Ergonomics and biomechanics provide evidence of the disadvantages of a hand that is not well matched to a piano keyboard. These relatively new disciplines can be used to determine the most efficient use of the human body in relation to piano technique. The basis of ergonomics is that ‘form follows function’, i.e. the design of tools and appliances need to be in accordance with the dimensions of the human hand. Biomechanical and ergonomic studies have determined that degree, repetitiveness and forcefulness of wrist motions are risk factors in tendinitis, carpal tunnel and other nerve entrapments. Female pianists, with their smaller hands and more delicate bone structure, are more susceptible to these ailments than males.

Wristen (2000) reviewed established quantitative data from biomechanical studies to describe and analyse the execution of selected piano tasks. She identified several motions and practice habits that have the potential to contribute to injury. These include wrist angle (radial and ulnar deviation, extreme pronation or supination) and repetitive motions of high force. Deahl & Wristen (2003) noted that small-handed pianists are at higher risk due to greater degrees of lateral wrist motion, flexion, extension and deviation that are required than for larger-handed players. Large chords, octaves and arpeggios repeatedly force small hands out of an ‘anatomic neutral’ position. This is consistent with the conclusions of Sakai’s (1992, 2002) clinical studies where he identified the playing of octaves and chords as likely causes of pain and injury.

Chong (2021) highlights increased fatigue affecting small-handed pianists. Fatigue occurs sooner when hands have to be positioned in awkward postures, which are defined as a deviation from a neutral position, such as in long passages of loud octaves.

Boyle (2013), in a presentation to the APPCA Piano Pedagogy Conference in July 2013, presented an analysis of the benefits of reduced size keyboards for smaller-handed pianists from a biomechanical and physiological perspective. This paper reviewed the pioneering work of Otto Ortmann (1929) early last century, which is based on sound scientific principles. Ortmann clearly recognized the significance of hand span in being able to play at the highest level, not just in terms of avoiding pain and injury, but achieving performance excellence. For example: ‘The three factors of hand width, finger length and finger abduction, to which, of course, the similar thumb values must be added, will explain a surprisingly large number of technical difficulties that are often wrongly attributed to defects of coordination or studentship’, and ‘Fine dynamic gradation with the fingers in extreme stretches is physiologically impossible’.

Biomechanical disadvantage also leads to increased muscular strain and mental effort, limiting a pianist’s ability to focus on musical expression. Renowned German scientist, the late Christoph Wagner (1984) hinted at this: ‘Perhaps the most important effect of biomechanical disadvantage lies in the increased load on the central nervous system’. 

Chi et al (2020) conducted a systematic review of ergonomic factors in violin and piano playing. While they found that smaller hand size is correlated with increased PRMD incidence among pianists, they concluded that inconsistent methodological quality and measuring tools or protocols hindered the ability to pool data and form robust conclusions. See also Epidemiological and clinical studies

Refer also to the page on Performance quality.