Piano-related injuries are no joke! Most non-pianists might laugh at the idea of someone getting hurt while sitting at a piano. But, if you’ve spent any significant time at a piano, you know how quickly you can start to feel pain, tension or discomfort.
As someone who deals with chronic pain from posture-related issues, I’m a firm believer in finding ways to help our bodies stay healthy and supportive at the piano.
I recently had the privilege of visiting with Dr. Michael Hyland of Hyland Physical Therapy and Wellness about ways pianists can maintain a healthy posture at the piano and prevent injury. This is such an important topic that affects nearly every pianist, so we wanted to share our conversation with you in hopes of preventing piano-related injuries. Injury prevention is Dr. Hyland’s forte and he has some really great wisdom to share with you on the topic.
You can read my interview with him below:
Megan:
Tell us a little bit about yourself and your goal as a PT. We’re thrilled to be learning from a physical therapist, but you’re no stranger to the piano, right?
Dr. Hyland:
No, not a stranger to piano at all! I started taking formal piano lessons when I was in grade school, took a break, then again through part of middle school and high school. Although the technical skills I learned are fading, I have continued to play and branched into composing my own pieces and lyric writing. That’s another story in itself.
But as far as me and my goals as a PT I will give you the cliff notes version. I was born and raised in Pensacola, FL and was raised by two parents in the healthcare field; my Dad being a dentist and my Mom an MD. So, when I went to college to earn my bachelor’s degree I was already primed to be a science major. I was very interested in life sciences, so I enrolled as a Biology major with a Pre-Health concentration. I wanted to help people, but was not drawn to medicine or dentistry. I had heard good things about physical  therapy from my Dad, as he had a long time friend who was a practicing PT.
I have now worked as a staff physical therapist in hospital acute care, outpatient rehab, and home health with over six years experience. I decided at the end of last year that I was finally ready to take the leap and become a business owner and go into private practice. My ultimate goal as a physical therapist is to help people to avoid pain and injury, particularly those 50 and older, and to help people to stay active and fit so that life and the aging experience, which is something that we all share, can be enjoyable and successful

Megan:
A lot of pianists deal with long-term pain, discomfort or injuries due to repetitive use, poor posture, tension or under-developed technique. Let’s talk about prevention first. What are some things pianists can be doing to avoid pain and injury?
Dr. Hyland:
In general, a short routine of stretches, as well as exercises that focus on strengthening the core musculature, are crucial. So, for stretching I would absolutely recommend emphasizing the neck, upper back, chest, and the nerves of the upper limbs. (Learn more about specific exercises in the questions below.)
Believe it or not, your nerves need to stretch too. Every nerve in the body is contained within a sheath of connective tissue that surrounds the outer part of the nerve; the perineurium. Furthermore, this perineurium is surrounded by the epineurium. This connective tissue also contains and surrounds very small blood vessels that supply the nerves.
If poor posture sets in this can actually result in restrictions in the nerve sheaths such that full range of motion of the limb, such as the arm, is impaired. Not only that, but those tissue restrictions or adhesions constrict blood supply from the nerves themselves and can cause pain in addition to the pain of muscles that are overworked from poor posture.
The key is to perform stretches for the upper body and spine, in addition to core exercises, in order to stimulate blood flow and increase metabolic heat so that once you start to play you are limber and are less predisposed to injury. Not only that, but the exercises will already help to address awareness of posture to avoid positions that could cause pain down the road.
Megan:
Posture is so important, but many of us settle in a the piano and completely forget to think about it. What are a couple of key points that we should be mindful of as we practice or perform?
Dr. Hyland:
As I eluded to in the previous question, some specific stretches for the upper back, upper limbs, and core strengthening exercises would help with awareness of posture and what adequate alignment feels like. That being said, once sat at the piano I would suggest a few deep diaphragmatic breaths with the feet flat on the floor and hands on the stomach to give self-feedback for deep breaths using the diaphragm.
When diaphragmatic breathing is done correctly you will feel the stomach push outward into the hands as the diaphragm moves down, hence the nickname “belly breathing.” The reason I suggest this is that to breathe in deeply, one tends to naturally sit tall and erect. In this sense its a natural cue to sit with good posture and also the deep breathing will encourage relaxation and good preparation for playing.
With regard to sitting at the bench, being aware of the deep core muscles and keeping them engaged while sitting upright and playing is a great way to avoid slouching and leaning forward. And, the arms will not become as fatigued when you sit upright with an engaged core due to having a stable base on which to work against. One must have stability of the trunk, or torso, in order to have stable and efficient movement of the limbs.

The last point would be to remember what your first piano teacher taught you when you were 5… remember the cue to “put your hands over the bubble?” This allows your wrists to stay neutral and your fingers relaxed. If you don’t listen to that inner voice from the past you may get a nasty reminder later when you get carpal tunnel syndrome from your wrists being either cocked up too much or flexed too much resulting in strain of the muscles of the forearm and compression at the carpal tunnel.

Megan:
Now let’s tackle some common issues that pianists face. If a pianist is experiencing any of the problems listed below, what are some steps they can take to improve? Are there specific exercises that you recommend that would help alleviate these issues?
-Low back pain
-Neck and should pain
-Hand numbness
-Wrist and forearm tension
-Carpal Tunnel
-Tendonitis
-Arthritis
The good news here is that there ARE exercises that can help to alleviate or prevent several of these at the same time. I recently wrote a blog post about self treating low back pain using an exercise ball. These exercises on the post not only would be helpful for low back pain, but could also help with neck/shoulder pain and/or arthritis. There are just a handful of exercises that could each help with neck/shoulder pain, wrist/forearm tension, hand numbness, carpal tunnel, tendonitis, and arthritis. I will list them here, but what’s even better is that I also created a post on my blog that discusses this very topic and there is also a video that goes along with the post where one can view the exercises demonstrated by me in just a couple of minutes. (Note from Megan: Click over to Dr. Hyland’s post and watch that video. You won’t regret it.)
Here is the list:
  • Doorway stretch (opens up chest and stretches upper back and arms)
  • Standing pec/biceps stretch
  • Prayer stretch for nerve gliding/upper body range of motion
  • Median nerve glide stretch
  • Radial nerve glide stretch
  • Ulnar nerve glide stretch
  • Standing neck rotation, side bending, and looking up/down
  • Standing trunk rotation with hands on hips
  • Standing back extension with hands on hips.
  • Lying trunk rotation with exercise ball

Click here to see a video demonstration of each of these exercises.

Megan:
Sometimes pianists deal with other injuries that affect their piano playing such as an injured finger from playing a sport as a kid. These injuries can have lasting affects and can really inhibit piano playing in future years. If a pianist has a lingering injury, what do you recommend?
Dr. Hyland:
So, in a case like this I would be remiss to give generalized advice. I firmly believe that in a case with injury it would be best to individually assess the problem. I say this because method of injury is important to understand as well as individual impairments and how it limits their activity, in this case playing the piano.
If local to Tulsa, Oklahoma, I would be happy to assess the situation and offer advice and treatment. If not local then I would advise to seek out either a PT or an occupational therapist (OT) in their area. Furthermore, some therapists are Certified Hand Therapists (CHT) and are even more of an expert in this area. Even if the problem is a chronic issue, its still worth pursuing. Same with a back injury; I wouldn’t prescribe anything specific unless I know exactly whats going on with that person, i.e. history of spinal fusion, disc herniation, stenosis, etc. 
Megan:
How can readers find you online? Do you offer any kind of long-distance services that a pianists and readers may want to take advantage of? 
 
Dr. Hyland:
Yes! There are many different ways that people can get in touch with me or receive information.
Facebook@hylandpt – Like and follow my page to get tons of free advice including live videos Tuesday through Friday each week.
Instagram@hylandpt
Website+Blogwww.hylandpt.com/blog – Be sure to sign up for my quarter newsletter which is another place where I share exclusive content. I write regular posts on my blog on physical therapy and wellness related topics that I feel need to be addressed to the public more often.
If you wish to have personalized advice or consultation with me I am more than happy to have a conversation via telephone, Facebook Messenger, or video chat. I’d be glad to discuss piano-related injury topics as well as any other issues you’re facing.
One of the products that I offer covers many of the areas of the body that we discussed today, and also contains opportunity for distance or in-person coaching from me. That product is called The Daily Dose – 30 Days for Better Fitness. In short, this is an email delivered exercise program that brings the exercises to you via video with included personalized instruction with two of the packages available. These exercises are designed to gradually increase in level of difficulty, and cover abdominal strengthening, core stabilization, lower body strengthening, stretches for posture, and balance exercises. Feel free to contact me to learn more about this.
Back to Megan…
Wow, what a wealth of knowledge! Thank you Dr. Hyland for sharing your expertise with us. I especially appreciate Dr. Hyland’s careful attention to maintaining activity levels through the age process. From simply going about daily life to enjoying your hobbies like piano, being mindful of your physical well-being is crucial.
If you’re looking for a few props to use at home to engage in stretching or exercise, Dr. Hyland recommends this exercise ball and this sturdy mat.
You might also consider an adjustable height piano bench, especially if your piano is shared with any other pianists.

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