Studies of classical music have typically neglected the physical production of musical sound, in line with an ideal that a musician's performance appears effortless. However, the costs of elite classical musician performance are increasingly becoming evident, as studies capture the very high incidence of injury and doping. This paper takes a preliminary step towards critically analysing elite classical musician performance enhancement measures and health implications by examining the contexts of music performance. Taking the case of pianists, I address the question of ‘enhancement to what end?’ arguing that what counts as optimum performance, and the methods by which it is achieved, is situated historically and socioculturally, and can be specific to factors such as gender. I suggest that studies of elite classical musician performance enhancement and health need to take account of this context, and contribute to this research approach through an examination of the cases of the ‘accomplished’ pianist, the classical pianist, and the female classical pianist.