Tissue Issues: Help! My student has tennis elbow!
Tennis Elbow-a mysterious and slightly perplexing name for a form of tendonitis, or an inflammation of the tissues that connect muscle to bone. Tennis elbow is also called lateral epicondylitis, because the bulk of the tendons attach at the lateral epicondyle of the humerus. (which you can see in the previous post's images of bones) The lateral epicondyle is a fancy way of saying the bony protuberance of your upper arm which makes up your elbow. (although there is also a lateral epicondyle of your femur, fyi.)
Image from yogaglo.com, created by Paul Roache MD.
While that information is all well and good, let's go deeper. The muscles and subsequent tendons that attach at the lateral epicondyle are your extensors (they extend the fingers and wrist) and the muscles of supination. If the muscles of the forearm are extremely tight, they can put more strain on the tendon, as well as non-ergonomic positions, overuse, and lack of blood flow. (This is of course in conjunction with fascial issues which may extend far beyond the site of sensation, which is a concept I will explain in the upcoming weeks.) This is perhaps a less common form of tendonitis in musicians, although I have heard of it mostly with guitarists and flutists because of extreme wrist angles while handling the instrument. Movements that will hurt include, (surprise!), extending the wrist and fingers and supinating. Unfortunately, those are crucial muscles to many instrumentalists. So what does one do?
1. Rest the area of pain and inflammation, and see a doctor for more medically specific guidance.
2. Possibly take anti-inflammatory medicine, if you are into that.
3. Ice the area, and eventually alternative ice and heat.
4. Start re-evaluating your setup or your student's setup and the "global" plan. What do I mean by that? While there may be sensation at a localized site, tension patterns usually resound throughout a fascial and muscular area, meaning that there may be issues in the tissues of the shoulder, back, biceps, hips, hamstrings, calves, etc. Ask yourself and your student these questions:
Where are other sites of tension, past injury, asymmetry, and discomfort? Are there body-reading discrepancies that you can see? Does he or she grip the bow too firmly?Does he or she enthusiastically pick up the fingers off the fingerboard or keys with excessive force?What other activities does he or she engage in? How does he or she hold a pencil, write, and use the computer/cell phone? Sometimes tendonitis is not the result of one action or one activity, but the composite of inefficient movement patterns manifesting in different areas of life.
5. If you can't assist your student, or you're at a loss of what to do with your own setup, find a teacher who has experience and knowledge of injuries and tension patterns. (stat!) Some tendonitis issues are extremely complex, and it's great to have a different perspective on setup issues, especially when resolving a long standing habit and preventing nerve entrapment. In addition think about other mind-body support methods, such as Alexander Technique, Feldenkrais, and Rolfing, to name a few.
6. Lastly, once these other avenues have been explored, start reassessing your practice time habits (or your students') and talk about practice breaks, warmups, and stretches (once inflammation has decreased.)