Editors Notes:

this whimsical paper is shown here at the inauguration of the Tasman Medical Journal as an example of the final formatting of *pdf versions of future publications and the formatting of citations and other elements, and to stimulate the interest of possible authors. It will be replaced by more traditional scientific papers as these are received and accepted for publication.

Tasman Medical Journal

ISSN: 2652-1881

Is Chopin Responsible For My Cervical Radiculopathy?

J Alasdair Millar

ABSTRACT

  1. Piano playing is regarded first as a form of musical and hence artistic expression However, it is physically demanding and can cause musculoskeletal damage. Frederic Chopin (1810-1849) was aware of this and advised one student that she should play his etude opus 10 No 1 as he demanded, to avoid damage to the hand.
  2. The author developed L arm neurological symptoms and R wrist arthritis while practicing the above etude and the 2nd Ballade (opus 38). Though the responsible L cervical skeletal dysplasia and wrist osteoarthritic abnormalities respectively were almost certainly chronic, it is possible that th attempt to master these demanding pieces produced acute symptomatic deterioration.
  3. Chopin may be blameworthy, albeit indirectly, for my physical deterioration.

Full Text

Introduction

Frédéric Chopin (1810-1849) composed predominantly for solo piano.  His music remains popular with the listening public and challenging for pianists.  In his lifetime the pianoforte was still a young instrument, having been made possible by the invention of “escapement” (of the hammer from the strings) by Bartolomeo Cristofori around 1700.  The resulting augmentation of dynamic range was exploited by Chopin (and Beethoven before him) and, as evidenced by Jane Austen’s text in Pride and Prejudice, the “piano-forte” was a feature of English drawing rooms by the time of Chopin’s birth.1

In exploiting the instrument, Chopin recognised substantially increased stressors on the hand.  He warned in respect of his étude Op 10 No. 1, which consists of rapid upward and downward arpeggios involving repeated spans greater than an octave, that “…this étude will do you very much good if you study it correctly.  It will stretch your hand.   But if you study it badly, it will injure you”.2  This opinion showed amazing foresight, since contemporary understanding is that playing a musical instrument is an athletic activity, and to ignore that fact is to invite the possibility of various injuries.3 Indeed, a combination of adverse factors affecting a keyboard player can cause symptoms and injuries of the entire upper limb structures including the neck.3

Relevant history

Recently, I worked up Chopin’s 2nd Ballade Opus 38 in F major and the Opus 10 No 1 étude.  The former interesting and technically difficult piece, published in 1839 but with earlier drafts from around 1835, is a study of extreme contrasts.  It includes two semiquaver arpeggio passages marked Presto con fuoco (fast, with fire) and a long violent coda marked Agitato, which, like Op 10 No.1, contains difficult arpeggio passages, in semiquavers over two octaves.  These passages contrast with several soft and melodic Sicilienne passages.  They combine to make the 2nd Ballade a most difficult piece. Its demands under my hands as I became familiar with it seemed to increase rather than decrease, possibly because, as the tempo increased progressively towards that implied by the composer’s markings, my fingers failed to keep up.

Opus 10 No 1 consists of ascending and descending arpeggios within intervals of 10ths, 11ths and even 12ths, played rapidly.  It is designed to strengthen the R hand, and the L hand has little to do but track or announce key changes.  At some points the fingering is challenging and marked abduction and adduction of the wrist is required.

My workup of the Ballade occupied February to October 2017, with one break of 4 weeks in May/June.  In late July I developed what I thought was a recurrence of L supraspinatus tendonitis suffered 10 years earlier.  Supraspinatus tendonitis is associated with playing the piano.3   My original symptoms responded quickly to corticosteroid injection.  However, on this occasion the typical shoulder pain and its radiation to the elbow was accompanied by neurological symptoms, namely paraesthesiae affecting the first and second fingers on the left, consistent with MRI findings of severe ipselateral disc protrusion at several levels including severe nerve root compression at C7.  I consulted an orthopaedic surgeon whose examination revealed L triceps muscle weakness and wasting, also consistent with C7 nerve root compression.  I subsequently developed similar symptoms on the R, temporarily causing great discomfort and severely limiting abduction of the R arm.  Practice became impossible, temporarily. Fortunately, the R-sided symptoms abated quickly, assisted by a judicious mixture of paracetamol, ibuprofen and white wine.  This allowed me to perform the piece to a small invited audience in October 2017. I addition to the above, in 2016 I became conscious of joint pain affecting the medial aspect of the R wrist, with tenderness over the scaphiotrapeziodal joint.  This occurred several months after initially attempting Opus 10 No 1 the previous year.  I have continued to practice this piece taking Chopin’s advice into account but nevertheless more likely in a harmful manner that would have attracted Chopin’s strong disapproval.  This symptom also became more noticeable during 2017 as I was also practicing opus 38, and remains.  However, I have the impression that the progression of the wrist pain has not been unduly adversely affected by my continued and so far unsuccessful attempts to scale this piece.

Summary and conclusion

My previously asymptomatic state was transformed during the practicing of two of Chopin’s most demanding pieces to one of substantial but fortunately temporary loss of neurological function affecting the R hand while working on the 2nd Ballade, and progression of a previous hand arthritis made manifest originally by practice of the étude opus 10 No 1.  It is likely that the R wrist osteoarthritis was exacerbated by injudicious practice of the two pieces.  Might one also suspect a contribution to the radiculopathy?  This is less certain, but one’s posture at the piano is a matter of controversy and practicing difficult pieces tends to induce muscle stress, of psychological or physical origin, which can include the hands, arms, shoulder girdle and neck.   Contracting the shoulder muscles at the keyboard is a common fault and can induce muscle pain and loss of function.3,4

The possibility that my discomfort was partly grounded in the work of a genius such as Chopin acts as a consoling counterweight to my symptoms and errors of posture, stress and piano technique.  I offer this history as a warning flag for other amateur pianists who, like myself, have the temerity to attempt pieces that are in fact beyond them.  But is not striving to achieve what initially appears impossible always admirable, as the basis for beneficial personal and social change?

REFERENCES

  1. Austen, J. “Pride and Prejudice”. T. Egerton‎, London, 1813. “Miss Bingley moved with some alacrity to the piano-forte, and after a polite request that Elizabeth would lead the way, which the other as politely and more earnestly negatived, she seated herself.” [Penguin Group (Australia), Ch 10, p. 55 (2008)].
  2. Esteban J, Ed. (reporting Chopin’s warning to his pupil Mme Streicher). Chopin Etudes opus 10 for the piano. Alfred Publishing Company, New York, USA. 1973 (page 6).
  3. Groff, CL. In pursuit of pain-free piano playing. Presented in partial fulfillment of requirements for the degree of Master of Arts in the Department of Music, University of Central Missouri. October 3013. In Central Space. Accessed 13 December 2017.
  4. Spanswick, M. Resolving Tension in Piano Playing: Article for EPTA’s Piano Professional. https://melaniespanswick.com/2015/01/24/resolving-tension-in-piano-playing-article-for-eptas-piano-professional/. Posted 24 Jan 2015. Accessed 13 December 2017.

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AUTHOR INFORMATION

PhD FRACP FRCP J Alasdair Millar

OCCUPATION
Physician and Clinical Pharmacologist
Editor, Tasman Medical Journal
INSTITUTIONAL AFFILIATIONS
Curtin University Medical School, Bentley, Western Australia 6845

Tasman Medical Journal, PO Box 499, Denmark, WA, 6333, Australia