Medical Matters
Frequently Asked Questions


What about vision impaired ringers? What about hearing impaired ringers?
Special Eyeglasses for Ringers. Noise Induced Hearing Loss
Handbell Symbols in Braille.
What About Carpal Tunnel Syndrone?
How to prevent elbow problems?

What About Vision Impaired Ringers?

From: "Kathy Leonard" <>
Subject: Re: Need quick solution! - Blind ringer

Our SAI chapter participated in the "Bold Notes" project, where we transcribed music onto large staff paper.  Looking at the SAI web pages ( just now, it appears that the scope of the project may have changed a bit over the years, but it does offer the following:


The following is a listing of a few resources from which literary and music materials in alternative formats to standard print may be purchased and/or obtained on loan or free of charge including literary and music braille, large print, audio cassette and floppy disk.

American Printing House for the Blind,         1839 Frankfort Ave.
Louisville, KY 40206
(800) 223-1839
National Braille Press, Inc.
88 St. Stephen St.
Boston, MA 02115
(800) 548-7323
Clovernook Center for the Blind, Inc.
7000 Hamilton Ave.
Cincinnati, OH 45231
(513) 522-3860

Library of Congress, National Library Service for the
Blind and Physically Handicapped (NLSBPH)
Music Section
1291 Taylor St., N.W.
Washington, D.C. 20542
(800) 424-8567

Recording for the Blind, Inc.
20 Roszel Road
Princeton, NJ 08540
Automated Response System: (800) 772-3248
Mon.-Fri. 7:00 a.m.-9:00 p.m. and weekends,
beginning Sat. 7:00 a.m. central time
Other inquiries: (800) 221-4792-93
Large Print

Large print music can be produced via computer by: Associated Services for the Blind. For specific information on how to go about having music put into this format, cost, etc., you may contact them at:

Associated Services for the Blind
919 Walnut St.
Philadelphia, PA 19107
(215) 627-0600
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Transcribing in Braille

I recently found this web site for transcriptional music in Braille.  Other than that, I have no information.  It would be worth a few minutes to look at the site if you have visually impaired persons in your handbell, vocal, or instrumental group.

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Special Eyeglasses for Ringers.

Dr. Vicky Vandervoort of the Omaha Eye Institute, who is both an optometrist and a handbell director, St. Mark Lutheran Church Omaha, Nebraska wrote the following article that has been widely distributed.

I am, by profession, an optometrist, and I would like to pass along some information to those of you with ringers over the age of 50.   The eye, as  most of you know, gradually loses the ability to focus at near range  beginning at about age 40-45.   By age 50, most need some help at intermediate distances, such as when reading bell scores.   The score will not be clear through the top portion of their prescription lenses, so you will see them leaning in with their chins raised up looking through the bottom of the lenses (getting into range of the bifocal segment).  This is even more difficult in "no-line" bifocals since the change is gradual and there is usually some searching (up and down movement of the head) involved.

If your ringers in this predicament are willing to spend the money for a separate pair of "bell glasses," have them stand in their normal ringing position and measure from their eyes to the music in inches (centimeters if you can, but no problem if you can't).  Then have them ask their optometrist/ophthalmologist to write a prescription with the top part being their normal distance prescription and the bottom part in a (technical lingo approaching) "flat-top 35 segment set at mid-pupil" with the power to be determined by your measurement (s/he'll know how to convert this into dioptic power).  The reason you want to have the segment set so high is because the person is usually in a slight chin-depressed posture while ringing, and you want the intermediate segment easily accessible (i.e., no head movement).  Then when they need to look up, they can see the director clearly through the top portion.

I have placed all of my presbyopes (translation: persons with older eyes) who ring bells into this arrangement and they all LOVE it.  It makes playing music so much easier since they don't have to worry about being able to see.  (No more excuses!!)

Also, if you have someone with reduced eyesight because of disease (i.e., cataracts, macular degeneration, etc.), get them LOTS of light.  One of my ringers has two halogen lights on her notebook.

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Handbell Symbols in Braille.

After reading  a posting on Handbell-L about the blind lady wanting to ring bells, I spoke to our blind ringer about his music. He wanted me to convey to the list that he has available all the handbell symbols (marts, shake, mallets, that kind of thing) in

If anyone is interested in a copy, please contact me via e-mail,   with your snail mail address and I'll have
Larry send you a copy.

What About Carpal Tunnel Syndrone?

In recent years, we have seen a significant increase in the number of injuries contributed to ringing handbells, primarily to the wrist and elbow.  It seems to be a combination of the stress caused by hyperextension combined with the weight of the bells that exacerbates the problem.   The problem is not restricted to handbells.  The unedited narrative below explains the the injury and offers some suggestions as to correction.

Some of the following was copied from   For a complete text and links to other information, click on then search "carpal tunnel."

Pronunciation   --  KAR-pul TUNN-ul SIN-drome

Synonyms  --   Repetitive stress injury, or RSI. Throughout  history, RSI has also been known as "writer's cramp" or "seamstress cramp."

Detailed Description  --  Carpal tunnel syndrome is one of the most common hand and wrist disorders. A serious occupational health problem, it affects people who use their hands in a repetitive, strenuous motion. Symptoms that indicate you may have carpal tunnel syndrome include:

  • Burning, painful numbness of the hands and wrist, especially at night.
  • Tingling or prickling sensation in your fingers
  • Fingers feel the pins and needles of "going to sleep"
  • Symptoms occur mainly in the thumb, forefinger, and middle finger
  • Symptoms are temporarily relieved when hands are shaken or rubbed
  • Weakness of the hands, i.e., you may have  difficulty opening a jaror picking up small objects
  • Stiffness and swelling of the wrists
  • Increased pain with repetitive activity, such as typing, piano-playing, sewing, or working on an assembly line
  • Increased pain or weakness of the dominant hand
  • The median nerve passes through a tunnel in the area of the wrist. When the nerve is compressed, irritated, or pinched, sufferers feel a painful burning or tingling sensation. Those with carpal tunnel may also experience a loss of strength in their hands. The pain or tingling, often worse at night than while working during the day, can extend from the first three fingers
    (thumb, forefinger, and middle finger) to the forearm and even up to the shoulder.

    Repetitive-motion stress may be only one cause (and repetitive stress may cause injuries other than carpal tunnel syndrome). Carpal tunnel syndrome can be a symptom of other conditions, including pregnancy, diabetes, rheumatoid arthritis, menopause, kidney failure, lupus, obesity, and certain thyroid conditions. Complications after a wrist  fracture can also result in the syndrome.

     What You Can Expect

    You might feel tingling in your first three fingers, especially at night. An intense, burning pain and hand weakness indicates a more advanced case. If the symptoms are left untreated, you may lose practical use of your hands through degeneration of the muscles at the base of the thumb. Additionally, there is the possibility of permanent nerve damage, accompanied by loss of hand movement and sensation. Severe damage can be prevented if the early symptoms are given medical attention.   So, contact your physician.

    Prevention:  Methods of prevention include:

  • Cease the activity  --  If the injury has already occurred, stop ringing bells or whatever caused the problem.
  • Wear wrist spints or elbow braces during activities and while sleeping.
  • Check your ringing stroke.  Keep the bell upright, do not move the wrist downward which puts all the weight of the bell on the wrist (causing further extension).
  • Exercise.   Lift light weights, do finger exercises.
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    Preventing elbow problems

    Question on Handbell-L:   Are there any products we can use to prevent pain and possible injury (braces or special gloves, etc.), and what about any special exercises we can do regularly to help keep in shape and not feel so weak while playing the bottom bells. It seems to be very common in bass bell ringers.

    Taylor Hawley responded:

    I'm no doctor, but I've seen a very good orthopedic surgeon about the same sorts of symptoms. As far as elbow and forearm pain, it makes a difference if the elbow pain is on the top, dorsal, or sunny, side of the elbow(extend arm, face palms down, "top" is the part closest to the ceiling), or if the pain is on the "bottom" of the elbow. When the pain is on top, it is usually the worst at the point of the bone on top of the elbow. Pain on "top" of the forearm is usually from the tendons that connect to that bone on "top" of the elbow and may be Tennis Elbow. I call it "Bellbow". You can put your arm down now. :-)

    Less frequently is Golfer's Elbow which is almost identical, but on the "bottom" of the elbow and forearm. The tendons and the point where they attach on the elbow get inflamed and cause pain and small tears in the tendons. Again, there other things that can look like Tennis Elbow and Golfer's Elbow, so it really is best to see a doc to know for sure, and to find out the best way to treat your specific problem.

    This is in now way a substitute for seeing a good orthopedic surgeon, but my doc put me on ice, Alleve, and gave me these cool Tennis Elbow braces with little inflated pillows that change the fulcrum of tension from the elbow to just forward, or distal, of the elbow. The pillow focuses the pressure right on the tendons involved. You can buy tennis elbow braces at any drug store, but if you can find the pillowed ones, they seem to really work. Ice two to three times a day (particularly immediately after playing), 2 Alleve a day, and the braces when playing, or doing anything that exerts pressure on that region, or makes the elbows hurt. This has worked for me.

    One person responded that stretching after putting ice on the "hurt" was not recommended. Ed.

    Rima responded: There is a terrific tennis elbow brace made by Aircast. Works far better than most out on the market, and they cost about $15. Campanile bought 20 of 'em a while ago, and we just keep a bag around for those 16 hour recording sessions.

    Stretching is good before, during and after playing and also, gently after ice. Stretching may be one of the most important preventive things from what I've been told and have experienced. Hold arm out as before, palm down, keep arm almost straight (never locked at the elbow), gently move hand down like waving the first move of good-bye, or last move of a slam-dunk. Leave hand there, and gently push it a bit farther, but only a bit. Now, rotate elbow outward. IF ANYTHING HURTS, STOP. If you feel a stretch right where it has been hurting on top of the forearm, you are doing it right. If you don't, do it the other way.

    The strain in tennis elbow, as far as I can figure and as told to me by the doc, is worsened by picking up the bells, or anything with your palms down. Try to pick things up with palms facing up or sideways. Also, when picking up the big bells, try to push the handle under the bell rather than pulling the bell up over the handle. The latter seems to put more strain on the forearm. Imagine the bell is in a tower on an axle; you would have to push the handle down and forward to make the bell come up. The first few degrees of arc of the big bell coming off the table seem to cause the most stress, because it is so top heavy....something like a ten or fifteen pound weight on a stick.

    I also wear Nike leather batter's gloves(from a suggestion I read on the L) and tape my wrists with athletic tape, but keep in mind that every time you mechanically modify your arms with braces, heavy gloves, braces, etc. it allows you to play in ways that are harder on non-braced or non-modified parts of your body, i.e. your shoulders, so try to be gentle and smooth. There is a whole different conversation that can take place about shoulder issues and big bells, but we'll save that.

    Lastly, some music is written and played at speeds that are simply dangerous for big bell ringers to play by themselves if they play every note. Pick and choose your notes if a given run hurts or, better, trade off with the person next to you so that you split the run between you. The best low bell players I see work very closely together and have to work out ways of handling tough passages. One of the coolest moves I've ever seen two bucket players do was when Karl Kay and Brian Christopherson of Agape were playing "Now the Green Blade Riseth" by Kevin McChesney. Karl had been malletting the C3 mercilessly, for several measure of solid eighth notes when a whole note C3 came on count one of a measure following the last measure of the repetitive eighth notes. Karl malleted every eighth note, and Brian swept up the C3 and played the whole C3 note on count one......with authority. Adjudicate that! has written a book entitled, I think, "Healthy Ringing". Last I heard it wasn't quite to print, but I'll sure buy a copy when it's finished.  (It is available.  JMK)

    Taylor Hawley

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    Revised: July 12, 2000.