Symptoms
What are the common symptoms of musicians’ focal dystonia?
It is important to stress that symptoms of focal dystonia vary greatly from person to person. Therefore, it is important that if you have any concerns, do not jump to conclusions and consult with a physician (preferably a neurologist specializing in movement disorders) first.
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Muscle spasms/cramps
Muscle cramps or spasms are the most common symptom of musicians’ dystonia. Put simply, in musicians’ dystonia the affected muscle, or group of muscles, is out of balance. For example, guitarists might find that a finger in their right hand begins to curl into the palm or even stick outwards uncontrollably. A trumpet player may they feel as though their top lip wants to pull upwards or outwards of its own accord, making playing even simple notes a challenge.
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Muscle Tremors
The struggle to regain control of the faulty movements caused by focal dystonia can sometimes result in a rather disconcerting and undesirable additional symptom, tremor. A dystonic tremor occurs as a result of the imbalance in the affected muscle or muscle group, and the body's attempts to compensate for this imbalance. For example, in the finger, the muscles that control the curling into the palm are called the flexors, and the muscles that straighten the finger are called the extensors. A common experience amongst dystonic musicians is an imbalance between the two muscle types. In this case, a hypotonic (underactive) extensor may be responsible for a hyperactive (overactive) response from the flexor muscle, causing a curling of the finger towards the palm. As the body attempts to compensate for the hypotonic extensor muscle, other, secondary muscles may be recruited to help, which in turn causes more disorganization and a muscular tug of war, manifesting as a tremor.
Altered Proprioception
Many musicians complain of a strange sensation of losing perception of how their instrument feels and interacts with their body. They will describe things such as not being able to judge the height of the strings, or not being able to put their lips to a mouthpiece without stuttering. This sensation is linked to proprioceptive dysfunction and is also a widely reported symptom in musicians’ dystonia. Addressing proprioceptive dysfunction in focal dystonia is a key factor in restoring normal movement.
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Loss of dexterity
As a consequence of the muscle cramps and spasms experienced in dystonia, another common symptom experienced by musicians with focal dystonia is a loss of dexterity, speed, or fluency in the affected area or limb. Techniques involving quick movements such as tremolos, trills, or double/triple tonguing can be compromised, although for many, slow movements may be more problematic.
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Psychological Distress
There is a growing body of evidence that points towards the involvement of psychological processes in the onset of focal dystonia in musicians. Pre-existing conditions including anxiety disorders, obsessive-compulsive disorders, and depression are sometimes associated with developing focal dystonia. Although in isolation, they are not likely to cause onset, they may increase the likelihood of onset when accompanied by further physical and psycho-social risk factors.
Conversely, when there appear to be no identifiable psychological risk factors prior to onset, the physical symptoms of the condition may provoke psychological problems which in turn may lead to further detrimental effects on the severity of physical symptoms.