Rhythmic Physician: 'Bow Worries
Drumming is a demanding activity requiring a tremendous amount of muscle conditioning, endurance, strength, and coordination. To become a great drummer we must practice long hours, performing the same repetitive activity over and over again to develop the necessary muscle memory to perform night after night. While the rate of traumatic injuries drummers sustain are low, greater numbers of drummers and percussionists are developing significant elbow injuries.
Medial epicondylitis, or golfer’s elbow, is a condition that causes pain at the inner or medial side of the elbow, where the tendons of the forearm muscles attach to the bone prominence on the inside of the elbow (medial epicondyle). Pain develops at the inside of the elbow and may spread into the forearm and wrist. Golfer’s elbow can be mistaken for ligament or ulnar nerve injuries in the elbow.
Golfer’s elbow is similar to lateral epicondylitis, or tennis elbow, except that it occurs on the inside, not the outside, of the elbow. Not limited to golfers, anyone who repetitively uses their wrists or clenches their fingers can develop golfer’s elbow, so a drummer’s vulnerability to this condition is self-evident. Injuries can also arise from a single forceful muscle contraction such as stiking the drum hoop with a stick or hand against a drumhead.
The onset of symptoms is often gradual and symptoms may persist for weeks before patients seek medical care. Pain and tenderness is localized at the inner elbow that is aggravated by resisted wrist flexion and pronation. The elbow often is stiff and weakness with grip may develop.
Most patients wait too long to seek treatment, thinking the injury will heal and symptoms will resolve on their own. Unfortunately, in the majority of cases the symptoms worsen, limiting elbow, wrist, and hand function.
Diagnosis is made by clinical examination and is confirmed by imaging studies including X-ray, musculoskeletal ultrasound, or MRI scans.
Treatment can be difficult for chronic or severe cases. Stopping the mechanisisms causing the injury (repetitive wrist movements and gripping) is the first step. Early treatment often includes physical therapy (streching of the wrist flexor muscles, physical modalities such as ice, electric stimulation, and therapeutic exercise). The use of oral medication such as anti-inflammatory medications are of little use since this is not typically an inflammatory injury. More aggressive treatments might include limited use of corticosteroid injections for severe pain.
Regenerative treatments such as platelet rich palsma (PRP) have also been shown to be benificial. For severe cases or those that don’t respond to conservative treatments, surgical debridement and/or tendon repair may be necessary.
When elbow pain develops with gripping a stick or hitting your drums, seek help immediately before you risk worsening the condition. If we can’t grip a stick and strike a drum, we are effectively useless in our craft.