Focal dystonia is a neurological movement disorder affecting 1% to 2% of musicians, where involuntary muscle movements occur in various parts of the body. It is typically focal, affecting one body area, and task-specific, occuring during the performance of a specific task, for example, playing a musical instrument.
The first signs of dystonia are usually lapses in the instinctive ability to perform on an instrument. These lapses may show up in technical passages, formerly not problematic, which become increasingly difficult. Brass players may encounter difficulty in one register, or with one specific technique, such as sustained passages or brief attacks. Over the course of months, performance problems progressively worsen. Increasing practice intensity or taking time off usually does not help. The problem is almost always limited solely to playing and is rarely present at rest or with other tasks. Brass players may be afflicted with focal embouchure dystonia, which affects the muscles around the lips, the corners of the mouth, and the jaw. Focal hand dystonia can strike any musician who uses their hands—pianists, string players, guitarists, harpists, and percussionists. Fingers contract, curl under, slide involuntarily, or pop up off the keys or strings. Woodwind players are in double jeopardy as they can be distressed in the hands or embouchure.
Causes and Prevention
There is no known cause or prevention for focal dystonia, and musicians often wrongfully blame themselves for overuse or bad playing positions. Muscle overuse or compressions of nerves, which occur far more frequently and usually present with pain, can result from bad technique. Dystonia is a neurological disorder, originating from the brain, and is almost always painless. The best analogy to understand dystonia is that it is akin to a virus affecting the software of the brain’s hard drive—each time the specific program is booted up (for example, to play the violin or perform soft attacks in the middle register of the French horn), the system crashes.
Musicians are not alone—any fine motor skill that requires great technique to learn can be affected by dystonia, such as surgeons using scalpels, golfers putting, tailors sewing, and even writers using writing implements. The disorder is common with people performing a repetitive fine motor skill as an avocation, and there are many case histories of musicians who play only occasionally, and strictly for their personal enjoyment, who develop symptoms.
Among current treatments, botulinum toxin injections can block the nerve impulses to the affected muscles. While these injections are not a cure, they can be useful in the right setting. For example, dystonia afflicted pianist Leon Fleisher has effectively used injections to extend the fingers of his right hand and famously reclaim the two-handed repertoire. Anticholinergic drugs, such as Artane, can be helpful by affecting the transmission of messages from the brain to the muscles.
The most resoundingly successful therapies have been retraining. Guitarist Billy McLaughlin and violinist Ryan Thomson reversed their hands, effectively playing backwards, to conquer their dystonia. Guitarist David Leisner retrained using different muscle groups, thwarting his dystonia.
Retraining is a long and arduous task, and these artists spent years relearning their instruments to perform dystonia-free. Patience and tenacity may prove well worth it if the new position does not present with dystonia.
Assistance with Musician Dystonia
Focal dystonia starts slowly and typically worsens over time. Early diagnosis, from a specialist in movement disorder neurology, usually produces better outcomes and reduces the amount of time musicians may spend suffering in silence.
The Musicians with Dystonia Program of the Dystonia Medical Research Foundation was initiated in 1999 to provide information, support, and medical referrals to the music community. Well-publicized cases, such as those mentioned above have helped tremendously to increase general awareness.
The Musicians with Dystonia Program has comprehensive information available atwww.dystonia-foundation.org and may be contacted directly at email@example.com or at the offices of the Dystonia Medical Research Foundation at 800-377-3978.
Steven Frucht, MD, is professor of Neurology and director of the Movement Disorders Center at Mount Sinai Medical Center in New York City. He is also a violinist and violist.
Glen Estrin enjoyed an illustrious career on French Horn, performing with everyone from the Chicago Symphony Orchestra to Frank Sinatra until His career was ended in 1998 by focal embouchure dystonia, and he cofounded the Musicians With Dystonia Program with Frucht, his neurologist.
This article is from our July-August 2012 issue. Click to order!