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Dealing with Carpal Tunnel Syndrome

Caitlin Ippolito | October 2008

    Disaster struck my life in 2002. I had been practicing a minimum of six hours a day preparing the Khachaturian and Ibert concertos and Villa-Lobos’ Assobio a Jato (The Jet-Whistle) for flute and cello, the latter for an honor’s recital. At the same time I was taking 17 hours of course work and teaching privately. With the recital a week away, I developed carpal tunnel syndrome in both my wrists making it impossible for me to play for even five minutes. After many tears at the thought of giving up the flute, I began seeking knowledge and any means of relieving the pain. Healing became a top priority.
    I had noticed warning symptoms for about two months when I shifted gears in my manual car. The movement caused a sharp pain that lasted a second and then receded. I also experienced extremely sensitive funny bones. The slightest tap the wrong way on the elbow sent stinging sensations up the forearm to my fingers, which in turn felt like the prick of pins and needles.
    I also felt fatigue and weakness in my arms that interfered with practicing. I did not take it seriously until it became impossible for me to attend piano class, and the weight of the flute grew too heavy to support. First I spoke to the professors at school, who offered various suggestions: apply alternate heat and cold for the inflammation, wear wrist braces, take an anti-inflammatory medication, and stop practicing. I also heard suggestions to use Chinese therapy balls, paraffin wax dips, stretches, and see a doctor. Other comments included: “You are way too young to be experiencing this problem” and “Your body is telling you to slow down.”
    At an appointment with an orthopedist, the nurse performed a number of quick tests for motion, strength, and loss of sensation in the fingertips; and the doctor diagnosed the problem as carpal tunnel syndrome, which is compression of the median nerve at the wrist. He explained various remedies such as physical therapy, but then advised that surgery was the only way to correct the problem.
    I decided immediately that surgery was not an option for me. It would put me out of commission for at least a year. I would not be able to play at all for six months, and then I would be limited for up to a year. The surgery also does not always correct the problem in musicians, and I did not want to go through it just to have the problem recur. The doctor recommended an anti-inflammatory and requested that I return for an electromyogram (E.M.G.) and a nerve conduction study (N.C.V.). I did not know what I was getting into. A month later I felt a little better, probably due to the medication, the braces I wore day and night, and playing little flute.

The Tests
    An E.M.G. measures the electrical impulses of muscles at rest and during contraction. For the test a doctor inserted a needle electrode into the muscles. It hurt enough that I refused to have it done to the other arm.
    An N.C.V. measures nerve conduction velocity, which determines how well individual nerves transmit electrical signals. This test, done by placing electrodes on the fingertips and arm, was not painful. Both tests confirmed that I had developed carpal tunnel syndrome. When the doctor again recommended surgery, I requested a second opinion. After the second doctor recommended the same thing, I went through the summer with no real answers and little hope.
    In November a school professor recommended a doctor, whose patients were mostly musicians. While he agreed that I had carpal tunnel syndrome, he thought physical therapy would help. I left his office with a referral and new hope.

Helpful Therapy

    My physical therapy routine in­volved a paraffin wax dip, sensory re-education, light strengthening exercises, massage, and stretches executed by a therapist while I laid on a table. The therapist stressed that the more work I did on my own, the quicker I would feel an improvement.
    I took his advice and bought a paraffin wax machine and did the stretches. The sensory re-education devices were simply containers of rice and elbow pasta; I moved each hand in and out of them, eventually searching for small buried objects, such as coins and marbles. That may sound easy, but it was extremely difficult. Without sensation in the fingertips, it is hard to feel the difference between the smoothness of a quarter and the elbow pasta.
    By the end of the physical therapy, I had regained both hope and a little feeling in my fingers. However, I still practiced little, never more than five to ten minutes at a time. I continued to wear braces for practice, and when I was caught practicing at school without them, the teachers reprimanded me.
    To participate in piano class I practiced the music without a keyboard, which allowed me to learn the fingerings and get acclimated to the piano without physically straining my hands. A pillow helped me sit higher on the piano bench and relieved much of the pain.
    My flute recital, which included performing on flute, piccolo, and Baroque flute­ – all with braces – took place as scheduled. While thoughts of giving up ran through my mind, my love and passion for music kept me going. 

A New Practice Regimen
    Using beginner-level materials, I started practicing for five minutes a day and worked up, minute by minute, to 10 minutes. After staying at 10 minutes for a week, I worked up to 15 minutes, and so on. Some days were better than others. I also kept a practice log, and the first time recorded in it is 14 minutes. It was tough to see my practice time diminish from six hours to 14 minutes, but I was on the road to regaining those longer practice sessions that I missed so much.
   I added a minute a day until it felt a little too much. Then I stayed at that practice time until I was physically comfortable. It took eight months to work up to an hour, and the practice time remained at an hour for a year and a half. I believe that this progress was largely due to the 30-40 minute daily physical therapy routine and a stretching routine that I had been doing for several years before the diagnosis.

Five Years Later
    Today I begin every morning with a  30-40 minute stretching routine, and I practice two hours – on good days perhaps three. Without surgery, I no longer suffer from carpal tunnel syndrome, although it tried to creep back during graduate school. I re­turned to physical therapy, and it worked wonders.
    The therapist stressed strengthening this time. After I reported that my neck felt as if it were bearing all the weight of the flute, we focused on my neck. Traction, which stretched the neck, and ultrasound treatments helped tremendously. The routine and care she provided helped me heal completely.
    During the first few years of this saga, I didn’t understand the initial cause of the carpal tunnel other than over-practicing. Now I realize that concurrent with the onset, I had changed my posture, completely defying a natural playing position and at the same time neglected my stretching routine. It was a big mistake. During long practice sessions, I took few breaks even though the repertoire was difficult. While it was enjoyable, there was nothing relaxed about my practice routine.
To help other flutists prevent injuries such as carpal tunnel syndrome, I offer the following suggestions:
1. Develop a stretching routine to use before practice. Musicians are athletes and should not ignore their bodies.
2. Take frequent breaks during your practice.
3. Refrain from practice when you are tired or ill.
4. Learn to practice without your instrument.
5. Make practice time enjoyable and stress free.
6. Drink eight 8-ounce servings of water every day.

    To flutists experiencing similar difficulties, I offer this bit of advice. If you love music and playing the flute, be persistent in seeking solutions to your playing problems and find the patience to work through them.