T Nation

Tendonitis, Wrist Pain, Injuries.


Ok, so who out there has experienced or is currently experiencing wrist pain/bicep pain/shoulder pain?

ME!!!

I am pretty sure they are all linked, speaking for myself, and at this moment in time I have rather sore wrists, a shooting bicep pain, and a shoulder problem preventing me from working at full capacity in pressing/pulling movements.

To give an idea of my activity levels, I am a personal trainer of six years (www.londonpersonaltrainer.co.uk), currently training a couple of times a day in the gym for myself plus running boxing circuit classes, doing padwork with my clients, and I play the drums(www.myspace.com/kubotan) several hours per day on most days including gigging regularly. Yes, I know there is a lot of wear and tear potential, but bear in my mind I have been training for 15 years of my life, and drumming for 4.5 years, so there is a large amount of tolerance and conditioning that has been built up.
No-one is indestructible though eh?

The various pieces of advice I have had from various sources - some officially qualified and some well experienced -come down to the following:

  1. Rotator cuff could be weak - try doing abducting/adducting cable rotator cuff exercises.

  2. Core stability could be weak - try improving on that aspect.

  3. Use gloves more often, if not always, as constant grinding/gripping with your hands on metal bars can damage nerve endings in your hands & fingers and lead to wrist inflammation.

  4. Stretch your back over a Swiss ball to help open the thoracic section of your spine.

  5. See an osteopath, get your back cracked, pay lots of money to them.

The latest thing I have seen which may or may not help are wrist supports and gloves from the following company, but to me these look not much different from the normal wrist supports and gloves available. Anyone used these?


So my strategy is to continue doing the parts in points 1-5 and also experiment by wearing wrist supports I already have for a few days non stop whilst giving the drums a rest and using gloves from now on.

Thoughts?
Ideas?
Suggestions?
Insults?

I will give you quick answers. Please forgive me if I am too blunt. I think you have to get this fixed asap before it really interferes with your quality of life.

I can say with 95% certainty you have a nerve impingement from your symptoms. You need to go to a professional today to get this checked out. Only hands on diagnosis will lead you to the correct treatment.

[quote]drummer wrote:
currently training a couple of times a day in the gym for myself plus running boxing circuit classes, doing padwork with my clients, and I play the drums(www.myspace.com/kubotan) several hours per day on most days including gigging regularly. [/quote]

Very good chance it is the drumming as it’s what you do the most frequently. Try stopping for 2 wks to see if your symptoms lessen in severity.

[quote]drummer wrote:

  1. Rotator cuff could be weak - try doing abducting/adducting cable rotator cuff exercises.

[/quote] If the problem is here, you would likely feel it mainly in your shoulder. Is there where the symptoms first started? Are you doing strengthening exercises for external rotation? Is there a difference between arms in strength? If so, this could be it, or an aspect of your injury that you can work on easily in the gym. Google for rotator cuff exercises for some ideas.

[quote]drummer wrote:
2. Core stability could be weak - try improving on that aspect. [/quote]
Crap. What do your shoulder, arm and wrist have to do with your core? At the least this is an unhelpful comment as it’s so broad. What aspect of core stability is weak? What do you work on? I don’t think there’s a direct relation, though poor posture can predispose you to certain problems.

[quote]drummer wrote:

  1. Use gloves more often, if not always, as constant grinding/gripping with your hands on metal bars can damage nerve endings in your hands & fingers and lead to wrist inflammation. [/quote]
    Complete crap (no offence). Who on earth thinks this is likely??? I hope this did not come from a fitness professional as it’s pure garbage.

[quote]drummer wrote:
4. Stretch your back over a Swiss ball to help open the thoracic section of your spine. [/quote] That might feel nice but I don’t think it will help your shoulder, arms and wrist problem unless they are directly related to your posture and you are stoop shouldered.

[quote]drummer wrote:
5. See an osteopath, get your back cracked, pay lots of money to them.
[/quote] This is the smartest suggestion. A word of warning however, osteopaths love to cut you so I would see a physiotherapist etc first. I severely doubt a chiropractor can help you, but there are some excellent ones out there who would be great to have on your team. If you’re worried about money, get some health insurance that covers these kind of therapies, suffer through the waiting period and then go. Not ideal but will save you cash.

[quote]drummer wrote:
The latest thing I have seen which may or may not help are wrist supports and gloves from the following company, but to me these look not much different from the normal wrist supports and gloves available. Anyone used these?
[/quote] You’ll never know until you try. What do you have to lose?

Good luck with this. If I were you, the first thing I’d do is the classic RICE (rest, ice, compression, elevation) with massage and very regular stretching. Also I’d eliminate possible causes one by one, starting with drumming as that’s what you do the most. I’d do it one at a time so I’d know which it was as opposed to dropping everything.

As far as weight training goes, I wouldn’t presume to advise except to stop using barbells for any exercise and to review your previous training to see if there are any imbalances (more pushing Vs pushing etc)

As a fitness professional, you have to be in good shape and it will enhance your skills if you know how to find help in case of injury. So you can call this on the job learning. And it may even be tax deductable as it’s business related. Use this as an opportunity to increase your skills. I would see a physiotherapist and pick their brain. Maybe mention to them that you could steer clients to them if they give you free treatment or a reduced fee?

Good luck with it.

Some questions…

Where did you first notice the pain when it started (i.e. the shoulders? biceps? wrists?)

Any numbness or tingling present?

Can you identify the exact areas that hurt (i.e. anterior delts, arm pit area, volar or dorsal side of wrist, etc).

Any scapular pain?

I agree with everything Sxio said so I’m not going to repeat any of it. However, I would like to expound a bit on what he said about the drumming being the culprit. I’ve been playing for close to 15 years (classically trained, Berklee college of music for a while, etc…). It could very well be a combination of your posture and playing style. There are thousands of little things that could affect you but I’ll bet it’s one or a combination of the following:

  1. Poor playing posture: Playing a drum kit tends to destroy posture. Most players have their snare and hi-hat too low and have a tendancy to hunch over while laying down a groove. Add into that the fact that your feet aren’t planted firmly on the ground and it’s really easy to sort of slump over like a fat man after Christmas dinner. Try raising your snare and hi-hat a bit and/or lowering your throne a little (even better is to get one with a low back rest to it.) Not saying this is causing your wrist pain, but it could be causing bad posture in general and creating a situation which caused some sort of problem (like nerve impingement).

  2. Bad wrists: This would be my guess as to the cause, or at least a contributing factor, of your problem. Many (read most, if not all) drummers, especially self taught, play match grip and thumbs up. Go ahead, sit back and air drum for a second. Look down at your hands, are you looking at the backs of your hands or the thumbs. If you answered the latter you may want to fix that. It’s hard, really hard, especially if you’ve been playing for a while and are used to the thumbs up way of doing things. You’ll feel weird for a while, you’ll lose speed, power, accuracy, and stick control. Your bandmates will yell at you and complain that you’re timing is off or you fucked something up. Blah, blah, blah, it get’s better.

Think for a second about how your wrist bends, where’s the biggest range of motion, side to side, or up and down? When you play with your hands turned sideways (thumbs up) you tend you use a lot more elbow and forearm to make up for that lack of ROM. This basically ends up treating your hand like the end of a whip. This puts a lot of pounding pressure on the cartilage in the wrist (TFCC maybe? my anatomy knowledge isn’t what it should be). I’ve also heard people say this can cause carpal tunnel syndrome and other problems (not sure of this, it was just drilled into my head repeatedly when I was learning to play palms down).

When you turn your hands over so you’re playing palms down you can use a lot more of the wrist’s intended range of motion and after you get used to it will probably find you have better stick control, speed, etc…

I’d reccomend taking a little time off playing the kit, grab a practice pad and work on fundamentals with your palms down for a week or two. This should help get you used to the feeling of playing palms down and the pad is a lot less pounding pressure than playing a kit (plus it involves a constant angle so your wrists aren’t turning over constantly). When you go back to the kit maybe try some light wrist wraps or tape (nothing too tight, just enough to provide a little support).

Wow, that turned out a lot longer than I expected. Anyway, just a few thoughts, if you have any questions or neither of those ideas seem to apply to you, PM me and I’ll see what else I can come up with.

Peace,
Jay

p.s. I checked out the songs on your myspace page, nice work, I like the sound, especially the metal song. Mix could use a little work but the songs sound great otherwise. Keep up the good work

My sister had the exact same problem, she drums regularly and suffers debilitating wrist bicep and shoulder pain. Doctors where at odds as to what was casuing it could have been nervous impingement due to broken clavicle, nervous impingement in the neck, RSI, tendonitis, epicondalytis, abnormal movement of the carpal bones. Even an MRI did’nt help

After i a few quick tests, i saw essentially she had that classic neanderthal posture, rounded back strong chest and shoulders, could’nt retract her shoulder blades properly, poor firing pattern in various muscle groups across her back. After getting her to focus on rebuilding her back, her pain went away totally, ive worked with a few drummers since complaining of the same issue and ive found it derives from weakness/imbalances in the upper back.

As the poster said before posture plays a huge role, you dont have to be Eric Cressey to realise that, alot of drummers slouch over heavily.

The other idea obviously is to look back across your training logs and look for any creeping imbalances that could lead to such problems.

Hope this helps

[quote]Sxio wrote:
I will give you quick answers. Please forgive me if I am too blunt. I think you have to get this fixed asap before it really interferes with your quality of life.

I can say with 95% certainty you have a nerve impingement from your symptoms. You need to go to a professional today to get this checked out. Only hands on diagnosis will lead you to the correct treatment.

Very good chance it is the drumming as it’s what you do the most frequently. Try stopping for 2 wks to see if your symptoms lessen in severity.

drummer wrote:

  1. Rotator cuff could be weak - try doing abducting/adducting cable rotator cuff exercises.

If the problem is here, you would likely feel it mainly in your shoulder. Is there where the symptoms first started? Are you doing strengthening exercises for external rotation? Is there a difference between arms in strength? If so, this could be it, or an aspect of your injury that you can work on easily in the gym. Google for rotator cuff exercises for some ideas.

drummer wrote:
2. Core stability could be weak - try improving on that aspect.
Crap. What do your shoulder, arm and wrist have to do with your core? At the least this is an unhelpful comment as it’s so broad. What aspect of core stability is weak? What do you work on? I don’t think there’s a direct relation, though poor posture can predispose you to certain problems.

drummer wrote:

  1. Use gloves more often, if not always, as constant grinding/gripping with your hands on metal bars can damage nerve endings in your hands & fingers and lead to wrist inflammation.
    Complete crap (no offence). Who on earth thinks this is likely??? I hope this did not come from a fitness professional as it’s pure garbage.

drummer wrote:
4. Stretch your back over a Swiss ball to help open the thoracic section of your spine. That might feel nice but I don’t think it will help your shoulder, arms and wrist problem unless they are directly related to your posture and you are stoop shouldered.

drummer wrote:
5. See an osteopath, get your back cracked, pay lots of money to them.
This is the smartest suggestion. A word of warning however, osteopaths love to cut you so I would see a physiotherapist etc first. I severely doubt a chiropractor can help you, but there are some excellent ones out there who would be great to have on your team. If you’re worried about money, get some health insurance that covers these kind of therapies, suffer through the waiting period and then go. Not ideal but will save you cash.

drummer wrote:
The latest thing I have seen which may or may not help are wrist supports and gloves from the following company, but to me these look not much different from the normal wrist supports and gloves available. Anyone used these?
You’ll never know until you try. What do you have to lose?

Good luck with this. If I were you, the first thing I’d do is the classic RICE (rest, ice, compression, elevation) with massage and very regular stretching. Also I’d eliminate possible causes one by one, starting with drumming as that’s what you do the most. I’d do it one at a time so I’d know which it was as opposed to dropping everything.

As far as weight training goes, I wouldn’t presume to advise except to stop using barbells for any exercise and to review your previous training to see if there are any imbalances (more pushing Vs pushing etc)

As a fitness professional, you have to be in good shape and it will enhance your skills if you know how to find help in case of injury. So you can call this on the job learning. And it may even be tax deductable as it’s business related. Use this as an opportunity to increase your skills. I would see a physiotherapist and pick their brain. Maybe mention to them that you could steer clients to them if they give you free treatment or a reduced fee?

Good luck with it. [/quote]

Sxio - thanks for your comments. They are well received, and I didn’t find them blunt in the slightest.

I have booked up with an osteo as over the years I have seen many physios that haven’t been able to help. I’ve had the wraps on the last couple of days and not picked up my sticks in three days (something VERY difficult to do when you are in love with your instrument and music). Some of the pain seems to have subsided so it is highly likely the drumming is the main issue.

The symptoms had originally started in my shoulder, spreading to my bicep and then wrist more recently, so I think it’s a whole chain effect as well as a direct effect from the drumming. Hopefully this osteo can shed some light. I have found though, I don’t really have massive imbalances in strength as I can normally push through the pain. Or at least until recently I could.

I agree with all your comments and suggestions and in a couple of weeks will post up a small update on how things are going so you can see the results of which bits worked out best.

Take care for now mate!

[quote]Ronrat7 wrote:
Some questions…

Where did you first notice the pain when it started (i.e. the shoulders? biceps? wrists?)

Any numbness or tingling present?

Can you identify the exact areas that hurt (i.e. anterior delts, arm pit area, volar or dorsal side of wrist, etc).

Any scapular pain?

[/quote]

The order of pain has gone :

Previous rib attachment/upper back injury TO
Shoulder pain in the rotator cuff area TO
Bicep pain near the elbow TO
wrist pian on the side nearest the small finger.

Can’t say I have noticed tingling or numbness, but the shoulder pain always increases from anything press related, or from working a punchbag, or even holding focus pads for someone to box.

No scapular pain, and no real inflexibility issues - I had those all tested by a physio.

Anything else you feel you can add to what anyone else may have said?

Thanks!

Sheraz

[quote]m0dd3r wrote:
I agree with everything Sxio said so I’m not going to repeat any of it. However, I would like to expound a bit on what he said about the drumming being the culprit. I’ve been playing for close to 15 years (classically trained, Berklee college of music for a while, etc…). It could very well be a combination of your posture and playing style. There are thousands of little things that could affect you but I’ll bet it’s one or a combination of the following:

  1. Poor playing posture: Playing a drum kit tends to destroy posture. Most players have their snare and hi-hat too low and have a tendancy to hunch over while laying down a groove. Add into that the fact that your feet aren’t planted firmly on the ground and it’s really easy to sort of slump over like a fat man after Christmas dinner. Try raising your snare and hi-hat a bit and/or lowering your throne a little (even better is to get one with a low back rest to it.) Not saying this is causing your wrist pain, but it could be causing bad posture in general and creating a situation which caused some sort of problem (like nerve impingement).

  2. Bad wrists: This would be my guess as to the cause, or at least a contributing factor, of your problem. Many (read most, if not all) drummers, especially self taught, play match grip and thumbs up. Go ahead, sit back and air drum for a second. Look down at your hands, are you looking at the backs of your hands or the thumbs. If you answered the latter you may want to fix that. It’s hard, really hard, especially if you’ve been playing for a while and are used to the thumbs up way of doing things. You’ll feel weird for a while, you’ll lose speed, power, accuracy, and stick control. Your bandmates will yell at you and complain that you’re timing is off or you fucked something up. Blah, blah, blah, it get’s better.

Think for a second about how your wrist bends, where’s the biggest range of motion, side to side, or up and down? When you play with your hands turned sideways (thumbs up) you tend you use a lot more elbow and forearm to make up for that lack of ROM. This basically ends up treating your hand like the end of a whip. This puts a lot of pounding pressure on the cartilage in the wrist (TFCC maybe? my anatomy knowledge isn’t what it should be). I’ve also heard people say this can cause carpal tunnel syndrome and other problems (not sure of this, it was just drilled into my head repeatedly when I was learning to play palms down).

When you turn your hands over so you’re playing palms down you can use a lot more of the wrist’s intended range of motion and after you get used to it will probably find you have better stick control, speed, etc…

I’d reccomend taking a little time off playing the kit, grab a practice pad and work on fundamentals with your palms down for a week or two. This should help get you used to the feeling of playing palms down and the pad is a lot less pounding pressure than playing a kit (plus it involves a constant angle so your wrists aren’t turning over constantly). When you go back to the kit maybe try some light wrist wraps or tape (nothing too tight, just enough to provide a little support).

Wow, that turned out a lot longer than I expected. Anyway, just a few thoughts, if you have any questions or neither of those ideas seem to apply to you, PM me and I’ll see what else I can come up with.

Peace,
Jay

p.s. I checked out the songs on your myspace page, nice work, I like the sound, especially the metal song. Mix could use a little work but the songs sound great otherwise. Keep up the good work[/quote]

Firstly, thanks for your comments on our music - that was real generous of you to say so. The mix was done by ourselves, and in about four months we plan on re-recording and paying a professional to mix it up so it should all sound much better!

Back to the issue though.

All the points you mentioned regarding posture, snare/hat height, palm down and wrist movement, are all things I have definitely been addressing with my current teacher. The whole relaxing/posture issue has been something that I have been pretty strict on from day one, but it’s excellent you highlighted those for me - thanks very much. I think your point on taking time out was the most important one, and I think that’s the most relevant. Also, one thing I didn’t mention was recently I switched to some very heavy Vic Firth “corpsmaster” sticks for practicing with so when I went back to my normal sticks they would feel lighter. I think this also could be an overuse issue so I’ll be cutting back a bit there too.

All on all it looks like the whole resting common sense approach is going to work best in conjuntion with a specialist to help rehabilitate.

Once again Jay, thanks for your comments and please do PM me with any music stuff you wanna share!

[quote]Wayland wrote:
My sister had the exact same problem, she drums regularly and suffers debilitating wrist bicep and shoulder pain. Doctors where at odds as to what was casuing it could have been nervous impingement due to broken clavicle, nervous impingement in the neck, RSI, tendonitis, epicondalytis, abnormal movement of the carpal bones. Even an MRI did’nt help

After i a few quick tests, i saw essentially she had that classic neanderthal posture, rounded back strong chest and shoulders, could’nt retract her shoulder blades properly, poor firing pattern in various muscle groups across her back. After getting her to focus on rebuilding her back, her pain went away totally, ive worked with a few drummers since complaining of the same issue and ive found it derives from weakness/imbalances in the upper back.

As the poster said before posture plays a huge role, you dont have to be Eric Cressey to realise that, alot of drummers slouch over heavily.

The other idea obviously is to look back across your training logs and look for any creeping imbalances that could lead to such problems.

Hope this helps [/quote]

Some good points brought up there my man, so thanks a bunch. I’ll be paying attention to the whole back posture issue, and even though I feel my posture is generally pretty good I’ll definitely be cross checking with my tutor to iron out any contributing problems.

Thanks again mate!

Sheraz

Hey drummer,
I play drums also and even though I don’t have the pain you do, some of the problems that you mentioned can be caused by drumming. Seat height and posture is important to prevent strain and I guess the type of music can do it too. I play extreme metal and do a lot of repetitive blasts and things like that so that can take a toll on the wrists.
P.S. I’ll check out your band