THE WAY OF PIANO • MIND • BODY • SOUL
Written by ANDREW EALES
The problem of musicians developing injuries related to their playing has received much attention in recent years. Happily, we can learn from a growing body of performing arts medicine research, and the insights of respected pioneers who have devoted their expertise to the fields of piano technique and movement retraining.
A systematic review (2018) of existing research into the prevalence of injury makes sobering reading, suggesting that up to three quarters of all keyboard players report experiencing musculoskeletal pain. And sadly we will all most likely have encountered players who suffered injuries such as tendonitis, carpal tunnel syndrome, and dystonia.
Avoiding injury is clearly a key concern. However, increased awareness of this important issue has been accompanied by confusion and disagreement between pianists and educators both about the causes of injury, and what constitutes “good technique”.
Minding the risks
Speaking to International Piano magazine in September 2010, Peter Feuchtwanger observed,
“In more than 40 years of teaching, the greatest problem I’ve encountered is a lack of body awareness. In their ungainly behaviour at the keyboard, many pianists have forgotten the simplest, most natural and functional movements. As we know from some very famous artists, this can lead to physical problems.”
This issue of mind-body connection is often raised in this context, and I will be returning to it later in this article, where we will consider how best to avoid injury.
For now, it is useful to notice that Feuchtwanger’s concern resonates with the writings of Dr. Thomas Mark, whose seminal textbook What Every Pianist Needs to Know About The Body (2003) includes diagrams that map the whole structure of the body as it pertains to piano playing.
He suggests:
“If the body is balanced and free, technique functions well and playing is secure, expressive and fluid. If the body is tense and out of balance, playing suffers and the pianist may be at risk of injury. Although the subtle involvement of the entire body in playing the piano is rarely taught, pianists and teachers need to understand it in order to improve their own and their students’ playing, and to prevent or cure injury.”
We can all enjoy enhanced freedom and fluency in our playing by having a better understanding of physiology. More than ever before, we can adopt and teach playing techniques that are medically sound as well as musically enabling.
However, the systematic review previously mentioned barely mentions technique among the risk factors commonly observed in those who develop injury. There and elsewhere, attention is rather drawn to the following key risk factors:
- a sudden increase in practice
(eg. when preparing for an exam, competition, audition) - lessons/practice for more than 20 hours a week
- practising for more than an hour without a rest break
- continuing to play despite experiencing pain
- repertoire calling for new or unusual techniques
- personal stress and/or anxiety
- having a physical growth spurt
- physical ageing
- poor physical fitness and/or lack of regular exercise
- lack of sleep, dehydration, poor diet
- female pianists have a statistically higher risk of injury
While some of these risks are beyond our control, many are within our gift to change. Unless we attend to our physical health, lifestyle, competitive mindset, obsessive practice routine, and have an approach that is appropriate to our age and physique, even the best piano technique won’t prevent injury.
For further information and help, check out the support and advice that’s freely available in the Pianodao Wellbeing section of this website.
Physical causes of Injury
Thomas Mark’s book offers a physiological analysis of particular movements which, when repeated over long periods and in the context of the other risk factors mentioned above, can lead to injuries such as tendonitis, carpal tunnel syndrome, and dystonia. He boils it down to four basic concerns, which I have adapted below for greater clarity:
Co-Contraction: Muscles work in pairs to enable movement. The agonist muscle contracts to create movement, while the antagonist muscle relaxes and lengthens to let the movement happen. When both muscles contract at the same time, it’s called co-contraction, which is important for controlling fine movement and keeping joints stable. However, excessive co-contraction (for example, localised during long piano practice) can increase stress on joints and cause damage, especially if the joint is already supporting weight.
Static Muscular Activity: When a muscle moves a body part, it contracts and shortens. When the part moves back, the muscle relaxes and lengthens. This action is known as dynamic. If the muscle exerts force without changing length, like pushing a heavy object that doesn’t move, it is called static. Static activity can restrict blood flow, leading to muscle fatigue, and increasing the risk of injury.
Awkward Positions: A muscle connects to the bone it moves via a tendon that crosses one or more joints. The position of the bones affects how well the tendon transmits force, and in the case of the fingers, they move over multiple joints. A straight wrist aligned with the arm provides the best mechanical advantage for the fingers. Regularly moving away from this position can strain movements and lead to injury.
Excessive Force: Stress on muscles, tendons, and other structures increases with greater force: the more force, the more stress. Playing piano keys actually requires little pressure: on a well-regulated modern piano, the key weight is usually between 50-60g. Players often use far more force (or arm weight) than is necessary, and with high repetition, using excessive force can cause injury.
Potentially harmful technical habits
For those who suffer injury, medical interventions can sometimes be needed, and a lengthy period of rest is usually essential, often accompanied by physiotherapy.
However, Thomas Mark suggests that permanent rehabilitation requires retraining our movements to be less stressful and injurious:
“Pianist’s injuries are rarely medical problems; they are movement problems. Health care professionals are rarely of much help to pianists who seek a permanent cure. An injured pianist does not need a doctor so much as a teacher, and the solution to the near-epidemic of pianists’ injuries will come not from therapy but from education.”
Many different approaches to piano technique have been taught over several generations. For much of this time, piano teachers have had little knowledge of anatomy, and performance medicine was not a recognised field of study. Simultaneously, the piano was itself developing as an instrument: the weight of modern piano keys and action far exceeds that of the pianos played by Mozart, Beethoven, Chopin, or Liszt.
Despite constant change, many continue to use and teach the same techniques and methods that were developed in a different context, and practise the same finger studies. At the other end of the spectrum, some seem intoxicated by novelty and experimentation for its own sake.
Regardless of the many conflicting theories on piano technique, medical science suggests that the following might prove harmful to players:
- Poor posture, with raised or hunched shoulders
- Sitting at an incorrect height or distance from the keys
- Supporting arm weight with the wrists
- Pushing the wrist downward, or pressing it up while playing
- Twisting sideways at the wrist
(ulnar and radial deviation) - Artificially formed hand arch, with high curved fingers
- Excessive key pressure and motion
While these issues are unlikely to cause more serious injury unless the player is also at risk due to their constitution, lifestyle, and the practice factors listed earlier, they are nevertheless likely to cause discomfort, and will impede musical fluency, progress, and enjoyment.
Healthy playing: mind-body connection
Now that we have considered the problem of injury from a range of perspectives, let’s revisit Peter Feuchtwanger’s observation, which I quoted earlier:
“In more than 40 years of teaching, the greatest problem I’ve encountered is a lack of body awareness. In their ungainly behaviour at the keyboard, many pianists have forgotten the simplest, most natural and functional movements…”
Our search for an effective way of reconnecting mind-body awareness can lead us to several ‘somatic’ (movement) approaches, with origins both ancient and modern.
The best-known include Alexander Technique, Feldenkreis Method, Yoga, Tai Chi, and Pilates. All these can help us develop a more healthy movement approach, and in so doing will undoubtedly benefit our playing.
Pianodao promotes Qigong exercises, which are the foundation of Tai Chi, and a complementary branch of Chinese medicine.
This site includes several free, introductory exercises that you can try for yourself: simple breathing and stretching warm-ups which anyone can freely and easily incorporate in daily life, use in piano practice sessions, and which can be introduced in lessons.
These health practices actually influenced the development of the Feldenkrais method which, like qigong, works to reconnect us with natural movement and flow. In this state of better mind-body connection, old wounds are healed, and we learn healthy somatic instincts that protect us from future harm.
In his book Restoring Your Life Energy, Master Waysun Liao explains (in words that very powerfully echo Feuchtwanger’s):
“In your mother’s womb, you moved like we do in qigong but you lost this natural way because you became “smarter”. You learned how you were supposed to move in order to hold a pencil or ride a bike, and you thought you were getting better and better, smarter and smarter. Not exactly. By learning artificial, rigid, and mechanical ways of moving, you were just giving up all the power and potential of the natural motion of flow you had before.”
You can find out more about the benefits, and access links to Pianodao’s free introductory exercises here:
Golden Rules for Avoiding Injury
Finally, a summary of some simple rules that we can all apply right away when we sit at the piano, and which will help us avoid injury:
Develop a healthy approach to practice. Vary sessions, plan carefully, warm up before longer practise sessions, stay hydrated, and take regular breaks. You can access more detailed advice in my book How to Practise Music.
Sit well. Ground yourself on the stool, your weight comfortably supported by the sitting bones, and with relaxed shoulders. Adjust both the height and the distance of the stool for a centred, neutral position. Align the elbow, wrist, and middle finger with the surface of the keys, with the forearm parallel to the floor.
Pay special attention to the wrists. Be aware of physical sensation. Keep the wrists soft, and allow them to ‘breathe’. Sense the weight of the hand, and its availability.
So far as possible, avoid or minimise:
• supporting arm weight at the wrist
• sinking the wrist, following through after playing a note
• pushing the wrist upwards with the fingers
• twisting, misaligning, or sideways deviation
Don’t curl the fingers. When fingers are too curved, this causes co-contraction. Avoid playing with the bony tip of the finger, and never retract the finger towards the palm of the hand after playing a note. Rather, connect to the key with the fleshy area of the finger tip, maintaining a naturally curved hand shape.
And remember to breathe! You can find advice and free exercises to help reconnect with your breathing at the piano here.
I hope that you will have found much to consider in this article. I recommend that you supplement this information by downloading and reading the BAPAM Factsheet: The Healthy Pianist.
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