Finger Pain and Prolotherapy

Do you suffer from finger pain?

Flatpick Magazine DOES PRACTICING HURT?
BY MARC DARROW, MD
How many guitarists have altered their style of playing from five fingered riff blazing virtuosos to simple chord strumming rhythmists because of finger, hand, wrist and elbow pain? Certainly too many.

While, there are many articles devoted to preventive exercises, stretching, warm-ups and other techniques to ensure the  guitar player can protect themselves from repetitive strain injury (RSI). This article will focus on those guitarists whose skill and dexterity has been robbed by painful fingers, hands, wrists, and elbows.

To no surprise, guitarists suffer from the same wear and tear injuries that plague computer users and others who make a living or act as hobbyists in activities involving the fingers. This injury is commonly referred to as repetitive strain injury and is caused by tearing and ripping in the connective tissue–especially the ligaments.

Loose Ligaments, Slow Licks.
Ligaments are the connective tissues in our joints that, as their descriptive name implies, connects the bones in a joints and hold them in place, and gives the joints strength.

To make an obvious comparison, when ligaments are tight and strong, like the new strings on a well tuned guitar, a beautiful sound is produced. When the ligaments become weakened and loose because of overuse injury, they become like the old, worn out strings–strings that have been overstretched by constant tuning and playing, no longer hold their tune and will no longer produce a beautiful sound, but rather, the “painful,” sound of “wobbly” strings.

So it is with our ligaments, over playing without taking proper rest periods and sufficient warm up, stretches out the ligaments making them “wobbly.” A cascade of pain then begins that lead some to give up on playing altogether, or alter the style of play to slower, “less painful” tunes.

Referred Pain
Why Your Arm Can Hurt From Shoulder To Finger

Pain from overplaying can start as an overuse injury in the shoulder as inflammation, bursitis, impingement syndromes. It can start in the elbow, in the annular ligament that stabilizes the two bones of the forearm, the ulna and the radius. Sometimes the pain in the annular ligament can refer itself down into the thumb, wrist and index and middle fingers, mimicking and sometimes leading to an incorrect diagnosis of carpal tunnel syndrome. Regardless, wherever it starts it can quickly make your entire arm feel as though it is injured.

How does this work? Referred pain is created by the lligament laxity around a joint, but, is felt at some distance from the injured joint. So as explained above, elbow pain may be felt in the fingers, equally, finger pain may be felt in the shoulders. As an example, the ligaments in the wrist are injured and strumming the guitar is painful. Your body compensates for this pain by constricting muscles and other tissues up and down your arm in an attempt to stabilize the pain. This constant “tensing,” will in itself lead to “tender points,” painful to the touch spots within the muscle

What to Do?
If you are not already in pain, their are many preventive measures you can take including stretching and warm up exercises, strengthening exercises and other techniques that can be found in many references. The focus of this article is for those players already in pain and altering their style of play or not playing at all.

Surgery and Pain Medications
Surgery has its limitations, drawbacks and risks, as do NSAIDS (Non-steroidal anti-inflammatory medications) and pain killers. Unfortunately, these treatments are usually the first and most popular treatments prescribed. Surgery is especially aggressive and not the choice of many patients because of the long recover time and possible failure of the technique. When the surgery does fail, most doctors resort to their one last option-sedating the patient with narcotic medications.

Prolotherapy To Strengthen Ligaments
There are other treatments options available, conservative treatments such as physical therapy and chiropractic care. There is also Prolotherapy which is becoming an increasing popular non-surgical alternative for over use related injury.

The term “Prolotherapy” is short for “proliferation therapy.” Proliferation, of course, means “rapid production.” What Prolotherapy rapidly produces is collagen, the necessary protein building element of ligaments.

Prolotherapy helps make collagen through a series of injections, not of collagen, but of dextrose (sugar), which stimulates the immune system’s healing mechanism to start repairing the damaged ligaments.

For the those with finger pain for an example, an injection of dextrosewill be made into the painful finger joint. The dextrose will start a very small inflammatory response in the area. This new inflammation will increase the blood supply to the area, (why ligaments do not heal quickly or are a source of long term chronic pain, is because they themselves have a limited and poor blood supply.) With a new blood supply comes the immune system cells that clean up damaged tissue and lay down strong new tissue. (Studies on Prolotherapy’s effectiveness have shown ligaments can become 50% thicker and their strength becomes 200-400% stronger.)

Depending on the severity of injury, a patient will typically need to be treated two to four times to show improvement.

Marc Darrow, MD is board certified in Physical Medicine and Rehabilitation, and is an Assistant Clinical Professor at the UCLA School of Medicine. He specializes in Prolotherapy which is the natural stimulation of the body to produce collagen and heal overuse or other injuries.
Questions? Call his office 310-231-7000 or email

Dr. Darrow is also an accomplished musician