For the next three months, Nathan's pain persisted, forcing him to apply ice packs to his arm after playing, until he finally stopped altogether in April 2004. Nathan then visited an orthopedic hand surgeon for advice, but the visit left him devastated, frustrated, angry and depressed.

"The first doctor I saw told me I had to stop using the computer keyboard forever and to stop practicing Aikido, and playing basketball, the violin and piano for a while," says Nathan.

Still looking for answers to his problem, Nathan's violin teacher at the Crowden School, in Berkeley, Calif., which specializes in the musical growth and education of children who play string instruments or piano, finally suggested Nathan visit the Health Program for Performing Artists at UCSF Medical Center. Founded in 1985, the center is one of the first its kind dedicated to the study, diagnosis and treatment of ailments commonly encountered by performing artists, including adults and adolescents. Although the center cares for all types of performing artists, they specialize in the evaluation and treatment of musicians.

Nathan was first evaluated at the center in May 2004 by physical therapist, Nancy Byl, and later, her colleague, physical therapist Peter Edgelow.

Nathan's mother, Satoko Yamamoto, who is a speech language pathologist, says the care Nathan received at UCSF was very impressive and much more comprehensive than what was offered to him by the first doctor he visited. "Nancy was very thorough and tested Nathan's muscle strength and observed how he played and held the violin, and his posture," says Satoko. "She figured out what may be the cause of his problem and how to treat it."

Nathan was diagnosed with mild scoliosis, a disorder associated with a curvature of the spine. Because of Nathan's scoliosis, his shoulders were not aligned properly, which affected his posture and the way he played and held the violin.

Byl taught Nathan various exercises to address the pain in his arms and back, improve the gliding of the nerves in his arm, as well as his balance. He was also given an insole for his shoes to help realign his shoulders, and a wedge cushion and Dynadisc for the chair at his computer desk, which he still uses when working on the computer.

It was also determined that a recent growth spurt, rather than over-practicing, had probably put extra stress on Nathan's body. While there was a documented growth in Nathan's height, the peripheral nerves in his arm now had restricted excursion — a state associated with the disorders known as neuritis and neurovascular entrapment syndrome.

"We know that peripheral nerves can become irritated when they are compressed by muscles under tension," says Byl. "We also know that peripheral nerves undergo strain when placed on stretch. For example, the nerves move when the arms move. This movement can put strain on the nerve. A small amount of strain can deprive the nerve of oxygen and alter the way the nerve conducts information. With repeated stretch, the nerves can become irritated and sensitive, triggering pain even when the movement is in normal range."

Because of Nathan's neuritis and neurovascular entrapment syndrome, he was unable to relax the nerves in his arms, even when he wasn't playing the violin. To combat this problem, Byl taught Nathan how to practice biofeedback, which is the process of monitoring and feeding back information regarding certain body responses, such as muscle tension, heart rate, breathing pattern and skin temperature. The feedback is given via computer video and audio displays. Once the awareness of certain unhealthy body responses and patterns is illuminated, patients learn to recognize and self-regulate these responses, thus improving their own health. By practicing biofeedback, Nathan gradually learned how to change his nerves' responses and relax them while at rest.

Byl followed Nathan through December 2004. "His symptoms never came back," says Satoko. "Nancy taught him how to prevent future injuries and help his body grow without unnecessary strain while keeping his musical and athletic commitments."

Nathan says that many musically active kids like him experience similar problems but don't get treatment, or have scoliosis and don't know it. "We constantly hear about kids having pain like Nathan's," says his mother, "and some of them actually leave the school because they can't cope with it."

Fortunately, Nathan is now doing great and is busier than ever. This summer he went to New Zealand for two weeks on the school concert tour and participated in Berkeley's summer music camp. Currently, he's participating in a summer windsurfing camp. And although he says he wants to be an automotive engineer when he gets older, rather than a professional violinist, he says the violin is a very significant part of his life.

"Violin is part of me and I cannot think about myself without it," Nathan says. "Playing it has increased my confidence and coordination, and taught me how to cooperate and work with other people."

Story written in August 2005.

Abby Sinnott is a freelance writer in San Francisco.