Knee Treatment: Torn Meniscus and Loss of Cartilage

knee-treatment

Before heading to see Shmuel Tatz, PT, PhD about my knee, I’d heard from more than one doctor the WHAT NOT TO DO LIST: No stairs, no kneeling, no crossing legs, no sitting on floor, no squatting, no dancing. Plus I had a hard time wrapping my head around my previous physical therapist experiences: lots of clipboards and sessions with different PT’s each time and no results other than frustration. Still left with an imperfect knee that had suffered a few life-injuries. First there was the fall resulting in the tibial plateau fracture, then the torn meniscus, then the basic wear and tear, and loss of cartilage. The messages I was receiving from the medical community was to accept my ‘trick knee’.

That said, I wasn’t willing to give up and started asking friends and searching online for a specialist in physical therapy. One that might take insurance was another issue as I was on a pretty tight budget. After calling at least twenty PT offices, I reached Dr. Tatz’ office whose lovely assistant ushered me in immediately.

Tatz, the NYC acclaimed gray-haired PT, wasn’t much for words. He was more interested in what my entire body was saying to him and his reactions to my body versus vocabulary. His navigations seemed to be intuitive rather than straight out of a medical journal. He ‘tuned’ my body from the jaw down, gentle manipulations that made me feel thankful for the solid hour away from the pressures of NYC. Sometimes when seeing practitioners, I worry about what’s going on outside of the room rather than relaxing and healing inside.

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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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A Student Volunteer’s Observations of Body Tuning

From these past few weeks that I have began working in the office, I have learned much about the practice of Body Tuning. Unlike the typical physical therapy office where you see a multitude of exercise equipment with patient repeating exercises to re-strengthen muscles after injury, Dr. Tatz works with patients on a much more personal level, giving mobility to patients, and then finishing up the appointment with modalities. The approach to the Body Tuning practice is more about helping a patient feel better after an injury with a lifestyle change, versus simply fixing an injury and re-training the body. This integrative practice is about fine-tuning the body with small, loose, circular motions lubricating the major joints of the body. If we do not take care of our body, injuries will build up over time, eventually leading to tension or injury in other parts of the body that we may not suspect. Our bodies are like cars; we would not drive a car with a flat tire, just as we should not keep agitating our body with a small discomfort. Without taking care of ourselves, our body will degrade and become injury prone over time.

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Steps to Treating Back Pain

back-pain-treatment

The first step is to have some form of cold/ice compress ready for your back. You can take a wet towel and place it in the freezer for an hour, or take ice and wrap it in a towel or use an ice pack.

The next step is to find a comfortable lying position for your back and spine. You can either lie directly on your back with your feet planted and your legs bent or your legs straight out in front of you. Another option is to lie on your less sensitive and painful side with a pillow for under your head and another pillow in between the knees. In this position you need to make sure your knees are close to your chest in order to have flection in the spine. A third option is to lie flat on your stomach and make a pillow for your head with your forearms and elbows and rest your forehead.

Once you have found a comfortable position for you, take your form of cold compress and place it on the sensitive/painful part of the spine. You should remain in pose and focus on breathing. The idea is to bring breath and air to the sensitive part of the spine and allow gravity to take over. Remain here for 15-20min.

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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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Our Therapeutic Machines

There are four treatment rooms in the Body Tuning clinic, each musical in name: Orchestra, Guitar, Piano and Violin. There are no instruments in the rooms but there are a number of impressive machines used to help patients’ ailments.

Vibration

In the open area there is a machine that looks like a treadmill; it vibrates and loosens muscles. Sometimes patients will stand on it for about 10 minutes with their lower body shaking before the appointment begins to remove tension in the extremities.

There’s also a smaller vibrating leg and ankle machine that is placed at the end of the treatment table also shaking things up, loosening ankles, feet, and lower legs.

Cold Laser Therapy

Cold laser is one of the treatments used, which is essentially a light amplifier, building on beliefs about the healing power of light going back to Hippocrates and ancient times. Throughout history many believed that light therapy could harness the power of the sun to heal. However cold laser is different from the sun as it is a compressed waveform, usually from the red spectrum of electromagnetic radiation. Low-level lasers provide a form of pure light to deeply penetrate the surface of the skin without heating or damaging body tissues.

Cold Laser has been approved by the FDA as an effective painless drug free therapy successful in treating muscle spasms, nerve pain and arthritis. It has also been shown to increase the speed of wound and fractures healing.

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Shimmisize

From my 40 years of experience and researching traditional and non-traditional techniques and philosophies, I have reached my own conclusions. I have watched dozens of students and patients naturally shimmisize. They made me see, that it is the fastest, most inexpensive and most effective movement approach to achieve a “tuned body.”

Shimmisize reduces pain, relieves tension and alleviates the discomfort in the body. The technique is based mostly on natural childlike movements. It makes stretching safer and more accessible. Shimmisize in performed in repetitions with comfortable non-invasive range of motion, always involving the whole body. It is all about feeling better one movement at a time, not about achieving goals or results.

How do you shimmisize?

  1. Start standing moving arms, hips and shoulders for 10-15 min
  2. Slow and deliberate walking for 5 min
  3. Lying on the floor, relaxing, breathing for 10-15 min

Simple easy movements involving the whole body, every aspect from head to toe.

Shimmisize with props

Use medicine balls, tennis ball, basketball, cane.