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Hello, I'm a nineteen year old piano student who's having trouble with repetitive strain injuries. About two years ago, I began to notice a slight ache in my wrists when playing the piano and during physical exercise. Over the course of a few months, the pain spread so that my entire forearm would ache and "burn" after playing for as little as twenty minutes.

When a doctor told me five months ago that I had a minor case of tendonitis, I took an extended break from playing. I just recently restarted with a teacher who tells me that poor technique was the cause of my problems. For the first two weeks, the new techniques this teacher taught me did not cause any pain, but during practice today I encountered pain in my right thumb and in the base of the pinky coupled with a slight loss of mobility in the pinky and ring fingers. The soreness has persisted all day.

While my new playing habits do not exacerbate the pain in my forearms, they are still tender in certain places. I get twinges of pain when I do things such as lifting, pushing, or gripping objects. I can't do pushups due to wrist pain.

Has anyone experienced this before and can tell me when the aches in my forearms will go away? And what might be causing the thumb and pinky pain? I think I might be practicing too much too soon (around 3 hours a day during my third week of retraining).

Hi Cole,

I'm very sorry to hear about your problems. Yes, RSIs associated with piano playing are very common. Piano World just put up an FAQ about them with advice about 1st Aid, various people's stories, the typical progression of symptoms, and some information about finding a doctor to work with. You can read it here:

https://www.pianoworld.com/forum/ubb...iano_Injuries_First_Aid.html#Post2129006

The kind of symptoms you report are usually indicative of someone who has not yet healed all the way. What kind of medical treatments have you received? Did you work with a physical therapist? If yes, how did they work with you? Have you tried any alternative or holistic modalities e.g. acupuncture, Rolfing, et cetera? Also, how did you respond to any of these approaches?

Also, you did not say what kind of approach or method your teacher uses in working with the injured. Can you give us some information about that? It will help us shape our answers.

Thanks, and I look forward to hearing from you soon!

I very rarely do this, but.. "what he said." Greg's spot-on.

One other consideration: you mentioned different kinds of activities, like lifting, gripping, pushing, push-ups. Would it be fair to assume you workout pretty heavily? I bring this up because it is possible that things other than the piano could be the "initial" issue, and the piano has simply exacerbated the injury to the point that it is noticeable and you are, for the most part, experiencing difficulty continuing. Improper form while exercising, combined with improper technique at the piano, can certainly do quite a bit of damage.

Greg's mentioned a great way to go forward.. discussing what you're doing at the piano. There are many experts here who can help; Greg's one of them. If piano is eventually ruled out, or marginalized, you may want to take a look at some of those other activities to see if the injuries aren't compounded over more than one type of activity.

Thanks for directing me to that enlightening post!

As for medical treatments, I've been to two orthopedic doctors with experience in music-related injuries. They both agreed that I have tendonitis in the wrists and forearms as well as a minor case of ulnar nerve irritation in both arms. Fortunately I do not have RA or any nerve damage. I went to physical therapy for about three months which got rid of a lot of the superficial pain but didn't completely fix the deep forearm/wrist pain or the nerve pain. Neither of the doctors I have visited recommended a form of treatment beyond PT and rest, but I'd be willing to try acupuncture or some other kind of holistic healing.

The primary difference between my new teacher and my former instructor is in the emphasis on relaxed posture and efficient technique. My former teacher never taught me core technique concepts such as arm weight, so every passage required extraneous effort from the muscles of my hand and arm, leading to tense playing and a strained sound. My new teacher is showing me how to align my arms so that my entire arm weight rests on my fingertips. Now I'm playing in such a way that my energy travels from my shoulders all the way through my fingertips into the keys. I don't feel any of the forearm tension I felt with my former style of playing.

Also, I have not done any heavy arms workouts in over six months. In fact, I haven't done more than a couple push-ups over the past three months and I've ceased all freeweight exercises entirely.

Hi Cole,

Thanks for the detailed answer. It's good to hear that you responded to your initial medical treatments. Some people don't, and then a good outcome can become elusive.

Orthodox medical approaches have their limits. They very often can take soft tissue only so far, so the next steps require a bit more imagination. Alternative modalities can be very helpful as a next step. It sounds like you've made some good progress, but are not yet completely healed. Further treatment can still be helpful if you find the right ones.

One thing you might consider is to find the very best PT you can to continue your work. It can't be just anybody; it has to be the very best practitioner you can find who has had lots of experience with RSI and consistently good outcomes. Their case histories should number well over 500, and they should have lots of experience working specifically with upper extremity RSI and especially in musicians. The best providers often can be excellent resources for information about alternative treatments, as well as help you quarterback, or manage, your treatment plan. When you go to speak with them, ask these questions and also if they can provide you with references from patients who had your problems and got better working with them.

A caveat: If you work with them, don't let them talk you into doing anything that hurts. They have a particular philosophy of treatment called "work hardening", and it is usually contraindicated in upper extremity RSI unless certain conditions are present e.g., atrophy/wasting, etc. Any exercises they give you should not cause any lasting or increasing discomfort. If it does, stop right away. "Working through he pain" is almost always a bad idea and can just make things worse.

And here's another idea. It's certain that you have some fibrotic scarring left from the initial acute injury. This is probably causing some residual dysfunction in the tissues, and possibly the circulation as well. It would be good to work on this directly using a form of myofascial therapy level IV, which the originator of the technique calls "active release". And the only good providers I've found of it are trained and certified. They can be found here:

http://www.activerelease.com/

You can find information about the treatment protocol, and there's a "find a provider" page. I've referred several hundred people to ART providers over the years, and with consistently good outcomes in most of the cases. The technique has undergone two large-scale trials with very good documented outcomes; both have been published in mainstream peer-reviewed journals. It works best when the injury is still in the early stages, but I think you'll find some help from it at this stage.

Another caveat: The best outcomes I've found with ART have been with MDs or chiropractors using it. If you decide to try it, you can call their headquarters in Colorado Springs to ask if they know of a successful provider in your area. If you're lucky, you could find a provider who is also an instructor in their institute. These providers are the most skilled and highly trained.

And here's yet another idea: Rolfing, yoga, and acupuncture have all been shown to be helpful with RSI when they are employed at the right stage of recovery. If you work with a yoga instructor, they must have ample experience working with people who are disabled or they will work you too hard.

Nobody can tell you how far along you can get in your recovery; I certainly can't. Beware of people who do. However, that doesn't mean you can't get better than you are right now.

I'm glad to hear you are happy with your teacher. I myself am trained in the Taubman method and was a teaching assistant at their institute for several years.

Let us know what you think about all this!

2 cents: you may find it takes years to put into practice what your new teacher is showing you. Old habits die hard.

Once again, like Mark C., who seems to have given up on this type of thread, I take tremendous umbrage at Laguna Greg dispensing Physical Medicine advice on this website. For every so-called statement of fact that he makes, you could find at least a dozen to the contrary.

I have 62 year old spindly thin fingers, with a small hand, and a woman's wrist. In addition, I have psoriatic arthritis, and every bone, joint, ligament, and tendon in my body is in some stage of inflammation.

So, I have had to jump through all kinds of loops and hoops to get to where I am today at the piano. And, today, I had a great day.

I worked on a section of the Schumann Concerto, and it went okay, physically. Then, I worked on L'isle joyeuse for the rest of the afternoon, and it went very well.

Normally, I would not stress my hand in that fashion, but I broke it up with a soft practice of the Debussy Reverie. Where is any of that in Laguna Greg's playbook?

My point is that your hands are your hands, and your body is your body.

My coach is Thomas Mark, author of "What Every Pianist Needs To Know Abut The Body" www.pianomap.com, who Laguna Greg basically considers an amateur. However, he has taught me basic principles of Taubman, and Alexander Technique at the piano. And most importantly, he has taught me that one size does not fit all!

As has been suggested by another post, you need to look at how you treat not only hands during the day, but also the rest of your body. And, most of all, listen to your body, and it will eventually guide you to proper health, your hands, as well as the rest of it.

"...during practice today I encountered pain in my right thumb and in the base of the pinky coupled with a slight loss of mobility in the pinky and ring fingers. The soreness has persisted all day.

"...my forearms... are still tender in certain places. I get twinges of pain when I do things such as lifting, pushing, or gripping objects. I can't do pushups due to wrist pain.

"Has anyone experienced this before and can tell me when the aches in my forearms will go away? And what might be causing the thumb and pinky pain? I think I might be practicing too much too soon (around 3 hours a day ..."

Well, Cole, with an unhealed previous injury, I think three hours of practice a day very likely is too much. I admire your energy and dedication, but you are going to have to back way off this schedule if you are to expect any lasting improvement. The tendons are unforgiving and can take a long time to heal. However, exercise does promote healing, as long as you stop when you first encounter any discomfort--- way short of immobility and impairment, daylong soreness, and lasting pain in the digits. I believe that you are not listening to your body's signals, and are not stopping soon enough. We have pain for a good reason--- it prevents worse pain, if we heed the body's warning.

Injuries of this sort can end careers. You will have a long life ahead of you to play, but for the present it would be better for you to concentrate on patient healing, rest, and working with your orthopedics doc.

You are beyond the stage of common first-aid measures. Still, you might get some help from them. Ice packs--- applied to the forearm, not the hand--- for a few 15-20 minute sessions a day, can help both with pain and inflammation. Common over-the-counter NSAIDS like ibuprofen and naproxen sodium can give you some relief. Be sure you talk to your doc about it, and follow the package instructions; over-doing it, or doing it for too long, can open the door to other troubles. There are physical therapy methods for addressing scar tissue, but you would best learn them from a good PT, working according to your orthopedist's instructions.

One thing that helped me greatly, was getting a good-quality, stable and adjustable piano bench. A lot depends on maintaining a good seated posture when you play. If your teacher is accustomed to working with students with injuries, you will receive instruction about bench height and seated posture. I ended up with a Jansen bench http://www.pljansen.com/
after trying a couple of others. They are quite stable, and of excellent quality; there are some less expensive Chinese-made benches which cannot say as much. An unstable seat invites tension.

I wish you good luck. It seems that you are getting the right kind of medical attention and piano instruction, so if you can just follow through with what you have learned from these people, I think that, with time, you will come out in good shape.

It is amazing to me how many people post what seem to be legitimate medical concerns on a forum that is frequented, for the most part, by hobbyists. What is even more amazing is that people take the advice doled out here as being legitimate.

Talking to your doc about it guarantees nothing. It was my doc who prescribed the mega-doses of NSAIDS that led to my developing a sensitivity to them and now I can't use them at all.

Einstein was a hobbyist, whose career was "patent clerk". Are you saying E=mc^2 is wrong?

Very well said.

I think this idea is a little misrepresentative... Einstein was no hobbyist, we all have to pay the bills. I read that he liked his job because it was mindless enough that he could focus on physics while he was at work.

Louis,

you're off topic. The OP seems quite happy with his teacher, who apparently has experience working with the injured. And it seems to be producing good results right now, and the approach, from what little he's said about it, seems sound. So leave him alone on that score.

I was just giving the same advice about post-injury medical intervention I give anyone who asks, not his technique. There is a very important place for that in recovery. If the tissues aren't healed enough to withstand the minimal stresses of of playing correctly, any injured person will re-injure themselves.

As much as I put a great deal of faith in Taubman's methods, I know from long experience that technical retraining is not a substitute for a good recovery. Taubman, Grindea, Marks, Alexander, Feldenkreis and many others swear that their technical approaches are wholly therapeutic and require little or no help from modern medicine. This is simply not true with a middle-stage RSI, which is what is being described here. In fact, the only way to fully recover from an injury like this is with a multi-disciplinary approach that starts off with orthodox medical intervention. Any injured person should go see a really good doctor first before they do anything else. The idea that your or any teacher can "teach you out of" an advancing and serious second-stage injury without any medical supervision is untrue, irresponsible, and dangerous. You have no business saying that.

I really don't understand you or your objections. On one thread, you praise me for my research and clinical experience in this area. And on other threads, you object if I say anything for no good reason. And you get pretty nasty about it too, which I think is way out of line.

As far as your teacher goes, I don't know what to say. To be clear, an "amateur" is one thing, and and "unknown quantity" is another. I don't know Mark's teaching, so I can't recommend it. He has published no research, so his methods and outcomes are a mystery. Taubman, on the other hand wrote quite a bit about it during her lifetime, and had her results scrutinized by several scientists as have a few of her best students. The results were compelling. My own methods have been put under the same scrutiny and produced similar results. Why on earth would I listen to you then? Or anyone else, for that matter? When your teacher does something similar by peer-review, I and many others will sit up and take notice.

Lastly, you don't raise any valid criticisms of what I suggested the OP do therapeutically. You just object that I say it, or anything at all. If you have any thing valid to say about that, then now's the time. Man up. Offer another therapeutic approach, one that has proven to be effective one way or another. You're not going to change my mind, or possibly anyone else's. But it will be fun to watch you try.

Hooweee! gettin rowdy in here

You ain't seen nothin' yet...

I also don't think much of Thomas Mark. I find his solutions for what is an extremely complicated mechanism to be rather simplistic.

The Taubman people I know all advise getting medical advice for injuries, along with retraining.

Personally, I think people with injuries are wise to look for all the advice they can get, including on the internet. Otherwise, they risk putting themselves in the hands of experts in one narrow field who may not be aware of other effective approaches. (Everyone has heard, surely, of surgeries that turn out to be ineffective or unnecessary.)

I think we might as well credit people with enough judgment to sift through the differing perspectives they'll get. (And if they haven't got the judgment to make intelligent choices, what does it matter where they seek advice? that'll be the least of their problems !)

Over my 40 years as a piano technician I have heard many pianists' discuss repetitive stress issues. Very few have been able to depend on MD's alone to help them. The number of physicians who would be able to diagnose and prescribe an effective treatment is small. Musicians must rely on casting a wide net to gain adequate insight into what would help them.

Making statements that experienced posters who have worked on these issues should not be given any credence because they are not medical professionals-is arrogant.

Perhaps, but no less misrepresentative than the original.