- Clara Wieck Schumann ~ Image via Wikipedia
The highly respected Collaborative Piano Blog has a recent post about an arm massaging device. I’m wondering what you think.
Performance injuries are not discussed nearly often enough, so I’m hoping we can get something going here. Prevention requires awareness. Most people don’t “go there” until they are injured themselves. And lack of information equals more serious injury. Once someone is on that path, the slide into serious injury doesn’t take long at all.
So let’s get it out there and create some buzz!
Ragarding the massage device, I respectfully disagree. In my opinion, if someone feels a need to use the device mentioned in the blog post indicated above, then they have most likely allowed pain to progress. Massage will not make it go away while someone is still playing day and night.
Instead, what is needed is more awareness. Taking breaks, alternating hands, supporting everything the arms are involved in throughout the day, and stretching in the opposite direction of the playing are all elements of good playing health.
Similar activities need to be alternated with less stressful ones. For example, practicing followed by weight-lifting or vice-versa would cause continuous stress on the arms, hands, shoulders, back, and neck. Why not take a walk, wash the dishes, or read an article or two after whichever activity you do first? (FYI, practicing before weight-lifting protects the small hand muscles best. After lifting weights, it can be hard to feel your fingers. Doing things in that order affects my playing.)
Other things we do all day long can be altered, too. Small changes make an enormous difference. Using plastic dishes rather than pottery saves carrying weight across the kitchen. Alternating hands helps a lot.
Using not just the hands, but also incorporating the arms, shoulders, and back means that bigger muscles are taking the stress.
Supporting the elbows at the waist (just press your arms into your body gently) means that healthy angles are being used. That translates into less stress.
Body alignment is always a factor. Do you keep your feet on the floor when you practice, supporting your body? It’s more fun to perch them on the rungs of the chair, but that will affect your comfort sooner than you may realize.
In addition, aerobic exercise is crucial. Our fingers need good circulation, because the muscles are so small. They are not built for all that work.
Staying on top of one’s general health and eating habits needs attention. If your metabolism is down, for instance, that will affect your playing as well as your stress tolerance. The potato chip diet really doesn’t work, either.
Here’s where I’m coming from:
I was injured while working at an intense law firm job. That was several years ago. Following the injury, I was very fortunate to be treated by doctors and physical therapists at the top of the field. Now I know the triggers and warning signs, and have been successful in handling the situation.
This is how things proceeded: Even when I knew things were serious (i.e., I was typing with pain), I didn’t stop because I was afraid I would lose my job. The pain got so bad, I was typing letters with one hand.
I kept working until I could get a doctor’s appointment a month later.
Big mistake. I then had to stop completely for 6 months. I wouldn’t wish that on anyone.
Restarting practicing was also so hard I wanted to cry. The allowable time at the beginning was one minute with 1/2 hr. off. Repeat. What, exactly, can you “practice” in one minute? That’s about enough time for 4 whole notes!
After a week or two of near-total frustration, I made a pact with myself. I wrote down the time I started and turned the clock around. The iron clad rule was that I had to stop immediately when I felt anything like an inkling of pain.
It worked. The total time I was able to play ended up being 45 minutes. So then I could increase slowly from there.
One of the doctors who treated me in NY now works in the Occupational Health department at Mt. Sinai. (The other, now retired, has written two definitive books on the subject, both available in paperback.) The Mt. Sinai doctor told me that, due to experiencing the injuries I did and subsequently obtaining treatment and retraining (someone watched me play, for which I am very grateful), I know as much concerning this type of injury as someone who has completed a year of physical therapy school. I appreciate what he said, but also w0uld not want that to be my only claim to fame!
A coworker at the law firm, a very talented painter, was injured so badly she was forced to change fields for life. She is now a psychotherapist.
This link will take you to several posts on this blog concerning injury, health, longevity, and injury prevention.
As you can tell, this is a volatile topic for me!
So yes! Get a massage. But don’t use massage to avoid other changes you need to make. If you truly need massage because you are in pain, then it’s time to look at what you do every day. No “Band-aid” temporary solutions.
Also, you can massage your arms effectively without using anything other than your opposite hand. Or go to a massage therapist.
And stay aware. Then you’ll circumvent injury in the first place. Believe me, you don’t want to go there.
What do you think? Have you ever incurred performance-related injuries? What did you do about that? Please discuss in the comment section below.
Thank you!
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Gretchen Saathoff 
deepercolors said:
Never saw one like that before.
GretchensPianos said:
Hi Carolyn,
Nor I!
My first, knee-jerk reaction was that it would be great in an art exhibit. Wall art.
Gretchen
Kennith Freeman said:
Gretchen –
Great discussion starter! I saw the blog on Collaborative Pianist last week and thought, “How interesting!”
Here’s my situation. I have never suffered a major injury (thank goodness!), but I have incurred some that required periods of rest and recuperation. During those times, I would have KILLED to have a mechanism like this (assuming it works). One of the major parts of my recovery was massage. I had been advised that I could self-massage, but I could never quite get it right and never felt the tension release. So I spent a lot of money on therapists that I didn’t have at the time as a student.
I think we’re on the same page here. I don’t recommend massage as a treatment for pain (the sure sign of serious injury), but I do find it important in maintaining good hand health and use it as a method of prevention.
Now I think I need to soak in a warm bath and make an appointment with my therapist…..I want a massage!
Thanks for the great discussion!
Kennith
Harold said:
With due respect to Chris, and thanks to him for his wonderful site, this suggestion is off-base.
With the many resources we have now as musicians, there is no reason to ever get to the point of needing this.
I study and teach the Andover Educators’ “Body Mapping”, and highly recommend the books in that series, especially Tom Mark’s excellent “What Every Pianist Needs to Know About the Body.”
http://bodymap.org/
Best,
Harold
Jane Hallowell said:
This is a fascinating blog that you wrote and supports my beliefs about health (as a yoga instructor)… basically of being aware of one’s body and leading a healthy lifestyle. Right on! Personally, I found that lifting weights injured me. Practicing yoga poses that are aligned and propped properly have taught me how to move my body in a way (and without forcing) that builds strength and endurance while always paying attention to how my body feels to avoid injury…and then, translating this into daily living.
GretchensPianos said:
Hi Kennith!
You make this discussion much broader with your insightful comments. Thank you!
Yes, I am speaking from the perspective of someone who incurred serious injury. Pain is a warning sign needing immediate attention, and is often ignored.
Massage is certainly helpful and welcome as a way to handle discomfort, at the same level as a “crick” in the neck, say. Also, the physical therapist who first treated my injuries used massage. In fact, he intentionally bruised the deep tissues in order to enhance circulation. I have to say, it worked. There was also ultrasound and stretching, which were just as important and helpful. And hot/cold packs.
What needs to be addressed, when someone is playing so as to be in pain (due to length of time or other factors), is not only massage. The time spent at the keyboard, body alignment, level of tension/stress, taking breaks, and use of the arms throughout the day need to be looked at. Technique could also be in issue.
Alignment not only applies to posture, but also the angle of the hands and arms w/respect to the keyboard. Each bend of the joints interferes w/circulation. So, the keyboard does not have to be approached at right angles.
Another crucial thing to look at is whether breaks are part of the mix. And performing two activities back to back, both of which stress the arms/upper body in the same way, would be much healthier with a less stressful activity between the two. Mixing it up gives the muscles and tendons time to recover.
Minor changes can mean the difference between having no injuries at all and being unable to play.
Thanks again! And while you’re at it, please make an appointment for me, too!
Gretchen
GretchensPianos said:
Hi Harold,
Yes, I have great respect for Chris, and always enjoy visiting his web site. He provides such comprehensive information!
I hesitated about writing this post for several days. But then, my strong reaction to this particular topic resulted in a long post written during a late night.
Thanks very much for your comments! “Body Mapping” sounds like an excellent resource for people to learn about, myself included. I will also be sure to look at Tom Mark’s book.
Nice to see you here! Glad you stopped by, and hope to see you again soon.
Gretchen
UPDATE: Visit http://www.bodymap.org. It’s a great site!
GretchensPianos said:
Thanks very much, Jane, both for the compliment and for adding your views to the discussion. Experience counts!
Would you agree that musicians tend to be driven personalities? Speaking for myself, I can “check out” and practice until I’ve “got it.” You know, no lunch, no breaks, no acknowledgement that taking a break might be called for.
The same scenario was true with word processing at the law firm… I’ll just go to dinner later, after I finish these 30 pages (as if that were only one paragraph).
Maybe when musicians are focused on the music, the part of the brain that registers self-awareness deactivates.
I have learned to have part of my brain available, so now I can tell when fatigue is setting in. It’s about having an independent observer watching, seeing whether you’re still sane!
Thanks again.
Gretchen
Jane Hallowell said:
I’ve known all personality types when it comes to musicians. I can relate to you about having a “driven” personality. As the years go by, I try to learn to pace myself and find more balance. Although I no longer play the piano, I think these principles can be applied to life in general. I appreciate how you articulate you are and how interesting each topic is on your blog.
GretchensPianos said:
Hi!
I guess it would be helpful to say that age, time, and experience provide perspective.
In thinking about being college-aged, it doesn’t seem that balance was part of the experience. And at the law firm job, it certainly wasn’t, either. Deadlines overtook everything else.
Not any more! 🙂
Gretchen
Rachel Velarde said:
Thanks Gretchen for this topic! One of the sessions at the NATS Conference at the beginning of July was on both noise “dose” and vocal use “dose.” In other words, how much leads to damage/problems in hearing/vocal ability? In both cases, the biggest mitigating factor was cited as changes in dynamics. So, as you mention throughout your post and within the comments, periods of low use should follow periods of intensive use – within sessions and not just in big chunks. The more highs and lows were recorded, the lower overall usage (“dose”) was recorded. An example for a singer could be singing several lines, and then working on speaking the text, paying lose attention to the vowel formation/rhythmic impulse, etc. This is a great thought to keep in mind for all the coaches out there too – we can’t all be full out all the time (plus, it’s just not *musical* when there are no contrasts). We can have full intensity of concentration, but we don’t always need full physicality (i.e. – judicious use of marking) to get the desired effect.
This is a GREAT discussion and definitely applies to all instruments, not just the piano. It could also apply to our hearing and how we use (and abuse) our ears. They are as much a part of our livelihood as our hands & voices.
GretchensPianos said:
Hi Rachel!
Thank you so much for your perspective!!!
When writing this post, I had wanted to provide something applicable to all musicians and computer users. But, since I’m a pianist, that is where my experience comes from.
So seeing what you have to say, and looking at the credibility of your outside sources, makes your comments even more important.
I couldn’t agree more. No one needs to go at full tilt at all times. That applies to every instrument, computer work, singing, conducting, even exercise. We all get sucked into whatever we’re doing. Case in point: the extreme difficulty in turning off the computer, even when it’s 4 a.m.
I would be very interested in knowing more about “dose” as it applies to both noise and voice use. I wonder, is there a similar evaluation method for typing work/arm and hand stress?
Thanks again for your astute contribution!
Gretchen
Kennith Freeman said:
I was just rehearsing the Chopin Ballade #3 (Ab major) and was making some good progress at the end so I was playing longer and faster than I probably should have. I started to feel the tension in my right forearm and heard a little angel on my shoulder named Gretchen yelling “STOP ALREADY!” You’ll be happy to know that I obeyed!
Thought you’d enjoy that story.
Kennith
nancycurteman said:
Alternating hands is great advice for computer geeks also. I now use my mouse with my left hand although I am right handed.
GretchensPianos said:
Hi Kennith,
HA HA HA! Thanks.
Hope you’ll return to the race tomorrow. 😉
Gretchen
GretchensPianos said:
Hi Nancy,
That would mean that you’re very well-coordinated!
When I was injured but still working, I looked for ways to alternate hands. It was easier for me to achieve variety when playing the piano. (For one thing, we used only function keys, not mice.) Tempo, alternate hands, loud and soft, fast and slow, even changing octaves all provide changes for the upper body.
It’s repetitive activities performed in one position for hours that are the riskiest.
One more thought about computers: a friend of mine temped at USA Today at the time when everyone was getting RSI, reporters more than anyone. The paper had programmed all computers so the screen would go blank once every hour.
It worked. If you can’t see what you’re working on, you have to stop!
Thanks for your thoughts.
Gretchen
deepercolors said:
a ha! Great comment. 🙂
GretchensPianos said:
tehe! …or a mobile.
This relates to the subject of “ergonomic” equipment catalogs. Anyone can market anything with the word “ergo” attached.
Chris Foley said:
Great article, Gretchen, and great comments everyone. I think there needs to be a much larger discussion on the subject of performance-related injury for students and professionals alike.
In my experience, here are some things that students, teachers, and professionals have found difficult in seeking solutions to performance-related injuries:
1. Finding the right therapist/therapy
2. Finding a teacher that teaches healthy playing
3. Finding a teacher that is aware of and understands how their teaching must fit into the student’s physiotherapy technique
4. Getting facts about the vast amount of systems and products available in a largely unregulated industry where many companies advertise how dangerous their competitors’ products are.
5. Finding affordable solutions in a field where many of the proper treatments often aren’t funded by health insurance or benefits.
My post on the Collaborative Piano Blog was never intended to be a cure-all for performance injuries. Armaid reached out to me with a deal for my readers, which I decided to accept. If their competitors are a bit sore (no pun intended) about Armaid coverage on CPB, perhaps they should reach out to bloggers such as Gretchen, Rachel, Kennith, and myself, offer similar deals, and create much more awareness about proper therapies.
GretchensPianos said:
Hi Chris!
Oh, I think your sentence about Armaid’s competitors is berry punny! 😉
Thanks for your comments, and for the compliment! That’s a great list of factors for people to consider.
Yes, there is an enormous need for discussions about performance-related injuries and prevention. Why don’t people talk about this? The risk is always there, largely because instruments were not designed ergonomically. There are some ergonomic instruments and adaptations available these days, though.
The other main contributing factor to injury risk is that musicians practice! That means all of us are spending hours repeating things. And that stresses muscles and tendons more than most people realize.
There is further information about this here:
I don’t consider my knowledge of ergo musical instruments to be comprehensive, but this one possible place to start.
Chris, you have inspired me to take this further. I’ll write a new post for Sat. about evaluating “ergonomic” products. It’s true that there is very little regulation. And there is SO much hype. Most catalogs I’ve looked at market every product they’re selling as “ergonomic,” but few of them help people perform tasks with less risk and enhanced comfort. A few reputable companies have physiologists on staff who test everything before products even make the sales list.
Thanks again for your valuable contribution. Hope you’ll have a minute to come back soon!
Gretchen
Kennith Freeman said:
Wow! This discussion is really making us think. Chris, I personally want to thank you for your comments here and your consistently excellent posts over on CPB to bring our efforts as collaborative pianists to the forefront. Your work has done much for our profession, so I personally say “thank you.”
While there are lots of valuable points that have been raised here, the one that popped out to me in Chris’ comments was the fact that relatively few of us receive training about performance injuries and their prevention. Sadly, this creates a cycle of passing bad information down to another generation of pianists.
Is there anything readily available that helps the pianist find good information about performance injuries that is assessible without being overly technical because of the medical terminology used? I have already recognized my personal need to become better educated in this area and plan to do so very soon; I am just hoping for a little direction of some good places to start. Any advice from my respected colleagues would be appreciated.
Thankfully, performance injury is getting more and more attention via conferences, blogs, and masterclasses. Personally, I’m grateful for the dialogue and have learned a lot from everyone’s comments and sharing.
GretchensPianos said:
Hi Kennith!
As to your first sentence: yes! It is! 🙂
There are 3 books I know of which are excellent. One might not still be available ~ I’ll look around.
Harold Gray posted a link in his comment to an excellent web site. I looked at listings for the books available there. Harold knows people related to the site, so he would be a better source than I. But from looking at book titles and descriptions, the resources there look great.
Also, there’s a lot of relevant info on this blog about performance injury and prevention, with more to come.
Give me a couple of days. As soon as I know more about books, I’ll post links.
On Sat., I’m planning to publish a post about ergonomic products. I’ll include links to a few things I use, and talk about how to tell what is ergonomic and what isn’t. (The post is cooking in my head right now. Must be all that hot weather.)
Hope this helps.
Thanks very much for your followup!
Gretchen
Frances said:
I only have a book to suggest that goes with this topic. I have really learned a lot from The Biology of Musical Performance and Performance-Related Injury by Alan D. Watson. It is a great reference book for understanding how the body works while playing music.
GretchensPianos said:
Hi Frances!
Welcome to my blog, and thanks so much for your comment!
I will take a look at the book you mentioned. Sounds like a good place to go.
Just now, I visited your blog and saw your posts about Westminster! I loved being in school there, and am thrilled that you enjoyed the choral festival, too.
Give my regards to Jersey, and thanks again for stopping by. Hope to see you here again soon.
Gretchen
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Gretchen Saathoff said:
Thanks very much for the pingback! Nice to see you here.
Gretchen