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SUSAN STAMBERG, host:

On a concert stage, under the bright lights, in their smart tuxedos or long, black gowns, you don't tend to think of musicians as athletes, but they are.

(Soundbite of music)

As Leon Fleisher, one of the finest pianists of his generation, likes to point out, musicians are athletes of the small muscles.

(Soundbite of music)

STAMBERG: And when a musician's muscles are damaged through over-practicing or too many performances or poor posture, or, or, or, the injuries can threaten their careers.

Leon Fleisher learned that bitter lesson four decades ago. His daughter, Leah, teaches that lesson these days to other musicians.

(Soundbite of banging)

Ms. LEAH FLEISHER (Physical Therapist): Good, and let's put your feet up on the bar.

STAMBERG: At her physical therapy studio in Washington, D.C., surrounded by the mats, pulleys and machinery of her ministrations, Leah Fleisher helps musicians avoid the terrible price her father paid at the peak of his career, when the fingers of his right hand began, quite involuntarily, to curl up.

Leon Fleisher lost the use of his right hand.

Mr. LEON FLEISHER (Pianist): Having spent 35, 36, 37 years of playing two hands and then to have it denied for me was an enormous blow.

STAMBERG: Leah was just four when Leon's right hand froze. She grew up under the shadow of her father's devastating injury.

Ms. FLEISHER: There was all this promise for his life and career that was just never fulfilled. That was a personal and family tragedy is what it was.

STAMBERG: Now, more than 40 years later, Leah Fleisher has fashioned a career that combines music and muscles. She's a licensed physical therapist and Pilates instructor. Her clients include a number of professional musicians.

Ms. HOLLY HAMILTON (First Violinist, National Symphony Orchestra): When I came to Leah, I couldn't play anymore.

STAMBERG: Holly Hamilton is a first violinist with the National Symphony Orchestra. She's been coming to Leah Fleisher's studio once a week for the past eight years.

Ms. HOLLY HAMILTON: I mean, how many occupations are there where you use your chin?

(Soundbite of music)

STAMBERG: When she first met Leah Fleisher, Hamilton was suffering such debilitating neck and shoulder pain that she'd had to stop performing.

Ms. HAMILTON: I mean, I went to so many doctors and therapists and chiropractors, and I got injections, I got all kinds of advice, which didn't work, and then finally at the bottom, I just thought I couldn't play anymore, and then I discovered Leah.

STAMBERG: Leah Fleisher says of all professional musicians, it's the string players like Holly who have the highest injury rate. They play more continuously than the other musicians. A tuba player sits out most of the symphony; violinists bow through every movement.

Their necks start to hurt, their shoulders, not to mention their chins.

Ms. FLEISHER: Violinists, they play very asymmetrically. Cellists have a lot of back problems and shoulder problems, as well, and harpists, tendonitis, wrist problems.

STAMBERG: All the injuries come from overusing certain muscles. So Leah Fleisher helps them strengthen various opposing muscle groups to balance their bodies.

Ms. FLEISHER: Everything we do is in front of us, our shoulders, our head, everything perches forward. So a lot of the work with physical therapy and Pilates is about strengthening the back of the neck, the back muscles, the abdominal muscles to create a strong trunk and core support.

Okay, Holly, let's do leg circles. So hold the straps, push off, and go ahead and reach all the way from your sitz bones down the heels. Extend long.

So you can see this really takes her out of her normal, her daily position of arms forward, shoulders rotated. Now her back muscles are working to keep her shoulders nice and back and open.

STAMBERG: Do you have a performance tonight?

Ms. HAMILTON: Yes, I do. It's a hard one. We're doing "Heldenleben," so I'm very sore today from last night. So she'll stretch me out, and then I'll go do another one.

STAMBERG: Holly Hamilton says she keeps coming to Leah to get fixed. Her neck is straighter, her pain is reduced, and there's another benefit.

Ms. HAMILTON: I grew an inch after working with Leah. I was 5'3" and now I'm 5'4".

(Soundbite of music)

STAMBERG: These days, Leah Fleisher says more musicians are developing injuries, even though we've become more exercise conscious and more aware of physical fitness.

Ms. FLEISHER: But on the other side is there's more time in front of the computer, there's more time spent in an automobile, and so we're not as physically active in general.

STAMBERG: With musicians, injuries tend to come not from a single incident but from accumulated stress on certain muscles. Professional musicians may have begun studying and performing at an early age. When they hit their mid-30s, the injuries start popping up.

Leah once worked with a concert pianist who had a herniated disk. He said he'd gotten hurt on tour, lifting a heavy suitcase, but Leah Fleisher thought it was more complicated than that.

Ms. FLEISHER: He would sit at the piano for six, eight hours a day, not take breaks, and also his actual posture at the piano was contributing what developed into an injury.

It was a relatively straightforward case, Fleisher says.

Ms. FLEISHER: We really worked on stretching the tight muscles in his low back and strengthening his abdominal muscles.

STAMBERG: The pianist recovered after just a few months. Stressed muscles, ruptured disks, tendonitis, repetitive-motion injuries, are not just 20th- and 21st-century curses. The 19th-century German composer Schumann developed a debilitating injury in the middle finger of his right hand when he was a young man, and he had to stop playing altogether.

He didn't stop composing, though. This piece, "Toccata in C Major, Opus 7," is quite difficult, but it never involves the middle finger of the right hand.

(Soundbite of song, "Toccata in C Major, Opus 7")

STAMBERG: Maybe Schumann wanted just one piece that he could still play.

(Soundbite of song, "Toccata in C Major, Opus 7")

STAMBERG: After Leon Fleisher injured his right hand, he worked his way through all the piano literature for the left hand and then began commissioning pieces so he could keep performing one-handedly. Eventually, Fleisher was luckier than poor Robert Schumann. In the 1990s, he got Botox injections in his right hand, and he was able, tentatively, apprehensively, to return to the concert stage to play with both hands.

But the 79-year-old Kennedy Center honoree is still not completely healed or safe from his daughter's sharp gaze.

Ms. FLEISHER: I'm always nagging him…

(Soundbite of music)

Ms. FLEISHER: …to really work his posture, to strengthen his back, and I do this from time to time. I write out all the exercises as little stick figures, and he'll do it for a few days, and…

(Soundbite of laughter)

Ms. FLEISHER: …what can you do?

(Soundbite of music)

STAMBERG: When she's not lovingly nagging her father or straightening our her professional musician clients, physical therapist Leah Fleisher makes her own music. She started studying the harp when she was very young. It's a family tradition. Her mother's mother was a harpist, her uncle played harp with Toscanini's NBC Symphony and later the Chicago Symphony, one of Leah's brothers and her sister are professional concert harpists, her sister-in-law, too, and talk about injuries, those harpists aren't toting around little piccolos.

Ms. FLEISHER: We have a long line of hernias. My grandfather, my uncle, my sister's husband, they all had hernias.

(Soundbite of music)

STAMBERG: Leah Fleisher wisely brought one of her smaller, daintier harps to play for us. An accomplished amateur, she loves making music, although as a physical therapist, Leah knows enough to stop practicing the moment she notices her neck and shoulders getting stiff.

(Soundbite of music)

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