pianomap: Pianists' Injuries
Movement Retraining is the Key to Recovery
By Thomas Carson Mark
3. How Injury Develops
Power to move our fingers, hands and arms comes from muscles, which are attached by tendons to the parts they move. Some tendons are quite long. For example, since the muscles that move the fingers are mostly in the back of the forearm, the tendons to the fingers extend through the wrist and hand. Tendons are like long fibrous cords. They are made of collagen, they are not very elastic and they are very strong. They slide back and forth as we move our arms and fingers; some by as much as 2 inches. To facilitate the back and forth movement, tendons may be enclosed in sheaths for part or all of their length. These are the synovial sheaths, which secrete a fluid (synovial fluid) that acts as a lubricant. Circulation of blood in the tendons is limited, which means that if a tendon becomes injured, recovery is slow.
For pianists and others who engage in repetitive motion, the tendons are the weak link in the system, the structures especially prone to stress injury. Most stress injuries of the hand, wrist, arm and shoulders involve the tendons. To be sure, muscles can also be injured, but they recover more quickly. The four causes of injury listed above are dangerous because they increase stress on the tendons. (One important pianist's injury which does not primarily affect muscles and tendons is dystonia, a neurological condition in which the brain's ability to control movement is impaired. Click here for more about dystonia.)
Tendons become injured because of repeated tensing or from rubbing on nearby ligaments and bones. Subjected to constant stress, tendons may fray or tear apart, or become thickened and bumpy. The injured area may calcify. The tendon sheath is also vulnerable; it may produce excess fluid, causing swelling. The tendon may become "locked" in the sheath and move jerkily; the sheath may become inflamed and press on the tendon. Inflammation and swelling in the restricted space of the carpal tunnel can put pressure on the median nerve, leading to the tingling and numbness of the thumb and second finger which often indicate carpal tunnel syndrome. All this starts to sound like a catalogue of medieval tortures, and for pianists who have been injured it might as well be just that. Symptoms include aching, tenderness, tingling, soreness--in short, pain. The pain can be so severe as to prevent not only piano playing, but everyday actions as well. One pianist (now fully recovered and playing beautifully) says that when suffering from acute tendinitis the mere lifting of a paperback book was excruciating.>> 4. Cure of Injury
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