Accommodations for Piano Students With Hypermobility

Now that many piano studios and the pedagogy field are embracing greater inclusivity, we’re seeing a lot more piano students with atypical bodies. Many students have hypermobility disorders like Ehlers-Danlos Syndrome (EDS). 

However, few resources on teaching this unique student population are available to us teachers. As a hypermobile pianist myself, one whose early teachers largely had no idea how to work with my collapsing joints, I aim to fix that!

Hypermobility disorders don’t always improve with age and/or physical therapy, and in many cases worsen or degenerate with age. Therefore, as teachers we should focus on an accommodation-based mindset rather than a rehabilitation-focussed approach.

In addition, hypermobile pianists will most likely have to periodically rework or add more accommodations to their existing piano technique as they age.

So what are some possible accommodation needs we should be aware of in the studio?

This is largely dependent on the student’s particular type of hypermobility disorder. Knowing the more common accommodations can prepare you for those moments when you encounter a student in need.

Physical Differences & Body Accommodations

When preparing to work with hypermobile students, consider their physical differences and suitable methods for dealing with them. 

Interoception

The concept of interoception refers to a student’s poor body awareness and internal organ signaling. Dealing with students struggling in this area may require:

• More frequent snack and bathroom breaks than their age suggests. Often urges aren’t necessarily felt until they’re extreme.
• Regular trips to the bathroom due to problems absorbing plain water. This condition is known as POTS (Postural Orthostatic Tachycardia Syndrome) and is a common EDS companion.

Skin & Nails

Students with hypermobility often have very soft, fragile skin and brittle nails. When this is the case, be sure to make adjustments like these:

• Take extra care with page turns to avoid paper cuts (I’m fully iPad faithful now, partly for this reason!)
• Avoid repertoire with a lot of glissandi, or create substitutes for glissando passages, like quick scale bits
• Be flexible and gracious when it comes to recital shoe choices due to fragile skin immediately blistering when shoes don’t fit just so. (Dress shoes are more frequently a problem!)

Joints

You may find that hypermobile students have joint laxity, dislocations and/or subluxations (slight misalignment in the vertebrae). Requirements for these students can include:

• Constant foot support (such as pedal extenders) if the hips are affected. It’s also wise to avoid organ studies until hip stability is evaluated.
• Ring splints on the fingers in extreme cases or while an injured joint heals.
• Rewriting (or avoiding) passages that ask players to cross the arms over each other since these students often have loose shoulder joints. You may also want to allow the student to “scoot” across the bench more often to align behind different registers.
• Reworking passages that are too big for their hands. Students who are hypermobile may not have a stable hand “arch”. This can make stretching more dangerous, or make players think their hands are bigger than they are.

If you’re looking for fun ways to address floppy fingers due to hypermobility, The Floppy Finger Predicament from ‘The Piano Physician’s Handbook’ is just what you need. Grab it in ebook or hardocpy on Amazon or wherever you like to buy books. Want a preview? Enter your details in the box below and I’ll send you an excerpt from the book.

If you’re a VMT member, you can access the ‘Piano Practice Physician’s Clinic‘ course straightaway. Not a VMT member? What are you waiting for?! Take a look at the membership and join today at vibrantmusicteaching.com.

Health Concerns

Immune differences and chronic pain conditions are relatively common for hypermobile students. This can affect their attendance as well as their experience in the studio environment.

• Students with weakened immune systems or bundled chronic pain conditions (fibromyalgia, migraines) may require a more flexible attendance policy. Consider an “a la carte” model where they pay per lesson, and schedule weekly rather than yearly .
• Pianists with overly touchy immune systems (even Mast Cell Activation Syndrome, a nasty immune overreaction disorder) may have numerous allergies. Be sure to restrict the food items you have around them in the studio or at recital receptions.

Body Temperature 

Dexterity problems due to temperature regulation issues commonly appear in students with hypermobility. Be certain to keep these matters in mind when teaching affected students.

• Raynaud’s Phenomenon is a common EDS/POTS side effect which can make the hands and feet lose blood flow. This means students can get too cold to play fast passagework at their typical technical level.
• If your area’s winter season is particularly cold, on-the-fly simplifications or conservative repertoire choices may be needed. (“Hot Hands” warmers sometimes make it worse!)
• Layer-able performance wear is always a good idea in case a recital venue is too cold or too warm.

Eye & Vision Issues

Keep in mind that hypermobile students commonly have eye issues like nearsightedness, dry eyes, excessive tearing or variability in the prescription needed for glasses.

• Adjustments will vary depending on the eye issue the student has, but some helpful accommodations may include large-print scores or printing PDFs at >100% resolution. Please give grace when a student is having blurry vision that day (This could be a good opportunity to focus on improvisation, aural skills etc.)
• I personally experience nystagmus, or shaking eyeballs, when extremely tired. While students are unlikely to be playing 4-hour blocks each evening like I did as a cruise ship pianist, it’s good to be aware of this tendency when students are looking toward professional piano careers.

Stiff Body

Yes, this seems like an odd one, but some bodies overcompensate for defective ligaments by stiffening the muscles. This is a way to hold the bones together, especially if a student has played contact sports which require bracing for impact. 

This reaction is unsustainable and leads to muscle injury down the road, so it’s important for us to spot these movement patterns in our students.

Brain Accommodations

In general, expect to make adaptations for cognitive differences like proprioception and body position sensing issues (technically termed dyspraxia) and ADHD/autism, all of which often come with (in particular) Ehlers-Danlos Syndrome.

ADHD/Autism

There’s already a growing literature on how to work with ADHD and autistic piano students, so I won’t spend a ton of time on that here. I will say that in my studio, I’ve found the correlation between hypermobility and this neurotype is strong. So if I see significant hypermobility on a student’s first lesson day, I’ll automatically teach them in an autism and ADHD-targeted way.

One accommodation I strongly recommend for ADHD/autistic students is to allow them to have their lesson on a non-school day, or in the middle of the school day, if possible.

This ensures that post-restraint collapse and sensory overwhelm from the school day don’t interfere with lessons. For students taking ADHD medications that wear off by those typical after school lesson times, this strategy is particularly helpful.

Dyspraxia

Dyspraxia may prevent muscle memory from forming, since the brain isn’t receiving information about the body’s changes of position and muscle movements. Therefore, if yours is a memorisation-focussed studio, these students may need to use other memory types, like intellectual/analytical memory, aural memory or visual memory, to learn their repertoire. 

Those who have the incredibly common comorbid ADHD may appreciate flexibility in memorisation requirements and a greater focus on playing from the score. After all, I’ve never been paid to play specifically memorised repertoire, but I am paid regularly, and often handsomely, to sight read as an accompanist and church musician.

Technique Accommodations

In short, hypermobile students need much more intense and consistent attention to technique acquisition and healthy body usage. That’s because this population has much less “room for error” for misuse before injury happens. 

The Right Teacher

Hypermobile bodies are just more delicate. This means that such students need to enrol immediately with the most knowledgeable technicians who can help them reach their full potential.

This is an important point for all students, but there’s also much less room for error in teacher selection with hypermobile students.

Proper Alignment

Teachers of hypermobile students should take the utmost care to make sure the student is showing proper alignment behind the finger being used in that moment. 

Position-based approaches can be used within the first few weeks of lessons. Hypermobile bodies tend not to have inherent stability and the position approach can briefly provide that.

Students shouldn’t be encouraged to think in singular, static positions, which can cause tendon and/or ligament friction at the “break” points in a misaligned hand/arm.

Finger Swing/Stroke

In addition, the “hold an apple/egg/lemon/ladybug” (or insert fruit here) concept is especially unhelpful for hypermobile pianists. Instead, attention should be paid to generating enough momentum through the basic finger swing/stroke from the lowest knuckle.

Further Reading

For further reading on the type of technique that helped me, I highly recommend tracking down a copy of Sándor’s ‘On Piano Playing’. Although out of print it can sometimes be found from used booksellers. I’m incredibly grateful to Sándor’s student, Michele Cooker, who fixed my technique and likely saved me from permanent injury back in 2004.

For more help teaching piano to students who have special needs, check out that section of Nicola’s Planning Lessons resource page.

Do what you have to do!

As mentioned earlier, I also strongly encourage rewriting potentially hypermobility-unfriendly passages in a student’s literature. After all, as Adele Marcus of Juilliard once said, music is an aural art – do what you have to do!

Are you recognising some of these traits in yourself or your students?

I hope these ideas empower you to teach your hypermobile students with more wisdom and confidence! Tell us how it goes in the comments below.