Q: What is “trigger finger” in the thumb, and what is the best way to treat it if you are a musician that uses his fingers a lot?

A:  You didn't mention your instrument.

Trigger Finger or, stenosing tenosynovitis, is a condition where your finger gets stuck in a bent position and you have to snap it open.

Various tendons originate in your forearm and run down to the tips of your fingers. Your tendons are encased in a sheath and everywhere where there is a bend, like a garden hose, your tendon sheath can kink. Your tendon can also develop scar tissue or nodules on them causing them to get caught in those kinks and this can lock them in place. Your tendons actually glide through the sheath and stretch.

The cause for this scar tissue or nodules or kinks is misuse of the fingers and has nothing to do with overuse. If you move improperly all movement is overuse. Move properly and overuse doesn’t exist.

There are four basic muscles which move our fingers; abductors which spread them apart, adductors which pull them together, flexors which flex your fingers and extensors which straighten them out.

Abductors are weak muscles and when, say, a pianist, abducts and flexes at the same time, most do, they are using two muscles to move one bone in two directions. This creates a dual pull or vector force and one or both of the tendons become strained. This can create tension, cramps, fatigue, pain, uneven playing or micro tears to the tendon. Since tendons don’t have a direct blood supply, they are VERY slow to heal and the body places scar tissue there as a quick fix. Scar tissue does not stretch and the next time you strain the same tendon, it tears further creating more scar tissue. Since the scar tissue is cumulative, eventually the fatigue and uneven playing becomes sharp pain or the fingers lock.

The solution is to learn to move properly by working with a teacher who actually knows what they are doing. This requires a knowledge of physics and anatomy - not just music. Good luck finding such a teacher. Many THINK they know about technique but they don’t. Pedagogy is often rooted in what virtuosos feel and how it appears they are playing, not the actual invisible movements under “the hood.”

An example of this is the Carrezando technique. When a pianist moves properly with in/out, up/down motions, as the arm moves the hand around there is a sensation of caressing the keys. The caressing is the end result of the arm movement but this was not understood so they taught pianists to force caressing into their playing which created tension. Relaxed fingers is the result of other larger muscles working. You can’t relax the muscles you are trying to use. So when a student complains of cramps an unknowing teacher might suggest they relax but, relax what? The better teacher will instruct them on the proper muscles to use so that they can actually relax the improper ones causing the cramps.

Your flexor muscles are strong but fatigable. Your abductors are very weak. Regarding the thumb, if you are a pianist, many pianists are taught to cross the thumb under the palm for scales and arpeggios but the thumb’s tendon intersects with the index finger’s long flexor tendon. When you cross under, they grind together resulting in nodules. In addition, the thumb’s flexor is under the palm. The thumb was designed for gripping and that is why its flexor is there. When pianists play down on a key with the thumb, they use its abductor, its weakest most fatigable muscle.

So instead of using the wrong and weakest muscles, a good teacher will teach the student to use indefatigable muscles to play. For instance, gravity combined with a forward shift, combined with pronation and up/down, the thumb can then play effortlessly and with great speed without using any of its grasping muscles.

Isolating any finger is bad for our anatomy because they are interconnected. That is why playing an instrument must involve the combination of several muscles so that no one single muscle or tendon is misused.

Most musicians’ first teachers often don’t know what they are doing and allow their students to develop these improper motions or bad habits and these errant movements instantly become hardwired into our brains. It has been my experience that most people either don’t have the intelligence, patience, discipline nor dedication to rewire their brains to move properly. It can take time to undo years of misuse.

Another movement never to do is pinching with the thumb. Especially with the index because, again, the intersecting tendons. This also isolates two fingers. All five fingers are designed to move in the same direction at the same time. When a pianist gets that into their playing, they will develop effortless playing. It is sometimes called “tapping.” Likewise, they must never press into a keyboard for when you push into an immovable force, it is pushing back. This will only strain the player. It would behoove a pianist to learn to play to the point of sound, not the keybed. Point of sound is that little “bump” you feel when you slowly depress an ACOUSTIC piano key down without making a sound. You will first feel a point of resistance then it gives way. That is the point to play to. No further. The end result of that? Carrezando.

A good technique is the end result of proper movement. You can’t brow beat it into your hands. A teacher who prescribes exercises, demands more practice or says to relax doesn’t know what they are doing. Problems of technique are fixed by adjustments and fixing what you are doing wrong.

-Malcolm Kogut.

Playing With Fire #9: Part One - Bad Teachers

I am often told that I am harsh, unfair and judgmental toward piano teachers. It is true. While many teachers may have much to teach regarding the artistry of playing the piano, it is also true that many of them do not know what they are doing mechanically. The body is a machine with levers, pulleys, rubber bands, torque and fulcrums. We learn about these things in Physics and Biology classes and it is too bad that our educational system doesn't use Physical Education class to combine it all together. It is also too bad that our teachers only know what they are taught and do not seek answers to problems other than relying on what they were taught: practice more, relax, work on finger exercises, build strength and endurance, you have no talent or, they just keep taking the students' money. Often, the cure for technical inefficiency or various syndromes is an adjustment to our movement but that is rarely addressed because a teacher only knows what they were taught and often that is practice more, relax, work on finger exercises, build strength and endurance. I have a friend who can't play tremolos because he tries to play them from his fingers. If he played them from his elbow, they would be instantly effortless. But, what do I know, his teacher told him to practice more and build strength.

I may not be able to pick up and move an 800 pound boulder across my yard but, with a crowbar and another rock, I could make a fulcrum and inch it over. Better yet, if I can nudge it up onto a dolly with wheels, I can then easily roll it over. My strength and endurance doesn't change, but how I use the laws of physics can make all the difference.

I took lessons from one of my area's leading concert pianists with the sole intention of improving my technique. He was one of those virtuoso pianists who simply moved properly. He had an ergonomic technique and didn't know how or why he could play with great ease. He called it talent. Students flocked to him hoping to become as good as he but he didn't know how to help his students find their true potential. Many of his lessons were spent with him playing hoping his students would imitate him but, the actual movement of playing is invisible and shared by several muscles many teachers are oblivious to because they don't know they exist. We think it is the fingers that play the piano but, it is first and foremost the arm. The unenlightened teacher focuses on the fingers, which have no muscles BTW.

This teacher has long since died and his daughter has taken over teaching. I had the opportunity to work with one of her students and his technique was dangerously close to crippling him. Sadly, he only wanted a magic lesson so he could play well and didn't want to put in the work of relearning how to move. There was nothing I could do for him. In order to relearn how to play one must abandon all previously learned movements and start over, which many pianists are not willing to do.

This kind of teacher may be fine for the student who just wants a taste of music, learn a little theory or be able to plunk out some notes for themselves but, a teacher's ignorance can stifle a student's progress, enthusiasm and even set them up for eventual injury. Mediocrity is not related to talent, it is a symptom of teachers who don't know about the physics of movement and our skeletal system.

You would not take your car in for an inspection only for the mechanic to tell you your brakes or tires are going bad but you can get a few more months out of them. Well, actually people do. That mechanic is putting your life and everyone you share the road with in danger because you probably won't come back in in a few months. Sure, you are saving a few bucks today but at what cost in the future? If your brakes are bad, get them fixed, don't drive more. Driving more won't fix them. If you technique is bad, get it fixed, don't practice more. Repeating improper movement only hard-wires it into the brain.

A piano teacher who does not understand that a student is using the wrong muscles or how to teach them to use the correct muscles is setting them up for problems or a career of mediocrity. Every technical problem has an ergonomic solution, and it isn't “practice more.” If walking knock-kneed causes knee pain, the solution isn't to walk more, it is to walk correctly. If your pinky and ring finger feel weak and in-coordinate, you don't need to strengthen them, you only need an adjustment to your forearm alignment.

I have had all the wrong teachers and although they made me who I am today, they set me up to be crippled with pain and to struggle with a mediocre technique. It has taken me years to relearn how to move but I am now pain free and syndrome-less because I stopped fighting the laws of physics and started using them. Although I have much more work to do, my technique has improved significantly.

Playing With Fire #8

Look down at your fingers. If you haven't noticed they are all different in length. Many pianists and typists are taught to equalize their fingers by curling them so that all five are touching the keys at the same time. This places your fingers in a constant state of flexation. It is impossible for a musician to relax their fingers if they are holding them in contraction. In addition, you can only move a bone in one direction at a time but we all have several muscles that can pull them in several opposing directions. So if you are trying to move a finger up or in a certain direction but another muscle is pulling the hand in an opposite direction, there is going to be strain or at the very least, in-coordinate movement. This is why some pianists struggle with scales, arpeggios or speed.

It behooves the pianist to play on the edge of the keys for the keys are lightest on the outside edge. If you have ever played on a see saw as a child, you know that regardless of weight, if one kid sits on the outside edge of their seat and the other kid is sitting forward, the kid on the outside will “weigh more.” Just like the see saw, the piano key is a fulcrum. Such as using a board and rock to move another rock, the further out you are on the board, the more power you will have. Your shoulder, elbow, wrist, knuckles and each phalanx of your fingers are all fulcrums.

If you were to place your middle finger on the outside edge of a white key, all your other fingers will be hanging off the keys in the air. This is counter intuitive to most teachers but by using your shoulder and elbow to move in and out to place each finger, it not only reduces how much you need to move a finger but, it gives the finger the power and weight of motion and gravity without having to use the sluggish flexor muscles. Indeed, the piano is forward so the pianist or typist needs to have a constant forward shift momentum to their movement. If they static load, since the body wants to contract, they risk falling off the keys or cramping. When that begins to happen, the pianist contracts even more in an effort to grasp at the keys and this just creates a downward spiral of technical inefficiency and tension.

To equalize the length of all your fingers you need to get in/out motions into your arm. The pianist who does not risks playing on the inside of the key where the keys are heavier, thus is born, the myth that the pianist needs more strength to play or, they might complain that the action of the piano is stiff. The keys feel stiff because the pianist is playing too far in. Again, this is counter intuitive to most teachers but the arm is much faster at placing a finger than a flexor is at playing.

Using the C scale, place your thumb on the outside edge of the C. When you play the index finger, come out from the elbow and play straight down. Because you are coming out, you need to replace it with a forward shift. The arm will come out, up and forward all at the same time. This is where the wrist and forearm work together. It is also what gives many pianists a look of grace. Even though you are coming out, you are also moving in, up and down. When you play the middle finger, you come out even more. When you play the ring finger, you simply shift forward without needing to use the actual flexor. The same thing happens with the pinky. You just shift inward but stay on the outer edge of the key. Be careful you know about forearm alignment first. I'll discus that later. That is another fulcrum.

Every scale has different patterns of in/out. Actually, many scales are easier to play because the black keys are already forward so there is less “out” to employ. However, since the black keys are higher, you need more forward shifting with an “up” in order to come straight down on the key. This too is where pianist create tension grasping for keys. The finger does not strain and stretch to reach keys, the arm places them where they need to be which is directly over the key. Singers are taught to sing higher than their target note so they don't sing flat. Likewise, when you walk up stairs, your ascending foot raises higher than the next step then comes straight down onto it. Notice also that when your leg raises up, the down muscles are actually relaxed and your up muscles are engaged. Then, you don't stomp on the step but rotate to the next leg. This is important for the pianist to know. They can only relax if they play up then let gravity play down. The moment they press down into the key they corrupt the arms ability to go back up. A dual tension occurs and anarchy of technique ensues.

Without up/down and in/out, the musician will risk strain and uneven playing. Up/down and in/out movements give the arm (fingers) a lot of power allowing the pianist/typist to truly relax the fingers/hands/long flexor muscles. Most hand and wrist strain is caused by using more than one muscle at a time to move one bone in two or more directions simultaneously. It is imperative to learn to use one muscle at a time. This can only happen by relaxing the flexors which are the very muscles most pianists are taught to use.

When you walk, you don't flex your toes with each step. The toes just go where the leg places them. Likewise, the fingers go where the arm places them. The fingers don't operate independent to the arm and they surely don't drag the arm behind them. When you are washing a window, writing on a chalk board or waxing your car, the hand goes where the arm places it and the fingers do as they are told, with no effort.

Playing With Fire #7

In Playing With Fire #5 I mentioned that stretching is not all it is cracked up to be. Let me recap this. Many people are taught to warm up by stretching. What is stretching and warming up?

When you stretch a muscle, you create micro tears to the muscle fibers and the body rushes warm blood to the site to begin immobilization and start repairing the damage. This rush of warm blood gives us the illusion of warming up. Body builders like this feeling because as the muscles inflame with tissue repairing blood it makes them feel bigger and their clothes tighter. Actors and models will often do pushups or other exercises before being photographed for it indeed makes them look slightly larger or more muscular.

Your muscles become tendons which are then attached to your bones. When the muscles are cold, they are contracted and tight. If you force your muscles to move when they are contracted, the tendon is caught between the forces of the muscle and bone. Most often, the tendon will strain or tear. Tendons, just like like muscle, contract and expand. Like uncooked spaghetti, bend it and it will break but add a little heat . . .

The greatest danger to any musician or athlete is the high school gym teacher or ignorant music teacher. Indeed, muscles operate at peak efficiency when they are warm, blood is flowing freely and they are expanded. You can't force that by tearing tissue. A better way to warm up is to sit in a warm room.

In the Journal of Strength & Conditioning Research, they found that stretching led to more than an 8% decrease in body strength. Researchers suggest that stretching may change or limit your muscles’ ability to fire efficiently because they are damaged. If you try to lengthen a muscle before giving it the chance to warm up, you can limit its potential to generate strength and power. This not only reduces your performance but it may also increase your risk of injury. https://www.ncbi.nlm.nih.gov/pubmed/22692125

You also can't spot warm up. If you stretch your legs in an attempt to warm up, the blood that you are using quickly circulates to other parts of the body. The only way to safely warm up the whole body is to actually warm up the whole body. You can not force warming up by stretching. Micro tears to the tendons may feel good on first stretch but over time the scar tissue that is placed in those tiny tears will build up to become full blown tendinitis.

In place of stretching, I would suggest gentle movement in your mid range of motion. When you static move to the extreme range of motion where you feel that satisfying stretch, you are creating damage.

Just because your teacher said that stretching is good, that does not mean they are correct. It only means that their teacher was wrong, too. However, if you do have scar tissue on your tendons which will result in inflammation and sharp pain when you move, breaking up the scar tissue is the first step to healing. Instead of stretching and risking augmented damage, get a deep tissue myofascial massage and let the therapist break it up for you without you risking another stretch and further amplification of damage.

Playing With Fire #6

The point of sound can be felt on an acoustic piano. Electronic pianos and organs have them but they are pretty much indiscernible.

Slowly press down on an acoustic piano key without making it sound. At one point you will feel a little bump. If you press beyond that bump, the key will give way and you will be pressing into the keybed. If a pianist wishes to achieve that pearly sound of fast and light notes, they need to learn to play to the point of sound.

As previously mentioned, pressing into the keybed will force a stretch to the long flexor tendon which creates strain. Not to mention, if you are pressing down into the keybed, you can't move your hand or fingers up to the next note because before you can play down you must first play up. Every motion has an equal and opposite motion. This is where some pianists and typists run into trouble because they are trying to maintain a “still and quiet” or relaxed hand. It is in their relaxation they are creating tension because when they use the wrong muscles, they create tension, then they try to relax the very muscles they are using.

When you kick a ball, you first back kick. Swing a bat and you will first back swing. Cast a fishing pole, back cast. Walk forward, press backward. Punch someone, back swing. When you walk forward, as your left leg reaches forward your right hip rotates backward. As your right hip rotates backward, your right shoulder rotates forward. Every motion has equal and opposite motions and your body is designed to work with other parts for balance, relaxation, power and efficiency. When you isolate a part, you will create problems. Pianists and typists are rarely taught this. They think playing comes from the fingers but it shouldn't. It should first originate from the larger muscles of the arm. When the arm does most of the work, it frees the fingers to do some of the more fine tuned movements and, to truly relax. BTW, the fingers don't have muscles. They are moved by the muscles in the forearm. When a pianist or typist tries to originate movement from the fingers, they will strain the tendons.

In order to type or play down on a piano, you must have an up movement to harness the power of gravity. If you play with your fingers pressing down on the keys, you will not have the power, speed and accuracy of the arms. You have probably seen pianists playing with graceful movements. They are not just putting on a show, they are feeling and moderating the weight of their arm. Ideally, most of the up motion should be minimized once it is in the brain. Even playing a simple scale, the arm might change directions via the pronator and supinator muscles up to six times. This is invisible to the eye but must be there in the player's arm. If not, they will static load and create tension, cramps and fatigue.

This law of physics also pertains to other muscles such as your pronator and supinator muscles. If you are rotating your arm to play a downward scale, your must first counter rotate to give the arm both power and to control its direction. Keeping all five fingers together and moving in the same direction will provide great facility. Even the fingers you are not using must go in the same direction and play down at the same time. Some piano teachers call this “tapping.” It is when we stretch our fingers out and pull in opposite directions at the same time we create cramps and fatigue.

Keep in mind that all movement, once learned and ingrained into the muscle memory of your brain, it must be minimized to being invisible. The opposite motions are all there, they just can not be seen anymore, however, the pianist will feel them and it will be a feeling of power and effortlessness because they are not using the wrong muscles to play. Most of us are taught to use the wrong muscles, or, we are not taught anything. It is a dangerous teacher who simply says to practice more, relax or prescribes silly exercises to build unnecessary strength and endurance, both which everyone already has aplenty within their arms. The reason teachers think a student requires strength and endurance is because the incorrect muscles a student may be using are indeed weak and fatigable. Strengthening them reinforces improper movement and sets the stage for the mythical beast called “repetitive strain injury.”

The Nativity Story in Candy

This is a wonderful children's homily but can be expensive, especially if you purchase jumbo sizes for visibility purposes.

As you reference each candy item, hold it up. As you write you own personal script for this, look for ways to repeat many of the candies so that anarchy ensues as you rifle through the once ordered pile to find what is next. Well, **I** think that chaos is fun.

Obviously your presentation requires the right inflection and pauses for the ultimate in campiness. Not only is this a wonderful children's homily but, the kids get to eat the homily after the service. So, in incomplete sentences, you can wax out the full story for yourself . . .

Angel appears to Mary, you are going to have a BABY Ruth.

He will be a LIFE SAVER

Joseph was a GOODbar about it.

They had to leave town because as an unwed pregnant mother, people in town would SNICKERS

The got on a donkey to SKITTLE out of town

They hit the TRAIL MIX

Exhausted from the trip, they decided to TAKE FIVE

When they arrived, they went from BAR to BAR to BAR (three Hershey's), there was no room anywhere.

Finally, at one inn, in a barn, they found room where Mary gave birth to her SUGAR BABY, our LIFE SAVER.

In the barn there were sheep, cows and maybe even a KIT KAT or a DOVE

Shepherds also TOOK FIVE and hit the TRAIL MIX

Mary and Joseph smothered Jesus with KISSES

(here, you can say "It get's worse.")

Herod was up to his old TWIX and sent three SMARTIES to find a babe in a stable.

They too hit the TRAIL MIX

These wise men astrologers were not DUM DUMs nor were they NERDS

They looked up into the MILKY WAY, assessing all the DOTS in the sky to find a specific STARBURST

Everyone thought they were MIXED NUTS to go on such a perilous journey to find a treasure (drops fistful of gold foil wrapped chocolate coins) in a stable.

When they found him, the gave him gifts of Gold (drops chocolate coins again), Frankincense and WHATCHAMACALLIT

They returned from their SNOW CAP'd journey to Herod and not wishing to reveal the location of Jesus, told him a WHOPPER.

Jesus, our LIFE SAVER is the RAISIN for the season.

When this homily was presented at my church, I don't think many of our kids got the puns but they oooh'd and ahhh'd at each delicious and yummy reveal.

Playing With Fire #5

In Playing With Fire #4 I mentioned dropping the hand or finger into the key. This is called playing with gravity or arm weight. Some pianists may complain that certain pianos have a stiff action or, when they are cold, they have difficulty depressing keys. That is because they are trying to use the flexor muscles or the non-existent finger muscles to play. Your fingers have no muscles. They are moved by the muscles of the forearm.

When a pianist plays with gravity, the keys go down effortlessly because they are not using any muscle to depress the key, they are only using gravity or the weight of the arm. The only muscle engaged is the bicep which raises the hand from the fulcrum of the elbow, then controls the descent.

It is important to note that once your finger depresses a key, after you hit the "point of sound," you unweigh your arm so that you are not pressing down, leaving just enough weight to keep the key down. Another source of the apocryphal "repetitive strain injury" is pressing into keys because pressing stretches the long flexor tendons and stretching can create strain and micro tears. Since tendons do not have an active blood supply to promote healing, the body places scar tissue in the wound but, scar tissue does not stretch and results in larger tears the next time you stretch.

Warming up through stretching is also a myth. What happens when you overstretch your muscles, you tear muscle fibers and the body rushes blood to the site to begin repairing the damage of the stretch. Since blood is warm, it gives the illusion of warming up. A better way to warm up is to sit in a warm room. Also, you can't spot warm up since your blood is always circulating. When muscles and tendons are actually cold, they contract and resist stretching. Stretching cold tendons is always bad because they are contracted, resisting stretching and more apt to tear than stretch.

It is sort of like stretching warm taffy into gooey strands. Try that with frozen taffy and it will break. It is important for a pianist to never play with a cold body unless you have mastered ergonomic playing and the laws of physics.