Physical Therapy for Pianists

Jerzy Marchwinski’s Road to Recovery

About ten years ago, the well known Polish pianist and pedagogue Jerzy Marchwinski began to lose control of the fingers of his right hand. Within a few years, he had stopped playing altogether. “At first, I started to make a few mistakes in concerts,” he explained, ” and eventually I lost sensation in my right hand. It felt like a piece of wood.”

For the last several years Mr. Marchwinski traveled around Europe, unsuccessfully seeking a solution to his problem. However, during a recent trip to Manhattan, he had the good fortune to meet and work with the respected physical therapist and educator Shmuel Tatz for a period of two weeks. My discussion with Mr. Marchwinski focused on both his odyssey through various unsuccessful treatments and the uniquely productive aspects of his work with Mr. Tatz.

Starting in 1990, Mr. Marchwinski began a series of visits to prominent physicians in Poland, England, France, and the United States. By the end of two years worth of medical exams, the only conclusion that had been reached was that he had suffered some degeneration in his upper spine. Some physicians suggested laser surgery; however, the explanation of the high risk of postoperative paralysis convinced him to forgo such a procedure.

Next, Marchwinski went to a Parisian clinic specializing in the treatment of hand malfunction. He was given a series of exercises which, to his disappointment did nothing to improve his condition. Acupuncture sessions were similarly unproductive.

By this point, Marchwinski had not played for three years, a period of time which seemed like an eternity for him. Frustrated by the many unsuccessful attempts at treating his condition, but unwilling to continue without the piano, he decided to try to play with only his left hand. Determined to reintroduce his right hand to the keyboard as well, he started to develop a limited technical approach that enabled him to play at least to some extent with his inflamed and dysfunctional right hand.

It was at this point that a friend suggested to Marchwinski that he come to Manhattan to work with Shmuel Tatz at Medical Arts. “I didn’t expect a miracle,” Marchwinski confided, “but Shmuel has helped me enormously.” Tatz began by mobilizing the joints in Marchwinski’s right hand through hands-on manipulation. Tatz also taught him hand exercises which have helped Marchwinski to begin to regain control of the fingers of his right hand.

“On a more general level,” Marchwinski elaborated, “Shmuel has introduced me to the sensation of relaxation, the feeling that the body is elastic, like a spring. It is important for me to be able to feel this sensation were when I am away from the piano–while shaving, for example.” After a mere two weeks of work with Tatz, Marchwinski found that in addition to his regaining some control of his right hand, his physical movements in general had become more relaxed and supple. “Thanks to Shmuel,” he remarked, “I even sleep better.”

An Interview with Shmuel Tatz, Body Tuner

With this column Chamber Music introduces a series of short articles about the ways by which various musicians are trying to overcome the problems that came between them and their audience, ranging from the many manifestations of performance anxiety to the actual physical pathologies that can affect them with pain, debility, and even atrophy.

Here, Barry Lenson talks with Shmuel Tatz, a New York City resident who calls that he does, Body Tuning.

Mr. Tatz and pianist Vladimir Feltsman
Mr. Tatz and pianist Vladimir Feltsman

On the eighth floor of Carnegie Hall, in New York, is a studio with the sign on the door that reads, “Shmuel Tatz – Body Tuning”. I knock and enter. Inside, I sit down in a small waiting room. The walls are covered with dozens of photographs of well known performers (e.g. pianists Bella Davidovich and Vladimir Feltsman, violinist Isaac Stern, dancer Merrill Ashley) each scribbled with a few testimonial words of thanks.

After a minute or two, Mr. Tatz enters and settles comfortably into a chair across from me. unlike other practitioners of “methods” I have met, he does not seem to move according to any visible technique or system, or to sit with any artificial posture. He just seems comfortable to be in his body. He excludes energy and extraordinary limberness.

Having ascertained that Mr. Tatz is himself a music and dance lover and his wife is a classical pianist, I start our discussion in typical journalist fashion: “What physical problems do you observe most frequently in instrumentalists?” But he quickly takes the conversation into another direction entirely – a philosophical inquiry into why people seek health care, and the mistakes they make in going about it.

Mr. Tatz: Today, we have over-use syndrome, repetitive motion problems. You are telling me these problems didn’t exist fifty years ago? Of course they did- but today, we have these new names. A musician goes to an expert who says, “Aha! You have such and such a syndrome, and the correct treatment is this”.

Barry Lenson: What is wrong with that approach?

ST: Sometimes the people with the most money get the worst treatment. They ask, “Who is the top person in the field of this problem?” And they go to the person, and may be the treatment works, and may be it doesn’t. There is a Russian expression, “I don’t need a hundred rubles, I need a Hundred friends”. Friend gives you advice, referrals, and ideas- there ‘s far more value in them then in money. You have to make inquiries, find the treatment that is right for you. You have to listen to what different people are telling you, and trust you instincts. Then you must believe. Nobody can decide for you what treatment to choose. Money won’t solve the problem.

BL: So you are saying that going to specialist is not always the best solution for a particular problem?

ST: Not always, no. When you have a problem with a joint in the pinkie, let’s say, you go to a specialist an he takes a close look. [Here Mr. Tatz does an imitation of a specialist, focusing his eyes closely at his own pinkie from half an inch away.] This specialist, perhaps, does not look at the bigger picture. May be the problem lies with the shoulder, elbow; or neck.

BL: So, the problem felt in the elbow or the wrist may be caused elsewhere in the body?

ST: Absolutely. when violinist, for example, experience problems with his shoulder, I often find that those problems come from the hips. [Mr. Tatz stands and imitates first a violinist who is tight and stiff in the body and arms, and then a violinist whose relaxed arm movements seem to emanate from a low center of gravity and free hip movements.]

BL: Why are so many musicians developing physical problems today?

ST: It’s a question of talent. Sometimes someone is a wonderfully talented musician, but has no natural understanding of the body- there’s abuse, too much practicing, the body is out of tune. So the person thinks, “I’m week, I need to do more.” Within a few years, very big problems arise.

BL: In your approach, how do you diagnose where the difficulties lie?

ST: I look at two things in the movement of the joints-accessory joint movement, and intra-joint movement.

Mr. Tatz uses my left hand and demonstrates. First, he has me band my hand as far inward toward my forearm as I can, and then he bands my wrist a little further, using his own hand. That extra range of movement, he explains, is accessory movement. Then he grasps my left hand at the palm, holds my index finger in his other hand, and moves his finger around within the knuckle joint – not in bending movements, but in back and forth and sliding circular movements. This non-flexing movement with in the joint, he explains, is intra-joint movement.

ST: I look at both the quality of the motion, and he range. A problem I find in the joint may later develop in the soft tissue- muscles, tendons.

BL: What type of treatment do you give? Do you manipulate the joints, like a chiropractor?

ST: The thing that matters most is that the person understands the problem, agree with the diagnosis of how he or she has been using the body improperly. Then I need only to show what exercises to do. I don’t manipulate or exercise – you do it. If you see results and I see results, you keep doing the exercises. If not, we try something else.

BL: So it’s not a question of making dozens of appointments with you, to get checked weekly on progress, or something like that?

ST: Why do that if the results are coming? You don’t need a baby-sitter. Most musicians have discipline anyway.

BL: Could you demonstrate some of the exercise you use?

ST: Yes. First, there’s throwing the rock into the river – very important for violinists.

[He takes a playful stance and mimes the action of lobbing a small stone into the river. The movement is loose and gentle, utilizing not just his arm but his back, hips and legs.] And then, for pianists, there’s “going outside on a very cold day”, as in Russia. [Like a cold man clapping himself on the back shoulders to fight the cold, he gives himself a rapid, body-smacking hug with both arms, then repeats the action several times, alternating the positions of his arms (first left above right, then right above left). The movement is very big and energetic. I try it too. It’s fun and it loosens my back and shoulders.]

BL: What do you call what you do? Some kind of physical therapy or chiropractic?

ST: I call my system Body Tuning, just as my sign says on the door.

BL: Tell me about your training. How did you develop your approach?

ST: I was trained .in physical education and medical exercise in Lithuania, where I worked principally with athletes. Each sports team had one physical therapist on staff. My assignment wads a soccer team. Later I emigrated to Israel and studied to become registered physical therapist. I worked in hospitals and with all kinds of problems.

BL: When did you begin to work with musicians and dancers?

ST: In Jerusalem, a young pianist came to me with arm problems. She had gone to an Alexander Technique specialist who told her to stand more erectly. (He imitates someone sitting very erect). When that didn’t work, she went to Feldenkrais teacher, who told her to be more fluid and flexible. (He imitates someone making exaggeratedly round and fluid movements). Now, I’m not saying that different methods are wrong. You just have to be aware that everyone is going to tell you something different. The physical therapist will say that your muscles are week and need to be strengthened. The chiropractor will say that you have a subluxation, that you need opening up. The medical doctor will prescribe a pill, the surgeon will want to remove something. It’s a mistake to go from one religion to another. Listen first. Then decide for yourself. The thing I do differently is to lead people to understand and accept the physical things they may be doing wrong. I have experience with such things, and if the person understands the problem first and is willing to work to correct it, the situation can usually be improved. I don’t say I achieve one hundred percent success in one hundred percent of all cases, but I have seen remarkable things.

In the words of the body-tuned

From a client’s perspective, how does Shmuel Tatz works? I decided to speak with two string players who have sought his help for quite different problems. Their names are not used because one of them requested anonymity.

Client A, a violinist who plays a ballet ensembles and orchestras, had experienced tightness and pain in her upper back and shoulders for years. Previous treatments brought a little relief … and she tried nearly everything, including acupuncture, Alexander Technique, hypnosis, chiropractic, massage, relaxation techniques and a regime of physical therapy that included treatment with heat and ultrasound. She finally found her way to Mr. Tatz. “The difference is quite amazing”, she said. “He seems to have an intuitive perception of the body, to combine technique and artistry as if he were a musician himself. I do have a chronic problem, and it’s not going disappear entirely. But he has brought me more relief than I believed possible”.

Client B, a violinist, first went to Mr. Tatz with an unusual ailment – she had bent over to pick up her case, and felt sudden and intense pain in her back. Not able to take time off from her schedule in orchestras and opera orchestras, she went to the Tatz Body Tuning studio when she heard he could get her up and running again quickly. “After the first treatment, I felt dramatically better,”, she says. “The treatment is mostly hands-on. What does he do? At first, he moved my arms, leg, neck, to see how flexible they were. He can push with his fingers, sense what is inflamed, and work on it. I can’t begin to tell you what his system is, but I know I feel fantastic. I walk down the street, and I see that my shoulders, which used to be up around my ears with tension is gone, even without his having told me to drop my shoulders or anything like that.”

Chamber Music
By Barry Lenson

A Body Tuning Session with Shmuel Tatz

Peter Brook’s production of the Indian epic The Mahabharata was stunning. But for Tara, whose hip joint and upper back have been giving her problems, watching the drama was an excruciating ordeal. The play began at one in the afternoon and ended at midnight; to add to the effect of antiquity, the seats in the specially remodeled theater in Brooklyn had been converted to bleachers with only light padding.

Though she loved the play, Tara’s hip and back ached as she left that night.

To add to the problem, Tara has just completed a five-day vipassana meditation retreat, a 14-hour-a-day regimen of hour-long sittings alternating with mindful walking. Despite her best attempts at yoga stretches and an ergonomic variation on a zafu for sitting, the course had left her hip and back in poor shape to endure the day-long play.

Luckily, Tara has an appointment with Shmuel Tatz at his Carnegie Hall studio.

At the session’s start, Tatz has Tara up on his bodywork table, lying on her left side. Tatz himself strikes a thoughtful pose before beginning to work.

“Before I touch anyone, I try to tune my own body,” says Tatz as he takes a comfortable t’ai chi stance, one leg a step ahead of the other, his body balanced between. Taking a moment to center, Tatz then gently places one hand on Tara’s back, the other on her ailing hip.

“I find the person’s rhythm of breathing, whether fast or slow,’ he says. “I breathe in tune with her.”

Then, pressing on Tara’s sacroiliac, he begins top massage her lower back with his left hand, checking to see if she is relaxed. Wherever he finds some tightness, he relaxes it with massage, then gently rocks Tara’s body side to side with his right fist.

The pressure at the sacroiliac releases tensions there and in the lower spine, while the rocking motion helps Tara’s tight muscles relax, at the same time letting Tatz see if they are indeed relaxing as they should.

Tatz himself rocks his legs in time with Tara’s rocking, simultaneously coordinating each press of the fist with her breath: pressing in as she breathes out, relieving the pressure as she breathes in.

This careful movement, finely tuned with Tara’s own natural rhythm of breath, typifies Tatz’s work as he moves his focus on her lower back, checking the motion of each vertebra with the fingertips of his left hand as he rocks her side to side with his right. As his fingers examine her spine, he stops between the third and fourth vertebrae. “Feel that?” he asks. “Yes, it’s painful there,” Tara answers. The diagnosis is right.

Trained as a physical therapist Tatz sometimes uses X rays to find the exact cause of compression between vertebrae – whether a disc problem, calcium deposits, or poor alignment, for instance. With Tara, he uses his fingertips to massage between the discs, softly forcing open space between them as he rocks her from side to side.

Shifting his attention to her legs, he lifts her right leg at the knee, working it through it’s natural range of motion. In doing this, he sees that the quadriceps is shortened, a mass of tightness in the quadriceps and tendons of the leg, each problem playing into the other. The back, too, is part of the same pattern; nerves running between the back and hip can cause a problem in one place to travel to the other.

In order to help free the hip, Tatz works with the leg, easing the muscles into relaxation through a combination of massage, guided movement, and acupressure. The body is so interrelated, he says, that working on a zone far from the central problem is all part of a holistic strategy aimed at the center. For instance, with Tara’s leg extended, he presses an acupressure point to the side of her ankle, tugs at the leg, extends it as though it were in traction, massages her abdomen, and tugs at her hands raised over he head – all to open the joint at the hip.

As she lifts her leg and waggles it, Tatz says, “Always I ask a question of the joint or muscles. As I lift the leg, I ask the hip joint, ‘How’s your internal rotation?’ If it’s okay, I go to the abductors and ask how they are. If they answer, ‘Very tight,’ I give some help.

The session ends with a touch of the Alexander technique, Tara walking around the room with Tatz holding her neck from behind in a balanced position where it is not fighting gravity. He explains that jutting the head forward, as most people do, creates constant tension in the neck and shoulders, as the muscles there struggle to counterbalance the 10 pound of the head.

The walk is just part of the re-education of Tara’s body. Tatz also gives her some homework, showing her a series of movements and easy stretches to help her body to hold the changes he has made in it.

After the session, Tara’s report is that she feels “great: free of pain, more balanced, and relaxed.”

Yoga Journal

By Daniel Goleman, PhD. – a psychologist and contributing writer on behavioral science for the New York Times.