The strategies suggested are all valid. These and other strategies are explored in detail in Lora Deahl and Brenda Wristen's Adaptive Strategies for Small-Handed Pianists, published by Oxford University Press in 2017. Redistribution will sometimes facilitate seemingly problematic passages for pianists with small hands. Other important approaches involve neutral hand and wrist positions, conscious alignments, clever fingerings, muscular releases, strategic leaps and discreet use of the damper pedal to provide connection.

Consideration should be given to the student's age, maturity level and physical condition. Overzealous attempts to stretch hands can easily lead to injury. In fact, as reported by Deahl and Wristen, "several research studies have implicated hand size as a distinct factor in the development of physical pain and injury among pianists." These authors dismiss most efforts to stretch small hands as ineffective at best. The exercises prescribed by pedagogues such as Dohnanyi, Pischna and Philippe are now considered to be of dubious value. Still, kneading and massaging the joints and tendons may promote relaxation so that a small-handed pianist may find it easier to manage a widely-spaced interval or chord. One exercise that is generally considered safe involves gentle stretching between the thumb and each finger in turn along the edge of a round or curved table, or along the vertical edges of the piano keys.