Playing With Fire #9: Part One - Bad Teachers

I am often told that I am harsh, unfair and judgmental toward piano teachers. It is true. While many teachers may have much to teach regarding the artistry of playing the piano, it is also true that many of them do not know what they are doing mechanically. The body is a machine with levers, pulleys, rubber bands, torque and fulcrums. We learn about these things in Physics and Biology classes and it is too bad that our educational system doesn't use Physical Education class to combine it all together. It is also too bad that our teachers only know what they are taught and do not seek answers to problems other than relying on what they were taught: practice more, relax, work on finger exercises, build strength and endurance, you have no talent or, they just keep taking the students' money. Often, the cure for technical inefficiency or various syndromes is an adjustment to our movement but that is rarely addressed because a teacher only knows what they were taught and often that is practice more, relax, work on finger exercises, build strength and endurance. I have a friend who can't play tremolos because he tries to play them from his fingers. If he played them from his elbow, they would be instantly effortless. But, what do I know, his teacher told him to practice more and build strength.

I may not be able to pick up and move an 800 pound boulder across my yard but, with a crowbar and another rock, I could make a fulcrum and inch it over. Better yet, if I can nudge it up onto a dolly with wheels, I can then easily roll it over. My strength and endurance doesn't change, but how I use the laws of physics can make all the difference.

I took lessons from one of my area's leading concert pianists with the sole intention of improving my technique. He was one of those virtuoso pianists who simply moved properly. He had an ergonomic technique and didn't know how or why he could play with great ease. He called it talent. Students flocked to him hoping to become as good as he but he didn't know how to help his students find their true potential. Many of his lessons were spent with him playing hoping his students would imitate him but, the actual movement of playing is invisible and shared by several muscles many teachers are oblivious to because they don't know they exist. We think it is the fingers that play the piano but, it is first and foremost the arm. The unenlightened teacher focuses on the fingers, which have no muscles BTW.

This teacher has long since died and his daughter has taken over teaching. I had the opportunity to work with one of her students and his technique was dangerously close to crippling him. Sadly, he only wanted a magic lesson so he could play well and didn't want to put in the work of relearning how to move. There was nothing I could do for him. In order to relearn how to play one must abandon all previously learned movements and start over, which many pianists are not willing to do.

This kind of teacher may be fine for the student who just wants a taste of music, learn a little theory or be able to plunk out some notes for themselves but, a teacher's ignorance can stifle a student's progress, enthusiasm and even set them up for eventual injury. Mediocrity is not related to talent, it is a symptom of teachers who don't know about the physics of movement and our skeletal system.

You would not take your car in for an inspection only for the mechanic to tell you your brakes or tires are going bad but you can get a few more months out of them. Well, actually people do. That mechanic is putting your life and everyone you share the road with in danger because you probably won't come back in in a few months. Sure, you are saving a few bucks today but at what cost in the future? If your brakes are bad, get them fixed, don't drive more. Driving more won't fix them. If you technique is bad, get it fixed, don't practice more. Repeating improper movement only hard-wires it into the brain.

A piano teacher who does not understand that a student is using the wrong muscles or how to teach them to use the correct muscles is setting them up for problems or a career of mediocrity. Every technical problem has an ergonomic solution, and it isn't “practice more.” If walking knock-kneed causes knee pain, the solution isn't to walk more, it is to walk correctly. If your pinky and ring finger feel weak and in-coordinate, you don't need to strengthen them, you only need an adjustment to your forearm alignment.

I have had all the wrong teachers and although they made me who I am today, they set me up to be crippled with pain and to struggle with a mediocre technique. It has taken me years to relearn how to move but I am now pain free and syndrome-less because I stopped fighting the laws of physics and started using them. Although I have much more work to do, my technique has improved significantly.

Playing With Fire #8

Look down at your fingers. If you haven't noticed they are all different in length. Many pianists and typists are taught to equalize their fingers by curling them so that all five are touching the keys at the same time. This places your fingers in a constant state of flexation. It is impossible for a musician to relax their fingers if they are holding them in contraction. In addition, you can only move a bone in one direction at a time but we all have several muscles that can pull them in several opposing directions. So if you are trying to move a finger up or in a certain direction but another muscle is pulling the hand in an opposite direction, there is going to be strain or at the very least, in-coordinate movement. This is why some pianists struggle with scales, arpeggios or speed.

It behooves the pianist to play on the edge of the keys for the keys are lightest on the outside edge. If you have ever played on a see saw as a child, you know that regardless of weight, if one kid sits on the outside edge of their seat and the other kid is sitting forward, the kid on the outside will “weigh more.” Just like the see saw, the piano key is a fulcrum. Such as using a board and rock to move another rock, the further out you are on the board, the more power you will have. Your shoulder, elbow, wrist, knuckles and each phalanx of your fingers are all fulcrums.

If you were to place your middle finger on the outside edge of a white key, all your other fingers will be hanging off the keys in the air. This is counter intuitive to most teachers but by using your shoulder and elbow to move in and out to place each finger, it not only reduces how much you need to move a finger but, it gives the finger the power and weight of motion and gravity without having to use the sluggish flexor muscles. Indeed, the piano is forward so the pianist or typist needs to have a constant forward shift momentum to their movement. If they static load, since the body wants to contract, they risk falling off the keys or cramping. When that begins to happen, the pianist contracts even more in an effort to grasp at the keys and this just creates a downward spiral of technical inefficiency and tension.

To equalize the length of all your fingers you need to get in/out motions into your arm. The pianist who does not risks playing on the inside of the key where the keys are heavier, thus is born, the myth that the pianist needs more strength to play or, they might complain that the action of the piano is stiff. The keys feel stiff because the pianist is playing too far in. Again, this is counter intuitive to most teachers but the arm is much faster at placing a finger than a flexor is at playing.

Using the C scale, place your thumb on the outside edge of the C. When you play the index finger, come out from the elbow and play straight down. Because you are coming out, you need to replace it with a forward shift. The arm will come out, up and forward all at the same time. This is where the wrist and forearm work together. It is also what gives many pianists a look of grace. Even though you are coming out, you are also moving in, up and down. When you play the middle finger, you come out even more. When you play the ring finger, you simply shift forward without needing to use the actual flexor. The same thing happens with the pinky. You just shift inward but stay on the outer edge of the key. Be careful you know about forearm alignment first. I'll discus that later. That is another fulcrum.

Every scale has different patterns of in/out. Actually, many scales are easier to play because the black keys are already forward so there is less “out” to employ. However, since the black keys are higher, you need more forward shifting with an “up” in order to come straight down on the key. This too is where pianist create tension grasping for keys. The finger does not strain and stretch to reach keys, the arm places them where they need to be which is directly over the key. Singers are taught to sing higher than their target note so they don't sing flat. Likewise, when you walk up stairs, your ascending foot raises higher than the next step then comes straight down onto it. Notice also that when your leg raises up, the down muscles are actually relaxed and your up muscles are engaged. Then, you don't stomp on the step but rotate to the next leg. This is important for the pianist to know. They can only relax if they play up then let gravity play down. The moment they press down into the key they corrupt the arms ability to go back up. A dual tension occurs and anarchy of technique ensues.

Without up/down and in/out, the musician will risk strain and uneven playing. Up/down and in/out movements give the arm (fingers) a lot of power allowing the pianist/typist to truly relax the fingers/hands/long flexor muscles. Most hand and wrist strain is caused by using more than one muscle at a time to move one bone in two or more directions simultaneously. It is imperative to learn to use one muscle at a time. This can only happen by relaxing the flexors which are the very muscles most pianists are taught to use.

When you walk, you don't flex your toes with each step. The toes just go where the leg places them. Likewise, the fingers go where the arm places them. The fingers don't operate independent to the arm and they surely don't drag the arm behind them. When you are washing a window, writing on a chalk board or waxing your car, the hand goes where the arm places it and the fingers do as they are told, with no effort.

Playing With Fire #7

In Playing With Fire #5 I mentioned that stretching is not all it is cracked up to be. Let me recap this. Many people are taught to warm up by stretching. What is stretching and warming up?

When you stretch a muscle, you create micro tears to the muscle fibers and the body rushes warm blood to the site to begin immobilization and start repairing the damage. This rush of warm blood gives us the illusion of warming up. Body builders like this feeling because as the muscles inflame with tissue repairing blood it makes them feel bigger and their clothes tighter. Actors and models will often do pushups or other exercises before being photographed for it indeed makes them look slightly larger or more muscular.

Your muscles become tendons which are then attached to your bones. When the muscles are cold, they are contracted and tight. If you force your muscles to move when they are contracted, the tendon is caught between the forces of the muscle and bone. Most often, the tendon will strain or tear. Tendons, just like like muscle, contract and expand. Like uncooked spaghetti, bend it and it will break but add a little heat . . .

The greatest danger to any musician or athlete is the high school gym teacher or ignorant music teacher. Indeed, muscles operate at peak efficiency when they are warm, blood is flowing freely and they are expanded. You can't force that by tearing tissue. A better way to warm up is to sit in a warm room.

In the Journal of Strength & Conditioning Research, they found that stretching led to more than an 8% decrease in body strength. Researchers suggest that stretching may change or limit your muscles’ ability to fire efficiently because they are damaged. If you try to lengthen a muscle before giving it the chance to warm up, you can limit its potential to generate strength and power. This not only reduces your performance but it may also increase your risk of injury. https://www.ncbi.nlm.nih.gov/pubmed/22692125

You also can't spot warm up. If you stretch your legs in an attempt to warm up, the blood that you are using quickly circulates to other parts of the body. The only way to safely warm up the whole body is to actually warm up the whole body. You can not force warming up by stretching. Micro tears to the tendons may feel good on first stretch but over time the scar tissue that is placed in those tiny tears will build up to become full blown tendinitis.

In place of stretching, I would suggest gentle movement in your mid range of motion. When you static move to the extreme range of motion where you feel that satisfying stretch, you are creating damage.

Just because your teacher said that stretching is good, that does not mean they are correct. It only means that their teacher was wrong, too. However, if you do have scar tissue on your tendons which will result in inflammation and sharp pain when you move, breaking up the scar tissue is the first step to healing. Instead of stretching and risking augmented damage, get a deep tissue myofascial massage and let the therapist break it up for you without you risking another stretch and further amplification of damage.

Playing With Fire #6

The point of sound can be felt on an acoustic piano. Electronic pianos and organs have them but they are pretty much indiscernible.

Slowly press down on an acoustic piano key without making it sound. At one point you will feel a little bump. If you press beyond that bump, the key will give way and you will be pressing into the keybed. If a pianist wishes to achieve that pearly sound of fast and light notes, they need to learn to play to the point of sound.

As previously mentioned, pressing into the keybed will force a stretch to the long flexor tendon which creates strain. Not to mention, if you are pressing down into the keybed, you can't move your hand or fingers up to the next note because before you can play down you must first play up. Every motion has an equal and opposite motion. This is where some pianists and typists run into trouble because they are trying to maintain a “still and quiet” or relaxed hand. It is in their relaxation they are creating tension because when they use the wrong muscles, they create tension, then they try to relax the very muscles they are using.

When you kick a ball, you first back kick. Swing a bat and you will first back swing. Cast a fishing pole, back cast. Walk forward, press backward. Punch someone, back swing. When you walk forward, as your left leg reaches forward your right hip rotates backward. As your right hip rotates backward, your right shoulder rotates forward. Every motion has equal and opposite motions and your body is designed to work with other parts for balance, relaxation, power and efficiency. When you isolate a part, you will create problems. Pianists and typists are rarely taught this. They think playing comes from the fingers but it shouldn't. It should first originate from the larger muscles of the arm. When the arm does most of the work, it frees the fingers to do some of the more fine tuned movements and, to truly relax. BTW, the fingers don't have muscles. They are moved by the muscles in the forearm. When a pianist or typist tries to originate movement from the fingers, they will strain the tendons.

In order to type or play down on a piano, you must have an up movement to harness the power of gravity. If you play with your fingers pressing down on the keys, you will not have the power, speed and accuracy of the arms. You have probably seen pianists playing with graceful movements. They are not just putting on a show, they are feeling and moderating the weight of their arm. Ideally, most of the up motion should be minimized once it is in the brain. Even playing a simple scale, the arm might change directions via the pronator and supinator muscles up to six times. This is invisible to the eye but must be there in the player's arm. If not, they will static load and create tension, cramps and fatigue.

This law of physics also pertains to other muscles such as your pronator and supinator muscles. If you are rotating your arm to play a downward scale, your must first counter rotate to give the arm both power and to control its direction. Keeping all five fingers together and moving in the same direction will provide great facility. Even the fingers you are not using must go in the same direction and play down at the same time. Some piano teachers call this “tapping.” It is when we stretch our fingers out and pull in opposite directions at the same time we create cramps and fatigue.

Keep in mind that all movement, once learned and ingrained into the muscle memory of your brain, it must be minimized to being invisible. The opposite motions are all there, they just can not be seen anymore, however, the pianist will feel them and it will be a feeling of power and effortlessness because they are not using the wrong muscles to play. Most of us are taught to use the wrong muscles, or, we are not taught anything. It is a dangerous teacher who simply says to practice more, relax or prescribes silly exercises to build unnecessary strength and endurance, both which everyone already has aplenty within their arms. The reason teachers think a student requires strength and endurance is because the incorrect muscles a student may be using are indeed weak and fatigable. Strengthening them reinforces improper movement and sets the stage for the mythical beast called “repetitive strain injury.”

Playing With Fire #5

In Playing With Fire #4 I mentioned dropping the hand or finger into the key. This is called playing with gravity or arm weight. Some pianists may complain that certain pianos have a stiff action or, when they are cold, they have difficulty depressing keys. That is because they are trying to use the flexor muscles or the non-existent finger muscles to play. Your fingers have no muscles. They are moved by the muscles of the forearm.

When a pianist plays with gravity, the keys go down effortlessly because they are not using any muscle to depress the key, they are only using gravity or the weight of the arm. The only muscle engaged is the bicep which raises the hand from the fulcrum of the elbow, then controls the descent.

It is important to note that once your finger depresses a key, after you hit the "point of sound," you unweigh your arm so that you are not pressing down, leaving just enough weight to keep the key down. Another source of the apocryphal "repetitive strain injury" is pressing into keys because pressing stretches the long flexor tendons and stretching can create strain and micro tears. Since tendons do not have an active blood supply to promote healing, the body places scar tissue in the wound but, scar tissue does not stretch and results in larger tears the next time you stretch.

Warming up through stretching is also a myth. What happens when you overstretch your muscles, you tear muscle fibers and the body rushes blood to the site to begin repairing the damage of the stretch. Since blood is warm, it gives the illusion of warming up. A better way to warm up is to sit in a warm room. Also, you can't spot warm up since your blood is always circulating. When muscles and tendons are actually cold, they contract and resist stretching. Stretching cold tendons is always bad because they are contracted, resisting stretching and more apt to tear than stretch.

It is sort of like stretching warm taffy into gooey strands. Try that with frozen taffy and it will break. It is important for a pianist to never play with a cold body unless you have mastered ergonomic playing and the laws of physics.

Playing With Fire #4

Another problem with fabled "repetitive strain injuries" is not only what we are doing wrong but, what we are not doing right. Not only are there movements which hinder playing but there are movements which augment it.

Some pianists develop thumb problems. Often they are taught to cross the thumb under the palm which is bad for many reasons and they are also taught to play the thumb straight down which cripples the effortlessness of the rest of the fingers. The hand requires balance and that can not be achieved if we isolate fingers.

The muscle that plays the thumb straight down is the thumb's abductor. Abductor muscles are rather weak and sluggish and fatigue quickly. The thumb's strongest muscle is its flexor which pulls the thumb under the palm. Your thumbs are designed for gripping and holding. But the keys to the piano are not in the palm, they are under it. Crossing under then down uses two muscles at the same time and creates a dual pull of the thumb's bone. In this vector force tug of war between two muscles, strain can occur and certainly uneven playing. In addition, the thumb's tendon and the forefinger tendon intersect. When you cross the thumb under and flex the forefinger, the two tendons grind together. Friction of a tendon is not good. Eventually the pianist may develop thumb problems. Instead of playing the thumb's abductor straight down, there are other movements which can give it effortlessness and power. I'll cover how to get the thumb over (and not under) for scales and arpeggios later.

The first movement is to simply let gravity play the thumb down. Lift your arm up then let if gently fall to the key and depress it (without pressing into the key bed). As you can feel, gravity, or the weight of the arm is very powerful and effortless. Often pianists complain that the action of some pianos are stiff. They are not. The pianist is just trying to play using the wrong or weakest muscles. While depressing a key using gravity, notice you did not use any muscle of the thumb at all. Another motion is to use your pronator and supinator muscle which are located around your elbow. From your elbow, rotate your hand from the elbow, left and right. Notice how fast and effortless you can move your thumb without using it. Make sure your wrist is straight. Now, from your shoulder and elbow, forward shift into a key with your thumb, like poking someone's eye. Again, you don't use any thumb muscle but only arm muscle. The elbow, or pronator and supinator muscles, is where trills and tremolos come from, not the fingers or hand. The pianist who attempts to play them from the fingers (which have no muscles) or hand will quickly experience fatigue, cramps or pain.

You now have three ways to use the thumb to depress a key without using the thumb's muscles at all. Combine all three then minimize them and you will be on your way to effortless playing. Eight fingers to go.

Playing With Fire #3

Median Nerve Entrapment, or carpal tunnel syndrome, is often the result of an inflamed long flexor tendon. When we move improperly or over stretch, micro tears form on the tendon and since the tendon has no direct blood supply it can't heal very quickly so the body places scar tissue in the tear as a quick fix. Tendons glide and stretch within the tendon sheath but scar tissue does stretch not and more stretching or continued improper movement creates larger tears. Soon, inflammation sets in. Our long flexor tendons run through the carpal tunnel where the median nerve also passes. It is a tight and compact space and when the long flexor tendon becomes inflamed or larger, there is no place for it to expand so it crushes the median nerve giving us symptoms of pain and numbness.

Overuse is not the problem or cause of tendon issues, misuse is. Worse yet is if you combine tmisuse and overuse. When you move properly, there is no overuse. Much like a car in peak condition, you can drive it for thousands of miles with little wear and tear. However, if your frame is bent or there is something out of alignment, wear and tear will happen very quickly. Our bodies are no different. Compare this wear and tear to the tires on your car. If your car is out of alignment and that imbalance is eating away at your tires, you can get new tires but the wear and tear will happen to the new tires, too. The better solution is to fix the alignment of your wheels. Likewise, fix the alignment of your movement. Treat problems, not symptoms.

Often doctors treat the symptom of this pressure to the median nerve with drugs, rest, splints, PT, injections or surgery. Symptoms should not be treated, problems should be and for most people, the problem is they are simply moving improperly. Even after surgery and the symptom is “cured,” the problem of poor ergonomic movement still exists. The doctor only made more room for more future inflammation.

The benefit of learning how to move properly is that not only will the symptoms of pain, fatigue and numbness disappear but, as a musician, your accuracy, speed and power will increase and improve. Also, as you transfer these movements to everyday life, you'll discover ease and effortlessness in other motions of your daily living.

There is one danger though, once you learn to move properly, there is no going back to improper movement. Moving improperly will promote muscle growth of the improper muscles and once you stop using them you will lose them, the incorrect muscles will atrophy. This is often referred to by musicians as being rusty. Proper movement does not need to be practiced once learned, like walking or riding a bike, it is always there. Improper movement requires constant maintenance because it is not natural. This gives rise to the old adage, “Miss a day of practice and you notice. Miss two days and your competition notices. Miss three days and your audience notices.” A proper, ergonomic or virtuoso technique, like walking, is there forever and requires no maintenance.

Should you ever go back to moving improperly, you can seriously injure yourself because the incorrect muscles will have atrophied. Proper movement is all or nothing. I have found that many people either don't have the patience, dedication nor intelligence to re-learn how to move. This is not a criticism, it just is.

Playing With Fire #2

Many pianists and typists move incorrectly and improper movement creates tension and fatigue.  If you've ever gotten cramps or had to shake your hands out or wake up in the morning with stiff fingers, it is most likely because you use the wrong muscles or, are using them improperly.  When you play a finger BONE down onto a key, it must go straight down, following the path of gravity.  Often pianists are employing three of four muscles at the same time and three muscles pulling on one bone in three directions is what causes problems.  It is like if you were driving a car and trying to turn left and I grabbed the steering wheel and tried to pull us right, that is what goes on with our hands and we condition ourselves to accept then multiple muscle pulls as normal.  Really bad teachers will tell the student to practice more or build strength and endurance then prescribe silly exercises when all a long the student only needs to use the correct muscle and stop using the wrong ones.  In the car example, you would not need to work out or practice driving to stop me from trying to run us off the road.  You only need to stop using me as your copilot.

I will elaborate on this much more but for now, know that it is gravity that plays the keys down, all five fingers must move in the same direction at the same time (they are NEVER isolated as many teachers teach – that creates abduction and flexation at the same time), all five fingers play together, it is the arm that places the finger, the flexors are used minimally. This goes against what most of us are taught but, the laws of physics must never be challenged. If we do challenge them, we will lose and our orthopedic surgeons will be eating steak this week.

In summary, tension, pain, cramps, uneven playing, weakness in playing or syndromes are symptoms of using two or more muscles to simultaneously move one bone. Like the game “Tug of War,” one of your tendons will eventually tire and give out.

Anytime a pianist experiences tension, more practice only hard wires improper movement into the brain's muscle memory. It would be best to stop practicing until the movement can be corrected. Also, over time micro tears can form on the long flexor tendons which will result in inflammation. An inflamed long flexor tendon will press on the Median Nerve within the carpal tunnel resulting in pain, fatigue or numbness.

Playing With Fire #1

Playing With Fire #1

There is a myth that repetitive movement creates repetitive strain injuries. That is false.  Improper movement creates strain, fatigue and injury. Over the course of a year I am going to address issues of movement and how it can lead to injury, especially as it pertains to pianists. 

With all five fingers together, wave "bye bye."  Now abduct your fingers (spread them out) and wave "bye bye." Feel the strain? At the very least, you should feel that your fingers don't move as effortlessly as they did when they were moving together in one direction at a time.  This is where computer users, pianists or anyone who uses their hands can go wrong.

When you wave with your fingers together, you are alternating between the flexors and extensors, the muscles in your forearm (your fingers have no muscle) that flex and extend them. Your flexors are designed to move your fingers in one direction and your extensors are designed to move them in the opposite direction.  You can not flex and extend at the same time because you can only move your finger bones in one direction. For instance, you can only steer your car left or right, not in both directions at the same time. 

However, when you use your abductors at the same time you use your flexors, you are pulling the bone in two directions at the same time and that creates a tug of war or strain to the muscles and more directly to the tendons. You are attempting to move them down but left and right, too.

Most people who experience strain, fatigue, cramps or pain are creating this force vector which can build up scar tissue over time resulting in inflammation to the tendons. 

Mouse Traps

Many people don't realize how dangerous the computer mouse can be to their manual health.  Someone was recently complaining about numbness to her hand as she used the mouse and this was essentially my reply.  Proper movement of the larger muscles can promote healing where there is inflammation or scar tissue to the tendons. 

There are many problems which can occur with improper use of the mouse.  First, you are most likely bending or twisting your wrist (ulnar deviation, radial deviation).  Just because you can, doesn't mean it is okay to do.  If you take a live branch and bend it left, then right, then left, etcetera, eventually it will develop cracks and maybe break.  That is what you are doing to the tendons and the tendon sheath in your wrist when you overuse and misuse your wrist in that way.  Go write on a chalk board and notice that your arm places your hand where it needs to be.  You need to move the mouse with the same unified gesture.  It is one movement without isolating the fulcrum of the wrist. The movement comes from the elbow, shoulder and back, and is counter balanced or supported by the stomach.

Second, you may be sitting too high or low.  The wrist not only has to be straight and not move left to right, but, the wrist shouldn't bend up and down, either (dorsiflexion, flexion).  If you sit too high your wrist will have a bend in it.  Sit too low, your wrist will have a bend in it.  Your hand to your elbow should be a straight line, like writing on a chalk board.  Many people will unconsciously try to straighten the wrist by either slouching or raising their shoulders.  This will literally give them a pain in the neck. 

Third, people rest their forearm on the table when they use the mouse.  That can cause a bend in the wrist and it can also add pressure to the carpal tunnel.  If your tendons are already inflamed and pressing on the median nerve, this added pressure or resting weight can further press on the nerve.  The arm should hover and not be lying flat.  You couldn't write on a chalk board if your arm was pressing on the surface.  You've got to find the medium position where you are resting up.  That may be tense for some people but if you are always moving and also resting down, the constant movement creates a sense of rest and ease.  If you sit in just one position, that is called static loading and you can create stress issues from maintaining a single position.  If you were to move your arm rapidly up and down as if you were spanking a baby a dozen times, your arm would fatigue because you are only using two muscles to go up and down.  Also, chances are by the time you start to go down, your up muscles are still being employed and this is called a dual muscular pull.  That is what causes tension.  Try it (not with a baby).   Now "spank the baby" again but this time instead of going up and down,  slowly make a circular motion with your arm.  You shouldn't feel the tension in your forearm at all because you are now using dozens of muscles to go up and down and left and right.  By the time the arm moves up, the down muscles have already relaxed and rested.  If you feel any tension it may be in your upper arm or shoulder.  Those are different issues.  You may also feel tension in your pronator teres muscles so to properly spank your baby, have them stand up so your arm and hand is vertical to the floor.   Dangle your arms to your side.  That is their natural position.  Now raise them up to 90 degrees with the palms facing one another.  You should not feel any tension.  Now pronate them or turn your palms so they face the floor.  Feel the tension?  Now supinate them so that the palms face the ceiling.  Feel the tension? 

Fourth, depressing the button on the mouse isolates the forefinger.  This is very bad and can lead to long flexor tendonitis.  Tendonitis is the inflammation of the tendon and when it inflames (swells up, gets bigger) it will press on the median nerve in the carpal tunnel within the wrist because there is no extra room in the tunnel for expansion.  Your fingers are designed for poking, not lying flat and pressing down.  Go ahead, lay your hand flat on a table and using just your forefinger, press down with all your might.  Feel awful?  Do you feel it radiate into the forearm?  Now lift your arm up and with naturally curved fingers, using the arm and without pressing, gently poke the table.  Effortless? When the phalanx, finger joints, knuckles, wrist and elbow are all aligned properly, they have tremendous and effortless power (not the same as strength).  The best way to to press the button of the mouse is to gently hold it with your thumb and pinky, not squeezing, you are hovering, and you forward shift into the button.  The button is pressed from the elbow and you are NOT ISOLATING A SINGLE FINGER.   As you forward shift, the whole arm, hand, wrist and five fingers are moving forward and you are using a very slight adjustment of the forefinger to press the button.  When you press it the old way, your are isolating the forefinger and since all your tendons are interconnected, you are creating a dual muscular pull, which is bad.   Try it with a doorbell or elevator button.  Isolate a single finger and press the button.  Then with all five fingers together, using your longest finger, press the button from the elbow.  Effortless?    

Teaching yourself to move properly can be awkward in the beginning but once you set up your work station to the proper ergonomic setting for your own body, and then employ the proper movements, you will heal.  My lap top is actually on a small table on a table.  I stand in front of my screen which is slightly higher than my head so that my back and neck are straight and stretched a bit.  My wireless keyboard is at waist level and angled so that my arms can dangle at about 135 degrees.  My wireless mouse is elevated at 90 degrees so my whole arm is free and can move effortlessly.  I can stand at my computer all day because I am in constant motion and there is zero static loading.  I also have a small padded stool in front of me at knee level in case I want to pause, I can lean on the stool with my knees.   There is also a bar stool behind me for moments of pause when I am reading something or don't need to use my arms.  My mouse pad is also on a clipboard which I sometimes pick up and hold to my stomach and I move as if playing a guitar.  It is the constant rotation of movement which prevents stress, fatigue and strain to my muscles and tendons.  I am also barefoot 90% of the time so that prevents ankle and foot fatigue and allows the ankles to do their job of micro adjustments for balance.   I also stand on four of those polyurethane foam bath mats for a nice cushioned and arch supporting feel.

Since some people have thoracic problems from slouching because they look down to their computers, they should take something like a Feldenkrais class to learn how to move the rest of their body properly.   If you stand on a garden hose, the water pressure will diminish.  If someone else stands on it a few feet away, it will diminish even further.  That is what happens to a lot of people.  There is a "kink" to the nerve at the neck and they are kinking the same nerve in their wrist causing a "double crush." 

Not everybody has the mental acuity or patience to heal.  Because of this, healing is easy for some and difficult for most others.  Most likely a doctor won't heal you if you have a problem.  They treat symptoms, not problems and the problem is probably your movement.   Many people will opt for surgery if they have "carpal tunnel syndrome" or, median nerve entrapment.  The surgery just provides more room for the symptom which is inflammation and, does not address the real issue and cause of the inflammation in the first place - which is improper movement.

Drugs, splints, braces, rest and physical therapy only treat the symptom and not the problem.  They can actually cause a further downward spiral of symptoms since they can alleviate pain, which is a symptom.  If you start to feel better because you are treating symptoms or taking anti-inflammatory drugs, you are still moving improperly and you will feel good only until the inflammation gets worse and surpasses the temporary alleviation of the symptom.  Pain is good, it tells us there is a problem.  Fix the problem, not the pain.

Toccata in G Minor

Toccata means "to touch."  Typically it is a fast-moving, lightly fingered or otherwise virtuosic piece of music emphasizing the dexterity of the performer's fingers.   HOWEVER, notice that in this piece (and in all pieces) I am not playing from the fingers but from the elbow and forearm.  Watch my arm and you will see the proper muscles work.  If your hands or wrists hurt, quit playing from those tiny muscles in the hand and use the larger muscles in the forearm which are actually the muscles which move your fingers.  In this piece since it only requires simple forearm rotation, my supinator and pronator muscles do all the work and my fingers effortlessly go along for the ride.   Although, that three manual stretch at the end is incredibly stupid but, I'll learn my lesson when I sprain something.  Stretching is bad.

Sorry about the aspect ratio being askew.  I upgraded some software and all my videos are coming out funny.  I need to take the time to figure out the settings.   For more information on arm, hand and wrist injuries, go here:

http://www.slideshare.net/sa/8652ca32b9f25fa5adb94fe916c18599

Tendonitis, Playing the Piano and Skiing

I recently wrote a blog about the prevention and cure for tendonitis where I opined that working on your piano or typing technique can improve other activities such as skiing.  Someone called me to task on that comment and challenged me to explain.

It is not that piano playing and skiing are that much related as much as the physics behind them is the same.  The concepts in common are gravity, alignment (kinematic chains) and reactions to actions.

One of the most common injuries to a skier is a torn ACL (anterior cruciate ligament).  It happens simply when the femur and tibia are not properly aligned and the torque doesn't go through the bones but is transferred onto the tiny yet powerful ACL.  The ACL is very strong when properly aligned but break that alignment and it is as weak as a piece of paper.

Every movement has equal and opposite movements.  In playing the piano the pianist has to play down and thusly he is required to have an up motion.  The muscles to make the arm go up are much stronger than the arms which make us go down because to fall down, no muscle is required.  The pianist also goes up and down the keyboard so in order to play left he has to go right.  Here is why:

If I were to swing a tennis racquet, I would toss the ball in the air and swing my arm backward, then swing forward to hit the ball.  To swing a baseball bat or golf club, I would do the same.  When I swim, in order to stroke, my arm goes behind me, then up and in front of me, then down and behind me.  If I were to swat a fly I would raise the swatter before descending down to smoosh its target.  If I were to slap your face, I wouldn't start with my palm on your face.  I would swing backward then forward across your cheek (and you'll let me do it seven times seventy times then turn the other cheek).

If I wanted to jump into the air, I would bend my knees and sink a little to the ground then propel myself upward.  If I were standing on a glass floor and wanted to break it.  I would jump up and keep my knees bent until I was close to the glass, then extend my knees and feet into the surface for maximum impact.

I come from the old school of parallel skiing where I keep my legs together and ski with them as one rather than two legs.  When you ski with your legs or feet apart, you have four edges to worry about and control (dual muscular pulls).  Catching an edge on the snow can cause you to lose balance and fall.  When you ski with your legs parallel, you only have two edges acting as one limb.  The skier always keeps the inside leg a little bit shorter by bending it slightly more.  Both legs and feet have to be turning together in the same direction at the same time much like all five fingers of a pianist  SHOULD only go in one direction at a time.  The skier needs to have his torso and head perfectly aligned and balanced in one chain.

The parallel turn is accomplished not just by jumping or grinding your edges into the snow but by un-weighing yourself.  When turning, there is a bend at the hip and the legs are extended to the right.  You can experience this, sort of, if you stand sideways about four feet from a wall, lean toward the wall with your left hand so that you are at an oblique angle.  All your weight should be in your right leg (inside the foot-radial side) and the left leg is parallel.  At tremendous forces the edge is digging into the ice (if you ski in the east) and snow (if you ski out west).

That is kind of what a turn feels like but not as static.  This is also a left turn.  As you turn left by leaning into the inside right ski edge, your body will feel the momentum and you would then slightly tuck both knees up and shift your legs to the other side but when you extend your legs so that your skis go down, you lean into the inside of the left ski edge:  These are equal and opposite motions, with perfect alignment, with both legs going in the same direction at the same time.

This method of un-weighing can look like the skier is jumping in the air but they are actually just extending their legs and shifting weight from right to left.  With balance, momentum, extension and retraction, this keeps him upright and in control.

Also, the skier needs to keep the front of his body always facing down the hill where the fall line is or where gravity is pulling him.  If he deviates from the fall line, there needs to be a lot of adjustments lest he catch an edge resulting in a face plant or yard sale.

It sounds complicated but if you are a parallel skier, it makes total sense.  The skier's whole body can only do one thing at a time, either turn left or right or coast forward.  Many skiers are taught to snowplow which is skiing on the inside edges of both skies at the same time but that isn't skiing.  It is ice making and it puts pressure on the knees and maintains constant flexion of the muscles.  As a novice masters the snowplow they are taught the stem Christie which is one step away from parallel but most skiers don't progress to the next step predominately because the nature of un-weighing the whole body is foreign to many people's concept and it requires a leap of faith.  A shy skier will never move beyond the stem Christie. They lack the confidence that their edge will be there if they un-weigh so they remain advanced beginners or intermediate skiers at best because they don't understand nor trust the concept of a closed-loop kinematic chain. 

Have you ever noticed that after somebody has a heart attack or loses a child or goes through anything really heavy, their outlook can change overnight?  They see life on a more deep level than before.  They tend to think about the bigger things and not care so much about the color their cars are or what clothes are in style.  When your mind and body are at one with the mountain, all the obstacles and gravity melts away.

So, like the pianist whose arm can only go in one direction at a time, the skiers body can only go in one direction at a time.  If his body or legs oppose that, he can still ski, just not well.

For the past twenty years ski makers have been designing parabolic skies which are shaped to promote parallel skiing and it is funny to see people skiing parallel without the un-weighing of their body.  Instead they are rolling the ski from edge to edge.  They still fall because they are trying to control the ground rather than control their body and go with gravity.

When skiing in deep powder or on ice, the skier needs this un-weighing as if they are trying to plunge through a glass floor.  This makes it so that the ski edges can dig in to whatever they are resisting.  Lack of un-weighing is why most skiers cannot ski on ice or in deep powder.  They then complain about the mountain or the conditions. 

A skier who tries to control the ski, control the ground and control gravity, will not be a good skier and can easily hurt themselves.  If they use the ski as an extension of their body and they go with gravity rather than fighting it, they can control everything and it will be effortless because they won't be static and engaging the same muscles all the time.  On the contrary.  Our muscles which aid in us going up are much stronger than our muscles that help us go down (Hamstrings Vs Quads).  Ironically, it is engaging the weaker hamstring which gives the quads a break and allows them to work more efficiently and most importantly - rest.

A pianist who fights with the mechanical nature of a piano will forever be challenged by it and their own bodies and, most likely, injured by it.  The pianist is not the engine to the instrument as much as a conduit to the music that already exists.  Only when the closed-loop kinematic chain of the body is achieved and alignment between body and instrument coalesce into one can a musician become an artist or a skier master the gravity of the mountain.

It is interesting to note that true artists or true prodigies don't know what they are doing.  What they do is simply natural to them.  When they try to explain what they do they get it wrong because they explain how they feel.  Bach, for instance, taught his students to scratch the key in a carrezando technique because what he was feeling when he played was his fingers caressing the keys.  What was really happening was as he was lifting and dropping his arm and moving in and out onto the keys because instinctively, he knew his fingers were different lengths and equalizing them caused micro tension.  The sensation of caressing the keys was a result of his arm moving the fingers.  That is what he felt but caressing the keys was not what he was doing. 

Another thing teachers get wrong is when they tell their students to relax the hand.  They need to relax the correct muscles at the right time.  But that is a topic for another time. 

Original slide on Tendonitis
http://www.slideshare.net/sa/8652ca32b9f25fa5adb94fe916c18599

Healing from Tendonitis

I put together a slide show on healing from tendonitis and carpal tunnel syndrome.  It can be found on SlideShare:
http://www.slideshare.net/sa/8652ca32b9f25fa5adb94fe916c18599

Heal Thyself

I once presented a series of workshops around the northeast called "Playing with Fire."  It was designed with musicians in mind but I have healed many people from various professions.  Not everyone has the capacity to heal themselves and much like Ellen Burstyn's "Edna" character in "Resurrection," I don't offer the workshop anymore.

Tendinitis is a particularly nasty injury because it's mostly caused by inflammation due to improper usage or prolonged use of certain parts of the body. If you ignore it, most likely it will get worse. Left untreated, you will get scar tissue which will cause more pain and discomfort. Tendinitis takes a long time to heal. As the tendons become inflamed, they can press on nerves.  One particular nerve which is susceptible to tendon inflammation is the median nerve in the wrist.  The pain and numbness resulting from that is often called carpal tunnel syndrome.  That problem has been around for centuries and has been called many different things, usually associated with occupations which are repetitive. Pain is the body's way letting you know it needs something or that something worse is about to happen. Never ignore pain.  Continuing to stress it will only cause more damage and more pain. When the pain becomes excruciating and you finally seek medical help there may be more damage than can be corrected.

It is actually quite easy to heal through movement modification because proper movement promotes healing. I had tendonitis and I was in so much pain for a six month period that I couldn't sleep.  I couldn't even pick up a piece of paper.  I drove with my knees.  Monday through Friday I did absolutely nothing (well, I got a great tan) and saved myself up for playing the organ for six Masses on the weekend only to find myself doing hours of contrast baths every Sunday evening to ameliorate the agony from the weekend abuse.  It wasn't until I sought the help of a woman who "healed" me in minutes. At the very least, she had me playing the piano pain-free. After an hour of special exercises, she asked me how my hands felt and for the first time in six months, they felt normal. Of course, it took six months of intensive re-training to actually heal but, I healed.  The really cool effect was that I began experiencing snapping sensations in my forearms as scar tissue was releasing and healing.

Healing does not have to be some elusive elemental thing. Many people think that surgery is a quick and easy solution for median nerve entrapment - provided you don't continue doing the movements which caused the problem in the first place.  Surgery solves the symptom but the underlying problem still exists and the problem is that we are simply moving incorrectly.  Current medical treatment consists of rest, medication, shots, physical therapy or surgery.  The best analogy I can come up with is if you have a nail in your shoe which is causing you pain and bleeding in your foot, you can rest until you heal. But the moment you begin walking again, the nail is still there and the symptoms of pain and bleeding come back.  You can "walk it off," work through it or try to build up muscle but that won't work.  You can take off the shoe and put on a band-aid but, the moment you put the shoe back on the problem will still be there.  You can take medication so that you don't feel the nail and its attendant pain but, the nail is still there.  The only solution is to remove the nail and the foot will heal.

If your car is out of alignment you will eat through your tires.  The worn tires are the symptom of the poor alignment.  You can always put on new tires but those will wear, too.  The solution is to fix the alignment.  Our bodies are fulcrums, levers, pulleys and rubber bands.  They are designed to work at prodigious efficiency.  Can they work inefficiently?  Absolutely.  Poor posture and misalignment has a respectable place in our repertoire of movement.  Misuse isn't the problem, overuse isn't the problem; it is when we combine both misuse with overuse that we cause problems. 

Surgery will open up the carpal tunnel so that our inflamed tendons are no longer be pressing on the median nerve.  The pain and numbness will go away but you still have inflamed tendons.  What happens when they become even more inflamed?  How many surgeries can we have to open up the tunnel more and more?  For someone who depends on fine and efficient movements such as a musician, at what technical cost is there in changing the landscape of this efficient and tightly compact design?  Think of removing the miles of intestine within our gut, then packing it all back in.  Sure, it can be done. Will it be the same?

Anyone who fishes knows that you can't cast a broken fishing pole.  Sure you can tape it together but it won't work as efficiently as an unbroken one.  Musicians all have the capacity to enjoy pain free virtuoso techniques but first we need to undo the motor memory of the very first flawed times we touched our instruments.  Not many of us had the right teacher at our first lesson. Pianistically, this teacher would have been someone who only let us play one key, with  one finger, for several weeks before we were allowed to employ a second finger.

As I said, I was suffering from a bout of long flexor tendinitis as result of overuse and misuse.  It was actually while building a deck in my back yard when I first noticed a twinge of pain.  Eventually, as I played the piano I was occasionally charged with a stabbing pain in my forearm.  It started off intermittently but then became constant with every use of my fingers or hands.  I went to see the doctor and he started me on a course of anti-inflammatory drugs.  They actually helped for a brief period.  The problem with these drugs was that they were taking away the pain or, masking the symptoms but not solving the problem.  The problem was that I was misusing my hands.  Since the drugs relieved the inflammation which was causing the pain, feeling better, I continued to misuse my hands.  This made my tendonitis worse.  Eventually the pain became bilateral and my arms were in pain 24 hours a day.  My doctor sent me to see the physical therapist who prescribed more movement which only made my symptoms worse.  In addition to the constant aching, I was unable to perform the simplest tasks.  I couldn’t pick up a pencil, I couldn’t brush my teeth, I couldn’t comb my hair, holding a fork was painful, flushing the toilet, zipping a zipper, driving, tying my shoes.  Everything caused pain and exasperated my symptoms.

After about a year of therapy, drugs, and rest, I thought my career as a piano player was over.  Movement re-education gave me my life back.  Mind you, I was not cured, rather, I just discontinued misusing my hands, proper movement put everything in natural alighnment and my body healed itself.  Every once in a great, great while I get a twinge of pain when I thoughtlessly revert back to my old way of moving but a quick readjustment of my alignment fixes everything.  I actually found that moving properly not only permitted me to move again, but it made me feel better in everything I did.  It took over a year when I realized that I forgot that I ever had the pain.  Those lessons have since been transposed into every aspect of my moving life.  Everything about me improved.  My music, skiing, hiking, even driving my car.

As I asserted earlier, I do  not heal people anymore but, know that there are alternative and amelioratative ways to mitigate this apparent failure of medical enterprise. Having been there, I am very disappointed that the medical community has not embraced the over 300 year old solution but continues to perpetuate false dogma.  Although, I suspect the blame lies with those of us who want a solution now, at whatever cost - along the path of least resistance.