Body Tuning & Physical Therapy

A client of mine, Mark N. Grant, is both a musician and a writer and has written an intriguing article for NewMusicBox, entitled: Does a Composer’s Body Need to be Tuned? I believe it may be of interest to many of you and so I am using it for this week’s blog. My thanks to Mark Grant and to NewMusicBox for allowing me to reproduce the article.

Professional singers and dancers have always been trained to think of their bodies as delicate instruments that need constant maintenance. Instrumentalists, less so—a bout of tendinitis is still regarded as something of an aberration in the professional life of a pianist or violinist, though not as much as it was a generation ago. But is it possible that we have not recognized heretofore that a composer’s body is itself an instrument, too? That you unconsciously “tune up” the body to compose as much as you tune up your cello, harp, or clarinet to play with other musicians? Even if this kind of “body tuning” doesn’t involve intonation or pitch per se?

In my view a composer is a musician who sings with his brain. But that brain state of composing is a somatic activity as well. To sing with your brain you engage your whole body, not just consciously in the physical labor of notation but unconsciously in the tension engendered by the anxiety of creation. Gershwin famously complained of his “composer’s stomach.” Morton Gould once wrote that for him “creating is like tearing out one’s guts—it is both a devastating and exhilarating experience….The period of digging into one’s self is always distressing.” To me that’s a remark you’d more likely expect of Mahler, but no, that was Morton Gould. And as for his supposed glibness as a crossoverish composer, Gould added, “Well—all I can say is that it is not an easy facility, and if it is—I would hate to function with any less!” So even the effortless Gershwin and the facile Morton Gould had nervous tension problems with the creative act? This makes me feel much better, because even when I’m sketching (especially then, in the early stages of composition), the creative act pitches me into a state of extraordinarily high physical and nervous tension. Is it performance anxiety of the brain? Is it that the body is being just as cooked as my brain by the mental pressures of the muse? Or is it because I’m unconsciously “tuning” my body as well as my brain in order to compose?

If you talk to a psychiatrist about the stresses of his/her work, you’ll be surprised to hear them tell you how physically (as well as emotionally) taxing it is to sit for hours in a chair listening to other people talk. There’s a famous, maybe apocryphal story about writer John O’Hara collapsing cold on the floor just after mustering the finishing keystroke on his typewriter for a short story he was completing on deadline. We composers, too, sit (or stand) for long, long hours with incredibly intense mental traffic coursing through our brains and bodies. Think of Strauss scoring his operas by sitting in the chair at his desk for 12-hour stints at his Garmisch villa interrupted only by his wife’s tea service. The Germans have a word for it: sitzfleisch.

It’s hard to separate the psychic tension from the sheer elbow grease (or “drudgery,” as William Bolcom put it to an interviewer) of composing. In the pre-software days of composing music (i.e. the entire history of the world prior to about 15-20 years ago), your body has to be a workhorse to tolerate the physical marathon of notating concert music in longhand. (How did Stravinsky do it with all those colored inks? And Boulez’s autograph scores, with his extremely microscopic handwriting?) Composing (i.e. thinking up and notating) a large scale work like an opera or symphony can put a strain on our bodies, and in some susceptible people can be as athletic and exhausting as performing. Sure, there are composers blissfully unaffected by strain of any kind, like Darius Milhaud, whose startling prolificacy was unimpeded even by rheumatoid arthritis (which disease, by the way, also afflicted Morton Gould). Milhaud’s close friend Kurt Weill was not so lucky. Endlessly writing out full score after full score for Broadway by hand, without arrangers’ help, on three hours’ sleep a night in the 1940s arguably helped kill Weill, who had hypertension, at 50.

It goes without saying that many great composers produced their output in spite of all manner of physical impairments, we all know that. But could we all function better and longer, both creatively and mechanically, if we had our bodies “tuned up” the way we have our automobiles tuned up? I for one suffer from the redoubled wear-and-tear of a lifetime’s double occupational exposure: I’ve always been both a writer and a musician. I have used my hands daily for both typing and playing the piano since I was a little boy, and now I’m in my fifties and my body has started to cry uncle. One experienced physical therapist in 2005 alarmed me by announcing, as she palpated, that there were bumps and nodules all over the tendons and fascia of my forearms (until she calmed me by adding that many professional musicians she had treated had the same invisible nodules). Though I’m an irregular piano practicer at best, I don’t know anyone else who has, cumulatively over decades, compiled as many keystrokes of both the typewriter and the piano keyboard as I have. I have typed both my books and innumerable published and unpublished pieces of writing going back to the 1970s. Many pianists who aren’t also writers have suffered tendinitis; I come to it through a triple physical insult, since I’m not only a writer but for some 30 years I composed entirely in longhand. As if this weren’t enough, in my early adult years I studied with a composer who was also an accomplished painter and whose breathtaking musical calligraphy with a dip fountain pen infected me with a compulsion to emulate him. I then attempted, despite being left-handed, to become a professional music copyist (copying was still by hand in the 70s), and to avoid smudging the ink with my southpaw moving left to right on the page I adopted a tight, twisted hand posture which somehow became permanent. Eventually I developed ulnar nerve syndrome and by the 2000s could no longer endure the longueurs of copying parts by hand, my own or others’.

I’ve also injured my hands through various non-music-related accidents (broken fingers, etc.) over the years. Yet I am typing this article and still playing the piano and working weekly as an organist and using my hands in the extravagantly labor-intensive task of composing and notating music, both by hand and by Sibelius, as well as writing prose (maybe 50,000 words in the last year) and doing the daily websurfing-by-keystroke-and-mouse we all do. How do I keep going? I get my body tuned up. By physical therapists and, occasionally, complementary medicine practitioners. It works. Acupuncture, for instance, substantially reduced my ulnar nerve pain and has even helped the early arthritis I have in my finger joints.

There is a Manhattan physical therapist named Shmuel Tatz who actually calls his method “body tuning.” Tatz’s work is premised on the idea that the entire body, like a single musical instrument or ensemble of instruments, must be “in tune” in order both to heal and to prevent injuries of chronic overuse. His system is self-evolved (over 40 years), intuitive, and eclectic—it is neither osteopathy, nor chiropractic, nor Feldenkrais, nor any other “brand name” of holistic body treatment. I went to him for treatment of a knee injury, and found in the very first session that he can “read” a person’s gait and physical mechanics in an uncanny way almost instantaneously, then manipulate your joints, tendons, and fascia with his bare hands to “retune” you according to this “reading.” Believe me, this is not mumbo-jumbo. In one session I mentioned in passing to Shmuel that while riding a bicycle my right arm was going numb. He immediately found a few points along my upper back and shoulder and pressed here and rubbed there. An unexpected by-product occurred that night, when I sat down to play the piano at home: my playing was suddenly like greased lightning. I had technique I never knew I had. Shmuel had truly “tuned” my body.

Shmuel says we musicians, for all our years of training and practice, have not properly learned how to live in our bodies. He doesn’t mean just the correct hand position or arm position you learned from teachers, he means the total body—your carriage, your hip, and other body areas remote from the actual scene of battle, so to speak. He uses many different machines to help reduce inflammation and pain, but his primary technique is to discern, with his eyes and hands, a lifetime of dysfunctional postures, gaits, and muscular imbalances you didn’t even know you had, then retrain you how to rebalance them. His principal therapeutic tools are his own hands. His hands are magic manipulators. He feels surgery is a “racket” and should be used only as a last resort. Treating carpal tunnel syndrome nonsurgically is “easy,” he says. He also says everybody, even world-class professionals, has physical problems, and if they say they don’t, they’re lying. Inasmuch as he’s personally treated musicians like Isaac Stern, Christa Ludwig, Rostropovich, and Penderecki, one takes him at his word.

Shmuel Tatz has just published a book entitled Hands on a Keyboard: A Guide for Musicians and Computer Users, co-written with Vladimir Mayoroff, a Lithuanian M.D. who is also a musician. “Both intense concentration and pure physical strength are required for public performance, and the musician is expected to have more stamina that many athletes do,” the authors write. The book explains several hand and arm ailments so you can really diagnose yourself, and then it describes many excellent self-treatment techniques that you can use for them at home, techniques new to me despite my many previous experiences in physical therapy. As a bonus, it also is a fine primer on hand anatomy for both keyboard and string players.

There are many clinics around the country that specialize in performing artists’ injuries and medical issues, such as the Performing Arts Clinic at Brigham and Women’s Hospital in Boston or the UCSF Medical Center’s Health Program for Performing Artists in San Francisco started by the late Dr. Peter Ostwald, a biographer of Schumann and Glenn Gould. To locate similar clinics in your area of the country try these two excellent links: www.lunnflutes.com/hophc.htm or www.yourtype.com/survive/clinics_for_performers.htm (—a caveat: some listed contact addresses may be out of date). But to find a complementary healer in your local area who can address musician’s body tuning issues may be a harder task, though some of the doctors at the performing arts medicine clinics may refer you to good alternative practitioners. Then again, you can always buy Shmuel’s book, or if you’re in New York City, you can make an appointment to see Shmuel.

But the question remains, can this kind of “body tuning” therapy also help a composer become a well-oiled mental machine—a better mentally and physically lubricated creator? Can parts of the body that are out of joint because of the stresses of composing music be adjusted so that composing will become smoother and more creative, too? Does the body really reflect our minds more than we know? Maybe the longevous Elliott Carter is just naturally tuned-up? If one can learn to be less physically tense, will the creative ideas issue forth more profusely? Or if not, if the creative act necessarily induces a certain a priori tension, then can one learn to cope with one’s physical tension better so as to access the muse more efficiently? Actors learn various techniques to explore their deepest emotions so as to liberate energy and improve their powers as actors. Some of these are physical disciplines, some are emotional release techniques. Could it work for composers as well? Maybe the secret of facilely prolific composers like Milhaud, Villa-Lobos, Hindemith, or Schubert is that they were able to carry states of mental tension without becoming physically tense. They didn’t even realize they were mentally tense because they never felt tense physically. They were, in short, in a natural state of good “body tuning.” They were good composing athletes.

For my part, physical therapy, in restoring my ability to work with pencil freehand, has thus also been psychologically liberating. Though I use Sibelius now (an older edition which I need to upgrade), I have a love/hate relationship with it—it affords me greater writing speed and the ability to extract parts automatically, and permits me to engrave large works in defiance of my ulnar nerve problems, but it also feels like wearing socks in the shower. Computer engraving is de rigueur now everywhere in our field, but there’s just no replacement for the unfettered creative freedom and sensuous hands-on experience of making that pencil (or ink) draft with your bare hands like a painting. Recently I returned to sketching and drafting by hand using green Aztec paper, Archives soy ink recycled paper, and my favorite pencil since the Eberhard Faber Blackwing was scandalously discontinued: the Mirado Black Warrior No. 1. (Not long ago a Carnegie Hall exhibit of Leonard Bernsteiniana displayed several sharpened-to-the-eraser Blackwings Bernstein evidently saved for posterity. “My soldiers,” he called them.)

But the final test will be to go back to Shmuel and see if further body tuning will help promote further creative liberation. I hope to “stay tuned,” in more than one sense.

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Mark N. Grant composes in all forms, especially music theater: he won a special Friedheim Award in 2006 for his cantata The Rose of Tralee. He is the author of two ASCAP-Deems Taylor Award-winning books, The Rise and Fall of the Broadway Musical (2004) and Maestros of the Pen: A History of Classical Music Criticism in America (1998), and wrote a biweekly column for NewMusicBox’s Chatter in 2007-2008.

Recently I met two people who were of great interest to me. One, an eleven year old girl, the other, a 63 year old man. The young girl has been actively engaged in physical training as a competitive athlete for 4 or 5 hours a day since she was 5 years of age. She has not been able to walk without pain for the past four months. The gentleman has been physically active since his teen age years. He now walks like a very old man.

The young girl’s doctor has suggested cortisone injections. The man has already had several surgeries for his tendons and bones. Neither client can imagine life without being active for at least several hours a day in organized physical activity.

It is true that we humans must move, move, move. We need to improve our endurance, our flexibility, strength, coordination and balance. But, the question is: how much do we have to improve our physical abilities? The answer is that we need to be carefully measuring this with a professional who knows the norms, that is how strong and flexible the muscles need to be, how much mobility there needs to be in the joints. Someone who knows how to help us improve our physical body, but who, understanding the cost of overdoing exercise, will tell us, for example, that there is no reason to run every day for three hours, which may be good training for a marathon but for which we will pay the price with musculo-skeletal or vascular problems later. Strength training for hours a day, or excessive yoga practice can also lead to joint problems and replacement surgeries, witness what happened to Jane Fonda. We see super athletes who have heart attacks and this is why in many cases, the emotional desire to compete, to jump higher, to be more flexible, run faster can have many unpleasant side effects.

In classical physical training, for every hour of physical activity, the athlete needs 10 minutes of rehabilitation, or ‘body tuning.’ Just as every car after 5000 miles needs to have adjustments, the same goes for athletes, dancers and musicians. After 5 hours of practice there needs to be one hour spent on tuning the body to prepare it for the next day’s activity. Olympic athletes hire professionals who work with them every day doing tuning and rehabilitation. In contact sports it’s almost impossible to avoid contact injuries, but in sports like running, dancing, bicycling, or yoga, in most cases there are no contact injuries. The injuries are from repetition. And, once again, just as mechanics check and reevaluate the various systems of our cars after many miles of wear, so, too, must we regularly consult professionals who can evaluate the wear and tear on our muscles, ligaments, tendons and joints and help us minimize the damage with a tune up.

Neither the 11 year old nor the 63 year old had the benefit of that advice. The child’s trainer did not suggest such an approach. The surgeon who did the gentleman’s several surgeries did not suggest how to take care of himself to avoid future problems. The best piano teacher who has a brilliant student sees a competition winner. He does not have it in mind to take care of that student’s psycho-physical condition to avoid future problems. A coach may see in a gifted student a future Olympic champion, but may not take good enough care to see that the student pays attention to his/her physical instrument in order to avoid problems later.  Don’t expect from your trainer, coach or teacher suggestions about keeping the body in tune. In my 40 years of body tuning, only a few professionals who saw students trying to do things that strain the body, recommended a professional who could help them avoid the consequences.

I am so happy right now that more and more people are searching the internet and evaluating the best practitioner for their physical problems. I see piano players, yoga practitioners, musicians, dancers, famous, wealthy, poor…all who suffer with body ailments. I treat each patient, each body with the same amount of time and expertise that I have gained in a varied practice over the years. And to each I try to give the same message: Take care of your body today for a comfortable life tomorrow. Treat it with respect and do not overstress it. For every 4 or 5 hours of activity, you must spend one hour of rehabilitation and tuning.

I keep hoping that people will learn something from me and keep themselves from having bigger problems as time moves on.

The other day a client of mine told me a story. Her housekeeper had fallen in the home of one of the people she works for. She fell on her right side, shoulder and arm. She didn’t think she had been hurt because she was able to finish all her work and continued to work for the rest of the week, but in increasing discomfort. When her pain level was too difficult to manage, she went to Bellevue Hospital and saw an orthopedist who took x-rays and pronounced no bones broken but probably a lot of muscle bruising and tendonitis. He injected her shoulder with cortisone. It did not help her. She then went to a chiropractor she had been told about who took more x-rays and told her that no bones were broken and to get a shoulder splint and wear it. She did but the pain increased. She then went to another chiropractor who sent her to a different hospital where the physician told her to take off the splint and to get some physical therapy because it was necessary for her to move her arm with proper instruction as how not to harm herself further.

This is a story repeated over and over in my office. There is a tendency in modern countries for injured people to believe that only an MD can treat an injury. It is my opinion that if physical therapy were sought as a first resort, many injuries would have less recovery time.

I applaud the work of dedicated physicians to their specialties. But the truth is that doctors receive no training in physical therapy. Nowadays, there is some training in medical schools in alternative methods of healing, but as far as I have been able to determine, no training or credit hours in physical therapy per se. Following Medical School, doctors spend at least four additional years in hands on training in their specialties, but that training still does not include the art of physical therapy.

Many people do not realize how well trained physical therapists are in diagnosing and treating all kinds of injuries. Of course they refer to physicians when they suspect there is something more at hand than the injury described by the patient. But too often physicians prescribe rest or injections for an injury when the more advantageous treatment would be gentle and then greater manipulation along with proper exercises designed to strengthen and heal.

The Education and Training of Physical Therapists

The education and training of physical therapists is lengthy. (See the United States Department of Labor’s website)  It includes science courses such as biology, anatomy physiology, cellular histology, exercise physiology, neuroscience, biomechanics, pharmacology, pathology, radiology/imaging, as well as behavioral science courses, such as evidence-based practice and clinical reasoning. In addition to classroom and laboratory instruction, students receive a great deal of clinical experience. Their training nearly equals the number of years it takes doctors to gain proficiency in their particular fields of interest.

Before entering an accredited Physical Therapy program many students have already completed an undergraduate degree. They can then study for a Master’s Degree or DPT (Doctor of Physical Therapy.) All graduates must pass the National Physical Therapy Examination and fulfill State requirements to obtain licensure, after which they are able to practice in hospitals, outpatient clinics and/or private offices. Most full time physical therapists work a 40 hour week.

Many States require continuing education as a condition of maintaining licensure. However, all physical therapists are expected to continue their professional development by participating in continuing education courses and workshops.

Physical therapists also carry personal liability insurance as do other health care professionals.

How to Find the Proper Physical Therapist

But knowing all of this, there still remains the problem of finding the proper physical therapist for you. A recommendation from a trusted friend can be helpful, but I will give you some guidelines for finding the help you need.

1. The physical therapist should have a minimum of 10 years of experience in private, solo practice and should spend a minimum of 30-40 minutes, hands on, with you.
2. Don’t be impressed with the look of the office or the convenience of the location.  What is important is the therapist’s knowledge of how to work with your body. The best physical therapist talks less, explains less and asks the minimum. His expertise is in finding in your body what you are not aware of and trying to fix it.
3. The physical therapist should know all about various modalities and manual techniques such as laser, ultrasound, short wave diathermy, non invasive electrical stimulation and also Alexander, Trager and Feldenkreis. Not necessarily to use all of them, but to choose the right ones for you condition. Then he must teach you how to behave with your body to minimize the damage you may be doing with every day activities.
4. Most important of all is how you feel. Ask yourself: “Do I like this touch?” Some pain that you may experience is not necessarily bad, but you must decide: “Is this right for me? Do I feel better?” If your answers are no, then you must find another therapist. However, give yourself at least 4-6 sessions with the therapist before deciding whether to continue or not. If all your answers are yes, and you are satisfied, then you are in the hands of a professional who has the training and ability to make your life a happier one, hopefully free of pain, with increased mobility and a more positive outlook on life.

Every health practitioner wants to help you. But nobody knows everything. You need to feel in your body that your choices are leading you to the shortest way to recover from discomfort, pain and tension in your body. For today and tomorrow.

Body Tuning is the name I have given to what I do as a physical therapist.

Because I have been involved with music and musicians over many years it has made me realize how much physical therapy is like tuning a beautiful instrument. For instance: a piano tuner comes with his bag of tools, but before he begins to work on the piano he asks the owner of the piano what she or he hears from the instrument that does not seem quite right. Then he sets out to discover on his own what the problems are. He plays, he looks at the strings, he tests, and with his various tools he tries to make the piano sing again, thereby making the owner extremely happy.

That is exactly how my practice of ‘Body Tuning’ works. My tools are my hands.

When you come into my studio I ask you to tell me your complaints, that is, what you feel are the problems with your body…something in your muscles, skin, tendons, bones, something inside that bothers you, some pain or discomfort. Then, my job is to ask your body for the answers to what is wrong.

Usually people who come to me have talked to several health practitioners. If you are in my studio then those conversations have not solved your problems. It is my task to then ask your physical body what is wrong, and if I don’t find the answers, I’m going to look at the different tests you’ve had…your lifestyle…your behavior…your habits.

But first I want to talk directly with the problem. I look at your body. I see its appearance and how it moves. Second, I try different passive movements with your body. I try to move your skin, your connective tissue, your muscles, your bones, your ligaments, to see how the mechanics of your body work.  And I listen to the noise…the sounds that the joints and muscles make. My hands feel and my ears listen and tell me what is wrong. This ability has come after many years of study and practice. Just as getting to play in Carnegie Hall involves ‘practice, practice, practice,’ so does learning how to tune the body. From simple body movements to deep manipulation it is like knowing how to play fortissimo on the piano without killing the piano. Working on the body deeply with expertise can accomplish solutions with perhaps some pain, but it is good pain. It is constructive and not destructive.

Body tuning is looking at, listening to, and helping the body restore itself and its ability to sing once again.