Focal Dystonia
What Is Focal Dystonia?
The Dystonia Medical Research Foundation defines dystonia as "a neurological disorder that causes excessive, involuntary muscle contractions." These contractions can affect posture, body movements, and an individual's control of their movements. In some cases, these atypical movements can be painful. Actual symptoms and changes in function vary with each individual, but typically display repetitive patterns. Dystonia can affect any region of the body and may look quite different from person to person.
Focal dystonia is task-specific and occurs during a particular action, such as moving fingers on a keyboard or forming a brass embouchure. Symptoms may include tremor, unusual twisting or flexing of the muscle, or loss of normal function. The involuntary muscle contractions do not otherwise occur. It may manifest suddenly or increasingly over time.
It is estimated that about 1% of all professional musicians are affected by focal dystonia, with many left without a definitive diagnosis. Most individuals with musician's dystonia are male, classically trained, and have a family history of dystonia. However, women and those with no relevant family history can suffer from focal dystonia.
Embouchure Dystonia
A particular type of focal dystonia can affect a brass or woodwind player's ability to form or maintain an embouchure. It may involve the muscles of the lips, face, jaw, or tongue. Symptoms may include these and other issues:
- inability to "buzz" (lip vibration) in the mouthpiece
- air leaks in the corners of the mouth or embouchure
- a distortion of the embouchure - pulling to one side
- tremor in the jaw (not associated with anxiety or nervousness)
These symptoms are new to the player, where there had not previously been any such difficulty.
What Causes It?
It is important to keep in mind that the cause or causes of dystonia are not yet known, although many theories exist. However, focal dystonia is triggered by the specific movement or task that is affected by it, such as walking, holding up one's head, or playing an instrument.
Diagnosis
There is no single method to diagnose dystonia. It is advisable, however, to seek a medical opinion if physical symptoms emerge that are new or unexplained. A physician may employ tests and other examinations to eliminate possible diagnoses, such as Parkinson's disease, anxiety, and other conditions that may create similar symptoms. A patient's history and family medical history will also be considered. An essential element of focal dystonia is the appearance of the symptom(s) during the specific task exclusively. The atypical muscle contraction is otherwise not present.
Possible Treatments
There is no known cure for dystonia. Treatments may lessen the severity of symptoms, but atypical contractions and functional difficulties remain. These treatments range from physical and occupational therapy to Botox injections. Since dystonia is a neurological condition, neurologists are often consulted for diagnosis and possible treatments. Musicians have also tried methodologies such as the Alexander Technique and Feldenkrais, and pedagogical techniques, including visualization and focusing on performance fundamentals, such as posture, embouchure formation, and breathing.
A promising area of interest is a concept known as neural plasticity, or the mind's ability to create a new neural pathway to control muscle contractions and movements. For the musician, this may involve retraining or relearning how to produce a sound on the instrument, to complete basic movements, or to conceptualize the sound. Dr. Peter Iltis, Professor of Kinesiology at Gordon College, describes this re-learning or adaptation this way:
Several musicians have achieved recognition for developing or teaching approaches that utilize this special ability of the brain to find another way. Jan Kargarice (Musician's Wellness), Joaquin Farias (neuroscientist and musician), Phil Smith (former Principal Trumpet, New York Philharmonic), Julie Landsman (Caruso Method), and Dion Tucker (jazz trombonist), among many others, provide resources to help musicians suffering from focal dystonia.
Other treatment options have included, but are not limited to, acupuncture, dry needling (performed by a physical therapist), and massage therapy.
Mental and Emotional Health
The psychological impact of focal dystonia on musicians should also be considered. It affects not only one's ability to play an instrument, but can also have a profound impact on confidence, self-esteem, and overall mental and emotional health. It is important to seek support from other musicians, especially those who have experienced focal dystonia themselves.
Suggestions from such musicians may include:
- pay attention to the air flow
- Do not try to fix it
- Focus on air and sound, and let go of the outcome
- set realistic goals
- forget what you know
Prevention
Performing musicians and students tend to spend many hours in the practice room and have learned to devote time and diligent effort to perfect their technique and musical skills. Dr. Hyder Jinnah of Emory Brain Health Center in Atlanta specializes in movement disorders, including focal dystonia. He has recommended that periods of rest be incorporated into the practice routine (5 minutes of rest per 25 minutes of practice). Dr. Jinnah and other neurologists who have made a career of studying and treating dystonia agree that musicians often exacerbate emerging dystonia by increasing their effort, by "trying harder" and practicing even more. Although this may be an instinctive response for a serious musician, it may also be a harmful course of action.
Selected Resources
Dystonia Medical Research Foundation - Musician's Dystonia: https://dystonia-foundation.org/what-is-dystonia/types-dystonia/musicians/
Musician's Wellness, Jan Kagarice - https://musicianswellness.com/
Discover Magazine, - https://www.discovermagazine.com/mind/focal-dystonia-a-musician-overcomes-a-movement-disorder-with-a-change-of
Find Support: https://dystonia-foundation.org/living-dystonia/support/
Dr. Peter Iltis - Embouchure Dystonia: Mind Over Grey Matter
Farias Technique - Neoplastic Movement Therapy
The Carmine Caruso Method (Julie Landsman) - Re-balance and Recovery
Federico Bitti - Dystonia: Rewiring the Brain Through Movement and Dance
Personal Stories
Virtual Band room (Phil Smith, trumpet): Dealing with Embouchure Dystonia
The Chops Shop (Dion Tucker, trombone): Focal Dystonia - One of the Best Things to Happen to Me
Fernando Perez, guitar - stay positive, be mindful, let go of the old, and embrace the new
Dave Biller, guitar - relaxation while playing, work around the issue, and do not give up