Musician's Nightmare

A diagnosis of Carpal Tunnel Syndrome or any repetitive strain injury of the arm
and hand muscles is a musicians worst nightmare. No musician wants to think
that their career may be over or limited. Without them, one can not hear or feel
the rhythmic sounds and vibrations of a drum, strumming a guitar, touching the
keys of a piano, playing the flute or hold the bow on the strings of a violin. The
Hands are the most important instruments a musician has.
What is Carpal Tunnel Syndrome (CTS)?
Carpal Tunnel Syndrome is the entrapment and compression of the medium
nerve due to the over-use and over-strain of the muscles of the neck, shoulder,
arm, forearm, wrist and hand. The median nerve, the nerve that goes through the
carpal tunnel, originates in the neck, descends down through the shoulder joint,
through the elbow joint and
through the wrist joint (carpal tunnel) and ends in the hand. It is the constant
repetitive use of the muscles that will cause a misalignment of the bones that in
turn reduces the functional integrity of the nerves, causing a loss of muscle
strength. I also must preface that other nerves, the ulnar and radial nerves
eventually become involved. It is the total movement of the upper body and
extremity that affects the wrist and hand.
Have you ever experienced numbness in your arm or hand after playing
a long piece of music because you hyperextend or hyperflex your wrist; had to
hold on to drum sticks firmly, constant time keeping on drum heads, cymbals and
heavy rim shots; or had pain at the elbow joint? If so, you may have experienced
Carpal Tunnel Syndrome and other muscular problems due to the repetitive
strain of the muscles.
This is the Musician Athlete. Using their arms instead of their legs to run with.
You run with your arms!
First I want to state: there is NO CURE for Carpal Tunnel Syndrome or any
muscular skeletal disorder. There is only Body Maintenance. A cure implies that
it will never reoccur again. The body is not a robot. It is meant to move and
because it does repeatedly move, it will again develop sore muscles. To insure
that the symptoms of RSI/CTS do not reappear, a preventive and self-care
program any individual can incorporate into their daily lifestyle and schedule is
recommended. Simple and easy exercises performed everyday to warm-up the
body, stretch, align the structure and bring the muscles back into balance and
free of pain is part of the program. The body moves in and out of balance daily
due to the mental and physical stress of normal activities. The inception and
growth of the computer age brought repetitive strain injury to the forefront. The
musician has been living with this occupational hazard since the inception of the
first musical instrument.

The key to preventing Carpal Tunnel Syndrome (CTS) or any muscular-skeletal

strain of the wrist and hand is correct postural position of the body within the
limits of the playing position of the instrument. And learning how to prepare the
body's muscles before, between sets and after playing to maintain this balance
and harmony.
The goal of any person is to have a productive body and that can only be
obtained through regular body maintenance. CTS is the first muscular-skeletal
injury to come around that is addressing the muscles. The number one muscularskeletal injury in this country is low back problems. But we can still function with
this injury. But we cannot function without the use of our hands. With the advent
of the computer age, more and more people are developing hand and wrist
problems and it is crippling their lives. As most musicians know, the loss of your
hands is fatal to your career. But that does not have to be. There is a solution.
The old saying, "Treat your body like a temple" is the truest statement in this
case. You should treat your body like your most expensive possession, make
sure it runs well, has no aches and pains to slow you down and it will continue to
perform at its highest level. The body needs rest and relaxation but it demands
maintenance care.
A musician whether he writes songs, or plays an instrument, requires the use of
his/her hands and is at risk of developing Carpal Tunnel Syndrome. This is the
disease of the '90's that has affected every person who works at a high risk
repetitive occupation and it has become an epidemic! The Bureau of Labor
Statistics reported, "1 million of 2.3 million nonfatal occupational injuries and
illnesses in 1992 resulted in days away from work involving sprains and strains."
"Of those 1 million injuries, the government said about 280,000 in 1992 involved
cumulative trauma disorders to the upper extremities like wrists, shoulders or
elbows." One CTS claim can cost as much as $30,000 to 100,000.
A musician spends hours a day practicing on an instrument, then goes and plays
at night. More hours are spent holding the muscles of the arms and hands in
contracture and in constant motion. The muscles of the arms and hands are
working just as hard as if they were running a marathon. The musician depends
on the arms and hands to be strong, flexible and relaxed to enable him/her to
play as fast or as slow as the musical piece demands.
The musician must hold the position of the instrument for a number of hours,
which can cause the muscles to contract, feel tight, stiff, and put stress on the
joints of the neck, shoulder, arm and hand. If the muscles are tired and sore from
overuse, they will fatigue and develop spasms or trigger points (hyper-sensitive
areas in a muscle that will not let the muscle fibers lengthen, and this has a pain
referral pattern. These areas are very tender to touch.)
Correct posture, structural and neural alignment (chiropractic care, if needed),
and most important, therapeutic massage to maintain healthy muscles, free of

pain. Correcting the cause of the situation prevents symptoms such as tendinitis
(tennis elbow), shoulder problems, and nerve damage from developing into
future problems. I must add that using splints or wrist and elbow wraps are
crutches and only act as temporary solutions to the problem. Taping the wrist too
tight can cut off blood circulation to the hand which could be detrimental to grip
strength. Using wrist splints can cause atrophy of the muscles and decrease the
flexibility of the wrist (picture of nerve pathway) Surgical procedures that cut
ligaments and tendons, which we do need for the support of our joints, are also
temporary because they are dealing with the symptoms and not the cause. The
pain will return. Only in cases of a tumor, degeneration of the bones of the hand
or cysts, is surgery an option. If continual pain does persist after trying every
option, don't hesitate to consult with your physician.
Eventually, over a period of months to years, the symptoms of CTS or repetitive
strain begin to show or reappear.
The Signs and Symptoms of Carpal Tunnel Syndrome are:
1. Loss of sense of touch.
2. Tingling and numbness in the fingers and hand.
3. Pain at night in the shoulder while sleeping.
4. Pain in the elbow joint.
5. Swelling in the wrist area.
6. Loss of strength in the hand.
7. Pain in the wrist joint when the wrist joint is in hyper extension (wrist bent,
fingers pointing to the ground, or hyperflexion (wrist bent, fingers pointing to the
sky.)
8. Increased occurrence of dropping objects.
9. In extreme cases, atrophy of the thumb and finger muscles in the hand.
(Atrophy is the tightening and shrinking of the muscles which decreases
movement and flexibility.)
10. Tendinitis in the elbow or wrist area. Has the pain started to move upper from
the hand to the elbow, shoulder?
11. Have you ever fallen and jammed your wrist, fingers, and felt it later in the
elbow or shoulder joint?

For a musician this is catastrophic. As a sports massage therapist, I would like to

share my solution to this problem. I have worked with a number of musicians, all
who play a variety of instruments. They all had two things in common, the
muscular grip strength in the hand muscles were diminished, neural integrity was
compromised, and the muscles were extremely sore and in pain. Once they
learned a program of self-correction of the elbow and wrist joints, and received
massage therapy, and chiropractic care, if needed, their grip strength returned
and the muscles were healthy again, light, supple and free of pain. They were
able to play with ease and power. Also remember if there has been any trauma
to the neck or shoulder area, this can be a sight of contention to the nerve
integrity through that pathway.
How can you determine if you have Carpal Tunnel Syndrome? Through the use
of applied kinesiology techniques (muscle monitoring), you can
determine the muscular strength of the muscles that are responsible for the grip
of the hand and if there is a misalignment of the elbow, wrist and hand bones.
Applied Kinesiology it is a system of evaluation to increase the performance of
the body. It is a unique tool used in the healing arts to accentuate recovery. As a
massage therapist, I seek to reestablish balance and harmony in the muscles of
the body.
Monitoring procedure:
Step 1. Palm side-up, place the pads of your thumb and little finger
together and have a friend try to pull the thumb and little finger apart. (Try and
hold the thumb and little finger together as hard as you can.)
Step 2. Palm side-down, place the pads of your thumb and little finger together
and have a friend try to pull the thumb and little finger apart.
In both tests, if the fingers part easily, you may have a misalignment of the bones
in the elbow and wrist joints which create the loss of strength of the muscles of
the hand and nerve integrity. You should be able to effortlessly hold the thumb
and little finger together without straining to do so.
Correction can be very simple in most cases and SURGERY CAN BE AVOIDED.
This is a postural, structural and muscular problem not a surgical one. In my
practice as a sports massage therapist, almost everyone I have tested has a
repetitive strain syndrome in one form or another. From the neck to the hand.
The types of syndromes are cervical radiculopathy, thoracic outlet syndrome,
pronator syndrome, cubital tunnel syndrome, carpal tunnel syndrome, and distal
ulnar neuropathy. It does not seem to matter whether you are typing at a
computer, hammering nails or playing an instrument. Any constant over-use and
strain of the muscles will cause stress on these joints and create a misalignment
of the bones and loss of muscular strength in the hand.

However, once determined, you can correct the structural misalignment, relieve
stress on the joints, restore vital energy and neural sensation, rebuild strength in
your hand, and relieve or prevent carpal tunnel syndrome and other forms of
diagnosed repetitive strain.
The Montgomery Method
Over the last 10 years I have developed a system of self-correction and release
of the muscles of the body. You will learn how to perform simple and easy
techniques for the alignment of the elbow joint and wrist. Self-massage for the
arm muscle to remove painful trigger points. There is a line of protocol for
keeping the body in balance.
Step One: POSTURE. This is the most important step to start with. Bad posture
leads to a life of pain! Correct the alignment of the structure. In many cases you
may need to see a Chiropractor versed in applied kinesiology to make sure the
spine is stabilized. This insures structural and neural integrity. Past car accidents,
traumas to the body, whiplash all impede the transmission of the nervous
system, which gives you the muscular strength needed to play an instrument. I
also want to say, in today's fast pace lifestyle and the high costs of health care,
we can not live in our doctors offices. By learning a program of techniques that
you can do with a minimal amount of time, you can save yourself many doctor
visits and avoid unnecessary surgery. In eighty percent of the clients I see, many
have the elbow joint out of alignment. By performing a self-care program of
aligning your own elbow joint, (forward and lateral
alignment of the elbow joint), you can increase neural integrity and regain muscle
strength within seconds.
Step Two: MUSCLE THERAPY. The KEY to preventing any repetitive strain
injury is to keep the muscles free of pain and tension. This can only be
accomplished by massage therapy. Eliminate the trigger points in the muscles
that cause pain and spasm, followed by strokes that spread and open the muscle
fibers. This will increase the circulation of blood, oxygen and nutrition to begin the
healing process of the muscles and rid them of pain. Everyone should receive a
regular Therapeutic Massage once a week or at least twice a month. It is your
muscles that are in pain. This is the best way I know to relieve mental and
physical stress and to keep you active, functioning and free of pain. If you want to
play faster like you once did 5,10 or even 20 years ago, you will invest in your
body.
Step Three: STRETCHING AND RANGE OF MOTION is necessary to maintain
a flexible and mobile body free of pain.
Step Four: NEUROLYMPHATIC MASSAGE: Rubbing reflex points called
neurolymphatic reflex points can detoxify and rid the muscles of metabolic

wastes that cause soreness, fatigued and pain. This will allow the muscles to
regain their strength and resilience and leave the pain behind.
Step Five: ACUPRESSURE is a way of restoring the vital energy to an area that
has been traumatized. By rubbing specific points for the arms and hands, that
can be accomplished. Acupuncture is a wonderful therapy to rid the body of pain
but to also harmonize it so a disease process can not begin.
Everyone Should Warm-Up
Simple Warm-Up Exercises
1. Shoulders, Chest and Elbow Stretch
This stretch opens up the chest and shoulder area. An added benefit is the
extension of the elbow joint that helps in the realignment process. *Only stretch
as far as it is comfortable.
Standing, clasp, and interlace fingers together behind the back, palms toward
back. Straighten the arms and elbows and stretch the arms up toward the sky
and away from the back. Perform this slowly and hold the stretch for a ten
second count. Relax and breathe slowly and deeply. Repeat this stretch as often
as needed, especially if you find yourself slumping or rolling your shoulders
foreword. If you play guitar, keyboard, fiddle, bass fiddle, or any instrument that
rounds your shoulders, you need to do this stretch.
2. Upper Back Stretch
Standing or seated. Clasp hands together in front of you. Inhale. Then exhale as
you extend arms out in front of you at chest level. Exhale as you stretch forward,
sinking the chest inward and rounding the shoulders forward (Imagine the chest
caving in). Hold stretch for a ten second count. Breathe slowly and deeply.
Inhale, releasing the hands and drawing the shoulders back and down. Repeat
two-five times. This feels so good when the upper back is tired. **After
performing this stretch, repeat stretch #1.
RANGE OF MOTION (ROM) EXERCISES AND STRETCHES FOR THE
HANDS.
Begin the day with these warm-up ROM exercises. They can be performed
anytime and anywhere.
1. Hand Circles: Clockwise and counterclockwise circles. five times each
direction.
2. Fist Clinches: Open and close your fists rapidly five times.

3. Wrist Bends: Stretch the wrists forward and backward. Hold for a four second
count in each direction. Use the opposite hand to help perform the exercise.
4. Finger Bends: Stretch fingers forward and backward., one at a time. Hold for a
one-two second count. Use the opposite hand to help perform the exercise.
5. Finger Rotations: Rotate the fingers clockwise and counterclockwise. Use the
opposite hand to help perform the exercise.
6. Finger Pulls: Pull gently on the fingers, grasping the finger joint closest to the
hand.
7. Hand Shakes: Shake hands gently.
8. Finger Spread: Spread your fingers wide apart and stretch fingers outward.
9. Finger Pinch: Pinch the ends of the fingers, firmly for one second count..
Stimulates the energy in six meridians in the Chinese Acupuncture system.
(Lung, Heart, Large Intestine, Small Intestine, Triple Heater & Pericardium.)
10 Palm Rub: Rub the palm s together rapidly for a friction rub. Then massage
the hands and fingers. A good way to increase circulation. This feels great!
Prevention and Body Maintenance are the keys to strong and stable joints. By
performing simple corrections before, after the second set, and the last set, you
are continually restoring proper alignment, nerve conductivity and strength to the
muscles. Weekly massage, along with daily strengthening and range of motion
exercises and stretches for the joints of the neck, back, shoulders, elbows, wrists
and hands will enable you to maintain structural and muscular balance.
I have put together a Twelve Step Corrective formula that is easy to perform and
incorporate into your daily routine and life. We all use our hands and this
epidemic is something that can be avoided only if you start learning how to
perform body maintenance therapies on your
body. Exercise and proper nutrition keep the body strong and fueled. But the
oiling, lubing and flushing of the body is another part of the maintenance routine.
A healthy, long lasting body is well taken care of both internally as well as
externally. Then and only then does the Body remain young, resilient, full of life
and able to enjoy life without pain.
*If continued problems of numbness or pain persist, consult with a
chiropractor versed in applied kinesiology and a certified massage therapist, to
assist the muscle release needed to take stress off the
skeletal structure. The stability of the skeletal structure and relief of
muscle spasms and tension is a must .

TESTIMONIALS
"With the current health trend of visiting local gymnasiums and being invaded by
commercial television to get some other device to improve your abs, it's
extraordinary that the one part of your body that you rely on to work and
communicate with is taken so much for granted. Until something goes wrong!
Regardless in which capacity you use your hands, whether it be punching stuff
into a lap-top or being a concert pianist, you'd do well to put Kate Montgomery's
program at the top of your health regime. Assuming, of course, that you have
one." Very kind regards Kate, Thanks for steering me the right way"
- Keith Emerson (Emerson, Lake and Palmer)
Keyboards
I recently saw Keith perform while on tour with Jethro Tull. This was his first time
touring in 3 years since his surgery. His first words when greeted by a thundering
applause, "I'm Back!" It was a treat for me to see a master perform with pure
love.
"...Thanks for taking the time at NAMM to show me what I was doing and help
me on the way to improved health and well being. The well being comes from the
fact that I can again do what I love. Playing the steel guitar and entertaining was
becoming a chore, that my mind started to dread. Now its pure joy. I've even
started playing banjo, guitar, bass, and dobro again now that my hands are no
longer aching. The Montgomery Method has helped me and I am teaching it to all
my students and at seminars that I teach the steel guitar.
Thanks Kate.
Joe Wright
Steel Guitar
"If you can imagine a whole year of dealing with increasing pain,
able to do less and less, and terribly anxious about not being able
to continue my career in music, the relief, and the new hope that
this pain-free state engendered, was very dramatic. I felt
overwhelmed with gratitude toward this knowledge woman. I have
learned the reasons for the pain, and that knowledge has strengthened
my resolve to take the corrective healing measures which Kate has
taught me. It all makes sense-and Kate is showing me the way!"
Sheila Sterling
Principle Harpist, San Diego Symphony
and San Diego Opera for 25 years
"As a professional drummer, I became unable to play without wrist
braces. Before meeting Kate Montgomery, I tried several different
medical approaches. After just one visit to Kate, I was able to
resume playing comfortably and my wrists were pain-free! As a

professional drummer, my hands are my most valuable asset. Thanks to

Kate Montgomery, I'll never suffer from wrist pain ever again!"
Tyler Buckley
Professional Drummer
San Diego, California
"Having been a big band drummer for over 50 years, the trauma
received from constant timekeeping on drum heads, cymbals, and
especially from heavy rim shots, created a pain in my hands and
wrists. Kate's carpal tunnel self-corrective exercises have
eliminated the pain and discomfort immediately. These can be done in
just a few seconds, even while sitting on the bandstand. My hands are
always strong and playing is effortless now!"
Jim Jaenicke
Big Band Drummer, Chicago 15
San Diego, California.