My Comeback from a Rotator Cuff Injury
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One fine fall day a year and a half ago I fell while walking on the sidewalk. One small misstep can have major, long-lasting effects. After I fell, my left shoulder was in extreme pain and I could not move my left arm. My first thought was “Will this prevent me from playing my violin?”
As soon as possible, I went to see my orthopedist. He told me that I had injured my left shoulder rotator cuff, but not too severely. I had not torn any tendons, just inflamed them. He recommended rest and then physical therapy. He told me that I could take physical therapy at his office, and I told him that I would search Youtube for gentle, beginning exercises for my injury. To my surprise, he said, “That’s a great idea.” This assessment of my injury didn’t sound too bad. However, my shoulder told me otherwise. I was surprised by the intensity of the pain and by how long it took for me to regain the use of my left arm.
I searched Youtube for gentle exercises to do just after a shoulder injury and I found some good ones (https://youtu.be/6u8QpNmQy_g, by Dr. Jo). I did them regularly and I slowly began to regain the use of my left arm. While searching Youtube for exercises, I also Googled rotator cuff injuries and the anatomy of the shoulder.
The shoulder is a complex and unusual joint. It has greater mobility than any other joint in the body because of the way it is constructed.
The shoulder is comprised of three bones, the clavicle (collar bone), humerus (upper arm bone), and scapula (shoulder blade). The humerus and scapula meet in a ball and socket joint. The ball is very large and the socket is smaller and almost flat. The joint, therefore, is extremely mobile but not very stable. It has been compared to a golf ball sitting, delicately balanced, on a tee. In exchange for its structural instability the shoulder joint has extreme mobility. Because of its low inherent stability, the shoulder joint needs to be stabilized by muscles and ligaments. Four muscles connect the scapula to the humerus, and these muscles and their associated ligaments and tendons make up the rotator cuff. In addition to these four muscles, there are about 20 muscles attached to the scapula and these muscles also help stabilize the shoulder. That is a lot of muscles to exercise after a shoulder injury.
To fully appreciate the mobility and range of motion of the shoulder joint, it is really helpful and quite impressive to watch a slow motion video of a professional pitcher in action. Keep in mind that the velocity of the baseball as it leaves the pitcher’s hand can be 90 to 100 mph.
Rotator cuff injuries are common among athletes who make repetitive, forceful throws (baseball and football players, especially quarterbacks), and athletes who play sports that involve overhead motions (swimming, volleyball, and tennis). Rotator cuff injuries are also common in non-athletes whose jobs involve overhead work (carpenters, painters, and custodians). Even musicians are not spared. Conductors and kettle drum players are at high risk for shoulder rotator cuff injuries because of repetitive up and down motions of their arms.
Violinists do not put strain on the rotator cuff by making large, strong movements but rather by holding the rotator cuff muscles steady for long periods of time. Ideally the violinist holds his or her violin with all the muscles relaxed, as shown in this photo of Jascha Heifetz:
However, this is not easy for everyone. There are extensive discussions on Violinist.com (Violinist.com, discussion forum, 4/29/19) and elsewhere about how to hold the violin comfortably and correctly. Much money has been made on assistive devices for the shoulder (shoulder rests) and chin (chin rests). I have a very long neck and I compensate by holding my shoulder elevated in an unnatural, tense position. Perhaps I have weakened my shoulder by playing with tense muscles for 50 years, making myself more vulnerable to rotator cuff injury.
After learning all this theory, it was time for me to do some physical work. First I did gentle exercises, which I got from YouTube, as explained above. Then I was ready to see a good physical therapist. I found one who was excellent, and he worked me hard. I simultaneously trained several different muscles which connect to the shoulder. My progress was slow but I just kept on working. It took me a long time and a lot of work to get my shoulder reasonably close to being in shape. Then, about a year after my injury, my PT told me what I had been longing to hear: I could start playing my violin again. At first I was only allowed to play for five minutes every other day. This really did not work. It took me more than five minutes to tune my fiddle and do a few scales as warmup. I told my therapist this, and he gave me permission to play for ten minutes every other day. Gradually I increased my playing time.
I was so very happy when I could finally start playing again. Can you imagine how horrible I felt not playing my violin for a whole year?
I had a few setbacks when I resumed playing a little bit at a time. The first happened when a friend asked me to play for his wedding. I worked frantically for a few days learning some Jewish wedding music, and then I played at the wedding. It was a wonderful experience, well worth the pain and setback in my recovery.
My next setback happened because I desperately missed my regular bluegrass jams. I went to one and played in a manner which I mistakenly thought was safe. I would play for a few minutes, until my shoulder felt tired or a little ache-y. Then I would stop, stretch, and rest. I would resume playing when I felt rested or when the group played a song I loved. I hurt for several days afterward and I had to stop playing for a few more days. My PT explained to me that I could play for a short time each day, not for several short periods of time in one day.
When I started playing after my one year hiatus, I was appalled by how much I had forgotten in technique, tunes, and general facility in playing. My skills as a violin teacher helped me tremendously. I could diagnose a lot of my own problems and assign myself exercises, pieces, and, of course, scales to work on. In spite of all these precautions and hard work, my skill level and rate of progress are frustratingly slow. On the whole, though, my joy at being able to play again and my increments of progress are more than enough to sustain and encourage me.
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