As soon as any pain is experienced, stop practising or reduce playing to a level that does not cause pain.  If you have swelling, doctors often recommend rest, ice and elevation to reduce swelling and inflammation during the first few days:  

Rest: (for the first few days at least) is needed to give the tissue time to heal.  A bandage or splint may help.​

Ice: reduces pain and inflammation. Apply an ice pack (or a pack of frozen peas wrapped in a towel) to the affected area for 5-10 minutes several times a day during the first 24 hours. Thereafter warmth is preferable.

Elevation: of the arm above heart level drains any excess fluid away from the affected area.   

A few days rest may be all that is needed.  However, if the pain does not go away then seek medical help.  The sooner the problem is diagnosed and treated, the quicker the recovery. 

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Seeking medical help

Firstly consult a medical professional for an accurate diagnosis. Your GP may be able to refer you to a specialist in hand or upper limb disorders (see BAPAM).  Be sure to explain clearly how your injury affects you as a pianist. A written doctor’s report may be helpful if your work or studies are likely to be affected. 

If you are in pain, then it is probable that continued arm rest will be recommended for a time. However, there is concern that complete rest is not helpful in the long-term. Scar tissue may form which shortens the muscles or tendons. Some ‘passive stretching exercises’ (See 'Forearm and hand pain'), if tolerated,  may be useful to keep the hand and arm gently moving. Alexander technique training, or other very gentle methods can be helpful at this stage.

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Identifying the trigger and causes

If your pain is playing-related, then however good the treatment you receive from the medical profession, there is a strong likelihood that the pain will recur in the future unless any underlying pianistic problems are addressed. This pain should act as a warning that there may be aspects of your piano technique that need to be re-considered.

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Recent triggers

Consider whether there may have been a very specific sudden or recent trigger, which sparked off the pain.

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• A sudden increase in practice - perhaps a stressful deadline?

• Were you practising a new, challenging technique?

• Were you practising on a piano with a stiffer action?

• What pieces were being played when the pain first occurred?  Which bars are most troublesome?

• Which type of movements cause most pain?

• Do any non-musical activities exacerbate the problem?

Underlying technical causes

Sometimes the short-term trigger is just the ‘straw that broke the camel’s back’. Many piano-related injuries are the end result of long-standing muscular imbalances, tension and ill-advised practice methods. An experienced piano teacher should be able to help you identify possible causes.

Underlying technical causes may include:

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• Poor posture 

• Tight wrist, elbow or shoulders

• Unnatural hand position and faulty alignment

• High, curved fingers

• Excess force or pressure on the keys

• Excessive repetition at a stretch

• Hyper-mobility or weakness and overcompensation elsewhere

• Faulty practice regime such as: insufficient rest; too challenging pieces; overly-repetitive mechanical practice; attempting to play too loud or too fast; over-emphasis on exercises to strengthen or stretch the fingers.

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Psychological stress

There may also be psychological problems, such as perfectionism, low self-esteem, performance anxiety or you may be in a period of emotional or mental stress.  All of this can put additional pressure on an already overstrained body and trigger pain. It may be worth considering studying a holistic activity such as Alexander Technique, Feldenkrais, Tai Chi or Pilates, a meditative practice such as yoga breathing or mindfulness or to see a counsellor or psychotherapist.  

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Keep busy

During the initial rest period it is important to keep busy in other ways. Stay motivated by revising technique in the other hand, reading books about music, listening to recordings, choosing repertoire.  Take this opportunity to learn how to prepare a piece effectively and memorize away from the keyboard.  

Physical therapy

Your doctor may recommend that you see a physical therapist such as a physiotherapist or osteopath (ideally one who has some experience with musicians) who may offer you  physical manipulation, massage or exercises.   However, do be cautious of overly strenuous stretches or any exercises which put weight on the hands.  ‘Listen’ to your body and tell your therapist if you feel that any exercises are too strenuous for you as a pianist.  It may also be important to think about maintaining general fitness and do some strenuous walking or swimming, or any other form of aerobic exercise that your body can tolerate. 

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Resuming playing

Once playing can resume, some guidance from an experienced teacher will be invaluable.  Make a clear recovery plan, and only increase the playing time incrementally, depending on the severity of the injury.  In her book ‘Playing (less) hurt’, Janice Horvath recommends starting with one session of 5 minutes per day, then if this is tolerated, build up to two then three sessions of 5 minutes.  Then move on to one session of 10 minutes per day, then two and three sessions of 10 minutes etc.  Stay below your pain threshold: as soon as pain is felt, stop and rest.   

Keep a note of achievements, new pieces or skills learned, and any noticeable physical improvement.

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Technical retraining during recovery

This is the best time to assess and modify your technique to prevent the pain recurring in the future.  Learn any new technique with the unaffected hand first before transferring the skills to the other hand.  If you have suffered from long-term pain, you may only be able to tolerate playing with a very light touch at this stage, perhaps even just ‘shadowing’ the keys.   Learn all new techniques slowly and piano initially. 

The following sections from The Complete Pianist teach very gentle healthy movements which can be beneficial to all pianists during recovery:

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• The Roskell warm-ups and shoulder releasing exercises

• Sitting posture

• The chapters on the wrist, shoulder, thumb, and elbow may have particular relevance depending on the type of injury

• Bringing the hands to the keyboard; improves alignment

• Correct alignment

• The pianist’s hand and finger: minimizing the stretch

• The Parachute touch: co-ordinate the arm and softens the impact on the keys by using arm weight

• The released hand and finger: reduces tension in hand and fingers

• Note endings

• Moving freely around the keyboard:  frees up lateral movement and softens the elbow

• Rotation technique: releases tension generally

• Practising:  encourages healthier practice methods

• Preparing a piece: reduces practice time by more effective learning methods

Find out more

When the hands are fully recovered, do not launch straight back into technically difficult passages such as repetitive octaves, large chords etc. Consider your approach to forte and fast playing. Do you engage the stronger muscles of the upper arm and back when playing forte? Do you practise loud passages piano, and fast passages slowly? Do you use an effortless technique and rely on gravity to depress the keys?

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Make a ‘Recurrence prevention plan’

Reconsider the original triggers and decide what changes you might need to make in the future to avoid recurrences. What are your limits? Are there certain types of repertoire that don’t suit you at this stage? Do you need to reconsider your practice regime? It may take quite a lot of perseverance not to slip back into your old ways in the euphoria of recovery!

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Enjoy playing again

When your hands are fully recovered, and your technique is well-co-ordinated, you just need to re-build confidence in your hands – neither making excessive demands nor over-protecting. You can now let go of conscious technical control in order to allow the music to flow. Enjoy playing again!