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Pianists and Injuries

You can’t avoid it. Athletics are part of piano playing so if you abuse your hands, arms, wrists, let alone your fingers, you’ll end up benched, like an overused relief pitcher.

Yesterday, I pushed the envelope, practicing rapid fire repeated notes in Domenico Scarlatti’s Toccata in D minor, well into the night. Ample streams of adrenaline fueled my earliest efforts, but after three uninterrupted hours, my fingers felt like silly putty, while my arms ached. Like a well-primed hurler, I had gone too many extra innings.

Word of warning: Even if you have a big arm swing, and can mix up your stuff, repeating a particular motion over and again, like a set of Forte parallel octaves, can cause an overuse injury.

From the Harvard Medical Alumni Bulletin, Summer 1999:

“Dr. Fred Hochberg, a neurologist at Massachusetts General Hospital, began treating instrumentalists’ injuries about 15 years ago, when a friend asked him to meet with Gary Graffman, a world-renowned pianist who was having difficulty with his right hand.

“He couldn’t lift his fourth finger,” Hochberg says. “And he wasn’t the only one—he had a list of friends with the same problem. These were pianists who played the same repertoire, or what are called the heroic pieces.”

Focal dystonias, involuntary movements of fingers, or an inability to freely move them, affected these pianists, that included Leon Fleisher and Byron Janis who routinely practiced the big warhorse repertoire.

Selective Movements

Still, about two-thirds of Hochberg’s musician patients presented with overuse injuries, not dystonias.

“They had a localized inflammation of the joint or tendon, probably due to microscopic tears of the tendon with hemorrhaging,” he said.

“Almost invariably, the problem related to the shoulder. Since the arm weighs between 15 and 20 pounds, and even though playing an instrument tends to involve selective movements of the fingers and wrists, the shoulder musculature takes most of the brunt of the movement. Most people can’t stabilize their shoulder while using their fingers.”

Teaching Perspectives

Since my private instruction has been slanted to avoid piano-related injuries, I favor enlistment of bigger energies beyond the fingers when practicing. Using larger, gross motor motions, minimizes redundant end-finger keyboard impact.

In the same vein, the use of a “spongy” wrist, delays entry into notes, thereby preventing pokey, percussive landings that could result in physical trauma.

For unusually big stretches in piece of music, a student can learn rotational movements to ease the flow of passages and create curvaceous phrases.


Irina Gorin, a Russian teacher based in Indiana and creator of beginning piano instructional materials, imbues her students with the image of a keyboard as a bowl of jello to prevent hard surface, key attacks. First, she will dip a pupil’s fingers into a jar of putty, purchased at the Dollar store, to provide the tactile “feel” desired, before a transfer is made to the keys. Lastly, a muscle memory of the experience helps the student play fluidly and produce a beautiful singing tone without exertion or strain.

In the following You Tube video, Gorin teaches a student the C Major scale using her “jello” model:


The Clinical Perspective

Dr. Hochberg recommends physical therapy and exercise to return an afflicted musician to a normal range of movement and to strengthen the muscles needed to stabilize the shoulder.

“Playing an instrument is not good exercise,” he said. “You would think the more you play, the stronger your arm would get, but that’s not true.”

Of the thousands of patients Hochberg has seen, fewer than 30 have undergone surgery, most commonly for carpal tunnel syndrome and ulnar nerve entrapments. And on average, patients take three months to recover. During that time, they may only play for ten to fifteen minutes at a time, two to three times a day.

“Michael Charness—director of the performing arts clinic at Brigham and Women’s Hospital in Boston, and a member of the Charness Family Quintet with his wife and three children—has a unique take on what it means to be a pianist with an injury.

“I started treating musicians because of my own injury,” he said. “I was starting to play some difficult pieces. The more I practiced, the more my fingers weren’t doing what they should. They were sluggish, less accurate, and less controlled. I had an electromyogram, which was normal. I had a fairly normal hand exam too, but I felt I had an enormous problem.”

Eventually, Charness underwent surgery to decompress his ulnar nerve on both sides. That was in 1984, and he slowly regained his strength and facility.

“I had a debilitating problem, yet my hand appeared normal to skilled clinicians.”

Charness sees focal dystonias as particularly vexing. “It’s a bizarre disorder,” he said. “People who have spent many years acquiring musical skills lose the ability to perform because their hands pull into a position that makes it impossible for them to play. Their ring finger, for example, may pull into their palm when they play a scale going up but not going down.”

When Charness meets with patients, he watches them play their instruments. “We’ve learned how to change people’s position to make it easier to sustain playing.”

How much practice is too much?

“That’s a difficult question,” Charness said. “I think most people ought to be able to get everything done in four to five hours or less. It has to be individualized, but there are some general principles that encompass, for example, not playing for more than 25 minutes without a break.”

I personally knew last evening, when it was time to stop, but it was well beyond Charness’s recommended time boundary.

Veda Kaplinsky, a Juilliard faculty member, and frequent judge at international competitions, insisted in a recorded interview, that after 5 or so hours of piano practicing, the blood supply to the muscles diminishes.

So true. The spurt of energy flowing down the arms into wrists, hands, and fingers maxes out and then begins to run dry. It’s the body’s warning to the player, to take a break, or call it a day.

Before my reserves were thoroughly depleted I managed to post an upped tempo performance of Scarlatti’s Toccata in D minor. This was a daredevil challenge to myself, notwithstanding the risk of overdoing it in one final recording session.


Since 1999, schools of thought have changed about performance-related injuries and how to prevent and/or treat them. The issue is not necessarily about over-practicing, but rather about how the player integrates relaxation techniques and mental imagery into all his playing.

Principle Players in The Performance Injury Field


Dr. Frank Wilson was an early contributor to the development of performing arts medicine in the United States and Europe in the 1980s. In 1986 he was a co-founder and neurologist for the Health Program for Performing Artists at the University of California, San Francisco, where his interest focused on impaired hand control in musicians. In this connection, he organized a research team studying focal dystonia as it affected performing artists.

In 1996, Wilson became the Medical Director of the Health Program for Performing Artists, and in 2001 accepted an appointment as clinical professor of neurology at Stanford University School of Medicine, joining a clinical research team that studied deep brain stimulation for patients with complex movement disorders.

The Golandsky Institute:

Edna Golandsky, a former student of former Juilliard faculty member, Dorothy Taubman, founded an Institute on the East Coast devoted to preventing performance-related injuries, as they apply to the piano. An archived collection of You Tubes fleshes out specific physical piano-related problems and how to remedy them.

My disagreement with Taubman/Golandsky circumscribes the wrist and its flexibility. Where Goldansky frowns upon “breaks” or dips of the wrist in piano playing, I join the ranks of many teachers, including Irina Gorin, who encourage the opposite. In fact one of the hallmark physical dimensions of producing a singing tone, is having a supple wrist that can spring up and down.

Finally, there are many schools of thought in the universe of teaching piano and injury control, so it’s best to research these, compare notes, and keep an open mind.


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