Randy Ellefson is an instrumental guitarist with endorsements from Alvarez Guitars, Peavey, and Morley Pedals, and a Bachelors of Music in classical guitar, Magna Cum Laude.
His most recent album, "Some Things Are Better Left Unsaid", was independently released in July 2007. Ellefson is also known for his extensive experience with tendonitis, which once took away his playing for five years.
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Like most guitarists, I never thought I'd get tendonitis, not to mention several times. One side effect is that, since launching my music career, I've fielded hundreds of questions about it. These range from how to avoid it, diagnose it, get treatment (and from whom), do home therapy, and continue with playing - and more importantly, get on with your life.|
The goal of this article is to enable you to take your first informed steps when you suspect you're injured, but since I'm not a doctor or other medical professional, I don't give out details of treatment. You'll have to consult a medical professional for that.
What To Do Now
If you have pain, muscle tightness, or soreness now, you should stop playing guitar now until a medical professional assesses your situation. Otherwise it will just get worse. You should also avoid unnecessary arm activities like sports, lifting, or heavy computer use.
If the pain goes away after some time off, it may still return when you resume action, so see a doctor anyway. It is much easier to prevent this than to deal with it (see under "Perspective" below).
To see any professional aside from a doctor, your health insurance (such as an HMO) might require you to see a doctor first and get a referral. Without one, your insurance may refuse to pay for your treatment.
There are many medical professionals who can diagnose and treat tendonitis, but some are more effective than others. Your primary resources are doctors and physical therapists, but in either case it's important to have someone who seems competent and informed about tendonitis. If they sound hesitant, unsure, or dismissive, get a second opinion.
Doctors generally see people once or twice about an issue, not the many times often needed for something like tendonitis. It is a repetitive stress injury that needs repetitive attention to heal. A multitude of appointments is more typical of physical therapy.
Acupuncture and acupressure are secondary options of less certain benefit, and a chiropractor is not likely to help you unless existing neck trauma, for example, is exacerbating your arms.
You should first see your doctor partly because they know your general health and can ascertain whether other factors play a role in your symptoms or not. A doctor can also confirm whether it is tendonitis or something similar, such as carpal tunnel syndrome, arthritis, or trigger finger. They can also diagnose severity and which type of tendonitis it is (lateral or medial).
A doctor may prescribe anti-inflammatories stronger than the over the counter variety and provide or recommend removable arm braces. He may recommend ice, heat, or both, and advise you on how and when to do these. Doctors will sometimes want to administer a cortisone shot directly into the forearm muscles during this appointment. Personally I did not find this effective and refused a second shot weeks later because it made symptoms worse.
If the doctor says you have tendonitis, ask them to recommend a physical therapist, preferably one with experience with tendonitis. Be forewarned that some physicians do not believe physical therapy can help with anything at all and be dismissive of its value. This is often not caused by knowledge of therapy but contempt for some treatments (also including acupuncture and acupressure) popularized after the doctor's initial education. You might want to find yourself a more enlightened doctor in general, not just in regard to tendonitis.
Physical Therapists (PT)
Physical therapists are specifically trained to diagnose and treat tendonitis and muscle injuries. That said, you should see a doctor first anyway (see above). Compared to a general practitioner doctor, qualified physical therapists are specialists.
They offer various kinds of treatments done while you lay down on a massage table:
- Manual therapy - This involves the PT positioning your arm and wrist in various positions to maneuver muscles, thereby revealing to the PT's trained fingers the muscle problems needing resolution. Hard pressure via fingers releases the knots, which feel tender and sore even before this. With some practice you can learn to do this yourself, but save that for later.
- Ultrasound - Just like what they use to see a baby in the womb but without the graphics, ultrasound is used to penetrate heat deep into the arm to increase blood flow (oxygen) to the wounded muscles.
- Electric stimulation - A pair of small pads are placed on the arm with electric current passing in between and through the muscles to cause contraction. The PT continues with manual therapy during this.
- Home therapy - Since you must be an active participant in your recovery, there are many activities you must do outside of the physical therapist's office. These may include stretching exercises, forearm curl exercises, and how and when to do ice and heat (and the purpose of each). They can also advise you on anti-inflammatories, vitamins, and topical pain gels.
- Device recommendations - There are a multitude of arm bands and braces available to either immobilize your arm to aid recovery, or lessen the strain on the injury during common daily tasks. Alternate computer accessories are also available. A physical therapist can recommend which ones to get and use under what circumstances.
- Behavior modification - There are things you might be doing to unknowingly contribute to the injury, such as your position while playing an instrument or using a computer. You might even be sleeping on one of your arms at night, applying pressure to the now inflamed joint. Your physical therapist should discuss these things with you to help you avoid straining the injury.
Sometimes I hear people complain about not playing guitar a few days or weeks when their arms first hurt, so to help your perspective, here are some details on my situation. I could not play at all for an entire year, then could play really simple music for 30 minutes, twice a week. Three months later I reached 90 minutes every other day and slightly harder music. At two years I developed a second case of tendonitis in both arms and started over. After five years, I was up to 2-3 hours at once, still alternating days on and off, and could finally play most of my own music. It wasn't until 8 years passed that I could play guitar two days in a row, with one day being a "light day" of easier music, though I could get away with up to 6 hours at once, depending on complexity. It is now 10 years later, and three days in a row is still unwise.
These numbers are rough, but I received physical therapy once a week for about five years, sometimes more often, sometimes less, and slowly tapered off to nothing after about 8 years. I did stretching for 9 years, heat for 9, ice for 8, ibuprofen for 7, vitamins for 3, slept in arm bands for 3, and used a foot mouse in place of a hand mouse for 5 years, and a dictation program for most typing (especially heavy) for 8 years.
In short, tendonitis does not affect only your guitar playing, but can impact every activity you use them for, including things you take for granted like sleeping, dressing, grooming, driving a car, opening things, and even how you are perceived by others. After all, there's still contempt for the seriousness of the injury and some people will disrespect you for having it.
If your arms are already bothering you, getting treatment sooner is much better than later. With lifestyle adjustments and good treatment, it is possible to live your life pretty well, albeit differently. It just takes time and rest, and sometimes a lot of both. The impatience you exhibited in over-using your arms may now force you to learn patience the really hard way.
If you have any questions, feel free to e-mail me. Best of luck to you!
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