Physical Risk Factors
Physical Risk Factors
The physical risk factors associated with musicians' focal dystonia include biomechanical, sensorial, and technical elements. Several of these are modifiable and involve a re-assessment of practice strategies.
Over Practicing
Practice does not always make perfect. Whilst musicians are often advised to take regular breaks or to stop playing if they feel pain, many continue to play with discomfort or when they are excessively fatigued. Symptoms of focal dystonia are more likely to appear during, or shortly after the body is in this fatigued state, and when combined with an extended period of intensive practice with inadequate rest periods, the risk of onset may increase.
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Excessive Repetition
Musicians, especially classical musicians tend to aspire toward technical perfection. During instrumental training, especially within the conservatoire model of teaching, technical perfection is often expected but rarely achieved. External pressures from teachers, deadlines or exams, and auditions can all contribute to creating a habitual pattern of practice that involves excessive and often obsessive levels of repetition within an often stressful environment.
Repeating a particular phrase or sequence of notes trains the brain to accept and re-enforce a particular schema or sequence of highly trained movements. In time, the particular movement sequence becomes automatic, hard-wired into our nervous systems, and less and less within conscious control. If the musician then asks the brain to adjust or change this movement sequence abruptly, maybe during a memory lapse in a concert, or preparing at short notice for a high-profile performance, the shift of focus to the highly automatized movement sequence changes instantly from the subconscious to the conscious.
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In musicians who are susceptible to focal dystonia, it appears that the brain then begins to misfire, sending erroneous and unclear signals to the affected muscles. This is thought to be due to changes in the brain's representation of the affected body part, leading to confusion in the brain's motor commands and resulting in the abnormal muscle contractions seen in dystonia. A limited ability to adjust and react to different playing situations has been linked to the increased onset of symptoms.
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Technical Difficulties
As with any learned skill, it is important to learn to walk before you run. As musicians develop their abilities, the difficulty of technical and musical challenges increases. Pushing playing abilities to the limit is an integral part of musical development, but in some cases, technical ability falls short of the technical requirement for a particular piece. This may be due to biomechanical problems, physical limitations, or practice deficits.
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Knowing your technical limitations and addressing them systematically is a key element of musical training. For many, compensating for a technical difficulty over time may generate excessive or uncontrolled tension, undesirable movements, and increased physiological and psychological stress. This combination of factors may elevate the chance of evolving symptoms of focal dystonia.
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Biomechanical Problems
Bio-mechanical problems that a musician faces when playing an instrument arise from muscle imbalance or weakness, bad posture, poor technique, repetitive motion injuries, and over-exertion of certain muscles. Poor posture can cause a lack of coordination between fingers and hands, leading to poor technique and inefficient playing. In cases of musicians' dystonia, compensating for postural problems by adopting a sub-optimal playing technique may encourage restrictive and inflexible movement patterns. Highly stereotyped and inflexible movements are associated with an increased risk of onset.
Repetitive motion injuries can be caused by overuse of the same muscle groups in a single position, which can cause inflammation and fatigue of the muscles. Over-exertion of certain muscles can be caused by incorrect technique or poor technique. This can lead to muscle strain and fatigue. Additionally, a sub-optimal playing technique can lead to a lack of balance when playing, leading to poor control and accuracy of the instrument.
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