Piano medicine?

[kaveh]

Hi all,

I have a question-

I'm a doctor, planning to specialise in musculoskeletal medicine/ sports injuries.  I also happen to be a piano afficionado.

The question is this:

I'm thinking of sub-specialising in piano-related injuries.

I know that many of the great pianists have been sidelined for months (if not years) at a time during their performing careers.  What a - potentially avoidable - waste.

Are piano injuries relatively prevalent?  Would there be much demand for this?

Any opinions appreciated.

Thanks,
Kaveh

[thalbergmad]

Sounds like an excellent idea to me. I am sure you will get a few customers from this forum.

My own piano related hand injuries were cured by acupuncture, a brutal forearm massage and a foul smelling oil.

[xvimbi]

To get an idea whether there is a "market", you could scan through the threads that contain the keywords "pain", "injury", "wrist", "hurt", "tendonitis", "carpal tunnel syndrome", etc. As you said, most professional pianists have had severe injuries, and most amateur pianists also have major and/or minor injuries at some point.

I am sure a bunch of people here would be very happy if you could give them some advice right now. You'll find a few people who stress the importance of proper movements to avoid injury, but it seems to be an uphill battle (which in turn works out well for doctors like you, because that will guarantee you patients ).

[prometheus]

I know there is a hand surgeon in London that specialises in musicians.

[alzado]

Not meaning any disrespect or discouragement, but I am not sure this is really worth your energy and effort.

You will find people who injure themselves through foolishness.

One thinks of Robert Schumann, who permanently injured his hand by using some quack "exercise machine."

As the poet William Blake wrote in his "Proverbs of Hell,"  'if a fool persists in his folly, he will become wise.'

Just let them become wise on their own.  Your medical skills can be better applied elsewhere.

This concept of yours is akin to plastic surgery for movie stars.

[xvimbi]

There is no doubt that there are plenty of injured musicians, not just pianists. If you expand your horizon to include violinists, cellists, clarinetists, etc., there will definitely be a big market, particularly if you can build up a reputation. The easiest will however most likely be to go into musculoskeletal medicine/sports injuries, and have musician-related injuries as a special field.

[xvimbi]

This concept of yours is akin to plastic surgery for movie stars.

Well, if pianists already have such an impression, what will the "public" think You think injured pianists don't need/deserve treatment? You think it's a luxury? Tell this to someone who earns his/her living with playing the piano.

No, this concept is akin to a doctor on a football team and very much in demand.

[kaveh]

My own piano related hand injuries were cured by acupuncture, a brutal forearm massage and a foul smelling oil.

Better you than me ;-)

You'll find a few people who stress the importance of proper movements to avoid injury, but it seems to be an uphill battle

That's exactly what awoke the possibility for me.  I recently returned to the piano after a 10 year hiatus.  I'd been mostly self taught before then.  Starting with a very well-informed new teacher I came to learn that I'd picked up some very inefficient, even dangerous habits that would inevitably lead to injury if continued.  Having had to 'relearn' the correct movements - which my teacher illustrated with a roll-call of the famously injured -  highlighted the potential scale of this problem.

I think it could be a useful service - given sufficient demand.

I know there is a hand surgeon in London that specialises in musicians.

That's the thing.  95% of musculoskeletal injuries don't need surgical intervention.  That's when sports medicine comes into play.  A huge industry in the USA, but only just taking off here in the UK.

Not meaning any disrespect or discouragement, but I am not sure this is really worth your energy and effort.

You will find people who injure themselves through foolishness.

I accept that many people injure themselves through foolishness, but even the most prudent and conscientious aren't immune, especially to chronic injuries.  After all, musicians - especially performing professionals - are constantly making huge demands on their bodies.  This can easily take it's toll.  Any sport/profession associated with activity of a repetitive nature is prone to this.

This concept of yours is akin to plastic surgery for movie stars.

Plastic surgery is - with few exceptions - cosmetic.  Sports medicine is the complete opposite, concerned with function.

No, this concept is akin to a doctor on a football team and very much in demand.

Exactly.  Demand is the only thing I'm curious about.

Thanks for all the comments so far.  I would love to know what everyone else thinks.

Kaveh

[Bob]

"Are piano injuries relatively prevalent?  Would there be much demand for this?"


Yes.  All areas of music.  Not just the injured, but those that want to achieve more for their efforts too.  It's the hot new area of music-medicine from what I hear.  I'm not surprised someone is talking about entering that field.

Keep us informed.  I'm interested for myself and for my students.  How to prevent and how to maximize practicing and push myself more, but safely.

[leahcim]

I'm thinking of sub-specialising in piano-related injuries.

Is that possible then?

I mean, I am not a doctor, but tennis elbow and golfer's kneecap aren't really to do with tennis or golf are they. You wouldn't expect a doctor to say "Sorry, you weren't actually playing tennis so $%^%$ off"

Why would you specialise in piano-related injuries unless pianists have different anatomy? Surely the injuries they get are the same as anyone who uses their hands incorrectly in a similar way? Stuff like tendonitis / CTS and so on.

I can grok a Doctor being aware of the need for the patient to find a teacher that can teach the proper movements etc - and if they can help with more than "don't play, take these", but why just piano? Why not sports, the trumpet, rock climbing and so on? I guess I can't invisage the mulitude of Doctors you'd need if they specialised in such a unique way, "Kids with saucepans on their heads" rather than a paediatrician, despite what must largely be similar injuries with the same root cause.

Surely that cause is more about posture / movement of the human body, than the lump of wood they thump or swing about isn't it? At least that's one theme that pops up in some of the posts.

I'm just curious how it would work that's all

If you're not going to give lessons in correct movement on the piano - which to me is where some of the criticism they get in these forums comes from, folk who have read a bit about anatomy and a lot about playing the piano. Completely unfairly imo - what the Doctor will say is usually true - if it hurts when you do that, stop doing it, and then mebbe save the next patient's life with the knowledge they have. Why anyone would expect them to start teaching their patient's piano [which is the advice the patient needs to stop doing it, but still do it, so to speak] doesn't make sense to me.

Is it a marketing / pricing thing or is there a bigger difference between tendonitis depending how you got it than I realise?

[xvimbi]

Is that possible then?

Well, you gave the answer to this question yourself. Of course, pianists don't have a different anatomy, but they use it differently than a smith or a rock climber. And no again, there are no injuries in pianists that don't show up in other people as well. And yes, the idea is to be able to tell what to do to fix the problem, not just to say "stop playing for a while" (although that's better than saying "take this, and continue what you are doing"). There are not many doctors who know anything about the piano, so the chance that one gets really useful advice is maybe 20%. Then one needs to find someone who can guide the patient through the retraining period. Finding one of those has a chance of perhaps 50%. So, one ends up with a chance of perhaps 10% overall to get proper treatment.

The situation would be entirely different if the doctor could also guide the retraining process and would perhaps even be an Alexander teacher. It would be more efficient and more successful. It's like an orthopedic surgeon and a physiotherapist rolled into one

There are plenty of doctors who specialize in musicians' injuries. Googling with "musicians injuries" shows roughly what is going on. It's practically a whole dicipline, with journals and everything. There obviously is a market, and as kaveh already said, it's only going to get more, because musicians slowly start to accept doctors (as they become more familiar with musicians' injuries) and start to look beyond voodoo.

[Bob]

Hey, I'm all for a doctor that plays piano and focuses on injury prevention.  Someone like a sports trainer?  Why not for music too?  Whether they do it for love of music or solely for money, they're working for a good cause either way.  

Someone who understands playing the piano and can help someone out with better movement and more effective practice -- I'm all for that.  I wouldn't expect a genius piano performers, but someone with a basic understanding of piano playing and lots of expertise on the injury prevention side would be great.  I think musician and piano worlds are unique enough to have someone with a little music background required.  It's not quite the same as tennis or typing.

[pianistimo]

yes.  i think you should set up shop here and there around universities.  drop off a few cards and give a lecture or two.  we need people to explain the alexander technique, what relaxation methods are available, and how much you charge for preventative medicine (which is where you would probably make the fastest money). 

to me, preventative starts with posture.  you could explain good and bad posture at the piano (and the long-term results of both -with pictures).  every person seem to need a different height of bench according to their height, but not many people bother to worry about this until their neck hurts or they start getting a hunch back.

another thing people don't tell you, is that in the winter, you need to do your utmost to keep your muscles warm.  to run them under warm water before playing.  it's not only easier to play, but the muscles relax.  now, what if you went around helping massage people's arms and/or putting some sort of warming wrist/forearm brace around  people before juries (that's a good $20 per self heating wrist brace right there).

personally, as i'm getting older, am thinking about investing in back massage at the chiropractors once a month or however much i can afford it.  after even 3 hours at the piano, my lower back hurts.  it's hard to walk around energetically.  to me, this kind of preventative medicine is really great because you KEEP yourself relaxed, thus eliminating injury.

i know at certain spas they use these hot rocks (kind of in similar but differnt fashion than acupuncture). they put them on certain spots to relieve muscle soreness and all.  now, if you had one on each wrist?  or higher? forearm?  i don't know.  just thinking about things that i might  pay for if i was getting tired a lot. 

aromatherapy is another great relaxator. (is that a word?) women are more likely to spend on these sidelines of natural medicine because we like things that smell good, feel good, and are relaxing.  i suppose feet would be another issue.  selling, at your doctor's office, shoes that actually have a wide toe (many shoes are pointed) and sole support.  there are so many things that go into our being able to relax.

[dinosaurtales]

Yes.  I am thinking here in Portland would be good. 

You would be highly successful as an orthopod in any case, but adding a specialty of music-related treatments would be a blessing in most areas.  Your name would be all over town in ten minutes.  Here in Portland there might be 2 guys that pianists would trust to do anything with their hands. 

My orthopod is exceptional. He's a sports guy.  I tend to bang myself up pretty regularly doing sports.  he can get me fixed up, back  on my feet, so to speak better than anybody.

But I am going to be approaching him differently with this hand thing, because somehow, it's more critical to get the little things right with most musical injuries.  i think it's because music operates a lot like sports, only on focused areas of the body, which makes it pickier to fix and heal.  You'd be greatly needed!

[hlconceiro]

Read this,  https://www.diariomedico.com/rec-templating/templates/diario_medico/cmp/imprimirDM.jsp?idNoticia=560541&coleccion=diario_medico

is an article about musical ilness. Sorry it's in spanish, but I'm triying to translate the most important facts soon. If you can read it (or translate via google) it's very interesting.
Best wishes
Hector

[leahcim]

And yes, the idea is to be able to tell what to do to fix the problem, not just to say "stop playing for a while" (although that's better than saying "take this, and continue what you are doing"). There are not many doctors who know anything about the piano, so the chance that one gets really useful advice is maybe 20%.

Yeah, I can see the physio idea. I wasn't aware that physios were Doctors?

To me, even if the number of Doctors who know about piano playing were 0%, the real problem is the teaching [or if it isn't, then it's the students not following the teaching] and it seems disengenous to suggest a profession that doesn't teach piano doesn't know about it, if the one that should doesn't either I know which I'd fix.

In fact I note a couple of the links for "Musicians injuries" you suggested have violin teachers and the like on staff as well as the surgeons / physios you'd expect.

As Bob says - he's all for someone who knows about the piano and can help out with better movement and practise - err, am the only one seeing the irony in that? That's what I thought you were supposed to be when you said "Piano Teacher" on the CV Ok, there's the anatomy side that some might think they need to know? But that's BS in a sense - one of the worst descriptions of playing the piano starts with the pictures of the gooey bits inside your hand/arm and then tells you to do something that aiui is wrong - so much for that gooey bit authority that might convince a few it's right because it talks about anatomy.

There, all the anatomy stuff does is, like the medical evidence in a trial, convinces people that something they have no clue about, like the injuries you'd expect get if you're hit by a poker 6 times, is irrefutable evidence because it's backed up with lots of latin. The proper movements are whatever they are, you don't need to be a Doctor to learn them and teach them afaict nor understand or teach human anatomy in order to do it.

For e.g, the ABRSM and Universities etc. That's where a lot are going through in the UK and the equiv in other countries, so they should be a drive for this if it's really as dire a situation as you sometimes paint. Are they churning out lots of injured pianists too? If there's a big call for specially trained piano doctors, surely someone should sue for their injuries - at least if they aren't mainly self-inflicted.

Not that I favour the compensation culture, but fear of litigation helped get companies to wake up to monitors / seating / wrist support etc when everyone got a computer on their desk.

[xvimbi]

Yeah, I can see the physio idea. I wasn't aware that physios were Doctors?

No they are not. It was to indicate that some doctors have an understanding of physiotherapy.

To me, even if the number of Doctors who know about piano playing were 0%, the real problem is the teaching [or if it isn't, then it's the students not following the teaching] and it seems disengenous to suggest a profession that doesn't teach piano doesn't know about it, if the one that should doesn't either I know which I'd fix.

Well, I have been saying this all along. Unfortunately, even if teachers knew all about proper movements, they can't look into a student's anatomy. What might be absolutely OK for one student, could be wrong for another. Therefore, in reality, we do have musicians with injuries that need proper treatment. Therefore, there is a market for doctors who spezialize in that.

As Bob says - he's all for someone who knows about the piano and can help out with better movement and practise - err, am the only one seeing the irony in that? That's what I thought you were supposed to be when you said "Piano Teacher" on the CV Ok, there's the anatomy side that some might think they need to know? But that's BS in a sense - one of the worst descriptions of playing the piano starts with the pictures of the gooey bits inside your hand/arm and then tells you to do something that aiui is wrong - so much for that gooey bit authority that might convince a few it's right because it talks about anatomy.

There, all the anatomy stuff does is, like the medical evidence in a trial, convinces people that something they have no clue about, like the injuries you'd expect get if you're hit by a poker 6 times, is irrefutable evidence because it's backed up with lots of latin. The proper movements are whatever they are, you don't need to be a Doctor to learn them and teach them afaict nor understand or teach human anatomy in order to do it.

I don't know what you are talking about. Nobody said one needs to know the Latin words, nobody said having information is equal to having knowledge. Of course, one must familiarize oneself with the concepts, not just open up a dictionary. That goes without saying, in any profession. Without that, everything is futile, so please don't drag the discussion down to such a level.

For e.g, the ABRSM and Universities etc. That's where a lot are going through in the UK and the equiv in other countries, so they should be a drive for this if it's really as dire a situation as you sometimes paint. Are they churning out lots of injured pianists too? If there's a big call for specially trained piano doctors, surely someone should sue for their injuries - at least if they aren't mainly self-inflicted.

Is the situation as dire? I don't know. I am reporting what I see around me. You judge for yourself.

[Bob]

I would like to see someone with real science behind them.  Someone who focuses on the training side of music, more like a sportscoach.  So if I were trying to push speed on scales, this person could tell me what exercises to do and what to avoid.  But someone with science behind it, not a regular teacher.  So many teachers have so many different opinions -- "This worked for me."  "I read this in a book."  "I took a class."  "This is what everyone else does."   I would like to hear opinions from the medical community that are based on a science. 

It would be nice to be able to hire a "piano coach" for a few months and have them guide you towards improved technique.  Imagine having that 'guarantee' that you would be improved and knowing that the things you do are really improving you.  I really doubt that everything I do in practicing is as effecient as it could be.  That means I'm wasting lots of time and effort which is tragic.  Years!  And then all the physical or mental pain you could through while practicing.  It would be nice to know that in a few months things will be better -- guaranteed.  I think there's only so far the layteacher or laymusician is going to go, even when working with each other, toward improving things.  At some point, science is needed to figure out how to do things better.

[xvimbi]

I would like to see someone with real science behind them. 

Unfortunately, this is not a well-developed area yet. Given the seemingly unsurmountable reluctance of pianists to look at the science of their playing apparatus as well as at that of the piano, I don't see things change anytime soon.

The closest one can find are Taubman teachers.

There is however quite a bit of information out there. However, it seems that only some professional musicians really bother looking at them. Check this out for starters:

https://eeshop.unl.edu/music.html#jonas

[leahcim]

I don't know what you are talking about. Nobody said one needs to know the Latin words, nobody said having information is equal to having knowledge. Of course, one must familiarize oneself with the concepts, not just open up a dictionary. That goes without saying, in any profession. Without that, everything is futile, so please don't drag the discussion down to such a level.

Calm down The point was I think you need that information to justify the method(s) but much of it probably should be dropped, unless the audience wants justification. People have used it in descriptions of piano playing that are wrong, and I think there is a certain danger that people will believe a method because it appears to be backed by science, even if they don't know whether the science is accurate or whether the bits that are scientifically accurate lead to conclusion that you should twiddle your arms in a particular way.

I suspect a lot of teachers would be put off by the material that discusses the detailed inner workings of the human body. Nobody needs to say people need to know it the book or method just needs to use them - or the flamewar needs to switch from piano technique [which nobody said they need to know either, but I figure folk playing piano want to know] to an argument about where the muscles are or aren't in your fingers [which, as you say, nobody said you need to know] - but if that's used as a way of justifying an approach to method, I've no choice but to know it to be able to say "Yep, that movement or approach makes sense, the other one is flawed"

I guess I'm saying there's no point writing something no one said you need to know

I think teachers might consider themselves needing to be Doctors to be able to know the correct movements and thus teach them if the language looks like that of Doctors - and also, perhaps, to believe it's something very different from teaching piano.

i.e there definately seems to be a split here - as though having the movement knowledge isn't teaching piano and teaching piano doesn't require knowing the movement stuff - to me that's absurd, but am I wrong?

That's not to criticise particular teachers. I've often seen Taubman described as something "for people who have injured themselves" - which is partly bad marketing on their part, but also I'd say, because of an idea I get from those threads, where some seem to think, you play the piano, and, if and only if you're one of the unlucky ones that gets injured then you need to be careful and do things like Taubman - or mebbe it's bad luck, weak hands or something and that means you find another career - even where folk won't give eye contact if injury is mentioned when approaching people who are supposedly experts in acadamia in teaching piano.

See, for me, I don't care - it's a hobby - if your average private teacher doesn't know - there's nothing I can do - I'll read the books, but if I get injured I'll stop - my life doesn't end - I'll learn to paint or whatever. I don't want my doctor to stop saving lives to pander to my choice of hobby. But, if kids are being pushed into lessons from 3+ and then through acadamia and the situation reads as it sometimes does, I'd take a different view - then it matters. But, and I know you've said it - it matters in a way that the solution is teaching, not medical.

e.g Jamie Oliver's school dinners - a TV programme that has influenced the food given to young children at school, because of the playstation generation fud - they are all getting fat etc etc - that taught Cooks, not Nutritionists. If everyone is getting too fat, the solution isn't more nutritionists. I guess that's my point w.r.t why teachers not special doctors, but yeah, people will still get injured, so you need Doctors.

I think saying piano teachers can't see inside anatomy is disengeneous - neither can the patient, so whether the correct thing to teach is "one set of specific movements for playing the piano for all" or "finding the correct movements per person for them to play", that's what they need to teach. I note most of the piano related books don't suggest the latter, they seem to talk about one set of movements [don't read too literally - obviously they'll talk about seat height etc but the general fink / berstein is movements, not finding movements]

[alzado]

leahcim--

This may seem off the topic, and a silly thing to say --

But I think it is terrific that you are going into medicine.

It is a truly noble profession.

Best success whatever your specialty turns out to be--

[xvimbi]

leahcim, I din't know you were going into medicine...

Calm down The point was I think you need that information to justify the method(s) but much of it probably should be dropped, unless the audience wants justification. People have used it in descriptions of piano playing that are wrong, and I think there is a certain danger that people will believe a method because it appears to be backed by science, even if they don't know whether the science is accurate or whether the bits that are scientifically accurate lead to conclusion that you should twiddle your arms in a particular way.

It doesn't matter how something is described, i.e. whether it is done in scientific terms or in "street" terms, one always must strive to understand it. Nobody should get impressed because someone is using a Latin word. Perhaps, using technical language does invoke respect, but that is not its purpose. The other way, however, with which movements are often taught should be bannished: authority. Authority does not allow critical thinking; science does.

I suspect a lot of teachers would be put off by the material that discusses the detailed inner workings of the human body. Nobody needs to say people need to know it the book or method just needs to use them - or the flamewar needs to switch from piano technique [which nobody said they need to know either, but I figure folk playing piano want to know] to an argument about where the muscles are or aren't in your fingers [which, as you say, nobody said you need to know] - but if that's used as a way of justifying an approach to method, I've no choice but to know it to be able to say "Yep, that movement or approach makes sense, the other one is flawed"

No, no. I said, everybody should know, but one doesn't have to know the Latin words. It is perfectly fine to use the words "muscles", "joints", "tendons", knuckles", "wrist", etc. As long as one is able to communicate the concepts, any language will do. There are plenty of books that use fairly easy language to describe anatomy as it pertains to piano playing.

I think teachers might consider themselves needing to be Doctors to be able to know the correct movements and thus teach them if the language looks like that of Doctors - and also, perhaps, to believe it's something very different from teaching piano.

See above. Musicians don't have any problems using hundreds of Italian words that are very scientific (sounding), and now they should have a problem with "inflammation" or "tendonitis"? No, it's the topic that turns them off.

i.e there definately seems to be a split here - as though having the movement knowledge isn't teaching piano and teaching piano doesn't require knowing the movement stuff - to me that's absurd, but am I wrong?

That's not to criticise particular teachers. I've often seen Taubman described as something "for people who have injured themselves" - which is partly bad marketing on their part, but also I'd say, because of an idea I get from those threads, where some seem to think, you play the piano, and, if and only if you're one of the unlucky ones that gets injured then you need to be careful and do things like Taubman - or mebbe it's bad luck, weak hands or something and that means you find another career - even where folk won't give eye contact if injury is mentioned when approaching people who are supposedly experts in acadamia in teaching piano.

This is really what frustrates me. Musicians don't think it's worthwhile spending time on health-related things, until they get injured. Serious athletes spend a lot of time on these issues. Unfortunately, prevention has never been something humans were interesed in. There is only one thing that I think is as bad as that, and this is not being able to learn from other people's mistakes.

e.g Jamie Oliver's school dinners - a TV programme that has influenced the food given to young children at school, because of the playstation generation fud - they are all getting fat etc etc - that taught Cooks, not Nutritionists. If everyone is getting too fat, the solution isn't more nutritionists. I guess that's my point w.r.t why teachers not special doctors, but yeah, people will still get injured, so you need Doctors.

In ancient Rome, doctors were paid when people were healthy, not when they were sick. That is in principle the correct concept. One must invest in order to stay healthy. Unfortunately, people tend to rather invest in fixing things.

I think saying piano teachers can't see inside anatomy is disengeneous - neither can the patient, so whether the correct thing to teach is "one set of specific movements for playing the piano for all" or "finding the correct movements per person for them to play", that's what they need to teach. I note most of the piano related books don't suggest the latter, they seem to talk about one set of movements [don't read too literally - obviously they'll talk about seat height etc but the general fink / berstein is movements, not finding movements]

What I was saying is that educating teachers in anatomical aspects will not guarantee healthy students, because the subject is too difficult and probably not yet well understood. But it would be a step in the right direction.

[leahcim]

leahcim, I din't know you were going into medicine...

I didn't either to be honest
I'm trying to work out whether it was mistaken identity or subtle sarcasm.

Besides....from the look of things I'd be more successful setting up a school to configure apache for piano related sites
wget -S https://eeshop.unl.edu/music.html
... snip...
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