Skip to main content

Marimba Body: Aching Elbows

As we gear up for fall and the concert season ahead, whether as a student, professor, or touring artist, it's a good time to reflect on our technical habits.  For those that took time off over the summer, there's the process of re-integrating hours of practice. For those that are preparing entire new programs (ehhem...yours truly), there's the challenge of not rushing through the learning process, mentally and physically. 

Throughout my time writing the Marimba Body series, folks have approached me with different questions of "do you have anything about ___?"  Coming up a few times is the issue of elbow pain - what it is, how we get it, and how to heal and then prevent it. 

Here's what I've learned, experienced, and found.

Three Common Pain Areas

Most commonly, percussionists experience elbow pain:
- on the outside of the elbow (lateral epicondylitis, aka: tennis elbow)
- on the inside of the elbow (medial epicondylitis, aka: golfer's elbow)
- at the back of the elbow (posterior impingement or triceps tendonitis)

Lateral Epicondylitis

Symptoms: tenderness and perhaps pain around the lateral epicondyle (bony bit outside the elbow);
          weakness when gripping small objects, such as mallets;
          weakness and tenderness when supinating the forearm (rotating outwards, as in to play mallet 2 or 3)

Causes: excessive use of the forearm that strains muscles;
          repetitive twisting of the wrist and forearm

Related to activities like writing, typing, playing instruments (guitar, violin, percussion, etc), painting, racquet sports (especially backhands)

Definition: inflammation at the attachment of the Extensor carpi radialis brevis (the muscle that extends the wrist, ie: during an upstroke) and humerus at the lateral epicondyle

Healing: go easy, and don't try to "play through" the ache, as it could result in a tear, as the drawing above shows;
          ice the area if it helps;
          apply a compression wrap

Awareness and Prevention: pay close attention to tightening the elbow during passages of tremolos, quick tempi, and large leaps - pause and relax the area before playing the passage again, focusing on a different physical sensation in the elbow than the time before

Medial Epicondylitis

Symptoms: slow-growing tenderness and pain at the medial epicondyle (bony bit on the inside of the elbow);
          pain while pronating the wrist (using the inside mallet on a surface too low for your height);
          tenderness during wrist flexion;
          numbness in 4th and 5th fingers

Causes: gripping a small object for long period of time (like mallets or sticks);
          repetitive wrist flexion

Related to activities like golfing, maxing-out with free weights, rock climbing, squeezing and rotating an object (ie: doorknob)

Definition: inflammation at the attachment of Flexor pronator muscles and humerus at the medial epicondyle

Healing: take a break from the painful activity;
          ice the area if it helps;
          begin therapeutic stretches and exercises as soon as possible

Awareness and Prevention: pay close attention to holding mallets or sticks tighter than necessary;
          when working on fast finger strokes, focus on a relaxed elbow and neutral shoulder

Posterior Impingement

Symptoms: pain and tenderness at the back of the elbow when the arm straightens;
          sensitivity to touch at the back of the elbow

Causes: activities that repetitively straighten the elbow while adding sideways pressure

Related to activities like pitching, martial arts, repetitive throwing, locking elbows during planks, or reaching for a note in an upper or lower octave from the elbow instead of the center of the body

Definition: compression and damage to soft tissues at the back of the elbow due to excessive extension

Healing: take a break from the painful activity;
          begin therapeutic stretches and exercises as soon as possible     
*Unlike the other injuries, posterior impingement is usually not damage to a tendon, and may take longer to heal.
Awareness and Prevention: take care that the instrument is the correct height;
          in sports activities, keep a slight bend in the elbow to prevent hyperextension

Triceps Tendonitis

Symptoms: pain at the back of the elbow when pushing against resistance;
          back of the elbow is sensitive to touch

Causes: forceful pushing, throwing, pressing as in a push-up (or applying too much tricep pressure during a stroke)

Related to activities like bench presses, pushing heavy objects, or push-ups without proper support from the shoulder and back

Definition: inflammation of the attachment of the tricep to the ulna at the olecranon process (bony bit at the back and bottom of the elbow)

Healing: stop the painful activity;
          ice the area, and use a compression brace if helpful;
          elevate the elbow

Awareness and Prevention: pay attention to not applying too much downward pressure with each stroke, especially during tremolos, rolls, and loud passages;
          when leaning against a table during study or meals, keep the back of the elbow relaxed
- - - - -
In conversations with different players, it seems that aching elbows most often occur in the non-dominant arm, while shoulder pains (especially at the insertion of the bicep) most often occur in the dominant arm.  This is just anecdotal evidence I've collected, but it would be interesting to investigate in a more formal way.

My hunch as to why it could happen is connected to my theories that improper shoulder alignment causes pain down below, as I talked about during my PASIC 2015 presentation.  Without proper support from above the elbow joint, the strength needed is dispersed to smaller muscles below the joint, hence the gradual appearance of aches and pains.
- - - - -
Sports Injury Clinic
Mayo Clinic
Hand and Wrist Institute
New York Orthopedics


Popular posts from this blog

Marimba Body: Back Muscles

This essay is all about the muscles of the back, since we talked about the spine in my last segment.  Since I get to talk all about shoulders at PASIC (woohoo!!!) on Friday, I thought a good connection between spine structure and the shoulder joint would be about the muscles of the back that help to protect both.

Though I've never experienced it severely first-hand, it seems like there is nothing worse than constant back pain.  Ask anyone who has dealt with it and they will say that you must protect your back so you never feel what they do.  Doctors warn their patients that once they have one surgery, chances are they will need more.  (This makes sense, as you can't fix one part of the long spinal structure without later needing to correct other areas.)

There's good news, though: keeping the muscles of the back strong, and freely aligning the spine, can help us lead pain and surgery-free lives.

Waterfall Muscles It's beautiful the way the muscles of the back cascade d…

Marimba Body: Thumbs


Without them who knows how we'd play our instruments.

Interest in the relationship between the hand, wrist, and thumb began a few years ago when I took piano lessons to refine my technique. (As similar as piano and percussion are in theory, there's much less crossover than I mistakenly thought and hoped.)   Anyway, something my mentor said was when the thumb isn't being used it should relax towards the rest of the hand and fingers.  Sure, may sound obvious, but in the throes of playing - piano or percussion - it's easy to forget little things like this. 
Brain: Play a broken 13 over 7, across 6 surfaces...crescendo...oh, right. THUMB. End Scene
Thumbs that are mis-mapped, working more than they should, or working when they don't need to contribute to funny aches, pains, and numbness that can get mistaken for carpal tunnel.  
Just like all other subjects in the Marimba Body series, how we relate to the structure and movement design of the thumb is evident in…