Case Study - Natasha

 

Natasha had been brought up with the highly disciplined and in her case, ruthless Russian approach to learning music - six hours of piano practise a day from age six.

She came to see me because she had been having intermittent pains in her left arm when she played the piano. She told me that she could play the organ (which she played more regularly than the piano) without any pains. This was fascinating because apart from a slight difference in weight of keys, the two instruments are very similar. It was becoming clear that this was not just a physical issue.

Natasha told me that her piano teacher had encouraged excessive dependence on her as a teacher. Both she and other students floundered when they stopped studying with this teacher even to the extent that they would ring her endlessly and travel internationally to continue having lessons with her. Natasha’s tendency was to collapse at the piano with rounded shoulders and a curved spine. She had literally and metaphorically lost her support and didn’t feel that she could play without pain. Natasha said she had developed a fear of playing the piano and that the pain would start as soon as she tried to learn a piece on her own. It would only leave for short periods when she felt a temporary wave of confidence.

I worked initially with her at the piano, grounding her feet on the floor, getting her to rock her pelvis until she found her sit bones and then finding her tallest spot from there. When she played, there was a constant stream of self-criticism. She told me that she couldn’t play and that she had lost her ability. I encouraged her to take her focus away from her arms and hands and to instead think of her energy up from the ground, through her legs, abdomen/spine and ultimately up through her shoulders and down through her arms and hands.  She started freeing up her arms and in turn her sound changed and became freer.

She decided to start a piece slowly to give herself time to focus on this new free sound. I then encouraged her to speed it up gradually and she managed a whole page of music without pain. Following this, she was interested to see how she would play the piece when I wasn’t there. So I left the room and she had pain in her left arm within seconds. She was intrigued by this and started to realise that she was in control of her pain!

We moved away from the piano, and I encouraged her to sit on a Reebok ball. This showed very clearly how tight and locked she was in her pelvis. She freed up by the second by playing around with it. She had enormous difficulty in lying over the ball on her back and showed considerable inflexibility in her upper spine and tightness in her shoulder blades.

I took her to the massage table, she lay on her back and I stretched her arms above her head. Then I took her arm over her chest and massaged the muscles around her shoulders. I then worked with her on a stool, taught her to meet my hand on her upper back and head, so that she was sitting in a well aligned position. I asked her to slowly take her head forwards and back (chin aiming to the chest) whilst I did myo-fascial work on her upper trapezius going down her back. I then tested this with her lying over the ball and she was noticeably freer.

I gave her a Feldenkrais exercise on the floor, which involved lying on her side and taking one arm over to the floor on the other side, specifically for opening up her chest, which was so constricted. This was followed with myo-fascial work on both her arms.

Her piano playing was much freer after the work and she said her arms felt like wings! I worked on her as she played, grounding her pelvis, her feet, lifting her head from the occiput and working on either side of her sternum freeing it up from both sides of the spine. She said she felt much freer and loved the feet being grounded and having her sternum freed up.

She decided she wanted to learn a piece of Brahms because she had never learned Brahms and she wanted there to be no associations with her previous piano teaching. I asked her to learn one piece for me and one for herself that she wouldn’t have to play for anyone; this was specifically to encourage independence and her own relationship to the music and the piano. I asked her to keep a notebook by the piano and write down which bar the negative thoughts came in and when the pain happened, to encourage her to be an objective observer and to take responsibility for her playing and her body. Her final comment was that she had learned that she could play the piano without pain!