AboutUnderstanding is the First Step of Acceptance.
If you are a musician who is confused about your movements,
If you are an experienced teacher,
Welcome to explore Musician’s Dystonia.
What is Dystonia?
Dystonia is a very complex neurological movement disorder in which a person’s muscles contract excessively involuntary, causing twisted movement, tremors or rigidity. It is a confusion between the nervous system, movement integration and sensory integration. When the brain transmits the signal to the muscles, some confusion occurs, which results in the phenomenon of continuous or intermittent muscle contraction.
In the past, dystonia was often considered a rare disease. But in fact, it’s the third most common movement disorder behind essential tremor and Parkinson’s disease. It is a condition that knows no age, ethnic or racial boundaries. Dystonia may affect any parts of the body, including: eyelids, face, jaw, neck, vocal cords, torso, hands and feet. A patient’s condition in which one or more body parts are affected is possible. The symptoms presented will vary from person to person.
The mechanism of dystonia is still inconclusive. At present, it is known that it involves many functions and areas, including: nervous system, prefrontal cortex, basal ganglia, cerebellum, thalamus, auxiliary motor area, sensorimotor cortex, etc. Due to changes in the state of the brain, these lead to impaired inhibitory ability, abnormal plasticity and impaired sensorimotor function.
Dystonia in Musicians
Dystonia Occurs in Musicians…
The most prominent feature of musician’s dystonia is the loss of original control over performance. In the initial stage, this kind of abnormal muscle contraction is not easy to notice, usually some vague and uncertain feelings, such as loss of original stability, slight tension, reduced flexibility or weakened control, etc. Musicians often attribute these early symptoms to lack of practice and fail to regard it as a physiological problem. However, after a lot of practice, the situation has not improved, or even worsened. They gradually realized that these symptoms did not stem from lack of practice, and then sought medical help.
Generally speaking, pain is not a typical symptom of musician’s dystonia. There are only some patients who clinically feel pain. Symptoms described by patients are mostly: loss of flexibility and control, inability to accept instructions, continuous curling of fingers into the palm, abnormal tension in certain parts (hands, arms, feet, face, vocal cord, lips, etc.), or tremors.
The pathogenesis of a musician’s dystonia has not yet been determined, but according to patients’ experiences and existing researches: it is not only a movement disorder, but also a sensory disorder, there are some affectations in the process of sensory input to the brain. The patient may feel unfamiliar with movements that were so familiar in the past, or feel uncomfortable when performing correct movements, and then unconsciously produce other compensatory movements.
In the past, musician’s dystonia was regarded as a movement disorder of a specific task, just like writer’s cramp, its symptom only appeared when performing a specific task. Some musicians’ dystonias are limited to certain specific movements or a specific instrument, and the symptom disappears after the instrument is put down; some musician’s symptoms appear in different parts of the body at the same time, such as: hand and mouth. In addition, there are some patients who not only have symptoms while playing, but also experience movement disorders in their lives, such as typing, or asymmetry of facial muscle, stiffness, etc. Apparently, the pre-existed theories related to musician’s dystonia seem to be insufficient to explain the symptoms that patients actually experience.
The factors that trigger musician’s dystonia are complex. There are many possible factors, and some patients have no abnormalities before the illness. The following are only a few of the more common causes.
- Sudden increase in practice
- Changes in performance techniques
- Stress and anxiety of practice or performance
- Psychological trauma
- Change of repertoire
Musician’s dystonia belongs to primary dystonia, that is, it is not caused by other diseases. In medical history, there is no clear medical test, which is mainly based on clinical judgment, the patient’s self-report and clinical observation, excluding other pathogenic factors that may cause movement disorders. Due to the difficulty of diagnosis, many patients fail to obtain the correct information and assistance for the first time, or were given the wrong diagnosis and even misled to other diseases. Here are a few pathogenic factors that need to be excluded.
Factors that need to be excluded:
- Central nervous system damage
- Other nervous system diseases
- Inherited diseases
- Carpal tunnel syndrome
- Muscle damage
- Temporomandibular joint syndrome
According to past data, it is estimated that about one to two percent of performers will suffer from musician’s dystonia. This is because there is little information about this disease in the past, so only few patients who really seek help from the medical system and actually receive treatment. But with the spread of Internet information in recent years, and more and more patients are coming forward, the actual proportion of illnesses should far exceed the previous data.
More vulnerable groups:
- The incidence of men is higher than that of women.
- Musical instruments with a high frequency of repetitive movements, such as flamenco guitars.
- Highly technical instruments, such as piano and violin.
In the book “Limitless” published in 2016, Dr. Farias boldly proposed a new theory. He believes that the cause of dystonia could be the reaction of the nervous system confronted with an emergency situation, which he called “cortical shock”. This reaction puts the nervous system into a state of stress, leading to the disconnection of certain neural circuits, thus making other neural circuits overactive.
In addition, Dr. Farias found out that the movements of patients with dystonia actually matched the primitive reflexes. He boldly speculated that after an accident in the brain, the brain automatically changed the route of the motor and returned to the primitive reflexes which originate in infants. Primitive reflexes are the fastest and survival-related reaction, but it is not necessarily the most efficient movement.
An instrument performing is undoubtedly the best representative of efficient movements. After a lot of practice, all the movements will transform into a sequence of motor patterns which are executed automatically. In this process, the musician will streamline the unnecessary strength and continue to optimize it to achieve the maximum efficiency. Therefore, once any movements in this series of movements returns to the primitive reflexes, it will also affect other movements and cause the overall performance to get stuck.
In the past, dystonia was classified in two ways: body parts and specific tasks (or occupations). However, these classifications could not explain the clinical diversity. Dr. Farias proposed a new hypothesis based on his complete experience in treating all types of dystonias. He observed that whether it is focal or generalized dystonia, the affected muscle groups are always the same. In other words, muscle groups affected by dystonia are specific, and the diversity presented by patients depends on affected areas and extent, not on the specific tasks they perform.
For example, affected muscle groups in patients with lower extremity dystonia and generalized dystonia are the same. The difference is that the affected parts of generalized dystonia are more severe, which may include other body parts such as upper limbs, head and so on. The affected muscle groups of musician’s dystonia and hand dystonia are also the same. The difference is that the subtle movements of instrument performing induce slight hand dystonia.
This is undoubtedly a significant discovery, which could explain why some players also have dystonia in daily life, not just while playing, or patients with embouchure dystonia have embouchure and hand problems at the same time. Dr. Farias’s new theory boldly subverts the past theories. Although some parts need to be verified by subsequent neuroscience, this new theory shed a new light for dystonia.