A Guitarists Experience Of Ulnar Nerve Entrapment/Cubital Tunnel syndrome
First things first, what is this injury? Well, you know the funny bone? It turns out that it is not so humorous after all. In fact it isn’t even a bone; it is a nerve that runs between the bones of the elbow joint (inner/medial side). Sometimes the ulnar nerve becomes trapped between these bones, it travels through the Cubital tunnel at the elbow and can become trapped at various locations within it. It can also become trapped by soft tissue damage either side of the elbow. In the UK we call it Ulnar Nerve Entrapment and in the USA it is called Cubital Tunnel Syndrome.
This blog is mainly for other musicians who are experiencing RSI injuries and want to know more about it. If you are like me you are probably spending many hours trawling the internet in the hope that you might find some answers.
At this point it is worth mentioning that this injury can be really bad and there are no quick fixes. I am finally better but it took 2 years and a lot of patience and if I am honest a lot of pain, depression and soul searching. Did I mention it took 2 years? Yes, good I may well say that again a few times. It takes some people a long time but the chances are you will get better without surgery.
For a musician, RSI type injuries are particularly bad news. If you are a professional musician there are practical issues such as loss of earnings, letting your colleagues down, not being able to do the gigs in your diary, can you still teach your instrument etc. Worth mentioning that I managed to get £2000.00 from HELP Musicians (formerly the Musicians Benevolent Fund) for my loss of earnings and they also provided access to professional medical advice. All musicians will feel a sense of loss from not being able to play their instrument. For me it was particularly hard to step back from music (but you must step back if you are in pain) Music is an outlet for my emotions, nothing else compares to music in this regard. This is compounded if you are feeling depressed because of the injury, sort of a catch 22 really. I could go on but the drift is this; RSI for the musician is a life changing event and one whereby it is hard to remain positive. For me and for a lot of others the only way to remain positive is to invest time (and money) into finding a solution to your injury.
Here is list of things/treatments that I tried:
There are probably more things I could add to that list but the truth is I am not sure how many of these treatments helped me. These are the ones which helped the most: Physiotherapy, Alexander technique, rest, sleeping with the arm straight, general health/ fitness and Yoga.
Did I mention that it took 2 years for me to get better? Over the 2 years, as well as trying all of the above, I came close to having surgery. Very close, 3 times. The 1st time (at about 12 months into the injury) I cancelled it because I wanted to give it a few more months to try and heal naturally; I was very worried about the possible outcomes of surgery. The 2nd time the surgery was cancelled the day before the operation was due to take place. It was cancelled by the hospital because there were issues with some of the equipment. This was a godsend really because I was ready to do it at that point. I then decided to give it another few months to try and heal naturally. In between the 2nd time and the provisional date for the 3rd attempt at surgery, I met a physiotherapist who had a masters degree in musicians injuries. I am so glad I did. She gave me lots of good exercises and ideas about posture, as you would expect. This wasn’t the best thing about meeting Dominique. No, the best thing was this; the moment I walked into her treatment room before she had even said hello she said “you don’t need surgery”. I was pretty dumbfounded, I was ready to have the operation and I felt I had tried everything else. I explained this to her and also that I really agreed with her stance but felt as if I had no options left. She backed this up with scientific studies of other musicians with similar injuries. All of whom got better eventually. She managed to talk me out of having surgery.
It took another 6 months and a leap of faith but it finally happened, I got better. There is still an element of moderation. I have a light touch now when fretting notes, If I have been teaching guitar for several hours I don’t come home and practice for several more hours straight away. No, I have a break and then do some practice. I listen to my body far more, if I notice any twinges I back off until I feel ok physically, and then I practice. If I have a gig that night I don’t practice all day, I save it for the gig and do the necessary practice on the days leading up to the gig. I think about my posture a lot, I do Alexander Technique, allow my body to recover. I keep fit and do Yoga and I don’t eat loads of junk food.
So my advice is this; wait and see, it may take ages but there is more than a good chance that you will recover if you give your body the necessary amount of time to heal. Nerves take ages to heal.
10/5/2015 08:54:56 am
Great article and advice! I saw a link for this through Mike Outram on Facebook. I too went through RSI in my early 20's and tried most of the treatments above. It took me about 2 years to recover. My situation was caused by tension, bad technique, drinking heavily every night and practising the next day for hours while hung over and bad posture. Just outside of Toronto (I am now based in the UK) there is the Musician's Clinic which was covered by the Ontario health plan. They were a tremendous help but what really helped me was tai chi. I was lucky enough to have some technique lessons with one of Canada's top studio guitarists. He taught me to relax when playing, breathe through the really difficult music parts and to play with hardly any pressure when fretting notes. At that time (late 80's) I think there was still a lot of scepticism about performance medicine. I needed a referral to the Musician's Clinic and my GP at first refused to give me one and told me to give up playing. He eventually did give me a referral.. Hopefully these attitudes are rare today. Glad to see you're playing!
I also heard about this blog through Mike. It's awesome to hear and read your stuff Jesse - particularly regarding this sort of difficulty.
10/5/2015 01:15:17 pm
Thanks Jack. If just one musician gets some valuable information about their RSI from this blog I will have achieved my aim. It's such a horrible thing to go through and there is a minefield of information/misinformation out there. Tai Chi sounds ideal too, might try out some lessons.
10/5/2015 01:20:39 pm
Thanks Adam. Great advice here about tension and breathing. On the money about the booze too. I still drink a bit but more moderately than I used to. I can remember when my injury was at its worst alcohol would make it much more painful. Probably because of the dehydration and I think it also causes more inflammation.
10/5/2015 09:47:46 pm
I was reading your blog, and it provided a really great overview of treatment options. When many of these conservative measures fail, I've referred my patients to this site for a brace to help their symptoms: www.thelonniebrace.com.
10/5/2015 10:44:17 pm
I had the same problem for 2 years. The only thing that helped was 'Mindbody prescription" by Dr Sarno. Anyone having RSI needs to read that book.
10/6/2015 12:02:54 am
I have read it and It's an interesting book, not for everyone I would think. If you have an open mind it's worth a look especially if you have a chronic injury that should have healed but hasn't.
10/8/2019 06:41:41 pm
Hi Jesse, I was reading the blog part of your site about your experience with ulnar nerve entrapment. I am experiencing a similar issue in many respects and was wondering if you recall having 'a nerve conduction test around that time?' Hope you are keeping well with my best to you. May
10/8/2019 11:10:22 pm
10/9/2019 08:05:32 pm
Jesse, thank you for replying. I totally agree, it really is a horrible injury isn't it. Your writing about your own experience is in so many way like seeing my own thoughts reflected in written form - the physical and the emotional. It’s really good to know that you are continuing to feel better.
3/26/2020 04:45:49 am
3/26/2020 08:39:05 am
Hi Francis, The physio was called Dominique Royal, she’s based in Penzance, I highly recommend you see her. You won’t find many physios with a masters in musicians injuries. Good luck, you will get through this with patience and time.
5/19/2020 09:55:44 pm
Hi again Jesse
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Jesse Molins, guitarist, performer, composer and teacher