Simple fixes for easing piano pain

Supporting Educators • Promoting Learning

Lesson Notes is an occasional series of blog posts reflecting on specific lessons I have given and the particular issues that arose and were addressed.

Bernice is a 76-year-old learner who took up the piano about 5 years ago. She has made steady progress, is now early intermediate level, and particularly enjoys playing traditional classical favourites.

Bernice’s Wrist Problem

Bernice has recently developed some physical problems in her wrist area. On the right wrist, she has a large ganglion close to the base of her thumb, which cases mild discomfort. The surgeon she has consulted is going to remove this soon.

On the left wrist she has a more chronic problem. Here there is a ganglion just below the fifth finger, not noticeable to the eye, and a scan has revealed that it is pressing against a nerve. There is possibly also minor swelling in the tendon. The medical specialist cannot operate, but has suggested that with care and anti-inflammatories the problem may dissipate.

The mention of tendons might be enough to convince some that piano playing should be avoided altogether. It is natural that we teachers don’t want our students to experience pain, and most of us will be aware of the real danger that tendonitis presents to pianists.

However, the medical advice here is that it is fine for Bernice to continue playing the piano, provided she is careful and exercises moderation. The hospital specialist has pointed out that such problems, as well as arthritis, might become an ongoing issue, but that these need not stop her from pursing her love for music (which is real and important to her).

Happily then, we can assume that Bernice’s medical problems are essential “minor” at present. But this doesn’t diminish the discomfort she reported when coming to her lesson, nor her fear that she might not be able to continue playing.

The Lesson: Simple Adjustments

With a few simple, minor adjustments, I was able to help Bernice get back to playing her current pieces without discomfort.

While these are specific to both her medical condition and the music she is studying, there are general principles here which I hope will help other teachers and players.

LH 5 is of course an important finger in piano playing; one which is very often used for the all-important bass/root note of the harmony. That said, it is easier to dispense with (in intermediate-level music at least) than other fingers.

Looking at the piece Bernice brought to the lesson, it was easy enough to suggest that she replace this fingering, which heavily uses LH 5:

with this one, which avoids using it:

Making this simple switch proved to be a decisive help, and Bernice was overjoyed.

As a teacher, it struck me as interesting that Bernice had not considered this solution on her own. We cannot underestimate the extent that our students (whatever their age) stick to following written notation and fixed “rules” unless we give them permission to break free.

Some students really need our encouragement to creatively experiment and seek their own solutions (while others we might actually want to discourage from doing so!).

Bernice noted that while using LH 5 on its own isn’t a problem, she has had more difficulty playing LH triads. Her solution has been to omit the bass note from each chord, so avoiding the use of LH 5.

This is generally a helpful and creative solution. Together we assessed how effective it was in context, particularly bearing in mind the importance of maintaining the harmonic integrity and expressive intention of the music.

In some cases, I showed Bernice how to use a different inversion of the chord rather rather than miss out harmonic notes altogether.

Happily, the piece needed very minimal adaptation – but once again the impact in terms of Bernice’s comfort was palpable, and she was delighted.

One of the most important elements of helping students establish good technique is ensuring a “correct” sitting position.

But we should treat the word “correct” advisedly, because what really matters most is that we apply a few important principles rather than insisting on a one-size-fits-all uniform posture. Everybody has a different physique, after all.

In general, we tend to sit centrally, with “Middle D” pointing towards our navel. However, with the swelling in the left side of Bernice’s LH, I was concerned that in her current repertoire Bernice’s discomfort would be exacerbated by ulnar deviation:

with ulnar deviation

The solution in this instance was to move the stool to the right, so that ulnar deviation is avoided. Specifically, with a little experimentation we found that an optimum position was around a Perfect 5th higher than usual, with the “A” above “Middle C” now pointing to the navel.

Note: this was the position which suited Bernice; it would vary according to the size of the player.

In this new seated position, the arm is more naturally relaxed, and in particular the outer arm is better aligned, relieving unnecessary strain in the area of discomfort:

without ulnar deviation

Of the three changes we made, this one proved the most significant of all, and Bernice was taken quite by surprise to notice how much more comfortable her playing became.

However, care was needed to ensure that the new seated position didn’t lead to significant ulnar deviation in the RH, especially given the ganglion that Bernice also has on that hand. As is often the case, a balanced compromise was needed to optimise overall comfort.


The adjustments made to help Bernice find comfort continuing to play the piano are all rooted in an understanding of the three dimensions of musical learning which underpins all my teaching: Musical Mind, Body and Soul.

We tapped into Musical Soul by making creative changes to the piece itself, adapting and interpreting it in such a way that it lost none of its own musical qualities. Musical Mind played its part too, in analysing the harmonic foundations of the piece. And of course the Musical Body was a primary consideration as we altered the siting position, wrist shape, and fingering patterns used in the piece.

While Bernice’s issue is a very specific one, hopefully these ideas will help those with similar difficulties; moreover, there are generic teaching principles here which are important to underline:

  1. Personalised Learning is absolutely essential; it is the unique set of problems that each student struggles with which defines their learning needs.
  2. Problem solving is a creative activity, and can always be presented as such. Fixed rules, dogmatic thinking and uniform “systems” of playing are rarely useful.
  3. Many physical issues which seem to be deal-breakers to the player can easily be solved with the support and insight of a qualified, expert, and experienced teacher.

Bernice has rarely left her lesson with such a spring in her step!

From doubting whether she might be able to continue playing, she rediscovered and affirmed the joy that playing an instrument brings into her life, and the hugely important role piano now has in as a regular activity in her retirement years.

Please note: “Bernice” is not the student’s real name.
However, her story is told here with permission, and with my gratitude.

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Andrew Eales

Andrew Eales is a widely respected piano educator, writer and composer based in Milton Keynes UK. His book HOW TO PRACTISE MUSIC is published by Hal Leonard.