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Tuesday 23 April 2019

The pianist and injury, part i- do common precautions do more harm than good?

(This first part will focus mostly on general pianists' attitudes to physical activity with the hands- exposing how a distorted myth regarding Robert Schumann has created completely unjustified paranoia that urgently needs to be countered. In a second part I'll also go on to explore why I believe the relaxation school may have actively contributed to making injuries increasingly common place- with proof of how the extensor muscles are generally worked considerably harder when trying to channel arm energy through a passive hand)

Introduction 

Firstly, I'll provide a couple of scenarios outside of piano playing, to set the scene.

Picture a tennis player who does no physical exercise apart from playing tennis. He aims to play to a high level and thus must often push his physical capability close to its limits, when holding a racquet in hand. However, don't fear. He won't be at risk of injuring himself. After all, he never goes to the gym, he consciously avoids all forms of stretching and flexibility based work, and he never warms up physically other than by actually playing games of tennis.


WHAT???!!! Let's rewind for a moment, for that's clearly the most deranged logic conceivable. This is not why he would be safe, rather it's why he is going to be actively prone to injury! To play top tennis, you must clearly CONDITION your body for the demands of the real life game, not exclude it from doing everything other than tennis. You don't get to have an incredible serve through avoiding all else!

If you're already complaining that music is an art and not a sport, I'm afraid I saw you coming.

In my second analogy, we have a ballet dancer. She never does any form of physical activity other than rehearsing the ballet routines that she is working at. After all, she must protect her physical apparatus from injury. She never works at flexibility prior to dancing nor does any form of non-artistic exercise to get started. Better to avoid such risks. This is exactly why it's safe for her launch into the splits at a moment's notice (as long as it has artistic context in a genuine routine), without any physical warm up.

WHAT???!!! Let's rewind again. This time you don't get to frown on a sport for being "different" to art, yet it's still abundantly clear that the whole premise is absurd to the very core. Anything that helps the body develop comfortable flexibility is clearly part of performing effectively and with safety. Alongside ballet practise itself, it's common for top dancers to do all manner of body conditioning- including flexibility and possibly even some degree of strength based work (especially for male dancers who may have to carry a partner's full weight). They don't serve their art by turning their noses up at anything that doesn't have artistic context. They work to keep their bodies limber and flexible specifically because it prepares them for the physical demands that they must meet during their art.

Finally, we have a pianist who is building up towards music college auditions. He never does any technique exercises beyond the odd scale, because he is too pure an artist to dirty himself with such matters (and he once heard a famous teacher say all drills are dangerous and should thus be avoided). He deliberately avoids all forms of "unnatural" hand exercise away from the keyboard. After all, everyone knows that Schumann damaged his hand beyond repair with some weird contraption. Other than practising his programme of difficult music, he keeps his hands fresh by resting them and avoiding activity. He has minimal risk of injury, because his hands do little other than musically artistic piano playing.

Now, this is the one where a great many pianists would nod in agreement, rather than shout "WHAT???!!!!". If so, why? If you do go on to continue thinking that's a good attitude, after having read this post, then very well. However, I have to insist that you at least stop to ask some serious questions. Now, there are also radically opposite stances- including pianists who obsess over an idea of extreme finger "strength" and genuinely overdo work on forceful exercises towards that end. I have no wish to promote that branch of extremism. However, the stance outlined above seems to have become widely accepted as if it were basic common sense, rather than the opposite pole of equally extremist madness. Did you notice how consistent it was with the previous examples? Somehow, something I'll call "pianist's logic" seems to have allowed this to be taken seriously within our field. Oh, and in the end, ironically enough that pianist does get injured by a "contraption"- an especially hazardous one, that subjects his poor hands to outlandish demands found nowhere in the natural world. It's called a "piano".

The Schumann myth

Before proceeding, yes I was indeed being facetious for the sake of a cheap gag. It was, however, also for the sake of making an incredibly serious point. This is where "pianist's logic" has come to differ from the default stance of virtually any ordinary human on this planet. Show us a little rubber band and suggest stretching it back and forth for thirty seconds (for the sake of building flexibility) and most of us will run for the hills, while screaming something incomprehensible about Robert Schumann's injury.

"Contemplate the possibility of facing such a wild risk as moving our fingers against incredibly mild resistance? No, thank you. Do you realise that I'm a pianist?".

But what if you ask us to engage them against the larger mechanical resistance of piano keys, for the continuous 30 mins+ it takes to play a Rachmaninoff concerto (featuring incredibly rapid runs, as well as vast physical stretches that must be taken with commanding ease while the hand bears the mass of the moving arm)?

"Sure, no worries mate."

 Contrast against any "ordinary" person and they're usually of sound enough mind to stretch that elastic band without fear, while quite probably expressing far more doubt about playing the piano like the clappers.

Who is right here? Well, how many people have you heard of whose career ended due to an injury associated with using an "unnatural" device (other than the piano itself)? If this were the gameshow "Pointless" and you knew of any tale other than that of Robert Schumann, you'd certainly be on to a winner. Compare to cases of pianists who were injured merely by playing their instrument and we have undeniable reams of evidence. Leon Fleisher and Gary Graffman are two famous examples among a huge number of piano based injuries. Glenn Gould too had a period of being severely afflicted. It's time to seriously reevaluate why the piano gets the "get out of jail free" card, while we are quick to call danger on all external exercises- which no ordinary person nor qualified physiotherapist would be faintly concerned by. Of course, I'm not saying we should ban piano playing based on the possibility of injury. The point is that it's completely irrational for us to issue blanket bans on almost anything else that involves significant hand activity and then happily spend hours at the "unnatural contraption" which has definitively been at the heart of many injuries.

Anyway, here's evidence of the fact that the old Schumann tale is almost certainly nothing more than a wildly distorted myth:

http://www.pianisttopianist.com/?p=10

http://focaldystonia.co.uk/#/robert-schumann/4563923100

Schumann may not have been wise to use the machine exactly as he did, but the severity of his problems already existed. Don't misunderstand, I'm not specifically saying we should all run to get a device like Schumann's, and then pull the crap out of our fingers, with expectation of becoming virtuosi. However, we should stop to ask questions before tarring all hand exercises in general! Where is the meaningful evidence for the crippling long-term injuries that can supposedly afflict those who dare to exercise their hands away from a piano? If there is any substance, I extend an invitation to anyone to point me to it. As far as I can see, it seems that we've been duped en masse, by scaremongering. Evidence suggests that the true worry is injury from playing wrongly, not from any complementary exercises. The pianist's paranoia about everything under the sun (except for pianism itself) does not seem to have any footing in reason at all. It lives in a legend, that somehow evolved into being taken as gospel.

Back in reality, it's widely accepted in science that engagement of muscles against comfortable levels of resistance is actively conducive to flexibility and general health- far more so than abstinence from activity. The only meaningful questions should be about what is a reasonable range to work within. In cases of significant existing injury, complete rest may sometimes be wise. However, even then a physiotherapist may well prescribe gentle work against low resistance- thus encouraging blood flow to assist healing. It's a remarkable situation, really. The very same exercises which are safe enough to be given by medical professionals to the significantly injured (to help restore function via gentle rehabilitation) are being denounced by a horde of medically unqualified pianists as too "dangerous"for the healthy. The idea that hands which perform extreme gymnastic activities at a piano must be protected from such simple exercises exists in the world of "pianist's logic" and nowhere else. Look around and you'll certainly see plenty of evidence of injury through repetitive activities like piano playing, typing and the like. But the Schumann legend seem to be both the beginning and end of the "evidence" behind this overblown hysteria about any kind of alternative hand exercises.

The evil of Stretching?

For some reason, Chopin has been pretty universally portrayed as the antithesis to Schumann- a pianist who respected the hand in its natural form and would never have considered trying to alter its natural state. Well, I'm going to have to shatter this myth too. Did you know that Chopin developed flexibility between his fingers by sleeping at night with wine corks wedged in between them? So much for the poster boy for leaving physical development to piano playing and nature alone...

http://online.wsj.com/article/SB122670581542929769.html

Now, it may be that Chopin changed his mind on this type of thing, but it's impossible to say with certainty that it had no effect on him. I'm not going to recommend going to such extreme lengths, but I'm certainly not going to rule out more gentle stretching exercises. When it comes to small handed pianists, people regularly cite Alicia de Larrocha as proof that they can flourish like any other. While this is spot on, what seems to be forgotten is the fact that she was obsessive about stretching her hands and actually managed to develop enough flexibility to strike a tenth. Weirdly enough, I've literally heard the same people who put her forward as an example to those with small hands, going on to argue that you should never stretch at all. Sometimes they even argue against basic legato. If someone wanted to construct a conspiracy by which to prevent those with small hands from ever transcending their slight disadvantage, they could scarcely do much better. Yes, there will be things which just aren't possible and which cannot be usefully forced. A whole lot of stuff can be coaxed, however. It's incredibly unlikely that de Larrocha would have reached the level she did, had she just decided that there was nothing she could do to improve on what nature gave her. People who treat their small hands as innately incapable (and a thing to be carefully protected from all challenges) are not going to come close to what she achieved. Also, even large hands need training. A large hand is not automatically flexible or limber, in much the same way that a tall person isn't automatically a professional level basketball player. There are good ways to train and bad ways. But it's a gross oversimplification to decide that piano playing counts as good, while everything else must be assumed bad.

Skepticism vs cynicism/"Hmm"vs "NO!"

The origins of this article were triggered by a post in a Facebook group for piano teachers- regarding *brace yourself* finger weights. Given the extreme nature of the responses that post received (displaying "pianist's logic" in full force), I will clarify at the outset that the only thing I wish to promote is the value of an open mind- that neither fully excludes nor fully accepts anything without reasonable cause. Skepticism is healthy. That's where we ask questions and seek further information, rather than accept any claim at face value. Uncertainty is healthy- where we recognise that we have inadequate information to give a final judgement. Cynicism, however, is not healthy. That's where we make a snap dismissal of anything that differs from the limits of our experience/assumptions- thus shutting ourselves in a cage and removing all possibility of someday being pleasantly surprised by a new discovery.

Anyhow, these finger weights were met with a torrent of casual dismissals (some arguably libellous in nature). I won't name or quote anyone, but I will summarise the prevailing nature of the responses. Other than myself, nobody had even cared to enquire about the size of the weight involved, before being ready to pass judgement. Needless to say, the Schumann references came thick and fast- only a couple of which tried to debunk the myth rather than spread it. Yes, one man got injured almost two centuries ago (in a tale of very dubious details) so from there onwards every conceivable mechanical device (except the piano) is to be assumed cripplingly unsafe for a human hand. Among a very large number of responses, I saw very few people who were raising questions or seeking to understand more deeply. Anyway, in the end one of few curious posters looked up the actual weight. It starts at...

10 GRAMS!!!!

As a skeptic rather than a cynic, I find it astonishing that the default assumption would be that putting 10g (!) on a finger will probably cause injury. Pop a pound coin (you'll have to Google your own closest equivalent if you're not in the UK) on the back of a finger and that's the corresponding level of mass and indeed danger that would be involved. I won't even tell you to do so "at your own risk". If you want to take me to court under the grounds that you injured yourself with that coin, all I can say is that you're welcome to try (although you'll need a bloody good lawyer). Remarkable claims demand remarkable evidence. The idea that a finger cannot handle 10g (one hundredth of a kilogramme!!!!) without probable injury is a truly remarkable belief indeed. Particularly given that the very same people who call danger are typically happy to preach the joys of setting the whole arm's weight upon the hand!

Most remarkable of all, the discovery that that merely 10g of mass are involved changed nothing in the tide of opinions! I was assured that the difference is that the arm's more substantial weight is "natural" and thus can't cause injury- in spite of applying radically greater forces. Conversely, I'm led to believe that as 10g is "unnatural", it will therefore become injurious. If you're happy with that as an explanation, then we certainly do live in a world in which facts no longer matter. In my second part of this post I'll go into detail as to how arm weight schools really can cause significant strain, when excess weight bears down on an underperforming hand. I can assure that 10g won't, however.

Anyway, it's not that I even recommend these weights. Rather, I was struck by what the response says about attitudes in general. As one poster mentioned, Liberace's rings were probably heavier than 10g.  You don't become an accomplished pianist by having the biggest and most rock solid finger muscles, but neither do you become one by wrapping yourself in cotton wool and 
living in fear of anything untried. Here's Tzimon Barto:



As a devoted bodybuilder, it's said that after a concert he could easily bench-press the piano for an encore. I think that's only a joke but, regardless, do you imagine that if you asked him to bear the weight of a coin on his finger, he'd back off in case his hands were crippled beyond repair? Or that he'd accept, only to be forced to cancel all concerts for the rest of the season (as a payback for such naïvely reckless bravado)? Other concert level pianists who are also into olympic style weight lifting include Leon Bates and Gen Hirano. I must stress, my point is not that you should lift colossal weights. But this gives some perspective on how utterly pathetic it is for a grown pianist to fear either a rubber band or the mass of a coin upon a finger.

Come back to our ballerina, or gymnast now. Sure, they might not be looking to benchpress double their body weight. However, why would they be scared to lift even small dumbells, when they have to execute chains of backflips? Likewise, why should a hand that is getting around virtuoso octaves be troubled by supporting 10g? I might not expect miracles, but injury via 10g is the very last thing that would be on my mind. No hand is going to shatter into a thousand pieces. The fact that fear of 10g reads like more like comedic parody, than observed reality, speaks volumes of how warped our culture has become. Pianists are being encouraged to cower in response to nothing- despite constantly facing serious gymnastic demands at a piano. And then they wonder why those precious little hands end up injured? You don't necessarily need to have remarkably strong hands, but if you want to tackle serious repertoire then you sure as hell need to have them agile and conditioned for activity!

Weights and Hanon exercises

One of the most useful exercises I've done is to practise occasionally with a 1kg wrist weight. I came upon the idea in a book by the pianist Seymour Bernstein. I'm not going to specifically recommend to anyone else, on an unsupervised basis. However, I will describe some of the details.When I play with a small weight on my wrist, it makes any flawed alignments extremely obvious. Holding the wrist either notably high or low would get tiring very quickly, if sustained. Without the wrist weight it can be like boiling a frog. If you don't know the expression, it refers to the fact that frogs can only detect abrupt changes of temperature- which means that you could theoretically boil one alive without them knowing they are in trouble. In much the same fashion, if I were to play a Chopin study with a slightly crooked wrist position, I'd probably both get away with it for a while and not realise that anything is amiss. Lots of slight imprecision of movement (none of which stands out on its own) slowly adds up though. All of a sudden, I'd eventually realise that I'm starting to miss plenty of notes and feeling everything seizing up.

I just about got away with much that kind of thing, in this rather old video of the black key Etude by Chopin.




The dressing gown slightly hides my long-term habit of holding the right wrist upwards, although you will visibly see a few rather jerky "hopping" movements of the arm, where the legato is poor and the arm is not properly supported by clear connection of the fingers. As I remember, although the accuracy didn't go horribly wrong, my forearm was rather tight by the end.
If I had tried the same with the wrist weights on, I'd know about the slight problems almost immediately, through a somewhat amplified sense of instability. I don't actually do it to make my hand work harder during a whole run-through though. Rather than struggle on while tiredness builds, I use the feedback to stop and adjust into easier coordination- where my wrist is properly suspended at length between a stable finger and the shoulder. The idea is to suspend that extra kilogramme without bearing the whole force down directly on the finger. I literally do it to AVOID weighing down hard on the hand, not to encourage it! When you get things wrong, there is indeed a significant sense of the hand being burdened by extra mass- which is why I don't try to plough through whole performances at speed. Instead, I explore sections (both at very slow tempos and fast burst of small units), looking for comfort and stability at all times. As soon as I detect any moment of awkwardness, I stop and fix it. Nowadays I play the same Etude with far less downward arm pressure and far greater ease of movement.

Also, this brings me back to technical exercises. I've heard many of people say that playing Hanon causes injury. If it can possibly do so, it's because your technique is wrong. Anyone with truly good technique should have no problem playing any of them safely. Avoiding Hanon because its dangerous is simply fleeing from your problems without actually solving them. It's far better to intentionally expose the problems (via only brief bursts) and then make corrections. There are few better places to both uncover and fix fundamental movement problems quickly. When I do the occasional Hanon exercise (with weights on or off) what I again almost never do is is run from start to finish. I'm not looking to build strength with endless repetition, but looking from immediate refinements of coordination. Instead I tend to do small bursts quickly (usually a bar plus one note) and then stop to assess how precise and easy the movement was. If I wasn't happy I'll then do it very slowly, checking for smooth sideways arm movement, while the fingers keep a clear legato connection (to stop the weight collapsing downward). If that works I'll probably do a little bit fast again. Eventually I may play through the whole exercise fast, but never to "feel the burn". If it's not effortless and precise I stop and build precision and clarity again. With this kind of focused approach (based on finding and solving slight problems in the movement, rather than drilling mindlessly) you can find the issues which get in the way of free and easy movement and then change things at once. If I find and correct any points of heaviness, with the wrist weights on, I know that I'll still be significantly clearer and lighter in my movements when I take them off again.

I'd have been far worse off had I simply shouted "Schumann!" (like some mindless parrot) when I first read about wrist weights.