Compression grips for pianists – do they help or harm?

June 4th, 2019 by Medico

Katherine Butler assesses the effectiveness of compression grips for pianists – do they help or harm?

 

The focus of performing arts medicine/is performance enhancement through injury prevention. It is essential that musicians warm up and cool down before and after playing, keep their instrument well maintained, develop healthy practice habits and live a balanced lifestyle. An alarming number of musicians suffer from various forms of inflammation and injury. According to recent reports, between 26 and 77 percent of all pianists suffer injury and inflammation related to playing at some point in their lives.

When treating performing artists, a holistic approach is required. Musicians can present with hypermobility, work-related upper limb disorder (RSI), nerve compressions, trauma, task-specific dystonia or injuries related to overuse or misuse. The majority of cases fall into the last two categories. Overuse can result from tissue overload and fatigue due to long practice sessions, repetition of a passage or a phrase without a break, preparing for a performance or examination under stress and not allowing enough recovery time between practice sessions or performances for
tissue adaptation.

Misuse injuries can be caused by incorrect technique, wrong muscle recruitment, exaggerated force and speed, poor ergonomics around the instrument and demanding repertoire not compatible with the musician’s physique and ability. Sometimes a short period of rest, use of a hot or cold pack and self-massage may make the symptoms go away. However, if symptoms persist or recur it is important to be assessed by a specialist who understands performing artists.

Thorough assessment leading to an accurate diagnosis, instrument-focused treatment and rehabilitation programme should start as soon as possible. Medical treatment may be indicated and could include the use of non-steroidal anti- inflammatory medicines such as aspirin, ibuprofen or diclofenac to help decrease inflammation and pain. Steroids may be used in some cases, but surgery is rarely required and would usually only be indicated in the case of trauma (eg a fracture or cut tendon) or nerve compression.

Hand therapy treatments may include soft tissue massage, exercise therapy, mobilisation techniques, management of scars, wounds and swelling, joint protection and energy conservation techniques, ultrasound therapy, acupuncture, neural glides, splinting, sensory re-education and postural adjustments.

For musicians seeking to avoid such drastic measures, a new compression wrap called WristGrips has recently been launched by a company in the US. Designed by and for musicians with the aim of ‘solving the problem of chronic wrist pain’, users claim that they ‘save broken hands’, ‘cure tendinitis’ and ‘heal hand pain’. A full list of suggested benefits can be viewed on the manufacturer’s website: www.wrist-grips.com

The wraps have a number of pros and cons. I like the fact that musicians have designed them for musicians, but they betray a limited knowledge of anatomy and the function wrist straps perform. It is true that compression can improve blood circulation which in turn means more oxygen is delivered to muscles, helping them to perform better. Compression can also provide stability and an increased awareness of where the body is in space (proprioception).

Yet a number of the manufacturer’s claims are impossible and therefore misleading. Compression cannot decrease or eliminate vibration, nerve malalignment or early carpal tunnel symptoms, and using them at night can compromise circulation. The manufacturer also contradicts themselves by saying that WristGrips prevent the wrist from going into extreme angles, but then says they allow the wrist and hand to function 100 percent normally.

I tried wearing a pair of WristGrips whilst playing the flute, piano and typing I found them very uncomfortable. Done up lightly they provide no support at all, but when tightened my hands went numb after about 30 minutes. The only use I can see for WristGrips would be as a retraining device as the range of motion in the wrist is
slightly limited, making it uncomfortable to play with extreme wrist movements.

I tend to use a splint when retraining wrist positioning at an instrument. Splints impose extreme limits on wrist movement and are very frustrating to wear but enable the musician to keep a neutral wrist while exploring the use of more shoulder and elbow movement. The enforced wrist position is of course completely artificial as wrist movement is required to play. Yet people often use too much wrist and blocking it can encourage increased movement in the upper arm. When the splint is removed, they find it incredibly liberating to adopt this technique since more power comes from the larger muscle groups it employs, allowing them to play heavier passages with less strain on the forearms and hands.

Overall, I would not recommend the use of WristGrips as they may encourage musicians to keep playing even when they feel pain. Too many of the manufacturer’s claims are unclear and cannot be supported by clinical evidence. A readily available wrist splint is a far better option if wrist position retraining is the objective. Other treatment options should be sought if pain and discomfort result from over-practicing or playing.
Katherine Butler is a clinical specialist in hand therapy and honorary associate professor at University College London and Plymouth University.