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Author Topic: "Golfer's" or "Melodeon Player's" Elbow  (Read 11236 times)

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Chris Ryall

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #40 on: June 28, 2011, 07:41:33 PM »

Yup. Given that there are about 500k deaths per year *in total* in England and Wales, this must be off by at least a couple of orders of magnitude. A quick Google suggests that the correct figure for the UK is 2,500. Still worth bearing in mind.

Might be about right - but a lot are 'aged and infirm' and it is frankly  difficult to ascribe cause of death to any one factor.  But Ibuprofen does have side effects - particularly internal bleeding. My good friend Dr xxxx was Boots chief medical officer - put her own rheumatic mother on the stuff only to see the lovely old lady hospitalised with a bleeding gastric ulcer  :-\

When my own left elbow flared (see above) our Dean of Medicine put me on the Voltarol gel - much stronger and it worked where Brufen hadn't.  It's one of the the 'rub on affected joint' creams -  which seems to achieve the magic of good effect and low side effect.

Once that inflammation dies down - do exercise gently  to build up some muscle again. That's actually your best protection. I did weights for a month before my Mory came from Italy.  "doc 3-row"
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Nick Hudis

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #41 on: June 28, 2011, 08:11:36 PM »

Chris, fair point about the stats  (:)

Quote
Once that inflammation dies down - do exercise gently  to build up some muscle again. That's actually your best protection. I did weights for a month before my Mory came from Italy. 

That is a really important point.  I'd be a lot less easy with my Loffet 18 bass (5.5K) if I didn't hurl kettlebells around regularly.  There are specific strength exercises that can rehab tendonitis: google "eccentric exercise" for more info.
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Thrupenny Bit

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #42 on: June 28, 2011, 09:08:48 PM »

Nick's final comment about breathing rings true too.
About a month ago I took the melodeon up to a local pub 'folk night' for the first time, and was sitting on my own in the corner quietly playing.
Some people came in and sat near me on a table. I felt myself tense so much I couldn't play.....then I realised  I was actually holding my breath  :|bl
Conscious efforts to relax got me over it, but it was interesting to see how I reacted to a situation where I wasn't confident with my instrument.....
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Kautilya

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #43 on: June 28, 2011, 10:18:54 PM »

Chris, fair point about the stats  (:)

Quote
I did weights for a month before my Mory came from Italy.  

Well the pudding stirring certainly brought out some new wrist and  elbow aches and pains. What's this Mory coming from Italy - I thought he was a player...or is he on Cnet? Or is there something we ought not to know? ::) ::)

I mis-li-ed you before; on recalculation, that RSI litigation was not 30 years ago-- it was 40... after I did some fingering on my abacus  -- I have brain dexmathskickslya.

On Ibuprofen: I must say the side effects being mentioned sound more like those of someone addicted to taking a few  (and the 400mg not the 200mg) every time they have a cuppa tea, rather than occasional use which might help here (see Hyppo-critical oath reference below).

I think Alison has her hand more on the pulse for the dead body count; but does anyone honestly admit to deliberately keeping a note of how many times they have corpsed when soloing at a session?

Mind you,reference Hook,  if you have two hooks, a la Edward Scissorhands you wont be getting fingering issues anyway and you are probably a great triller  or even a sixiller.

Of course all this comes with the usual caveat: to consult your GP (as you should always do especially when you can get an appointment...so we keep Melodeonhealthservices Inc. off the hook. And help the pharmacos keep struggling to earn a few bob.)

On a lighter note, for non-Ibuprofen fanciers, the external application of Arnica oil produces for most an immediate reduction in joint/muscular pain. Our butane camping gas derivative for paranoiac melodeon/player/sniffers ( that is how Ibuprofen got its technical name of C 13 H 18 O 2) 2-(4-isobutylphenyl)propanoic) came in around 1969 or 1974 (choose your country).

In contrast  Arnica only has a couple of thousand years of proven use behind it as an anti-inflammatory. It don’t make the same money as a registered chemical formula job of course as it is pushing up all over the place. You could probably make it yourself with a small  attachment to you bellows to squeeze out the active compound and you could charge in pints or  50p a squirt at sessions. Same for feverfew for melodeon migraine headaches - also all over the place but don't chew the leaves direct as they cause tongue ulcers (see Chelsea Physick  Garden migraine study around 1980s).

That chain H&B (not the whiskey) has Arnica (they say balm but it's oil, see later)  but it aint cheap and mixed pricing at the main UK manufacturer,  near Buxton-ish. Cheaper in Germany and Eastern Europe, Balkans for your big stage tours.

Great thing is the oil (some wrongly call it balsam which in my apothecary-manual , from Richard Wilson, is ointment) is very slippy and goes a long way and a little bottle lasts for ages (like six months a year....)
In fact, my wee bottle (a Shot-tisch of Arnica!)helped my tented neighbour's back at ECMW t'other day...

(Actually,much against my wont as they aint paying commission I see that H&B have an offer on which is cheaper than the manufacturer so in the interests of fair playing, ere u go: Oh gawd, in fact I now "see" one is double size of the other so maybe there aint no difference - just much cheaper abroad....

http://www.weleda.co.uk/aches-+amp-pains/massage-balm-with-arnica-100ml/invt/204001/

http://www.hollandandbarrett.com/pages/product_detail.asp?pid=1453&afid=70&safid=msn&scid=13444&cm_mmc=MSN-_-Nelsons-_-PS%20-%20Weleda%20Massage%20Balm%20with%20Arnica%20-%20MTB-_-weleda


But back to that hook.  Though this may not be the case for most of us (check your session neighbour) we do not use our hands as  claws. That is usually reserved for animals higher up the chain.

Most  mice require an unnatural (non-humanoid) claw action/hold.  Hence inflammation through unnatural repetive movements of the relevant sinews and muscles and joints when moving most mice around; or flat keyboards (computer) often compounded by nodding donkey syndrome (keyboard out of sight under the screen table and not your eyes in as near as possible alignment with the computer screen -- producing "Head up head down head up head down").

You solve the latter either with bifocals with a reading distance set, not for books on your lap, but the longer distance to the computer screen; and the screen in front and on the same level as the keyboard (geddit??!! Or do you need a picture?). Watch youtube group music sessions and you will see claws all over keyboards and bass buttons as well as nodding donkey syndrome to music stands (particularly common amongst English tina players :D)

Those who flop their fingers onto basses (and particularly  noticeable amongst some of the classy young tina players here  in one or two of Leo's videos:  http://www.concertina.net/forums/index.php?showtopic=12981
 or flautists and whistblowers) and buttons almost certainly have less strain problems.

Second trick is alternate the mouse between your left and right hand.
A cable free mouse will also reduce clawed twisting around on the mat (mouse mat!) to get the cable out the way as you try to pull the cursor across the screen (cursing reduces strain too).

Apply the same principle to your keyboard and box-holding position.  Let it all “hand out” rather than being all tensed up. let gravity do the dropping rather than pulling on the bass strap as our Freeleader recommends.  See John Kirkpatrick on melodeon around youtube or Whitney 2010 finale concert. And the whizkid in front of him.

Greek medicine of course is fairly recent but the fundamental message you will remember from school even if it was all Geek to you holds good; and it applies to how much ibuprofen, best bitter, aspirin, parachutamolling to earth, claw practice or arsenic Mickey Finns you stick in your neighbours’ pint to stop his playing aggravating your complaint:

Μήδεν  αγαν! – nothing to excess or as you might more easily remember – all things in moderation…….. :||: :|||:
(consultortion payments at the door are acceptable  in eggs, hens, cucumbers (the latter only if washed in potassium permanganate).   ;) ;)

« Last Edit: June 28, 2011, 10:34:06 PM by Kautilya »
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Kautilya

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #44 on: June 28, 2011, 10:41:17 PM »

Nick's final comment about breathing rings true too.
About a month ago I took the melodeon up to a local pub 'folk night' for the first time, and was sitting on my own in the corner quietly playing.
Some people came in and sat near me on a table. I felt myself tense so much I couldn't play.....then I realised  I was actually holding my breath  :|bl
Conscious efforts to relax got me over it, but it was interesting to see how I reacted to a situation where I wasn't confident with my instrument.....
Q
Right on the money Thrupenny Bit! That's why I do not and did not have beans with the full ENGLISH breakfast at ECMW - 
(they said the bacon was not Danish by the way.......but despite the laudanum aim of English purity throughout I think the delicious plum tomatoes had something of O Sole Mio about them. >:E
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Chris Brimley

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #45 on: June 29, 2011, 09:19:06 AM »

I must admit that this thread has made me think quite a lot recently, and now I'm wishing I'd joined in the discussion earlier! - there have been some very interesting contributions.

Surely, until melnet came along, it is somewhat unlikely that anyone has previously put together the symptoms suffered by long-term push-pull box players, which are likely to differ from those suffered by PA players, for example.  So, following Nick's wise dictums, I would have thought that there's likely to be merit in us pooling our experience of physical problems, to see whether there's any common features which could lead to recommendations on playing stance and even box design.

My only experience of playing-related pain was in the right elbow, and I think it was the same thing as Marje's.  I cured it very simply (and very surprisingly to me!) by supporting my right wrist at my workstation, so that I wasn't always bending my wrist backwards when I was using the mouse.  I find some difficulty with this movement, because of the structure of my hand and arm joints, I think, and for example have found trying to play a concertina excruciating.  (I would imagine that concertina players must have huge RSI problems.)  I had worried that my RSI was going to curtail my box playing problems, but as soon as I sorted the mouse problem, the pain evaporated, and I realised that it wasn't the box that was causing me my difficulties.  I believe that my right hand position on the box, using my thumb on the edge and keeping my hand naturally above the keyboard and bent forward, has helped me greatly.  I notice that people who play with their thumb behind the keyboard often push the keyboard away from their chest, and I suspect the reason is that otherwise their wrists have to bend backwards too much for comfort.

But I've never had a left elbow problem at all.  I find this surprising, since I play heavy boxes.  Again, I think the reason is possibly that my left wrist is bent forward, in a natural position for me.  My conclusion is that for me elbow problems are related to the tendons from the finger/wrist area.  I do wonder to what extent the heavy strains imposed by playing golf, tennis, or weightlifting are actually different problems, not directly related to box-playing?
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Guy

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #46 on: June 29, 2011, 09:53:31 AM »

And, in relation to a slightly different area of the body, I seem to remember John K talking about going to his GP some years ago with persistent knee problems. When asked whether he did anything strenuous which might cause this ,like marathon running or triathlons, he replied "absolutely nothing". He then realised he'd spent the best part of his adult life with one foot up on a box case whilst playing for Morris and dances...which I guess is why he now plays standing up.
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Nick Hudis

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #47 on: June 29, 2011, 10:57:22 AM »

Quote
I would have thought that there's likely to be merit in us pooling our experience of physical problems, to see whether there's any common features which could lead to recommendations on playing stance and even box design.

I've spent my entire life among musicians of all styles and the sad, unspoken truth is that pains and strains are endemic among players and singers alike.  If you never have trouble of this sort you are one of the lucky ones. 

So it will be grand to use use our on line squeezing community to bring this scourge out into the open and help each other.

I plan to gradually add more exercise videos and informative articles to my blog site covering prevention and treatment for back, neck, shoulder and limb problems.  This won't happen quickly, but I can post here when ever I've got something new out. And (sneaky commercial plug) I am happy to be invited to workshops, festivals etc to offer mobile massage or exercise sessions. Also always glad to offer a perspective on a one to one basis although, outside of a professional consultation, my comments need must be quite general.
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Chris Brimley

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #48 on: June 29, 2011, 11:07:27 AM »

Nick, I think it's your general input we most need, and I for one would find it really useful.  Do you have view on my golf/tennis/weightlifting relevance query?  Or any other general points on stance/design?  I have to say I have always thought box design has never had enough attention given to basic ergonomics - why put the fingerboard off-centre compared with the centre of pressure, for example? Isn't that just asking for trouble as players try all the time to counteract the twisting moments about the vertical axis that this inevitably creates?
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Nick Hudis

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #49 on: June 29, 2011, 12:09:43 PM »

Quote
I do wonder to what extent the heavy strains imposed by playing golf, tennis, or weightlifting are actually different problems, not directly related to box-playing?

Mmm but when you see some folks thrashing their boxes maybe Wimbledon or power lifting are not so different ......  (:)

Seriously Chris, you are exactly on the ball (no tennis pun).  Our body tends to be at its most efficient mechanically when the joints are in neutral position ie neither excessively flexed or extended.  You are right too about elbow problems often stemming from the wrist and fingers.  The muscles that move the wrist and fingers are mainly in the forearm and anchor to a tendon at the elbow at one end with long tendons that cross the wrist to connect with the hand at the other.  Often its the elbow end attachment that gets strained.

The ideal playing position is with the wrist neutral or slightly flexed (flexed = moving the palm side of the hand towards the inner arm extended = the opposite direction).  The fingers too work best with a  natural curve in the flexed direction.  If  the wrist or fingers are excessively flexed then tendon strain is likely.  If they are excessively extended the same is true and this is a common problem for pipers who play with very flat fingers.

Please read these next comments in the understanding that I am a great therapist (and modest!!!) but a pretty new and crappy box player. 

On the melodeon, a player who grips the fingerboard with their thumb or the heel of the hand, or who holds their elbow tensely close to the body is likely to put the wrist too far into extension. A player who tensely holds the elbow away from the body is likely to put the wrist to far into flexion.  So for the right hand, ensuring the shoulder and elbow are relaxed and natural is the starting point to get that neutral wrist and graceful open curve in the fingers.  I try to play with a hand or arm position that is not so very different to a pianist or classical guitarist:  shoulder and elbow relaxed, wrist straight fingers in a graceful curve as if you were gently holding a ball (about grapefruit sized). Thumb resting lightly in the groove on the side of the fingerboard.

For me the left hand is more challenging for three reasons.

1) on my box at least the fingers have to curve more to reach the buttons creating excessive flexion.  I wonder whether boxes with clearly stepped ranks of buttons on the bass side might be easier to play.

2) the thumb risks being in excessive extension to reach the air button.  Again design is probably a key thing here.

3) the left arm must support and control the movement of the left end. My own approach to this aspect reflects my playing style as a cross row player of heavy boxes and as other folk have mentioned letting gravity do the work.  I find the fanning of the bellows so movements  involve hinging really helps on the push.  Again a naturally relaxed shoulder and elbow are essential.

But we need to go back a step.  For the arms and hands to work efficiently, the torso has to be upright and stable. Your shoulder blade is like a foundation or base plate for your arm that itself is stabilised by the muscles that connect it to the spine and ribs.  If the spine is leaning, bent or twisted, the shoulder blade muscles have to tense to support the arm and that tension is transmitted right down to the fingers.

I am a great believer in the two (or even three) strap approach which takes the weight of the box off the shoulders and onto the spine and indeed hips.  The more symmetrical and upright we stand, the less the risk of strain.

In fact it is the assymmetry aspect that causes problems for so many musical instruments (and sports like tennis and golf)  I see this time and time again with fiddlers, flutists, sax players, guitarists etc.  The paradox is "how do I maintain an underlying symmetry in my body while doing an asymmetical action?"  Exercises that train and restore that underlying symmetry like the passive back release

http://integramassage.wordpress.com/2011/06/11/the-passive-back-release/

are really helpful.




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Nick Hudis

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Re: "Golfer's" or "Melodeon Player's" Elbow
« Reply #50 on: June 29, 2011, 12:34:55 PM »

Quote
A player who tensely holds the elbow away from the body is likely to put the wrist to far into flexion

Oops didn't mean that.  Excessive flexion  at the wrist is going to be a problem if the elbow is held in and pushed forward.
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