If you have a friend or spouse who plays tennis, goes bowling, or enjoys golf, you may have heard them complain about tendonitis, a common sports injury. But you’re a musician—that nagging pain in your shoulder or wrist can’t possibly be tendonitis, right?
Musicians, like athletes, should know how to treat tendonitis, so an acute case doesn’t become chronic, impacting your ability to play.
Tendonitis means inflammation of a tendon, which is the tough fiber that joins muscles to bone. Many “aches and pains” can be put down to tendonitis, which in its acute form causes swelling, redness, pain, heat, and stiffness. Acute tendonitis usually lasts two to four days. When inflammation and pain lasts longer or reoccurs, it is called chronic tendonitis.
Tendonitis can be caused by overuse of a tendon (in a pianist’s wrist, say, or a drummer’s shoulder), by abnormally stressful positioning of a tendon (a result of poor posture, for instance, or holding up an instrument for long periods), or by incomplete healing of an acutely inflamed tendon.
When overuse or poor posture stresses a tendon, it fatigues, weakens, and inflames. Now it must heal itself. New components are delivered by the blood, and the tendon begins to rebuild. This delivery process is the reason for inflammation. Once components are delivered, swelling goes down and rebuilding and strengthening begin.
The components the blood delivers are called collagen fibers. In a healthy tendon, strands of collagen align in parallel bundles, allowing the tendon to take a large force, but individual strands can break, and the more strands that fray, the weaker the tendon becomes.
A damaged tendon is especially vulnerable when healing. The body decides that a stronger tendon is called for, so as the tendon rebuilds, it adds more collagen fibers for added strength.
However, new fibers don’t properly align at first and may be positioned haphazardly rather than in parallel orientation. In order to align properly, the body dissolves some fibers and adds new ones in parallel.
During the rebuilding phase, a tendon is most vulnerable. There is no pain or inflammation during this phase, which is why chronic tendonitis can be caused by constant reinjury.
After a few days, the injured tendon feels better and a musician might return prematurely to full practice, injuring the weak tendon again. This pattern of injury, inflammation, and reinjury is the reason why an individual can have tendonitis for a long time, never seeming to get rid of it.
What should one do? In order to avoid reinjury, take a case of acute tendonitis seriously, and try the following:
1. During the inflammation stage rest the injured tendon for a few days. Pain may be alleviated with an over-the-counter analgesic. Once the signs of inflammation decrease, a musician should return, very slowly, to practice.
2. Using a healing tendon may mean just bending the joints back and forth to stretch them and maybe lightly practicing scales and other basic exercises. Watch carefully for signs of inflammation; this is the body’s warning signal that you have done too much.
3. After the first week, the tendon can be worked and used a little more each day. Stretching the affected tendon and muscle group is important as this is one way to help the process of properly aligning collagen fibers and maintaining a full range of motion.
4. Tendons do not have many blood vessels, so they heal slowly. It may take four to six weeks for a tendon to heal, rebuild, and align completely. This means that it might be four to six weeks before you can play at full strength.
5. If the tendon continues to cause trouble, seek the advice of healthcare practitioner. Your family physician might suggest you visit a physical therapist or an athletic trainer—two healthcare professionals who see many cases of tendonitis.