Experiences with Ganglion cysts?

Playing Technique
#1

Hey everyone!
In the past half a year, I developed recurring issues in my wrist due to two small ganglion cysts in my fretting hand, confirmed by a doctor and MRI. I am doing physical therapy that consists of stretching and weight exercises to strengthen the wrist muscles. While playing guitar, I do not experience pain or discomfort (even after two hours). However, the cysts tend to cause discomfort and limitation in mobility only several hours later. This usually disappears after 1-3 days. The physician (also guitarist) and my guitar teacher both confirmed that my posture (playing standing, wrists absolutely straight, sufficient warm up, breaks in between) is very unlikely to be the origin. Other information that may be relevant: I climb about 3-4 times a week, which significantly increases the total load on the wrists. I play a Gibson-style Les Paul with a thin U-shaped neck.
Questions for you: Do you have any similar experience with Ganglion´s in the fretting hand? Do you think the shape of the guitar neck influences the strain on the wrist? Could playing a flatter (C-shaped) neck lower load on the fretting hand and increase ergonomy?

Thank you all for your advice!

#2

I’m sorry to hear that you’re struggling with injury.

Obviously, I can’t comment on your playing posture or fretting mechanics without seeing your playing.

I have a history of RSI in my wrists. I had chronic tendinitis/tendinosis for nearly two years. It was primarily due to poor typing posture and technique, but it absolutely limited my ability to play the guitar.

I would mention a few points.

If you’re strong enough for climbing, you’re most definitely strong enough to play a guitar.

There are no “guitar” RSIs (or “typing” RSIs or anything else). Stress is cumulative, all of your activity contributes to your cumulative stress.

Lighter strings and lower action could help to reduce your overall stress.

If playing guitar for a couple of hours is enough to trigger your symptoms, then there’s either something wrong with your fretting posture/mechanics that your teacher and physician haven’t identified (which I believe is very possible), or it’s the metaphorical straw that’s breaking the camel’s back. In either case, you should absolutely consider if you can reduce your cumulative stress by modifying your playing form.

In my own case, my playing posture and mechanics were quite good, but there was still plenty of room for optimization.

If your adding weights, you could just be adding more cumulative stress which could be counter productive. I’m not saying not to do so, I’m merely encouraging you to be mindful of your cumulative stress.

Most guitar “warm ups” are junk volume that are just adding to your cumulative stress.

I don’t believe that any particular neck geometry increases strain on the wrists generally. However, we organise into posture and movement through tactile, proprioceptive and kinaesthetic awareness. How the neck feels to you could be encouraging you to adopt a form which increases your stress while playing.

Another neck profile may well encourage you to adopt a form which reduces your stress. However, for this to be true, you would need to be doing something now with your Les Paul that you would cease to do with another guitar. So, your fretting mechanics and posture would need to be a problem now for this to be the solution.

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#3

I haven’t specifically had problems with Ganglion cysts, but I have had issues with my CMC joints on both hands and it took a long time to get the pain to go away!

These are some of the things I did that helped me - I would suggest trying lighter strings, maybe 8s, if you’re not playing them already. I would lower the action too, as low as you can get without significant buzz coming through the amp or the string choking out.

Have you ever tried playing sitting down in the classical position? That might help with wrist position.

These things helped me with my hand issues. I know you have a slightly different hand issue, but maybe this advice might be useful for you.

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#4

Hey everyone!

Thank you both for your feedback!
@Tom_Gilroy I agree with you that it is most probably cumulative stress. I will try to reduce the warm-up time and divide the practice sessions into two, one in the morning and one in the evening. The action is on both guitars already quite low (<1.5mm 12th fret low E, <1mm 12th fret high E).
I quickly took some footage with two guitars, the first one with a flat C shaped neck and the second with a U shape. I tried to give as much of a perspective on the fretting hand.

@aliendough I usually mix between classical position sitting and standing. About 30 - 70 ratio. I prefer standing because mostly I am practicing for rehearsals with bands. I will try out to play several days only seated and see how if I trigger an inflamation.

Thank you!!

#5

Your knuckle line is overly parallel to the neck and you’re overly supinated. This is forcing you to achieve your spread through constant engagement of the abductors and your hypothenar muscles. This is also forcing extension at the MCP joint, so you extensor digitorum communis is in constant tension. The constant flexion at the DIP joints is indicative of constant activation of your flexor digitorum profundus. Your thumb is in constant oppostion requiring constant activation of the opponens and thenar muscles.

Basically, you’re assuming strenuous grip called a sphere grip, and it’s forcing awkward cocontractions which is making your fretting much more strenuous than necessary. You want to begin with the anatomical position of your hand at rest and grip like you’re holding a cylinder.

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#6

Do you have a glossary for all the joints and such you’re discussing? It’d help me understand this post a bit better.

#7

I’ll try to explain.

Supinated means that the forearm is rotated so that the palm of the hand faces up. The abductors are small muscles in the palm with spread the fingers. The hypothenar muscles are the muscles of the palm on the pinky side, their function is to spread the pinky out, rotate it to oppose the thumb and create a curvature in the palm. The posture @Garbor is assuming is demanding constand activation of these muscles.

The MCP (metacarpophalangeal) joint is the joint where the fingers join the palm (the large knuckle). The extensor digitorum communis (EDC) is a muscle in the forearm which extension all fingers. In particular, it extends the MCP joints. Extension at the MCP joint of the middle finger is a clear indicator of EDC activation, and this is also present in his fretting posture.

Opposition is a movement of the thumb, bringing it against the fingers. This position requires constant activation of the opponens and the other thenar muscles, which in the palm at the base of the thumb.

The DIP (distal interphalangeal joint) is the joint between the middle and last bones of the finger (near the finger nails). The flexor digitorum profundus (FDP) is a muscle in the forearm, and it flexes all fingers. Most importantly, FDP is the sole flexor of the DIP joints, so flexion at these joints is a clear indicator of FDP activation.

EDC and FDC are (essentially) mass action muscles, they don’t (and can’t) act upon fingers independently. Moreoever, they oppose eachother. Cocontraction of these muscles is strenuous and should be avoided. Constant cocontraction of these muscles is strenuous and fatiguing.

Nobody is strong enough to fight against themselves and win. No amount of strengthening the wrist will fix the problem. @Garbor is not working to overcome external load. He’s working one side to overcome forces that he’s creating on the other and vice-versa.

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#8

Thanks @Tom_Gilroy for these incredibly detailed and helpful posts! Super interesting observations! The supination explains why my extensor digitorum communis is tired after a few minutes of legato exercises at the lower frets. This may also explain why I sometimes have a bit of strain at the bottom of the thumb (palm side). For completeness, the cysts are located between the lunate and the capitate.

I seem to have a misconception of good posture, as I always considered wrist and knuckles parallel to the guitar neck as the ideal. Hence, I thought increasing supination and activating more muscles may remove strain from the wrist. I put particular emphasis on this in the last six months, during which the frequency of my wrist inflammation significantly increased. (And I was wondering why things are getting worse…)
Do you have suggestions/instructions how I can fix my posture? Is it as simple as playing with less supination?

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#9

I’m happy to help.

This is very common. People think of “good posture” as a collection of idealised, static positions. The result is that people attempt to adhere to these idealised positions rigidly.

It’s far better to think of posture as a dynamic skill.

This is definitely not what you want to do.

You want to learn to habituate default positions which closely resemble your hand at rest, and learn to align your stronger muscles to task without unnecessary cocontractions.

The usual advice of telling people to relax is totally useless. It’s like starting a sentence with “Don’t panic, but…”

You can’t voluntarily relax, because relaxation is not controlled by the sympathetic (voluntary) nervous system.

This is not about learning to “do” something. It’s about learning how to “not do” the things you’re doing.

That’s very unfortunate, hopefully this is where things start to change course.

I have some general fretting concepts videos I posted here a few years ago.

Start by understanding the resting position of your hand, and learn how to approach the neck so that your natural grip mechanics are optimally aligned to your goals.

There’s nothing easier than resting, so start at rest. Remember, your grip forces are far greater than the playing forces required on a guitar. If it’s difficult or fatiguing, it’s wrong.

Don’t obsess about how it looks, and don’t look at your hands too much. Whether you realise it or not, you have some preconceived ideas of what “right” looks like, and those ideas are wrong.

The problem is that “right” is a feeling, and you just don’t know what right feels like yet. You have to learn through tactile, proprioceptive and kinaesthetic awareness.

I’m happy to answer questions you have but this is about as much as I can really communicate through text. I am available for lessons if you’re interested.

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#10

Funnily enough, I had a recurrent one in my picking hand for years. Eventually got an x-ray, just to rule anything else out, and they were like ‘yeah that’s just a cyst, because you’ve had a broken wrist that healed weird.’ To which I then informed them I have never broken my wrist, followed by, ‘yes, you have.’

Learn something new every day :slight_smile:

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#11

Thank you for your advice! The video series is truly amazing! I began to apply the concept of resting position and realized how much unnecessary effort I was exerting in my playing. I also learned that instead of shifting the fretting hand position, I was performing unnecessary stretches. I will post an update in a few weeks.

#12

I’m very happy to help.

I think most players would be surprised how much effort they exert unnecessarily in their playing. It’s habitual and it doesn’t feel unusual.

It’s difficult to perceive unnecessary effort. If it were obvious, nobody would habituate these suboptimal movement patterns. The contrast between the resting state and whatever we’re doing provides a clear haptic awareness of these efforts.

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#13

Update after two weeks:
Following the advice of @Tom_Gilroy , I compare the tension in my hand while playing with the resting position during guitar exercises. I also focused on not supinating my left hand, and this eliminated a major part of the tension while playing. There is no fatigue in my left arm anymore after playing legato for a while. Although I still feel a slight tiredness in my hand after intense speed exercises with a focus on hand synchronization.
I played for one week only with my superstrat (D-shaped neck) and for a few days with my Les Paul (U-shaped neck. Contrary to the Les Paul, I found that the tension on the left hand was lower with the superstrat, because it felt to me that I could place my thumb more comfortably on the neck. Then, I borrowed an Ibanez 7-string from a friend, and it took me some time to get used to the wider neck. After playing for some days, I found that reaching for the lower string increased the tension in my hand and felt slightly strenuous.
Lastly, I noticed that bending introduces a significant amount of stress at the bottom of my thumb.

@Tom_Gilroy I will send you a DM now for some lessons :sweat_smile: Time to fix the rest of my left hand as well.

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