Look - two hands!

Leon Fleisher has been in Britain this week to give the European premiere of a new Concerto for Left Hand, written for him by the American composer Lukas Foss. He has already played the piece at concerts in Manchester and Huddersfield; his last performance is in Newcastle tomorrow.

He will be playing only with his left hand, as he has for the past 30 years, in a distinguished career as pianist and conductor that has taken him to most of the great concert halls in the world. He has recorded most of the existing piano repertoire for left hand alone, as well as generating a whole new complement of left-handed literature from leading contemporary composers. Only last weekend, he dazzled Carnegie Hall audiences with his virtuosity in the left-hand piano concerto written for him by another American composer, Curtis Curtis-Smith.

But the week before, something strange happened. On 20 April, in Cleveland, Ohio, Leon Fleisher played with two hands, feeling "relief, ecstasy, all kinds of things", as he emotionally recalls in his deep, resonant voice. His performance of Mozart's Piano Concerto No 12 with the Cleveland Orchestra received rave reviews as "a model of incisive rhythm, exquisite phrasing and stylistic grace".

The tall, bearded, bespectacled San Franciscan, now living in Baltimore, Maryland, had been receiving such reviews for 20 years as a two-handed pianist before what has been diagnosed as "repetitive stress syndrome" struck on the eve of a prestigious US State Department tour of the Soviet Union and Europe in 1965. Practising seven or eight hours a day, he had been feeling a weakness in his right index finger, and practised even harder to overcome it, until, as one critic observed, "at times his right hand did not seem to know what his left hand was doing".

He cancelled all concerts for a year, and consulted doctors and hypnotists - to no avail. Over the next 17 years, he submitted to a succession of tests and therapies and eventually to state-of-the-art surgery for carpal tunnel syndrome (an entrapment of the median nerve to the hand) which led him to attempt a two-handed concert in 1982, without great success.

So he resigned himself to the fact that, "short of a miracle", he would never again perform with two hands, although his early two-handed recordings of the Beethoven Piano Concertos, considered a definitive interpretation, have recently been re-released on CD to best-seller status.

So what "miracle" has now brought his right hand back to life at the keyboard? "My wife," says the three-times married Fleisher (of whose five children, three are professional musicians). "My wife Katherine [Jacobson - also a pianist and formerly one of his pupils at the Peabody Conservatory] is very interested in dance and, noticing that I keep stretching out my hands, suggested I do what dancers do - hold the stretch for 30 to 40 seconds. That has made an enormous difference!

"Then she suggested I see a therapist she knows, a Rolfer. They stretch out the fascia material of the body - the membranes that cover groups of muscles and tendons and attach them to the bone. This allows the muscles and tendons to assume their rightful position and capabilities.

"I've never given up looking for answers," adds Fleisher, who in everything but playing the piano has remained right-handed, and uses his right hand vigorously in conducting. He has even continued to practise with his right hand, to prevent it from atrophying.

"The problem was originally diagnosed as torsion dystonia, but now as repetitive stress syndrome. When you work a muscle you make little tears in the fibre, so you should rest it on the second day. Athletes know that, but no one tells pianists."

With hindsight, and the knowledge he has now acquired, Fleisher believes he could have prevented his condition from developing. "But back then, no one even recognised this as a legitimate medical problem, and everyone felt ashamed or embarrassed."

In Britain, RSI (or Repetitive Strain Injury as it is commonly known, although it has many names) is a syndrome that office workers, journalists and others who spend long hours at keyboards are trying to have recognised as a bona fide occupational health problem. But there is as much debate over it as there is over ME.

Dr Ian James, who runs the Performing Arts Clinic at the Royal Free Hospital in London, and sees many cases of the complaint, believes that it is caused by one or more of the following three factors: "Bad technique; bad posture; emotional tension."

But Fleisher, who is considered "a direct artistic heir of Beethoven" - since he studied with Schnabel, who was a student of Leschetizky, who was taught by Czerny, who was a disciple of Beethoven - is known for his brilliant technique and teaching (on the faculties of Baltimore's Peabody Conservatory, New York's Juilliard School and Manhattan School of Music, and Toronto's Royal Conservatory). His posture also appears to be fine.

What about emotional tension? Does he give any credit to that possibility? "No," he says firmly. "People have come to realise that this is not a psychological problem, but one of overuse. It's a syndrome that Gary Graffman and other well-known pianists have suffered." (Including, apparently, Robert Schumann, who invented a device to strengthen his fingers which ended up damaging them so badly he had to concentrate exclusively on composing.)

The composer William Bolcom is in the process of writing a concerto for two left hands - and two pianos - for Graffman and Fleisher. "It will be a concerto that Gary and I can each play separately and can also combine together," Fleisher enthuses. "It's been commissioned by a consortium of four orchestras in the US and will be premiered in April of next year."

But isn't he impatient to get back to the two-handed classics? "I think people will gradually accept the change, but I want it to be gradual," Fleisher stresses. He doesn't want to neglect the left-handed literature, so much of which has been created especially for him (four concertos by major contemporary composers, a number of solo pieces and some chamber works).

Oddly enough, he is grateful in many ways for his disability. "It may sound Pollyanna-ish to say so, but I'm convinced that, had I continued as a two-handed pianist, I would have wound up a much narrower person. I got into conducting because of my hand; my teaching became far more effective. I don't think any of these things would have happened otherwise."

n Leon Fleisher plays Foss's 'Concerto for Left Hand' tomorrow night at Newcastle City Hall (box-office: 0191-261 2606)