Q: I am a semi-professional pianist with a serious problem that could put the kibosh on my career. Anytime I play for more than an hour, my hands start to go numb. I've heard that it's possible to do some technical retraining but I don't know how to go about this. What do you recommend?

A: As you well know, musicians often spend quite a bit of time in awkward positions. The pianist may get in the habit of slouching or hunching over the keyboard. Some piano music requires the pianist to stretche the fingers beyond theirn normal range to reach more keys. Holding both hands over the keyboard using the fingers, wrists, forearms, and upper arms repetitively during long hours of practice can lead to problems eventually.

Preparing for a concert often involves increasing the number of hours practicing and rehearsing. Some muscles contract and hold without a break. Joints open and close over and over and over. Inevitably injuries occur for many musicians. Pain, stiffness, cramping, spasm, numbness, swelling, clicking and popping, and tremors are just a few of the more common symptoms experienced.

Sometimes the very thing that makes it possible for a musician to play well is the contributing factor to their injury. For example, joint hypermobility from lax ligaments gives joints greater flexibility. But without strong muscles to stabilize that joint, pain, fatigue, and spasm can develop. Loss of finger or hand dexterity can be devastating to the musical performer.

You may be experiencing symptoms associated with a condition called thoracic outlet syndrome (TOS). TOS involves the compression of nerves and blood vessels in the neck area. Muscles that contract fiercely and repeatedly can clamp down on these soft tissues and cut off circulation to the muscles. This same type of compression puts pressure on the nerves causing numbness, tingling, and sharp pains. Poor posture can be a big factor but obesity and being female are other possible risk factors.

Technical retraining helps the musician identify, recognize, and stop using postural and motor patterns that have contributed to the problem. Usually, a hand therapist (physical or occupational therapist) is the expert who addresses these problems. Reducing the number of hours played, paying attention (and correcting) posture, and use of pain relievers can be tried, too.

Alignment and posture can be addressed. In some cases, the instrument can be modified to unload pressure and reduce fatigue and compression. With the piano, the piano itself isn't changed but the seating may be altered. Sometimes just practicing for shorter periods of throughout the day and taking more frequent breaks is enough to allow for healing and recovery.

The therapist will work with the patient as he or she plays the instrument and provide technical retraining.Stretching, range-of-motion exercise, and strengthening are important aspects of conservative care. In the case of thoracic outlet that does not respond to conservative care, surgery may be needed. No musician likes to hear that word but sometimes something as simple as shaving a rough edge of a bone or removing a rib may be all that's needed.

Reference: Andrew J. Rosenbaum, MD, et al. Injuries Complicating Musical Practice and Performance: The Hand Surgeon's Approach to the Musician-Patient. In The Journal of Hand Surgery. June 2012. Vol. 37A. No. 6. Pp. 1269-1272.