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What are the side effects of playing piano?

Rapidly repeated clusters played by the sides of the hands cause quite a lot of stress on the wrist. Change the passage or avoid the piece, rather than risk injury. Mental tension and depression and their effect on the muscles. A grim attitude to practice - not having fun.

musicianshealth.com - Physical Stresses of Playing Piano - Musician's Health.com

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What do pianists do?

Richard Beauchamp

Notes of a talk prepared for a BAPAM conference in Edinburgh in 1999 - aimed at physiotherapists and doctors

This article is from the website Music and Health

What, and how much, do pianists practice?

Many professional pianists spend an hour or more daily on technique as such. This can comprise exercises like Hanon (five finger exercises which cover many different patterns) or Dohnanji or Cortot for finger individualisation - (I think the latter two are particularly dangerous and can result in injury unless practised with great care and some knowledge of inter-tendinous connections), scales (there are many forms of these - including the basic 36 scales [major and two forms of minor], plus chromatic - which can be played hands separately and together - in similar motion from the octave, the third and the sixth [sometimes other intervals as well], in contrary motion from various intervals, in double notes [thirds, sixths and octaves] and all of these either staccato or legato or a combination of these, and with a variety of dynamic schemes. Similar practice is done on arpeggios, which usually include major, minor, diminished, diminished seventh and dominant seventh in all their inversions), and studies (pieces which concentrate on a particular technical difficulty) ranging from Czerny and Clementi through to Chopin and Liszt, who's studies are frequently performed in public. Most pianists manage to design a practice regimen which enables them to practice a variety of skills each day without having to spend more than an hour on technique. It is worth remembering though, that Geoffrey Tankard’s book “Pianoforte Technique on an Hour a Day,” published in 1960, was considered something of a breakthrough in its suggestion that pianists could condense their technical practice into so short a time. A technical training of this kind is required by most pianists if they wish to be serious contenders in the highly competitive world of their profession. It is very similar to the kind of training an athlete would be expected to do - and a musician should be regarded as an athlete, but with an added responsibility for the artistic and intellectual dimension that music requires. An enormous amount of repetition is needed by most people just to keep reflexes active, chord spacings etc. automatic, and simply to keep fit. The stamina required to play some of the big works is considerable. Someone calculated that it takes the equivalent energy of shovelling three tons of coal just to move the keys in Rachmaninov’s Third Concerto - and this does not take into account the emotional and intellectual energy used! Some pianists reach a stage where they feel that they get all the technical practice they need to keep their playing in good order through the music they are playing. Others feel they have to do designated technical practice every day. Shura Cherkassky apparently used to play scales and arpeggios in every key every day, while Barenboim, for example, is said to do remarkably little practice, technical or otherwise. This amount of practice seems to depend on the pianist's natural ability - including ability to practise mentally, physiognomy, co-ordination and training - and sometimes also, perhaps, on a superstitious fear of not practising. It does seem that pianists differ widely in their ability to maintain physical memory for the muscular feel and spacings in music; although this picture can be confused by the fact that some pianists do not like to admit to the amount of work they actually do! Time has to be spent on note learning. Again this varies enormously depending on the intellectual quickness and physical co-ordination of the player. Some players have to do hours of actual physical playing because they rely on what is known as ‘muscular’ memory, while others can simply look at the score and have it memorised in a matter of minutes. This is not necessarily a matter of the superiority of one player over another, rather it reflects a different balance of physical and mental aptitudes. Slower learners sometimes have a superior sensitivity for sound quality, for example, while a quick reader (as far as the notes are concerned) may not be someone you would want to listen to! I feel that the development of knowledge in the theory and analysis of music should be started early, as this can save a huge amount of time spent at the keyboard later on. Not everyone would agree, however, and to quote the American pianist, John Browning, “Students often seem to think that there is some secret formula that the masters use to learn a work. If there is, I never found it. I simply play a piece over and over until I know it by heart.” One could argue that his intellectual processes must still be involved, whether he is conscious of them or not. There is also the need to keep a repertoire going. Many professional soloists have to keep a large repertoire ‘in their fingers’. This can include 20 concertos or more, most of Beethoven’s 32 Sonatas, many of Bach’s 48 Preludes and Fugues, plus Suites, Partitas and other pieces which are ‘standard’ repertoire, Mozart and Schubert sonatas, many works by Chopin, Schumann, Brahms and Liszt, much of Debussy and Ravel etc. and the rapidly increasing ‘standards’ from the 20th Century repertoire by people like Messiaen, Bartok, Stravinsky, Ligeti, Berio, Berg, Shoenberg etc. The pianist/harpsichordist/organist may be a specialist in early music or in the contemporary repertoire. In the latter case there is the added strain of deciphering what is often a new language, learning the piece quickly and of being recorded at the first performance, usually with the composer present (to whom the standard of performance matters a great deal). Simultaneously, and perhaps above and beyond all these kinds of practice is the constant refining of sound, the never ending striving for evenness in scale and arpeggio passages, the search for different qualities of sound, experimenting with chord balancing and pedalling to find as many colours as possible, and phrasing and articulation. In chord balancing, the fingers have to learn to play with at least two different levels of tone in the same hand (melody and accompaniment), and often three or even four simultaneously. The opening chord of Beethoven’s Concerto No 4 has many pianists in a sweat, faced with eight notes which must be perfectly balanced, and no opportunity to test the key resistance first. Every pianist will make this chord sound different (given that their technique is refined enough to convey their personal mental image of the sound), even on the same instrument. I feel that more time spent on these activities, with their greater proportion of mental work, instead of ‘note bashing’ with the primary aim of speed and loudness, is much healthier for the player and, paradoxically, results in a better technique because it involves more listening and muscular/aural feedback, which in turn tends to result in a more finely balanced physical state. Above and beyond all this is the study of style, learning about the composer and the period he/she lived in with comparative studies of poetry, literature, painting, architecture and dance. Again, more time spent on this results in fewer injuries and better informed performances.

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Through all this preparatory work, the pianist is striving to find the emotional or ‘spiritual’ meaning of the work, the subtleties and balance of the structure, and to find ways of communicating all this to the audience as though it is a fresh inspiration of the moment. I have not dealt with all the other kinds of pianists, such as orchestral players, lieder, duo and chamber music specialists and repetiteurs. All have their special problems - and in fact many players survive by working in most if not all of these areas. So, practice time can differ enormously from pianist to pianist. Basically most pianists practise as much as they have to in order to prepare music for a deadline, and this time will be different with each individual, varying from three hours a day to ten or more. My personal view is that more than four hours a day is unnecessary for most people if efficient practising techniques are used.

Some causes of stress

Practising for too long without a break - particularly fast playing which doesn’t give the muscles time to recover. Excessive practising brought on by panic when trying to learn new music against the clock, or when worried about auditions or exams. Returning to a full practice regimen after a holiday or other break from the instrument. A full practice load should be built up to gradually after a break. Poor posture and unsuitable seating - often resulting in back, neck or shoulder pain. Faulty technique, especially resulting in excessive muscular tension, awkward positions of the joints, imbalance between opposing sets of muscles or un-ergonomic tendon paths.

Over-lifting the fingers.

Strongly curved hand position - particularly with clenched fingertips.

Extreme position of wrist - too high (extensor strain) or low (flexor strain).

Excessive lateral or ulnar deviation of the wrist.

A fixed position of the wrist.

Excessive abduction of the fingers - especially in loud playing.

Influence of other pianists’ example.

Danger of expecting all pianists to be able to do the same work/ practise for the same hours etc. ‘Mammoth achievements’ such as all the Chopin Etudes in one sitting - These are not realistic for everyone, and depend on stamina, physical build etc. Some pianists are naturally strongly built and never seem to experience problems, even with poor posture and/or technique.

Unrealistic standards of perfection from listening to edited performances on CD.

Anatomical differences e.g. small carpal tunnel, more or tighter intertendinous connections.

Danger of treating all pupils the same, and of applying ‘received’ theories of technique unquestioningly. Music which doesn’t suit an individual pianist's physique, e.g. the big stretches (esp. fff) in Rachmaninoff and Brahms - . Stretches with a moving part in the middle. Repeated octaves and chords (e.g. Schubert’s “The Erl King” and Liszt’s Sixth Hungarian Rhapsody). Contemporary techniques using the hand and arm in unusual ways e.g. fist, forearm etc. various kinds of clusters. Rapidly repeated clusters played by the sides of the hands cause quite a lot of stress on the wrist. Change the passage or avoid the piece, rather than risk injury.

Mental tension and depression and their effect on the muscles.

A grim attitude to practice - not having fun.

The strains of touring - accommodation, food, unsympathetic people, jet lag etc.

Fear of performance, or ‘stage fright’.

Critics - fear of their negative response and its effect on a young career.

Attitude of teachers, parents, friends. Feelings of “letting people down” etc.

Being ‘nice’, ‘obliging’ and ‘no trouble’. The traditional image of the accompanist who is supportive without thought for self can be a problem if it means not taking time to warm up properly before a rehearsal or concert. The pianist in a chamber group or concerto rehearsal has a similar problem.

Things unrelated to music e.g. DIY, gardening, sports etc.

Prevention of injury

Warm up before practising and cool down afterwards.

Physical exercise warm up.

Hot water warm up.

Note learning can be a good warm up and economical use of time.

Use of stretches (but warm up before stretching).

Smile whilst practicing. Consciously make every movement as enjoyable as possible.

Breathe whilst playing!

Learn a physical awareness technique, such as Alexander technique, Feldenkreis, Yoga, Tai Chi. Take up a sport (low impact, e.g. swimming, cycling) to build stamina. Weight lifting could result in muscle imbalances - aerobic sports which increase heart and lung efficiency are better. Take frequent breaks in practice sessions, with movements and stretches that counteract the predominant playing positions, e.g. back and neck stretches, spreading arms wide etc.

Sitting and posture

Stool height should be adjusted so that the thigh slopes slightly down to the knee, so that lower back lordosis in maintained and shoulders tend to sit back as part of a normal spinal curve The forearm should be at a height (usually level with the keyboard) so that the wrist can operate in its middle range of movement, where the tendons can travel in a more or less direct line to the fingers. This position can vary according to individual physiognomy (e.g. the extensor/flexor balance in the forearm). Note: It is frequently impossible to get both the thigh slope and the forearm height correct, as only the seat is adjustable and not the keyboard height. This can be a big problem and many pianists have to adopt a compromise position. Ideally the piano should be able to be raised and the pedals lowered (to avoid extreme extension at the ankle) to accommodate tall pianists. Correct posture should make it possible to avoid extreme angles in any joint - and to play in the central range of movement.

Practice technique

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Vary the material practised to give some muscles a change of position or a rest. Practice scales and arpeggios for no longer than 10 minutes at a time, and these should be separated by playing forms which don't stress the same muscles in the same way. This applies equally to any other other stressful form of playing. Use a kitchen timer to limit the practice time in one session. This could vary from 10 minutes to 20 or 30 minutes, depending on the material being worked on and the type of practice done. More than 30 minutes should be exceptional. Take time during each practice session to get up from your instrument and do some stretches and/or relaxation exercises (e.g. Grindea technique or Tai Chi). Use of mental practice. Frequently the real problem in learning a new piece is analysis - an intellectual understanding of the structure of the music. Note bashing tends to be used far too much as an ‘easy’ option which can often result in injury - especially when there is a limited time to prepare. Take time to educate yourself musically, instead of spending all of the practise time ‘note bashing’. This could involve theoretical studies, reading, and listening. Develop a greater knowledge of music at the keyboard, including reading from figured bass, improvising and sight reading. This is generally much less physically taxing than playing pieces over or working on technical exercises. Use of extracts from pieces can be used instead of studies - saves time.

Know what you are going to practice before the practice session.

Don't always start at the beginning of a piece. Keep a list of the bits that need to be worked on every day, those that need revision less often, and those that scarcely need to be practised at all. Use prime time for the most intellectually difficult work (often learning new music). This will be the first 20 minutes of your first practise for the day. So often students waste this period by playing favourite bits they know very well already. Design an appropriate technique for each passage instead of mindlessly repeating it in the hope that it will eventually ‘come right’.

Building stamina

This requires regular, carefully timed work at the instrument, as well as exercise away from the instrument. It is important to take part in some form of exercise which gives a regular aerobic work out, although exercises which concentrate on building strength alone should probably be avoided, as they can result in imbalances which could later cause injury.

Playing technique

Techniques should be checked against ergonomic and biomechanical principles. (Don't just swallow what Granny's teacher said, even if she did study in Vienna!)

Look carefully at, accept and design for individual physiognomy.

Maximum effect for minimum effort.

Minimising stress

Strategies for overcoming performance fear - “Inner Game” etc.

Permission to be less than perfect

Give others permission to be less than perfect. We need each other's support. Recognise that our abilities vary with bio rhythms, what we eat, illness, sleep deprivation, emotional stress, jet lag etc.

Alexander technique, Yoga, Tai Chi, meditation, aerobic sport etc.

Post injury programme

Doctors and physiotherapists often recommend a recovery programme with gradually increasing time limits on the amount of practice done, but to do so without regard for the various kinds of practice possible, involving different techniques and stresses, could result in the patient practising material which could be harmful even in a short session. There is therefore a need for doctors to be aware of the many kinds of playing possible on the keyboard, and of the differing amounts of stress which result. Keyboard music is usually more stressful for one hand than the other, so a choice of music for each hand separately may be helpful. Passages form a Haydn Sonata may be more stressful to play than those from a Liszt Etude. (Example: double third passages and rapid scales in first movement of Haydn’s “English” Sonata, compared with gentle arpeggios in much of “Un Sospiro,” the floating touch used in “Waldesrauschen” and much of “Harmonies du soir” by Liszt). Certainly, Liszt’s “Consolations,” some pieces from “Années de pčlegrinage” (e.g. “Vallée d’Obermann”) and Hungarian Rhapsody No 5 are quite relaxing to play. There are often several different techniques which could be used for the same passage. The choice could depend on ergonomics, the musical effect required and the physical set up of the player.

Categories of technique

The following is an attempt to provide an example of some kind of table in ascending order of stress. Each category becomes more stressful if played either louder or faster.

musicianshealth.com - Physical Stresses of Playing Piano - Musician's Health.com

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