This article isn’t just targeted at string instrument players any musician that requires you to put sustained pressure on something with the little finger may also find this article useful.
If you want to skip ahead to recommendations on how to address or more importantly PREVENT this issue then scroll down and look for the red text. If you want to know more about what’s going on then read on!
People who play the cello, violin, viola or any other instrument within that family may be particularly vulnerable with 75-87% of such musicians developing upper limb problems in their musical career.
The Problem!
As you reach your little finger over to press the string down the little finger collapses from an arched position into an overextended position. Sometimes it can feel like you can’t get it back out of this position again. Other times it can cause soreness in the joint. Either way, it can be very disruptive to your playing.
Here’s a general idea of how it starts:
1. Hypermobility Syndrome – a potential predisposing factor
While many musicians strive to have flexible fingers, sometimes the joint can become too flexible in some directions to the point where it becomes unwieldy. This is where you can see the middle joint of the finger (the proximal interphalangeal joints) collapse. Over time it can get very annoying and even become painful or distressing.
This problem can be more common in women than men (Brandfonbrener reported 35% in women vs 17% in men).
Some people are even born predisposed to over flexible joints such as the case of Marfan’s Syndrome.
2. Repetitive Strain Syndrome – a possible mechanism of injury
As the name suggests you get an RSI from stressing something over and over again. A Repetitive Strain Injury (RSI) covers a broad scope of problems and describes how you got injured more than it describes the injury itself. In the context of finger pain, it can mean that the tendons, the sheath surrounding the tendons and the joints themselves have been rubbed raw over time and can even develop some internal scarring.
Both of these conditions can set the stage for further problems to arise such as Synovitis or Tendonapathy.
Synovitis: Syno (referring to the joint capsule around the finger) itis (meaning inflammation): – Inflammation of the capsule that surrounds the joint in the finger
- If you have a lot of swelling in the finger joint and there is a sense of heat radiating off it then you will likely need to stop playing for a while. Replace your playing time with ice massage to the finger (e.g. gently rubbing an ice cube all over the sore spot) and take anti-inflammatory medications. If the inflammation goes down then you should start the exercise program given at the end of this article before you start playing again. If you can’t bring the pain under control in this way then it’s time to see a health professional.
Tendonopathy: Tendon (the cord that connects the muscle to the bone) opathy (an altered state)- Degeneration of the tendon that connects the muscle to the bone.
- This can happen after long years of stress on a tendon where the tendon and nearby joints can become scarred and thickened making movement difficult.
In either case, it’s a good idea to talk to your doctor first to diagnose the problem.
Two muscles that you will want to know about include:
Palmaris longus – This is one of the muscles responsible for flexing (bending) your wrist and fingers. It starts all the way up in your elbow and becomes a tendon further down your arm. Think of it as part of a rope and pulley system leading to your fingers.
This muscle can be a little odd because not everyone has one. It’s easy to test if it’s there or not, simply press your thumb and pinkie finger together and flex your wrist towards you. If you see a tendon bulge out of your wrist you have one. If you don’t see the tendon then finger strengthening exercises have just become all the more important and you will be relying a great deal on the next muscle called:
Flexor digitorum profundus – This muscle has a lot to do with bending your fingers right down to the furthest tip of the finger. Like palmaris longus, it starts all the way up in the elbow and pulls on the tendons in your hand that makes your fingers move.
This muscle is very sensitive to the position of your wrist. If your wrist is flexed (bent towards you) then this muscle will lose leverage on the farthest joints of your fingers which leads us to the next topic of:
Why wrist position is important
My cello teacher was great at noticing my flaws. If she noticed I was memorising a piece instead of sight reading she would take it away instantly and give me a completely different piece.
The principle is to NEVER pollute your technique with bad habits. The moment you notice your wrist getting too rigid or moving out of alignment you have to stop and reset! Especially in the early days.
There are a lot of muscles that control the wrist and fingers but let’s focus on two distinct groups. The wrist extensors tilt your wrist upwards, the wrist flexors tilt your wrist down. You need both to create a stable wrist.
- Static hold
- To perform a static hold you keep your wrist locked in perfect neutral. Then you hold a weight in your hand (in this case you can use your heaviest weight). Your goal is to keep your wrist in neutral while slowly turning your arm from palm up to palm down, back and forth. Try doing this both when looking at it and when looking away from it. Also, try reaching your arm up so that it’s in the same position you would play in.
- Slow concentric and eccentric flexion and extension – always return to neutral.
- Your goal now is to take your newfound sense of control of the wrist and develop some endurance. Switch to a lighter weight and hold the weight in your fingers. Use one finger at a time to slowly pull the weight up into your palm, then slowly let it come down again.
Strengthening the fingers
With your wrist in a better position to support them, it’s now time to strengthen the finger flexors themselves.
Your overall goal is to train your technique so that you try and push mostly from the tip of your finger and try and pull back a small amount.
- Static strengthening.
- Static strengthening means that your joints are not moving but your muscles are still pushing. In this photo, you can see me squeezing a self-massage tool (called a “Pocket Physio”) between my thumb and fourth finger. The key here is I’m focusing hard nonplacing just the tip on the Pocket Physio and at the same time am trying to drag the finger back by trying to flex the last joint in the finger.
- Concentric and Eccentric contractions
- For this exercise, I chose something everyone has access to. Here your goal is to use your newfound muscle memory and develop your endurance. Start with some fingernail clippers and then move on to something that will give you more resistance such as a foam ball. Squeeze the clippers together as slowly as you can without losing control of the joint, then open up again as slowly as you can. Use the same technique as above trying to bend at the furthest joint in the finger and use your fingertip rather than the pad of the finger.
Tips for Music Teachers
If you are a music teacher then I ask that you screen your students for the issues mentioned above.
- Look for the palmaris tendon. The absence of one shouldn’t mean the end of your students’ musical dreams. Rather it means they will have to spend more time than usual strengthening and coaching the wrists and fingers.
- Look at the strength of the wrists. If your student’s wrist keeps collapsing it may be best to pause the practical music lesson and start strengthening the wrist muscles. The exercises listed in this article should give you a generalised idea of what to do.
- My cello teacher would take the sheet music away from me the moment she realised I was playing from memory and not sight-reading. It’s the same principle, never give the bad habit room to develop.
- Look at the strength of each finger in the hand. Does one finger generate less power than the others? Does one finger already collapse? Does the whole hand and wrist try to move when just one finger is supposed to move? This could be a sign that they are at risk and may need to put extra effort into their hand strengthening.
- Watch what part of the finger your student uses to push down the string. Pushing down with the pad of the finger can leave them vulnerable to collapse. Instead, coach them to press the string with the tip of the finger while at the same time trying to bend the last joint of the finger as if they were trying to pull on the string.
Exercise Program
Preventative medicine – Much better than the cure – The violin/cello warm up checklist
I would recommend you do this as a dedicated exercise BEFORE you practice and as a warm up if you are getting ready to play for real.
- Self massage
- Flexor muscle group -2 minutes (Palm Down)
- Extensor muscle group -2 minute (Palm up)
- Muscles of the palm – 2 minutes – I sometimes use the tip of the waist of my cello to press into the muscles of the palm.
- Another self massage that can assist in any pain is shown in this picture below. You can use a cream such as fisiocrem or Voltaren and massage into the identified pain area until the cream is absorbed into the skin
- Wrist static exercises – A “Wake up call” to your wrist
- Warm up: For 1 minute place your hands on top of each other with an open palm. Push the hands into each other while keeping them rigid.
- A dedicated exercise: 5 minutes with a heavy weight – can be done while you read over your sheet music. Hold the wrist palm up for 2.5 minutes and palm down for 2.5 minutes. Make sure to keep the wrist set in neutral and the fingers as relaxed as possible around the weight. Rest for a moment then spend 1 minute holding your hand in its playing position with the weight in your hand.
- Wrist concentric and eccentric strengthening with a weight, stretch band, grip trainer, etc – as slow as you can.
- As a warm up: 1 set of 10
- As a dedicated exercise: 4 sets of 10
- Static finger strengthening (I just pinch the side of my cello)
- As a warm up: one 90 second static hold. Try to touch the string with the tip of your finger and try to curl it a little to keep the arch of the finger.
- As a dedicated exercise: 4 x 90 second holds
- Concentric and eccentric contractions of the fingers (you can use
anything from nail clippers to a foam ball or a rubber band, as long as the
pushing of the little finger remains the same).
- As a warm up: 1 set of 10 as slowly as you can
- As a dedicated exercise:
When you have completed the warm up list then start your actual playing warm up (scales etc). Pay special note of your fingers position while you play your scales and work on applying what you have learned.
It takes only 2 weeks of effort to make a measurable change in how you are moving. If you are still struggling to gain control of your hand within this time, you should then talk to a professional.
If you have any questions or would like to know more about the equipment you can use feel free to contact Casey Allied Health at daniel.carner@caseyalliedhealth.com.au
Wishing you the best hand health
Daniel Carner
Musculoskeletal Therapist
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