When NYC’s quarantine began in March, and more and more people began working from home, one of the biggest challenges for many, was finding a usable workspace in already-tiny apartments. 

Over the last month for instance, my wife has spent more time using her piano as a desk than as a piano (HA! sick burn…) – but then again, I guess this beats using a hamper in the hallway, an ironing board, or (my personal favorite) a jumbo pack of toilet paper in front of the toilet.

And sure, it’s kind of funny and novel at first – but these lighthearted photos of makeshift work-from-home setups have given way to more serious articles about how to deal with (or prevent) neck and back pain, and how working all day on the couch is setting us up for all sorts of issues down the road.

The difficulty, from what I understand, is that the little things – like the angle of our head when we’re texting, or the way we stand while in line at the grocery store – may not be a big deal in isolation, but when you add them all up, especially over time, these seemingly trivial habits can not only lead to worrying levels of pain in our day-to-day lives, but potentially even make us more susceptible to experiencing playing-related injuries (!).

Meet Howard Nelson & Pamela Frank

Howard Nelson has been a physical therapist for over 30 years, and specializes in addressing movement system impairments – that is, identifying and modifying the habitual movement patterns and postures that lead to pain and injury. He worked at NYC’s Hospital for Special Surgery for ten years, including five in HSS’s sports medicine department, but in recent years, has begun to share his expertise with musicians.

Pamela Frank is a world-renowned violinist and highly sought-after chamber musician and teacher. She is on the faculty of the Curtis Institute of Music, coaches at Tanglewood, Ravinia, and Verbier, and having recovered from a career-threatening injury herself, has been presenting workshops and teaching with Howard to help musicians not only learn how to avoid injury – but also play and practice more effectively too.

In this episode, we’ll explore:

  • The story of how Pamela got injured, met Howard, and relearned how to do everything – from playing to walking to brushing her teeth. (4:21)
  • What Howard asked her to do in the first session that made her think “What is this? This is not physical therapy, I need a real physical therapist!” (8:25)
  • The reason why you’ll see Pamela often lift her arms up, and rest her hands on her head while sitting or standing. (10:28)
  • We tend to think of playing-related injuries as being caused by playing-related posture or bad habits, but Howard and Pamela describe ways in which our daily habits away from the instrument influence our aches and pains in our playing too (and vice versa). (17:03)
  • And speaking of laptops at eye level, Pamela also explains why your music stand should be higher up than it probably is – even in chamber music! (20:33)
  • How you don’t suddenly become an artist – artistry has to be trained. (22:59)
  • What non-judgmental and effective and efficient/thoughtful practice looks like (the next four minutes might be my favorite bit of the interview). (24:31)
  • Pamela explains how general, unspecific self-criticism is a “cop-out” (wait…maybe this is my favorite bit of the interview?) (29:17)
  • Howard explains why trying to avoid risks, and not giving yourself permission to make mistakes reduces fluidity, increases, and paradoxically, leads to more mistakes. (31:51)
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Noa
Today, I’ll be chatting with physical therapist Howard Nelson and violinist Pamela Frank. But before we get started, I wanted to share a little bit of background. I may have alluded to this on a previous episode, but a couple years ago, I sustained a neck injury where essentially I got pushed over backwards onto my neck, heard some crunching and popping sounds, and ended up having quite a bit of pain afterwards. Fortunately, things weren’t so bad that I needed surgery or anything like that, but the specialist I saw did send me to physical therapy. I have to confess that I didn’t understand physical therapy at first, meaning a lot of the things they asked me to do seemed kind of trivial. And sometimes I couldn’t even quite connect the dots between what they’re having me do, and where I was experiencing pain. Plus, even though I was going two or three times a week, nothing seemed to be changing. So I was kind of skeptical, but given how scared I was, or the possibility of a future in which my neck and upper back felt this unstable and painful, out of desperation, I dutifully did the exercises they prescribed to me. And then suddenly, one day, I noticed that things were a little bit better. And so I continued to do the exercises and began to understand how everything was interconnected. And that over the years, I had developed a whole assortment of muscle imbalances and asymmetries and weaknesses and tightness that had made me something of a ticking time bomb anyway, even if I hadn’t experienced this particular neck trauma. My experience in physical therapy gave me a whole new appreciation for how much of an impact the tiny, seemingly inconsequential postural habits we engage in on a daily basis can have when you compound that effect over hours, days, weeks, months and years. So a few months ago, when I saw that the violinist Pamela Frank and a physical therapist named Howard Nelson, were giving a talk on physical therapy at a conference I was attending. I was intrigued and went to check it out. It ended up being a really awesome talk. And there were so many things they said that really stuck with me. And then I couldn’t stop thinking about the rest of that day. Like how sounding good can delude you into thinking that how you’re playing your instrument, it’s okay, and how it can be important to divorce music making from your body, and what that even means. What was cool was to see the overlap between Pamela’s expertise and experience as a violinist and Howard’s expertise and experience as a physical therapist. So I reached out to them, and they were generous enough to take some time out of their busy schedules to sit down and chat. The first thing I was curious to find out was how their paths crossed in the first place. Here’s Howard:

Howard
I got a phone call from [Pamela’s] physician. And he said, I have a patient for you to see who’s a friend of mine, who’s a great player. And he told me a little bit about her problem. A spinal surgeon referred me to this doctor. And so I got to see Pam through her physician. And then I didn’t know anything about who she was or what she did, but just treat her like a normal person. And that was November 5, 2012. And then I saw her probably three times a week for the next few months, or six months, six months, which is unusual to see somebody that frequently which was very lucky for me, so I could really go slowly and methodically into the things I thought would help her and usually people come very infrequently and sporadically. And you can’t if somebody, if somebody needs to change their use of muscles and their moving patterns, it takes guidance and practice. And oftentimes I feel like I haven’t had enough time with somebody with Pam, I was lucky,

Pam
Actually was seven months now that I think about it. And from my point of view I had, I had been wheeling my father in a wheelchair on his first day, confined to a wheelchair. So I was trying to cheer him up and I wheeled him up, up and down the Upper West Side. And the next day, I had to play a concert and go on tour and I woke up and I could barely move. I was just sort of muscle bound, not knowing what kind of strength and fitness that requires to wheelchair up and down curbs and hills. But of course, you know, I ignored the pains and my concert and then I went on this tour and I remember hoisting a piece of luggage overhead and feeling something happened in my neck. And of course, ignored that too, because I was on a tour and I was very excited to be on tour. And so you play through pain with adrenaline and you know, you ignore it. And then about 10 days later, I really couldn’t move my head at all. I couldn’t sleep and I really just couldn’t function at all. And so I went to a doctor, I went to a surgeon where I, where i was playing, and they said, get an MRI and the MRI, you know, short showed herniation of two discs in my neck and the neurosurgeon said, you need a spinal fusion. And I called my doctor and he said, Well, first of all, you don’t get a spinal fusion right away, you come home, and I see you and so I did that. And he said, you do nothing of the sort. You go see Howard Nelson. I do what my doctor says. So I went and see. So Howard Nelson. But I basically had to stop everything. I just stopped work, teaching, travel, playing everything. And I became a devotee of Howard Nelson’s methodology, I guess, and it made perfect sense. It made so much sense to me. I’ve been to many practitioners. before but this was really about common sense and cause and effect. And though it was very slow, I knew that it was going to be permanent because it was very slow wasn’t a quick fix. And I’m an excellent student. And it was also because it was career threatening, I had to do something about it, I didn’t have a choice to ignore it anymore. And so I became a religious, PT, patient. And my whole day was basically spent doing the homework. And six months later, I was much, much better. And then eight months later was much much better and, and eventually, I was totally fine. But I had relearned how to use my body completely, not just in playing but in walking and sitting and sleeping and eating, standing everything. But I had learned how, with the guidance, I learned how to retrain my body for a permanent fix, not a not a quick fix, forever fix. And of course, we know that real change is slow. real learning is slow, and so it took really a year and a half to start playing again. But, but now I have a completely new set up and I have a new way of doing everything. And I pay attention to it all the time. It’s sort of forever, also the awareness.

Yeah. And so, you know, we had to get married.

Noa
Pamela noted that she was a good student and great at doing her physical therapy homework. But even so, I wondered if she experienced any of the same sorts of skepticism or resistance to physical therapy that I had at first.

Pam
Well, I wouldn’t call it resistance. I would just say that I’d probably been ignoring small signs my whole life. You know, I remember saying to Howard, I’ve never had anything like this. I’ve never had any aches and pains, you know, and all my friends and colleagues are injured all the time, and I’ve never had anything and he said, probably not. Probably you did have things that you either repressed or decided not to pay attention to or have forgotten. And that’s that’s probably true. So but there wasn’t resistance. It was just I really had no choice. I mean, because it was such an acute situation that I, I went whole hog in but I must say that I’ve been to many practitioners and I’m skeptical of voodoo and magic touch and, and I’m skeptical of having things being done to me, because that’s not teaching me how to do anything different for myself. And so, though I, at first I was skeptical because my the first couple of sessions all Howard did was put my arms on pillows, and I’ve been so used to being poked and prodded and kneaded and having done things to me, that I called my doctor after the first session, I said, “What is this? This is not physical therapy, I need a real physical therapist.” And he said, stick with it, you know, because and your explanation is always because the arms are attached to the neck and something as basic as that never even occurred to me. So I was skeptical at first but then when I started realizing that all the things in my daily life were improving, like walking and sleeping, and sitting. Then it started to dawn on me that there’s a connection between how you move all day long and not just on your instrument. And then as I said, the common sense aspect of it really appealed to me like I understood like cause and effect if I do this, and it hurts, don’t do that and with with the proper guidance, find a different and better way to do that. So then I became a real acolyte.

Noa
I was also curious to hear Howard’s perspective and what his initial goals were for Pam when seeing her for the first time.

Howard
She was sort of in a was post traumatic stress situation where she was cold, she was clammy. I knew I couldn’t make her do many things. That’s why I tried to get her some relief by putting her back to a neutral place, neutral anatomical place. So if I align her well, and I take away the weight of arms. How does that feel to her? And she said, Well, that’s better. So that’s a big deal if you can really concretely say that this is a better feeling when I’m like, such and such. So I was pretty much hands off for the first two weeks, because I knew she was very acute in doing the least bit of the wrong thing would have set her off. And so I was very careful just to be very, very easy with what I did.

Noa
I’m sort of smiling inside a little bit, because, and no one could see this, but Pam has her hands on top of her head. I understand that that’s something that you’ve started doing more to make sure that your posture is better, or something along those lines.

Howard
Yeah, I mean, that’s a really great way of using the muscles in your middle upper back, that help move your shoulder blade, which is part of moving your arm and musicians who are spending three, four, five, six, seven, eight hours with an instrument in front of their bodies. That’s a big stress on those muscles, and we just want to make sure that those muscles get used in a normal way intermittently during the planning. So they’re healthy. And some people, they never raise their arms up over years of time with an issue in front of them and they have problems lifting their arms up, and that’s a important part of treatment that they can do that.

Pam
It took me months to be able to actually lift my arms overhead. I mean, in fact, I used to do a cheap, cheap way of standing up straight, which you call cheap way standing up straight which is put your arms behind your back, which I see a lot of people doing, but in my case that was the exact opposite of what I should have been doing. I should have been detraining those muscles and and learning how to go up here and it did take months for me to be able to go without my hands on the wall just in free space. But it makes perfect sense because if your arms are attached to your neck, you want to take the load off your neck, and that comes from underneath your shoulder blade which you know those muscles I didn’t need couldn’t even find them at first took me months to locate them, let alone strengthen them. But sort of like a hanger, if you pull weight on the hanger, it’s gonna like cause the neck to bend. And it’s not necessarily gonna break. But to lift the weight of the arms is really important. And basically, once I could do this, I live up here, I mean, I’m on the line at the airport like this, and I’m in the grocery store line like this and at the bank, and, and for the first half year or so I had to teach like this, so that my arms wouldn’t be hanging out with my neck. And it makes a huge difference. If you spend more of your life up here than hanging down.

Noa
I gave this a try myself. And strangely enough, it felt really good to me as well. But is this something that’s good for everyone to do? Or is it unique to Pamela, or just folks who have experienced neck injuries? Here’s what Howard had to say.

Howard
Something you need to rule out when you evaluate somebody’s ability to use their arms. You want to know if they have symptoms from their arms being in, we call it in a depressed position, the scapula or the shoulder blade, if it’s too low, if it hangs too low, that is called scapular depression in terms of the movement system that I use. And if by taking away that depression, when the person either is aligned or moving, if that makes them feel better, that tells us that that’s contributing to their problem. So it’s something to rule out with anybody who’s got a neck-shoulder issues, what’s the influence of their scapula position on those symptoms, and often that’s not evaluated too much, but I think all musicians should have the ability to lift their arms to the ceiling to the sky, pain free without obstruction. That just makes perfect sense to me for a musician.

Pam
Well, because it’s the opposite of what we do like holding hold down

Howard
Holding something in front of your body. Yeah,

Pam
yeah, yeah. But also it’s not just shoulder and neck, if I could just add on to that. I mean, I had symptoms in my hands, too, I had numbness in my hands. And a lot of people don’t equate the hands with the neck. And so often something comes from the neck and the shoulders and extends to the hand, right?

Howard
If you look at a nerve as being like a piece of spaghetti, hanging down from your neck, into your arms and fingers, and if you just let time go by and the arms are hanging down, that spaghetti is going to stretch and that stretch is tension and could cause symptoms eventually. So by getting that that nerve off that constant gravitational pull, it puts the nerve on slack, and makes it oftentimes feel better.

Pam
So I don’t think it’s just for musicians also, I mean, think about all the people that sit at a desk or at a computer. I mean, it’s the same, same positional danger. And it’s shocking to both of us, I think how many young people cannot raise their arms and that’s just a symptom or a sign of how much of everybody’s life is down here. You know at lap level.

Noa
This made me think about my own desk setup and how I have a very shallow desk with only enough room for the computer monitor and keyboard. And also a chair with no armrests, so I’m probably having to expend unnecessary energy and effort to keep my right arm elevated over the trackpad. As you can imagine, Howard had some helpful suggestions on things we can all do to improve our posture and avoid putting more stress on our bodies while on the computer.

Howard
So the solution would be either to get your muscles very, very well trained, the ones that elevate the shoulder blades and arms so that having arms out in space feels like nothing. But if it automatically or feels like a stress to have your arms floating in space when you’re typing or something then you would definitely want to share this guide arm supports are adding on supports to your desk would be an alternative.

Pam
Don’t you always, or often advocate for the same reasons, a separate keypad? Well, angled keypad,

Howard
If you’re using a laptop that’s too low, you can get one of these laptop supports that elevates the screen. And so you’re not looking down and then you have your separate keyboard, a separate mouse so that you could work with that with the monitor being at a higher place. The alternative is if you don’t have arm supports to get your chair to go underneath the desk, that means you need to have space underneath your desk. So you can rest most of your forearm on the desk, hopefully with your head and shoulders being a good good place also.

Pam
See, this is why this makes so much sense to me. This is not voodoo. This is just common sense that takes an intelligent person to know how… I mean, one of your big themes is make your environment adapt to you and not the other way around. And there’s so many little things that we can adjust and modify, that help our body being in a safer, more neutral place ze don’t even think about, like the arm supports.

Noa
Could you guys actually describe some of the things that like, for instance, specifically that you were doing that you didn’t realize you were doing that were causing problems, whether it’s in line at the grocery store or chopping vegetables,

Pam
I don’t chop vegetables. But yes, plenty of things. I mean, certainly on the instrument, my left arm was pinned to my body, there was no space here, and my head was permanently turned left facing my fingers. So my head was you know, my neck was twisted. And then my scroll was really pointing to the floor. So those and as a result, my head was being pushed forward also forward and to the left and the left arm pinned into the body.

Howard
Your head was tilted left too

Pam
right, tilted left, turned left and forward.

Howard
Right. Just to describe what that did to the muscles in your… so when her arm is pulled into her body, the rhomboids are the muscles that pull the blade towards your spine. That muscle was so overused and dominant that when I first tested her and said, Okay, let me see you reach your arm up and forward, her shoulder blade did not move up and forward with her arm, it actually move backwards. So that’s just a great, great example of how your body adapts to what you do with it. So she kept by doing a bring your shoulder blades together and pulling your arm into her body when she played. That muscle was working over time. She had to learn to let go of that muscle so that it could follow the arm up and that allowed her to get some pain free arm or motion. Unfortunately, I don’t have video of that because that would have been so great to see that scapula moving the wrong direction.

Pam
But also walking I mean, without the violin obviously. When I was on my right leg, I would dip left. My torso would dip left, which is of course, what I do when I play the violin. So it’s replicating the same problem, the same problematic position. So I had to relearn how to walk. Actually, I had to train my glute muscles to prevent myself from dipping left on every step, which is a lot of mental work and physical work. Then sleeping, sleeping was another thing where I used to sleep in severe fetal position, which is, of course, doing the same thing. I’m the left arm is pinned in my, my head is forward and to the left. And so Howard had me find a neutral spine by putting a pillow under my left arm, a pillow between my legs and a body pillow in front, so that the spine retained its natural curves and that made a big difference because that’s eight hours of your day. So walking, sitting, I used to sit on the front of my chair, which would arch my back and push my head forward. So I learned how to sit, using my feet, the back of the chair also for feedback, with the feet planted firmly on the ground, which they had never been before either. Even the music stand, you know, it used to be very low music stand because I thought it promoted more communication, which is total nonsense because if you’re paying attention, you’re communicating, so I had to learn how to play with a stand at eye level, and then just communicate more with radar and not rely on seeing the people around me so much. She was eating and drinking, even just bringing the plate to me instead of like, you know, he always says if you have a sprained neck, you want to keep it stable, right? So I used to move my head towards the plate, instead of bringing the plate towards your head. Same thing with a glass. And then of course, just basic talking. I mean, I’m a probably an over expressive talker. And so I i gesture a lot and I had to learn how to just talk with my mouth and not with my head and washing my hair used to wash my hair with my head instead of me and Howard would say, well “Couldn’t you move your hands could use your hands to wash your hair or brush your hair with your hands instead of your head?3 And so everything became an arm exercise actually, because I was using my head instead of my arms for a lot of activities, brushing teeth, putting on chapstick.

Howard
She was a very compliant patient because I say, you know, you really shouldn’t be wearing such heavy jackets. You should get maybe a lighter down jack because the weight up on your neck and shoulders. She’s so great. I’m glad because she comes back, “I bought three different colors!”

And so you got to know my answer to get something like a pillow. She’s Oh yeah, I got this great big pillow. She loved to shop.

Pam
Well, I used it as an excuse for shopping. I used to joke that I’d send you the bill. But it’s because all those things made sense to me. It’s all those little things that add up in a day. So and those really have nothing to do with playing the violin

Noa
Our conversation. began with a focus on how our habitual movement patterns in our day to day life can contribute to various aches, pains or injuries. But then the conversation begins to shift to a concept that coaches and sports often say – “that you play like you practice.”

Howard
One of our themes of our talk is, you get what you train for. And that’s what I say in physical therapy. Your body adapts to what you do with it all day long. The way you use it for eating and drinking is the way you’re going to use it. For other things. Pam has the same philosophy with playing. Do you want to discuss?

Pam
Well, I mean, I always just say the way you have practiced is the way you’re going to play. So if you’ve practiced safe, safely or mechanically, that’s the way you’re going to get on stage. I mean, you’re not suddenly an artist, artistry has to be trained. And so it’s important to practice the way you want to sound all the time and not you know, I overhear people saying, Oh, I need to practice. today. I’m going to practice for intonation and tomorrow. I’m going to practice for phrasing. And this is just ludicrous to me because great playing is playing on all those things at once, the simultaneity of everything. And so, if you practice with commitment and 1,000% expression, then the only difference on stage is that they’re going to be people with whom to share it that expression. And it’s also different physiologically, if you’re engaged or if you’re half engaged, or God forbid, if you’re totally passive and watching TV or thinking about other things. My father used to say you can actually unlearn things if you’re not paying attention. So to not only pay 1,000% attention, but to play in your practice room with full adrenaline with full intention with full communication because that’s also training. It’s not just training your mind and your and your soul. It’s training your body so that you’re not caught unaware, when you get on stage when suddenly there’s nerves and an audience and adrenaline. If you haven’t trained what it feels like to play with all of that, you’re going to actually get nervous. And that’s going to cause more tension. And then it’s a vicious cycle. So I advocate, advocate both things. One thing is what you mentioned, which is that, what are just the mechanical problems in this passage, and to be completely objective about it and not judgmental, which is Howard’s specialty, which is why I think you’re a great physical therapist is that it never becomes personal or emotional. It’s just mechanics. And so if you can identify, like a scientist in your practice room, where’s the problem? And not what is the area of the problem, but in what measure is the problem as specifically as possible and in what beat and then, okay, it’s beat three, now is the problem in the right hand or in the left hand? Again, totally objective, you know? And is it an intonation problem? Well, thank god there’s only 50 you have a 50 chance of being sharp or flat so you can already anticipate what your problems are. Just intellectually, you can… you know what the Bible says, Know thyself, you can you can guess your tendency ahead of time. And then, or is it a problem with as you said, not getting the right angle of the stick or the bow. I mean, there, there’s a finite number of factors in both hands, what a problem is. So the first thing is just to identify it, and then to say, Okay, well, how am I going to fix it, you know, rationally and then to give yourself fewer chances in which to fix it. That is a big part of my philosophy, because I believe in practicing much less, I believe in thinking more and practicing less, thinking more means something doesn’t go right. You play it once you stop, you analyze, you say, Well, what was it and the next time you play, it’s going to be a correction. If you repeat the problem, you’re just in graining the problem. If you don’t need to confirm that it was terrible you need to already … every time you play should be an improvement of something, consciously and specifically. Then, if you haven’t fixed it by three chances, you’re not paying attention. You’re not thinking enough, that kind of practicing is much more effective, it’s much less time consuming. It doesn’t lead to repetitive stress injury. And but it’s much more tiring. It’s much more tiring on the brain. So you have to do it for shorter amounts of time. But yes, I think a lot of it is just analyzing what a problem is. And then the flip side is then playing that same passage with 1,000% expression to see what happens to your body and to your mind and to your soul. Also, the other thing that is really important is to restrict the amount of time that you have because that will force you to prioritize. If you have all day you think everything is equally important, which we know is not the case, I would say cut your practice time in half, and then cut it in half again, and give yourself a very short laundry list three things to fix. If you can really fix three things instead of semi fixed 10 things it will be better for your planning. It’ll be better for your confidence. The trick is to be honest when you practice and please do not practice what already goes well. So if the problem is in measure 39, don’t even practice measure 38 or 40, even if it feels good for the ego, because the sooner you can just attack your demons, the better off you’ll be. And then the the other big thing about thinking more and playing less is score study. I mean, if you can learn a piece with your eyes and make all the decisions before your hands get involved, you’ll be a better player and a better musician and you’ll also save your save your body. So, to answer your question in a very long winded way, part of it is totally objective analytical way of being way of thinking of, of identifying problems in a non judgmental way. And then when you play, play for real.

Noa
Pamela alluded to the concept of non judgement a couple times to this point, not just here with regards to one’s own practice, but a little bit earlier as well. Noting that Howard’s ability to remain non judgmental is what makes him such an effective physical therapist. I wanted to hear more about what she meant by this because one of my favorite studies as a 1976 study of legendary college basketball coach, John Wooden’s coaching style, where two psychologists observed 15 practices and tracked and categorized every single thing that he said, adding up to over 2,300 acts of teaching in total. The researchers found that surprisingly few of his acts of teaching were judgment based, with only about 6.9% being praised, and 6.6% being criticism. Almost all the rest was instruction, in other words, feedback without positive or negative judgment. I described the study to Howard and Pamela and asked if they could each say more about judgment as it relates to each of their particular areas of expertise.

Pam
What I say to myself and also to my students is if you’re going to start using negative terminology on yourself, for every negative thing you say about yourself, you also have to say one positive thing, because the truth in life is gray. It’s not black and white. That’s the first thing. The other thing is I think that generalizing criticism is a total cop out. It’s an avoidance technique. You know, when I say to the students, so what’s the matter? And she says, it’s out of tune, I say, Well, where is it out of tune, and she points to the whole page? Well, that’s not useful. It’s demoralizing. And there’s no way to go about that, you know, you can just throw up your hands and say, I suck. And, but there’s no magic pill, the trick is just to say, okay, probably not all of it is out of town. So if you could just localize to the small, find the smallest common denominator, the smallest cell of what a problem is, then you start to realize that the other 99% of that page was actually okay. So that kind of scrutiny I think really helps. And then really what what are the mechanics of it? It’s not you it’s not your soul. It’s out of tune. It’s sharp or flat or that the bow, you know, the sound wasn’t right. Okay, so look at what all the properties of the bow are, is it the flatness of the hair? Is it the location on the stick? Is it the location on the instrument? Is it the sounding point? Is it How many fingers are engaged in the right hand? I mean, there’s a finite number of variables with the bow and the left hand. And so if you can just just analyze, just analyze and say, Oh, well, I guess maybe the problem really was only in one beat. It’ll make you feel better about yourself and about the rest of it.

Howard
Yeah, it’s a great subject. You know, she’s, you are a different sort of species. She’s unbelievably the opposite way. She’s, she can turn lemons into lemonade very easily. So she’s got really great skills in this department, she actually tells me to write a good journal, like in the evening to say what was good about stuff that happened during the day. So it’d be really interesting to figure out how do we change somebody’s judgment of themselves, where they’re playing over time? And how do you how can you figure that out? If you’re able to do that, I mean, I just try to give little instructions. There’s a psychologist named sports psychologist named Alan Fox who works with tennis players, who has a great little article that I can show you later, but embrace risk is one of the fun parts of playing and you’ll be less prone to missing and so with tennis players, it’s true like the fun of the sport is like to let yourself go and maximize what you can get out of your body with allowing yourself to screw up and miss. So that’s a huge element. It’s allowing yourself to screw up and miss is very, very difficult for people to do.

Pam
But you also say that of your own tennis playing, like you would have a problem with your … swing

Howard
Oh, yeah, not so hard or my shoulder problem in my left side was because when I got nervous, and I wanted to make sure the ball stayed in the court, like a musician will want to make sure that note is perfectly correct, you use excess muscles and you stop letting yourself be fluid. So I would stop myself from rotating on a forehand. And this, this is a position that can cause shoulder pain because this is not an optimal position. But if I rotated, this was a better shot. I had much more power when I uncoiled from that backstroke. And the pain wasn’t there, because I wasn’t in a bad position. So that was a eye opening for me to figure out that I Oh, I need to swing in my forehand.

Pam
But there’s a perfect correlation with playing also. I mean, this false notion that perfection is the goal neither in sports nor in music, I would say only brain surgery should be perfect. And otherwise there are no consequences to screwing up. And the irony is that if you’re trying to get through, let’s say a game perfectly or a piece perfectly, that does cause tension, and ironically, it will cause negative results that but if you allow yourself to relax and say you’re going to miss a shot, or miss a shift or miss something, usually the opposite happens because you’re relaxed. But can I just say one thing also about what makes you a good physical therapist, which I don’t tell you often enough is that, I mean, having been to many practitioners for various things, what I appreciated and in the way you treat patients, is with the same objectivity. There’s never anything personal, like, Oh, your tissue is what’s one of the things that you have loose connective tissue or you have have a weak spine or you know, the vertebrae are screwed up. I mean, in other words, somebody terms like that get bandied about in physical therapy sessions with practitioners. And it was never about that I never felt like, oh, it’s my body’s fault, or it’s my fault that I ended up this way. It’s like, here’s what it is. And here’s what we’re going to do to mechanically improve you. And that took all the pressure off me or the onus off me to feel like I was somehow responsible for my problem. That’s a big difference between you and a lot of practitioners.

Noa
So how does one retrain themselves to change movement patterns that have become habitual over the course of many years or even decades?

Howard
Sometimes it’s unbelievably simple when somebody is shown, oh, this causes you pain. And this movement does not cause you pain. Can you open your garage door the right way? Can you steer your car without bringing your elbow way out to the side. And the person says well yeah, sure. And they do that. And it’s better. And they can do that repeatedly through their day, I treated a friend of mine to serve a tennis ball by not bringing his elbow out to the side, but dropping it and going in the other direction. It helped him. So

Pam
he was also he’s an orthopedic surgeon

Howard
An orthopedic surgeon who is going to have possibly have shoulder surgery

Pam
and you tell him how to tie knots.

Howard
Oh, in the OR when they tie knots they can go like that, which is causing impingement to the shoulder, or you can tie knots and go this way. So those things are very, very doable for the right person, for the wrong person. They’re gonna say to me, are you kidding me? You’re telling me I have to get out of a chair and not keep my knees going together. I don’t want to have to think about that. I got too much in my day to think about. So for the wrong person. It doesn’t make any sense to them to change their movement pattern. A really stupid example for me is last night, I started to get sharp pain in my pinkie from flossing because the floss goes right over that joint. And it’s wintertime and the skin is dry and it just searing pain. So I have to say, okay, let’s let’s get the floss to go over the the next thing. And that’s a pain in the ass. I have to take my, I can’t coordinate that, but the pain is not there, then this will heal up. But it takes time and effort and focus and it’s a pain in the ass sometimes.

Pam
Well, I found it very difficult, but I because it was not just changing habits. It was almost sort of changing my personality. But I was extremely motivated for a number of reasons. I mean, I could not do what I love to do the most which is play. And also this just made sense to me because I was involved in the healing process. I was not a passive recipient, and I found that really empowering and very different than any other kind of therapy that I’ve had. Because that means that you’re in charge of yourself ultimately, and you’re going to do yourself in or you’re going to really help yourself. And I like the feeling of being in control. And that way, like a good parent or a good teacher or a good physical therapist, you are helping your child, student or patient become independent and not dependent on the the practitioner, the parent or the teacher. So I found that very inspiring to continue to do but as you said, for a long time, especially under duress, in stressful situations when there were nerves involved. Those are usually the times where you go back to what you know the best because it’s the safest, it’s your default position. But I found that I didn’t regress as much as I had feared in those situations, the first couple of times of performing, ironically, because it had been so long it had taken so long to get to that point of the first performances taken. 14 months. And so with that kind of time, the body has the time to relearn something. So it’s more ingrained than a quick fix. You know, it’s like I always equate this to the opposite of cramming for a test. If you cram for a test, you take the test the next day forgotten everything that you crammed. But with real learning being so slow, I went back to my old ways, far less than I had feared. And that was also very encouraging. And then I realized, Oh, you can teach an old dog new tricks and I can, I can still play the violin. And I actually think that I played better, even if it feels uncomfortable or awkward. And I also know that this is going to be my lifelong new habit. And so it’s all psychological, but you know, you’re doing the right thing for yourself. So you’re gonna get over the awkwardness. And if you regress a little bit, it’s not like you’re gonna go back to square, square one, you know, you go back a little bit and then next time to go back, a little less, a little less and a little less. But the other thing is, the flip side of all of this is that I’m permanently thinking about it, I will never become complacent and think, Oh, well, I’ve been retrained. And that’s it. No, because the tendency is always to go back to what you’ve done for 45 years.

Howard
Right? So a lot of it has to do with the person’s psychology, can they handle the idea of retraining an automatic movement pattern like this? For some people, it’s just out of the question. They can’t even contemplate that.

Pam
You need to have kind of a strong ego, also, because you have to I mean, when I first started playing again, with completely new setup and equipment and everything in it sounded awful. And I had to just tell myself, Well, okay, it’s okay to sound awful. And that was another example of how objective you were. He said, you know, if you’re doing if you’re doing the right thing with your body, you get an A plus from me, it’s we’re not judging the playing, because you have to leave your ego at the door. When you learn. retrain something, it’s not going to sound good or feel good, but you have to be okay with that knowing that over time it will get better. So you have to just tell yourself the right things, but this is temporary.

Howard
And I like to use the example of Pete Sampras, who was as a kid when he was told you should not use a two handed backhand you should use a one handed backhand and he he played like crap, he lost tons of matches. But the goal was to develop one handed backhand, he allowed himself to not be so good in those matches. That’s the way you you’re going to retrain your body. And he now obviously he was one of the best that ever lived. His other players I’ve watched players kids, Peter Fleming, who was John McEnroe’s doubles partner who he was totally wild as a kid, as a 14 year old and then he just kept hitting these big shots that were missing, but he kept doing it and doing it and finally became the number one doubles player in the world.

Noa
Howard story seemed to support Pamela’s advice to practice taking risks in practice, and the importance of practicing playing with 1,000% expressiveness which she thought also had a connection to nerves and why it is that we get nervous in performance.

Pam
I think the reason most people get nervous is that they haven’t simulated an onstage experience in the practice room. And the idea of saving yourself for the performance. I mean, we’re not singers, we don’t need to mark, you know, we don’t have vocal cords that need protection. I mean, it’s quite the opposite. I think that, that people would enjoy practice a lot more, if they practice really going for something and playing the most X version of something the most passionate or the most exciting or the most that you know, your most if people practice like that, they would realize that they actually would overcome the things that they’re worried about sooner, like these missed things or missed shift or whatever, missed notes. And I think to that end, it helps to simulate performance in every possible way like to play in as big a room as possible and if you need to line up stuffed animals or vegetables with eyes or in anything that has eyes simulates a human being on the furthest corner and you make it dark and put a spotlight on or in my case, I never wear pantyhose. And so when I put on pantyhose my adrenaline starts going my heartbeats really fast because I know this concert time, you know, so put on your pantyhose, put on your concert clothes, do whatever it takes. And then when you play, play as if it’s the last time you’re ever going to play this and give yourself one chance to say at all, not 10 because in reality, you have one. And that’s part of it sounds sadistic, but I think restricting the laundry list. restricting the amount of time that you give yourself to improve is really important because in reality, you don’t have that luxury. And so see what happens to you. If you just go for it every time. Then you’ll start to enjoy that feeling and then it won’t be foreign but what I try to do is connect the feeling of the practice room to the stage.

Noa
It reminds me a little bit of like the NCAA limits of 20 hours a week for their student athletes. What would it feel like if musicians couldn’t touch their instruments for more than 20 hours a week, it’d be interesting to see what kinds of adaptations people make in order to make sure they can get as much work in as possible.

Howard
That’s very interesting. Yeah,

Pam
Well, I mean, we do that when we work with people together, we, we try to develop a practice program for them, where it literally cuts their time in half, and then in half again, and even within that time to do small bouts, because the brain cannot tolerate long bouts of really concentrated practice. And what it teaches you I mean, those boundaries teach you to be efficient to prioritize, not everything sucks equally, it just doesn’t. And then, even though it’s really hard on the ego, you actually improve more quickly, even though it’s more difficult. And then you get more confidence. I mean, people wonder why they’re not getting better and they’re practicing eight hours a day and I said, Well, it has nothing to do with how many hours it’s what are you doing in those hours, and you don’t want to walk on stage, you don’t wear a sign “really, I practiced 10 hours a day” nobody cares or knows. So yes to restrict the amount of time would force efficiency in people.

Noa
I think speaking of efficiency, there’s a quote often found on the internet sometimes attributed to Abraham Lincoln, which goes something like, if I had four hours to chop down a tree, I would spend two of those hours sharpening my axe. Putting aside the fact that Lincoln doesn’t seem to have ever said anything like this. If we were to apply this to music, one could argue that it speaks to the importance of warming up properly before playing. But why is it so important to warm up?

Howard
All the tissues in your body muscles, joints, connective tissue function better when the circulation is optimal. So when you wake up in the morning, you are cold, you know, the first five minutes waking up that you’re not going to do something strenuous at that point because you’re joints muscles don’t quite feel right. So if somebody, maybe they’ve been up for an hour or two and they haven’t touched your instrument yet, you just want to go through the process of using your muscles in a very easy light way. But prior to that, systemically throughout your body, if the circulation is improved, you’re going to get warmth, blood flow to all the areas. That’s the safest way to make sure that you have good circulation going through your fingers. And by doing that as a whole overall body movements such as a walk up down the stairs, couple times, do some jumping jacks, walk around the block a couple times, any of those things would be good to loosen up. But you definitely want to move your fingers also in a very easy way initially, it’s shocking to me that students who are willing to like just go full blast, read from the first note, no matter what state they’re in, they don’t even think about that. But that’s, I think important.

Pam
Well, I remember when I first started lifting the violin again under your supervision and you said, go take a walk. I mean, taking a walk is such a basic thing hands free of course cell phone free, errand free, you know, take a simple walk and get your body moving. And another occupational therapist once told me that it’s much more important as you just said to get your heart rate up, because then your extremities will be warm. It’s a much safer place to start if your hands are not cold, but of course, that comes from if your heart if your heart is pumping or not. So yeah, jumping jacks running in place up and down the stairs, break a sweat, and you’ll be in a safer place to start and then don’t start with fast loud and you know, fingered octaves and all the rest of that just get it going slowly because actually, if you spend more time at the beginning slowly in a safe way, it’ll save you time. In the end, people like to cut to the chase and that it ends up wasting time. Possibly.

Noa
At this point I stopped recording and began packing up. And of course, as we continued to chat, the conversation got interesting.

Pamela began talking about how important it is to appreciate that all of this is not just about injury prevention and recovery. It’s also about sounding better when you play this way. Howard mentioned that he’ll often have clients record themselves playing, playing once like they normally do and then again, but with as little tension as possible. And then when they listen back, and variably they choose the version with less tension. And when they do this exercise with video and watch the two versions, people tend to choose the less tense version here too.

Howard also described his dream of one day making it possible for all musicians in orchestra to have a one minute stretching break at some point during every 90 minutes of works to rehearsal, not to be used to chat or to look at their phones, but to stretch, move around, and put their instrument down for a moment so that they have an opportunity to keep the gradual accumulation of tension throughout the rehearsal from getting too high.

The last thing that came up had to do with the importance of making sure to get treatment advice that is unique to you. Rather than relying on generic advice, or a one size fits all approach. Just like how you want to make sure to customize your violin setup to fit you and your unique needs instead of trying to adapt yourself or your playing style to the instrument.

If you’re interested in learning more about Howard and Pamela and the collaborative workshops and teaching they do, go to fitasafiddle.nyc. And for a full transcript of this episode, as well as links to random things that came up in conversation, please visit bulletproofmusician.com/blog.

Notes

Additional resources from Howard and Pamela

Here’s a sweet 9-min video about how Howard and Pamela’s paths intersected, and how that led to their work together now: Fit as a Fiddle @Articulate

They’ve put together a 2-page PDF with simple, practical suggestions on healthy playing: Playing Healthy: Suggestions for a long career without aches and pains, by Howard Nelson & Pamela Frank

And if you’re curious to learn more about movement systems, here’s an article about Howard’s own personal experience recovering from a shoulder injury that was affecting his tennis game, and how he came to discover physical therapy and the concept of movement systems: Aligned At Last

How to work with Howard and Pamela

You can learn more about Howard and Pamela’s workshops and teaching at their website: fitasafiddle.nyc

About Noa Kageyama, Ph.D.

Performance psychologist and Juilliard alumnus & faculty member Noa Kageyama teaches musicians how to beat performance anxiety and play their best under pressure through live classes, coachings, and an online home-study course. Based in NYC, he is married to a terrific pianist, has two hilarious kids, and is a wee bit obsessed with technology and all things Apple.

After Countless Hours of Practice, Why Are Performances Still so Hit or Miss?

It’s not a talent issue. And that rush of adrenaline and emotional roller coaster you experience before performances is totally normal too.

Performing at the upper ranges of your ability under pressure is a unique skill – one that requires specific mental skills and a few tweaks in your approach to practicing. Elite athletes have been learning these techniques for decades; if nerves and self-doubt have been recurring obstacles in your performances, I’d like to help you do the same.

Click below to discover the 7 skills that are characteristic of top performers. Learn how you can develop these into strengths of your own. And begin to see tangible improvements in your playing that transfer to the stage.

NOTE: Version 3.0 is coming soon! A whole new format, completely redone from the ground up, with new research-based strategies on practice and performance preparation, 25 step-by-step practice challenges, unlockable bonus content, and more. There will be a price increase when version 3.0 arrives, but if you enroll in the “Lifetime” edition before then, you’ll get all the latest updates for free.

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