When longtime Baltimore Symphony Orchestra violinist Ivan Stefanovic lost the sensation in the index finger of his left hand, he asked colleagues where he could get help. The answer for Stefanovic, as it has been for a number of the orchestra's musicians: David Shulman, a former professional clarinetist turned physical therapist.

"What impressed me was that the first thing he said was, 'Bring in your instrument.' That immediately told me he was a different therapist," Stefanovic says. "We don't have to explain what we do and how we do it. He knows what kind of injuries we sustain and how to treat it without injuring us further."


Shulman, 61, is the first person many Baltimore-area musicians call on to relieve pain and injury. He has treated percussionists, string players, horn players and other instrumentalists from the city's most prominent musical institutions, including the BSO, the Peabody Conservatory and the former Baltimore Opera Orchestra.

He understands the physical demands of musicians and says they are like Olympic athletes, only they concentrate on a smaller area of the body.


"You start playing an instrument when you're 5 or 6, so by the time you're 18, you've already had years of working," he says. "At the conservatory, you're playing eight or nine hours a day - solo practice, chamber music, orchestra. Just try holding a violin under your chin for eight hours. ... Over time, the muscles become stronger and stronger and stronger, until they start going over to the dark side."

That triggers lots of injuries. Rebecca Barton of the University of Indianapolis School of Occupational Therapy has estimated that 89 percent of musicians suffer pain and injury.

A major 1988 survey of more than 2,200 symphony and opera musicians found that 76 percent had at least one serious medical problem that affected their playing.

In the 2002 book "The Science and Psychology of Music Performance," Alice Brandfonbrener, director of the Medical Program for Performing Artists at the Rehabilitation Institute of Chicago, advises that "musicians' symptoms are not the stuff on which most medical texts are based, so careful practitioners must know not only their medicine but also their music."

The energetic and engaging Shulman, who has degrees from Cornell University and the University of Maryland's School of Physical Therapy, fits that bill. In his Towson office, a stereo system fills the multibed patient room with sounds from his sizable classical and jazz collection.

"I found out about David when he came to Peabody to do a lecture," says Doug Perry, a percussion student there who experienced severe pain in his arms and tendonitis of the thumb a couple of years ago. "I felt he was the first person I had seen who understood injuries from a musician's perspective."

Perry's problems developed at the highly competitive conservatory.

"There is a lot of pressure to keep up with everyone else," he says. "I used to practice, have lunch, practice, have dinner, practice, then play video games or go onto the computer, which was not good for the hands, either. Then one day, I picked up marimba sticks and shocks went up my arms."


Before discovering Shulman, Perry was treated by another therapist. "You would go in one week and have zero symptoms and be told, 'OK you're all better.' Then the next week, you'd go back because the pain had returned."

Perry found lasting relief from Shulman's methods, which included massage, electric stimulation and "trigger point therapy" using small needles. The percussionist cut back on his activities for about a year and is at the end of his recovery period.

"I carefully regulate my practice time now," he says, "to three or four hours. It's how well you practice, not how long you practice."

Professional musicians still have to cram in a lot of practicing to keep in good technical and musical shape. It's never an easy regimen.

Shulman says, "You don't want to say, 'I can't play this gig because I'm in pain.' You have yourself to support, your family to support, the audience to support - they're coming to hear you play. So you muscle your way through, no pun intended, until one day you have to stop. That's where hands-on physical therapy comes in."

Shulman's hands-on approach is the result of straightforward guidelines developed over his 31 years as a therapist in the Baltimore area.


"The pain was mechanically induced, so it has to be mechanically reduced," he says. "A warm muscle is a happy muscle. Cold contracts the muscle and tightens the blood supply. Tightness is the precursor to pain. If rest and exercise alone were going to fix people, I wouldn't have a job."

There are varying styles of massage and physical therapy, as BSO violinist Mari Matsumoto discovered.

When shoulder pain got so bad that she could no longer hold her bow, she decided to have surgery. During the recovery period, she sought a therapist near her home because driving was painful.

"That therapist was more involved with sports medicine," she says. "He decided I needed pulling, pushing, twisting, lifting weights. I got gradually worse."

Although Shulman's office was a half-hour of painful driving away, Matsumoto switched. After about three months of therapy, she was asked to bring her violin in and play for him.

"I was so embarrassed. I felt like a beginner - I sounded like a beginner," she says with a laugh. "I couldn't lift my arm very well."


Over the ensuing months, the violinist resumed practicing, starting with five minutes in the morning, another five at night. She continued therapy three times a week, alternating with Shulman's assistant, Marcy Hankin, who also gets high marks from Matsumoto.

"I really had faith in [Shulman]," the violinist says. "There were times when I thought my career was finished, but he kept encouraging me. He is more than a therapist. He's like a psychologist."

Matsumoto resumed playing in the BSO last season, initially for half a program, eventually for whole concerts.

"Now I'm back to normal," she says. "If I had gone to David from the beginning, I wouldn't have had the surgery."

Violist Maria Lambros, a Peabody faculty member, had surgery to correct a torn labrum in her right shoulder.

The strengthening therapy that followed was, she says, "a positive experience. ... But their specialty was getting me back to ordinary activities. They told me I should go to someone who really understands musicians."


She met Shulman by chance at the synagogue they attend. He noticed she was having some trouble with her shoulder and effectively applied a little therapy on the spot. She became a patient.

"He really understands the body. He's incredibly intuitive. He has a great sense of humor, too, and a calm demeanor. I really trusted him. A gifted healer - that's how I'd describe him."