Pain at base of left thumb after playing stride piano

Question

I am an experienced piano player. I played for 20-something years starting in my childhood, and even studied classical piano at the university level. At my peak I was practicing and playing from 4-8 hours per day, or so. I would sometimes get some minor pain in my forearms that would subside within a week, but never had any serious issues beyond that.

I'm now in my late 40s and have started playing again after a 15-20 year hiatus. I'm currently practicing 2 pieces that involve a lot of left-hand motion - Scott Joplin's Maple Leaf Rag and Maxence Cyrin's piano arrangement of The Pixies' Where Is My Mind. I have played Maple Leaf Rag before and did not experience any pain. The left hand involves moving from octaves to chords on every beat. For Where Is My Mind, there are 2 sections where the left hand is arpeggiating a chord from the root to the 10th, so it's a bit of a stretch. I suspect this may be what's causing the pain.

The pain is at the base of my left thumb extending towards my wrist. When it first happened about a week and a half ago, I took some anti-inflammatory meds and stopped playing for about 5 days. It got significantly better. However, I still notice that every now and then, I'll turn it a certain way, or hold an object a certain way and it will return.

Given that it's subsiding, I don't think it's serious. However, I'm curious if I did something wrong that caused it to happen, or if it's just from having been away from the instrument for so long? Are there exercises I could do to get me more in shape for playing again? (I am doing technique exercises from the Hanon series, but I'm not sure if that's helping or hurting my hand.)

Answer 1

I would avoid treating SYMPTOMS. If you have a nail in your shoe and it is impaling your foot, you can take the shoe off for a few weeks, take anti-inflammatory drugs and put a bandage on it. All these actions treat the symptom. The problem is when you put the shoe back on you still have a nail in your shoe. Take out the nail and the symptoms go away. Problems with ergonomic issues in your playing are exactly the same.

I'd have to watch you play to tell what you are doing wrong. What you do wrong can cause these SYMPTOMS. YOU are not broken. Your technique is.

Some of the many thumb problems you may have: Pressing into the keybed. Once you hit the "point of sound," pressing into the keybed only causes strain to the tendons. Remember HS physics, when you press into an immovable object, it is pressing with just as much force back into you. You will break, not it. Remember, the piano is stronger than you.

The muscle most pianists incorrectly use to play the thumb is the thumb's abductor. The abductor is a weak, slow and fatigable muscle. It is designed for gripping and holding, not playing down. A better muscle to use would be the pronator in combination with arm weight, up/down and a slight forward shift from the elbow/shoulder. Used simultaneously, this completely frees the thumb and provides a nice rotation for the rest of the hand (what the fingers are connected to) to get where it needs to go next and, facilitates the grouping of fingering.

Another error pianists make is crossing the thumb under the palm. The thenar and index tendons intersect. When you cross the thumb under, they grind together. That can't be good over time. To get around this, using the pronator, supinator and elbow will not only give you tremendous speed in scales and arpeggios but, will make the thumb feel effortless and powerful. The same is true with the pinky and ring fingers. They are not weak nor incoordinate, we just fail to adjust the forearm alignment from the shoulder and elbow.

Abducting all your fingers and stretching out your thumb's extensor (spreading out for an octave) creates a ton of muscular pulls and vector forces. This is the foundation for most injuries, uneven playing and mistakes. The arm can only move in one direction at a time. When we play from the fingers, we attempt to drag the arm and that creates tension in the fingers and tries to pull the arm where we don't want to go.

Of course I suggest seeing a doctor but most doctors treat symptoms and not the problem. A really good doctor will send you to a movement specialist who treats injured pianists and will fix your errors in movement and the symptoms will disappear.

This is the state of our pedagogy right now. A student experiences pain, fatigue, tension or cramps and a teacher will suggest they relax the hand or build up strength and endurance. All those answers are incorrect. It is the arm that plays the fingers. Your fingers have no muscles. A forearm muscle flexes, it pulls a tendon, your bones bend. When we play from the fingers, we strain the tendon caught between the bone and muscle. When a student experiences cramps from using the wrong muscles, the teacher suggests to relax but, they are relaxing the same muscles they are trying to play from. When we play properly from the arm, indeed, the fingers are relaxed. If a teacher says "relax," you should then ask, Okay, what do I use instead?

The solution is to take a lesson from HS physics and use the muscles and bones designed to move the fingers. If you must treat your symptoms, I suggest a contrast bath four times a day. Fill one large plastic trash pail with ice cold water, the other with hot as you can tolerate hot. Plunge both arms into each pail all the way up to the elbows for one minute. Then switch. Do this five or six times. The cold reduces inflammation and the hot increases circulation. End in hot. But, if you continue you play improperly, you achieve nothing. Our body does most of its maintenance and repair when we sleep. Make sure you get plenty of it.

Ultimately, just find a teacher who knows what a pronator and abductor is. They will fix you right up.

Answer 2

Be very aware of tension. I am a pianist also, and sometimes my worst issues come from things that have nothing to do with playing. For example, driving can cause great tension in my shoulders and arms due to the way I hold the steering wheel. Also, the way the arm rests are located, if I place my elbows on them they cause my shoulders to go up and my elbows to push down hard into the arm rests. I am often better off not using them.

Other times, I will find myself holding a cup of coffee in a weird way (especially to-go cups), and my thumb will be literally pressing into the side of the cup. Why? I do not know. But at times I have even caused my thumb to fall asleep just by holding the coffee cup weird.

So whenever I have a pain or tingling or other strange feeling in my arms/shoulders/wrists/hands, I try to figure out where that is coming from. I ask myself "what is my exact posture right now?" and see if I can find the source of tension. Releasing that tension usually resolves the problem. If I have been doing this repeatedly for a long time, it may take longer for the problem to go away, but it does.

Another time to consider arm and shoulder posture is when falling asleep. I sleep on my side and sometimes my shoulder on the side facing up will fall forward and droop down in front of me. This causes tension because it ends up pulling through the shoulder and upper back. So, I try to at least start off my sleeping with my upper arm resting on my body in a relaxed fashion. Also be aware of what you are lifting throughout the day and how you hold you arms and shoulders while sitting at the computer.

The reason I bring up these non-playing issues is because the tension can build up elsewhere but become a real problem while playing. It just may not be the playing that is causing the problem. I had a student that was having some wrist issues and they hurt while she was playing. I could not see what she was doing wrong at the keyboard and in conversation learned that she was doing some Yoga postures that I suspected were straining her wrists. She just wasn't holding that posture long enough during Yoga to notice. But sitting down to practice for a length of time aggravated it.

I use Hanon exercises as well, but I have realized that the admonishment to lift the fingers high may not be too helpful. It is important that they move independently, but I have found more usefulness in practicing my scales and Hanon exercises with all my fingertips resting on the keys at all times and gliding my whole hand up and down the keyboard as necessary. Also make sure your piano bench is at the right height. An inch or two in the wrong direction can make a huge difference!

If self-care doesn't help, I suggest seeing a physical therapist.

Answer 3

I've had that kind of pain, and I know it's frustrating. I've had it as a piano player and from painting my house. For me it goes away eventually, and I haven't always had to stop the activity before it gets better.

It might be from tightness due to stress. You probably had less stress when you were in college than you do now. Try feeling where you're holding tension when you play and then practice letting the tension go. It might not be just in your hand, but could be in your arm, neck or back, too. Let your body relax so that it can be flexible and strong in it's natural way and have the best chance to adapt to what you're doing with it. Meditation, Hatha Yoga, sleeping and exercise are great ways I know of to release stress and relax the whole body.

This is from personal experience, not medical knowledge, and of course, if it gets worse, stop and/or see a doctor.