Tendinitis in elbow. Advice greatly appreciated!

[Tom_Gilroy]

@anon25405869

I believe it all applies to guitar playing as well. The basic takeaway is that pain results from exceeding the stress threshold of what a tissue can tolerate. The remedy is not rest, medication, stretching, etc. but a continuation of activity with a reduction in intensity. You must keep moving to heal.

There’s a huge problem here.

In weight training, reduction in intensity is quantifiable. We can reduce intensity by lowering the weight, doing less reps or less sets, increasing rest time, etc.

When it comes to guitar, it’s much harder to quantify reduction in intensity, beyond simply playing less. Also, in many cases, the external load really isn’t the issue.

I didn’t suffer with tendinosis for over a year because typing was too intense an activity for my body to bear. I suffered because my poor typing form required my extensors to be constantly engaged. There was no reduction in intensity which would have solved my problem, I had to retrain the movement patterns.

I would expect that the majority of repetitive strain injuries from guitar playing are similar, and that the solution is to identify the movement patterns which are problematic and retrain them.

[Muso1981]

Agreed there is so much non science based stuff out there about tendon injury but basically modern science is poor at treating this stuff.

The Gtn patches are definitely working for me though and there have been clinical trials hinting that it does work. It’s a fairly recent thing too, unlike the old stretching, pain killers, rest, lower weights etc.

For a lot of people a steroid injection will work quite well, or just stretching and doing less activity.

At the end of the day do what works for you, everyone is different and there isn’t a one fix for all otherwise everybody would know about it.

[Tom_Gilroy]

@anon25405869

A reduction in guitar playing intensity is also quantifiable, either by time spent playing or by the speed at which you play (using a metronome, etc.).

Not in quite the same way. Sure, if we keep what specifically is being played and how it’s being played fixed, then yes, spending less time playing or playing at a lower tempo is a reduction in intensity.

However, not everything is equally strenuous to play. Some things can be played very quickly for extended duration without causing fatigue. Some things are very strenuous to play at even slow to moderate tempos.

Also, we can massively reduce intensity through form. Learning how to position our hands so that we allow our muscles the greatest possible mechanical advantage and learning to move efficiently (preventing co-contraction and unnecessary muscle activation) has an enormous impact.

@anon25405869

As to your typing injury, how do you know your typing “form” caused your injury and not the amount of typing you were doing? And how do you know that “retraining your form” when typing wasn’t simply a placebo effect that only worked in relieving your pain because you sincerely believed it would or that the retraining process itself was not a reduction in intensity that permitted your tissues to heal.

Since correcting my form I have completed similarly large typing projects without issue.

Of course the re-training of typing form was a reduction in intensity. My point was that the degree that re-training reduces intensity is not so easily measured, and that the process of reducing intensity involves first the identification of the problematic movements and the retraining of those movements.

Saying “reduce intensity” isn’t actionable advice unless we can outline how to actually achieve that.

@anon25405869

The data show that any form or technique can be employed without pain provided the user adapts to its use over time without exceeding his tolerance. In short, no form or technique is inherently more injurious than another provided adaptation occurs gradually.

The ability of the body to adapt to a wide (even shocking) variety of techniques or forms is not an implication that there are no techniques or forms which are inherently more injurious.

As an example, string hopping will inherently cause greater fatigue and carry a greater risk of repetitive strain that a true alternate picking movement using antagonistic muscles. It’s an inherently more strenuous and less efficient movement pattern.

Similarly, there are fretting actions which are inherently inefficient. There are positions which inherently cause stresses which can be completely avoided. There are limits, we cannot fight our own anatomy and win.

@anon25405869

My only point was that most of the standard recommendations for pain are not supported by any scientific evidence and can be counterproductive. Particularly, implorations to stop playing immediately and see a doctor reinforce notions of fragility that have been proven to actually impede recovery (i.e., the more you catastrophize your situation, the more likely you are to continue experiencing pain).

Just to be clear, I’m not disagreeing with this.

[Tom_Gilroy]

@anon25405869

That’s a hypothesis you’ve posited based on the reasoning that a more inefficient movement is more likely to cause injury.

An inefficient movement pattern will exceed the a tissues threshold of what a tissue can tolerate since it’s causing causing greater stress by virtue of that inefficiency.

Simply you have to work harder to achieve the same results. I’m not disputing that you can overwork on a more efficient movement pattern and cause injuries.

[bradejensen]

I would say if music or guitar isn’t your job, putting it away isn’t the end of the world. It will always be there when you heal up.

[Tom_Gilroy]

@anon25405869

People perform inefficient movement patterns or “bad form” all the time without injury. The fact that string hopping is inefficient does not make it more injurious. It just rules it out as a means of alternate picking sixteenth notes at 200 BPM.

You’re kind of missing my point here.

An inefficient movement pattern forces you to work harder to achieve the same results. If you are attempting to use an inefficient movement pattern to achieve results at the edge of it’s capability or beyond, you may overwork and experience strain.

[Tom_Gilroy]

@anon25405869

If you experience pain while playing, chances are the remedy is not to change your form but to reduce the amount of playing you’re doing.

I agree with the condition that you know your form is actually capable of what you are attempting to do with it.

If it isn’t capable, then the form is the problem and needs to be re-trained.

[Muso1981]

Just to add to this I’m an elbow picker and a string hopper, I never got any tendon injury in my right hand from playing guitar, it’s always been my left arm that gets injured because it’s doing more. Holding down the strings causes more injuries than picking, I’ve never noticed and pain from picking at all.

When I did get tendon pain in my right band it was from typing and using the mouse too much so again pressing down activities. When picking you aren’t pressing, I’m confident that it’s pressing too many times which causes the pain.

But I suppose if you have a really bad picking motion it could cause injury.

[jptk]

I am recovered now, apart from the occasional mild pain but that only happens if I’m either playing very tense or doing something in an uncomfortable way.

I don’t know what specifically helped. I did all the exercises shown to me by my physiotherapist. I kept practicing but changed my posture from playing on the right leg to the left leg, which for me is more comfortable for both hands. If I felt the pain when practicing, I’d take a break and try again later, or give it a rest for a day.

[Malmsteen109]

This happened to me for many years… it was always present. I didn’t know why. I iced the elbow, I stretched it, saw doctors, ect…
In the end… It was a nerve being pinched because of my posture while practicing hours per day.
I got a back support, and went to a chiropractor… boom
TOTALLY FINE!!!
Much luck.