Wrist pain in advanced pianists

Question

I’ve been playing piano for ten years now. I am preparing about 40 min of music for a recital and camp, and I’ve been practicing between an hour and 4.5 hours a day. I made a jump in practice time from 2 hours to around 3 on average about four weeks ago. My left wrist was fractured (the distal radius or something- the bone on the left side of my left forearm, very close to the wrist. That happened a couple years ago, but my wrist started hurting suddenly on the left did last week, actually while I was just going about daily life and I wasn’t doing anything that put strain on my wrist. It hurts to twist my wrist or move it to either side, so playing piano is uncomfortable sometimes. I’m not sure if this pain is related to the fracture, my increase in practice time, a new injury, my technique, something else, or a combination of the above. It only really bothers me when I have octaves or treble clef in my left hand, or ostinato octaves for several measures. Here are my current pieces: Moonlight Sonata (all three mvmts) Mendelssohn Rondo Capriccioso Bach Partita I Liszt Waldesrauschen Chopin Nocturne op 9 no 1

Answer 1

This doesn't sound like something one can "play through" and reasonably expect to go away with time. I'm guessing that if your wrist healed from the earlier fracture, this pain is more the result of the additional load you are putting on your hands with the extra practicing than the previous injury. Regardless, one has to be careful, and a doctor's opinion probably would be a good thing.

It is possible that there are some aspects of your technique that can be adjusted as a way to put less stress on your wrists. But chances are you will still need to give it some rest and healing time, as well.

How to figure out if there are technical things that can be adjusted? The usual approaches are to consult with a high-level teacher, and/or a physical therapist acquainted with music-related problems, such as an Alexander Technique or Feldenkrais practitioner. Sometimes it can take a long time to figure out the root cause and a solution.

Sometimes the answer is easy to spot, but is rejected or only adopted reluctantly. We ignore advice about proper posture or technique, thinking it's not really all that important. Or we tell ourselves that the effort to rethink and retrain fundamentals would be too onerous or more fallaciously, too big a step backwards.

Examining what you do in a very analytical way, making finer distinctions, emphasizing awareness of sensation, will be key. No doctor, teacher or practitioner can tell you what you are feeling. It is a very different kind of practice and work, to heighten sensation and awareness. But heightened awareness will be crucial for the successful refinement of technique.

Answer 2

The internet is no place for medical advice so definitely find a doctor who works with musicians - not just a doctor. You may have to go to a large city like NY to find one who specializes in the unique yet natural movements of a pianist. Find a doctor who sleuths out problems, not one who treats symptoms.

First, know that all injuries are forever. Sure, the body heals but never 100%. Ask any old person with aches and pains and chances are they can reference an injury to every body part that aches. Although, sometimes something like a shoulder injury can affect the knees because our bodies are designed to move with equal and opposite motions (shoulders move opposite hips which affects torque in the knees (the same is true for the arm but most piano teachers don't know this stuff)). Pain in the wrist is often an elbow alignment problem.

A friend of mine developed aches on two toes, her coccyx, shoulder, knee and pinky. She eventually went to her doctor who realized that these aches are all locations of previous injuries and he immediately ran a test for Lymme Disease and she tested positive. Lymme first attacks areas that are already compromised which in her case was every place she has had previous injuries. Injuries heal, but not 100%. Lymme attacked these weaknesses.

I personally beleive that proper movement promotes healing. At the very least, it allows us to move without further vector force strains on our body parts. I fell and sprained my wrist a few years ago and every movement was very painful. However, I could play the piano with no discomfort.

If an electrical current was traveling through a wire from A to B, all is fine and the current flows effortlessly. However, if you touch the wire between the two points, that is where the current stops and you will be in big trouble.

The same is true with your wrist. The weight and power of the arm, radius, ulna and all muscles and tendons, all that energy wants to pass through the fulcrum of the wrist, knuckles, phalanx and into the key. If you have a break in any fulcrum, that is where our power stops and does its worse.

Have you seen those talent shows where an acrobat will stack ten chairs one on top of the other and he does a hand stand at the top? It works because everything is perfectly aligned and balanced. The slightest imbalance will cause everything to topple. The same is true with our piano technique. The slightest imbalance, vector force, dual muscular pull . . . can cripple us because our power isn't going into the keybed but, getting snagged within our fulcrum.

The anatomy of your arm is the same. If there is the slightest imbalance in any fulcrum, it will manifest itself in sloppy or uneven playing or, in your case, pain where there is an injury.

These movements can be dorsiflexion, ulnar or radial deviation, pressing into the keybed, poor alignment of the forearm, not using the pronator and supinator muscles, etcetera.

So, find a doctor who specializes in injured musicians. He may not be able to heal your injury but he may be able to educate you on the true mechanics of your arm so that you can move effortlessly and painlessly. Study the physics of a fishing pole or crane and it will all make sense. A pyramid can only go as high as the size of its base. So, a pianist who plays from the arm and elbow will fare much better than one who plays from the fingers (which have no muscle).

Who knows, this injury could be the best thing to ever happen to your musical career. I had bilateral tendonitis from building a deck on the back of my house and for two years sought help from dozens of doctors. I finally found a woman who was not a doctor who showed me how to move and I was pain free in less than an hour. Totally healed in six months. The added bonus is my technique improved. I still have bad habits to eradicate so I still have work to do. I just played a concert and while studying the video I made, I still have rotation and ulnar deviation issues to fix.

Good luck. It ain't over until . . . who is this fat lady?