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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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

Alternative Treatments Can Benefit Musicians: Body Tuning

The physical problems of musicians, particularly injuries due to misuse of the body, have received considerable attention in recent years. Most of the interest has been focused on resolving injuries that already exist, rather than on preventing these injuries. A recent discussion with Shmuel Tatz – a rather remarkable Manhattan-based physical therapist and physical education specialist – provided some important perspectives on these subjects.

Tatz has worked with hundreds of musicians during his career, including such artists as Isaac Stern, Yehudi Menuhin and Vladimir Ashkenazy. He has also worked with countless ballet dancers, and with people who work in other fields. When asked how the average musician’s case compares to that of a dancer or a person who works outside the arts, Tatz pointed out that “everything we do in life can lead to physical problems. It’s just a question of when in life the problems begin. For a dancer, the problems usually start between the ages of 15 and 20; for a musician, between 20 and 30; for someone who has a desk job, between 30 and 40.”

Why this discrepancy? “Dancers have problems the soonest, because they demand so much from their bodies that they abuse themselves. Mussicians, on the other hand, are often taught early on to ignore their bodies. Frequently, when a teacher or parent discovers that a child is musically gifted, the child will be discouraged from engaging in normal physical activities, such as sports. This is very bad for physical development. It can prevent the child from acquiring the strength, flexibility and endurance that serious instrumental study and performance require. It may also set the stage for problems later on.”

A knowledgeable, attentive teacher should recommend that a student’s parents allow normal amounts of physical activities. In addition, teachers’ understanding and awareness of what may turn out to be physical misdevelopment in their students, coupled with referrals for physical therapy when required, can go a long way towards reducing these problems in childhood and afterwards.

“Unlike a ballet dancer, musicians generally require only normal strength and flexibility, to perform at a peak level,” Tatz said. “What is surprising is how many musicians don’t have even normal mobility. Often, the development is uneven – an arm is too flexible in one direction and stiff in the other, and therefore unstable.” Specific physical training is not the norm among musicians. “In fact, musicians are frequently taught to disregard the body, to be result-oriented – only the musical product matters, no matter what kind of physical deprivation or damage is required to achieve that end. In general, people are taught to see a health practitioner, such as a physician or physical therapist, only when they are already sick or injured. In my opinion, that is waiting too long. People need to seek out physical educators and medical doctors who are willing to help someone who is healthy to stay that way, so that certain avoidable problems can be prevented from ever occurring.”

What about adult musicians who are already suffering from physical problems? Tatz uses a unique approach called “Body Tuning” in his work as a physical therapist. “The body is an instrument that needs to be kept in tune, just like a violin or an automobile. When a musician comes to see me, I try to address not only the specific problem he is having, but also more general aspects of movement and posture.”

Tatz’s Body Tuning draws on a diverse combination of Eastern and Western disciplines. One component of his approach is “manual medicine” – hand-on physical therapy, a discipline to which he ascribes European and Australian origins. Manual medicine served as the focus of his studies in Israel. His earlier studies in Russia dealt with the use of “therapeutic modalities” such as laser therapy, microcurrents, ultrasound and magnetic therapy. “Russia is 15 to 20 years ahead of the West in these high-tech applications,” Tatz explains. “These approaches have caught on in the West only during the last ten years. In Russia, electrical modalities and magnetic therapy were already in use in the 1950s.”

Tatz also incorporates disciplines from the Far East, such as yoga, Tai Chi, energetic healing and acupuncture, as well as Western adaptations such as the Alexander and Feldenkrais techniques.

When working with a patient, Tatz begins by trying to establish a spiritual rapport. “I want a musician to feel that I understand what it means to be a professional musician, that I know how much energy and passion go into making music, and what the physical demands are. If a pianist, for example, knows that I understand his art and way of life, he will trust me to help him to take proper care of his body. This trust is the most critical aspect of my work with the patient.” After a personal connection has been made, Tatz begins by testing the mobility in the patient’s joints, the flexibility and strength of the muscles, and the condition of ligaments and tendons.

The second step is to help loosen tight joints or muscles through hands-on manipulation of parts of the body. Next, Tatz shows the patient exercises that can be done on one’s own to increase flexibility and strength in the areas that need improvement. “I start with the specific problem or injury, but in the back of my head I am always thinking of the patient’s general health. Once the particular problem is fixed, I go on to do a more general tuning, as a mechanic would tune up an automobile after replacing a defective part.

“Afterward, I might make some more general suggestions. These suggestions could deal with general physical health, including diet (in which case I have sometimes referred patients to a dietician)m and physical presentation on stage, which is extremely important for performers, but which teachers often neglect to address. The way in which a performer moves on stage is a crucial factor in establishing a connection with the audience.”

The last step in the process is finding out what kinds of physical activity the patient enjoys. According to Tatz, finding a physical activity that someone really enjoys is the best way to ensure that the patient will continue to exercise effectively. Continued exercise is critical, because it is “only when a musician can fully enjoy playing his instrument.” And that is, after all, the kind of enjoyment that musicians seek.

Allegro: Associated Musicians of Greater New York
By Richard L. Simon and Adam C. Fisher

Double Acts

Shmuel Tatz is the favoured physiotherapist of many of Manhattan’s Leading Musicians, among them New York Philharmonic Violinist Hanna Lachert

Physical Therapist Shmuel Tatz and Violinist Hanna Lachert

I WAS INTRODUCED TO HANNA ABOUT 20 YEARS AGO THROUGH her husband, the Manhattan violin maker David Segal; she has been a regular client ever since.

Eighty per cent of her treatment is using hands only and for the other 20 per cent she gets individualized exercises. Just like a violin pupil plays a sonata at their lesson and the teacher after listening to it makes some suggestions, big and small, so only when I am touching or watching the body can I maneuver it and give some suggestions, some ideas. Hanna’s a very good student as, like most musicians, she has the discipline needed to practice. You don’t need to rush to the tuner, you can do self-tuning – if you have problems you need to go to the master, but mostly you can do it on your own.

I wish in our sessions we could talk about the interpretation of music – I can only listen, to hear how in tune the body is. When I’m working on a musician’s body I’m listening with my fingers, my hands; I can feel the vibrations of every muscle, every joint and every organ.

One thing I have learnt from Hanna is not to wait when we have some little problem – the sooner you go to the tuner, the less time it takes to get better. With Hanna, any discomfort in the body – perhaps she feels something a little bit out of tune – and she immediately calls and makes an appointment; it takes a couple of sessions and everything’s OK. She doesn’t wait until the body starts to scream and needs to takes some drug straight away.

I often hear Hanna play. I recently heard her in piano trios by Rachmaninoff, Chopin and her composer brother Piotr. I’m crazy about piano trios, so I enjoyed that very much. Fortunately she’s a very active chamber player and doesn’t only work with the Philharmonic. But not long ago I also heard her play in Verdi’s Requiem. Afterwards we were having some supper together and she was so excited – she said, ‘This time not only you had fun but I had fun.’ It’s a great piece – 90 minutes felt like 15 or 20.

I’ve learnt so much from Hanna and other musicians about their particular physiological challenges and ailments – things that other health professionals haven’t always grasped. For example, I’ve had violinists with shoulder problems who have been to very well-known orthopedists. One of them had a session following a famous tennis player who had got over a shoulder complaint by switching arms – so the orthopedist suggested the same for the violinist! It shows such little understanding of violinists! Hanna knows to phone me before she has an injection or gets some medicine; she knows to trust me.

THE FIRST TIME I SAW SHMUEL WAS AT MY HUSBAND’S SHOP; he was with a violinist friend of his who was one of my husband’s clients. That fellow was raving how fantastic Shmuel is. I was skeptical at first – just another physiotherapist. He insisted on demonstrating right there on the floor what he could do and it was encouraging. So I said alright, I’ll try. And true enough I was very much impressed and have been going to him ever since, whenever I have a problem.

In my case it’s often my shoulder, but recently I had some swollen joints and he was able to help with that – which borders on a miracle! My husband, David, once twisted his ankle so that he was on crutches, painkillers – you name it. The next day we called Shmuel, who said to just come over; we drove there and an hour later David walked back to his work.

My sessions with him don’t involve me playing, but he will show me exercises to improve my condition. On a basic level he told me always to pay attention to the way I sit, the way I drive, what’s happening to my shoulders when I write or am at the computer – basic things about posture that we tend to forget. That’s on top of his manipulations. He also uses some electronic devices – I’m not sure what they are, but I trust him!

“When I met Shmuel he insisted on demonstrating his treatment right there on the floor.”

We usually talk about music, because Shmuel loves it and he goes to many, many concerts. He’s very knowledgeable and strongly opinionated about who he likes and who he doesn’t and why. He comes and hears me with the New York Philharmonic perhaps once or twice a month, and he comes to practically all my chamber music concerts. He doesn’t like too much new music, but at my last concert at BargeMusic I played a piece written for me and my piano trio by my brother, and Shmuel said he liked it. It was only written last year, so very contemporary – I was happy that he could appreciate it.

We’ve long been friends and he sometimes comes to us for dinner or festivals such as Passover. We have a tradition on the first of January of an open house; all our friends come with their instruments and we play chamber music, accompanied by food and wine. He’s been to that several times and he even surprised me once and revealed e can pay the piano.

The Strad
Interviews by Matthew Rye