The information presented here is not intended as a substitute for professional medical care, nor it is to be considered professional advice for a particular individual. Please seek professional care before under going any treatment. If you have a serious condition or a condition which has failed to improve in two to three weeks, you should seek professional health care.

 

Types of Injury
There are essentially two types of drumming injuries which can occur. These include:

1) Over-use injury - continual impact, muscular contraction and gravitational force leading to an over-load of the tissues creating inflammation. Although inflammation is the body's way of healing, it can lead to altered motion, swelling and pain.

2) Traumatic injury - drummers encounter many sources of traumatic injury, which are sudden, single event accidents. These can include, drum stick breakage and fragment impact, knuckle impact, strains and sprains, trips and falls.
 

TENDONITIS            TENDONOSIS     
Tendonitis is a term which is used to described an "inflammation" of the tendon and its covering/sheath. Recent research has shown however that "tendonitis" conditions are not really an inflammation at all (examination of tissue samples at the injury site fails to reveal any inflammatory cells. A more proper term suggested is Tendonosis). However, the term tendonitis has stuck and it has come to be know as an inflammatory condition.  The general thinking is this:

When the tendon and its covering are irritated, overloaded or frankly damaged, the tissues swell up to begin the process of healing. (Inflammation is the bodies method of healing, and it is an all or nothing response). If the swelling constricts the motion of the tendon through its sheath, pain and loss of motion occur. At the same time, fluids and tissue cells and debris build up in the area. This can lead to further irritation.

How to Avoid Tendonitis Type Conditions:
Thorough warm up and stretching on a regular basis combined with good mechanical technique and general physical conditioning will go a long way to avoiding tendonitis type conditions. Overuse and over-exertion should be avoided.

Treatment:
The treatment of tendonitis type conditions depends on the severity and the duration of the condition. If the pain has been felt just recently (Acute) for the first time, it is essential that you:
1) Stop playing as soon as possible.
2) Ice the area effected for 7 to 10 minutes until the area is numb.
3) Rest the area for only 24 to 48 hours and then begin
Early Controlled Motion.

Long standing (Chronic) conditions are much more difficult to treat. Patience and consistent treatment is required. Treatment may include:
1) Active rest. This involves limited use of the effected body part, while using non effected body parts. Cross training is a similar term.  This allows decreased risk of further irritation of the effected part, while increasing the conditioning of non-effected parts.

2) Specific physiotherapy modalities to increase the local metabolism and increase blood flow to the effected area. Modalities such as moist heat, ultrasound, cold laser and electrical stimulation may be used. (Note: none of these modalities is a Cure a problem. They may be used as part of an overall treatment plan)

3) Limited use of anti-inflammatory medications. These have some positive effects early on in acute cases, however they have unwanted direct effects ("side-effects"). The risk of internal injury with prolonged use of these medications may not worth the slight possible benefit.

4) Controlled Motion, including stretching, mobilization and manipulation of the joints surrounding the effects parts. Controlled motion creates positive reflexes which enhance the bodies ability to move while decreasing pain. Controlled motion also enhances the quality of the healing process, leading to a stronger more flexible injury site.

ELBOW EPICONDYLITIS
The elbow has a bony process on the inside or medial region and on the outside or lateral region. This region comes under great stress from due to the action of the tendons and fascia which pass on or near the area.  If the area becomes inflamed it may not fully resolve.  In this case a chronic elbow pain can result.  If the area becomes chronically involved seek treatment from a qualified provider. 

Poor mechanics and technique can contribute to elbow epicondyle pain. Poor mechanics while playing can place lateral or sideways stresses into the elbows. Using too much elbow force and too little rebound can over-load the muscles and tendons in the arms. Stretching the forearms and wrists prior to playing can help prevent elbow and arm trouble. Icing sore and overworked joints can also lessen the chance of the problem becoming chronic.

Treatments of value may include heat, friction massage, joint mobilization and manipulation, ice, specific stretching and exercises or ultrasound therapy.  Cortisone injections are controversial in the treatment of epicondylitis. Oral anti-inflammatory medications may prove ineffective as once again; edicondylitis is often not associated with an actual "inflammatory" process.

NEURITIS: 
Irritation, (subtle or frank compression of a peripheral nerve) or infection along a nerve can create a condition where the nerve tissue becomes "excitable".  If this occurs, pain and loss or distortion of sensation, taste, sight, smelling (olfaction) or hearing can occur. In drummers brachial neuritis (in the arm/wrists) can occur creating pain or altered sensation in the wrists, fingers, elbow shoulder or neck.  Proper symmetrical technique, good ergonomics and warm up can limit irritation of the peripheral nerves in the arms, hands and fingers. Neuritis is classified generally by the nerve effected and the cause (if known). Long standing or severe cases require diagnostic work up by your physician. As there are some systemic illnesses which cause neuritis or neuritis-like pain, diagnostic testing including blood labs, MRI or CT Scan and electrodignostic studies may be required to better determine the causation of the neuritis.

 

CARPEL TUNNEL SYNDROME
Within the wrist pass the nerves, arteries and veins which control and feed the hand and fingers. There is an anatomical tunnel on the underside (palmar surface) of the wrist through which the median nerve passes. The median nerve controls motion and carries sensation to the thumb and 2nd finger. It is important to remember that the nerve pathway begins at the neck and passes into the arm through the thoracic inlet.  (compression of the neurovacular bundle in the inlet is referred to as thoracic outlet syndrome) The health of any of the nerves which supply the arms and hands is dependant upon uncompromised function through the entire length of the nerve.  Compromise by subtle compression due to inflammation or hypertension of the musculature can occur in the neck, the shoulder the elbow the forearm or the wrist.  For this reason, many professionals prefer to treat the entire nerve pathway if it is found that there may be areas of compromise. 

Proper stretching of the wrist, forearms, fingers, shoulders and neck can help to lessen the possibility of carpel tunnel like conditions.  Such stretches are also critical in the proper treatment of these conditions.

SPRAINS: 
Sprains refer to the tearing or over stressing of the ligaments of the body. The classic example is a sprained ankle. In a sprained ankle the ankle rolls over, forcing the ligaments on the outside of the ankle well beyond their usual range of motion. If this occurs the ligament tears. The down side to this is that ligament and the soft tissues of the musculo-skeletal system heal with scar tissue. Scar tissue is less elastic and more pain sensitive than the tissue it replaced. (Bone on the other hand heals with bone. That is why it is often said that it is better to break a bone than sprain a ligament) Use of ice as soon as possible after a sprain is critical and can cut the healing time by as much as 50%!

Many of the same principles used to treat muscle strains are used to treat sprained ligaments. A severe sprain however may require a short period of complete immobility followed by the introduction of early controlled motion.

See Treatment Section  
Also see:
Self Help Guide
 

STRAINS
Strains refer to soft tissue injuries to tissues other than the ligaments. Muscles, tendons and fascia are examples of soft tissues which be strained. In a muscle a strain is often referred to as a "Pull".  In actuality, a strain represents a tearing of the soft tissue or muscle. This tearing of the muscle can occur to as little as a few muscles fibers or may be a complete tear of a muscle. As with many soft tissue injuries, strains can be prevented by proper condition, stretching and nutrition. 

A large muscle tear can occur when a muscle is overloaded of activated when the muscle is in a "rest phase". A sudden high intensity load on the muscle while it is at rest or caught off guard can easily overload a muscle. A large muscle tear is often accompanied by a sensation of tearing or popping. Sometimes people even report hearing a muscle tear! A large tear will usually present with an area of apparent bruising. This occurs as the muscle bleeds internally and the iron in the blood oxidizes (rusts!) turning blue, yellow and black. The area can swell and will usually become still and painful.

If you have sustained a muscle strain, ice the area at once for 7 to 10 minutes until numb. Use ice over the next 2 days 3 or 4 times per day.  Ice helps lessen swelling and blooding and speeds recovery time.  During the healing process, collagen fibers are deposited by the body into the injured area. These collagen fibers form scar tissue within the injured area. By it's nature, scar tissue within the healing muscle is more pain sensitive and less elastic than the muscle tissue it has replaced. Slow and gradual range of motion exercises and Early Controlled Motion helps strengthen the muscle fibers in the muscle and allows collagen fibers (scar tissue) to lay down in a more linear and functional fashion. Immobility by contrast creates scar tissue which is less organized and more pain sensitive and less flexible. Early controlled motion allows for the best possible healing.  Depending on the extent of the injury you may require professional evaluation of the condition.

See Treatment Section

 

LOWER BACK PAIN
Lower back pain has been called an epidemic in the United States and the Western world. There are a great many causes of lower back pain. Unfortunately, the true source of the pain is often never identified. This can leave patients and doctors who treat lower back pain frustrated. Long standing lower back pain, pain which began following an accident or injury, pain associated with leg pain and loss of sensation, pain associated with changes in bowel and bladder function, pain with systemic illness or loss of weight should all be evaluated by your health care provider, as these can be related to severe conditions.

While it is impossible to discuss all of the possible causes of lower back pain, it is possible to discuss several things which can be done to help prevent and treat some common causes of lower back pain.

1) Maintain the lumbar curvature. (Keep the curve in your lower back by sitting tall) Proper positioning is critical.  Try to limit slouching and bending forward as this places greater stress on the tissues of the lower back.

2) Keep the lower back and abdominal muscles well conditioned.

3) Stretch your gluteal muscles, hamstrings and lower back.  If you already have back pain you may well benefit from professional help in this area.

4) If you feel pain stop what you are doing.  Ice the area at once. Rest only for a day or so, but get moving as soon as possible.  Walking a short distance helps stave off deconditioning and helps ease pain.

5) If your pain fails to improve within a few days OR if you have:
- Significant leg pain
- Loss of bowel/bladder control
- Fever
- Unexplained weight loss
- Loss of muscle strength, numbness or tingling


you should seek professional health care at once.

See Treatment Section

Also see: Self Help Guide

NECK PAIN
The neck contains a remarkable series of joints. It offers great range of motion, while protecting the delicate spinal cord and blood supplies to the brain. Unfortunately, it seldom receives much attention until it is injured or sore.

Neck pain is often more easily diagnosed accurately than is lower back pain. This is due to its superficial anatomical orientation and it less imposing soft tissue size.  Neck injuries can however lead to arm and hand pain, headaches and other severe conditions.  As with all health conditions, it is important to seek care if the pain fails to go away after you have followed proper rest and ice instructions.

For drummers, neck injuries and pain often occurs due to over-use from postural stresses or due to frank spraining or straining of the tissues of the neck. Good posture while drumming will help limit the forces which can over-load the tissues of the neck region. Make sure that you are seated at a height which allows you to maintain the lower back curvature. This allows your head to be more efficiently balanced over your shoulders.

 
              RIGHT                                           WRONG

              

If your pain fails to improve within a few days OR if you have significant arm or hand pain you should seek professional health care at once.

 

BLISTERS AND HAND PAIN:
Selection of drum stick size and weight should not be considered finding a stick "large enough to do the job!" I have found that many drummers select their stick size in order to produce volume, with little attention to what size stick is most appropriate for their hand/finger/arm size. Finding the right stick isn't about trying to create volume; it is about finding a stick you can control. It is about finding a stick which fits your hand/finger size.

Good stick selection is can go a long way to preventing hand pain and blistering. If the stick is too small or too large for your hand you will be forced into altering your grip.  Remember, the grip should be light and not a strangle hold.

Good technique is also very important in avoiding hand pain while drumming. Playing "through" the drums is another common mistake I see. The drummer may play too hard and lose the physical energy of drum head rebound. Good technique teaches us to USE rebound to create speed and volume. Playing "through" the drum or striking too deeply will only increase stress on your hands and decrease your use of rebound energy.

High quality sticks are another important factor when trying to deal with hand pain and blisters. I have found that different stick models made by the same manufacturer have different abilities to dissipate energy away from your hands. Once you find the stick sizes you prefer, try that similar size made by a different manufacturer. You will no doubt find, as I have, that some stick sizes and shapes have more vibration or "buzz". Ideally, find a stick which helps dampen buzz and impact energy.

Here I go again about Regal Tip sticks. Although they are not alone in producing high quality sticks, Regal Tip tends to use high quality wood stock with tight grain. This helps them produce sticks which can aid in reducing stick vibration.

Blisters can and will occur if you suddenly introduce more drumming per day than your hands are ready for. This can happen after a lay off or when preparing for a new project. When possible try to slowly increase playing time. Blisters are actually a natural (and required) response to the friction generated while playing.

If (and when) blisters occur, some feel it is best to drain the blister using sterile techniques. Runners and hikers do this quite often when blisters surface on the feet. This should be done only after sterilizing the skin and a needle. Only one small pin prick at the edge of the blister should be used to drain the blister. Re-sterilize the area and cover with a bandage for 12 hours.
(This is not a recommendation to do so. Seek advise from your doctor prior to performing any treatment for your blisters.)

As the blisters fade, calluses will form. A callus is a thickening of the skin at the high friction points. It acts as an insulator, protecting the skin from the friction and heat developed. A callus can however be "good" or "bad". A good callus maintains a healthy lubricated layer of skin and is not painful. A "bad" callus however can crack, causing painful openings similar to cuts. If you are getting cracks on the callus, several things may be happening.

1) Your technique is generating too much friction the callus is being over stressed. The skin is breaking down and the skin is drying. This will lead to cracking.

2) Your hands are dry. While working your hands into shape, use hand lotion after washing and drying your hands.

3) You developed blisters and the resulting callus while using a stick which was not balanced for your hand. You are working too hard to control the stick. This leads to the same overload mentioned above. Do some research and try other stick makes and sizes.

Hand pain can also be aided and possibly lessened by building up slowly. Do not perform long rehearsal or practice sessions right off the bat. Take your time and build up your playing time AND intensity. Just like an athlete preparing for a big game or event. Build up each day adding a few minutes at a time and slowly add more intensity. I do not recommend rehearsing or practicing continuously for more than 90 minutes. You risk over-use injury as the tendons, ligaments and muscles become over taxed and micro-trauma begins. During breaks, do a few stretches, drink some water and take a walk to cool off.

TREATMENT CONSIDERATIONS
While it is always best to avoid injury, properly treating an injury once it has occurred is equally important.  For sprains, strains and overuse injuries, the following should be done as soon as possible:

1) Stop Playing if Possible.
 While rest alone will not heal the injury, it is important to prevent further damage to the injury.  If you need to complete a set or several day stretch of shows, MAKE SURE that you do the following:

2) Ice the Area.
 Early use of ice to a sprained ligament or strained muscle can cut healing time by as much as 50%.  Ice massage is effective as is an ice water immersion of the injured part if possible (ankles, wrists, fingers, elbows).  If you are using ice massage (Styrofoam cup filled with water and frozen) or an ice pack, make sure that you ice UNTIL THE AREA IS NUMB.  This takes about 7 to 10 minutes.  Do not ice less or more than this.  The goal is to decrease swelling and decrease pain. 

Ice 3 or 4 times per day over the first 48 hours. 

If using an ice pack, use a thin towel between your skin and the ice pack. (a T-shirt thickness works well) This helps prevent the possibility of frostbite or chilblains.
(
Chilblains is inflammation of the small blood vessels in the skin in response to cold but above-freezing temperatures)

*Note: Use of ice can be painful over the first few minutes, especially to the wrist and elbow (the nerves are near the surface). Such pain is normal and will decrease over the next few minutes. Icing will feel cold, then burning, then achy and finally the area will feel...numb. Stop at when the skin feels slightly numb; about 7 to 10 minutes.

3) Use Compression, Elevation and Early Controlled Gentle Motion.  Using a wrist wrap or ankle wrap can decrease swelling, however; use wraps only if you need to keep playing during the first few days following an injury. 

Elevating a body part above heart level can help decrease swelling.

After an injury the goal is to improve the quality of the healing by using "early controlled motion".  This means safe, slow and gentle motion which moves the joints and muscles through their normal range of motion.  Such motion enhances the healing of the area by decreasing swelling, improving the quality of the new tissue and enhancing blood flow to the area.

As an example; with a mild ankle sprain, ice, elevate and compress for the first 24 hours. Then gently and slowly start moving the ankle up and down in an elevated, non-weight bearing position.

4) Treat Pain and Injuries Promptly. This is very important as minor problems can become major ones if neglected. For more information on treatment after an injury see Self Help Guide. It goes without saying, never ignore a problem in the hopes that "it just go away." These are famous last words. It is always best to take care of a minor problem before it escalates.

 



Copyright ©2013  Dr. Daniel Buch. Last Update January, 28 2013
Daniel Buch, BS, DC, QME
All content is the original work of Daniel Buch.