Most drums are tuned before playing and left alone; the tsuzumi is tuned constantly, during the performance itself, by the player's own grip. Its hourglass wooden body is laced with cords connecting two leather drumheads, and squeezing those cords tightens the heads and raises the pitch, while relaxing the grip lowers it, so a skilled player produces a range of distinct tones from a single strike depending on hand pressure rather than from a fixed drum. That flexibility is part of why the instrument suits kagura, the sacred music and dance performed at Shinto shrines, where a small ensemble of tsuzumi, flute and other percussion accompanies masked or costumed performers reenacting stories from Shinto myth, most famously the retreat and coaxing out of the sun goddess Amaterasu, whose withdrawal into a cave and the gods' effort to lure her out with music and dance is treated in some readings as kagura's own mythic origin story.
The player's calls and vocalizations between strikes, a distinctive part of tsuzumi performance practice, are themselves considered part of the music rather than an incidental habit. Professional tsuzumi players train for years under a named school lineage, since technique and repertoire are transmitted through specific teaching houses rather than from written notation alone.