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This page is dedicated to people who have questions regarding their health and would like to have a chiropractic viewpoint on their condition. If you have a question that you would like answered by a Doctor of Chiropractic, then visit our referral page for the Chiropractic Performing Arts Assn. and find a doctor in your area.

Question #6

Q: I'm so glad that there is such a thing as "Musician's Doctor" because I have been trying to play some old songs by Metallica and they require massive speed picking. Whenever I try to speed pick, my hand sort of stalls on me. While I'm mentally speed picking, I'm physically not moving. Is there a secret I'm missing? After some time of attempting this, my hand begins to cramp.

A: There's a few reasons why your hand is not keeping up with your brain's messages. First, maybe you need to perform some speed drill exercises to develop the muscle fibers in your hand and forearms. I would suggest doing this on one or two strings (not trying to play anything - just pick the open strings. Start off relatively slowly and then build your speed. You'll get to a point when you begin to have trouble keeping the speed. This is the "trouble zone" and this is where you'll have to concentrate at developing the skill. Perform this exercise twice a day for at least one month. Do it for about 10 to 15 minutes only each session. We're not trying to fatigue the muscles - we're trying to build speed. You should start to see your speed increasing. The purpose of this exercise is to enhance the firing of the muscles fibers.

The next reason why you may not be able to keep up the speed is because of a pinched nerve going from the brain to your hand. Your brain is simply unable to send the complete signal down to the hand and your hand is screwing up. This problem would have to be determined by a chiropractor who can then release the pressure on the nerve via a chiropractic spinal adjustment - usually in the neck area - and your speed will then increase naturally. (a painless procedure - feels great!)

Finally, the last issue I would look at is your nutritional status. Muscle contraction is highly controlled by minerals like calcium, magnesium, and sodium. Nerve conduction is the same way, and requires a great deal of B vitamins. You may want to begin taking a multivitamin/mineral complex as an insurance policy that your body has the right nutrition to perform the work.

Good luck in your playing ability.

Question #7

Q: I'm a musician from Bolivia. I play the electric guitar. I'm 23 years old. I work on computers too. I'm actually having problems with my wrist. It`s very sensitive now. When I play I feel a little pain in my wrist, when I move it sounds like a little crack!!.

Please Help me!!!

A: This is something that needs to be looked at right away by a health practitioner to prevent further injury. I'm not sure what's available in Bolivia, but you should seek someone who is familiar with the muscles of the forearm and can perform massage techniques and spinal joint and wrist joint manipulation. The manipulation is important to restore nerve flow to the arms and hands. The wrist pain can be coming from tightened, contracted muscles in your arms. Feel your muscles by the elbow. Are they sore to the touch? How about the area just before the wrist in the forearm? Is this area sore also? I would suspect you have a great deal of muscle tension in the arm putting strain upon the wrist joints. The computer use can also strain the wrist. Make sure you are keeping your wrist in a neutral position while typing or mousing. There's some good books available on computing and repetitive injuries. Visit my web site www.musicianshealth.com and visit the "recommended books" section. It will be very important for you to become more educated about what's happening in your body. Take care of this problem now before it worsens.

Question #8

Q: The pad in my left hand suffers from barre work. I'm playing some difficult pieces from the L.Mus list and often struggle with the demands of holding on the neck for the many minutes each piece is. Is there an exercise that will strengthen my grip??

A: There are a lot of good exercises to strengthen your grip. Your hand is simply fatiguing from the prolonged tension. The first thing I would recommend is to seriously look at the amount of tension held in your hand while playing the barre chord. Is there any way of reducing the tension while at the same time producing the tone? Some other factors to check in to are these:

1. A thinner gauge string will allow less pressure to produce the tone. Consider changing your strings to allow your hand to reduce its work load.
2. Check into the diameter of the guitar neck. If you're struggling to get your hand to cover the barre chord, then the neck might be too big or bulky.
3. Take more frequent breaks while playing. For example, practice for about 20 to 30 minutes, then take a 10 minute break and stretch your hand. Some warm wet towels on the hand can increase blood flow and relax the muscles.

To get your hand stronger, get a tennis ball, or the putty-like material you can find in any drug store or sporting goods store, to help begin developing the palm muscles and forearm flexors. Don't forget the finger extensors though - they are working just as hard. Use a rubber band around your fingertips and extend them outward against the rubber band.

Begin using these tips above and let me know if it helps you.

Question #9

Q: My question is this...is it at all likely that a minor operation can fix this? I know that for some people suffering from carpal tunnel that a minor "cut" can alleviate the problems...please let it be a possibility :)

Oh, and my technique/positioning now is perfect, I warmup very slowly and for at least 20 minutes, and I take 6-800 mg of Ibuprofen before I play.

A: First, there's no such thing as a "minor" operation, especially the one for cubital tunnel syndrome. Personally, I don't think getting an operation at this point without seeking alternative healing methods is a good move on your part. I've talked to too many people who have had the nerve transposition surgery (typically that is what's done with cubital tunnel surgery) and have had little results, and some have actual worsening of their condition. I'm sure your surgeon will downplay these side-effects, but it is something that must be considered.

The fact that the problem came right back with your renewed interest in guitar playing tells me that it is the playing itself that is triggering the nerve deficits - even though you're trying to use good technique. Unless you correct the underlying problem with your playing the problem will not go away - even with surgery. I perform videotape analysis on my guitar-playing patients to help determine the underlying biomechanical cause of their CTS.

Another thing to understand is that your ulnar nerve may be getting pinched in your neck as well (called a "double crush" phenomena). This weakens the nerve and by the time is makes it through the cubital tunnel, there's simply no transmission of energy from the brain to the fingers. I like to use the analogy of a garden hose. Imagine if you put a kink in your garden hose - what happens to the flow of water. It trickles out at the end instead of working at full force. The same thing happens if there's a pinched nerve in your neck. The flow of energy only trickles out down to the arm. Then if there's another "kink" at the elbow, no flow of energy can reach the hand - thus the tingling and numbing sensations. Of course, you would have to be examined by a doctor of chiropractic to determine if these pinched nerves are present.

I would definitely recommend a chiropractic evaluation before you ever consider surgery. If you're walking around with a pinched nerve in your neck and elbow, the cubital tunnel surgery will be worthless, and most likely will make your condition worse.

Another thing - taking ibuprofen can be the worst thing you can do. Not only does it inhibit the body's inflammatory response (that's why you are taking it), but it also inhibits the body's healing response via small substances called prostoglandins. Recent studys have shown that the use of ibuprofen in low back pain prolonged recovery by four to six weeks. Taking ibuprofen is simply masking the problem, and you can actually worsen your problem by playing with the injured elbow (and/or neck). Instead of ibuprofen, begin taking essential fatty acids such as borage oil and flaxseed oil. These slow down the inflammatory response naturally, and are needed for cellular and brain function.

Question #10

Q: 1) I know you are not in a position to make a personal recommendation to a stranger over the Internet, but in your opinion, should I refrain from playing until I see the hand specialist?

A: 1)I would recommend a Doctor of Chiropractic. A chiropractor is better suited to determine the actual location of the pinched nerves - which can be occuring in the neck, elbow, or wrist, or a combination of all three. A hand surgeon will want to perform surgery - that's the way they make money. (Think about that for a minute). A chiropractor will help your body heal naturally via hands on spinal "adjustments" and extremity muscle work.

I would recommend holding off playing until you find out the underlying cause of your symptom. You see, it may be the way you are playing that's flaring up this whole condition. I always videotape musicians playing to determine structural and biomechanical causes of their illness.

Question #11

Q: I've heard that Vitamin B6 therapy over the course of a few months has shown success in alleviating the symptoms of carpal tunnel syndrome for some sufferers, have you heard of vitamin or other therapies that offer similar relief for ulnar nerve inflammation?

A: B6 is not always the answer. Again, it is determined upon what the cause is. A good B-complex vitamin is a great idea though, just as an insurance policy that you're getting the vitamins you need.

Question #12

Q: 3) If I'm seeking a physician who has experience treating guitarists, do you know of any referral network that might complement my own attempts of trying MDs out through trial and error?

A: Again, I wouldn't recommend an MD for your condition. The typical MD approach is steroid injections, splinting, physical therapy, and when that doesn't work surgery. Medicine is reactive to the complaints - not proactive at determining the underlying cause of the complaints and then allowing the body to heal naturally by removing the interferences to health.

Question #13

Q: I have been living and working in Cyprus, as a violin teacher for the last 15 years. I have a very good violin student aged about 11. He was doing very good progress as a violinist until last June, whne he begun to complain of a pain in his right forearm. the pain then went away during the summer although he continued violin lessons with me. But in September his problem worsened. He was also playing tennis, which he started last spring, so I persuaded his parents to stop that for a while. However, he still complains of that pain, even when he writes at school, although the pain is not constant. He went to a doctor, who is not a specialist, but managed to locate the pain in the inside of his right elbow joint. They run all kinds of tests on him but everything turned out to be ok, except the pain kept, and still is, reappearing. May I add that from the beggining he had the tendency to use a lot of bow when playing, something which gave him a good strong sound, although at times he exaggerated. I don`t know if that`s the reason, in fact, I don`t know what else to suggest. May I add that there are chiropractics in Cyprus, but I wouldn`t know if in his situation he eould be able to get any help. Problem is he`s got exams on the 17/11 and although he`s learned all his pieces etc. very well, lack of practice is starting to take its toll.

A: Are your school systems based on a September through June schedule like here in the States? If so, I would seriously look what is happening in this child's schooling - there may be some serious stressors (physical or emotional) there that are causing him to respond by being more prone to inflammation - a common reaction to emotional stress. I noticed you said he was better during the summer (not is school, I assume).

I'm working in my clinic with a cello player that goes through the same pattern. During this past summer, she felt great and was back to her regular practice schedule. But as soon as she went back to college, the arms became inflammed again and she could only practice 15 to 20 minutes at a time. We began addressing this issue and started her on mental relaxation exercises and stress reduction - it seems she was overextending herself and trying to do too much. Her body and mind simply couldn't handle it.

I really don't know if there are chiropractors in your area. You'll have to do a little searching on that one. I would recommend it though. You need to rule out nerve irritation as the cause of the pain - this is chiropractic's forte.

Question #14

Q: I'm 27 and in relatively good health. I work on a PC for 8 hrs a day and play guitar 5-10 hours a week. My symptoms are different from most other diagnoses I've seen thus far. My forearms get "tight", wrists are painful, and fingers often ache. Am I a candidate for RSI? Also any practical suggestions would be greatly appreciated. >>

A: You are definitely showing early signs of tissue stress. I wouldn't say you are a "candidate" for RSI (I don't like the term candidate, since it implies that it is something useful to work towards.) Your body is giving you signals. At this point in time, you have to make a decision. Are you going to ignore it and hope it goes away? Or are you going to take these signals seriously and find our why they are happening? I hope that you follow the latter question. From a chiropractic viewpoint, the tissues weaken because of dis-ease or lack of ease in the tissues. This results from an inability for the body's intellegence to correct the imbalances. The body's intellegence flows through the nervous system. Therefore, I would take a very close look at your nervous system function to determine the underlying physical cause of your symptoms. The computer work is a physical stress upon your body, and may be part of the stresses on your tissues. You may want to pick up one of the many books on ergonomics at the computer so you can reduce the stress on your body.

A chiropractor is the only doctor who can detect stresses upon the nervous system due to what is called "subluxation" of the spine - a misalignment of the spinal bones that weakens the impulses from the brain to the tissues and visa versa. I would recommend you visit one in your area to determine if subluxation is the cause of your tissue injuries. It may be the most important step you make in taking control of your health.

Your body is giving you symptoms to tell you that something is wrong. Don't ignore them.

Question #15

Q: First up, the website is inspired - a godsend in an area that seems, still, to be massively under-represented. You are evidently a very generous man. I only hope that time will see it flourish, expand, and become ever more comprehensive.

I am a pianist, living in the UK, that has been experiencing acute tendonitis for the past 2 months. Specialist help is very hard to get here (if one isn't London-based) - which is why I am writing for your advice. Any help would be recieved with utmost gratitude!

I apologise in advance for the length of this message. It is only through trying to be as thorough as possible - I am very conscious of the demands I am making on your time.

The case history goes as follows: In June of this year I began intensive piano practise. 4-5 hours a day, very few breaks, emphasis on muscle strengthening, Hanon, and so forth. Although I felt unusual pains around the elbows, I decided to press on. By September/October, the tensions seemed to be receding, and I felt my technique had massively benefitted from the experience.

In October, I began heavy full-time kitchen work, involving repetitive till work, minor lifting, washing up, cold temperatures, and very few rest periods. I was still trying to practice 3-4 hours a day! However, I must stress that my playing seemed relatively pain-free, and there was no problem until after 1-2 weeks into my new job. From then on, the pain increased, eventually to a crippling level. I worked in this pain for 3 weeks before quitting on November 4th. Total period in work was 5 weeks.

For the last month & 1 week my lifestyle has been very sedentary indeed. I have been on Ibuprofen for 3 weeks. I have had two sessions with a physiotherapist, and have been regularly massaging and stretching the elbow area. I have been bathing my elbows in the hottest possible water at least once a day. I should also mention that the weather here in the UK has been rather cold. However, the pain on resuming shop work has been extreme in both arms. When piano playing it is only my left arm that is painful: it is a general ache, stemming from fingers 3 4 & 5, and lasting up until 1-3 hours after playing.

Symptoms/observations are:

Tender flesh around the bony protrusions on both sides of both elbows Without Ibuprofen - a constant dull ache in both arms With Ibuprofen: sharp pain (one can trace the lines) during till/shop work duller (but not ache) pain when playing, mostly in left hand, mostly in weaker fingers, lasting up to 3 hours after playing No pins & needles/pain when pressing the Carpal Tunnel Pain reduced in warmer conditions Pain reduced when exercising An apparent 'switching' of the pain between arms. I mean - when playing, it is either the left or right arm that will hurt. Rarely both.

These are the questions I strongly need answers to. I have been through all regular sources of help (NHS, sports injury...) with little success.

1. How serious is my tendonitis? How much time would it take to recover?
2. I have three options available to me: Cortisone injection through NHS (FREE) 2/3 week therapy at sports injury clinic, involving massage, ultrasound, ice/heat, stretch therapy Chiropractor/alternative healing centre. What treatment do I take? I can only afford one of the last two: which would be of most use? (I understand from your website that you are strongly in favour of chiropractice, but I trust your impartiality)
3. Can I still practice through the treatment period? 4) Can I still work through the treatment period? Both important - I am a university student.

Once I again I thank you for the time you have taken to read this. It is a revelation to find a medical authority that can offer informed, and PRECISE (!!) advice on such a complex issue.

A: As a Doctor of Chiropractic, I'm always looking for the root cause of a condition, not just investigating the symptoms. There's three main reasons why the body will begin to malfunction (any organ system can be involved by the way) : Physical, Chemical, and Emotional stressors.

Quickly ramping up practicing time is an example of a physical stressor. It's like weightlifting a 10 pound dumbbell every day for a year, then immediately switching to a 40 pound dumbbell without any attempt to allow the body to adapt. This can lead to irritated tissues, strained and torn muscles, and pain. But the body does have an amazing coping mechanism, that if you continue with the long practice times, the body, if working perfectly, can recover and adapt.

Other things to consider are these: When you began your kitchen job, what was going on in your mind? Did you not like the job? Were their situations in the job that stressed you mentally? Were their chemicals you were around more? The reason I'm asking these questions is that I don't think it is a coincidence that you pain level worsened with this last job. There's definitely a connection there, again either physically, chemically, or emotionally. The physical is the easy on to figure out - chemical and emotional can be tougher. We know now through research that people who do not like their jobs, or the job environment, have a much higher incidence of pain syndromes.

Chemical stressors can be things like the cleaning solutions you were using, any consumption of diet or regular sodas, smoking, drugs, overconsumption of alcohol, etc. And let's not forget an inadequate diet.

So the question is now, what are you going to do about this. First off, the traditional medical route will invariably get you nowhere. Medicine treats symptoms, not cause. For example, you will most likely be given physical therapy just for the elbow. In my experience, these conditions involve not just the elbow, but also the entire arm, the spine, and nervous system. If you work only on the elbow, but leave out the rest, you've missed 80% of the problem. That's the inherent weakness of chasing symptoms. Drugs make your body sicker - so it couldn't heal this problem even it tried. Ibuprofen leads to kidney and liver malfunction. It also blocks healing because it inhibits secretion of substances in the body called prostaglandins. They are definitely NOT the answer.

You have to choose a health provider who will integrate a total-body knowledge that your arm pain is simply an expression of your overall health. This is what we call the "holistic" or "vitalistic" model of healing. When someone comes into my office with arm pain, that means there whole body is sick, not just the arm. The arm pain is just an extension of their dis-ease. So how do we address this? By allowing the body to regain health! Sounds pretty simple doesn't it? In essence, it truly is. When you overall health improves, your circulation improves, your immune function improves, your tissue healing capability improves, your nervous system is optimized, your innate healing mechanisms are powered up. The end result - no more pain, and feeling better than you have in years.

So where do you go for this type of healing? Here's a few helpful hints:

1. A principled Doctor of Chiropractic is essential for overall healing of your body. I'm not saying this because I am a chiropractor, but only due to the years of understanding physical healing, and the incredible power of enabling your nervous system to overcome dis-ease by taking restrictions away from nerve stresses.
2. Begin getting some nutritional support. I'm not an expert in nutrition, but here's something you may want to investigate more. Essential fatty acids, found in such things as Borage Oil, Flaxseed Oil, and Fish Oils are essential in healing and blocking inflammation. Of course vitamins and minerals, especially trace minerals are essential as well.
3. Begin an exercise program, if you have not already. Increased blood flow is essential for healing. Just walking 20 to 30 minutes a day is helpful.
4. Here's the most difficult one- begin looking for emotional and/or chemical stressors that are stressing your body. These are short circuiting your nervous system and creating dis-ease.

And just to let you know, chiropractors come in different flavors. Some are pseudo-MDs, who will take the same approach- chasing the symptoms. There are others, of which I am a member of what we call "principled, subluxation-based" chiropractors who focus on total body healing by removing nerve interference. We do not solely focus on the symptoms, but focus on the cause. I would recommend this type of chiropractor. Always talk with a chiro before consenting to a treatment program. Find out his/her philosophy of healing. Go with one that you feel right with.

One final word- you must give your body time to heal. Don't expect the pain to be gone in two chiropractic visits. I often find that it takes the body two to three months minimum, after a repetitive injury, to show signs of healing. Hopefully yours will be faster if you're including nutritional support, exercise, and stress relief. A good chiropractor will place you on a program of care of at least three times weekly for six to eight weeks. It sounds like a lot, but there's a great deal of work to do to allow your body to overcome these maladies.

Regarding the practicing and working through the healing time - this has to be taken case by case. I often recommend a musician to continue practicing, even if it is only 10 minutes at a time. You don't want to loose your touch. Just practice wisely and listen to your body. Pain is a sign that it is time to stop and rest. DO NOT PLAY THROUGH PAIN!

Working is the same. You have to listen to your innate wisdom. If you believe this working is making your body worse, then there's lots of other jobs out there that will stress your body less during this healing time. Treat your body like a king right now, and you'll make it through this.

I hope this helps you make a decision. If you don't mind, I would like to place this Q&A on my web site. Your name will be omitted of course. This may help others in your situation begin to realize that their bodies can overcome these maladies.

Question #16