In my last carpal tunnel solutions for musicians article, I went over how to interact with computers at work or in the studio, for those that derive most of their carpal tunnel symptoms from heavy computer work. In this article, we’ll focus on carpal tunnel solutions with regard to interacting with musical instruments.
This opinion article is for informational purposes only. It is not a diagnosis, treatment, advice, or individualized medical plan for the reader, and cannot guarantee safe, improved outcomes. You must see a licensed healthcare professional to garner such services.
Warming up
It’s important to warm up your hands, fingers, and forearm muscles that control such, before beginning to interact with your instrument. Further it is important to also warm up the muscles that surround the entire pathway of the median nerve from its cervical and upper thoracic origins down to the forearm. That means all the involved neck muscles through the upper arm muscles as well. This is especially true in colder parts of the globe, where your body may be trying to conserve heat via vasoconstriction in your upper extremities, resulting in colder, tighter muscles that are seeing less blood flow.
The more warmed up you are, the looser your arm muscles will be, and the better your forearm tendons will glide through the carpal tunnel region of your wrist. Blood flow is also important in clearing inflammation, which in our case is being generated by repetitive stress in and around the carpal tunnel.
Light upper body warm ups
You can find several upper body warm up exercises by Googling the topic. For instance here is an article that lists several of these exercises. I would just pick the ones that don’t require any exogenous equipment to accomplish, but if you do happen to own bands or a pull-up bar etc. then likely those are fine to integrate into your warm up.
The warm up exercises that provide multifactorial benefits, such as a small set of push-ups, which warm up the arm muscles, increase your heart rate/blood flow, and if accomplished by pushing on the ground, by way of placing your palms flat on the floor, can provide some flexor muscle stretching, maybe your best bet. An easier version of the push-up can be done by pushing from your knees, instead of from your feet.
However you will have to experiment around with the best upper body warm up exercises for your situation. For example most of these may be fine when your symptoms are absent to mild, but you may have to attenuate or avoid certain ones that you feel are irritating your carpal tunnel symptoms, especially when you are experiencing moderate to severe symptoms.
Warming up the carpel tunnel through tendon/nerve gliding exercises
Exercise One on the below video not only warms up your carpel tunnel, via tendon/nerve gliding through the area, but research shows can also increase the amount of space in the tunnel thus alleviating symptoms. It is actually somewhat similar to the finger extension exercises needed to build forearm extensor strength that helps lift the carpal bones away from the tunnel thus increasing space in the region.
The video also goes over some stretching techniques which could also be integrated into a warm-up. However sets of these, and other exercises, should also be performed throughout the day to get the full benefit from them.
FlexTend Glove
Also you could integrate something that’s generally helped my carpal tunnel symptoms, a FlexTend Glove, into your warm up. I talk more about that in my article on physical remedies to carpal tunnel symptoms for musicians.
But using this glove strengthens the forearm muscles that raise your fingers away from your instrument (opposite direction of pressing a key, valve or string down). It’s often that imbalance between the muscles that let you press down with your fingers (which are stronger) and those that pull the finger back up (which are weaker) that contributes to carpal tunnel symptoms.
However using the glove in a warm up also gets the tendons and nerve gliding properly.
Stretching
If you’re interested in stretching your flexor muscles in your forearm it’s likely best to only perform this when your symptoms are absent or mild. This is because these type of stretches temporarily put extra pressure into the carpal tunnel, potentially aggravating your symptoms.
However if you can get away with this type of stretching with no increase in symptoms, it’s possible it can provide some benefit.
And again if you are able to, the best benefit from this type of stretching occurs when you perform it multiple times throughout the day for several weeks to eventually achieve looser flexor muscles. After all, as stated earlier, it’s the imbalance between your flexor and extensor muscles in your forearm that contributes to carpal tunnel symptoms.
When I personally do this type of stretching, I immediately follow it up with an isometric extensor muscle exercise that temporarily pulls the carpal bones up away from the tunnel a little bit, and reduces the pressure there. This also contributes to rebalancing the forearm muscles so that the flexors are not stronger and tighter than the extensors.
Upper body stretching
It’s also important to stretch all the muscles of your upper body that surround the median nerve and those that feed into it from the neck area. So don’t forget to perform chest stretches, neck stretches, overhead stretches, etc.
However I would avoid any type of nerve stretches, as nerves don’t like to be stretched, especially those that are irritated or inflamed.
General interactions with your instrument
Concentrate on slower, less involved music when having carpal tunnel symptoms
The number one thing that really irritates my carpal tunnel symptoms when interacting with my piano keyboard (and computer keyboard as well) is performing rapid sequences of notes at a brisk tempo for extended periods of time (or rapid keystrokes on the computer keyboard).
This is because when you’re executing rapid passages, your tendons are rapidly gliding through the carpal tunnel increasing frictional force in the area (tenosynovial tissue) and thus increasing the risk of inflammation, and more pressure/swelling in the area.
Thus as a general rule, if you have carpal tunnel symptoms, regardless of their origin, you need to find ways to interact with your instrument when practicing or composing, that involves slower or less involved music.
Here’s the first page of a tune I wrote for clarinet and piano. Note the piano part, which is relatively easy, with no large interval stretching. And note the clarinet part, which is a bit more involved, but still relatively easy:
Practice at quieter dynamic ranges for percussive type instruments
And such could further involve performing or practicing music at a quieter dynamic range for some instruments, including piano/percussion or even string players experiencing symptoms on their bowing or strumming hand.
Forcefully hitting the keys on my piano keyboard to achieve fortes or double fortes is also a significant contributor to my carpal tunnel symptoms.
Strive for light, ergonomic and efficient interaction with your instrument
Indeed you should always consciously be striving to interact with your instrument in the lightest, most efficient and ergonomic way possible. This involves testing your ability to perform using less muscular force, and less muscular tension in your arms, while really paying attention to that mind-muscle connection.
For example, are you pressing harder against your fretboard than need be, if you are a string player, or are you slapping down keys/valves more forcefully than what is needed, if you are a wind or brass player?
This could also involve turning down or minimizing the amount of rapid vibrato you’re using on string instruments.
It may take time to relearn how to interact with your instrument, and you may feel in the interim that you’ve lost some skill, but if you correct your approach to playing such that you are using the least effort possible, then in the long run you may be able to reduce your symptoms of carpal tunnel, and perhaps even achieve greater skill levels.
Practice good posture when interacting with your instrument
You should also be conscious of your posture, both with your instrument and away from it. Poor posture could be creating unnecessary strain or tension in your upper body, which could be translating to less efficient interaction with your instrument.
Explore the ergonomics for specific instruments website to gain insight on best posture for your particular instrument.
Rest but don’t abstain
While you should strive to rest your hands as much as possible, you shouldn’t stop interacting with your instrument. I find that very light interaction with my piano keyboard, where I’m using my hand and forearm muscles and increasing blood flow into the area can be therapeutic, and help clear inflammation from the carpal tunnel region.
Minimizing carpal tunnel symptoms when playing the piano/keyboard
As stated above, not only should you be finding music that’s at a slower tempo and is less involved when playing the piano or composing on the instrument, but you should also be practicing or performing at quieter dynamic ranges.
Higher dynamic ranges involve not only more force from the flexor muscles of the forearm, but also create more shock that your tendons and carpal tunnel have to absorb, as the momentum of your fingers is abruptly stopped or decelerated, when the piano keys reach the end of their range of motion, i,e. when the keys are fully depressed, or when the internal hammers from the key levers in question meets their piano strings.
If it’s possible, try to practice at lower dynamic ranges, then occasionally practice at the written dynamic ranges to get the true feel for what is needed to perform your piece, reserving such for when you’re not experiencing symptoms. Also you may want to practice in your head away from the instrument, after you’ve gotten a feel for what it’s like to perform your pieces at the true dynamic range.
Pay attention to symptoms during wide interval stretches
Paradoxically stretching my fingers out to play octaves on the piano, or playing chords that involve octaves, seems to also irritate my carpal tunnel symptoms. Otherwise this type of stretching on its own should increase the amount of space in the carpal tunnel. So you should be paying attention to whether or not large stretches are helping or hurting your carpal tunnel symptoms on the piano, to get an idea on what to avoid.
Composers using a piano/keyboard to compose
Using a keyboard with smaller, unweighted keys
Another aspect of interacting with the piano as a composer with CTS, is that I find a midi keyboard with smaller keys, and which is unweighted, is more comfortable for me. I couldn’t say for sure but it looks like my particular keyboard has keys that are about 3/4ths the size of a normal piano’s keys.
So if you are having trouble at a regular piano or a weighted keyboard, try switching out such for a non-weighted, reduced key size instrument. I’ve been able to write entire symphonies with this type of setup.
Compose slower, low note density pieces
And again the same rules as above applies: if you’re having carpal tunnel symptoms, then it’s time to concentrate on composing some adagios or lentos, or even some choral works.
And it’s best to record music into your digital audio workstation at a quieter dynamic range, and then adjust the dynamics in your DAW with your mouse, if you need fortes or double fortes.
Avoid composing for piano or harp
Further I find when having symptoms it’s best to compose for non-polyphonic instruments, so that you’re only recording single lines into your DAW, and even possibly spreading out the work between both hands as you’re doing so, again minimizing repetitive type work for any single tendon in your carpal tunnels.
Using a pedal to hold chords
Also when figuring out the harmonic outline of your music, you should be using a sustain pedal so that you’re not holding down keys, further engaging your flexor muscles of your forearm. Just play your chord, press your pedal, and let your hands relax. Rinse and repeat.
Tips for guitar players with carpal tunnel syndrome
Electric guitar players
Strap height
I know it looks cool when performing rock related music to have your guitar hanging low on its strap. But when I’m playing the guitar, if the guitar is too low on the strap, then this causes unnecessary flexion and extension of my wrist area, putting unnecessary stress on my carpal tunnel, and less efficiency when fretting, and thus is more likely to irritate my carpal tunnel symptoms.
So the very first thing you should do when interacting with your guitar, is to find the best strap height that allows for the least effort in fretting and picking. Likely this will involve hanging your guitar higher up on the strap. Take a look on YouTube at Allen Holdsworth or Frank Gambale, and note how their guitars are hanging higher than what a rock guitarist would be interested in, from an aesthetic standpoint.
Neck width (nut width)
You may or may not be in a position to do so, but if your hands, and finger lengths, are on the smaller side, then you might consider obtaining a guitar with a less wide fretboard (nut width). That means trading in your Les Paul or Ibanez for a Stratocaster (Amazon link) or equivalent neck/nut width guitar.
To me, a Strat, with its slight curvature of the fingerboard, also feels more ergonomic, compared against my old Ibanez, whose fingerboard feels more flat.
Action
Guitarist should also considered lowering the action on their guitars. I know it may feel awkward at first, where your instrument feels too delicate. But once you practice for a few weeks with your lower action, then it will feel more normal.
Remember, being able to perform with a lighter touch is the goal. Lower action means less flexion work for your forearm muscles, which can minimize carpal tunnel symptoms.
And if you notice buzzing from your action being too low, you can ask a luthier to sand/polish the areas of the frets that are causing the buzzing, instead of trying to re-raise the action to avoid such.
String gauge
Also picking up a set of strings with a lower gauge can also reduce the work of your fretting hand, and thus minimize carpal tunnel symptoms. Yes you may have to deal with more incidents of breakage for your top E string, but it’s still better to be obligated to own a few extra E strings than have carpal tunnel symptoms.
Experimenting with different picks
Not only should you be experimenting with how to pick with the least effort possible, not overlooking how much effort you are applying to squeezing your pick between your fingers, but you should also be trying out different picks.
For instance a pick with a more pointed contact point with the strings, may allow for more precise picking with less motion or work involved with any up or downstroke. This can improve efficiency and reduce wear and tear on your wrist. I personally use the green Tortex “sharp” picks from Dunlop (Amazon link). Those feel the most comfortable for me.
Classical guitar players
Dealing with carpal tunnel syndrome, and having a dedication to the classical guitar, is a bit more tricky than what an electric guitar player would experience.
Not only are you dealing with a guitar with higher action and a wider fingerboard, but the nature of the music, where you’re playing both the melody and the harmony, which necessitates more involved and awkward fingering, and more intricate right hand work, can certainly exacerbate carpal tunnel symptoms.
The classical guitar is limited on how low its action can go, as the strings need room to vibrate to project enough sound into the room. And unlike an electric guitar where you can adjust the action up or down, the only way to obtain a lower action classical guitar is by doing just that – obtaining a new guitar.
You might consider performing guitar duets, trios, quartets, etc. just so you’re dealing with more linear and less polyphonic music. Certainly the most strain on your flexor muscles comes when you are trying to hold down large cords or while trying to finger a melody at the same time you are doing such. So participating in a group where all that work is spread out between multiple people can alleviate the hardest part of playing the classical guitar.
Brass valved instruments
Trumpet & Horn
The main three things to worry about when dealing with carpal tunnel and playing the trumpet/horn are posture, how tightly you’re holding the instrument, and if your valves are properly lubricated and cleaned.
Then of course, the same general rules apply: slower, less involved music may help, as might experimenting with how light you can go, when pressing the valves, before it affects your technique.
Trumpet posture
With regard to posture, try holding the horn almost parallel to the ground, making a note not to pull your shoulders back as were you in a marching band, as that creates more tension in the area, including in the nerves that feed the median nerve, which can then further irritate this nerve at the carpal tunnel region.
Chris Braun, on his video entitled, Effortless Playing – How to Play the Trumpet with Ease, states, “Hold your horn loose and lightly. Don’t grip the horn hard. If you come up to me and I’m playing properly, you could pull the horn out of my hand”.
However if you’re having trouble holding up your trumpet, due to carpal tunnel symptoms from holding your trumpet, you may need to invest in a support system, like the ErgoBrass trumpet support system, to use when practicing, or even possibly performing.
Horn posture
Horn posture is best explained on the ergonomics for musicians website, as follows:
There are, in general, two basic positions for the French horn:
One is to sit with the shoulders completely symmetrical, without rotating the torso. This requires turning the head to the left in order reach the mouthpiece. In this position, it is possible to support the instrument on the right thigh. Make sure both arms have a little space between them and the torso, so there is room to breathe freely and expand the trunk of the body.
The other on, in order to avoid twisting the head around, begin by holding the arms with a 90-degree bend in the elbows, and feel the torso rotating from all the way down in the pelvis – a little twist to the right, so that the right elbow ends up a little behind the body. The head follows this movement. Now take the instrument to your mouth.
Depending on the size of the instrument, it can occasionally be easier for a beginner to stand with the instrument while playing.
The instrument is held up by both left and right arms. The left hand functions best when you do not stretch between the middle finger and the little finger.
Stable distribution of weight is achieved by a “duck foot”, for example, or another means of assistance, which will place the weight between the thumb and index finger. How you place the thumb on the valves is also important for how the weight is distributed on the hand/arm/shoulder, so that your position of rest is one in which the thumb is relaxed, i.e. with a slight bend in all its joints. The right hand is placed inside the bell, both to affect the sound and also to hold the instrument up. It is also possible to place the weight of the instrument on the right thigh, even if this results in a static position. It is important for the distance up to the lips to be correct so that the neck does not become strained. A leg support or a firm cushion can also offer support.
Keep your valves well lubed and maintained (horn & trumpet)
Again the idea is trying to do the least amount of work with your flexor forearm muscles as possible. So lube those valves up to make them glide easier.
On a particular Reddit post entitled, “guide to make the valves really smooth and easy to push?” a few posters recommend using a higher quality valve oil, with one stating the following:
They cost more, but the top synthetic oils (Hetman, Ultra Pure, Yamaha) are far superior to anything I’ve used before. A couple troublesome older horns now behave like new, a cheap junk horn now behaves like it’s actually well made, and my good horns are so fast and smooth. Currently a bottle of Yamaha costs me about $10 locally, which is a lot more than Al Cass, but I buy like 1 a year and even then I could probably use less since the synthetic lasts longer and most of the time when I oil my valves it’s because I think I should not because the valves feel like they need it.
Good oil isn’t a substitute for proper cleaning or maintenance and it won’t fix a dented valve or casing.
Experiment with avoiding slap valve technique
Some trumpet instructors may recommend holding the fingers significantly above the valves to increase range of motion and thus increase valve speed. This results in a ‘slap’ sound as the valves are depressed at a high velocity
However, when you’re playing slower (which you should be doing when having carpal tunnel symptoms) try interacting with your valves with the tips of your fingers to garner the most ergonomic motion possible, thus minimizing stress in the carpal tunnel region.
Minimizing carpal tunnel symptoms on woodwind instruments
For clarinets, oboes, bassoons, saxophones, etc., there’s always the option of a neck strap, or harness, to hold the instrument up, taking strain off your hand and arm muscles.
Further you can also purchase a Pogo stick looking device, that attaches to your instrument, also holding it up as you play. Such then allows you to provide a lighter, more nimble touch to your keys. Just visit the ErgoBrass website to see if they have something for your instrument. Below is a video of a clarinetist demoing the ErgoClar stick:
Loosening your key springs
And your second option is to experiment with looser springs attached to your keys, so that it takes less flexor muscle work to perform on the instrument. You might not want to adjust them yourself, and instead opt to use a repair technician, but the below video goes over DIY spring tightening and loosening.
Less involved music in simple keys may be more comfortable
Obviously you’re not concerned with the dynamics on a wind instrument, but again, practicing or performing slower, less involved pieces may minimize carpal tunnel symptoms derived from interacting with your instrument.
For wind players this also could mean avoiding odd keys, that have loads of sharps or flats, that obligate you to higher degrees of compound fingering (holding down multiple ancillary keys for a given musical section). Thus you may need to transpose a particular piece if possible to make it easier on your hands.
Here’s a clarinet’s guide to general transposition to get a feel for what is needed.
Further reading
Here is an article I wrote on physical therapy I do to reduce my carpal tunnel symptoms.
And here is an article I wrote on interacting with computers, if you’re like me, and derive your carpal tunnel symptoms from heavy computer use at work.
And here is a ergonomics website for musicians, where you can learn best sitting/standing techniques for your instrument, as well as hand strengthening exercises.