How To Resolve Dystonias: A Movement Perspective
by Barbara Conable
All across America musicians are getting interested in how they are moving. This is good because the conditions for dystonia are too frequently put in place early in musical training by faulty pedagogy in which the student is made to concentrate on what is being done with little or no attention to how it is being done. Mistakes are therefore made about the nature and quantity of muscular and mental work that playing requires. The conditions for dystonia are in this way learned, and they can be unlearned.
Most musicians never suffer dystonia because they move well and pay attention well to what they are feeling with their fingers. Moving beautifully, without tension, with balance and variety, is protection against dystonia. So is fluid, whole body awareness. For dystonia to resolve, the suffering musician must unlearn bad habits and abnormal movement and learn to move freely, with full awareness, like those safe musicians, with no concentration on any one part of the body.
I have met at least a dozen musicians who did this spontaneously and resolved their problem fairly quickly. One guitar player said, “I figured I wasn’t doing something right, and I found out I had to get all the tension out of my body in order for my fingers to do what I wanted them to do instead of locking up on me and stuff.” “Locking up” is a good description of this condition called dystonia. Dys is a prefix indicating poor condition. Dystonia, poor tone, is an is imbalance of muscle firing (too much tone or too little) resulting in stiffening, involuntary movements, and inability to control the movements. Sometimes it is the embouchures that won’t do what the musicians want them to do, rather than the hands. Organists can experience nearly identical problems in their ankles, for identical reasons. Dystonia is a very real sensory-motor disorder, not a psychological condition.
The musicians who spontaneously resolved their dystonia did the opposite of what most musicians do. Most try to control the offending part by concentrating on it and therefore increasing the tension in and around the part. This only makes it worse. When the guitar player “found out I had to get all the tension out of my body” he had to do the opposite of concentrating. He had to expand his attention to the whole of him in order to free up his hands, so that he could simply do the work of fingering and plucking the strings without interference. He had to experience his fingers in movement as part of the whole of him in movement as he played. “All the tension out of my body” had to continue throughout his practicing, rehearsing, and performing.
Getting the tension out of the body and out of the hands requires a period of retraining in which professional help is secured, in which inflammation is treated with anti-inflammatories, in which scarring and deterioration are prevented by cutting back performance and practice to safe levels, in which the constant goal is to change the strategies for playing the instrument.
Retrain and Relearn
Recommendations that follow from scientific investigation of dystonia are consistent with what some musicians have spontaneously discovered. I have in hand a list entitled Practical Guidelines for Sensory and Selective Sensory Motor Training by Dr. Nancy Byl, PhD, PT, Professor and Chair of the Department of Physical Therapy and Rehabilitation Science at the University of California at San Francisco. Dr. Byl and her close associate Alison McKenzie, Ph.D., PT, in neuroanatomy in the Physical Therapy Department at Chapman University, are scientists who seek to solve the mystery of dystonia and provide means for its resolution. The top of Practical Guidelines reads, “Goal: Restore the somatosensory representation of the hand and normal fine motor control.” Among her suggestions under Specific Sensory Activities are:
“Identify everything about the surface of the instrument, eyes closed (strings, fret, white keys, black keys),”
and under Mental Imagery,
1. ” …reflect back to the time when the hand was working normally.”
2. “constantly remind [yourself] how easy it was to do the task, how warm the hand felt, how each individual digit felt absolutely controlled…and how coordinated the hand felt.”
I selected these two recommendations because I have seen them work wonders. Sensitively exploring the instrument brings an increase in tactile and kinesthetic clarity. Constructive use of memory gradually restores a former constructive condition. If you want a copy of a handbook of recommendations like these for dystonia sufferers,consult the side bar. Nancy Byl cautions that this handbook is only helpful as a reminder. She says all who are recovering from dystonia should work with a physical or occupational therapist or a Feldenkrais worker (side bar) or an Alexander Technique teacher (side bar). I would add that you may need a big support team, including a support group, family, friends, sympathetic and curious colleagues, a psychotherapist or cleric. This needs to be coupled with a return to a state of positive health by becoming physically fit, well hydrated, eating a balanced diet, getting a reasonable amount of sleep, and managing the stress in life.
This is how Nancy Byl describes vulnerability to dystonia: “The people at risk for…are those who have poor posture and use stressful hand techniques (e.g. up on the finger tips, fingers lined up, and rapid interdigitated, alternating movements of the fingers) rather than having a stable base with good posture, moving from the shoulder and the elbow, letting the weight of the hand/arm depress the keys and simply releasing the pressure down rather than extending the adjacent digits. Focal hand dystonia could ultimately develop in cases of continued excessive, rapid, stressful repetitive hand techniques that become very stereotypical and near simultaneous in time. These types of movements ultimately exceed the capacity of the nervous system to integrate the information required to perform such rapid movements. The brain cannot keep up with the inputs and consequently the motor outputs become disorganized as well. The hand loses its unique and distinct representation on the brain. This condition represents abnormal learning and can be measured as decrease in sensory sensitivity and a loss of finely graded hand movements particularly on the target task. Treatment is re-education. The goal is to restore the normal somatosensory representation of the hand by: decreasing stress, stopping the abnormal movements, learning stress free hand techniques, and restoring the normal sensory representation of the hand.”
If you have dystonia, use free, fluidly attentive musicians as models for the changes you are making. Watch your models to see how they move, and imitate them. Watch them in concerts, in rehearsals, in lessons, and on video. Good models don’t have to play one’s own instrument, they just have to play very freely and with a wonderful quality of attention. Notice how their movement and their attention support their musicianship.
If you have dystonia, or any other tension related problem, work to systematically develop a first rate body map (or body model, body scheme, or internal representation, as it is also called.) Pore over anatomy books, reading the illustrations for the sense or the truth of them (you don’t need the Latin). Cultivate a self conception that matches the reality of your body, identifying any errors and correcting them. Do this because tension often comes from errors in internal representation, and because for dystonia to resolve the correct “somatosensory representation of the hand” must be restored. This can be simple. I have seen drummers with emerging dystonia symptoms who think of holding the sticks with their two hands. When they change their conception to holding the sticks with their ten fingers and whole arms, the symptoms disappear and integrity is restored to the movement. The brain had “clumped” their fingers into hands based on years of conceiving them that way.
We can remind ourselves, by way of analogy, how much suffering and dysfunction come from mistakes in the mapping of breathing: locked ribs, nearly spasmed bellies, frozen posterior abdominal walls, unresponsive pelvic diaphragms, loss of coordination and support in the breathing. If mistakes in the way we think can so disrupt breathing, why not hands, embouchures, and ankles?
Cultivate the greatest possible variety of movement when playing your instrument. At-risk drummers, for instance, may think of themselves as using this “grip” or that “grip.” When they drop all notion of grip and instead think of holding and moving the sticks in such a variety of ways as to set the drumhead vibrating with sounds of wonderful variety, always matching the movement to the sound that’s wanted, they are no longer at risk.
Finally, if you have dystonia, seek to acquire in your body sense all the same skills you have in your ears. Do a kind of body training that mimics your ear training. You especially want to be able to feel any part of you clearly in relationship to the whole of you, the way you hear a note in a chord or a phrase. You want to know how you are moving and you want to make moving freely a matter of intention. Don’t go looking for tension and then try to get rid of it. That’s about as effective as listening for out of tuneness and trying to get rid of it. Instead, you learn to intend movement that is free and fluid and of appropriate effort, just as you learned to intend and execute pitches.
Keep making music every single day, even if you can’t play your own instrument for the time being except in retraining. Sing. Play with the other hand. Improvise within your limitations. Learn another instrument. Anything to maintain your status as a musician in your own mind until your retraining is complete and you enjoy “normal fine motor control.”
Barbara Conable is the Founder of Andover Educators®.