2 The key width for the modern piano wasestablished about 130 years ago. Beforethen, the key widths varied and were typ-ically narrower than the modern piano as

shown in Figure 1. During these early years itwould have been normal for pianists to playand compose on different sizes of keyboards. Infact, technically challenging pieces writtenbetween 1750 and 1850 were probably com-posed using pianos with narrower keys under-scoring Sakai’s rationale as to why manymodern pianists struggle with difficult pianotechniques on a modern piano.1 Since the dis-tance of an octave span became fixed around1880, pianists have been dealing with the ideaof a one-size-fits-all piano and the disappear-ance of optional key widths for the piano.

Figure 1: Average octave span of 75 historical pianos2

Some may argue that different-sized key-boards are unnecessary. However, the normalrange of hand sizes is substantial, and thereare many small-handed pianists includingwomen and children. To illustrate, Figure 2shows hand span data from about 400 stu-dents measured at the University of NorthTexas. The difference in span between thesmallest hands to the largest is about 11 cm, ora little more than 4 inches. This difference isclose to the width of five piano keys. As shownin Figure 3, it is obvious that the larger hand(span = 246 mm) shown in this photo fits thekey width of this modern piano better than thesmaller hand (span = 185 mm).

Figure 2: Right hand span of 397 students and pianists

The Application Of An ErgonomicallyModified Keyboard

To Reduce Piano-Related Pain

By Eri Yoshimura and Kris Chesky

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Figure 3: Right hand playing a chord (B-C#-G#-B) onthe modern keyboard

What makes this discussion serious, urgentand, possibly ethical, is the fact that small-handed pianists are clearly at a disadvantage toperform certain literature and likely to experi-ence pain because of mismatches betweenhand size and key width. These types of prob-lems are not exclusive to the piano or pianist.However, they are often addressed throughprinciples of ergonomics, or the concept of fit-ting tools or workspaces to human anthropo-metric indices. Ergonomics is a universal andwidely accepted safety and health practice thatis used throughout the world to minimize occu-pational injuries.3,4,5

In addition to the logical conclusion that onemight draw from observing small-handedpianists at the piano, research studies provideevidence that hand size is a crucial risk factorfor pain and subsequent injury.6,7 Two recentstudies by the authors of this paper reportedthat 86 percent of 35 piano majors at theUniversity of North Texas and 91 percent of 47piano teachers attending a Music TeachersNational Assoication conference experience painwhile playing the piano.8,9 Both studies reportedsignificant negative correlations between handsize and pain. Reports of higher prevalence forplaying-related pain among females also sup-port this relationship because female hands aregenerally smaller than those of men.10

Despite calls by some pianists and instruc-tors to consider and adopt the use of modifiedkeyboards for small-handed pianists based onthe principles of ergonomics,11,12,13 the key widthof the vast majority of pianos used today con-form to the so-called “standard” size of 188 mmper octave. Some manufacturers like Yamaha(Japan) and Steinbuhler (Titusville,Pennsylvania) have built and sold narrower-sized keyboards. Yamaha stopped making these

keyboards in 2003 due to the lack of demandafter 14 years of production. Steinbuhler offerskeyboards that can be temporarily or perma-nently placed into any piano.

At UNT, we offer students the practice pianoswith permanently modified keyboards and theoption for modifying the key width of our con-cert grand pianos to be used during formalrecitals and concerts. As we routinely witnessthe profound significance associated with pro-viding these options, we also realize that UNT isone of only a few music schools in the UnitedStates embracing this concept and offeringthese resources to students. Attempting toexplain or rationalize why these options are notwidely adopted by other major music schools inthe United States is beyond the scope of thispaper. One reason might be the lack ofresearch studies documenting the effect ofmodified keyboards on performance-relatedpain. To address this lack of supporting evi-dence, the purpose of this study was to assessthe effectiveness of an ergonomically modifiedkeyboard for alleviating playing-related pain.

MethodsProcedure

College students majoring in piano wererecruited to participate in this study. After sign-ing an approved Institutional Review Board con-sent form, each subject was given instructionsfor participation, a copy of musical repertoire tobe used during the study and a schedule withperformance dates and times. The schedule con-sisted of a two-week time frame to practice theassigned repertoire that included 45 minutes ofaccess to a piano with a 174-mm keyboard.Following the two-week period, subjects per-formed the assigned repertoire on two consecu-tive days and two different pianos. One of thetwo pianos was fitted with a 174-mm keyboard,and the order of piano used was randomly deter-mined. All performances were video recorded(Sony DCR-TRV18 camcorder) from a fixed posi-tion directly above the keyboard. Immediatelybefore and following both performance require-ments, subjects responded to questions listed onan assessment questionnaire.Repertoire

The assigned repertoire consisted of three sec-tions. The first section included ascending and

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descending octave scales in C major played with8th notes, 16th notes and then sextuplets, firstperformed at dynamic level piano and then atforte. The second section included ascendingand descending chord scales in C major playedwith 8th notes, 16th notes and then sextuplets,first performed at dynamic level piano and thenat forte. The metronome marking for the first twosections was presented as quarter note = 60.The third section included a one-page excerptfrom L’Isle Joyeuse by Claude Debussy (Measure220–243; Publisher: G. Henle Verlag Urtext).

PianosTwo grand pianos (Steinway, Model L) were

used for this study. One of the two pianos wasfitted with a 174-mm keyboard (15/16 –Universal model, Steinbuhler & Company:Titusville, Pennsylvania). The difference betweenthe two keyboards is shown in Figure 4. All setups, tunings and modifications of the pianoswere conducted by a full-time piano technicianworking for the university. The pianos wereplaced side by side in the same room to mini-mize differences in the acoustical surroundings.

Figure 4: Octave Span of the Standard-sized Keyboard(Top) and the Ergonomically Modified Keyboard (Bottom)

MeasuresIn addition to basic demographic, anthropo-

metric and musical background information,10-cm Visual Analogue Scales (VAS) wereemployed to determine levels of pre- and post-performance pain. Pain and tension while play-ing were also measured following eachperformance using VAS scales. After the secondperformance, subjects were asked, “If you weregiven a choice, which keyboard would you pre-fer to use? And why?”

Overview Of Data AnalysesWe examined the hypothesized associations

between pain related to playing the piano, key-board size and hand span. First, we compared(paired t-test) the pre-performance pain levelsacross the keyboard conditions for the wholegroup to control for any differences in painreported before performing. Secondly, we calcu-lated the changes in pain by subtracting the pre-performance pain scores from thepost-performance pain scores. Paired t-tests wereused to determine whether the changes (differ-ence scores) in pain were different across the twoperformance conditions (174-mm versus 188-mmkeyboard). The same test was utilized to reportdifferences in the post-performance pain and thepain and tension while playing across the twokeyboards. Thirdly, Pearson correlation coeffi-cients were used to examine the relationshipsbetween pain and hand span. To further explorethe influence of hand span, the subject groupwas split into two sub-groups across the average(mean) hand span of the whole group. Unpairedt-tests, correlations and scatter plots were usedto examine differences of the pain and tensionwhile playing (assessed following performance)across keyboards within these two groups.

Video ObservationThe still images of subjects’ hands were cap-

tured from the video files using the Image Capturesoftware. The selected frame for observation wasthe moment when the subjects played a chord (B-C#-G#-B) from Debussy’s L’isle joyeuse (Figure 5).First, the largest and smallest hands among thesubjects were compared when playing on the 188-mm keyboard. Secondly, angles of fingers 2 and 4were measured to evaluate the difference acrosskeyboards of the small hands. Thirdly, two imagesof the same hands playing on the 188-mm and the174-mm keyboards were outlined and thenstacked in order to observe differences in posture.

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Figure 5: Chord (B-C#-G#-B) from Debussy’s L’islejoyeuse

ResultsSubjects

A convenience sample of 35 piano major stu-dents at the University of North Texas agreed toparticipate in this study. Table 1 and Table 2describe demographic and anthropometric dataof this subject population. These data were alsoreported in a previous paper.14

Table 1: Descriptive Demographic and MusicBackground Data

Table 2: Anthropometric Measures of Upper-extremity

Statistical Analysis Of Pain Data Subjects did report the pre-performance pain

(mean = 1.18, SD = 1.79) and, as shown in Table 3,no significant difference was found between the pre-performance pains reported prior to performing onthe 174-mm keyboard compared to prior to per-forming on the 188-mm keyboard (t = .655, p > .05).

Subtracting the pre-performance pain levelsreported before performance on the 174-mmkeyboard (mean = 1.09, min=0, max=7.5) fromthe post-performance pain levels (mean = 0.95,min=0, max=5.8) resulted in a reduction inpain of -0.13. The mean pain level reportedbefore performance on the 188-mm keyboardwas 1.27 (min=0, max=8.6), and when sub-tracted from the post levels (mean=1.98, min=0,max=9.2), the increase in pain was 0.71. Thelevels of change were significantly different (t =2.193, p < .05) when compared across the twokeyboard conditions. Confirming this finding,the reported levels of pain while playing on the174-mm keyboard (mean = 0.96, S.D. = 1.48)were significantly less (t = 3.001, p < .01) thanthe reported level of pain while playing on the188-mm keyboard (mean = 2.07, S.D. = 2.74).

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Similarly, the reported levels of tension whileplaying on the 174-mm keyboard (mean = 2.20,S.D. = 2.54) were significantly less (t = 2.215, p< .05) than the reported levels of tension whileplaying on the 188-mm keyboard (mean = 3.17;S.D. = 2.92).

Table 3: Pain and Tension Scores As shown in Table 4, hand span was not sig-

nificantly correlated with the pre-performancepain for either keyboard condition. However, thepain while playing on the 188-mm keyboardwas significantly correlated (inverse) to left handspan (r = -.631, p < .01) and right hand span (r = -.532, p < .01). Correlations between handspan and the pain while playing on the 174-mmkeyboard were lower but still significant for lefthand (r = -.521, p < .01) and right hand(r = -.416, p < .01). Similar associations wereobserved for the tension while playing and handspan. These relationships are graphically dis-played in Figures 6a and 6b to show individualpain while playing for the 188-mm keyboardand the 174-mm keyboard respectively. Thenegative slopes of the trend lines illustrate thathand span and pain scores are inversely corre-lated for both conditions. However, the slope ofthe regression line is less steep for the 174-mmkeyboard condition meaning that the pain whileplaying on the 174-mm keyboard was less thanthe 188-mm keyboard.

Table 4: Pearson Correlation of Hand Span andPain/Tension

Figure 6a: Scatterplot and Regression Line of LeftHand Span (X) and Pain on the 188-mm Keyboard (Y)

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Figure 6b: Scatterplot and Regression Line of LeftHand Span (X) and Pain on the 174-mm Keyboard (Y)

As indicated in Table 5, subjects with smallerhands (< 212.4 mm) reported significantly morepain (p < 0.05) and tension (p < 0.05) than stu-dents with larger hands (> 212.4 mm).

Table 5: Mean Comparison of Pain and TensionBetween Small and Large Hands

Further illustrating the influence of keyboardsize, Table 6 shows that pain and tension werealways lower with the 174-mm keyboard whencompared to the 188-mm keyboard regardlessof hand size. However, only the smaller handedgroup reported significantly different levels ofpain (p < 0.05) across the two keyboard sizes.

Table 6: Mean Difference of Pain and Tension acrossTwo Keyboards

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Analysis Of Hand PostureFigure 7 displays the images of the subjects

with the smallest and largest right hand spanamong the study population playing the samechord (B-C#-G#-B) on the 188-mm keyboard.Visually, the difference in hand position andposture is evident. The fingers of the smallhand seem uncomfortably stretched-out andare barely reaching the octave. In contrast, thefingers of the large hand appear to be naturallycurved and easily pressing all four keys. AsTable 2 reports, the hand span difference ofthese hands are about 7 cm (2 ¾ inch). Thedistance is equivalent to the width of threepiano keys.

Figure 7: Smallest Hand (span: 183 mm) and LargestHand (span: 250 mm) on the 188-mm Keyboard

The images shown in Figure 8 (a,b,c) are righthands with less than 200-mm hand spans.When the same chord was played on both key-boards, the angle between digits 2 and 4 issmaller on the 174-mm keyboard. Moreover,each hand looks more comfortable on the 174-mm keyboard compared to one on the 188-mmkeyboard; (1) The thumb looks less stretchedand more curved (Figure 8a); (2) fingers arecentered more on the keys (Figure 8b); and (3)fingers 1 and 5 are reaching a wider range ofkeys (Figure 8c). These observations suggestthat these subjects would be able to play withmore dynamics and accuracy on the 174-mmkeyboard.

Figure 8a: Right Hand (span: 183 mm) Plays on the188-mm (Left) and 174-mm Keyboard (Right)

Figure 8b: Right Hand (span: 190 mm) Plays on the188-mm (Left) and 174-mm Keyboard (Right)

Figure 8c: Right Hand (span: 197 mm) Plays on the188-mm (Left) and 174-mm Keyboard (Right)

Another way to observe the same hand on thetwo different keyboards is to outline and stackthe images in order to see the differences. InFigure 9, the large hand postures are almostidentical and both outlines are closely matched.Only the tips of the fingers are displaced slight-ly, and the span between fingers 1 and 5 is notchanged. In contrast, postures of the smallhand are significantly different as demonstratedby the two outlines. This suggests that thesmall-handed pianist experiences sensationsassociated with excessive stretch or range ofmotion when playing the 188-mm keyboard andless so when playing the 174-mm keyboard.One notable difference between the two imagesis that two keyboards appear to influence theentire small hand but only the placement of thefingertips for the large hand. In other words, the174-mm keyboard would help the small-handedpianists more than the large-handed pianists byimproving the posture of hands and reducingunnecessary extreme stretch.

Figure 9: Stacked Images of the Largest Hand (Left)and Smallest Hand (Right)Outline for Right Hand on the 188-mm (Blue) and174-mm Keyboard (Red)

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Video A: Large-handed pianistplaying on the 188-mm keyboard

Video B: Small-handed pianistplaying on the 188-mm keyboard

Video C: Small-handed pianistplaying on the 174-mm keyboard

ConclusionTo our knowledge, this is the

first study of an ergonomicallymodified piano keyboard onplaying-related pain amongpianists. After performing onboth modified and standard-size keyboards, overall playing-related pain and tension wasless on the 174-mm keyboardthan the 188-mm keyboard.Whereas pain increased fromperforming on the 188-mmkeyboard, pain decreased fromperforming on the 174-mmkeyboard.

Overall, the results from thisstudy support the general andwidely applied principles ofergonomics. Based on theresults of this study, the fieldsof performing arts medicineand piano pedagogy can con-sider this approach as “evi-denced-based” for dealing withplaying-related pain––especiallyfor pianists with small hands.However, this does not suggestthat all musculoskeletal prob-lems associated with pianoplaying are due to mismatchesbetween hand span and key-board size. Occupational injurycausation is multidimensional,and this relationship representsonly one important factor.

Due to the limitations asso-ciated with this study, addi-tional research is warranted.Because this study includedonly 35 college music majors,larger sample sizes with morediverse and balanced subjectpopulations are needed. Sincethe current study was limitedto one two-week preparationperiod and only 45 minutes ofpractice time on a piano withthe modified keyboard, addi-tional studies are needed toexplore acclimation periodsand long-term effects on pain-related outcomes. This studyalso lacks data regarding keyforce and upper-extremitymovement. The authors’ mostrecent research includes forcesensors and motion-capturecameras for biomechanical andkinematic evaluations.

Furthermore, future studiesneed to assess the influence ofkeyboard size on performance-related outcomes. Based onour experiences and observa-tions, we believe an ergonomi-cally modified keyboard mayhelp some pianists extend theamount of practice time, per-form wider chords as writtenwithout arpeggiating or leavingout notes, voice desired notes

in certain chords, play relaxedand with reduced muscle ten-sion or expand repertoire toinclude pieces usually per-formed by large-handedpianists.

DiscussionPianists’ playing-related

problems can be traced backto around 1830, about a cen-tury after the piano wasinvented. So-called “pianist’scramp” was a major strugglefor Robert Schumann15 andwas recognized in a medicaljournal in the late 19th centu-ry.16 Despite this long-termawareness that playing thepiano can cause playing-relat-ed pain and other medicalproblems, research related topianists’ health is extremelylimited. This lack of researchmay be due to the belief thatpain is a normal and expectedpart of playing piano or due tounhealthy conditions, lifestylesand habits. Moreover, pianoteaching and learning are tra-ditionally viewed as subjectiveactivities that rely heavily onthe senses and steeped inlong-held traditions. In ourview, these tendencies stifledgrowth and contribute to alack of scientific research andobjective data designed toexplore risk factors and solu-tions for prevention. PeterBragges confirmed this prob-lem when he reported scientif-ic credibility in only 12 of 482publications dealing with theprevalence and risk factors forplaying-related musculoskele-tal disorders of pianists.17 Inother words, there are manyindividuals offering insightsand solutions but only a hand-ful of scientific studies provid-ing verification. Therefore, andbecause so much is at stake,information should be viewedcritically because of its poten-tial to mislead pianists. For

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example, numerous publica-tions suggest stretching beforeplaying the piano as a methodto reduce the risk forinjury.18,19,20,21 The researchdata, however, is insufficientto verify that stretching actual-ly helps prevent injury. On thecontrary, our previousresearch showed that stretch-ing increases risk.22 Other evi-dence suggests that staticstretching should be excludedfrom warm ups for strengthand power activities23 and thatstretching significantlydecreases muscularstrength.24,25,26 Other examplesof the potential to misleadpianists are books and meth-ods that limit or exclude rele-vant and important factors.For instance, one book sug-gests that, other than prob-lems associated withnon-music related medicalconditions or trauma, all pianoinjuries come from inefficientuse of the body and poorhabits of movement.27

Unfortunately, it is possiblethat some pianists with smallhands will buy into this falseassumption and then spendyears trying to “discover andcorrect those poor habits.” Wehave witnessed young pianistsinvesting in these falseassumptions, feeling guiltyand doubtful, and then realiz-ing their pain is directly relat-ed to their hand size and theproblem can be relieved withsimple ergonomic modifica-tions. For some of thesepianists, the self-doubt andperceived inability to play cer-tain pieces is more devastatingthan the pain itself. The pianocommunity must consider theramifications of youngpianists, perhaps with smallhands, who read and trustthese statements.

The results of the currentstudy suggest an effectiveapproach to reduce piano-related pain for small-handedpianists. However, the idea ofusing modified keyboards isforeign to the piano world, inpart, due to the “standardiza-tion” of key width in late 19thcentury. To influence thepotential adoption of modifiedkeyboards, advocates shouldconsider attitudes and con-cerns of potential users. Forexample, a few small-handedsubjects in this study (handspan less than 200 mm)reported they were eitherunsure about the modifiedkeyboard or would prefer the188-mm keyboard to the 174-mm keyboard. Those thatsaid they would prefer the188-mm keyboard reported:4 I am used to playing the

standard piano (x 3).4 Accuracy is easier, to me

[sic], because it is really justas comfortable as the modi-fied keyboard, and I ammore at ease with the stan-dard.

4 Less slips.The students reporting being

not sure stated:4 The 174-mm keyboard is

comfortable and less tensionfor forearm, but I alreadyknow standard piano andmy muscle also know thatpiano [sic].

4 Depends on the piece, if itrequires big chord sound, Iwould like to use the modi-fied keyboard because itmakes my hands and shoul-ders more relaxed and lesspain.Although more research is

needed, these quotes providesome insights into the atti-tudes and perceptions amongsmall-handed pianists. Someseemed to choose the 188-mmkeyboard simply due to itsfamiliarity. This concern is

understandable becausepianists are accustomed to the“standardized” keyboard.Another concern is that theymay be at a disadvantage whenthey travel to a new location orvenue that does not offer orallow use of an ergonomicallymodified keyboard.

Several approaches are sug-gested to overcome theseobstacles. First, to reduce stu-dents’ fear of the unfamiliar,faculty and teachers need toinform students that it is notdifficult to adjust technique,especially when their hands fitmore naturally to the smallerkeyboard. In fact, we encour-age students to practice onboth keyboards so switchingbecomes familiar. We encour-age students to consider thatswitching is similar to whatsaxophonists do when switch-ing from alto to tenor to bari-tone and back. The more onedoes this, the easier and morenatural it becomes. Secondly,we recommend that pianomanufactures offer optionalkey widths and that allNational Association of Schoolsof Music (NASM) accreditedinstitutions make ergonomical-ly modified keyboards avail-able for student pianists.These goals are challengingbecause of financial hurdlesbut worth the expense becauseof the large and growing num-bers of female and Asianpianists attending these insti-tutions. Moreover, consideringthe piano budgets of mostmajor schools of music, thisinvestment is reasonable inlight of the size and scope ofthis problem.

Beyond these logistical con-siderations, the most challeng-ing obstacle for embeddingthis idea into the piano worldis the culture. Since the cur-rent keyboard size becamelabeled as the “standard,”

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anything outside “normal” maybe discriminated against. Forthis reason, the piano worldshould eliminate the term“standard” and rename key-boards based on key size.Under this rule, the “standard”keyboard should be called the“188-mm keyboard” and themodified keyboard we used inthis study, the “174-mm key-board.” The measurement ofoctave span varies in literatureand factories; however, thecurrent study defines theoctave span as the span ofeight keys (188 mm), ratherthan seven keys (165 mm) asshown in Figure 10. Adoptinga consistent labeling systemwould reduce confusion.

Figure 10: Difference in measuringoctave span

Another major concernregarding the culture is thatpianists genetically fortunateto have been born with largephysical traits might label theuse of an ergonomically modi-fied keyboard as “cheating.”This perspective has beenobserved and should be con-sidered irresponsible andunsympathetic. Perhaps repre-senting the pinnacle of suchperspectives, some small-handed pianists are consid-ered “less talented” becausethey struggle with a repertoire

that requires playing largerchords or because they are nolonger able to play due to pain.These issues reflect an unfor-tunate cultural phenomenonthat needs to be changed onbehalf of current and futurepianists. Understanding beliefsand attitudes through surveyresearch would be oneapproach to normalize opin-ions and acceptance levelstowards the use of ergonomics.Hopefully all pianists wouldeventually agree that anergonomic intervention to com-pensate for hand size is feasi-ble and essential, just likeadjusting the height of a pianobench to compensate for leglength and body height.

Being aware of the existingproblems and availableresources is an essential com-ponent to protect the health ofstudents and professionals. Toencourage awareness ofmusic-related health risks andwellness through education,Health Promotion in Schools ofMusic (HPSM) was establishedby the University of NorthTexas (Texas Center for Musicand Medicine) and PerformingArts Medicine Association(PAMA).28,29 In response toHPSM recommendations, someNASM accredited institutionsare now offering “OccupationalHealth” or wellness cours-es.30,31,32 Some large organiza-tions, such as MTNA,33 theFrances Clark Center forKeyboard Pedagogy,34 and theNational Association for MusicEducation,35 support this pro-ject and have encouragedadditional efforts to educatestudent musicians about occu-pational health and wellness.

Looking forward, we seeuntold opportunities and chal-lenges as we increase ourunderstanding of the occupa-tional health risks involved withlearning and performing the

piano. While our researchinforms us that modestergonomic changes can reducepain, the extent to which thisoption becomes available andapplied is considerably lessclear. Due to its rich historyand resilient traditions,addressing the health risksassociated with piano is chal-lenging. However, if we continueto modify how we approach thisissue and the social contexts inwhich these problems becomesocially patterned, widespreadlasting change is inevitable.

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NOTES

1. Naotaka Sakai, “KeyboardSpan in Old MusicalInstruments: Concerning HandSpan and Overuse Problems inPianists,” Medical Problems of

Performing Artists 23, no. 4(2008): 169-171.

2. Ibid., 170.3. Occupational Safety &

Health Administration, “Safetyand Health Topics:Ergonomics,” OSHA,www.osha.gov/SLTC/ergonom-ics/index.html.

4. Ritva Ketola, RistoToivonen, Marketta Häkkänen,Ritva Luukkonen, Esa-PekkaTakala, and Eira Viikari-Juntura, “Effects of ErgonomicIntervention in Work withVideo Display Units,”Scandinavian Journal of Work,

Environment & Health 28, no.1 (2002): 18–24.

5. Jennifer Hess, StevenHecker, Marc Weinstein andMindy Lunger, “A participatoryergonomics intervention toreduce risk factors for low-back disorders in concretelaborers,” Applied Ergonomics

35 (2004): 427–41.6. Naotaka Sakai, “Hand

Pain Related to KeyboardTechniques in Pianists,”Medical Problems of Performing

Artists 7 (1992): 63–65.

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7. Luc De Smet, HelenaGhyselen, and RoelandLysens, “Incidence of OveruseSyndromes of the Upper Limbin Young Pianists and itsCorrelation with Hand Size,Hypermobility and PlayingHabits,” Annales de Chirurgie

de la Main 17, no. 4 (1998):309–313.

8. Eri Yoshimura, PamelaMia Paul, Cyriel Aerts, andKris Chesky, “Risk Factors forPiano-related Pain AmongCollege Students,” Medical

Problems of Performing Artist

21, no. 3 (2006): 118–125.9. Eri Yoshimura,

Anncristine Fjellman-Wiklund,Pamela Mia Paul, Cyriel Aerts,and Kris Chesky, “Risk Factorsfor Playing-related Pain amongPiano Teachers,” Medical

Problems of Performing Artists

23, no. 3 (2008): 107–113.10. Chong Pak and Kris

Chesky, “Prevalence of Hand,Finger, and WristMusculoskeletal Problems inKeyboard Instrumentalists,”Medical Problems of Performing

Artists 15 (2000): 17–23.11. Christopher Donison,

“Performer’s Perspective: Handsize vs the standard piano key-board,” Medical Problems of

Performing Artists 15, no.3(2000): 111–114.

12. Carol Leone, “GoldilocksHad a Choice,” American Music

Teacher June/July 2003:26–29.

13. Brenda Wristen, Myung-Chul Jung, Alexis Wismer, andSusan Hallbeck, “Assessmentof Muscle Activity and JointAngles in Small-HandedPianists: A Pilot Study on the7/8-Sized Keyboard versus theFull-Sized Keyboard,” Medical

Problems of Performing Artists

21, no. 1 (2006): 3–9.14. Yoshimura, “Pain among

College Students,” 118–125.15. Eckart Altenmüller,

“Robert Schumann’s Focal

Dystonia,” Neurological

Disorders in Famous Artists 19(2005): 179–188.

16. G. Vivian Poore, “ClinicalLecture on Certain Conditionsof the Hand and Arm whichInterfere with the Performanceof Professional Acts, EspeciallyPiano-playing,” The British

Medical Journal 1 (1887):441–444.

17. Peter Bragge, AndreaBialocerkowski and JoanMcMeeken, “A SystematicReview of Prevalence and RiskFactors Associated withPlaying-relatedMusculoskeletal Disorders inPianists,” Occupational

Medicine 56, no. 1 (2006):28–38.

18. Margaret Redmond andAnne Tiernan, “Knowledge andPractices of Piano Teachers inPreventing Playing-relatedInjuries in High SchoolStudents,” Medical Problems of

Performing Artists 16 (2001):32–42.

19. Jacqueline Csurgai-Schmitt, “Pushing thePhysiological Envelope,” in ASymposium for Pianists and

Teachers, ed. Kris Kropff(Ohio: Heritage Music Press,2002), 147–155.

20. Norman B. Rosen,“Overuse, Pain, Rest, and thePianist,” in A Symposium for

Pianists and Teachers, ed. KrisKropff (Ohio: Heritage MusicPress, 2002), 156–166.

21. A. Grieco, E. Occhipinti,D. Colombini, O. Menoni, M.Bulgheroni, C. Frigo and S.Boccardi, “Muscular Effort andMusculoskeletal Disorders inPiano Students:Electromyographic, Clinicaland Preventive Aspects,”Ergonomics 32, no. 7 (1989):713–714.

22. Yoshimura, “Pain amongPiano Teachers,” 107–113.

23. Warren B. Young andDavid G. Behm, “Should Static

Stretching Be Used During aWarm-up For Strength andPower Activities?” Journal of

Strength and Conditioning 24(2002): 33–37.

24. Janne Avela, HeikkiKyröläinen and Paavo V Komi,“Altered Reflex Sensitivity AfterRepeated and ProlongedPassive Muscle Stretching,”Journal of Applied Physiology

86 (1999): 1,283–1,291.25. Tammy K. Evetovich,

N.J. Nauman, Donovan S.Conley and Jay B. Todd,“Effect of Static Stretching ofThe Biceps Brachii on Torque,Electromyography andMechanomyography DuringConcentric IsokineticmuscleActions,” The Journal of

Strength & Conditioning

Research 17 (2003): 484–488. 26. Jeni R. McNeal and

William A. Sands, “AcuteStatic Stretching ReducesLower Extremity Power inTrained Children,” Pediatric

Exercise Science 15 (2003):139–145.

27. Thomas Mark, What

Every Pianist Needs To Know

About the Body (Chicago: GIAPublications, Inc., 2004), 1.

28. Health Promotion inSchools of Music, “InitialRecommendations for Schoolsof Music,” UNT,www.unt.edu/hpsm/.

29. Kris Chesky, WilliamDawson and RalphManchester, “Health Promotionin Schools of Music: InitialRecommendations for Schoolsof Music,” Medical Problems of

Performing Artisst 21, no. 3(2006): 142–144.

30. Ralph Manchester, ed.,“Health Promotion Courses forMusic Students: Part 1,”Medical Problems of Performing

Artists 22, no. 1 (2007): 26–29.31. Ralph Manchester, ed.,

“Health Promotion Courses forMusic Students: Part II,”Medical Problems of

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Performing Artists 22, no. 2(2007): 80–81.

32. Ralph Manchester, ed.,“Health Promotion Courses forMusic Students: Part III,”Medical Problems of Performing

Artists 22, no. 3 (2007):116–119.

33. Music Teachers NationalAssociation, “MusicianWellness,”www.mtna.org/Resources/MusicianWellness/tabid/470/Default.aspx.

34. Frances Clark Center forKeyboard Pedagogy, “WellnessResources,”

www.francesclarkcenter.org/NationalConferencePages/resources/wellnessResources.html.

35. National Association forMusic Education, “Health inMusic Education,”http://menc.org/connect/surveys/position/health.html.

Born in Osaka, Japan, Eri Yoshimura earned a music education

degree from Shinshu University before moving to Denton, Texas. There,

she received a doctor of musical arts degree in August 2009 following a

master’s in piano performance degree from the University of North Texas

under Pamela Mia Paul with a related field in music and medicine under

Kris Chesky.

Yoshimura’s scholarly research has focused on understanding and pre-

venting piano-related medical problems. Her research papers were pub-

lished in the Medical Problems of Performing Artists journal in 2006 and

2008. She is also interested in the application of an ergonomically modi-

fied keyboard (a narrower-sized keyboard) for reducing piano-related pain among small-handed

pianists and has been using the modified keyboard at the University of North Texas for the last

four years. She has presented her research in conferences at Aspen (PAMA), Chicago (NCKP),

Serbia (EPTA) and England (RNCM). She won the research scholarship in 2008 and was fea-

tured on the university homepage and on a local news broadcast.

Yoshimura has performed solo and four-hands recitals in the United States (including Hawaii),

Japan, Mexico and Hungary (Franz Liszt International Festival) and participated in music festi-

vals in Italy and Vienna. She and Hungarian pianist, Emöke Ujj, released their first album

together, “Contemporary Piano Music for Four Hands” (available at

http://fourhandspiano.com/), which contains the works by four living composers. All composi-

tions in this album were specifically composed for the duo.

Kris Chesky holds degrees from the Berklee College of Music and the

University of North Texas. After completing his undergraduate degree in

trumpet/jazz studies, he worked as a bandleader and sideman. During

graduate studies at UNT, Chesky studied music therapy with Texas

Women’s University Professor Donald Michel while working for a psychi-

atric in-patient hospital in Fort Worth. After completing a doctorate degree,

he conducted research on the pain-relieving effects of music vibration at

the UNT Health Sciences Center, University of Texas-San Antonio and at

Cook Children’s Hospital of Fort Worth.

Chesky is currently associate professor within the UNT College of Music

and director of the Texas Center of Music & Medicine. He oversees and teaches courses in music

medicine including an undergraduate course titled “Occupational Health: Lessons for Music.”

Chesky is executive director of the Health Promotion in Schools of Music project

(www.unt.edu/hpsm) and holds leadership positions in the Performing Arts Medicine

Association (www.artsmed.org) and the National Hearing Conservation Association (www.hear-

ingconservation.org).

Chesky has received research grants from the National Endowment for the Arts, the Grammy

Foundation, NAMM, IFMR, the Scott Foundation, and others to study health issues related to

learning and performing music. He has published scientific research articles in the areas of epi-

demiology, biomechanics, audiology and mental health. Chesky has participated in many confer-

ences over the past 15 years including some in Canada, England, France, Germany, The

Netherlands, Spain, South Africa, Scotland and throughout the United States.