Advice on tuning techniques for recovering tendonitis sufferer

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Robert writes:

<< lateral epicondylitis in my left arm, or tennis elbow. I am not sure if I 
got this by practicing the piano, tuning pianos, lifting a heavy suitcase, 
playing golf or what. I have had a couple of cortisone injections and physical 
therapy sessions, and now the problem has almost disappeared. <snip>the last 
thing I want to happen is to aggravate my arm and for this problem to come back, 
and then to eventually need surgery. I have heard that surgery is not always 
successful and can lead to permanent irreversible damage. It's a very scary 
thought since I am a concert pianist and teacher as well.  >>

Greetings, 
    Ah, at last something I know a lot about!   I have had this, had the 
therapy, had the injections, then had the surgery.  It is an agrravating 
condition, and once had, is more easily caused to recur.  
    The problem is not directly attributable to hitting the key,  the 
inflamed tendon is the one that is lifting your arm after you hit the key!  Itis 
called "tennis elbow" because of the stress put on this tendon when pulling the 
racket back,not forward.  For this same reason, do NOT get near a bowling alley, 
since the action of bringing the ball up back behind you prior to sending 
forward is extremely stressful on this tendon. So,  what I found was that my 
technique had to change in what I did after striking a note.
    Think about how abruptly you raise your hand, and how much rigidity you 
have in your wrist as you lift your hand off the key.  What helps me is to 
constantly remind myself to keep a relaxed left arm as I tune and in lifting the 
hand, allow the wrist to "push off" the key with a flexation, rather than 
jerking my whole lower arm upwards.  This allows the muscles under the lower arm to 
do some of the work.  Think fluidity of motion, and spread the working 
movment over a larger area. The surgeon told me that the tendon in my elbow had 
worked its way down into the joint tissue and looked like a rope that had been 
been sawing through a rolled up rug!  
    Once this condition occurs, it will be a painful return, and the rehab 
hurts as much as the original problem. 
Relaxation is key,(as with so many things), and the repetitive nature of our 
work lends itself to these kinds of problems.  We have to think looser, work 
looser, and be very conscientious about the ergonomics involved.
Malinda Powell gave a class in which she demonstrated a technique for keeping 
the forearms loose.  It helped a great deal.   
Good luck,
 
Ed Foote RPT 
http://www.uk-piano.org/edfoote/index.html
www.uk-piano.org/edfoote/well_tempered_piano.html
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