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February 4, 2007

BehindTheMedspeak: It hurts to play beautifully — Why classical musicians are rarely at 100%

Stuart Isacoff's January 31, 2007 Wall Street Journal article brought out from the shadows one of the dirty little secrets of classical music: pain and disability are routine accompaniments to playing an instrument at a high level.

Here's the most interesting piece.

    Classical Musicians Suffer for Their Art

    Classical musicians enjoy gossip as much as anyone; just consider the popularity of Blair Tindall's book, "Mozart in the Jungle: Sex, Drugs, and Classical Music." But there is a subject that even the most jaded sophisticates in this profession still speak about in hushed tones, if at all: performance-related injury.

    Pain and disability are commonplace aspects of a life in sports. But for musicians, who are, in the words of pianist Leon Fleisher, "athletes of the small muscles," they are often considered a personal failing — as well as a threat to status and career. As Dr. William J. Dawson, president of the Performing Arts Medicine Association (PAMA) put it recently, "There's always somebody lurking over your shoulder to take your chair."

    Mr. Fleisher, a leading pianist of his generation, spent many years playing repertoire for the left hand after his right hand was afflicted with crippling problems, and only recently managed to release his first recording of the standard repertoire in 40 years. Tonight, he will be performing at the Kimmel Center in Philadelphia.

    Gary Graffman, another of America's most promising artists, also lost the use of his right hand and began playing concerts with his left alone. Violinist Peter Oundjian, a remarkable musician and onetime first violinist of the Tokyo String Quartet, had to give up his instrument entirely; he now conducts. Pianist Murray Perahia has been waylaid more than once by a swollen thumb. This is the public face of the problem.

    Yet the true extent of the situation is stunning. Dr. Kris Chesky of the Texas Center for Music and Medicine remembers attending a recent conference at Northwestern University during which it was reported that 100% of their entering music majors reported some kind of physical difficulty. At the University of North Texas, with which Dr. Chesky is affiliated, 86% of piano majors participating in a survey reported having pain associated with their playing. Such data collection is a relatively new phenomenon.

    Many of the most dramatic examples follow a pattern similar to Mr. Fleisher's. "Back in 1964," he reports, "I experienced an involuntary curling of my fourth and fifth fingers.... I went from doctor to doctor, then on to Eastern medicine. I tried everything from aroma therapy to Zen Buddhism, and no one had any answers. It turns out what I have is called 'focal dystonia,' which attacks a limited number of muscles. It usually happens to people who use fine muscles under pressure — surgeons get it in their hands, horn players in their lips, singers in their vocal cords."

    There is no clear answer about its origins, says Mr. Fleisher. And, he explains, although he is playing again, he is not cured. Yet a combination of deep muscle massage known as Rolfing and botox injections to control muscle spasms has let him fight his way back.

    If there is no known single cause, however, he can certainly point to several culprits. "Students think that if they are simply pumping ivory -- or, these days, pumping plastic — they are improving. That's nonsense. Anything that's done mindlessly is dangerous," he says. "I also place some blame on the record companies, and on Vladimir Horowitz. Young people don't realize that his piano was rigged with extra light action and lacquered hammers for a bright sound. Students working on a lousy piano try to get that same sound and speed. They fail to realize that there is a limit to what you can do." There is only so much physical effort that anyone can safely exert.

    Mr. Oundjian has similar ideas about the nature of the problem. "When I think about Leon, with whom I have spoken a lot, I realize that we are in some ways similar personality types. Playing the music of Beethoven, Brahms and Shostakovich, we put perhaps too much of ourselves into it. This situation rarely happens to someone who keeps a more objective approach — you have to have your soul in the music, of course, but not every muscle in your body. It is so important to use minimum contractions. Even today, young violinists are taught to press their fingers down with force, and it is very destructive. In my own teaching I talk of using weight instead of pressure, placing the focus on lifting and releasing."

    Until recently, musicians seeking relief had only limited opportunity for expert care. But methods of relaxation and balancing, such as yoga, tai chi and the very popular Alexander technique are offered in most cities and at many festivals. And some solo practitioners have developed impressive reputations for healing. In an apartment in New York's Carnegie Hall, a Lithuanian-born physical therapist named Shmuel Tatz, who bills himself as a "body tuner," has garnered endorsements from such celebrity musicians as Isaac Stern, Yehudi Menuhin, Rosalyn Tureck and Christa Ludwig. A session with Mr. Tatz, who prods and massages and puts you through a rigorous routine of movement and posture adjustment, does amount to a tuning of sorts, and his admirers are legion.

    Yet many suffering musicians have been unable to find a ready solution to their problems. Janet Horvath, associate principal cello with the Minnesota Orchestra, ended up writing a handbook called "Playing (less) Hurt — An Injury Prevention Guide for Musicians" (www.playinglesshurt.com). "My phone has rung off the hook with injured colleagues from all over the country who need a shoulder to cry on and trusted references," she reports.

    Still, things are rapidly changing for the better. When Alice Brandfonbrener, director of the Medical Program for Performing Artists at the Rehabilitation Institute of Chicago, began working at the Aspen Music Festival in 1978, there was no coordinated effort to help musicians. In 1983, Dr. Brandfonbrener put together the first meeting ever of doctors to discuss the subject, and her efforts grew into PAMA (www.artsmed.org), now a world-wide network.

    Today, in Chicago, she explains, new and better approaches are being developed. Research has offered a glimmer of hope that specific exercises and techniques to retrain the fingers can alleviate many problems. "We found changes in the brains of the people we have been treating this way," she announced, indicating that long-term relief may be in sight.

    Education has also become a priority. According to Dr. Dawson, the National Association of Schools of Music now mandates that music schools provide health information to students as a requirement for recertification. At the University of North Texas, explains Dr. Chesky, music students are already offered classes in musicians' health issues as part of the "wellness" requirement in the core curriculum. They learn about preserving muscular health, avoiding hearing loss, dealing with emotional problems and more. One interesting conclusion of the research program is that many piano students are now Asian or female, and both groups tend to have smaller hands. As a result, at this university, two Steinways are modifiable, so that narrower keyboards can be slipped into place. Doctoral recitals sometimes utilize a smaller keyboard, preventing unnecessary strain on the performer. And why not? Standardized keyboards are a fairly recent development, and some artists of the past — including the legendary early-20th-century piano virtuoso Josef Hofmann — used pianos with narrower keys.

    The field seems to be blossoming. The newly opened Louis Armstrong Music and Health Clinic for Musicians and Performing Artists at Beth Israel Hospital in New York, run by music therapist Joanne Loewy and Medical Director Stephan Quentzel, employs what they describe as a holistic approach to address the physical, emotional and musical aspects of the problem.

    "Say you bring your car in for repair and it has a problem with the muffler," explains Dr. Loewy. "You get a new muffler, but the problem is still there. Then you put in new shocks or brakes, but ultimately you realize that the problem really lies with the driver.... Integrating all the systems is the key. We'll assess how you play, alone and with others, study the cognitive maps that may be tweaking your situation, address the anxiety that comes from not having control. In treatment, fun, creativity and spontaneity are an important part of the process. We might have you choose an instrument you are unfamiliar with, to address things in a new way, or make use of improvisation. Every patient receives both a music therapy assessment and a medical assessment, and we use every means at our disposal to help." It's another sign of progress in the effort to shepherd today's musicians out of harm's way.

    Mr. Isacoff is editor of Piano Today magazine and the author of "Temperament: How Music Became a Battleground for the Great Minds of Western Civilization."

February 4, 2007 at 10:01 AM | Permalink


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clifyt et al, this came up at Sunday dinner too, about Bach and was supposed I didn't like that sort of thing much. I replied I preferred Mozart. Bach always seems too sad. Mozart is never and too mathematically precise; something I never appreciated until graduate school (business, not music, unfortunately as I am not so talented).

Posted by: PerhapsCreativeEnough | Feb 19, 2008 12:26:40 AM

Damn...I missed this the first time around...

I don't know why ANYONE would play hurt...it isn't like musicians are dumb and can't do anything else with their lives. It is an art...it isn't a living...anyone that forgets this needs to never play or listen to music again.

After the rhematory arthritis hit at 29, and TRYING for a year getting cortisone shots in my wrists (and thought of getting surgery that *WOULD* have crippled me, but would have given several more years of playing before that happened)...I gave up and went back to school and decided to focus on my 'second career'. ALL musicians should have second careers...one of my friends is a noted horn player (think memphis...ok, not that one, but if I said it you'd know)...and he sells insurance on the side.

Six years later, I'm considering getting back in somehow...working my hands and practicing against a heavily weighted piano-action synth (and then move back to the light-weighted one to just work on timing...I have no sense of timing any more). But the fact is, if it looks like I'm doing any permanent damage I'll go back to composing with a damn mouse and that will be it. I'll be sad, but what is meant to be, will be.

Beyond that, I can't stand listening to musicians that seem to be having no fun...music, no matter how serious, should be emotional. Playing because you have no other opportunity is not fun. Musicians that take their lives too seriously ruin it for everyone else...I'd rather listen to a second rate musician that enjoys what they do...

Anyhoooo...ranting....fingers are sore...

Posted by: clifyt | Feb 18, 2008 11:40:26 PM

Thank you for posting this article. If anyone would like more information visit www.bodytuning.us. There is a lot of great articles and other general information that hopefully can be helpful.

Posted by: Shmuel Tatz | Feb 18, 2008 10:05:23 PM

I found the Alexander Technique greatly helped my singing and violin playing - definitely worth trying. You can learn more about it at http://www.alexandertechnique.com

Posted by: Jack Martin | Feb 4, 2007 8:24:41 PM

So very, very true. I've known pianists, string players, percussionists with debilitating joint/finger problems, brass players with chronic shot lips, you name it. If ANYTHING affects your hands, it'll affect your playing. Woodwind players possibly suffer somewhat less in the embouchure department (at least fl[a]utists do), but the odd cold sore or tongue irritation can screw up everything.

What astounds me is the beating that classical singers' voices take. Imagine standing up and shouting at the top of your lungs for a couple of hours straight, and trying not to lose anything in volume or "quality" in the process. It's amazing that singers get as many years out of their voices as so many of them do. (Yeah, lots of them carry on when they should've quit way earlier, but that just gives everyone more to discuss after a performance.) The voice has got to be the most sensitive, demanding instrument there is, opening the "player" up to all kinds of injury. And things aren't so easy to fix, or replace.

Posted by: Flautist | Feb 4, 2007 4:21:58 PM

The last 50 secs of the video are wonderful. Just to see the striving, and then the payoff... the smiles. Nothing like moments like that in music. When the conversation of the instruments arrives at the understanding of the theme. Worth all the pain. That's what I tell my fret-hand. Thanks!

Posted by: Joan of Argghh! | Feb 4, 2007 11:02:40 AM

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