Q & A: Ask The Doctor


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This page is dedicated to people who have questions regarding their health and would like to have a holistic viewpoint on their condition. If you have a question that you would like answered by Dr. Jameson, Please email your question to DrJameson@musicianshealth.com.




Question #1

Q: I am a guitarist that has been playing for twenty years; I am 32 now. I've been playing professionally for the last 10, and and even though I don't practice as much now, we're talking many hours. Well the problem with practicing you see is that my left wrist has become somewhat of a problem. From what I know about Carpel Tunnel, it doesn't seem like I've got it. The problem then---I'm not sure. I have developed a "bump" on the top of my wrist, that is located about 1/2" inch from the bone that ordinarily sticks out along the side of the pinky. This would be just south of that bone if I were looking at my watch. It feels hard like a bone in itself, unable to be massaged away. When I play, it becomes distinct, and usually there is some dull pain, sometimes a feeling of weakness. Any ideas? I am about ready to see a doctor, but who, what, where? Thanks for your advice. >>

A: What you explain sounds like a ganglion cyst - a small protrusion of a tendon's sheath. This is a benign problem and responds to deep tissue massage techniques and other natural therapies. Medical doctors will typically excise the cyst with a "simple" surgery. (If you can call any surgical procedure simple.) Of course, you would need to be examined to determine the exact nature of the problem. Ganglions develop due to a prolonged stress on the tendon.

So my thought is this - what is making this develop in the first place? I would take a look at your playing style to see if you are stressing your hands in any way. You always have to look at the underlying stressors to determine why the problem is developing. If you don't, you'll simply run the chance of redeveloping the problem again.

As to what doctor to visit - I would recommend chiropractic care simply because of my knowledge of the body's self-healing abilities. I would recommend a hand x-ray to rule out any oddball things that could be causing this bump. I would implement massage therapy in with the chiropractic care to help the tendons heal properly. I would recommend a video-tape analysis of your playing style to determine how you are stressing your hands.

I recommend the conservative care for about four to six weeks. If it does not reduce the size of the bump over that time, than I would recommend a medical consult with a hand surgeon for more invasive procedures. But always do conservative care first before considering surgery.

I hope this helps you out. Good luck in your decision-making.

Question #2:

Q: Whenever I play for periods of time my finger starts to hurt and almost bleed. What should I do?

A: How long have you been playing? Are you a beginner or advanced player?

If you are a beginner, then your fingers will need to develop calluses (a toughening of the skin) through regular playing. I would recommend playing your instrument just to the point when you begin to notice some soreness in the fingers - then STOP. Continue again the next day again just until you feel your fingertips hurt. After a period of one to two weeks, the fingertips will begin to callus in response to the pressure (this is the body's innate response to stress on the fingertips).

If you have been playing for a long period of time and are devloping these hand symptoms, you should consider how much pressure you're placing on the strings. Use this simple test - push down on the strings at your body's strongest possible force. Register this pressure in your brain and give it a 100% rating. Now barely touch the strings with your fingers and give this a 0% rating. You should be able to produce a tone with about 30% of your maximum pressure. (This varies depending upon string gauge and action). Take a serious look at how much pressure you are using to play.

Question #3:

Q: I am writing to you for a recommendation about a problem that I am experiencing related to guitar playing. Six to ten hours after playing a 40 minute set (normally the next morning) I experience a sharp pain in the first knuckle of the ring finger of my left hand (I am right handed). In addition their is considerable swelling and stiffness which subsides with icings, anti-inflammatory drugs (aleve), and rest within two days. The pain seems the worst when their is side to side force on the finger (eg when string bending). Any ideas you have would be welcome.

A: There's a few things that can be happening here. Even though it is your finger that's hurting we have to investigate many sources for this discomfort. The stresses upon your finger joints from playing the guitar are most likely responsible for the pain, but let's look deeper into why your fingers are resonding to the irritant so severely.

First, you have to take a good look at your overall nutritional state at this time. Are you getting in your fruits and veggies every day? Are you balancing your meals to include carbohydrates (starches, breads, pastas) with proteins (meats, fish) and fats? Poor nutrition will lead you do developing joint irritation. I often recommend that people with joint pains begin taking Essential Fatty Acids, such as Borage oil and flaxseed oil daily to help their bodies regulate the inflammatory response better. Secondly, I recommend glucosamine sulfate for joint pain conditions. This is a substance found in cartilage and helps to rebuild the joint surfaces.

The second avenue I would look into is the health of your nervous system. Joint pains can result from irritated nerves from the neck. The joints receive their nerve supply mostly from the radial nerve - which stems from the lower neck. Irritation of the lower neck can result in joint pains down in the fingers! Think back to any neck injuries or previous neck complaints. A chiropractor can easily determine if this is a problem that can be initiating your finger pain.

The third thing to look at is your playing style itself. How much pressure on your putting on the strings and how much force is being put into the joints? Sometimes simply playing with less force can reduce the irritant to the joints and thus reduce the swelling and pain that follows.

All this must be taken into consideration in providing an answer to your question. Seek a Chiropractor who looks at all these factors and you should see beneficial changes within one to two months.

Question #4

Q: I am a beginning piano player and have developed pain in my arms and forearms since I began taking lessons. I am practicing about 90 minutes per day since beginning a couple of months ago. Should I just take a few days off (that is what I dread doing since I am already addicted to learning to play). Or can I just put up with the discomfort and continue to practice without causing "permanent" injury? Should I begin a weight training or exercise program to help my arms heal?

A: There's much to discuss here about your new interest in piano playing. To start off with, what is your sitting posture like while you are playing? If you are too close due to reading and learning new music, you may be exerting strain upon the neck, shoulders, and arms. How are your arms situated? You may be extending (bending back) or flexing (bending forward) your wrists too much while hitting the keys. Another important factor is making sure you have enough light to read the music so you're not straining your eyes at the same time.

It is common for these tendonitis problems to pop up when you begin a new activity that involves a great deal of repetitive motion over a relatively short period of time. Think about this - you're going 90 minutes per day of using your fingertips to hit the keys. You probably have never done an activity such as that before. It is not a surprise your body is screaming at you. Just imagine if you started hammering nails 90 minutes per day for five weeks - you'd be hurting just as bad.

If you keep at the same schedule, most likely your arms will not have a chance to heal. In fact, if you keep up your schedule without changes, you are guaranteed a more serious problem developing. I wouldn't recommend weight training just yet because you're simply going to strain the already injured muscles. You need to start off by cutting down just a bit on your training schedule - not for a long time, just maybe a two or three weeks. Do 30 - 50 minutes per day instead of 90. Most importantly though, STRETCH your hands, forearms, arms, and shoulders before, during and after playing. If you are not aware of stretching routines, there plenty of books on the topic in your local bookstore. Do not play for more than 15 - 20 minutes at a time without a stretching and relaxation break.

Drink LOTS of water - your muscles are composed of 75% water. If they are dehydrated they will strain much more easily. Drink a 10 ounce glass of water every hour, starting now! You will urinate quite often, but it's worth the recuperative powers of the hydration. During every break, drink some water.

You can speed up the healing process a bit by seeking care from a chiropractor or massage therapist who specializes in myofascial release techniques. This will reduce the adhesions developing in your tissues due to the inflammatory process and allow the muscles to heal faster.

Good luck!

Question #5

Q: Dear doctor: I have enjoyed very much your article available on the Internet. My name is Julia and I am a cellist. I have suffered from all kinds of problems in my left arm since April of 1998 and so far I have been unable to find the right help or even a hint of support from any doctor. My main problem at this moment is a result of a car "accident": I smashed my left index with a car door. Fortunately the X-rays show no sing of a bone fracture. However I still experience a very sharp pain inside of my fingertip when I try to play and some times when my index is in contact with something very hot or cold. At the same time all the area between my last joint and the tip feels sleepy, specially in the exact spot where the car hit me. Doctors have told me that there is no possible way of finding out what is wrong because of the small size of nerves and tendoms in the fingertip. I want to believe that there has to be a way of getting a diagnosis and fight this problem. I have also thought about trying accupuncture, but I don't know what technique would be good for me . I have just moved to Calgary and plan to attend The Banff Center of the Arts in October as an artist in residence. You can imagine how desperate and how lonely it feels to be here with not a clue of what to do. I would very much appreciate any suggestions from you. I hope that maybe you have dealt with similar cases in your hospital and maybe you happen to know about a professional that happens to live in Calgary or near by and who isused to dealing with musicians injuries.

Thank you very much for taking the time to read this letter and I look forward to your response.

A: I wish there was an easy answer to your dilemma, but your finger is in the middle of healing from this injury and it's going to take time for that process to be completed. When you have a crush injury, like smashing your finger in a car door, it involves damage to all of the soft tissues in the finger, including blood vessels, cells, nerves, tendons, and bone. It's going to take months for all of these tissues to heal. Playing the cello with the damaged finger is simply slowing the process of healing - you're putting continued pressure on the damaged area and stressing it more.

One of the best healing methods that can aid your body's healing ability is chiropractic care. A Chiropractor will check the functioning of your nervous system. Your nervous system is the controller of all bodily healing - it drives the healing process. If your nervous system is compromised in any way by spinal misalignments (subluxations) it will slow the healing process.

I recently worked with a man who was unable to flex his fourth finger to his palm. He wasn't sure of the reason why. By adjusting his spine, restoring nerve flow to the finger, and performing muscle and tendon massage to his hand, within five visits he could flex the finger normally again. This shows the power of a properly working nervous system.

Acupuncture may be helpful in this situation also by enhancing microcirculation in the region of the injury.

I personally do not know of any chiropractors in the Calgary area, but you may want to call around and ask them if they believe they can help you. Make sure you find a chiropractor who is subluxation-based and understands how the nervous system controls your healing mechanisms.

I wish you well and hope that your body's healing ability is optimized.

Question #6

Q:I've been a pharmacist here in San Antonio, Tx for the past 27 years. I'm also a part-time professional magician working trade shows performing with a deck of cards. I also enjoy playing fingerstyle blues guitar on my acoustic. Recently, I've had a few(not many) hand specialists & neurologists starting to prescribe prenatal vitamins to their patients with carpal tunnel syndrone. Seems like these vitamins are loaded with plenty of the B-complex vitamins and lots of folic acid(1mg). What are your thoughts on these? I've been diagnosed with CTS; however, my left ring finger & pinkie tingle but usually at night when I go to sleep. What helps a lot is sleeping with a wrist splint. I haven't noticed it much affecting my guitar playing, but I have noticed that my left hand fingers don't have the same amount of strength or touch when performing sleights with a deck of cards. Your assistance/thoughts would be gladly appreciated.

A: The only problem about vitamins for CTS is that they can't unpinch nerves. CTS results from long term nerve irritation either from the spine or from multiple areas along the nerve's path from the spine to the hand. I agree that vitamins help the body heal (if it is already deficient in vitamins) but vitamins are not the entire answer to healing from CTS. I have found with ALL cases of CTS involvement of the nerve roots at the cervical spine level. Once we begin clearing up the disturbance of nerve function to the arm and hand, healing begins to take place. This may take 6 months to a year, depending upon how long you have had the condition and how severe it is. So my advice to you would be to have a chiropractic evaluation and have some massage work done to the chest and upper extremities.

Question #7

Q: My son is 14 years old and has been playing guitar since he was 4 yrs old.  He has recently begun working on his speed and playing complicated pieces such as Guns & Roses guitar solos, putting more stress on the left hand/wrist/forearm than normal.  He is now experiencing a combination of an ache & stabbing pain in the left wrist under along the pinky side of the wrist.  The pain is after he plays, and is painful to apply any pressure on the hand.  it extends to about an inch up into the hand (pinky side) and about an inch up the forearm.  We have been soaking and he has cut down on his playing extensively over the past couple of days.  He is also extremely upset over this as he wants a career in guitar/music and this is his main focus.  What kind of treatment/therapy or rest would you recommend?  Thank you in advance for your time.  Your piece on Cubital Tunnel Syndrome was very interesting and helpful


Your son may be experiencing an overuse injury of his muscles and tendons due to the more challenging pieces he's been playing lately.  The area you're speaking about that is hurting him has many tendon attachments and muscle insertions.  These muscles and tendons work hard when performing faster moving solos, especially involving reaching with the pinky finger to higher frets. There's a few things you can do at home to try and remedy this before you seek the help of a professional:
1) You can first easily evaluate your sons muscles by putting some deep pressure starting in the hand and working your way up the forearm.  Find out which muscles are sore to the touch.  Also check the biceps and triceps in the arm, and finally, make sure to see if his shoulder and neck muscles are sore to the touch.  Many times, even though the hand may be the painful area, these problems can travel all the way up to the neck.

2) Once you've found where the sore muscles are, begin a daily massage routine of "stripping" the muscles upwards towards the heart.  You may want to do this a couple of times a day.  After that, massage across the muscle fibers as well.  This will help push the swelling out of the area and release tension in the forearm.

3) Consider giving your child fish oils - you can find these in your local health food store in capsule form.  They are antiinflammatory in nature, and tremendously beneficial to the body, and will help the healing process.  Also, if you son isn't taking general multivitamins and minerals, add those as well. DO NOT give your child antiinflammatories to remedy the pain and swelling. These will prevent healing and will simply mask the problem, making him more prone to serious injury if he plays while taking the drugs.

4) Have your son drink at least six glasses of pure, spring water per day.  (not from the tap). Muscles are about 70% water and dehydration will make him more prone to these types of injuries.

5) Avoid all soft drinks and caffeinated products. Increase green leafy vegetables and more natural whole foods to enhance his nutrition to allow his body to overcome the problem.

6) If you find that after a week of doing this there is no change in your son's condition, and especially if it seems worse, then visit a chiropractor on my referral board located on mywww.musicianshealth.com site.  Click on the Chiropractic Performing Arts Network page. If the problem persists, there may be neurological involvement that would need to be evaluated by a chiropractor who can restore the function to the nervous system and to the hand.

7) Finally, many of these problems are the result of poor posture, playing styles, technique, and other physical factors such as poor diet and nutrition.  To really prevent this in the future, you have to evaluate that overall state of your son's health and find where improvements can be made.  Make sure a good guitar instructor helps him improve technique and posture while playing.  I would refer you to another article I've written "What Makes Musicians Prone to Repetitive Injuries" that you can find at this link:  Musician's Health .  It will give you a new perspective at injury prevention.