A large number of my patients are musicians. I also see a lot of patients who enjoy sport and like to go to the gym. Since lockdown, live performances have ceased and gyms have closed. So, lockdown has been an interesting scientific experiment for me, to see what happens to hands and wrists that are constantly strained by these sorts of activities, and to see what happens when patients are confined to their own home. This is what I have learned.
Patients who are musicians who have problems related to stiffness, ligament strain or tendinitis have largely not improved by having a rest. Keeping a regular daily practice regime seems to be helpful and stopping playing altogether seems to make stiffness worse. I suppose this is intuitive, but this has been thrown into sharp focus by lockdown. I have therefore been encouraging my musical patients to continue to play at a level they feel comfortable with, in addition to doing their normal hand therapy. Steroid injections may be required to help refractory cases to settle.
This was always a common problem for freelance musicians before we had ever heard of lockdown. A lot of freelance musicians will have had periods of no work, followed by very busy periods of work. It is very typical to see patients who have problems related to tendon strain and ligament strain if they suddenly start to expose their musculoskeletal system to loads that the body is not used to. This is typically when tendons fail.
In the sports world it is very similar. If a sportsman is off training for a period of time, as a result of injury or other circumstances, then it is very common to try to ‘catch up’ with training by doing more than would be normal for them. This is very likely to result in tendon or ligament or muscle failure. That is why it’s very important to keep a background level of fitness in musculoskeletal organs. ‘Catch up training’ or ‘catch up practice’ is not to be recommended. A graduated return to these high levels of elite performance is to be recommended.
Spending more time at home because of lockdown, has also led to a large number of patients taking up activities that they hadn’t previously engaged in. Home exercise programmes, gardening and domestic decoration being good examples. I’ve seen a number of patients who have possibly injured themselves doing activities that they are not accustomed to. This reinforces my view that tendons and ligaments and muscles fail when they do things that they are not used to. Acclimatisation seems to be an appropriate approach. The problem with tendons and ligaments is that they often don’t let ‘the owner’ know that injury has happened until the next day.
In conclusion
Many of my patients who have been forced to rest during lockdown, have not experienced an improvement in their symptoms. My advice is therefore as follows:
- Patients who are musicians who have hand/wrist problems related to stiffness should keeping a regular daily practise regime, combined with normal hand therapy, stretching exercises, gradual return to more play and maybe some of my ‘Finger Yoga’.
- For sportsmen/women who have been injured; off training and resting for a period of time, a gradual return to high levels of elite performance achieves better results. Catch up training is not recommended, as this is very likely to result in tendon or ligament or muscle failure
- Tendonitis can be treated more effectively using a systematic approach, including steroid injections; hand therapy and ergonometric adaptations and sometimes surgery
The good news is, at the time of writing this blog and with lockdown restrictions easing, patients can now access a number of mulitdisciplinary treatments options such as:
- Physiotherapy and hand therapy. Many practices are now re-opening
- Steroid injections. Patients can now see me in clinic again for the minimum therapeutic dose
- Ergonometric adaptations. Patients can access consultations with technique tutors on specific musical instruments. These can be really useful for devising technique work-arounds
Mr Mark Phillips, Consultant Hand & Wrist Surgeon
For more information visit:
https://sportsortho.co.uk/specialist/mr-mark-phillips/