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A lot of songs I play have ostinatos with riffs over large intervals and include a changing a middle note.

The treble clef in the image below is a good example.

enter image description here

I have been trying to play this with my fingers 1 and 5 spanning the b octave, and just switching my index and middle finger notes.

When playing intervals like this (which, without a middle note would be close to the maximum interval I can easily reach), through a combination of finger movement and wrist rotation, sometimes my forearm gets tired (in a workout way, not in a painful way).

I am fine practicing these until my forearm is strong enough and my arm comfortable with the interval but I am curious, what is the ideal technique from a physical standpoint to play large repeating intervals? I think this is called "extended position".

Should I try to use fingers only? Should I try to use mostly my wrist with rotation, or something else?

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    Use arm weight as much as possible, I think. Don't attempt to do it just with your hands. Jul 29 at 22:20
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    I think your hands are smaller than mine, so how I play it is not likely to be the best way for you to play it. That suggests your best option for mastering wider intervals without injury is to hire a teacher who can help you address these intervals in a way catered to your hand size. Jul 30 at 9:11

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It obviously will depend on your hand/finger physiology, but for me, I rest my hand on the 2 B notes, and see where the fingers fit with regard to the others. Just as you do, index on E, middle on F♯ seem to work best. But a consideration is where the rest of me and my arm are at the time. By sliding left/right, you'll give yourself some leeway, and one position will feel most comfortable. Also the height your hand is above the keys will have a slight influence on comfort. For fast, repetitive passages, wrist rotation isn't a good idea. Keep experimenting!

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