Musicians

Treating wrists and forearms hurt from playing the violin

violinist-treatment

Tatz醫生的醫式好像中西醫運合的。他好像中醫會用全面的方法,但他也會用現代的機器而不會只是依靠傳統。

我是由於拉小提琴傷了手腕及前臂。我看了西醫物理治料而感到它們慣例的伸展活動和超聲波沒有效, 而Tatz醫生這樣完全明白。他第一眼見到我已經說我整身體緊。這個我已經知道,而我都下意識知道這個問題對我平常一舉一動有挺大的影響。可是,從來都沒有人(過去的物理治料師,健身教練等等)跟我應對過這個全面的問題。

Tatz 醫生會動生幫你按摩及鬆解你的肌肉。第一天他沒有對我的手腕或前臂做任何東西,他跟我說不想一天醫好我,而他只按了我的腰和背部。他也教我一些超輕柔的“運動”,是很微細的整體左右擺動。每次最後的15-20分鐘,他會放你在一部磁性機器下“睡覺”。下來的預約,他有按鬆我超繄的肩膀,腿等等,及教我多些擺動的運動。第三個預約,他按了我的手腕(不是無痛的!),而我的手腕這大半年沒感到過這樣好。但是, Tatz 醫生也說,“We have a big project” (我們有一個大工程)。他要我用八星期,二十次見他。

Tatz 醫生是一個好人,也想醫好你。 他會多說,人愈用腦多,身體就愈繄。他多強調,我們的身體自然懂得動。他也說,身體放鬆“loose”,比強的身體好。


Dr Tatz’s style seems like a mix of Eastern and Western philosophies. He takes a holistic approach like Chinese doctors, but he also uses modern technology and doesn’t rely on tradition totally.

I hurt my wrists and forearms from playing the violin. I had been to a physical therapist and found that their prescriptive methods of stretching and ultrasound useless, and Dr Tatz understood completely. The moment he looked at me he already said that my whole body was tight. I was already aware of this, and I already had a suspicion that this affected a lot of what I did in life. But, no one (including previous physical therapists, fitness instructor etc) had ever addressed this for me.

Dr Tatz heals you hands-on, massaging you out and loosening your muscles. Our first appointment he didn’t do anything to my wrists or forearms; he said he didn’t want to heal me in a day, and he worked on my core, front and back. He also taught me some super mild “exercises”, which were sort of micro movements that involved shaking/twisting left and right fairly quickly. The last 15-20 minutes, you are almost always put under some magnetic machine to “sleep”. Our next appointments, he loosened my shoulders which are super tight, and my legs, etc, and gave me more similar exercises .On our third appointment, he massaged out my wrists (it wasn’t painless), and over the last 6 months my wrists haven’t felt better. But, as Dr Tatz says, “We have a big project.” He wants me to come for 20 sessions over 8 weeks.

Dr Tatz is a nice man, and he wants to get you better. He says often, that the more you use your brain, the tighter your body. He emphasizes that our body naturally knows how to move. And, he also says, that a loose body is better than a strong body.

Treatment of Trumpet Player’s Swollen and Stiff Right Hand Fingers

trumpet-hands

Bud is professional trumpet player. His strong hands have been crucial to his successful life as a musician. While his wife has spoken about Shmuel Tatz, PT, PhD since the time they met, Bud has been quietly skeptical about what a physical therapist can really do. Meanwhile, Tatz has taken care of three generations of his wife’s family: First his wife’s father, then his wife and now their son.

Bud continued to be a skeptic until his right hand started giving him grief. The right hand being responsible for a trumpet player’s three musical buttons (valves) responsible for placing the instrument’s notes. It wasn’t an accident per se, but probably Bud’s life-long playing that caused his right hand fingers to become swollen and stiff. This was not only affecting his trumpet-playing technique, but had the potential to interfere with his career, not to mention his gift as a musician. He was concerned.

First, Bud went to an MD who diagnosed his condition to be polymyalgia rheumatica. He received a series of steroid shots plus medication. While Bud received some relief, it really hadn’t solved his problem – his fingers were not healing. His entire hand was in pain. As the weeks went on, he became continually worried about his right hand and the consequences it could have on his life-long career.

Bud’s wife suggested, “Why not go see Tatz? What do you have to lose?” So, he eventually he did.

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Rethinking Physical Therapy for Musicians

As natural as music is to the human ear, the same cannot be said for the process of making music. When compared to laughing, walking, crying, or even screaming, playing any instrument is not a natural function of the body. As musicians, we spend thousands of hours performing actions that our bodies are capable of, but not designed for. This inevitably leads to tension and discomfort — the feeling that something is out of tune, as opposed to the in-tune, fluid feeling that most of us remember from our childhood.

As an athletically inclined music student, performer, teacher — trained at NYU and the University of Michigan in clarinet performance — I have always had a keen awareness of the effects my physical condition had on my playing. So when it came to choosing a backup career, physical therapy seemed a natural fit. Searching for a therapist with a similar background that might be able to help me learn to work with musicians, I contacted Dr. Shmuel Tatz, whose work with performers had been described in a lengthy New York Times profile of him titled “The Therapist as Shaman.”

The Physical Therapy Assistant program I am enrolled in required only 50 hours of volunteer work, but I ended up working with Dr. Tatz for more than a 150. The experience has completely changed my concept of physical therapy and what is realistic when it comes to protecting our health as musicians.

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Treatment of the Face for Trumpet Player

For trumpet players, and most wind instrumentalists, there is a lot of activity in the face muscles and scalp while playing and practicing. Though we spend many hours trying to make our playing feel natural, playing any instrument is not a natural activity compared to laughing, crying, or even screaming.

From being in an unnatural position, it is inevitable that we develop discomfort in the body. Some people recover quickly after long periods of practice, but some people do not. They need help with the recovery process.

In an effort to improve recovery, control, and stamina, many people try to make stronger muscles. But this is the biggest mistake. The right approach is to make stronger muscles that we have better control over.

The first thing to learn is how to control the sphincters of the face, which are the eyes and mouth.

The second is the scalp. We know that using the muscles of the lips is important for wind musicians. But the lips are connected to the eyes, and the eyes are connected to the scalp. To keep the muscles of the head in harmony is the best way to support the embouchure.

The third area to address is the jaw. First we must learn to the move the jaw actively. This includes moving the jaw left to right, forwards and backwards, and up and down. After this we can progress to moving the jaw passively by holding it in our hands and moving it freely as if it were floating in space. The jaw should hang freely without fighting gravity.

After moving the jaw actively and passively, the third skill to learn is manual maneuvering and self-tuning. This includes self-mobilization, message, and the application of acupressure points.

When the musician has learned these skills he will have the tools to maintain his body and help it repair after demanding playing sessions.

Flute Player’s Pulled Neck Muscle Treatment

Clara, a flute player, came in for therapy on Tuesday morning reporting that she was in too much pain to play her instrument and could not function normally during the day. She was exceptionally busy the previous week playing upwards of 8 hours a day and performing three concerts in one week. On the Monday morning after this week, the day before her first treatment, she was drying her hair and pulled a muscle in her neck. She felt a sharp pain that resulted in an immediate loss of motion. She was un-able to play her flute that day due to intense pain. Clara had had no previous episodes of neck injury but commented that she plays flute, so she has some “inherent neck tension.”

She immediately went to seek medical help. She made an appointment with an internist for that Monday afternoon. The physician told her to make an appointment with an orthopedist. This usually takes about 2 weeks. In the meantime, she was instructed to apply ice and take Advil. Clara made the appointment but was not satisfied with waiting. She was also told by the physical therapist at Juilliard that no appointments were available until the following week. It is essential for a working musician to be able to receive immediate treatment and begin practicing again.

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Student Musicians’ Injury Treatment

I spoke with a client of Dr. Shmuel Tatz’s named Sarah, recently in the office after her treatment.  She is a violinist at Mannes conservatory, which is part of the New School; the campus is on the upper West side.  She came to Shmuel initially for about 3 months of treatment and by the end she showed significant improvement.

Most importantly, she is now able to play again with ease and more comfortably. She feels much better overall.  She gave a glowing review of Shmuel’s abilities, “He is wonderful, he is the best, he is better than everyone else I’ve seen.”

She is never sore after a treatment and is able to play at events and concerts the same day, which is a concern for musicians I’ve learned. In many cases musicians in physical therapy may have to schedule therapy on days they don’t play, because you don’t want to be sore from a treatment on the day of a performance.

The young student said that her school does not have any formal support programs in place to help musicians who are experiencing pain from playing their instruments.  She wished that they did have this option available, as many need physical therapy services.

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Finding the Right Physical Therapist

For musicians, professionally related physical trauma can be one of the worst kinds of trauma because working musicians can repetitively, step-by-step, hour-by-hour continue to damage their bodies.

Musicians’ injuries usually don’t happen overnight, and healing doesn’t happen in one day. It takes time. Injuries related to the music profession can become aggravated because they are generally related to overuse and are difficult to avoid.

It is the job of a good physical therapist to help a musician heal in the shortest amount of time because the next day he or she may be off to London, Moscow, or Tokyo. Whatever the case may be, working musicians must be in excellent physical condition.

I have been working with musicians for more then 30 years. Using a hands-on physical therapy method, I have learned to feel the musician’s pain so that I can help him or her heal as quickly as possible.

I also have learned that being a musician is not just a profession, it’s a lifestyle. In order to play, you have to be in top shape, but you have to be prepared for injuries as well. This means you must know how to find the right kind of physical therapist in whatever city you are playing, just in case treatment becomes necessary for the show to go on. To help I have compiled a list of frequently asked questions:

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Tune Your Body

I’ve worked with thousands of musicians from Rosalyn Tureck, Mstislav Rostropovich and Issac Stern, to Leon Fleisher, Richard Goode and Gidon Kremer. Most of the pianists I have seen have had good training in the mechanics of playing the instrument properly: how to sit… the importance of arm weight and relaxation… and having a nicely rounded hand. Even so, there are many pianists for whom the normal pedagogical training simply doesn’t apply, and yet, regardless of their anatomical make up-whether their hands are large or small, whether they play with straight fingers or curved or hold their hands high or low-they still achieve wonderful results. Vladimir Horowitz often played with almost completely straight fingers. Glenn Gould sat very low and almost seemed to play from under the keyboard.

What was their secret? They managed to be at the keyboard in s position where their muscles and ligaments were working for and not against them. It is possible to play for long periods of’ time without experiencing any tiredness or pain. And to achieve that, the body must be as in tune as the piano.

One of the ways that you can help your body to help you is through active physical exercise. Another is through passive exercise, and by that I mean lying on a table and allowing someone like me to move your body. I will talk more about that but first, here are a few tension-relieving exercises that can be done by any pianist when taking a break from practicing, (hopefully after 5000 minutes at the keyboard). Please note that none of these should be clone with out first having an evaluation by a physical therapist to make certain they are right for you.

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Professional Performers: Christa Ludwig, Alexandra Danilova, Isaac Stern

Located in Carnegie Hall, Shmuel Tatz’s studio is in the center of New York’s artistic community. And with good reason. Many of Tatz’s clients are virtuoso performers whose work places unusual stress of their bodies. This is the kind of stress Tatz has honed his Body Tuning methods to relieve.

Isaac Stern is one of the many violinists who has benefitted from Tatz’s help over the years. “Not only is Shmuel an enormously gifted, highly trained experienced physical therapist,” says Stern, “he is also knowledgeable in the unique needs of artists who so often have problems that are caused by professional work.”

Whether it is the musician’s repeated motion of bowing a violin, the singer’s breathing techniques or the dancer’s wear and tear on muscles and joints, all performing artists demand a lot of their bodies.

“My instrument is my body, and I need a healthy body to be able to sing,” says Crista Ludwig, one of the world’s great sopranos who performs internationally. When she is in New York to sing at the Metropolitan Opera, she makes a point to visit Tatz for Body Tuning.

“My back is always the first to go,” she explains. “The breathing I do as a singer involves holding my breath when letting the tone out and slowly breathing with it. If I have a long phrase to sing, holding my breath can make my back very stiff. On top of that, if I am nervous it always goes to my back.

“Shmuel has very special hands,” she adds. “He always goes deeper than massage and really works with the joints. When I am with him I can feel where the problem is. He relieves my tension and as a result my voice always gets better.”

Another thing Tatz has taught her is the importance of exercise. “We singers are always shrinking because we don’t move,” says Ludwig. “We sit in planes or in taxis or we stand on stage, but we don’t do any kind of sport. Shmuel really knows the right exercises for each age and body weight.”

The importance of taking good care of you body as you get older cannot be over-stresses, says Tatz. In the performing arts this is particularly true of dancers for whom endless hours of training ultimately takes its toll. Alexandra Danilova whose career as a ballerina has spanned much of this century and some of the most famous ballet companies worldwide, including the Maryinsky in Russia, the Diaghlev in London, and the School of American Ballet in New York where she taught for many years, works with Tatz for just this reason.

“When you dance you must look after your muscles,” she says. “One cannot neglect a little pain, you must take care of it and learn exercises to do to stay healthy.”

Danilova continues to live by this principal in her retirement and goes to Tatz once a week for Body Tuning. “I still work on my whole body,” she says. “I don’t want to stop or I’ll get stiff.”

“Shmuel really appreciates dancers,” she adds. “He knows the way their bodies work.” Ballet, she explains, has many parallels with Yoga. Exercises such as the pontes de bras and adagio come directly from Yoga. The reason Body Tuning is so effective for dancers, she says, is that it too is based on Yoga and therefore is a natural extension of the exercises dancers do in Ballet.

For Ludwig and Danilova Tatz’s work shows a particular sensitivity to the art. But Body Tuning for both has not just been physical therapy and massage to relieve pain or stress. Working with Tatz, they say, has taught them important new ways to think about movement. This influence has enabled them to work by them selves on using their bodies in a way that is more relaxing and, in the long term, more healthy. “Because I have a bad back it is often painful to move,” says Danilova. “But Shmuel has found a way to help me stand up straight. I have to say to myself ‘I am the queen.’ It feels a little strange every time I say it, but it really helps me to balance. If I don’t say this when I get up in the morning I find my self falling into a droopy position, saying this reminds me to hold myself up.” Ludwig says Tatz has changed her sense that exercise needs to be done quickly. “Every time he shows me exercises he always reminds me to do them slowly. I can always hear him say it, ‘slowly … slowly.’ Now that I have realized the importance of this I am dissatisfied when working with anyone who is not Shmuel.”

Both Danilova and Stern agree. Tatz’s highly developed technique and sensitivity to performing artists is unparalleled. “It is not only too rare to find this combination,” says Stern. “He can be an invaluable aid to any performing artist.”

HEALTH CHRONICLE
by Alice Nadine