Osteoarthritis

Osteoarthritis

Osteoarthritis is a common condition which affects the joints, most commonly the hips, knees or hands.  It typically affects the DIP and PIP joint of the fingers and the CMC (base joint) of the thumb, making them feel painful and stiff.  It is a medical condition, caused by wearing down of cartilage and joint inflammation.  It is associated with hereditary factors (if one or more of your family has hand arthritis), gender (it is more common in women than in men), a previous hand injury and increasing age. It is not a piano-related injury as such, but it can be exacerbated by high-intensity wear and tear (overuse) of joints in professional pianists who practise intensely.  Moderate piano playing, however, is often recommended as a healthy, therapeutic activity which keeps the joints supple. 

Pianists with arthritis may find that the stiffness and malformation limits their strength and agility at the keyboard and they may need to find ways to manage the condition and modify their technique to work around any changes that occur. If intense practice sessions exacerbate pain in the joints, they may need to reduce practice time or take more regular breaks. 

This article focuses mainly on osteo-arthritis affecting the hands.

Symptoms

Typical symptoms of osteoarthritis are: 

​

  • Stiffness in the joints

  • Pain and inflammation in joints

  • New bone growth (spurs) which may lead to malformation of the joint

  • Muscle weakness, leading to loss of strength in the fingers and weak grip.

  • Clicking of joints

Treatment

Treatments offered may include:

  • Painkillers (NSAIDS – either in tablet form or as cream or ointment) can reduce pain and inflammation 

  • Hand exercises that aim for a balance of strength and suppleness

  • Bracing of joints with splints

  • Steroid injections

  • Surgery (usually only offered after other treatments have been tried)

  • Other treatments which are sometimes recommended (but need further research) include: hot and cold compresses, anti-arthritis gloves; warm water; modifications to diet; herbal remedies; acupuncture.

Technical modifications

For the pianist with osteoarthritis, joint pain may become aggravated by heavy practice and lengthy playing sessions. Here are some suggested technical modifications which may help to manage and control symptoms (specific sections and exercises from ‘The Complete Pianist’ are suggested in brackets)  

  • Warm-up before playing to bring blood to the hands (See The Roskell Warm-ups). 

  • Soften impact on the keys with softness in the joints (See Parachute touch and singing finger touch – both avoid grip and minimise impact). 

  • Avoid excessive curling of fingers (Equally curved fingers, Parachute touch and Singing finger touch).

  • Avoid a sudden increase in practice time – think ‘little and often’.

  • Minimise and avoid stretches if the stretch is compromised (see Pianists with small hands, Widely-spaced chords and The Splay) 

  • Change repertoire if necessary (eg less forceful pieces or ones with less stretch)

  • Change to a lighter keyboard if possible.

  • Also consider how you use your hands in other aspects of your life, such as typing, texting, preparing food or any other activity that requires grip.