“Begin slowly and increase gradually any unaccustomed use of the hands.”
Violinist Peter Oundjian, guitarist Liona Boyd, pianists Leon Fleischer and Gary Graffman – all are musicians whose careers were upended by the mysterious condition known as focal dystonia (FD).
FD is a movement disorder characterized by painless, involuntary muscle contractions that occur when a person does a particular activity.
The image at right shows a violinist's left hand during dystonic contractions.
Among the approximately 1% of musicians who develop FD, the effects are debilitating. Some who retrain can continue to perform, but few regain their pre-dystonia dexterity.
That is, people afflicted with FD generally engaged in a skillful, repetitive activity across a span of years – the playing of instruments being a prime example.
Over time, usually decades, the program in the brain that they depend on to control their movements gets corrupted, and they lose command of certain task-specific actions.
For instance, violinists with FD might experience curling of the left 3rd and 4th fingers when they play, but those fingers will function normally when they do other activities.
Researchers also find that FD "appears more often in the more intensely used hand” (Jabusch and Altenmüller, 2006). Hence, violinists are more likely to be affected in the left hand, pianists in the right, although any muscle group could be involved, even arm or shoulder muscles.
Some musicians diagnosed with FD seem to develop it without any precipitating factor aside from long-term repetitive movement.
For others, the condition surfaces months or years following a change of instrument or technique, subsequent to a dramatic increase in playing time, or after they begin doing a new, skillful repetitive activity.
In those types of situations, the process via which a musician’s brain acquires a new movement program corrupts the pre-existing one and then dystonic contractions result.
On top of that, physician Raoul Tubiana reports that the musicians he diagnosed with FD displayed awkward postural and movement habits.
It’s conceivable, then, that physical misuse contributes to provoking FD in some individuals, maybe because musicians who move awkwardly foster more convoluted and corruption-prone wiring in their brains. But that’s just speculation on my part.
Given that FD can run in families, a genetic component seems certain.
According to the Dystonia Medical Research Foundation, “At present, researchers have recognized multiple forms of inheritable dystonia and have identified at least 13 genes or chromosomal locations responsible for the various manifestations.”
Note that the forms of dystonia referred to in that quote don’t include FD, for which no culpable genes have yet been discovered.
Still, the published research also implies that if we emphasize certain behaviors and avoid others, we can probably reduce the chances of FD arising.
So here are seven precautions we can take that could help us sidestep FD as well as protect us from other music-related maladies.
1. Never push through fatigue or injury
2. Increase playing or singing time in stages
3. Acclimate gradually to any unfamiliar instrument
4. Initiate technical changes in increments
5. Curb new hand-intensive or repetitive tasks
6. Commit to healthy practice habits
7. Adopt good use
* * *
For more information regarding musicians’ wellness and injury prevention, see Chapters 12 & 13 of The Musician’s Way – dozens of photos are included that depict musicians employing good vs. poor use.
A version of this article first appeared on The Musician's Way Blog.
© 2011 Gerald Klickstein
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Gerald Klickstein is from Baltimore, Maryland. Biography
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