Help! Treatment and habits affecting nerve entrapment
Notice how the wrists are not in line with the forearms here, and there's a break in that red line at the wrist.
On Monday, we talked about nerve entrapment, and how it's often the result of inflammation surrounding the nerve, either in ligaments, tendons, muscles, etc. Entrapment can sometimes be coupled with tendonitis as well, i.e. one starts with forearm tendonitis which then begins to compress the adjacent nerve, which is obviously no good. Traditional treatment strategies include NSAID's (non-steroidal anti-inflammatory drugs) to decrease swelling in surrounding tissues, cortisone shots to reduce swelling, bracing, and sometimes surgery. But this ignores the fundamental causation of the problem- how did this arise in the first place and how will you prevent it from recurring once you have healed? If you're not injured, how can you prevent such an injury for you or your students?
In the right image, you can see that the wrist is dropping below the fingers and keyboard, which can cause and escalate wrist issues.
1. Computer/table/phone use: many of us have less than optimal alignment when using our screens. Slumped spines, head forward position, distorted wrists, elbows resting on chairs, and so on. How many hours a day are you on your devices? How much of that is frivolous and how much is that is truly necessary? Are your wrists in line with your forearms? Do you drop your wrists to type?
2. Your movement habits (or lack thereof): Injury in one part of the body can lead to all-over lack of movement, meaning you're not walking, not taking the stairs, and not getting basic movement nutrients into your diet. Sitting in chairs for 10-12 hours a day won't help this, especially if you have a plush couch that allows you to turn off all of your musculature to sit. If you do nothing else every day, walk a few miles. It's essential human movement, and a whole body practice, especially when coupled with reciprocal arm movement.
One sided carrying can create pressure in the chest/brachial plexus area, which is nerve rich and sensitive!
3. How do you carry your stuff? I've talked in the past about carrying things- cases, purses, man bags...repeating a one sided carrying habit can exaggerate asymmetries in the body, and in the case of musicians, a purse or case strap can compress an already tight tissue in the neck, chest, or if carrying bags on an elbow or wrist. Diversify your carrying habits, and notice when any pain symptoms arise.
4. How do you sleep? If you've had ulnar nerve entrapment, you may know that bending your elbows at night doesn't help your discomfort. Most of us sleep on one side, with our spine rounded, and our arms bent under our pillow. Try supporting your arms with pillows (or a person/canine/feline in your bed) so that your arms aren't constantly bent. If you know you have compression elsewhere, see if you sleep on your back with a pillow under your knees. Some therapists also recommend bracing at night to keep the arms/wrists straight in rest, which would involve wrapping the arm with a scarf, ace bandage/etc to keep the elbow straight.
Lots of really high position violin/viola playing can start to create issues in the elbow, especially if the body isn't in great alignment while doing it, because of chairs, size of instrument, etc.
5. How do you play? If you're working with a private teacher and you develop an injury, see if you have a playing-related habit that is exacerbating your issue. Take regular breaks in practicing. If you're in an ensemble rehearsal, allow your arms to hand at your sides when you're not playing. Notice if your instrument or repertoire (super high violin rep!) is creating some elbow misuse and over-twisting as you shift. Observe if your shoulders elevate as you play, which can create issues in the biceps, deltoids, coracobrachialis, and into the elbows and wrists, especially if you're a string player. If your teacher cannot help you with the issue, seek the assistance of other movement therapists- Alexander Technique, Feldenkrais, and bodymapping can be incredibly useful.
6. How often are you carrying your cellphone up to your head with your elbow bent or shoulder lifted? How often are you holding your phone in front of you, head forward, elbows bent? Do you really need to check your email that often/text people?
7. How often are you gripping things with your hands? This could be carrying cases, bags, kettlebells, pull-up bars, etc. There's nothing wrong with gripping things, as long you develop grip strength over time. Going from hours of playing to a serious pull-up/weight lifting session can cause some wrist issues, especially if the amount of work isn't added gradually. When I developed tendonitis, I wrapped my pens with an ace bandage so that I wasn't gripping my pen so tightly. (I had thumb tendonitis). This also includes eating utensils, cutting, etc!
Younger students might develop some wacky elbow habits, which should be corrected ASAP to prevent long term movement distortion!
As always, please seek medical advice if you or your student is injured, but don't be afraid to look at the whole body and other movement habits that are affecting things.