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.

Dr. Tatz studied medical exercise in Lithuania, medical massage in Russia, and physical therapy in Israel. Formerly located in Carnegie Hall, and now in an office near Lincoln Center, he has treated some of the most illustrious performing artists of our time: Kathleen Turner, Lou Reed, Isaac Stern, Yehudi Menuhin, and Mstislav Rostropovich, to name a few. With over 40 years of experience, Dr. Tatz has combined the best of western physical therapy with eastern healing arts in his own system called “Body Tuning.”

As he writes on his website, “Body Tuning is an approach to diagnosing and treating the cause of pain, much like that of a skilled musician communicating with his instrument.” It involves “first scanning the body manually with the hands to zero in on the source of the problem, and carefully ‘listening‘ to each of its parts, in order to begin the healing process through an array of modalities.”

Dr. Tatz calls himself a body tuner, but any health practitioner working with the musculoskeletal system, which includes chiropractors, physical therapists, and traditional osteopaths, can implement the body tuning method.

During my time with Dr. Tatz, I witnessed the treatment of over 30 patients. I have come to understand that in the music world, health practitioners are generally considered damage control and recovery specialists, when they should really be considered preventative maintenance and ease of playing specialists. Many of the injuries I saw were unexpected by the patients, and could have been easily prevented with good self-maintenance habits.

The following are answers to some of the questions that came up during my time at the Body Tuning Studio. They have been edited with the approval of Dr, Tatz, whose international approach to the English language precludes a verbatim account.


Dan: So if a body tuner can be found in various professions, what makes a physical therapist or chiropractor a body tuner?


Dr. Tatz: A body tuner considers the entire system as a whole. A specialist may work on the sight of the pain, like the hands and wrists, while another specialist may work on posture as a way to address the source of the pain, but a body tuner will work on both the end and the beginning of the pain. A body tuner draws on all available resources, techniques, and modalities as a means to bring the entire body back in tune.


Dan: How does a musician know when to visit a body tuner?


Dr. Tatz: The same way we get check-ups to see if we have high cholesterol, musicians should go for tune-ups to see if there are some silent problems building up. If you do not feel any problems in the body, you should come for a check-up after the first four of five years of playing or at the age of 12. Also, if a student makes the decision to take on music as a profession, they should immediately go see a body tuner. Once you have reached the level of practicing three hours a day or more, as is usually the case at the college level, you must have your body tuned monthly by a practitioner, and daily by yourself. At this practice rate, at least thirty minutes a day must be spent doing specific exercises to maintain the body. This is the minimum in order to maintain feeling good.


Dan: It sounds like you are talking about preventative maintenance?


Dr. Tatz: Yes. It is important to start body maintenance early in life. A lot of problems are age related and become hard to reverse the longer they are allowed to persist. Young musicians should acquire a strong physical education. By avoiding sports and exercises that might endanger the fingers, ultimately weakness, pain and discomfort manifest.

Even a physically educated musician will inevitably need a tune-up due to the repetitive nature of practice. Just like if a violin is a little bit out of tune, the player can compensate, but when it is too far out it becomes impossible to play in tune. The same can be said for the body. We can compensate for being slightly out of tune, but it needs to be addressed by a body tuner before it goes too far out.


Dan: And what should people do when something has gone too far out?


Dr. Tatz: It is important to go for treatment immediately upon injury or discomfort. Rest is not always the best and stretching is often times harmful. It is essential that musicians maintain their practice schedule and are able to perform continuously. Many doctors first recommend rest, ice, or Advil, but this does not solve the problem, it is only a temporary solution. A body tuner can bring you back up to speed quickly. Also, if a teacher sees something wrong with a student’s body, he should immediately refer the student to a body tuner. It is not the teacher’s profession to fix a shoulder and it is a big mistake for a teacher to try to cure a student of pain.

Heinrich Neuhaus, the soviet pianist and pedagogue who taught at the Moscow Conservatory, wrote in his book the Art of Piano Playing, that a musician’s body is supposed to be like a dancer’s body, strong and flexible. He did not understand how to teach his students this so he would send them to a special teacher that could create strength, flexibility, and coordination in his students.

When we watch great musicians like Jascha Heifetz or Martin Frost perform, we can see that their instruments are played with an ease that makes them appear as extensions of their bodies. But this cannot happen if the body is out of tune. If an instrument is a little bit out of tune, we can adjust it. If it is too far out, we must go to a repairperson. It is the same for the body. If the student’s body is just a little bit out of tune, it’s a good idea for the teacher to stop the lesson and do some minor exercises. But beyond that, professional help should be sought.


Dan: I have met many musicians that found Alexander technique or Feldenkrais method lessons very helpful in maintaining their body and improving their instrumental technique. Are these approaches good for recovery as well?


Dr. Tatz: If the injury or pain is not so overwhelming, it is common for musicians to seek relief outside of the medical community. For some conditions, these techniques can be great. But they are very general techniques, and if your specific problem lies outside of their scope, you will have a slow recovery. To recover faster, musicians should see a person that is more familiar with both conventional and alternative approaches. Someone who is familiar with the special needs of different instruments, someone who was not lucky enough to be a professional musician, but became a medical practitioner.


Dan: How should people prepare for a visit to a musculoskeletal specialist?


Dr. Tatz: Most practitioners have online videos you can watch that show what kind of treatments they do and what their work environment is like. You should review these before visiting so that you know what to expect and are not clouded by doubt. During the treatment, you should be focusing on the sensations inside your body while feeling comfortable at all times.


Dan: About how long should one treatment take?


Dr. Tatz: Sessions should be 45 minutes, plus or minus.


Dan: What should one expect during a body tuner visit?


Dr. Tatz: Treatment should not be aggressive. You should report any pain or discomfort throughout the treatment while staying focused on internal sensations. You should feel like the practitioner is being sensitive to your body and that you are learning; patient education is important for prolonged recovery.


Dan: Does that education include at home exercises?


Dr. Tatz: Yes. A good music teacher can tell you how to play a specific passage, but he can also tell you what kind of exercises to do to help learn the skills needed for the passage. The therapy and homework should be very specific with the same tailored quality you would expect in a private lesson. If a therapist gives you a preprinted list of exercises, send this list to your grandmother.


Dan: As a wind musician, should I look for something specific in my treatment?


Dr. Tatz

Wind musicians need special attention to the pulmonary system. This includes the motion of diaphragm, ribs, and chest. Mechanical problems with breathing can be corrected by a body tuner. The student who is constantly being reminded to lower the shoulders and breath from the gut has more than a mental habit. A body tuner can help make the shoulders fall naturally into alignment while correcting the motion of the diaphragm. There is a big crossover between instrumental technique and the body’s well being.


Dan: How can we tell, while we are at a practitioner’s office, if we are getting a good treatment?


Dr. Tatz: During the first treatment you must listen to how your body reacts. Any practitioner can talk your ear off about the effectiveness of their approach and the science behind it, but the only information that matters is how your body responds to the treatment. The body should tell you, “I like this. I feel more comfortable. I feel less tension and pain.” Any great music performer can explain how a musical phrase works and even describe the technique involved in producing that phrase. But when we are in the audience, we simply enjoy the sound. This is how it should be during treatment. Explanations and understanding are secondary to results.


Dan: But it’s normal to be curious. Shouldn’t people ask questions for peace of mind?


Dr. Tatz: Of course. This does not mean that you shouldn’t ask questions, but it is a reminder that your role during the treatment is to stay focused on listening to your body. And if you can’t do that because your practitioner is spending too much time explaining the treatment to you, something is fishy. A good practitioner will ask thousands of questions through touching and moving your body; you need only listen to the answer your body gives. By expressing ideas through your body, the practitioner can educate your body rather than your mind.


Dan: For some people, it might be daunting to be physically manipulated by another person. What should people be aware of while a practitioner is working hands-on with them?


Dr. Tatz: While the practitioner is working hands-on with your body, you should get the sense that he is constantly switching between diagnosis and treatment. First he works a bit on your body, then he tests to see if it made a difference. The diagnosis may take only a few seconds while the treatment may add up to 30 seconds or 5 minutes. As musicians know, it is not wise to spend all of their practice time on the single measure that has a problem spot in it. Musicians need to learn in context and always reference the piece as a whole as they address a specific problem in a specific measure. When working on one tendon, the whole body should be incorporated. If a practitioner works too much on one spot, it becomes irritated and the holistic concept of healing is lost. Again, treatment should not be aggressive. If the body gets scared, something is wrong. A little pain can be ok, but you should not have to endure anything.


Dan: What should people expect on their second visit?


Dr. Tatz: After you go home and try the homework exercises, you need to report your results at the beginning of the second treatment. In a private music lesson situation, the teacher doesn’t know how long it will take for you to learn a specific movement or technique. The same can be seen in the body. The health practitioner should only know what the second treatment would consist of after hearing the report of the first treatment. Only then can it be determined if the right actions are being taken or if a new direction would be better for you.

If you go for the second treatment and it starts without you giving a report of how you felt after the first treatment, and very similar procedures are being done, you can assume you are getting a generic and non-specific treatment. Again, you need to feel that something in your body happened, and the practitioner needs to listen to your response and adjust the treatment accordingly.


Dan: What do people usually report after the first treatment?


Dr. Tatz: There are four possible outcomes. You feel much better, you feel a little better, nothing changed, or you feel worse. The best-case scenario is that you feel a little better. The second best reaction is that you feel a little bit worse. If you feel worse, don’t worry. Sometimes a few sessions are needed to adjust the techniques used and the intensity of the treatment, but this should take no more than three sessions. The wrong thing to feel is that you are a lot worse. And the most suspicious reaction is that you feel much, much better or that nothing changed.

This may sound counterintuitive at first, but if you have a problem in the body there must be a realistic timeline for recovery. If you have just a small problem then one session with homework can make it much better. But if you have a chronic condition, which means pain for more than two or three months, you must make an investment and expect your treatment to be a longer process.


Dan: How can I choose the right practitioner for me?


Dr. Tatz: First it is important to understand how a medical practitioner becomes qualified to practice and how they really gain knowledge. School is meant to provide only a baseline of academic knowledge, just enough for students to pass a licensing exam. Many licensing exams no longer require a practical element. Many students are coming out of school without proving they can handle a body with care.

The real education comes from experience. Practitioners learn from their patients. There is no one best way to work on a patient and each practitioner is continually developing his or her own technique and approach. Just as different private music instructors can offer different ideas on how to play the same piece, so too can different practitioners find different routes to health. But like anything, if you don’t practice, you wont get better, no matter how good the ideas are.

A professional soloist takes a minimum of 10-15 years of appropriately guided practice to acquire the skills needed to succeed in front of the public. Body tuning is not an exception to this idea. The same amount of hands on experience is needed to become a master of body manipulation. Similarly to music, the body tuner must be practicing the correct repertoire.


Dan: So, if you are a musician, you want a therapist that knows how to work with musicians. This seems obvious, but many people assume that all physical therapist know how to handle all problems in the body. After all, it’s their job, right? What steps can people take to evaluate their choice of therapist?


Dr. Tatz: The best thing you can do to feel confident about your selection is to talk to a former patient of the practitioner you are thinking of visiting. If you are able to do so, the most important question to ask is, “how many practitioners have you seen? And what were the results you got with each practitioner?” When you are checking the practitioners website, make sure to look for any reviews that were written by patients.

Any music teacher can teach you. Maybe you wont become a virtuoso, but they can always help you get a little bit better. The same goes for doctors. Any practitioner can help you, but the question is how much?

The therapist who really understands musical terminology is going to give a better treatment to musicians. He doesn’t need to be a virtuoso to understand your situation and why it is so important that you are able to keep practicing and recover rapidly. He will be able to communicate ideas about the body through musical jargon to help you quickly grasp concepts. If you try taking lessons with a new teacher and they don’t show you anything special, you wont go back. It is the same for body tuners, if you don’t feel anything good in your body, don’t waste the time.


Dan: In my years as a music student, it became obvious that not all students gain the same knowledge from the same lesson. At the University of Michigan, we had large studios, about 30 students across two professors, and everyone advanced at different rates. Do you have any advice on how to get the most out of your treatment?


Dr. Tatz: Your treatment should not end when you leave the office. It is important that the therapist gives you homework. Regular maintenance is essential to long term recovery. You should strive to maintain the feeling of the treatment after you leave the office. Not just how you feel when you leave, but also what it felt like to perform the movements during the treatment. In a private music lesson, a good teacher will make you feel something new on the instrument and it should be your goal to recreate and maintain this new technique during your practice sessions. If a therapist gives you an exercise, you should record it mentally so that you can practice it on your own. The more you participate in the healing process, the faster your recovery time will be.

Above all else, the most important thing you can do is sleep. Even if you are seeing the best practitioner, and doing your homework, if you don’t sleep well your progress will be slowed significantly. You should avoid strong exercise at night and eating late meals as these can throw off your sleep habits. It is best to do a few minutes of Shimmisizing before bed to help calm the body and improve circulation.


Dan: Shimmisizing? Is that a Yiddish word?


Dr. Tatz: It’s the name of the exercise system I have been researching for the last 5 years. It utilizes small shimmy motions to naturally reorganize the musculoskeletal system and help improve circulation.


by Daniel Padmos