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About the Lister-Sink Institute

The Lister-Sink Institute is an educational organization dedicated to promoting a healthful, well-coordinated keyboard technique to maximize musical artistry and help prevent potential injury at any point in the career.

Cues | Tips to Prevent Pianist Injury

“. . . she will be historically noted . . . for the impor­tant and necessary marriage between the medical/scientific and the musical/artistic worlds . . . Barbara Lister-Sink has this unbeatable combination of talents, knowledge and experience to finally build a bridge between the worlds of music and science.” 

— Jaiyoung Ryu, M.D. Professor & Chief, Section of Hand Surgery Department of Orthopaedics, West Virginia University
It is possible to play with control, ease, agility, and power–without unnecessary tension, discomfort, or injury–and develop our full musical potential without physical impediments, for a lifetime. On this page of the website, you will find many resources to aid your quest for developing well-coordinated injury-preventive piano technique.

Cues for Injury-Prevention

I. Preparing to Play

  • Watch the BREATH
  • Balance torso on SITTING BONES
  • Allow SPINE gently to lengthen
  • Allow SHOULDERS to remain relaxed
  • Free NECK of unnecessary tension
  • Balance HEAD lightly on torso (like a helium balloon)
  • Feel pendulous ARMS supported by torso
  • Sense FEET supported by floor
  • Allow LEGS to fall gently apart
  • Watch the BREATH

II. While Practicing & Playing

  • Maintain KINESTHETIC AWARENESS (monitor spine/neck/head constantly)
  • Release MEDIAL DELTOID regularly (let upper arm hang as often as possible)
  • Release EXTENSORS regularly (lift forearm with biceps and let hand hang slightly to prevent accumulation of extensor tension)
  • Keep WRIST FREE when moving side-to-side or up-and-down (release extensors and let fingers “hang”slightly from wrist)
  • Rest NON-PLAYING FINGERS on keys (don’t waste extensor muscle energy holding non-playing fingers in the air)

Potentially Harmful Habits of Body Use

Torso/Upper body

  • General poor spinal alignment and imbalance resulting in loss of skeletal support and the 4 natural curves of spine–cervical, thoracic, lumbar and sacral
  • Slumping, compressed torso resulting in inadequate breathing, spinal misalignment, and improperly supported arms
  • Failure to find optimal balance and mobility of torso on sitting bones
  • Unnecessary raising and tightening of trapezius (shoulder) muscles
  • Jutting head forward, tightening jaw, tongue, and facial muscles
  • Tightening of neck muscles


  • Unnecessary and continuous contraction of triceps (upper back arm) in opposition to biceps
  • Continuous holding out of upper arms (like flying buttresses) instead of allowing the upper arms to be pendulous and release into gravity from the shoulder socket
  • Continuous tightening of wrist and hand area
  • Sustained excess tension in lower arm
  • Hyperextension (excessive lowering) of wrist
  • Gripping-type movements and contractions of the hand muscles
  • Lifting of fingers while curling them in (co-contraction) or holding fingers up
  • Continuous fixation of joints resulting in muscle fatigue, loss of joint mobility and flexibility

Legs (for organists)

  • Misalignment of spine so that balance on sitting bones is not established and maintained
  • Holding or squeezing together at knees instead of allowing legs to follow the natural alignment out from the hip sockets
  • Unnecessary tightening of ankles and lower legs instead of allowing them to hang and swing as freely as possible

REMEMBER: Work WITH gravity, not against it.

Checklist for the Healthy Pianist

I. Whole Body/Mind/Emotions/Spirit


  • Eat a healthy diet with adequate protein, avoiding processed foods.
  • Eat 2-3 fruits and 3-5 vegetables daily
  • Minimize sugar & caffeine
  • Drink 6-8 glasses of water daily


  • Do 20-30 minutes of aerobic exercise 3-4x a week
  • Train moderately with light weights or elastic bands 2x a week


  • Sleep 7-8 hours restfully


  • Restore the body and mind each day = HAVE SOME FUN!
  • Take 5 minutes 2x a day for deep breathing in a relaxed position

II. Before Practicing or Performing


  • Do a 5-minute progressive relaxation scan on floor or in a chair
  • Stretch like a cat until the body feels lengthened and supple
  • Stand comfortably (knees soft), lengthen spine and BREATHE
  • Gently & slowly:
    • Roll shoulders
    • Rotate neck
    • Lengthen arms over the head, alternately 4x
    • Rotate the fingers, hands, forearms, upper arms
    • Bend over gradually, like a rag doll, and lengthen spine
    • Close eyes and focus on releasing unnecessary tension
    • Take 3-4 slow, deep breaths through nose & out mouth

III. At the Piano – Before Playing

  • Adjust bench for best height and distance from the keyboard
  • Balance torso on sitting bones
  • Allow spine to lengthen
  • Relax the shoulders
  • Let the arms hang freely, supported by the torso, from the shoulders
  • Release excess tension in the neck
  • Balance the head like a helium balloon on top of the spine

IV. As You Play

  • RELEASE WRIST by slightly LIFTING the FOREARM regularly
  • LISTEN to your SOUND