Much like athletes, injuries can also affect musicians. Wrist pain is one of the most common afflictions of the violinist, and can be triggered by any number of culprits, including repetitive motion and overuse. These injuries can put a violinist out of commission for days, and sometimes months. Just like practicing the violin, treating wrist pain and preventing future incidences requires a good amount of patience, discipline, and resolve.
A number of conditions can produce wrist pain in violinists. Carpal tunnel syndrome occurs when the wrist's median nerve comes under pressure. This can result in a tingling sensation or numbness in the fingers. Similarly, De Quervain's disease is an affliction caused by a repetitive motion condition, which can inflict pain on the side of the wrist as well as the thumb. De Quervain's can specifically inflict the violinist's bowing and fingering hands, since both are engaged in repetitive motion. Another injury caused by repetitive use is tendinitis of the wrist, which occurs when the wrist tendon becomes inflamed or irritated.
In the case of mild wrist pain associated with playing violin, the injury can be treated at home. Severe wrist pain, however, should be immediately checked by a doctor. A physical therapist may ideally conduct passive tests, probing the wrist gently, to ascertain the level of pain.
In passive wrist flexion, the violinist's elbow is held at a 90-degree angle, and the wrist is gently bent down toward the forearm. A healthy wrist should bend to a 90-degree angle in relation to the forearm without pain. In passive wrist extension, the violinist's elbow is held with one hand and the wrist is gently stretched up into extension. Any pain or limited movement is noted.
In passive ulnar deviation, the violinist's arm is held just above the wrist with one hand and the hand is grasped in a handshake position. The hand is then gently raised upward. This test determines whether pain or limited movement resides in the radial (thumb) side of the wrist. In passive radial deviation, the back of the hand is gently pressed downward to determine whether pain or limited movement resides in the ulna (small finger) side of the wrist.
Mild wrist pain or limited use can often be self-treated by several days of rest and over-the-counter medications to alleviate pain and swelling. Prolonged symptoms, however, can be met with a variety of treatments.
A combination of friction therapy, injection therapy, and exercises are effective treatments for wrist pain in violinists. Friction therapy applies just enough pressure to tender areas of the wrist before it becomes painful. The friction aims to break apart scar tissue to allow the healing process to begin.
Injection therapy is useful in loosening scar tissue as well as tightening ligaments to reestablish joint stability. Gentle exercises can be done without an assistant and are an important component to injection therapy. Exercises that utilize the full motion potential of the wrist are particularly therapeutic. Examples include waving up and down in a goodbye motion; moving the hand sideways in a hammer motion; holding the hand up at the wrist while applying pressure to the back with the other hand; and holding the hand down at the wrist while applying pressure to the front with the other hand. All exercises should not cause pain.
When it comes to avoiding wrist pain, prevention has become a regular part of the professional and amateur violinist's repertoire. The violinist should spend several minutes exercising the wrist prior to picking up the instrument. Exercises that utilize the wrist's full range of motion are helpful in warming up the wrist tendon and ligaments. Breaking for 10 minutes per each hour of practice also allows the violinist to stretch out and avoid injury.
Similarly, varying the repertoire enables the violinist to change up the types of muscles used to perform. Spending too much time on one piece that requires repetitive wrist motion can tax the tendons. For this reason, long pieces should be learned over the course of several days. Reducing practice intensity prior to a performance is also useful in avoiding wrist pain on the day of a concert.
Because a violinist uses so many different muscle groups, wrist pain can also be caused by other parts of the body. Increasingly, posture and alignment have become cornerstones of the violinist's crusade against pain. Thinking about and applying proper posture and alignment techniques to everyday movement, not just playing the violin, can greatly improve the chances of avoiding wrist pain.
The Alexander Technique, for example, is a method that works to alleviate muscle tension among the various working parts of the body. The technique emphasizes proper alignment between the head, neck, and torso. By creating mental reminders, the violinist can break bad posture habits and improve overall flexibility. By understanding gravity's harmful effects on the body's alignment, the violinist gains an edge in becoming a truly pain-free performer.
- "Massage & Bodywork" magazine; Wrist Pain: Radial and Ulnar Collateral Ligament Injuries; Ben Benjamin; February/March 2005
- "The Sacramento Bee;" Instruments of Pain; Edward Ortiz; June 28, 2009
- "Strings" magazine; Fiddling Freely; Paul Stein; May 1, 2007
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