What is Musician’s Dystonia?
Musician’s dystonia is not simply a performance injury; the underlying issue lies in the brain’s control of movement. Involuntary overcontraction of certain muscles prevents musicians from precisely controlling their movements, resulting in a loss of motor control.
Limitations and misconceptions of classification
Familiar melodies, once played with ease,
now seem lost in the labyrinth of my mind.
A New Paradigm for Treatment:
Beyond the Limits of Musician’s Dystonia
As previously discussed, the term ‘Musician’s Dystonia” is overly broad and can obscure the underlying commonalities among patients. Dr. Farias has discovered that despite the diversity of instruments and techniques, for instance, whether it’s a violinist, pianist, or typist, individuals with dystonia affecting their hands exhibit fundamentally similar underlying motor control issues. Therefore, the key to effective treatment lies in addressing these underlying movement deficits and then tailoring the therapy to the specific demands of the individual’s instrument.
The exact pathogenesis of dystonia remains elusive. It is known to involve multiple brain regions and functions, including the nervous system, prefrontal cortex, basal ganglia, cerebellum, thalamus, supplementary motor area, and sensory-motor cortex. Alterations in brain state result in impaired inhibition, abnormal plasticity, and sensory-motor dysfunction. Dr. Farias has observed that patients with dystonia exhibit imbalances in both hemispheres and the nervous system. Therefore, rehabilitation should focus on restoring motor control in affected areas and enhancing brain and nervous system function rather than simply relearning playing techniques. In fact, motor memories are not lost but are often linked to primitive reflexes. These reflexes, controlled by the central nervous system, especially the brainstem and spinal cord, are innate responses that bypass the cerebral cortex. When the brain cannot effectively inhibit these reflexes, they are prioritized over fine motor memories stored in the cerebral cortex. Thus, the goal of dystonia rehabilitation is to suppress these primitive reflexes and restore previously stored fine motor memories. Dr. Farias aptly describes his neuroplastic training as the ‘Art of Memory Recovery’, utilizing neuroplasticity to restore cognitive, perceptual, emotional, and motor functions.
Symptoms
Early Signs of Musician’s Dystonia
Musicians with dystonia often experience a gradual loss of control over their playing movements. In the early stages, these abnormal muscle contractions can be subtle and may manifest as:
- Loss of stability: Feeling shaky or unsteady while playing
- Slight tension: Experiencing increased muscle tension or stiffness
- Reduced dexterity: Difficulty with fine motor movements
- Diminished control: Losing precision or accuracy in playing
These early symptoms may be easily dismissed as a result of overtraining or lack of practice. However, as the condition progresses, these symptoms become more persistent and can significantly impact a musician’s ability to perform.
While pain is not a defining characteristic of musician’s dystonia, the condition can manifest in a variety of ways. Common symptoms include loss of control, involuntary movements, and abnormal muscle tension. Affected areas can range from the hands and arms to the face and vocal cords.
The Diverse Symptoms of Musician’s Dystonia
Musicians with dystonia exhibit a wide range of symptoms, varying from person to person depending on the affected body parts, the severity of the condition, and the instrument played. Despite this diversity, there are common underlying patterns. Based on the affected body parts, four main types of symptoms can be identified:
Hand/ Wrist/ Arm
Hand dystonia is the most common form of musician’s dystonia. The intricate and highly specialized movements required for musical performance, often developed from a young age, make musicians particularly susceptible to even subtle changes in hand movement.
Common upper extremity symptoms:
Foot/ Ankle/ Leg
While less common than hand dystonia, foot dystonia can still significantly impact musicians, particularly drummers and those who play instruments with pedals. This condition can affect any part of the lower limb, from the hips to the toes, and can result in difficulties with coordination, timing, and overall performance.
Common lower extremity symptoms:
Embouchure
Embouchure dystonia is a neurological condition that makes it difficult for musicians to maintain the correct lip position for playing wind instruments. This is due to involuntary muscle spasms that affect the lips, cheeks, jaw, and tongue. As a result, players may experience difficulties with intonation, tone quality, and endurance.
Common embouchure symptoms:
Dysphonia
Spasmodic Dysphonia is a neurological voice disorder characterized by involuntary spasms of the muscles that control the vocal cords. These spasms can lead to disruptions in voice, changes in voice quality, or alterations in pitch. There are three main types of spasmodic dysphonia: adductor, abductor and mixed, with adductor being the most common. In addition to the vocal cords, the muscles of the diaphragm, lips, and tongue may also be affected.
Common Dysphonia Symptoms:
Treatment
I. Movement Training and Biofeedback: Reshaping Brain Circuits
Combining movement training and biofeedback has become a cornerstone in the treatment of musician’s dystonia. This approach, inspired by Victor Candia’s constrained-induced movement therapy, involves using splints to limit compensatory movements and biofeedback devices to provide real-time feedback on physiological signals. This combination allows musicians to actively participate in the relearning process and promote neuroplasticity.
II. Psychological Interventions for Neurological Conditions
While the exact cause of dystonia remains unknown, psychological factors have been increasingly recognized as playing a significant role in its development and progression. Although dystonia is primarily a neurological disorder, improving mental health by reducing anxiety and stress can positively impact brain function and alleviate symptoms for some patients. In recent years, innovative therapeutic approaches such as Eye Movement Desensitization and Reprocessing (EMDR) have shown promise in treating dystonia.
III. Diverse Structural Therapies for Dystonia
A variety of structural therapies have been explored for the management of dystonia. These approaches aim to improve body alignment, reduce muscle tension, and promote neuromuscular balance. Techniques such as the Feldenkrais Method, Alexander Technique, chiropractic, Rolfing, and craniosacral therapy are commonly used. Additionally, the emerging field of TMJ adjustment offers a promising new avenue for dystonia treatment, highlighting the dynamic and evolving nature of this therapeutic field.
IV. Surgical or Brain Stimulation Interventions for Dystonia
Traditional surgical interventions for dystonia, such as thalamotomy and DBS, involve invasive procedures. The first is a stereotactic “thalamotomy”, which involves precise destruction of a specific region of the brain to control symptoms; and the second is deep brain stimulation (DBS), where electrodes are implanted into specific locations in the brain and a brain pacemaker is used to deliver electrical stimulation to modulate abnormal neural signals and improve motor symptoms. Additionally, focused ultrasound is an emerging treatment that uses precise heating to destroy specific neural tissue in the brain, modulating abnormal neural signals. This technique is still in the experimental phase. Regarding brain stimulation, some clinicians have explored the use of transcranial magnetic stimulation (TMS) and autonomic nervous system modulation in dystonia patients, though the efficacy of these approaches remains uncertain.
Apart from the treatments mentioned above, botulinum toxin injection is an alternative for managing dystonia. Nevertheless, it’s a symptomatic treatment that only offers temporary relief. The effects typically last for three to four months, necessitating repeated injections. Regarding pharmacological treatment, there are currently no specific medications for dystonia. Neurologists often resort to medications used for other movement disorders, but the results are often unsatisfactory.
Farias Technique:
Pioneering Neural Plasticity Training for Primary Dystonia
Why Do We Need a New Treatment?
Despite the multitude of treatment options available, the outcomes of dystonia treatments have been less than satisfactory. This may be attributed to several factors. Firstly, the underlying mechanisms of dystonia remain unclear, leading to an incomplete theoretical foundation. Secondly, most studies have small sample sizes, making it difficult to establish a comprehensive patient profile. A review of past treatments reveals that almost all approaches have been unidimensional, such as attributing “musician’s dystonia” solely to psychological factors or attributing the disorder simply to poor physical alignment. Such a narrow perspective may be one reason for the limited effectiveness of these treatments. Moreover, the small sample sizes of most studies, which often isolate “musician’s dystonia” as a separate category or even classify it by instrument, place excessive emphasis on skill recovery while neglecting the possibility of observing commonalities among dystonia patients. This makes it difficult to construct a complete patient profile. Therefore, we need a new treatment that is grounded in a more comprehensive theoretical framework and can provide a more complete picture of the patient.
What is the Farias Technique?
The Farias Technique is the first therapy specifically designed for primary dystonia. Based on Dr. Farias’ clinical experience with thousands of dystonia patients, this innovative treatment method was developed by establishing a comprehensive patient profile from a large sample size and incorporating knowledge from neuroscience. What sets this technique apart is its unique understanding of dystonia and its core concepts. It goes beyond addressing overt movement disorders by delving deeper into the impact of dystonia on brain function and the nervous system. As a result, the treatment is not limited to movement training but also includes exercises to improve brain function and balance the nervous system.
Movement-Based Training Utilizing Neuroplasticity
The Farias Technique is a movement-based therapy that differs from other approaches by leveraging neuroplasticity and neuroscience to enhance brain inhibition and restore motor control. Dr. Farias observed that specific nerves and muscles are often selectively affected in dystonia, and based on this observation, he identified characteristic movement patterns and developed simple yet effective exercises. These exercises, though basic in nature, serve as the foundation for long-term rehabilitation of dystonia.
Is this therapy designed for musicians?
Dr. Farias initially developed this therapy to treat “musician’s dystonia” and later expanded its application to other parts of the body affected by dystonia. While the movements involved in playing different musical instruments vary, there are underlying commonalities in human movement patterns, such as fine motor control. In addition to fundamental movement training, the Farias Technique offers tailored exercises for various instruments, enabling musicians to gradually recover their playing abilities.
Musician’s Dystonia FAQ
Wondering the same thing?
Join us as we delve into the top questions musicians have.
Is there a cure for musician's dystonia?
When discussing diseases, we often use the terms “cure” and “recovery.” The former implies the complete elimination of a disease or condition, while the latter refers to the restoration of health or normal function from an illness or injury. For dystonia, “recovery” is a more appropriate term as most patients experience varying degrees of improvement, and some may even relapse after a full functional recovery. Therefore, it is not accurate to judge solely based on whether or not a cure is achieved. The extent of “recovery” is difficult to standardize and depends on the individual’s activity requirements. For example, a musician who only plays simple pieces has different recovery expectations compared to one who challenges highly difficult compositions.
How long does rehabilitation take?
Is this a disease caused by psychological factors?
The complex nature of dystonia is rooted in neurological dysfunctions, particularly in the brain’s motor control centers. While emotional responses, such as anxiety or depression, may intensify symptoms, they are not the underlying cause. For musicians, the loss of playing ability can be a devastating experience, leading to significant emotional distress. It is essential to recognize that these emotional reactions are a natural consequence of the condition, rather than its cause.
Is this a disease caused by excessive repetition?
To attribute dystonia solely to repetitive practice is a hard-to-believe speculation. After all, musicians’ training is fundamentally based on repetitive practice. Why then do most musicians who practice repetitively not develop dystonia? And why do some amateur musicians who practice very little also develop this condition? Dr. Farias’ chapter ‘The Monkey with Emotions’ in the book ‘Limitless’ delves into this question, and interested readers can explore further.
Will taking a complete break from playing help me recover?
Generally speaking, most patients do not see improvement in their symptoms with rest. Some patients, even after years of not playing, will experience symptoms as soon as they pick up an instrument. However, a minority of patients do improve with rest, especially those who experience symptoms early on and immediately take a break before neural pathways become well-established.
Do I need to relearn all my performance techniques?
The idea that patients must relearn all techniques to recover from dystonia is overly simplistic. The variable presentation of symptoms, with periods of good and poor performance, suggests that the underlying neural mechanisms are more complex. Rather than a complete loss of motor skills, dystonia may involve a disruption of the balance between competing neural circuits. Thus, treatment should focus on restoring basic motor control rather than relearning all techniques.
What should I do if I experience symptoms outside of playing my instrument?
It’s not unusual for dystonia symptoms to manifest in daily activities. This often occurs when the brain’s inhibitory mechanisms are overwhelmed. While this can be distressing, it’s important to remember that there are treatment options available. Consult your therapist to develop a personalized treatment plan.
Why do some musicians find wearing gloves helpful?
Wearing gloves can enhance sensation, allowing the brain to better perceive and control movement. Many patients with dystonia experience varying degrees of agnosia. When sensory nerve signals are weak, motor control can be affected. Therefore, enhancing sensation through touch or sensory tricks is a strategy that patients can try.
How can I improve my brain and nervous system?
Practices such as meditation, deep breathing, exercise, and nature immersion can enhance brain function and overall nervous system health. Engaging in activities like dance, drumming, tai chi, and yoga can also contribute to a greater sense of mind-body balance. Individual responses may vary, so it’s essential to explore different activities to find what resonates with you.
Will stress make my symptoms worse?
Stress management is a crucial component of dystonia rehabilitation, as increased stress can exacerbate symptoms. Stress tolerance varies from person to person, making it important for dystonia patients to learn how to identify their stress limits and develop effective stress management techniques.
Rehabilitation Tips
For Musician’s Dystonia
Diagnosis
When you suspect you may have dystonia, it is imperative to consult with a healthcare professional for a proper diagnosis. Dystonia is a symptom that can be associated with many different conditions, including Parkinson’s disease and medication side effects. The specific treatment for dystonia depends on its underlying cause, making an accurate diagnosis essential for effective management.
Neurologist
Understanding
Our understanding of a disease significantly influences how we approach it. Previously viewed as an incurable condition, dystonia is now seen through a new lens. A personalized rehabilitation plan is best developed with a thorough understanding of the condition. To explore dystonia from the perspectives of movement, brain function, and the nervous system, we recommend Dr. Farias’ book, ‘Limitless’.
Treatment
Make an appointment with Dr. Monica Chen
Practice Strategies
Psychological Support
For musicians, the most challenging aspect of developing musician’s dystonia is psychological adjustment. Many patients are professional musicians who have lost their ability to perform, which can be a significant blow to their self-esteem. Seeking psychological counseling or joining support groups can provide the necessary support to help patients navigate the long road to recovery.
TESTIMONY
After experiencing a strange discomfort and stiffness in my playing for a couple of months, and being bluntly told by a doctor to give up playing as there was no cure in Taiwan, I desperately sought help to improve my condition. Fortunately, a friend who had taken a course with Dr. Monica Chen introduced me to the concept of dystonia and its improvement methods. I realized for the first time that the symptoms described perfectly matched what I was experiencing, and decided to contact Dr. Chen for lessons.
Dr. Chen explained in detail how even the smallest movements of the fingers were connected to the entire arm, shoulder, back, and even the whole body. It wasn’t just a problem with the fingers themselves. For example, I used to have trouble extending my ring and little fingers, but through Dr. Chen’s guidance and my own practice, I realized that it was closely related to the relaxation of the entire palm, the thumb, and the shoulder and neck.
Although I describe it lightly now, it took nearly two years of repeated practice and verification to regain my playing feel and technique. The torment, the physical discomfort caused by incorrect playing, and the feelings of frustration and helplessness are something that only those suffering from dystonia can truly understand. During this time, I often doubted whether Dr. Chen’s teaching was sufficient to completely improve my condition. However, time has proven that the teacher’s methods and techniques are effective and very important. Sometimes, it’s impossible to understand the content without actually doing it, but through persistent practice, I always realized that what Dr. Chen taught was correct after seeing improvements.
Finally, I would like to encourage my friends who are suffering from dystonia. There may be people with more severe symptoms than me, but please be patient and maintain a positive attitude. The rehabilitation process is always tough, and the ups and downs can drain your energy and motivation. It’s easy to feel impatient and discouraged when you don’t see progress, but believe that with continuous practice and observation of your own condition, combined with the playing concepts and practice methods established by Dr. Chen, there will always be good results and progress. Perhaps after overcoming this great difficulty, you can play with a more grateful heart, and the beauty of music that we all love and that enriches our souls will fill your life.
Erhu player / Professional orchestra musician
As musicians, we often go to great lengths to achieve the perfect sound and music we envision. We’re willing to adopt strange postures or use unconventional playing techniques, all in the pursuit of our artistic ideals. However, we must often ask ourselves: are these sacrifices truly necessary, or are we merely convincing ourselves that they are? When we get injured, can we truly listen to our bodies and heed their warning signs, or do we ignore them and push ourselves even harder?
In 2020, I found myself re-evaluating all my basic exercises. I was disappointed in myself for not being able to play cleanly. By chance, I came across the term “dystonia,” but I’ve always been reluctant to make excuses for myself. It took me some time to accept that the slow, uncontrollable movements of my right-hand fingers might be symptoms of dystonia, rather than a result of insufficient effort. This mindset has been both a blessing and a curse in my musical journey.
When I met Dr. Monica Chen, she carefully assessed my right-hand fingers. Although I was initially hesitant to admit it, I’m grateful for my courage in deciding to be curious about my condition.
The course covered understanding dystonia, movement training, mindset building, and a deeper awareness of my own tension levels. Dystonia initially made me feel anxious, incomplete, and as though I was missing a piece. But looking back after completing Dr. Chen’s course, I realized that dystonia might have been a gift.
Dystonia hasn’t hindered my ability to play music; instead, it has made me more aware of the present moment and allowed me to truly connect with my body and mind. Through Dr. Chen’s course, I not only learned how to live with dystonia but also gained a deeper understanding of how to live a fulfilling life.
Professional Clarinet Player