Objectives: Playing-related musculoskeletal disorders (PRMDs) are a recognised problem in elite (college/conservatory or professional) pianists. The aim of this study was to explore the behavioural, emotional, and physical world of the elite pianist and the interaction between this world and the experience of having a PRMD. Methods: A qualitative, grounded theory methodology was used. One-on-one interviews were conducted with 18 elite pianists, 6 health practitioners, and 6 teachers who had had or managed PRMDs. Interview questions focused on the experience of being an elite pianist, the impact of PRMDs on piano playing and other activities, and the pianists¿ feelings about the effects of PRMDs. Interviews were transcribed and then analysed using grounded theory. Results: Major categories were ¿pressure: external,¿ ¿pressure: internal,¿ and ¿culture of silence.¿ The central category was ¿playing through pain.¿ Elite pianists experienced many internal and external pressures but were reluctant to declare physical problems due to a culture of silence, and they played through pain. This situation led to development or worsening of PRMDs, with physical, psychological, and global effects. Worsening symptoms or an impending examination or recital led pianists to seek treatment. Poor medical awareness of musicians¿ needs often resulted in suboptimal management of PRMDs. Conclusion: Open discussion of PRMD issues in elite pianists and dissemination of PRMD prevention and management information are warranted to help prevent the physical, psychological, and global effects of such disorders.