[1.III.10] Cold Hands, Slippery (Dry/Sweaty) Fingers, Illness, Hand Injury (Carpal Tunnel), Ear Damage (Tinnitus)
Cold, stiff, hands, on a cold day, is a common affliction caused mainly by the body's natural reaction to cold. A few people suffer from pathological problems that may need medical attention. But the majority of cases are natural body reactions to hypothermia. In that case, the body withdraws blood, mostly from the extremities, towards the center of the body in order to conserve heat. The fingers are most susceptible to this cooling, followed by the hands and feet.
For such cases, the solution is, in principle, simple. You just need to raise the body temperature. In practice, it is often not that easy. In a cold room, even raising the body temperature so high (with extra clothing) that you feel too warm does not always eliminate the problem. Clearly, any method of conserving heat should help. Of course, it is best if you can raise the room temperature. If not, common aids are: (1) soaking the hands/arms in warm water, (2) use of a room heater, such as a portable radiant heater (about 1KW) that you can aim directly at the body, (3) thick socks, sweaters, or thermal underwear, and (4) gloves without fingers (so you can play the piano with the gloves on). If you just want to keep the hands warm before playing, mittens are better than gloves. Hair dryers do not have sufficient power, are not designed to be used for more than about 10 minutes without overheating dangerously, and are too noisy for creating warm air around a pianist.
It is not clear whether it is better to stay warm all the time or just when practicing piano. If you keep warm all the time (such as by wearing thermal clothing), the body may not detect hypothermia and therefore will maintain the desired blood flow. On the other hand, the body may become more sensitive to cold and eventually develop cold hands even when the body is warm, if the room is cold. For example, if you wear the gloves without fingers all the time, the hands may become accustomed to this warmth and feel very cold when you take them off. And the warming effect of these gloves may wear off once the hands get accustomed to them. Therefore, it is best to wear them only when practicing or just before practicing. The counter argument is that wearing them all the time will allow you to play piano at any time, without warm-ups or having to soak the hands in warm water. Clearly, this is a complex problem and just wearing gloves usually does not solve the problem and can make it worse.
The playing muscles are in the arms, so if you want to warm up the piano muscles, it is more important to warm the forearms/elbows than the fingers. In fact, every muscle from the forearms all the way to the center of the body is involved in piano play. Therefore, if you are using warm water to heat the hands before a performance, try to soak the forearms, especially the upper half (near the elbows) where the flexor and extensor muscles are concentrated. If this is not possible, then you have to soak the hands long enough so that the warm blood can flow from the hands into the arms. The interossi and lumbricals are in the hand, so these need to be warmed also.
Cold fingers of this type are clearly the body's reaction to cool temperature. The best solution might be to soak the hands several times a day in very cold water to acclimate them to cold temperatures. Then they may not react to cold at all. This might provide a permanent solution. For example, you might cool them this way right after practice so that it does not interfere with the practice. The objective of the cooling is to get the skin acclimated to cold temperatures. Dip in cold water for no more than 5 to 10 seconds; do not cool the entire hand down to the bone. In fact what you might do is to first warm the hands in warm water, and then cool just the skin in ice cold water. Such a treatment should feel good, without any cold shock or pain. This is exactly the principle behind the Nordic practice of jumping into an opening in a frozen lake after a hot sauna. This seemingly masochistic practice is actually completely painless and has beneficial consequences, such as acclimating the skin to cold temperatures and stopping perspiration that would otherwise cause the clothes to become soggy and freeze up in the extreme cold. In fact, without jumping into cold water, a person with clothes wet from perspiration after a sauna could freeze to death! The pores in the skin can be closed by dipping the hands into cold water after warming, thus preventing perspiration and retaining heat in the hands.
Slippery (Dry/Sweaty) Fingers
When the fingers are overly dry or wet, they may become slippery. Too much washing using strong detergents can cause the hands to become dry. Application of most quality moisturizing lotions such as Eucerin will solve this problem. In order to avoid smearing the piano keys with excess lotion, apply in small amounts and wait until the lotion is completely absorbed into the skin before applying more. Several small applications will last longer than a single large amount. Wipe off any excess before playing the piano. People who tend to perspire while playing must also be careful about slippery fingers. If you initially apply a lotion because the hands were dry, but you begin to perspire while playing, you can get into terrible problems with slipperiness if the fingers have excess lotion. Therefore, if you tend to perspire, be careful about using any kind of lotion. Even without any lotion, wet or dry fingers can be slippery. In that case, practice using thrust and pull motions so that you can control the finger positions more accurately. These motions require some slippage of the fingers over the keys and are therefore more compatible with slippery fingers.
Some people might think that a harmless illness, such as a cold, might still allow them to practice piano. After all, there is nothing to do while resting with a cold and piano is not considered strenuous work. That is a bad idea. It is particularly important for parents to understand that playing the piano involves significant exertion, especially of the brain, and not treat piano as a relaxing pastime when illness strikes. Thus youngsters with even mild colds should not be made to practice piano, unless the child is willing to do so on her/is own. There is much more brain activity during piano play than most people realize. Infections do not affect the whole body equally; they usually settle opportunistically in stressed organs. If the person is running a fever and then plays the piano, there will be some risk of brain damage. Fortunately, most people lose the urge to practice the piano even when only mildly sick, and this is a clear signal that you should not practice.
Whether one can play piano when sick is an individual matter. To play or not is quite clear to the pianist; most people will feel the stress of piano playing even before the symptoms of the illness become clear. Thus it is probably safe to leave the decision to practice or not, to the pianist. It is useful to know that, if you feel sudden fatigue or other symptoms that make it difficult to play, it might be an indication that you are coming down with some illness. The problem with not playing during an illness is that if the illness lasts for more than a week, then the hands will lose a considerable amount of conditioning. Exercises that do not strain the brain, such as scales, arpeggios, and Hanon, might be appropriate in such a situation.
Learning the health consequences of piano practice is important because any activity can be conducted in a healthy or unhealthy way. Stress-free, psychologically sound approach to piano practice can enhance a person’s health whereas practicing without concern for well-being can be unhealthy. It is important to learn proper breathing so as to avoid apoxia. Frustrations resulting from an inability to memorize or acquire certain skills must be prevented by learning efficient practice methods. This book discusses methods for avoiding fatigue. Hand injuries are avoidable. Excessive nervousness is bad for health, not only the performance. We must think through, or learn from experience, the correct relationships among students, teachers, parents and the audience. Therefore, by paying attention to health concerns, piano practice can be made into a beneficial activity just as effective as proper diet and exercise.
Hand Injuries (Carpal Tunnel, etc.)
Hand injury is generally not a major issue for students up to about the intermediate level. For advanced pianists, it is a major issue because the human hand was not made to withstand such extreme use. Injury problems with professional pianists are similar to those of professionals in sports, such as tennis, golf, or football. Therefore, the limitations from possible injury may be the second most important limitation after availability of time to practice. It might appear that, because relaxation is an essential component of piano technique, injury should not occur. Unfortunately, the physical requirements of playing at advanced levels are such that (as in sports) injury is likely to occur in spite of well known precautions and other measures that professionals take. Injury tends to occur while practicing to acquire difficult technique. Students who use the methods of this book must be particularly aware of the possibility of injury because they will quickly start practicing material that require high technical skills. Thus is it important to know the common types of injuries and how to avoid them.
Every injury has a cause. Although there are numerous documented accounts of injury and success/failure of cures, definitive information on causes and cures has been elusive. The only general cures mentioned are rest and a gradual return to playing using stress-free methods. I injured the flexor tendons in my left palm by using golf clubs with worn, hard grips although I always wore golf gloves. My hand doctor immediately diagnosed the cause of my pain (a notch in my tendon), but could not tell me how I injured my hand, so he could not really tell me how to cure it. I figured out later that the pressure of the golf grip had created notches in my tendons, and these notches moved up and down in my hand during piano playing; the resulting friction caused inflammation and pain after long piano practice sessions. The doctor showed me how to feel these notches by pressing on the tendon and moving my finger. Now I replace the grips on my clubs frequently and have added pads in my golf glove (cut out from Dr. Scholl's self-stick foot-pads), and my pain problem has been eliminated. However, years of gripping the club too hard (I knew nothing about relaxation in those days) has done permanent damage to my hands so that my fingers are not as independent as I should like them to be.
You can accidentally sprain certain muscles or tendons, especially in the shoulders and back. These are generally caused by poor alignment of the hands or body, and non-balanced playing. The best approach here is caution -- pianists must be extra cautious and avoid such injuries because they can take years to heal. Stop practicing if you feel any pain. A few days of rest will not harm your technique and may prevent serious injury. Of course, it is best to see a doctor; however, most hand doctors are not familiar with piano injuries.
Fingertips can be injured by playing too hard (loud). This condition can be temporarily alleviated by proper bandaging. The curled finger position can cause bruising of the fingertips because there is minimum padding between the bone and skin at the tip. In the curled position, you can also peel the flesh off from under the fingernail if the fingernail is cut too short. Avoid both of these types of injury by using the flat finger position (section III.4.2).
Most hand injury is of the repetitive stress injury (RSI) type. Carpal Tunnel Syndrome (CTS) and tendonitis are common ailments. Anecdotal accounts suggest that surgery usually does not solve the CTS problem and can do more harm than good. In addition, surgery is irreversible. Fortunately, massage therapists have recently solved the problem of curing CTS. Why massage therapists? Because both pianists and massage therapists use the fingers as their main tools of their professions. Therefore, they both suffer from the same injuries. However, massage therapists are in a better position to experiment and find cures while pianists are not medically trained and have no idea how to even diagnose their ailments. It turns out, fortunately, that pain is felt long before irreversible damage occurs so that the syndrome can be cured if treated as soon as you feel pain. Although pain is usually felt near the wrists, the cause of the pain is not at the wrists but mainly in the arms and neck where large muscles and tendons can exert harmful forces on the tendons running through the transverse ring of tendons at the wrist that bundle all the tendons running to the fingers. This is why treating the wrist does not cure the pain and wrist surgery only aggravates the problem. The group with the most advanced methods for CTS is the SET (Structural Energetic Therapy) massage specialists; they start with cranial and then progress to deep tissue treatments of the relevant areas of the head, arms, and body. Cranial is necessary because it gives the quickest relief and the tissue work alone does not cure the problem. Until you receive treatment, it is hard to believe that the bones of the skull are related to CTS. See the SET site for more details. Although this site is for massage therapists, you can learn what is involved in treating CTS, to what extent it is curable, and how to find the appropriate therapist. There are still few therapists trained in this art, but at the very least, you can contact the experts and discuss your problem. There is a simple test for advanced cases of CTS. Stand in front of a mirror and dangle the arms straight down, completely relaxed, and in their "normal" positions. If the thumbs are closest to the mirror, you are OK. If more knuckles are visible (arms turned inwards), you have more advanced cases of CTS. Also, the body stance should be straight. Practically no one has a perfectly straight stance, and it may also be necessary to straighten any inappropriate stance in order to treat the CTS completely. Athletes such as golfers and tennis players are an exception because their non-symmetric playing motions will create asymmetric changes in bone density and structure. Right handed golfers will have higher bone densities in their right hips.
Stress reduction methods of piano practice, such as Taubman, Alexander, and Feldenkrais, can be effective both for preventing injury, and for recovering from injury. In general, it is best to keep the playing finger (except the thumb) in line with the forearm as much as possible in order to avoid RSI. Of course, the best preventive measure is not to over-practice with stress. The HS method is especially beneficial because stress is minimized and each hand gets to rest before damage can occur. The "no pain, no gain" approach is extremely harmful. Piano playing can require tremendous exertion and energy, but it must never be painful. See the Reference section for some informative web sites on hand injury for pianists.
Ear Damage (Tinnitus, etc.)
Ear damage generally occurs as a function of age; hearing loss can start as early as age 40 and by age 70, most people have lost some hearing. Hearing loss can occur from over-exposure to loud sounds and can also be caused by infections and other pathological causes. The person may lose hearing in the low frequency or high frequency range. This is often accompanied by tinnitus (ringing sound in the ear). Those who lose hearing in the low frequency range tend to hear a low, roaring or throbbing tinnitus, and those who lose hearing in the high frequency range tend to hear a high pitched whine. Tinnitus may be caused by uncontrollable firing of the hearing nerves in the damaged section of the ear; however, there may be many other causes. See the Reference section for information on the internet on hearing damage.
Although severe hearing loss is easily diagnosed by an audiologist, its cause and damage prevention are not well understood. Mild hearing loss is difficult to diagnose even for audiologists because the human brain tries to compensate for such losses by increasing the internal sound amplification mechanisms. For example, those with mild hearing loss have difficulty understanding conversations, but are extremely sensitive to loud sounds -- even moderately loud sounds that do not bother normal people can be painfully loud -- simple audiology tests would show that these people have sensitive hearing. There is no method to diagnose tinnitus except from the comments of the patient. For tests and treatments you need to see an ENT specialist (Ear Nose Throat). For non-pathological cases, damage is generally caused by exposure to loud sounds. Yet some people exposed to very loud sounds, such as pianists who play every day for hours on concert grands, piano tuners who routinely use "pounding" during tuning, or members of rock bands, may not suffer hearing loss. On the other hand, some, who are exposed to less sound, can lose their hearing, especially with age. Therefore, there is a wide difference in susceptibility to hearing loss. However, there certainly is a tendency for those exposed to louder sounds to suffer more hearing loss. It is quite likely that hearing loss by pianists and piano tuners (as well as rock band members, etc., and people who routinely listen to very loud music) is much more widespread than is generally known because most of them go unreported.
Tinnitus is present in essentially 100% of people 100% of the time, but is so soft in normal people that it cannot be heard unless the person is in a soundproofed room. It may be caused by spontaneous firing of the hearing nerves in the absence of sufficient stimulus. That is, the human hearing mechanism automatically "turns up the amplification" when there is no sound. Totally damaged regions produce no sound because the damage is so severe that they cannot function. Partially damaged regions apparently produce tinnitus because they are sufficiently damaged to detect almost no ambient sound; this silence causes the brain to turn up the amplification and fire the detectors, or the system develops a leak in the sound signal circuit. These detectors are either piezo-electric material at the base of hairs inside the cochlea, or ion channels opened and closed by molecules attached to the hairs -- there is conflicting literature on this topic. Of course, there are many other causes of tinnitus, and some may even originate in the brain. Tinnitus is almost always an indication of the onset of hearing loss.
For those who do not have audible tinnitus, there is probably no need to avoid loud music, within reasonable limits. Thus practicing the piano at any loudness should be harmless up to about age 25. Those who already have tinnitus should avoid exposure to loud piano. However, tinnitus usually "sneaks up" on you, so that the onset of tinnitus often goes unnoticed until it is too late. Therefore, everybody should receive tinnitus education and wear ear protection after age 40 during piano practice. Ear protection is an abhorrent idea to most pianists but when you consider the consequences (see below), it is definitely worthwhile. Before wearing protection, do everything possible to reduce sound intensity, such as soundproofing the room (adding carpets to hard floors, etc.), closing the lids of grands, and generally practicing softly (even loud passages -- which is a good idea even without possibility of ear damage).
Ear protectors are readily available from hardware stores because many workers using construction or yard equipment need such protection. For pianists, an inexpensive unit will suffice because you need to hear some music. You can also use most of the larger headphones associated with audio systems. Commercial protectors completely surround the ear and provide a better sound barrier. Since protectors available today are not designed for pianists, they don’t have a flat frequency response; that is, the sound of the piano is altered. However, the human ear is very good at adapting to different types of sound and you can get used to the new sound very quickly. The piano sound will also be quite different when you take the protection off (as you will need to do once in a while to see what the REAL sound is like). These different sounds can be quite educational for teaching us how much the brain influences what sounds you hear or don’t hear and how different persons will interpret the same sounds. It is worthwhile to try ear protection just to experience these different sounds. For example, you will realize that the piano makes many strange sounds you never heard before! The differences in sound are so startling and complex that they cannot be expressed in words. For lower quality pianos, ear protection will result in sound simulating a higher quality instrument because the undesirable high harmonics and extraneous sounds are filtered out.
The brain automatically processes any incoming data, whether you want it to or not. This is, of course, part of what music is -- it is the brain’s interpretation of incoming sounds, and most of our reaction to music is automatic. Thus when you wear ear protection, much of this stimulus disappears, and a large amount of the brain’s processing power is freed to do other jobs. In particular, you now have more resources to apply to your HS practice. After all, that is why you practice HS, and not HT -- so that you can concentrate more energy on the difficult task of playing with one hand. Thus you may find that progress is faster HS when wearing ear protection! This is the same principle behind why many pianists close their eyes when they want to play something with high emotional content -- they need all the resources available to produce the high level of emotion. With eyes closed, you eliminate a tremendous amount of information coming into the brain because vision is a two-dimensional, multi-color, moving source of high bandwidth information that must be immediately and automatically interpreted in many complex ways. Therefore, although most audiences admire that a pianist can play with the eyes closed, it is actually easier. Thus, in the near future, most piano students will probably wear ear protection, just as many athletes and construction workers use helmets today. It doesn’t make any sense for any of us to spend the last 10, 30, or more years of our lives, without hearing.
How does piano sound damage the ear? Clearly, loud sound containing many notes should be most damaging. Thus it is probably not an accident that Beethoven became prematurely deaf. This also cautions us to practice his music with ear damage in mind. The specific type of piano is also important. Most uprights that do not produce sufficient sound are probably least damaging. Large grands that transfer energy efficiently into the strings with long sustain probably do not cause as much damage as medium quality pianos in which a large amount of energy is imparted into the initial, instantaneous bang associated with the hammer striking the strings. Although much of this damaging sound energy may not be in the audible range of the ear, we can detect it as an unpleasant or harsh sound. Thus the medium size grands (6 to 7 ft) may be most damaging. In this regard, the condition of the hammer is important, since a worn hammer can produce a much louder instantaneous sound than a properly voiced hammer. This is why worn hammers cause more string breakage than new or well voiced hammers. With old, hardened hammers, probably most pianos can cause ear damage. Thus proper voicing of the hammer may be much more important than many people realize, for playing musically, for technical development, and for protecting the ear. If you have to close the lid of a grand in order to play softly, or to reduce the sound to a pleasant level, the hammers probably need voicing.
Some of the loudest sounds are produced by those ear phones used to listen to music. Parents should warn their youngsters not to keep turning up the volume, especially if they subscribe to the culture that plays loud music. Some youngsters will fall asleep with their ear phones blasting; this might be very damaging because the duration of exposure to loudness is also important. It is a bad idea to give gadgets with ear phones to youngsters -- postpone it as long as possible. However, sooner or later, they will end up with one; in that case, warn them before they suffer ear damage.
Except for some special cases of tinnitus (especially those cases in which you can alter the sound by moving your jaws, etc.), there is no cure yet. Large doses of aspirin can cause tinnitus; in that case, stopping its use can sometimes reverse the process. Small amounts of aspirin taken for cardiac purposes (81mg) apparently do not cause tinnitus, and there are some claims in the literature that these small amounts may delay the onset of tinnitus. Loud tinnitus can be extremely debilitating because it cannot be changed and is present all the time, and it only increases with time. Many sufferers have been driven to thoughts of suicide. Although there is no cure, there are remedies, and all indications are that eventually, we should be able to find a cure. There are hearing aids that reduce our perception of tinnitus, for example, by supplying sufficient sound so that the tinnitus is either masked or the amplification in the damaged area is reduced. Thus for tinnitus suffers, absolute quietness may be damaging.
One of the most annoying traits of hearing loss is not that the ear has lost its sensitivity (frequently, sensitivity tests reveal very little deterioration), but the inability of the person to properly process the sound so as to understand speech. People with normal hearing can understand speech mixed with a large amount of extraneous sound. Understanding speech is usually the first ability that is lost with onset of hearing loss. Modern hearing aids can be quite helpful, both by amplifying only those frequencies needed to understand speech and for suppressing sounds that are loud enough to cause damage. In other words, if your hearing aid just amplifies all sounds, it may cause even more damage. Another approach to tinnitus is to train the brain to ignore the tinnitus. The brain is amazingly trainable, and part of the reason why tinnitus causes suffering is the inappropriate brain response of the person. The brain has the ability to either concentrate on the sound, thereby driving you crazy, or to ignore it, in which case you won’t hear it unless you are reminded of it. The best example of this effect is the metronome. Most pianists do not know that if they practice with the metronome too long, the brain will play tricks so that you either do not hear the click at all, or hear it at the wrong time, especially if the metronome click is sharp and loud. This is one reason why modern metronomes have flashing lights; in addition to enabling you to time yourself without the sound, it allows you to check to see if what you hear matches the light flashes. Thus modern treatments of tinnitus start with teaching the patient that others have succeeded in living with it with minimal discomfort. Then the patient receives ear training in such a way as to be able to ignore the tinnitus. Fortunately, the brain is quite adept at learning to ignore a constant sound that is always there.
If you read enough stories about tinnitus suffers, you will probably follow the advice to wear ear protection after age 40, at least when practicing loud passages for long periods of time. At the first hint of tinnitus, it is imperative that you start ear protection procedures because once the tinnitus starts, ear deterioration can proceed rapidly with exposure to sound, with significant deterioration every year. Use of a digital piano and turning the volume down is an excellent solution. Look for an ENT specialist immediately, especially one experienced in tinnitus treatments. Ear protection applies to other members of the household; therefore, if at all possible, isolate the piano room acoustically from the rest of the house. Most quality (glass) doors will be sufficient. There are a few herbs and "natural" medications that claim effectiveness against tinnitus. Most of these do not work, and the ones that seem to benefit some people have dangerous side effects. Although it is true that there are precious few specialists treating tinnitus, the situation is improving and there are many sites on the internet with information on tinnitus, such as The American Tinnitus Association.