pianomap : Pianist's Injuries: Movement Retraining is the Key to Recovery
By Thomas Mark
Movement retraining is an exacting process. It requires consistent, careful attention as the injured pianist develops awareness of the coordinate use of the entire body to play every note. Describing this in detail requires a book (such as my book "What Every Pianist Needs to Know about the Body," GIA Publications). Individual instruction from an appropriate teacher is immensely helpful, especially in the beginning stages. The time required for recovery varies a lot, but some injured pianists who were unable to play at all have progressed in six months to full, unrestricted playing with no pain. Others may take a longer or shorter time. Much depends on the length and severity of the injury and the dedication of the pianist.
I shall not describe movement retraining in further detail here, but conclude conclude with three practical suggestions. The three principles I shall offer are aimed more at prevention than cure, but if teachers inculcated these habits in their students, we would see fewer injuries.
The first principle is to sit at the correct height and insist to students (or their parents) that the bench at home be at the correct height. Some piano methods do say things like "the forearm should be level when the student sits erect without hunching the shoulders," which is correct; much the same advice is found in any ergonomics text. If a person is not at the correct height, the body is likely to compensate somewhere. A person sitting too low may hunch the shoulders or lift the elbows, a person sitting too high may drop the wrist or pull the shoulders down. All of these compensations involve static muscular activity that limits freedom and can in time lead to injury.
Since the correct bench height is the one that puts the forearm level, it is not the same for everyone, and it may not be the same even for people of the same stature. The correct bench height is determined by the relation between the length of the upper arm and the length of the torso, and this proportion varies from one person to another. A handy way to find the correct height is to sit upright with the arms hanging freely and the fingertips resting on the keys. Then adjust the height of the bench so as to place the tip of the elbow even with the top of the white keys. To many pianists, the correct height will feel high at first, since most benches are too low for most people. Even adjustable benches do not go high enough for many people.
The second principle is to avoid dropping the wrist. The wrist should be roughly straight with the forearm, neither arching way up nor falling appreciably below the level of the main knuckles. The reason is that any other position puts stress on the tendons as they pass through the carpal tunnel. Forcefully flexing the wrist (as in "wrist octaves") is an important cause of carpal tunnel syndrome. The mid-range position of the wrist is the one in which the fingers move most easily and have the greatest strength, with least stress on the tendons.
The third principle is to avoid ulnar and radial deviation (which many pianists call "twisting"). That is, the hand should not be turned to either side, but should be straight with the forearm sideways as well as up and down. Again, the reason is anatomical: sideways bending of the wrist inhibits free motions of the fingers and puts extra stress on the tendons that pass from the arm to the hand. Common situations in which people twist are in bringing the thumb to the keyboard, or in playing black keys with the thumb. Twisting is one of the most common causes of injuries in pianists. (In terms of the four causes of injury given earlier, dropping the wrist and twisting both count as awkward positions.)
The three principles are not equally easily adopted. The first, correcting the bench height, is easy. A person soon gets used to the new height, and most people find that their playing improves immediately when the bench height is corrected. The other two principles are harder to assimilate, since they may involve changing long-established habits. If I habitually drop my wrist in playing chords, or twist when passing the thumb in a scale, I will need to learn a new way to accomplish those tasks.
Throughout this paper I have advocated movement retraining as the way to avoid or cure injury. But there is another point that is equally compelling: we play better if we move efficiently. Many pianists have retrained after injury because it was the only way they could play at all, and then discovered that they could play better than before. Others have retrained without being injured and discovered the same thing: they could play better, with greater ease, play more difficult pieces, and overcome problems that formerly seemed hopeless. These facts are profoundly important, and every pianist or teacher should reflect on them. What they imply, I believe, is that all of us, students, pianists and especially teachers, should make the effort to learn the principles of efficient movement at the piano and apply those principles first in our own playing (since we can't teach what we can't do) and then in our teaching. An efficient technique is not only the way to cure or avoid injury, it is the best way to further our artistic goals.
Note: I am a pianist, not a health care professional. I am grateful to William Pereira, MD, MPH, of the Interdisciplinary Ergonomics Research Program at Lawrence Livermore National Laboratory, for discussion and clarification of many issues relating to repetitive stress injuries.
Readers with comments or questions about this paper can contact me by email.
An abridged version of this paper was published in The Oregon Musician, Spring 1999, pp. 11-13.
Copyright 2001 by Thomas Mark
What Every Pianist Needs to Know about the Body
Pianomap is created and maintained by pianist/teacher Thomas Mark.