There are several occupations that put people at risk of Repetitive Stress Injuries. The best known of these injuries is probably Carpal Tunnel Syndrome. It has been commonly associated with office work involving computers and keyboards, but is also relatively frequent in dentistry, massage therapy, painting, and playing an instrument.

The common factor among these careers is the repetitive motion of the hands for long periods of time. Musicians put in thousands of hours of practice. By the time a person has become a professional musician, he or she has already spent in 6,000-10,000 hours at their instrument.

The picture below is a cross section of the left wrist as viewed from the elbow. The carpal tunnel is the small, grey-shaded area in the picture. It is surrounded by the bones of the wrist and contains nine ligaments and tendonsin addition to the median nerve. What causes Carpal Tunnel Syndrome is the pressure placed on this median nerve by lack of space.

 

When the wrist is in a natural position, such as hanging relaxed from the shoulder or resting in a splint, the space in the carpal tunnel is enough for these tendons to function properly without pinching the median nerve.  Problems arise when the wrist is not in this natural position. Bending the wrist in any direction severely reduces the space for the median nerve as does gripping objects tightly. Doing such a motion once or a hundred times won’t cause problems. But doing it thousands and tens of thousands of times causes a cumulative trauma.

There are ways to continue high risk activities, though. With conscious attention to the movements of the body, a person can avoid injuring themselves. In piano there are so many things to think about at once that technique is often thrown by the wayside unless a teacher is around to point it out.

Here are two common technical problems I often correct in students.

Pianists with small hands especially struggle with this problem. The thumb is a short finger and stretching over a big chord can be tricky. There are two solutions to this. One is immediately releasing the thumb and swiveling the wrist behind the pinky so that it is pinching the nerve for only a moment. The other is playing the thumb out on the tip of the key and the other fingers much closer to the fall board. This will change the angle of the wrist to a much more ergonomic position.

 

The low wrist happens most in beginners. The student is usually focusing on having nice, curved fingers and forgets about the posture of the arms. Unfortunately, this position puts serious pressure on the median nerve and is probably one of the biggest culprits for Carpal Tunnel Syndrome.

Other factors can affect the space within the carpal tunnel. Tension in the muscles of the arm and hand can also pinch the nerve. Tight muscles frequently result from insecurity, the pianist not being superbly comfortable with what he is playing. Relaxation requires deliberation in new, half learned music. It does not come naturally.

The pianist aware of these dangers and trained to avoid them is much less likely to develop any repetitive stress injuries including, but not limited to, Carpal Tunnel Syndrome.