions too high so the pads wont leak or the technician just didnt know the reason(this is where you need a good repair person to adjust things properly). Just making it work does not cut it, it needs to work properly with the least amount of stress and best sound.
Post Edited (2004-02-07 01:11)
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Author: Dee
Date: 2004-02-07 13:28
Another thing to check besides the thumb rest location on the instrument is the position of your right hand and arm. Many people have an incorrect position and end up with too much bend in the wrist. This can lead to major problems. The instrument's thumb rest should straddle the base of them thumbnail. If it is any further down the thumb, you will be putting too much bend in the wrist. You may be having a similar problem in typing on the computer and using the mouse. The wrist needs to be straight not bent. Unfortunately it is difficult or inconvenient to maintain the proper position.
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Author: sdr
Date: 2004-02-09 02:13
Strongly suggest that the medical specialist you should see is a PHYSIATRIST (a.k.a. Physical Medicine and Rehabilitation, a.k.a. PM&R). Physiatry is the intersection of neurology and orthopedics. They are the MD counterparts of physical therapists. (With apologies to my medical brethren in the following specialties:) Neurologists tend to be focused on diagnosis rather than treatment, orthopedic surgeons tend to be looking for surgery and be disinterested in other forms of management. Physiatrists are obsessed with function in daily life. If you check around, you will certainly find some with special expertise in repetitive stress injuries and you may find one with special interest in musicians.
-steve rauch
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Steven D. Rauch, MD
Dept. of Otology and Laryngology
Harvard Medical School
Mass. Eye & Ear Infirmary
Boston, MA
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Author: D Dow
Date: 2004-02-09 13:39
I also reccommend after having any condition treated and solved midically investing in some Alexander technique lessons...
which work at preventing these problems from occuring..
.in other words specific physical exercises stretches and approaches to practice which will end any dehabilitating problem from recurring.
Mental tension as well can lead to all kinds of neck and shoulder problems....get a large mirror and watch what happens after an hour of practice to your posture, shoulders and hands....
David Dow
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Author: Ben
Date: 2004-02-09 14:16
Thank you all for your helpfull coments... Resting some has helped, but I think I will still try to find an physiatrist and see what comes of that; it sounds like the best branch of medicine for my problem. I have also been interested in Alexander technique, so maybe I can find a teacher in the area? I have emailed a couple people about that.
Thanks again!
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