Playing‐related pain is a common and serious problem among pianists. Information on cause and prevention is extremely limited due to a lack of scientific research. The purpose of this study was to (1) review and describe risk factors for piano‐related pain among college students and piano teachers that were reported in my previous two research studies, (2) justify the use of an ergonomically modified keyboard as a potential solution for reducing playing‐related pain, and (3) test and evaluate the effectiveness of an ergonomically modified keyboard for alleviating pianists' pain. Both study populations reported high prevalence rates for playing‐related pain: 86 % for college students (n = 35), 91 % for piano teachers (n = 47). For both populations, statistical analyses confirmed that pianists with small physical size (hand size) were more prone to pain. This finding helped rationalize the use of an ergonomically modified keyboard (the key width is 1/16 narrower than the standard) for small‐handed pianists as an ergonomic intervention. To test the effectiveness of an ergonomically modified keyboard, 35 college students played identical music on both the reduced-sized keyboard and the standard keyboard. Observations of video‐recorded performances revealed that small-handed pianists can avoid extreme stretching of their hands when playing on the modified keyboard. Statistical analysis of questionnaire data confirmed that the modified keyboard helped small‐handed pianists to play with less pain and tension. These results warrant the serious consideration of adopting ergonomic principals into the world of piano.