 The Clarinet BBoard
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Author: MondeLuna
Date: 2009-11-14 15:36
Hello Everyone,
I have been dealing with tendonitis problems for a few years now. Recently it has gotten considerably worse. I see an ortho on Monday for x-rays and possibly a cortisone shot. While I think it would be in my best interest to stop playing for a while that is not an option at the moment. I play in small intervals and stop when it hurts. (when able)
Currently I use a neck strap most of the time. I rest my clarinet on my knee or between my knees when sitting. This is pretty standard for me unless I am playing a show that switches clarinets frequently.
Anyway to get to the point if anyone has any experience with the Kooiman thumbrest could you share it? I've read about it in previous posts but I would appreciate if someone with tendonitis could talk about it in further detail. I'm a little leery about spending $200 on a thumbrest to drill into my clarinet. But if it truly works it's a godsend. Thank you for your time!
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Author: donald
Date: 2009-11-14 17:44
A good friend of mine has had similar problems to you from the sound of it, and (like you) was in a situation where taking a complete break was difficult...
In her case the tendonitis was almost entirely in the right arm/wrist with some minor problems in the right arm.
She has had Osteopath treatment which helped... the dreaded injection (which in her case helped, then after a few weeks suddenly stopped helping and the problem came back with impeccably bad timing) AND has been working closely with an Alexander Technique practitioner. She had tried a Kooiman thumbrest, and not liked it. If it had been used from day one it might have helped but by the time you're in the "it really hurts to play" it doesn't provide the total support you need for relief (as I understand it, your problem has gone way past being about support though... right?)
With both of us in mind (i have had problems this year with a broken wrist that wouldn't heal... all better now) i had a friend make something we call "the spike". This is a floor spike that goes from the bottom joint of the clarinet onto the ground (it is attached at the bell tenon). Using this you have to play sitting, and my intention was that this would just be used for practise time, not performance. I personally like using this, and have done so for many hours of practise- including a professional rehearsal (playing a John Adams piece that had some stamina issues- on a day where i had 9 hours of rehearsal). The disadvantages of "Spike" are....
- it's long, so carrying it around can be an issue
- you can't move the clarinet around when playing, not an issue for me but my friend found this most annoying- and it does make it difficult to "lead" in chamber recitals etc
The latest development- a stomach support thing from Steven Fox. This is a neck strap with post that goes to the stomach so that the right wrist doesn't have to push out. This arrived on Wednesday, and was installed on Thursday (it has to be stuck on by someone who knows how to get tenon rings on and off). So far, it has proven to be a miracle lifesaver... I don't know if she will use it for performance (but i've got a feeling she will use it on a program on Monday where she has a demanding unaccompanied piece)
However- a period of complete rest is essential for the problem to really go away. Fortunately for my friend the summer is about to start here in NZ, so very few performances etc until February, and she is able to take serious "time out". I have heard of a player taking a whole year off with this problem...
hope this was helpful
dn
btw- I've been meaning to post photographs of "spike" for some time, might try to do this in the next few days
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Author: Ed Palanker
Date: 2009-11-14 19:45
I've had students with Tendonitis and usually they needed a wrist brace and a neck strap, which you already use. Chances are it will not improve until you can take a few weeks rest too. I've noticed from time to time that correcting the hand position or the way you hold your wrist can go a long way in helping improve the pain. When you go to the doctor next week take your clarinet and show him/her how you hold your clarinet, you may be putting undo strain on yourself. You could also experiment a bit with the position you're holding it depending on where the pain begins and ends. As an example, if you're stretching your pinky to reach the lower keys you may have to lower the thumb rest, I did that many years ago and it really made playing easier for me. On the other hand if the strain is on your first fingers you may have to raise the rest. You could also be bending your wrist a certain way that puts more strain on one spot or another so bring that closer to you or further out to see if that helps. ESP http://eddiesclarinet.com
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Author: skygardener
Date: 2009-11-15 00:49
I have used the Kooiman for about 6+ years and it is great for me!
One thing about it, though; it is NOT intuitive. It will take time for you to learn how to adjust it to best fit your own hands. The way you adjust it can make all the difference weather you feel an improvement or not.
When I say "take time" I mean it will take about 2~3 months of little adjustments everyday until you feel that it is in the "right spot". Also, it is fully guaranteed so if you need anything replaced, you can contact Ton K. and he will have the parts mailed to you for free.
Over time I have had to replace one screw because I had used it so much the head lost the shape in the hex hole.
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Author: MondeLuna
Date: 2009-11-15 01:29
Donald I basically need my clarinet to be suspended in air w/o the need of any support from my hand. The spike sounds like a great idea and reminds me of something I think I read about before. Isn't there a product that connects to your chair that you can place the bell of the clarinet into for support? I think that could be good for practicing. As for rest I'm planning on taking the week of thanksgiving off as well as a couple of weeks in December, I'm hoping this will help.
Ed I have been playing around with different hand positions but nothing seems to be comfortable. I have had a few peers check out my hand position but they don't see anything wrong. I even asked one of the symphony clarinetists and she said she didn't see a problem w/ my positioning either. But I will keep trying. =)
One thing that did seem to work a little bit was turning my thumbrest upside down and playing with a neckstrap attached but that isn't ideal. I'm thinking about ordering the Ridenour Thumb Saddle. It's inexpensive and seems to have gotten some good reviews. If all else fails the Kooiman might be worth a shot. Thanks for your input everyone it has been most helpful.
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Author: EEBaum
Date: 2009-11-15 01:36
If it's thumb tendonitis like I had, I also came to realize that it wasn't just the clarinet that aggravated it. Anything that found my wrist rotating in the direction of my pinky was problematic. Computer keyboards, computer mice, and my hand position on the steering wheel were the biggest culprits.
Experiment with hand positions until you find one that is comfortable in which your fingers are parallel to your forearm. Keeping the tendon in a neutral, as opposed to stretched, position for prolonged periods is key.
-Alex
www.mostlydifferent.com
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Author: donald
Date: 2009-11-15 02:04
The Steven Fox neckstrap/stomach pad set up completely takes all the weight etc of the clarinet- it's like playing with the clarinet suspended in mid air before you! Check out his web page...
www.sfoxclarinets.com
... you have to go to the instruments menu, then look under accessories.
dn
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Author: DavidBlumberg
Date: 2009-11-15 02:15
Also you can have your thumbrest raised to a more ergonomic position - thumb rests adjust in position, but they almost always adjust DOWN which is the wrong direction!!!
You can have your thumb rest changed so that it will be more even with the index finger. Possibly not dead even, but not below it like a regular thumb rest does - that causes tension in the hand.
http://www.SkypeClarinetLessons.com
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Author: OmarHo
Date: 2009-11-15 14:44
Another option is the FHRED (http://www.quodlibet.com/FhredConcert.php), there are posts on it you search the board.
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Author: Ed Palanker
Date: 2009-11-15 15:49
I really have to disagree with David B on what he said "down is the wrong direction" for the thumb rest. I base that on the fact that, as stated above, I had my thumb rest lowered quite a bit on all my clarinets, except my Bass and Eb. It was the best thing I've ever done for my right hand technique and comfort level in my right hand and wrist. It so much depends on your finger position, where the tension is or is not and what feels comfortable. When I tried a students years ago that had that done I couldn't believe how good it felt and how much it improved my right hand pinky technique. I don't have to stretch to play the lower pinky keys and because of the way I position my hand I easily get to the side keys in the upper joint. As a matter of fact my index finger is positioned very close to the Eb-Bb key so there's no problem there at all. Remember, everyone is not built the same. This is a case when size can matter. Some thumbs are bigger, smaller, fatter or thiner then others as are the pinky fingers. If you have to stretch to reach them you may need to lower the thumb rest not raise it so you don't strain or pull the third finger off the hole while trying to reach those lower keys. It's different for everyone, just like everything else about clarinet playing. One size does not fit all. ESP http://eddiesclarinet.com
ESP eddiesclarinet.com
Post Edited (2009-11-16 01:00)
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Author: MondeLuna
Date: 2009-11-17 02:06
Well I had my appointment with the ortho today. We both decided against getting cortisone shot at this time. He gave me a brace to wear and cautioned me that it may not help anything. I cannot play with it and it makes most tasks almost impossible. But I supposed that is the point.
Alex I think my tendonitis is very similar to yours. I have De Quarvins (in the thumb) and regular tendonitis on the left side of my arm palm facing upward.
I am trying to decide between the Fhred and the Stephen Fox support brace. If I can alleviate the stress from the clarinet on my wrist during practice hours I should be fine in the long run. Experimenting with everything else will also be an ongoing challenge. I thank you all for your input you have been most helpful! =)
Post Edited (2009-11-17 02:10)
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Author: EEBaum
Date: 2009-11-17 04:17
Think that's what I had, but no palm tendonitis. My course of treatment...
-Visit to the student health center. Doctor takes X-rays, says she thinks it's tendonitis. Gives me a wrist brace and the standard student health center prescription (ice and ibuprofen).
-Followup visit to the student health center a week later. Different doctor, of course, even though I asked for the same one. This one asked me a bunch about whether I was sexually active. MY WRIST HURTS FROM PLAYING CLARINET! I insist, but she continues the questionnaire. Seemed poorly equipped to diagnose tendonitis. Keep wearing the brace, ice, ibuprofen.
-Wore the brace and got a neckstrap. A month or so before I'd do much of anything without the brace, though I took it off to sleep. About 3 months before I played clarinet without it.
-Once the pain had mostly subsided, went to my chiropractor, who proceeded to crack at my hands and wrists like no tomorrow. Felt better, but still tender. Better mobility, in any case. Regular visits every month or so.
-Started playing without the brace, still with neckstrap, once I could do so without it bothering. Testing found that it still hurt without the strap after 5 minutes or so.
-Noticed that computer keyboard irritated it significantly, as did computer mouse. Bought split keyboard and trackball.
-Got into a regular stretching routine that I picked up in the Bob Anderson "Stretching" book. Highly recommended.
-Made a point to always take breaks while playing, with greater frequency if I'm woodshedding.
-In under a year (maybe 6 months... I wasn't really keeping track), I only felt anything if I played clarinet on and off without neckstrap for 20 minutes, or for over an hour with neckstrap and no break.
This was in early '05, and I'm now fully recovered, to the point of playing sans-neckstrap for long periods with no problems. However, I am quite careful now. Factors preventing recurrence:
-Frequent breaks
-I didn't play nearly as much in mid06-mid09 as before, and most that I did play was on bass.
-Vigilance to not let myself get stuck practicing the same thing too long at one sitting
-Improved posture, Alexander Technique courses, attention to wrist angle
-Proper stretching before playing
-Regular exercise, incl. weight training
-High awareness of when fingers start to tense up and bunch up due to repetitive motion and prolonged position, to the point that I'll feel my right thumb acquire a little hitch in its motion. If it happens, I take a break, and do various stretches and exercises with it for 30 seconds or so until full range of motion is reestablished. This effectively cuts off the first step toward irritating the tendons.
-Less time on the computer altogether, and purchase of an extremely awesome (though expensive) keyboard, the Kinesis Advantage.
I really don't know if I'm actually fully recovered, or if I just have so many protective measures now in place that it just doesn't have a chance to happen again. For now, I don't much care whether there's a difference between the two. It doesn't bother me at all, so that works for me.
-Alex
www.mostlydifferent.com
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Author: smb9220
Date: 2009-11-18 02:59
I developed tendonitis from using the computer and iPhone. I now use a Fhred on both A and Bb clarinets and they are terrific. The don't require any alteration to the clarinet except for a ring soldiered onto the thumb rest (which you might already have). It's easy on and off and takes the pressure off the wrist.
I also use a wrist brace and found that the best result comes from sleeping in it as my wrist tends to bend when I sleep and that makes the problem worse.
Most of the time, I now have few problems and can pretty much play for up to 6 hours without much problem.
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Author: donald
Date: 2009-11-18 09:36
When i was recovering from wrist surgery i found the same thing as smb9220- even if my wrist was fine during the day, sleeping with the brace on made a huge difference. The parent of one of my students (who is a medical professional) also made a good point- to keep the wrist/arm warm at night. Over the winter here in NZ i was waking up with a sore arm, probably because i was letting it get cold by having it outside the covers while i slept (no central heating etc here, unlike in USA). Wearing the brace at night, plus a bandage/sock etc to keep the arm/wrist warm made a huge difference.
Natalie Harris played a challenging recital on monday night using the Steven Fox stomach support thing. Her rendition of the Rozsa sonatina was stunning, flawless technique and interpretation. Only two weeks before she had required days off playing due to tendonitis pain, and yet with the Fox support she was able to perform with no pain. YAY
hope this is encouraging.
dn
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