Health & Fitness for The Working Bassist – Part 4: You’ve Got Some Nerve
Strapped — Proper Strap Construction and Use
Typically bassists are used to having a heavy weight around their necks. Earlier in this series we studied problems related to the wrists and forearms, which are usually muscle and tendon related (tendons attach muscles to bones, hence when overuse occurs it is from the pulling that the tendons do to the muscles). Nerve problems can sideline the working bassist so pay attention to your body’s signals.
Commonly, nerve problems affect the wrists and forearms. They will likely be experienced as sensations traveling downward from the neck or shoulders to the wrists and forearms. These uncomfortable sensations differ from the pain bassists experience from strictly muscular issues which are often felt as traveling upward – for example, from the wrists up the forearms towards the elbow area. Nerves in the elbow area can also be affected, with unpleasant sensations radiating downward towards or to the fingers and hand.
Nerve problems radiating from the neck or shoulder area usually originate in the neck itself, as a pinched nerve going down the shoulder and arm, sometimes to the hand and fingers, or from the area between the neck and where the shoulder begins to turn into the arm. This area, known as the brachial plexus, is where all the nerves going down into the arm come together before branching off and connecting to separate muscles there. This area is where the strap lies, often causing a heavy bass to pull down on the strap putting unwanted pressure on this plexus of nerves day after day, night after night, and gig after gig. When this happens it can cause pinched nerve type symptoms.
As the nerve plexus is compressed, it will exhibit these symptoms which may be relieved once the bass is taken off or the strap removed. Or the discomfort may continue as the muscles, which lie over the plexus, could have tightened and shortened and thus continue to compress the nerves even when there is no direct pressure on them.
Tips for Choosing the Best Strap for You
One way to minimize this problem is to carefully consider the following when choosing a strap:
- A shoulder strap will cut into the shoulder it is lying on, especially if the strap isn’t padded. Because some of the muscles of the shoulder attach to the neck and back of the head, they will pull down on those areas causing discomfort, sometimes manifesting as stiffness, a pulling tightness, or headaches. They can also cause a pinched nerve, a condition in which a nerve is compromised so that you feel sharp pain or numbness and tingling going down the arm from the neck, sometimes up to your elbow, sometimes into your fingers.
- Therefore, when choosing a strap it is important to pick one that is comfortable. Generally a wide padded strap at the top of the shoulder area will take direct pressure off of the nerve plexus that most regular width straps will apply. With a wider strap, the weight of the bass will rest on the whole shoulder rather than on this one specific area. Once set, the strap should be holding the bass at the same level all the time, and should be used whether standing, sitting, and while performing or practicing so that the bass will always be at the proper height. This is important for your technique and muscle memory but also because it will get the body used to where you wear the bass and which will encourage your body to properly acclimate to the strap.
- Incorrect strap height is one of the most common sources of problems electric bass players inflict upon themselves. Playing too low can hyperextend your fretting hand and wrist (bending backward rather than forward, as if you were going to do a pushup), while playing too high puts pressure on the plucking hand and wrist putting them in a state of hyperflexion (bending forward, which is the most common problem for electric bass players). Ideally, one should try to keep the wrists in as neutral a position as possible so that they aren’t bent forward or backward in such a way as to cause discomfort.
Don’t Forget the Gig Bag — More Strap Logic
A poorly designed gig bag can produce the same symptoms caused by the strap cutting into the shoulder. A good gig bag will have two straps on the back so you can wear it in the center, backpack style, reducing the pressure that would be put on one side or the other by the standard over the shoulder gig bag. When you use one side of the body more than the other, whether playing or carrying the instrument, this can cause muscles in the back to tighten and develop asymmetrically. This can cause problems most commonly in the mid back between the shoulder blades. If you do use a gig bag with one strap for one shoulder, break it up by wearing it on one shoulder one day and the other the next to give your body a break.
The Dreaded Carpal Tunnel
One of the most common and commonly misdiagnosed and misunderstood repetitive stress injuries is carpal tunnel syndrome.
What is carpal tunnel syndrome? For one, it is what everybody at work, home, the rehearsal studio, and the music store thinks you might have when you complain about any hand or wrist problems, because they have heard the term before and because their cousin’s best friend’s fiancé had it once. Sometimes, your health care professional may also misdiagnose you. True carpal tunnel syndrome exhibits some or all of the following symptoms:
- Numbness and tingling starting from the wrist and extending into any part or all of the thumb, first two fingers, and half of the ring finger of either hand or both. It can be noticed anytime, but particularly when the hands are in flexion, which is the angle the wrists will make when one is picking or plucking with the right hand, or fretting with the left.
- Pain in the wrist or hand that wakes one up at night (this is key).
It should be noted I have not seen you as a patient, therefore I cannot diagnose you, so these observations are shared for informational purposes only, and are no substitute for a proper diagnosis by a health care professional. Therefore, if you are experiencing discomfort coming from the neck or in the little finger it is likely something else is happening.
So just what is a carpal tunnel? It is a narrow area formed by the bones of the hand which are called carpal bones. These bones are directly above the crease in the wrist, and a couple of them can be found easily if one feels just above the crease on the pinky side and the thumb side in line with the index finger. Bony prominences should be felt on both sides just above the wrist crease, towards the fingers, not up the arm. About a thumb width above the wrist crease and in between these bony prominences is the carpal tunnel itself, bordered by the bones and a ligament which is located at the wrist crease. If you tap on this area and it’s painful, this can be an indicator of carpal tunnel syndrome.
There is a nerve there called the median nerve which goes through the tunnel and which controls sensation and motion of the thumb, second and third fingers and half of the ring finger. It can become aggravated or inflamed in the tunnel which it shares with nine other structures, tendons and tissue. Overuse in flexion at the wrist (bending as in playing or fretting position) can cause crowding in the tunnel, inflammation, and discomfort. If the ligament at the crease of the wrist tightens up due to overuse, it presses down on the nerve causing discomfort.
True carpal tunnel syndrome will be present at night and can wake one up due to discomfort. It will usually hurt more at night because during the day one is in frequent motion, which provides a massage like action and diverts fluid away that would otherwise build up in inflamed tissues. At night, no motion, fluid accumulates, inflammation aggravates the nerve and wakes those with carpal tunnel.
While playing the bass may cause problems in this area that are not actually carpal tunnel syndrome, with the advent of home studios and pro tools etc, many computer composers are afflicted with the real deal.
What To Do
The most important thing when dealing with injuries, especially nerve injuries, is to get a proper diagnosis. Playing through pain will frequently give short term relief with long term problems resulting. Nerve problems will usually progress from once in a while or only while playing to be more intrusive in everyday life. Here are some things that can help once you know what you are dealing with:
- Rest from the offending activity, sometimes longer, sometimes shorter will usually help to tone down the symptoms. Many times a doctor, usually unaware of musicians’ injuries or physical medicine as a whole, will suggest stopping the activity altogether. Get a second opinion; it is easy to tell a bassist to stop playing because it usually works, but doesn’t truly help because bassists must play, and will continue to play.
- Your doctor may also recommend a cortisone shot. Cortisone shots help to reduce pain by reducing inflammation. Sometimes one will work, sometimes you need more than one, supposedly up to three in one year but if they play with the dosages, you can have more than that. This is a steroid, and I suggest this measure only if your next step is surgery. Surgery has a significant failure rate, due to patients’ repetition of offending activity and scar tissue build up.
And Now Some Good News
- If caught early, carpal tunnel can usually be managed. Shake out your hands before and after playing. Warm up slowly, but warm up see the previous column. Stretch before and after playing. If you are playing and it hurts, stop. Reassess technique, see the first column in this series. Take frequent breaks, especially if computer composing, and shake out your hands often.
- A chiropractic adjustment can help to lift the ligament off of the offending nerve if this is the problem.
- Acupuncture can relax local musculature and relieve inflammation and nerve pressure.
- Ultrasound, electric stimulation, cold laser, muscle specific massage and stretching, splinting at night can all help and may be appropriate for the condition.
Nerve Health Checklist for Bassists:
- Choose a strap that has some padding and some decent width so it doesn’t concentrate all your basses’ weight directly on the nerve plexus in you shoulder causing nerve problems and muscle strain there.
- Find a comfortable height for the bass, not too high, not too low, that doesn’t put the wrists in either hyperflexion or hyperextension, and always wear it at that level when playing or practicing. Try to keep your wrists in as neutral a position as possible.
- When experiencing problems in the wrist, don’t play through pain, stop, reassess technique, if problems recur have the problem properly diagnosed.
- If an issue is discovered, try more conservative methods before stronger ones such as shots or surgery.
- Shake out your hands and take short breaks frequently, especially if on the computer often.
- If someone says you have carpal tunnel syndrome, make sure you do—get an expert diagnosis and perhaps a second opinion.
Keep warming up, exercising, practicing, and playing in thoughtful ways informed by this series. Then add in the tips and guidance shared in Part 4 if this series, concerning choices related to straps and positioning of your bass while playing and how these choices can impact nerve health. Doing so will contribute to your overall experience as a bassist—you will have a lot more fun and sound your best.
The comments and questions you have been sharing in connection this series are appreciated. Please keep them coming!