Do ergonomic keyboards and mice really help to prevent/decrease pain?

Pain and hand problems are caused by moving improperly. Ergonomic equipment, in theory, is designed to force your body into proper positions. They CAN work but it would be better for you to learn how to move ergonomically without the equipment.

The reason is, let’s say you have an improper ulnar deviation when you type (wrist twists to the left on your left and right on your right), you can still execute that improper motion with an ergonomic keyboard and, what good is fixing your typing deviation when you open doors, brush your teeth, write, use your phone or drive your car with the same deviation?

You can’t spot fix ergonomic problems. It is all or nothing. That is why people don’t heal because they try to fix isolated symptoms and not everything that is part of the problem.  You may have pain in your wrist but that is only the location of the symptom.  The problem is most likely how you are using your whole arm.

Often it is not a single movement that is a problem but a cavalcade of movement issues. You may type with flat fingers, curled fingers, too much pressure, equalized fingers, not enough “up,” radial deviation, you may abduct too much, you might isolate a finger, dorsiflexion, have an isolated elbow or shoulder . . . there are a lot of motions we should not do but we do them because many of us are lazy and unaware.

In the old days, manual typewriters forced us to type with the weight of the arm or, gravity.  Today's effortless keyboards have insidiously encouraged us not to use gravity and the fulcrum of the elbow to type and thus, we isolate smaller parts which strain our tendons. There is no such thing as "repetitive stress."  There is only improper movement and if you move improperly, all movement is then "repetitive stress."

Imagine casting a fishing pole with just your fingers, you'd probably hurt yourself.  Now imagine that only with the wrist.  That is better but still not optimal.  Now with your elbow.  Better.  Add the shoulder.  Notice how you are now using all the parts of the arm for one movement.  No single part is isolated but they all share in the casting, including but not exclusively the fingers.  Now as you cast, notice how your feet are planted, how your weight or center of gravity is distributed, your back and abs, notice also the equal and opposite motion required to cast.  In order to cast forward you must first cast backward.  Typing, too.  In order to type down you must first have an up motion.  Without it, you will strain your flexor tendons.  That is also the most dangerous part of using a mouse.  We rest our index finger and long flexor tendon flat on the button and click with no "up" or equal and opposite motion.  There is nothing wrong with the mouse, only how we use it.

The laws of physics must be obeyed. Break them and there is a price to pay.

How long does it take a pianist to retrain muscle memory to play a new motion?

This is a wonderful question. There is no such thing, literally, as muscle memory. Movement is hardwired into the brain, not the muscles.

New muscle memory movement is very easy to wire into the brain and it can be immediate however, the brain never forgets the old patterns so, as a musician, if you get nervous or your body is cold, or you go into autopilot, it is very easy for the old movements to reassert themselves and take over despite new and more efficient neural pathways having been created since. This is especially true for musicians and also, how and what we play is very important.  This is why musicians often claim they can play perfectly in their living room but on stage it all falls apart. What is happening is the old muscle memory takes over because of environmental factors such as the presence of an audience, different bench height, temperature, nerves, etcetera. 

There is another danger here. Many teachers instruct the student to build strength and endurance to overcome technical deficiencies. This works to a certain extent but also puts the musician on the path to injury. If the musician then learns new and proper movements, the improper muscles used previously will immediately atrophy. This is why improperly trained musicians feel rusty or stiff after missing a few days of practice because the wrongly built muscles will get weak, quickly. Proper playing utilizes fulcrums, alignment, gravity, ergonomics and the laws of physics, not muscle. This is counter intuitive to most musicians and to many teachers who are ignorant of anatomy and physics. Mediocrity is the result of using the wrong muscles, not lack of talent. This is because most teachers have no idea what they are doing. They only know what they know but what they don’t know is what creates injury, tension, fatigue and sloppy playing.

A beginning student may learn a piece of music and there may be flaws in his movement. Over time he gets better and learns new songs and rewires some of the improper movements in his brain. He progresses further and his technique improves and his brain learns newer and even more proper movement. THE DANGER is playing old repertoire because even though his technique improves and he now has proper movements, the brain remembers the lesser or improper movements of previous repertoire from a time when he moved less properly. It is important for musicians to either never play old repertoire or, re-learn each piece with the newer, more proper motions.

The greatest danger is, as I previously said, the improper muscles atrophy if not used. If a musician built improper muscles to play a piece well, then as he progresses and loses that muscle because it is no longer needed since he is more ergonomic now, then he plays that old repertoire, the brain expects that the former muscle is there and tries to play the work “normally.” Since the muscle is no longer present, this is when the musician runs the risk of greatly injuring themselves. This is why a well trained musician can one day, out of nowhere, injure themselves.  Most injuries are actually cumulative and it is one of those "muscle memory" moments that serves as the proverbial "straw that breaks the camel's back."

In addition, rewiring your brain on your instrument isn’t sufficient. You must simultaneously do the same with how you ring a doorbell, tie your shoes, brush your teeth, pick up a piece of paper, type, swipe, wipe . . .

There is no such thing as repetitive strain, only improper movement.  If you move improperly, all movement can become repetitive strain and as I said, it is cumulative.  That is why a forty year old might get out of bed with stiffness, aches and pains while a 70 who has moved properly all their lives can rise with elan and alacrity.  You can take that to the movement bank.

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. 

Musicians Warming Up

Every once in a while I come across a piano teacher or musician who think that they need to stretch their hands or run scales to "warm up." The myth behind warming up is that you are able to isolate a body part such as the hands and move them to warm them up.  If that were true, the blood that you think you warm up in your hands while moving them, because of circulation, doesn't stay there.  It circulates throughout the rest of the body meaning "cold" blood is coming back into the hands.  Furthermore, you are not warming up the blood or muscles, the blood is already at its maximum temperature.  The real issue is circulation.

A danger in moving cold hands or other body parts is that the elasticity of the muscles and tendons are compromised because they are in a contracted state and if you try to move cold body parts fast, you can cause damage to the tissue such as micro tears and pulls to either the muscles or the tendons.  Slow movement and in the medium range of motion is always advised when the extremities are cold.

When the body is cold, the blood is kept near the core vital organs and circulation is slowed to the extremities such as the hands and feet. That makes our hands and fingers feel cold and stiff.  Stretching is not a solution and our teachers and coaches have been teaching this mistruth about stretching for years.

When you stretch beyond the mid range of motion you are creating micro tears in the muscle tissue or tendons and the body's response is to rush blood to that site to both immobilize and repair the damage.  This process gives us the sensation of "warming up" when in reality we are damaging our tissue structures. Whenever we move, we must only move as far as the mid range of motion, not the extreme where we will stretch, tear and damage tissue.

There are actually two categories of muscle, fast twitch and slow twitch.  Musicians should take the time to learn which ones are which and how to utilize them in their craft.  Even so, forcing fast twitch muscles to move fast or to stretch them when they are cold and in their contracted state could damage them.  Think of your muscles as being like warm gravy.  The gravy can easily pour out of the bowl when it is warm.  Now put the bowl in the fridge for half an hour and note that it no longer pours fluidly.  You can't just run a spoon through the gravy to warm it up, it needs to come out of the fridge and be warmed totally.
  
If you have a teacher or coach who prescribes stretching and isolation exercises to warm up the body, find another teacher.  It is not their fault that they have been given erroneous information themselves from their own teachers, but, their ignorance on the subject can cause you permanent damage.  Ignorance is not bliss if it results in tendon, nerve or muscular disorders.  That is like going to a mechanic who says that your tires are bald but you can probably get away on them for another few months. He may be the best mechanic in the world but he is risking your life.

If one wishes to truly warm up the body and consequently the hands, one needs to sit in a warm room so that the whole body warms up, not just the part they are going to use.  Another solution is to do some mild whole body movement to get the blood pumping throughout the circulatory system.

There are mini steppers on the market for under $50 that a musician can take to a gig with them and use in the green room before a performance. After doing twenty minutes or about 2,000 steps on one of those, the blood will be circulating efficiently throughout the whole body and one may even break a small sweat.  You won't have to warm up your legs because you've already been walking all day and, movement that is well known such as walking is as simple as the brain turning on and off a switch.  One doesn't need to warm up to remember how to ride a bike.  The brain just knows what to do, like flicking a switch.

Conditioning is important, too.  If you can only do three minutes on the stair stepper before fatigue sets in then you're not going to achieve a full body warm up in that amount of time so, it would behoove you to do this every day so the body is conditioned to work at that level without fatigue.  One doesn't want to go on stage exhausted and weak.  It is also advised to be hydrated before, during and after this simple body warm up procedure.

I'll not endorse any particular brand but you can find mini steppers on Ebay, tax and shipping free. Read the user reviews on Amazon to find a brand you think you can trust.

Playing With Fire Workshop

I recently presented a workshop called "Playing With Fire" which was designed to teach people how to move ergonomically whether they are musicians, computer users or stay at home moms who make arts and crafts with the kids during the day.  There is an epidemic of repetitive strain injuries and the current treatment options presented by the medical community are flawed, destructive and unnecessary.

The first thing everyone needs to know is what causes the most common of repetitive strains: Carpal Tunnel Syndrome.  It's medical name is Median Nerve Entrapment.  If someone misuses their hands to the point that they inflame the long flexor tendons in the forearm and wrist, the inflamed tendons which now takes up more space, has no place to go.  There are bones on one side of the wrist and the traverse carpal ligament on the other.  So when the tendon inflames it presses on the only other tissue in the tunnel - the median nerve.  Much like sitting between two overweight people on an airplane.  The symptoms of a crushed nerve are pain, numbness and tingling.  The reasons for the inflammation are quite easy to understand.  The most common is a break in the wrist while performing repetitive tasks.  The other is dual muscular pulls. Obviously we can only move one body part in one direction at a time but we often move our fingers in two directions at a time.  We may flex one and either abduct or extend another. Even though we can do this, the extender and flexor muscles are still interconnected and we are using both at the same time. This act of tension usually puts all the strain on the tendons. In the piano world, our teachers either tell us to practice more, build up the muscles or relax.  That is all bad advice.  Practicing more bad movement, building up the wrong muscles and relaxing the wrong muscles will only create more problems.

When someone develops symptoms of median nerve entrapment they go to see their doctor who then begins to treat the symptom.  They may ask what you think caused the strain and may suggest that you stop doing it for a while.  This logic is greatly flawed.  If you are moving incorrectly and rest for a while, the inflammation may indeed dissipate however, the erroneous movement is still part of you and when you take up the practice again, the problem will still be there and the symptom will come back.  Symptoms are actually good.  They tell us that something is wrong.  Fix what is wrong, not the symptom.

Other treatment options may include anti inflammatory drugs, cortisone injections (which do a lovely job at dissolving tissue), splints which goes against everything we know about movement or, surgery, which is often totally unnecessary.

The actual solution and "cure" is simply movement re-education.  The patient needs only to learn how to move properly.  This could include not bending or twisting the wrist, not moving the fingers while bending the wrist, learning to not use tiny muscles to do some movements but instead use the larger muscles which are naturally designed to do that movement, learn the proper alignment of the arm and how it is the arm that must support the hand and not the hand moving independent of it, avoiding dual muscular pulls which can be crippling to the hand. 

Not everyone has the capacity, patience, intellect or determination to heal.  We've come to beleive that a doctor can fix our problems and we all want a quick fix.  Who wants to spend months or even years learning to undo bad habits when a doctor can make a slice with a scalpel and like magic, the issue seemingly disappears.  As I said, doctors tend to treat symptoms and not the problems. If the problem is we are moving incorrectly, we shouldn't be seeing a doctor.  My favorite analogy to use is if your wheels are out of alignment and wearing down your tires, you don't just get new tires, you have to fix the alignment.  If your body is out of alignment and wearing down the soft tissue in your wrists, you don't just make room for the inflammation by having surgery, you need to fix the alignment.

Healing from Repetitive Stress Injuries Naturally

Healing from Repetitive Stress Injuries Naturally

The original video was an hour long so I made copious cuts to shorten it.  Unfortunately, the many cuts caused an audio sync issue.  Deal with it.  Close your eyes, don't watch my lips. 

Organ Technique

This is a video of a series of classes I gave on organ technique.

Embrace Failure

It is impossible to argue with someone who knows more than you do.  During the intermission of a show where I was the pianist, a young man came up to me saying that he came to the show just to watch me play.  He went on to disclose that he knew I had healed myself of tendonitis, an affliction which he was currently suffering from and he wanted to see me play for himself and talk to me about how I healed.  The conductor was listening in and immediately chimed in with his opinion on the matter.  He began by saying that he had a doctorate in piano pedagogy and trained with some names of people whom I never heard of.   He opined that our injured inquirer needed to work through his pain, build endurance and do strengthening exercises to overcome his malady.  He couldn't be more wrong and since the injured pianist was giving him ear, I quietly slipped away.

The truth is that it doesn't take very much strength nor endurance to play the piano.  The fallacy here is that a lot of pianist feel that the keys are heavy and they need more muscle to dig into the keys.  Everything we need we are born with and our everyday movement is enough to equip us with all the muscle we actually need.  To play properly it is more a matter of what not to do.  For instance, it doesn't require strength to depress a key, only a small amount of arm weight.  When a pianist feels they need to play harder to get the keys down, that is actually a symptom of a dual muscular pull - they are using two diverse muscles to make the hand or fingers to go in two directions at the same time which makes them feel weak.  The muscles are fighting one another to move the bones.  A dual muscular pull will cause tension, pain and fatigue which is not an issue of endurance or strength but, poor technique and lack of knowledge.

Go to a piano and press down a key, notice that it doesn't take very much strength to make the key go down, nor a lot of weight.  Notice also that after you reach the point of sound, when the note plays, the key rests on the key bed. A mistake a lot of pianists make is to play into that key bed.  No matter how hard they play, once the key reaches that key bed, no amount of pressure is going to make more sound nor make playing easier.  The sound has already been made.  Go ahead and play a note, then press into the key bed as hard as you can.  You will probably feel fatigue and pain.  The solution to the fatigue and pain you are now feeling is to allow only enough weight to play the key to it's point of sound, then no more.  Many educated pianists will say that it is impossible to play to the point of sound but that is because they can't do it.  In that case, they are correct.  It can't be done, by them.

Every motion requires an equal and opposite motion.  As you sit at a keyboard, rest your hands on the keys.  If your arms are totally relaxed, your hands should fall off the keys and dangle to your side.  The body wasn't designed to sit in that static position but it can overcome it by forward shifting, shaping and playing with rounded motions which are all equal and opposite to playing down.  Many pianists attack the instrument with brute force because they don't know what effortless playing feels like, so instead they force themselves to feel effortless with strength and endurance.  What they are really doing is training the body to accept fatigue and as my doctorate friend said, build strength and endurance to fight through it.  Fighting tension with tension is a no win situation.  If you play using natural arm weight, you won't be using muscles to the point of fatigue by pressing into the key bed in the first place.

Let's look at body building.  Many people who go to gyms and work out on machines which are only isolating certain muscles.  Stand barefoot on one leg  (if you can) and look down at your ankle.  You should see dozens of tendons and muscles come into play in an effort to maintain balance.  Chances are that you've never isolated and trained each of those individual muscles but, your everyday normal motion is enough exercise and maintain those muscles.  Normal and beneficial activity incorporates many muscles at once.  To exercise your ankles or legs on a machine, the machine will exercise one specific muscle and both legs at the same time because that is how these machines are designed.  Exercising each body part separately but whole would be better.

If someone were to bench press with a single bar with weights on both sides, both arms will assist in the balance and pressing of the bar.  If that person were to use two separate dumbbells, each arm will have to engage all the ancillary muscles to adjust and maintain balance, just like your ankle did.  Going to gyms and working on those machines can be a waste of time.  It would be better to work with free weights.  Free weights are also more demanding of the core so it is like exercising more body parts at one time.  You can't get that whole body workout on a machine designed to isolate a muscle.

Strength and endurance have little functional value in playing the piano just as weight lifting doesn't in our everyday lives.  If I can bench 350 pounds but work at a desk five days a week, all that training is of no value to real life.  The performance demands in our every day life consists mainly of manipulating our own body around desks and computers and pushing pencils.   When is the last time you exerted yourself while writing a memo or reading a report? 

Okay, working out  makes you look good.  That's another issue best discussed with your mental health provider. 

Working out makes you feel good.  Actually, getting adequate sleep, eating a proper diet and drinking plenty of water makes you feel good.  I've worked out before and to be honest, I did not feel good the next day. 

There are two kinds of pain; there is the kind with lactic acid build up where swelling occurs when muscles tissue is torn and the body rushes oxygenated blood to the site in order to repair it (good) and pain from strain and stress on bone, ligaments and tendons (bad).  Pressing into a key bed strains the bone, ligaments and tendons. 

Ligaments hold our bones together.  If you bend a bone or hyper-extend a joint beyond what is normal, you can tear or stretch a ligament.  This is bad since they don't grow back.  This happens often to football players, basketball players and skiers because their foot and knee alignment don't line up.  One goes one way, the other goes another and the ligament in between bears the brunt of the misaligned torque.  A third degree tear of a ligament can only be repaired with surgery.  A first and second degree tear can either be tolerated or it may "scar down" but you will lose flexibility.  For a professional athlete it might be better to have a third degree tear so that a surgeon can graft a new one in its place.  That happened to me and my repaired knee is now stronger than my good knee. 

Tendons move our bones around.  When you stress a joint to the point of stretching or tearing a tendon, this too is bad since they can take years to heal.  Tendons do not have strong blood supplies going to them so they scar before they heal.  A pianist with scarred tendons will feel sharp pain as they move.  That is the scar tissue tearing.  The good news is that this can easily be healed with massage therapy and proper technique.  Proper movement promotes healing.

If you tear muscle, muscle tissue can heal overnight or in a few days as muscles have an ample supply of oxygenated blood flowing to them. 

People think the more they work out the more endurance they are building.  Actually that isn't true.  They are actually improving their economy of motion.  Movement doesn't become easier because of endurance, the body is just becoming more efficient at that particular movement.  Your body is requiring less strength and oxygen than you did prior. 

Have you ever watched "Dancing With The Stars" and witness professional athletes and body builders who have no endurance?  They not only come off the dance floor exhausted but all that muscle robs them of flexibility and true endurance as the muscle mass is starved for oxygenated blood.  The body has to move all that weight and the large muscles get in the way of joint flexibility.  I've even witnessed long distance runners get winded riding a bike.  Why is that?  They trained and isolated specific muscles rather than full body training.   The muscles used to run are different than those used to ride a bike.  That is why ballet dancers can do most everything with ease.  Some astute football coaches even encourage their players to take ballet.  People who have trained in a certain way generally have equal and opposite weaknesses equivalent to their strengths.  Pianists are no expectation.  Train for strength and you will be weak.  Train to the laws of physics and you will play effortless - which is not the same as "strong."

Sharp pain and fatigue are not good symptoms to have.  They indicate that you are doing something wrong.  Any time you feel those two symptoms you should stop and not continue until you figure out what is wrong with the movement.  Otherwise permanent damage may occur.  If your car is giving you problems, continuing to drive won't make the problem go away, the problem will only get worse and become more expensive to repair.  Remember the old adage that an ounce of prevention is worth a pound of cure.  Live it or pay later.

What about people who exercise for weight management?  The simple truth is, in order to lose weight (or burn fat - which is not the same thing since exercising to build muscle can put on weight in numbers even if you lose fat.  A mirror is a better judge than the scale), you need to burn off more calories than you consume.  If you eat more calories than you burn off, no matter how much you exercise, you won't lose anything. 

The good news is that muscle by its mere existence burns fat without you having to do anything.  One pound of fat can fuel the body for up to 10 hours of continuous activity.  But most people can't and shouldn't go 10 hours without eating.  Beside the amount you eat, what you eat is very important.  Complex carbs, protein, vegetables and lots of water will build muscle and burn calories.  Sugar and simple carbs that turn to sugar will not burn fat.  You're burning the sugar and storing the leftover as fat. 

I'm not a doctor but I have been injured.  I've also been lucky to know people without PhD's who taught me to heal myself.  Some of them didn't even have high school diplomas and they could do what no doctor could.  Because of them, getting injured was the best thing to ever happen to me.  If you are lucky, you'll never get injured but, getting injured might save you from technical and professional mediocrity if you have the capacity to heal.  Consider Gandhi, failing the bar exam saved him from a life of professional oblivion.  Failing isn't so bad, it is what you do with it that makes all the difference.

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.

Heal Thyself; An Ounce of Prevention

ARRGH.  I recently went hiking with a couple of friends and one of the hikers is a high school gym teacher.  I hiked in silent horror as he offered endless advice to his teenage son, daughter and the rest of us  about technical issues and body mechanics.  This man has a Masters in PE and is professionally teaching kids - to harm their bodies. 

The first bit of bad advice he gave was regarding warm ups.  He led our group in unsolicited stretching exercises.   I stood by and watched.  He admonished me to participate saying that if I don't warm up, I will injure myself.  This is true.  However, after getting out of my toasty bed that morning, I sat in my sauna for forty five minutes, took a hot shower, ate a hot breakfast and drove to the mountain base with my car's heat on full blast.  My entire body was warm to the core and raring to go.  But I waited patiently. 

When you stretch muscles, you are tearing tissue so the body has two defensive actions.  The first is to rush blood to the area of damage to begin repair.   This sudden rush of blood gives a feeling of warmth.  You are not really "warming up" the existing tissue (nor the whole body).  You are actually destabilizing isolated parts with micro tears which CAN lead to injury.   It is better to warm the entire body with heat rather than isolating body parts and foolishly think you are warming up by tearing muscle tissue.  The second defensive action of the body is inflammation which leads to the next bit of bad advice.

While hiking, his son sprained his ankle - despite being "warmed up."  Dad, without looking at it immediately told him to "walk it off."  Provided there were no broken bones or torn tendons, walking it off does have some merit. 

If you overuse or injure a body part such as a tendon, the body's response is to do a quick fix by putting scar tissue there.  This however, could lock or freeze up parts which were designed to move.  In the old days doctors would put your body part in a cast, splint or brace.  When the immobilization device was finally removed, the body would be stiff and it would take weeks, months or even years to get full mobility back - if.  Many doctors today favor using simple tape on the injured limb so that the body can still move in its mid range of motion and not to the extreme range of motion where further damage can occur.  A stretch for instance is an extreme range of motion. 

Maintaining gentle mid range movement keeps tendon sheaths lubricated with synovium fluid, prevents scar tissue from forming and tethering a tendon to its sheath and, promotes circulation so that blood can carry away toxins and damaged tissue which are created by our injury or stretch.   Most people can recognize this simple fact after sitting in a car for a long time or resting in the middle of some physical activity.   When they get back up, their body is stiff.  Our circulatory systems are designed to circulate.  Why do you think a "deer longs for flowing streams?"  Flowing water is fresh.  Stagnant water is, well, stagnant.   So, walking it off is good provided there is no serious damage.

Both a friend of mine and myself fell around the same time and both of us injured our right wrists.  Both of us had swelling and bruising.  He wore a brace and I decided to take advantage of the wonderful pain to work on proper body mechanics.  Although my wrist hurt and was tender to the touch, I was still able to play the piano without pain and playing actually made my wrist feel better because I was able to use it and not aggravate it.  Here is a link to a video of me playing a recital just two weeks later.

Flight of the Bumblebee
http://youtu.be/A1FHmgkwi2U 

I admit there were a few problems in my performance but the reason I was still able to play was that I wasn't using my wrist but moving my fingers by using my long flexors and employing the rotation of my forearm.  I am pretty much pain free right now but I still can't dorsiflex but, why would I want to do that to my carpal tunnel?  My friend is still wearing a brace today and has limited mobility and great stiffness.   The difference between us is that I used my body mechanics to promote healing and he is using the stagnation/immobilization method to heal.  I offered some advice but some people won't listen.  He's gobbling down ibuprofen and wearing a brace. 

Back to the hike.  When we returned to the parking lot, our teenager took off his shoe and sock to reveal a purple and swollen ankle: a gorgeous example of nature's cast.   Dad told him that when they got home he could ice it and elevate it.  That's fair.  Treating symptoms can make you feel better but doesn't fix problems.  If your car's tires have uneven wear, getting new tires will treat the symptom but not the problem of the car's alignment.   The first thing this boy needed was an x-ray to ensure there was nothing broken or fractured.   I suggested that the boy put both his feet in a contrast bath and Dad, who has a Masters in PE asked, "What's that?"

If my kid's teacher or coach ever suggested stretching and warm ups in this manner, I'd find a new coach.  Sure I could try to educate them but some egos are too big to admit they are wrong or to change.  That is the beauty of making mistakes but only a few of us can learn from them.  Touch a hot stove and you may never do that again.  Get caught stealing and maybe the shame will make you never do it again.  Sprain your wrist and maybe you will analyze what hurts and what doesn't and you will discover your body's optimal alignment and be better at everything you do - or you can wear a brace and heal in time.

We've all heard the stories of a seeker who ascends a mountain to get an answer from a Zen Master at the top.  When the seeker arrives at the top, finds the Zen Master and asks his question, the Master doesn't answer.  That is because if you don't discover the answer on the journey, you won't understand the answer if it is given to you.  The answer is:  Don't seek the truth - just drop your opinions and the answer will come to you.  A friend of mine is a great songwriter but he is not a musician.  The reason he can come up with beautiful melodies is that his mind is not cluttered with theory, style, propriety or technique. 

Ultimately the newly minted resilience of youth is powerful.  Kids will heal and come back.  But when they turn fifty, and their joints begin to stiffen and become sore, they move and exercise less, they begin to put on weight which stresses the joints further, they develop arthritis and tendonitis, diabetes, clogged arteries and shortness of breath - know that it all started thirty years ago with a stretch and a warm up.  

"When the task is done beforehand, then everything else is easy."
-Zen master Yuan-tong.

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
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