The Healthy Pianist

Introduction

Check our health resources for more advice and resources, including guidance on warm-ups, physical and mental health, vocal health, nutrition and touring. Find out about our free healthy practice training sessions and creative community support by looking at our events.

This factsheet is also available as a downloadable PDF and a folding pocket sized leaflet. To order copies of the leaflet please email info@bapam.org.uk.

Piano playing can be very demanding physically and prevention of injury is a primary concern for all musicians. Pianists who experience tension, pain or injury need to complement medical advice with a re-assessment of their technical approach to avoid the problem recurring.

In this Factsheet:

• Health and posture
• Technical Principles
• Adapting to the instrument
• Practising
• Warning signs
• When to visit a specialist

Health and Posture

• Maintain a certain level of fitness with regular aerobic activity such as swimming, walking or running (sports involving weights and tight hand grip are not recommended for pianists).
• Study a method which helps to improve general posture and suppleness, such as Alexander Technique, Yoga, Tai Chi, Feldenkrais or Pilates.
• The spine needs to be erect and ‘lengthening’: neither overly tense, nor slumped.
• The body weight should be evenly distributed between the sitting bones, with the bones pointing down and very slightly backwards into the chair.
• The stool should be at a height that allows the arms to hang loosely from the shoulder, with no clenching of elbow, shoulder or wrist.
• Distance from keys should be such that the chest remains open, and there is enough space to enable the arms to move freely towards the extremes of the keyboard or across the body when required.
• Feet should be firmly placed on the floor (or on a firm support). When pedalling, the foot pivots lightly from the ankle.
• Discover the balanced, neutral position of your wrist by allowing the arm to hang loosely by the side. Start each practise session from this neutral position with the wrist neither habitually too high nor too low.
• Observe the individual curvature of your hand, and use this as your starting point for finger action avoiding excessive lifting or curving of the fingers.
• Wherever possible, let the elbows hang loosely from the shoulder, and keep the forearm in line with the third, fourth and fifth finger.
• Work towards muscle tone and muscular co-ordination rather than strength and stamina.

General Technical Principles

• The fingers are designed for agility, subtlety and independent detailing, not for power. Pianists can learn to use the stronger muscles of the torso and upper arm to support the action of the fingers.
• Bring the arm to the keyboard with a free swinging motion, so that the hand hovers lightly over the keyboard before playing.
• Practise using gravity and the natural release of the weight of the arm to play chords.
• After playing the note, there is nothing to be gained musically or technically from continuing pressure on the keybed.
• Aim to align the forearm with the third, fourth and fifth fingers, not with the thumb.
• Avoid excessive stretches: use coordinated sideways wrist-arm movements to bring each finger towards the next note. Change fingerings, and consider leaving out notes if your hand requires it.
• Think of opening out the hand naturally from a soft wrist, rather than forcing the fingers to stretch apart.
• Look out for resting points and practise minimising tension between repetitive octaves or large chords.
• Refine movements to the point where they are tension-free. Use the required amount of effort to raise the hammer to the string – and no more.
• Exhale deeply before playing, or before a difficult passage.

Adapting to the Instrument

• Pianists with smaller hands need to be careful not to overstrain, and need to choose repertoire that suits not only their temperament, but also their hand size.
• If choosing a new piano, it is worth considering whether a lighter or heavier action is more appropriate for regular practice. Smaller sized keyboards are becoming increasingly available. Take a look here: www.smallpianokeyboards.org

Practising

• Warm up the muscles to bring a full supply of blood to the hands before practising any technical exercises, scales or pieces. Warm-up regularly before, after and in between practice sessions.
• Practise in twenty minute sessions, interspersed with ten minute breaks, to allow the hands time to recover between sessions.
• Valuable work can also be done away from the keyboard (studying the score, note learning, rhythm work and memorising).
• Vary practice as much as possible, changing frequently from right to left hand, fast to slow passages, forte to piano. Using all the registers of the keyboard when you are practising helps to keep all the joints fully mobile. In particular, avoid any technique involving repetition at the stretch for more than short periods of time.
• Do not launch into the most difficult passage at the beginning of a practice session.
• Practise passages quietly and slowly with minimum effort initially, gradually building up to full tempo and dynamic without increasing tension.
• Pace your practice, both on a daily basis and over longer periods. Avoid sudden increase in practice time by learning new pieces sufficiently well in advance to allow a ‘settling’ period before a performance or exam.
• Avoid playing fortissimo when you are fatigued or until you are able to do so without straining the hands.

Warning Signs to look out for

• If you do start to experience tension or fatigue, consider these as warning signs that you may need to reassess your technique, your practise methods, or to change your programme.
• Think carefully about other activities which may be causing additional strain(typing, texting, carrying heavy music bags, or recreations such as sport or gardening).
• If you experience pain, stop immediately

When to visit a Specialist

There are some typical signs and symptoms that may need early medical advice:

• Pain around the wrist on stretching the thumb with occasional swelling and redness, worse when underpassing the thumb or during octaves or in chords.
• Localised swellings around the wrist or at the finger joints that can come and go or change in size.
• Thickening of the skin in the palm of the hands.
• Sensation of a ‘click’ or ‘block’ when a finger is opened or closed.
• Numbness, pins and needles or pain.
• Clumsiness in handling objects and weakness in the hand.
• Uncontrolled finger movements or inability to move a finger voluntarily.
• Pain around the elbow occasionally with redness and swelling.
• Shoulder pain that may become worse when raising the arm.
• Neck or back pain that is persevering.

The above list is by no means exhaustive and it is generally advisable to seek a medical opinion if concerned. Early detection and treatment can increase chances of full recovery and return to play with no symptoms. If you have any concerns, contact the BAPAM clinic line to arrange an appointment.