Musicians' Health Matters: Discussing Music-Related Injuries and Prevention Strategies 🩺
As we all know, playing music can be a physically demanding activity. Whether it's from hours of practice, or performances, our bodies can take a toll. I wanted to start a conversation about the topic of music-related injuries, and invite all musicians to share their experiences and advice on how to prevent and treat them.
Have you ever experienced pain or injury as a result of playing an instrument or singing? How did you handle it? What steps did you take to prevent it from happening again?
I think it's important for us to have open and honest discussions about these issues, so we can all learn from each other and take better care of ourselves as musicians.
So please, share your stories and let's start a conversation!
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I hope you are familiar with the taubman approach of piano playing
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Martin, thanks so much for starting this topic! I’ve been wanting to learn what others have experienced, and what resources they have found to help with the types of injuries to which muscians are prone. In the next few days I’ll gather some of the resources I have discovered and share them here.
Here is an image to show my current state:
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Michael Hi Michael,
I was sorry to read about your current problems when they started a few weeks ago and was wondering if you are getting better at all?
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Here is one resource of information about pianists’ injuries and injury prevention, with links to further references:
https://www.pianomap.com/index.html
I hope others will share any references they have found useful.
It would also be interesting if people can share any information they have gathered relating to medical clinics or experts specializing in the care of musician’s injuries. References might be found through looking into Gary Graffman’s and Leon Fleisher’s experiences—both perhaps alluded to in Tonebase interviews. If I recall, dystonia was one diagnosis.
Some conservatories, like Peabody, have established relationships with clinical facilities prepared to address injuries in performing artists:
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I started looking into Taubman Approach and Penelope Roskell's "The Complete Pianist" book after 2 years of getting back to practising the piano (after 20+ years hiatus). I was bringing back the last movement of Beethoven's Tempest Sonata and my right forearm felt a lot of tension and on the verge of pain. I decided to spend a couple of weeks relearning how to "drop" into the keys, and turned down the difficulty level of the pieces by several notches.
That was 2 years ago, and I feel my playing has improved since then, both physically and sound quality. I'm much more aware of the movement I make and how easy/difficult it feels and adjust accordingly. I still play relatively shorter and easier pieces currently, though I don’t feel like that’s a bad thing as even a seemingly easy piece can also be deceptively difficult to play well sometimes. I hope to have face-to-face lessons with actual Taubman teacher or attend Penelope’s workshops in the future as there’s a limit to what I can learn and do on my own. It would be good to have proper guidance, esp with so much online resources out there sometime it’s hard to know if an advice is a good one or would actually lead to further injury.
As for resources on Tonebase, I like Robert Durso's Taubman Approach course as it gave me more understanding and clarity on the approach, and Keyboard Choreography by Seymour Bernstein. I have also worked through part of "The Complete Pianist" book which I also find useful.
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Priya Viseskul in the course of your training as a pianist, did any instructor when teaching technique or in observing your technique ever address the potiential for injury?
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Michael It was a long time ago when I had lessons but mostly they focused on interpretation, much less so on techniques, and rarely correcting the techniques and how to practice the passages effectively and safely. A teacher who I studied with the longest at least addressed the arms and shoulders ... I think my playing was less fluid back then but as I was young it was still possible to just drive through the tension thinking it was normal.
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Michael Popping into this discussion: my son's first teacher (group online lessons during the pandemic) didn't address technique much. But his second teacher (again, online - she's in NYC) was very concerned with technique and injury avoidance. She took her pedagogy training at NYU (after her performance BA from University of Florida), so my guess is that the younger generation of teachers may be more attuned to watching for and preventing common injuries. She worked often on proper use of wrist and arm with him, and when he wouldn't stop playing pieces which were technically too difficult she took him through those pieces slowly so that he would avoid injuring himself and learn poor technique on his own. I'm not sure how his current teacher will address technique, as he has been with her just one month, but she is already encouraging relaxation and lightness.
He was able to take a lesson with a Taubman teacher (she was trained by Robert Durso), and in that one lesson there was a noticeable difference in his playing. She had a different perspective, and recognized technique issues very quickly. She focused on use of arm weight, as he tends toward some tension in his wrist/hands. Our schedules did not work out, or we might have gone with her when he had to switch teachers at the end of last year.
One note with my son: he worked with a harpsichordist last year on some Bach. One technique given regarded separating the notes (clarity between notes). His teacher at the time, the NYU trained one, agreed with everything the harpsichordist said with the exception of this technique. She said that using this on piano (at least for my son right now) would create tension and cause injury. She preferred that he work on a more legato (I forget the term she used) technique until he was able to find relaxation.
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I think this could be a wonderful workshop comprised of hand, arm and neck specialists who treat injured musicians, the injuries the see most, and the ramifications of not taking precautionary measures to address injury before it gets to needing a surgeon to correct. Then you could have a highly trained physical therapist who could provide full body exercise workouts for musicians, both men and women, as well as warm up exercises for before playing. I have replied to the tonebase survey asking what we would like to see on tonebase, and have provided names of some of the top people in NY who work with injured musicians from Julliard and the NY Philharmonic. (Since Tonebase already has a series on the Taubman method, I would hope this new series of workshops would stay focused on topic and not go down the Taubman method rabbit hole, which is not a financially viable option for most struggling musicians)
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Chris Deiturriaga I too have suggested to tonebase very recently that they introduce injury as a topic in the forums (is this one the result?), and it would be great to add presentations on injury prevention and treatment by medical authorities. Dominic did a livestream with an upper extremity surgeon that was helpful: https://app.tonebase.co/piano/live/player/healthy-musician-bill-kleinman. It would be great to have more presentations on this topic, perhaps in the form of a course.
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Chris Deiturriaga could you share the names of some of the NY experts in treatment of muscian’s injuries? Here are some links that I’ve discovered when searching for experts in this field (not an endorsement):
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Michael Dr. Alton Barron…Hospital for Special Surgery…NY. Hopefully, you will not injure yourself to the point where you need him ( like I did for trapped ulnar release surgery) But he’s the best…works mainly with injured musicians. Lots of musicians learning Feldenkrais Method and Alexander Technique theraputic exercises and mindfulness training to prevent injury as well.
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Chris Deiturriaga thanks so much for identifying Dr. Barron!
I'm now reading Ian Winspur's The Musician's Hand: A Clinical Guide ed. 2.. It has helped somewhat in planning my approach to self-remediation before seeking clinical attention. I'm finding that the assessment of these problems can be tricky as there is so much overlap between musculoskeletal and neurological etiologies, and also the possibility that problems arising from several locations can have a cumulative effect.
After at about two months of abstention, my symptoms have substantially improved but worsen after even a few minutes of piano playing.
I've also known musicians who have benefited from having an Alexander Technique instructor monitor their posture and provide feedback while playing. I'll look into Feldenkrais too.
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My personal experience with injury and its treatment involves mostly repeated exacerbations of carpal tunnel syndrome and lateral epicondylitis. I have come to the piano as an adult having not had any significant training on the piano itself. Rather, I learned on the harpsichord starting at age 13, so all my technique is built around finger movements, and the learned octave span is shorter than that on a piano. None of my ingrained muscle memory is suited to the piano, but it comes tantalizingly (and perhaps dangerously) close. Many years of serious study enabled me to play most harpsichord literature. After a hiatus of many decades I have come to the piano, with some skills that allow me to jump (like an idiot savant) into pieces that a devoted pianist would only attempt after years of technical training. During the hiatus, I acquired occupational repetitive stress injuries, and I got old.
My career included work as a musculoskeletal radiologist with special interest in MRI of the extremities, including the fingers, hand, wrist, elbow and shoulder. Although I did not treat the conditions that I diagnosed, I have some familiarity with them. That background allows me to offer (in subsequent posts) a few off-the-cuff, birds-eye view observations about the way the topic of piano technique and injury is often presented. I’m hoping to encourage conversation, elicit the expertise and the experience of others.
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Do you think that the many schools of piano technique (including Taubman) intended to prevent injury can be boiled down to some common features:
- The physical effort of getting a finger to a key and act of depressing it is distributed as broadly as possible to multiple joints and muscles all the way from the shoulder to the finger. The concerted effort of the whole arm (including wrist supination-pronation (“rotation”), wrist and elbow flexion and extension, all shoulder motions) minimizes the effort of any single joint and of the smaller muscles.
- The coordinated effort is intended to minimize the activation of opposed or stabilizing muscles (i.e. “stiffness”, “tightening”)
- Movements and positions that increase friction between tendons and neighboring anatomy, or that disadvantage them mechanically are avoided. A prime example is radial or ulnar deviation at the wrist (“twisting”).
- Movements need to be as efficient as possible. No muscles are activated needlessly.
The technical instructors seem to be lumping these concepts into various gestures, or broader coordinated movements, so they can be described and assimilated.
Am I missing something?
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Michael I think the techniques like Taubman or Roskell set themselves apart from others because they are backed by understanding the physiology of the human body, particularly finger/hand/wrist/arm ... understand that which muscle/joint is good/bad in doing what movement, and the combinations which led to tension and are to be avoided. On top of that is understanding the mechanics of the piano and use it for more efficient playing. Once you understand that then it's easy to grasp the reasoning behind the techniques they describe.
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michael
You may be interested in the work of Rae de Lisle ( piano professor at Auckland, NZ) who has studied pianists’ rehabilitation for several decades after losing her performance career in her twenties due to an overuse injury. She is an international level pedagogue and has recently published a bookcalled Fit4Piano available in hard copy with embeddened video demos or as an e-book. She worked with our leading concertpianist here, Michael Houston, who made a complete recovery from debilitating focal dystonia,having previously had to retire from the concertplatform. He had to rebuild his technique from scratch. Iknow of one student who was just beginning to develop the condition whostudied with her and reported that she wasunsurprised that he had previously played theHarpsicord. Presumably a very different finger action? Perhaps not transferring well to the piano keyboard. Herbook is very clear, easy to understand, and concise.Very user friendly. I heardsecond hand that of all the pedagogues she interviewed she considered Penelope Roskill’s work andphilosophies closest to her own. I have both books. I have huge respect for Rae and have attended several of her presentations. She is a leader in her field.
Here is a link to a presentation she gave to an international conferenceabout her work.
https://youtu.be/JvqCRyfzz4oand her website. (The book may look like it’s intendedfor children but it is directed to all levels and specifiesadvanced repertoire wherea particular exercise isrelèvent and helpful. )
https://www.raedelisle.com/fit-4-piano.html
I’m sure you will find much of value here. She’s worked with many healthprofessionals and may beavailable for consultation byZoom, I’m not sure. -
Michael Rae has just released an additional online course detailing the application of technique to piano repertoire. It’s discounted until February 17th.
https://www.academy.fit4piano.co.nz/courses/exploringpianotechniqueI’ve bought it and will work through it in the coming week/s.
I hope you are feeling more optimistic about your recovery. :-)
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marina I watched the link to fit4piano in your post and agree that her approach is indeed very close to Penelope Roskell (certainly the parachute and hot air balloon analogy!)
Fyi she is also running a technical clinic workshop (in person and online) next month.
https://practisingthepiano.com/events/technique-clinic-with-penelope-roskell-mar-23/
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marina thanks for the tip! I hope you will let us know what you think of the course as you proceed.
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Priya Viseskul another great lead. Thanks.
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What do you think about this simplified view about piano technique, which offers some premises in the interest of allowing technique to be built around injury prevention?
- Ortmann’s two seminal books seem to establish that the performer has only a few mechanical effects at his disposal: the velocity with which the key is depressed, how long the key is held down, and what is done with the pedals
- All the various desciptions of techniques devoted to eliciting specific characters of sound and the elaborate gestures needed to produce them are actually just maneuvers to control the velocity with which the key is depressed, timing of its depression and release. There is no magic.
- The various timbral qualities supposedly elicited by technique also result from only the velocity with which a key is depressed (and interaction with other events like concurrent notes being played, pedal effects, and thumping of the key or other mechanical components against felt). The timbre of any note which is imagined to be controlled by some technical finesse (“brighter”, “darker”, “singing”) is also a consequence only of key velocity (and ambient sound environment). The timbral changes are the consequence of the elastic or compressive properties of the hammer felt, which have a non-linear relation to the force with which it strike the string, hence eliciting more or fewer upper partials.
None of this minimizes the finesse and skill of the pianist in creating music, but thinking in this way might facilitate development of a safer, simpler technique.
Is this perspective controversial?
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Michael I feel that this kind of view that boils everything down to plain and dry physics of the piano really doesn't help as it ignores human physiology and also does not describe in anyway what/how one should do to avoid injuries at the piano.
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Priya Viseskul yeah, that view doesn’t deal with the fundamental, practical problem of “how should one play this contraption”.
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I had left hand wrist pain due to 1. not understanding how to release tension, 2. collapsed knuckle bridge (I don't have strength in these muscles) 3. my LH finger 5 and 2 second knuckle also collapsed for some reason - so I overused wrist to compensate these issues. I finally found a teacher who pointed out these issues, and now I'm working on slowly developing these muscles and finger strength and proactively working on releasing tension when I practice.
My new teacher constantly put her hands on my shoulder to remind me to relax my shoulder. I often tense up my shoulders as I am engaged in practice. I put a mirror next to myself to watch my movement now.
I'm open to hear your feedback if you have suggestions!
