Manual Dexterity & Injury Recovery

[checktest]

Wasn't sure where to put this, but Performance Enhancing seems to be the most appropriate section.

Background:
I like to play piano as a hobby (mainly classical, some jazz, little pop here and there), and I was wondering what are some good approaches to improve approaching pieces (mechanical movement, flexibility, dexterity) and possibly memory. Not as a serious venture...just out of curiosity.

Used to play quite a lot, but overdid it maybe 7...9 years ago or so. Was rehearsing for a concert and just didn't let up on my arms. Ultimately between over-practice and years of bad posture and the like, did quite a number on them and had to give it up for a while. Physiatrist and neurologist were both a little surprised how functional I was (the concert went pretty well, actually), given what I presented with. [4th + 5th finger numbness + cold, sharp sharp pain in mid-right back.] It was never particularly clear, but likely had either a C8-T1 radiculopathy or cubital tunnel superimposed on thoracic outlet syndrome (R > L, though absolutely present in both). Missed an EMG appointment due to a snowstorm, and the neurologist eventually decided that it never would be too clear and told me just to rest them for a long time.

Since I've had the chance this past year to play more piano, I've really been hoping to get back into shape. I've been taking it slow and easy, making sure to not stress my hands and forearms what-so-ever. Seen a teacher about some stretches and proper positioning- always was pretty good, it was more about overdoing.

Question:
What else can I do to help restore functioning and perhaps help my processing of pieces? To outline a more specific goal, I might want to try to get a passable 4-5 trill over a period of...2 years, maybe? I'm also working through Bach's Well-Tempered Clavier, very slowly. https://www.youtube.com/watch?v=OzerJmdStq8

Side-note:
I take vortioxetine (15 mg) and methylphenidate (2.5-10 mg). I've been meaning to do a post on Neuroscience about possible interactions with 5-HT1a agonism (partial) and other sections. Taken the same dose range for a while. Seems to remain good for me- the methylphenidate has probably been the best thing for my anxiety, oddly. [I've always been a bit paranoid about drugs, so it has been a surprise.]

https://www.ncbi.nlm.nih.gov/pubmed/27087081
https://www.ncbi.nlm.nih.gov/pubmed/26408868

Thanks in advance.

 

[CFC]

For your posture and some of your nerve issues, I would strongly recommend load-bearing exercises performed in a gym. Especially back-extensions or deadlifts, posterior-chain exercises and so on. But strengthening all over your body would undoubtedly help. I also think you might benefit from buying some hand grippers and working on your hand/finger strength. It should elevate growth factors and improve cartilage and protect the nerves somewhat.

Meanwhile, cardiovascular and HIIT-type training would help your brain, your memory and your ability to focus.

I'm going to move this over to NPD as I think you may get more feedback there.

 

[Cotcha Yankinov]

Hey OP, I'm familiar with TOS.

Manual release and stretching of the pectorals and scalenes/anterior neck is really important, and correcting breathing mechanics can also be important if you are a chest breather. It's easy to lose your posture while playing, so the stronger your low/mid trapezius/spinal erectors are and the looser your pecs/scalenes are the better off you'll be.

Often times people have issues with "double crush syndrome" with TOS, meaning that your ulnar neuropathy compression at the elbow may not be that appreciable without compression at the thoracic outlet.

Nerve conduction studies are most often negative for TOS by the way. Diagnosis for TOS sucks and a lot of providers suck at treating it.

Botox/local anesthetic injections into the anterior and medial scalene as well as pec minor can help, and scalenectomy can show excellent-good results in about 70% of cases and fair results in about 20% of cases.

But obviously conservative treatments come first, especially manual therapy and stretching of the pecs and scalenes along with strengthening low/mid traps and spinal electors with back extensions and deadlift genre exercise as CFC mentions.

Correcting forward head posture with chin tucks is also very important.

Another thing that can be very important is strengthening the serratus anterior. Lots of people have issues with shoulder mechanics and shoulder winging with TOS.

As far as breathing mechanics, the goal is to breathe in through the stomach (diaphragmatically) and avoid using the ribcage too much, as inhalations kick in the scalenes.

Stretching hip adductors and flexors can help you achieve some lordosis in your back while sitting and help you breathe into your stomach and avoid chest breathing as well. It's hard to breathe into the stomach when hunched over so many people end up rib cage breathing.

Ultimately get your butt into physical therapy with someone that knows a thing or two about TOS. Paying a regular masseuse to do myofascial release of the pec can be very helpful too.

Hope this was helpful, any questions are welcome.

 

[checktest]

Appreciate the advice!

The overall injury was those many years ago, and right now I have no major problems. Definitely went through the whole rigamarole of treatments- trigger point injections (scalenes + others?), variety of muscle relaxants (not effective), PT, massages, a whole set of posture arrangements and alignments. I am reasonably consistent at the gym and do a variety of stretches, back extensions (with weight), and full bridges for part of the back. Occasionally pull-ups, some barbell rows and presses, though I was told to avoid high weight a while ago. I'll have to explore that. Had a hernia that led me to stop doing deadlifts...I'll have to go back. Squat maybe 300? Forget the weight of the bar. 45x3 each side. At one time I used to run ~30-50 miles/week- now about 2.5 mi at most per session. For some reason intense exercise makes me feel even worse with depression, so I cut back...and I feel better in general.

I guess the question more resolves around fine motor coordination. Having gone back to practicing a lot more the past year or so, I've noticed a major difference in how my fingers have come back. The thumb, pointer, and middle are really doing just fine...but the 4th and 5th are iffy. Perhaps part of it is hesitation and being careful with them, but it definitely seems like some sections of pieces are uneven when it comes to those fingers.

I've heard mixed things about hand grippers with piano, strangely enough. Some people do well, others aggravate strain and get less flexible. All I know is that if I lift too heavy and do too much forearm work, my playing of delicate sections or difficult parts drops off.

I guess I also want to learn, and re-learn, how to approach sections and movements. Try to avoid the traps that lead to tension and strain before. And perhaps improve on acquisition of pieces. HDAC inhibition is interesting for some memory tasks, e.g. Valproate perfect pitch study.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848041/
[Wary about messing with too much, given what I'm on and have been on in the past. But the concept is interesting. Perhaps low low dose.]