RSI Musician’s Injuries


I think many people might be surprised to learn that, in the past, I struggled with debilitating pain and nerve damage in my arms (RSI ‘repetitive strain injuries’ or ‘overuse injuries’). I nearly lost the ability to practice shakuhachi by my mid twenties. I’m 38 at the time of writing this which happens to be a bit over 10 years pain and nerve damage free!

As an aside, there are some usually well meaning people who blame the person for their ailment(s), usually without realizing it. They imply that the ill or injured person is somehow not “enlightened” enough, “healthy” enough, “trying” enough etc. It’s hard for people who have an “invisible illness” or injury like RSI, something people can’t see. People struggling with such invisible illnesses and injuries are of course not inferior, spiritually or physically, and many are trying and have tried countless things to get well (look up “spoon theory”).

Often, our bodies just need the right inputs. However, with everyone after our money it can be very difficult to find actual help or answers for what ails us.

My experiences with debilitating RSI and recovery

“Musician’s injuries” are sadly all too common and run adjacent to many occupational “overuse injuries”. In my case, I started crafting bamboo flutes full-time around age sixteen or so (it’s how I made a living, in fact). I moved to NYC at age nineteen to study shakuhachi so I would also practice playing for around six hours a day. Add to this typing on the computer, cooking my meals, washing dishes, and everything else, and I developed RSI fairly quickly (I also have a very skinny, long build from my mother and she was RSI prone as well.)

First, it was the tendons in my right forearm and the nerves that run adjacent which were getting rubbed ragged by the repetitive motions of the tendons. These nerves travel from the tips of our fingers all the way to the neck . I actually switched from righty on shakuhachi to lefty about a year into my studies in NYC around 2007 to relieve the pain. My playing posture was not ideal back then and I spent years correcting it in my early twenties. (I didn’t switch back to righty on shakuhachi until about 2020 or so. I switched back because righty feels more natural for me.)

I also started doing a lot of things left-handed, from flute work to brushing my teeth. Eventually, however, the tendons and nerves of my left forearm started having the same issues. At first, over the years, I tried alternative medicine and Yoga. Nothing truly helped my arms or even made them worse. Eventually, around age 25, I was able to very briefly access health insurance in the US and sought help from modern medicine, which was… a learning experience.

I had scans of my arms done as well as an electric response type test called a nerve conduction study in which they sent electrical currents through the nerves in my arms. This included shocking my elbow ulnar nerve, commonly called “the funny bone” nerve. It’ll wake you up better than caffeine!

The test has some big holes in it, as all tests do, often causing misdiagnosed carpal tunnel syndrome and ulnar nerve entrapment, aka cubital tunnel syndrome. Typically, it’s actually unnecessary for diagnosing those two conditions as there are more reliable, simple physical tests for these that anyone can do at home (I learned this only afterwards…)

After the shock test and scans, I went to a surgeon, and would you guess, they recommended surgery (“when all one has is a hammer then everything looks like a nail”). They wanted to snip the band holding my tendons together at my wrists to ‘relieve carpal tunnel syndrome’ (transverse carpal ligament).

They also wanted to take my ulnar/”funny bone” nerve out of its protective home in the bone and place it outside of the bone, just beneath my skin, so as to relieve ‘ulnar nerve entrapment’. The doctor joked that after this surgery “if you slap the inside of your arm it hurts like crazy”. How fun. I told him I wanted to look into my options and he said, “Ok, we’ll just wait while your arms deteriorate.” Thankfully, the doctor’s pushy, macho demeanor set off my alarm bells.

I went home and looked up information on carpal tunnel syndrome and ulnar nerve entrapment. What I immediately found odd about the diagnosis of carpal tunnel syndrome in the first place was that I had no wrist pain, and I told the doctor as much. He brushed this away, assuring me that the nerve conduction tests didn’t lie…

I found simple physical ‘flexion/extension’ tests online for carpal and ulnar, no electrocution required. You simply hold the positions for the given test and wait for pain. I held them and waited, and waited, and waited. No Pain. Specifically, no wrist pain nor any ulnar/elbow pain.

While I was clearly injured, I clearly did not have these conditions or need those horrible surgeries which surely would’ve left me worse for the wear. I then looked into matters more and I came across a book called The Athletic Musician. The book was great, if anything, for raising awareness that we musicians can and do get injuries from playing, quite regularly in fact.

I reached out to the author and she told me that surgeons often “farm-out” those gruesome procedures knowing full well that they may not be treating the root of the issue. The book and author recommended some good stuff, to be sure. I delved deep into correcting my posture for a start. However, the pain continued and I lost more and more function over the years to come. By age 27 I was looking into disability and having to give up shakuhachi.

By this point, I was having to decide what I could do each day because I could only do so much. If I pushed things too far I wouldn’t be able to do simple things like hold utensils to eat, both from pain and loss of motor function and sensation from nerve damage. I was contrast bathing my arms twice a day just to make it through.

This involved filling a small plastic wastebasket with around 8 trays of ice cubes and cold water, then another identical basket with hot water. These were in the bathtub and I would squat down with one arm in the cold and the other in the hot up to above my elbows (3 minutes each, then flip, 3 rounds total, 16 minutes). It’s a far more effective method for healing than most. It’s not, however, what I would call fun.

From the net: The process of a contrast bath is a form of hydrotherapy that involves repeatedly dipping a limb in hot and cold water. This gets done at a specific rate, temperature, and time. The repeated switching between the two temperatures may cause constricting and dilating of blood vessels, leading to a pump effect.

You definitely feel ‘pumped’! This pumping is said to help your body remove dead cells and heal. The cold also reduced my pain and inflammation. I had taken NSAIDs before until I learned they’d probably give me more health issues on top of everything. The ice water it was then. I got used to it and looked forward to the relief it brought. To make the best use of this ice time I would often work on memorizing the Honkyoku I was currently learning by singing it and picturing the notation in my mind. While icing really helped, things still got worse. I was looking into Buddhist temples to go join…

One day, it occurred to me that I never once had any forearm pain after heavy lifting. At the time, playing shakuhachi, making them, typing on a keyboard, cooking (I love to cook), were all very aggravating to my forearm tendons and ragged nerves. Like I said, I had to pick what things to do with my day and plan to ice my arms after certain tasks. However, lifting a 30lb vise, no problems! (Of course, “repetitive motions” cause these injuries but it tends to make one cautious of heavy lifting too, at least it did in my case).

It was a long shot, but based on this little insight, and considering my circumstances, I figured why not look into lifting weights. As I said, I was already on the verge of losing my way of life as I knew it, my whole craft of shakuhachi, and joining a Buddhist temple, so I figured why not try weightlifting first. Before jumping in there I did a lot of research into physical training. I decided I would only perform the safest of exercises and do everything the most ergonomic way (always neutral wrists/grip and the safest exercises like ‘farmer’ and ‘suitcase carries’). If I felt any worsening pain I would consider it a failed experiment, take life from there, and try to join a Buddhist temple.

First day in the gym, no forearm pain. Second day, no pain, and so on…

Within about six months I could play shakuhachi, type, and do seemingly anything without forearm pain. I regained motor function and sensation that I had lost from nerve damage. It felt like a miracle healing. I took all those ice cube trays to the local thrift store and donated them.

I studied even deeper into these matters until I finally found “tendon remodeling”. From the net: tendon remodeling involves both synthesis and degradation of collagen with a net degradation that begins immediately after exercise and then shifts to a net synthesis.

In layman’s terms, lifting weights caused my body to heal and modern science knew about it all along. Tendon remodeling should be primary knowledge considering RSI of the tendons is extremely common. Yet every healthcare professional I had gone to before was either ignorant of tendon remodeling, forgot something so primary, or had reasons for not mentioning it. It’s like going to the ER with a bad laceration and no one will stitch you up because they don’t know how, or they’ve forgotten, or maybe they want to try and sell you something.

If you can believe it, I’ve had some people essentially express that weightlifting isn’t exotic or sophisticated enough in their opinion. While Yoga, Tai Chi and Qigong are all amazing practices, there’s no substitute for gripping something like a humble weight or hanging from a pull-up bar, which is the same of course as those playground bars some of us found so much joy swinging from in our youth. If someone looks down upon lifting weights or hanging from a bar, truly the weight is in their mind.

I wrote this out for anyone who’s suffering, losing the ability to do what they love. If you’re struggling with RSI, I hope you get the help you need to unlock your path toward healing. Lifting weights may not be what’s right for you and it’s of course best to at least try and find competent professional help, however rare and expensive it may be. No matter what, don’t give up on your body, Josen


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