Cuban-born pianist Maria del Pico Taylor is out to debunk an adage that’s as popular among musicians as athletes: No pain, no gain. “People say, ‘If I ache, that’s because I practice hard, and it’s okay, because at least my hands are getting stronger,’” she says. “That’s a complete fallacy.”

Taylor, a professor of piano at Temple University and performer with the Latin Fiesta ensemble, says that music by great masters doesn’t need to involve harm to pianists’ hands. But lack of understanding of healthy keyboard motions can diminish or even derail their careers.

Indeed, serious musicians spend hours practicing, polishing, accompanying and performing. It can be grueling, physically intensive labor. As in elite-level sports, injury is common.

The renowned pianist and composer Robert Schumann is perhaps the most famous of hundreds of keyboard casualties. Back in the 19th century, when numb fingers affected his ability to dazzle audiences, Schumann engineered a finger- strengthening device that he thought would restore his touch. The device actually caused further injury, forcing Schumann to abandon performing and focus on composing full-time.

Paola Savvidou, assistant professor of piano pedagogy in the MU School of Music, hopes to spare pianists from the toll injuries can take on their lives. In a recent study, “Assessing Injury Risk in Pianists: Using Objective Measures to Promote Self-awareness,” she and an interdisciplinary team of MU researchers set out to help pianists improve their technique by becoming more aware of body mechanics.

Wellness and injury prevention among professional performers is a big, important topic right now,” says Peter Miyamoto, associate professor of piano and chamber music, who performs as a soloist and with symphony orchestras worldwide. Miyamoto says his eyes were opened to piano-related injuries when he studied with the renowned pianist Leon Fleisher at the Curtis Institute of Music in Philadelphia. Fleisher suffered from focal hand dystonia, a neurological disorder that prevented him from playing with his right hand for 40 years. Finally, in 1995, Botox injections every four months relieved Fleisher’s symptoms.

“I think that his generation tended not to know much or focus upon injuries,” says Miyamoto. “They were probably happening, but people were not talking about it. A project like this is wonderful, because it’s actually bringing some data to the problem.”

The researchers compared pianists’ perceptions of their hand positions at the keyboard to footage, captured by a Microsoft Kinect depth camera, of them playing a piece of music. While 79 percent of the participants (11 students and three professional pianists) self-reported that they used a neutral hand position most of the time, the footage showed that none actually did.

“You can see that most of the time, what participants thought they were doing is not what they were actually doing,” says Savvidou. “They thought they had this beautiful hand position, and the camera showed collapsed, twisted positions. Given that information, we know that we have to train students kinesthetically so they have a better sense of what tension feels like and what a poor position feels like.”

Self-awareness in any activity can be difficult, but when it comes to the intricacies of proper piano technique, it can be especially challenging. For pianists, maintaining a neutral hand position is fundamental, and Savvidou works with her students on developing this position from day one.

“I’ll have them let their arm hang by their side and shake it, then without doing anything to it, just bring it to the keyboard,” she says. “Often that will be their perfect hand position. It’s nothing forced or imposed, or pushed and molded. It should be the most natural way that you hold your hand. You’re learning to keep those knuckles aligned to transfer the arm weight into the keys.”

The study also indicated that using this neutral position made quite a difference. Seventy-one percent of the participants reported that they were experiencing pain during a practice session, but nearly all of them – 90 percent -- reduced their discomfort by adjusting their hand positions. As might be expected, the professional pianists in the study spent more time in the neutral position than all but one of the student pianists.

“Our survey results kind of blew me away,” says Brad Willis, an assistant teaching professor in MU’s Department of Physical Therapy and member of the research team. “We had a pretty small sample size, but the study reinforces common findings in the literature about how important it is for individuals to have good body awareness.”

Body awareness has been important to Savvidou throughout her life. She began taking ballet and modern dance at age 7; she incorporated movement into her master’s thesis; and she pursued a dance minor while completing her doctorate in music. Currently, she teaches a movement and wellness class for musicians as well as a yoga class for students and faculty.

“Music and dance are so connected,” she says. “Even though the word dance intimidates a lot of pianists — they say ‘oh I don’t dance’ — actually what they do at the piano is move to the music. They connect to the music, so it’s dance.” She says it makes sense to her that musicians can benefit from learning to move in ways that prevent injury.

“We’re athletes,” says Savvidou. “The endurance that it takes to sit down and practice for a long time, the mental and physical demands, require you to be in decent shape. You absolutely use your core.”

Helping pianists become more aware of the physical challenges of their craft is especially important in light of larger studies reporting a high incidence of playing-related musculoskeletal disorders (PRMDs). One such study, conducted by a team of Italian researchers in 2008, reported an injury rate of 40 percent of the 195 students surveyed. Injuries included neck and shoulder pain, nerve entrapment, tendinitis and muscle pain in the wrist and hand.

Haley Myers, a student of Savvidou’s, is one of these statistics. Myers struggled with tendinitis, a condition Savvidou herself suffered from earlier in her career. Myers turned to Savvidou for guidance and support. Eventually, she recovered fully.

“Dr. Savvidou played a huge role in my recovery,” says Myers. “She had a lot of books, and also just a great knowledge base of musicians’ experience with injury and how to get better, so we kind of worked through my injury together.”

In Myers’ case, it became clear that poor technique was at the root of her injury. Like many music majors, she spent most of her life playing with postures that hadn’t been a problem until she faced the increased demands at the university level. Savvidou and her research team hope that one day a device that’s portable and inexpensive could help pianists catch these problems early.

“Definitely it would be helpful to piano teachers and students, because it’s quite hard to know what your alignment is really like,” says Myers. I think that having this kind of graphic illustration, a dynamic one that helps you watch your alignment as you play, would be super helpful.”

Although Myers wasn’t one of the subjects of the study, she did help with some of the early testing in the lab. In the initial phase of the study, Savvidou and Willis identified problematic postures, such as collapsed knuckles and overflexion or extension of the wrist.

From there, Mengyuan Li, a recent MU graduate in computer engineering, developed an algorithm that allowed the Kinect to capture these postures and compare them to the preferred neutral position. Marjorie Skubic, a professor of electrical and computer engineering, had identified Li as someone who could work on this, and Savvidou was able to hire her as a research assistant with funds from a Mizzou Advantage grant.

“She did so much of the work in testing whether we could use the Kinect,” says Savvidou. “She compared it against the Vicon, the gold standard for motion capturing. She developed the algorithms. Without her, I don’t think this would have been possible, because it was a lot of work.”

'It’s quite hard to know what your alignment is really like. I think that having this kind of graphic illustration, a dynamic one that helps you watch your alignment as you play, would be super helpful.'

Li points out that it’s almost impossible for a teacher to supervise a student all the time, but a device like the Kinect that’s programmed in a certain way can offer regular feedback. It can also allow users to compare their hand positions to those of professionals.

“I think Mengyuan did an excellent job in figuring out how to make that work,” says Skubic, who was Li’s advisor. Skubic has been working with the Kinect since its release in 2010. In addition to the piano study, Skubic has lent her expertise to collaborations with the MU School of Medicine (See “ACL and Risk,” Fall/Winter 2015) and in the ongoing Eldertech project at MU’s Center for Eldercare and Rehabilitation Technology.

Skubic points out that although these projects employ the same hardware technology in the Kinect, the real contribution from the engineers is the software methods they develop to process the data. “It’s the same sensing device, but what the engineers do with it is completely different, depending on the project,” she says.

Skubic, who has been a member of the MU faculty since 1997, arrived knowing she wanted to explore working with a range of disciplines outside of computer science and engineering. She says that ideally, members in interdisciplinary collaborations come together on equal terms, rather than some becoming subservient to others.

“The solutions happen at the boundaries of the different disciplines,” she says. “I like to work on projects where there are cutting-edge advancements being made in multiple disciplines simultaneously. “You can tell this is happening if you’re able to publish the work in the different disciplines’ journals and they’re accepted as being cutting-edge.”

Many interdisciplinary projects are so innovative that team members aren’t only workers, they’re also listeners. They come to the table without preconceived ideas for solutions and need to understand the problem before collectively coming up with possible answers. The challenge for the engineers in the piano study was to make sure the technology solutions were driven by the problems and needs of the pianists.

“Paola Savvidou came to me and had this idea,” says Skubic. “Could we do something to figure out how to monitor body posture? In the end, once we got into the project, we decided we had to narrow the scope somewhat, so we ended up doing it specifically on the hand postures.”

Skubic prefers working face-to-face to using electronic communications such as video conferencing. She says that human contact works best, especially for establishing rapport and facilitating brainstorming. Being on the same campus is also a big plus. For the study, the team was able to move a piano from the music department into Skubic’s lab, and Savvidou could recruit piano students to participate. The convenience allowed Savvidou to collect data and make sure the Kinect was capturing things correctly on a regular basis.

“You come to the table with this team, and it’s a realization that projects like this really need everybody to help in their own way,” says Brad Willis. MU has been such a wonderful place for collaboration. I feel really fortunate.”

MU’s spirit of collaboration is, Willis says, what brought him to the study. He had worked with Skubic and Aaron Gray, an assistant professor at the MU School of Medicine, on research designed to prevent ACL injuries, and Gray thought that the piano study would be a good fit for him. Willis’ experience helping patients with other types of repetitive-task injuries, such as those sustained on computers, carried over well. “It was a neat opportunity for me as a practicing physical therapist to come on to a project that involved repetitive strain and musculoskeletal disorders in musicians,” he says. “Their types of injuries can be very specific to them, but in general, repetitive injuries are incredibly common.”

Willis says the study’s use of different types of feedback hit home to him, and while it's clear that physical therapy is a crucial part of the study's goals, the research has been beneficial to Willis as well. He says he learned a tremendous amount about the specifics and intricacies of playing the piano at a high level, all of which help him in his practice.

One of these intricacies is balancing the technical aspects of playing the piano with what makes it worth listening to. Musical expression and technique are inextricably linked, and tinkering with one can affect the other, says Savvidou.

“It’s a very delicate thing to work on technique, because it’s so personal,” she says. “It’s about your body and how you use it; you carry tension, you carry emotion with it. You want that emotion to be there. It’s all tied together. Technique and expression -- for me, they’re one.”

This is why she thinks the findings in the study have implications for the future. Li and Skubic, for example, envision possibly developing a digital app that could provide objective, distanced measure to help pianists make gradual changes on their own.

“You could just turn your phone on and record for two minutes and go back and look at it,” she says. “I would like something practical that people could use easily to help them identify some of these things to prevent injury. As pianists and piano teachers, I hope this would be a nice challenge for us to embrace technology in a new way.”

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