musiciansdystonia.net

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Recommendations for reducing risk factors associated with musicians' dystonia include practice modifications, taking regular practice breaks, focusing on playing with a good technique, practicing in moderation, using relaxation techniques, physical exercise, stretching, and looking after mental health. These recommendations are important, but often quite vague and don't always offer a clear explanation as to why they may be specifically useful in reducing the risks of developing focal dystonia.

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The following section offers a number of movement health recommendations and focal dystonia risk reduction strategies that can be incorporated into the practice routines and lifestyles of performing musicians. The objective is to encourage more performing musicians to make informed choices that may help maintain or improve their movement health.

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​1."Practice regularly, but avoid over-practice to reduce the risk of muscle fatigue, injury, or exhaustion."

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​Why?

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Of course, this is common sense and good practice for any musician. However,  in the context of focal dystonia, it has been shown that the condition often develops during a period of sudden increases in practice time and stress, maybe in response to intense performance schedules, or other pressures such as looming deadlines, difficult teacher/student relationships,  exams or auditions.

 

As with athletes, if a musician suddenly demands a greater response from the body, it may not respond immediately in the way that we want or may be required, causing injury or physical discomfort. When the musical/technical demand is greater than the available physical output, we compensate for the physical demand/ subsequent discomfort by recruiting extra muscles and subtly changing the way we perform certain motor tasks.

 

These subtly adapted motor tasks also require the subtle alteration of motor sub-routines at the cortical and sub-cortical levels within the brain. Over-practice then increases muscle fatigue, which in turn requires the body to further alter motor sub-routines in order to fulfill musical/technical demands. These "compensations" may begin to include the recruitment of extra muscles, provoking co-contractions, and unwanted movements. A state of muscle "imbalance" may emerge, and at this point, correcting the "over-practiced" altered motor commands may become difficult. 

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In certain individuals, over-practice can lower the brain's defense against unwanted movements, and begin to affect fine-movement control. As with many things in life, trying to do everything at once leads to burnout, stress, anxiety, and reduced performance. Our nervous system needs time to process the information that we demand of it to perform healthily. Over-practicing reduces the ability of our brains to adapt to the physical demands required of it, which in turn increases the risk of focal dystonia.

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2."Incorporate rest and recovery into your practice routine,       taking regular breaks."

​Why?

Once again, this is obviously good practice for all musicians. However,  when questioned, many musicians confirm that they do not, or feel unable to, incorporate sufficient rest and recovery into their practice schedules. Although most musicians acknowledge the importance of sufficient rest and recovery, there is often still a badge of honor attached to those who practice the longest or the hardest. 

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In the context of focal dystonia prevention, regular breaks are an essential part of reducing risk. Our brains require periods of quiet time to assimilate and process the information that we accrued during a practice session. When we exclude or reduce these periods of rest and recovery, we begin to "overheat", neurologically speaking.

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3." Slow Practice is your friend."

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Why?

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Slow practice is incredibly beneficial for musicians for several reasons:

 

• Understanding the Piece**: Playing a piece slowly allows musicians the time to thoroughly understand the structure of the piece, note sequences, chords, and key changes. 

 

• Technical Precision**: Slow practice enables musicians to learn the correct fingerings, bowings, breaths, or other technical elements without feeling rushed. Achieving proficiency and accuracy requires focused attention to detail, which is more manageable at a slower tempo.

 

• Memory and Consistency**: By practicing slowly, musicians strengthen their muscle memory. Playing correctly, over and over, even slowly, helps create reliable neural pathways that support automatic and consistent performance. 

 

• Mistake Identification**: Mistakes become more evident when playing slowly. It makes it easier to identify and correct errors, helping to prevent musicians from ingraining wrong notes or techniques. 

 

• Gradual Increment**: Once the piece is mastered slowly, it's easier to gradually increase the tempo. This methodical approach reduces the risk of mistakes while increasing speed.

 

• Performance Anxiety Reduction**: Slow practice can reduce performance anxiety. By knowing a piece inside and out at a slower tempo, a musician can feel more confident when performing it at normal speed.

 

• Expressiveness and Artistry**: Playing slowly allows musicians to understand the emotional content of their music deeply, helping them give a more expressive and convincing performance. They can pay close attention to dynamics, phrasing, and articulation, which can sometimes get overlooked at faster tempos.

 

In the context of preventing neurological health problems as well, slow practice helps:

 

• Motor relearning**: Constantly practicing quickly without thinking may cause the brain to develop irregular neural pathways for certain movements. Slow practice helps in creating new, more efficient neural pathways. By slowing down, musicians can focus on the quality of each movement, making sure it's accurate and precise.

 

• Enhanced focus**: Slow practice allows musicians to pay more attention to their fingerings, hand movements, breathing, posture, etc. This increased focus can help them spot potential triggers or stresses that could signal a potential problem.

 

• Reduced stress**: Playing slower reduces the physical strain and stress placed on the involved muscles, potentially decreasing the intensity and frequency of focal dystonia episodes. 

 

• Improved muscle memory**: Playing slowly helps to engrain the correct sequences and movements into the memory. If musicians rush too quickly through difficult passages, incorrect sequences may become habituated instead.

   

• Greater control**: During slow practice, musicians have more time to anticipate and prepare for each individual movement, providing renewed control over their muscular output. 

 

Remember, "slow is smooth, and smooth is fast" is an adage that often holds true in music practice.

 

 

4." Avoid constantly repeating the same thing over and over when practicing."

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Why?

 Musicians affected by dystonia are often at risk when repeating sections of music over and over because:

• Overuse of Specific Muscles: Repeatedly practicing the same piece can lead to overuse of certain muscles, possibly exacerbating the symptoms of dystonia.

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• Intensifying Symptoms: High repetition and duration in practice might risk intensifying the specific motor tasks associated with dystonic symptoms, thereby worsening the condition. 

 

• Unflexible Nervous Systems: When we repeat actions we “stereotype” a movement sequence, attempting to replicate a perfect version of the same pattern, every time. Although musicians strive for perfection, obsessively attempting to perfect something can become a source of stress, and frustration, and may involve the use of techniques that may not be suitable, or even physiologically comfortable for the player. This may lead to an inability to be flexible when playing, for example, if during a concert something doesn’t go well, if we do not know how to calmly navigate a situation or adapt to circumstances, our training can be a hindrance, causing both physical, neurological, and psychological distress, which in turn increase the risk of the onset of focal dystonia.

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• Habit Formation: If a musician develops certain dystonic symptoms while playing particular sections of music, repeating those sections over and over again can potentially reinforce the "faulty" motor pathways in the brain, institutionalizing the dystonic movements.

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• Psychological Stress: The stress and frustration of practicing the same difficult passage again and again could potentially exacerbate symptoms since stress is known to worsen dystonia. So, for musicians with dystonia, it's typically recommended to modify their practice strategies, including varying the repertoire, incorporating regular rest breaks, emphasizing slow practice, and possibly using mental rehearsal techniques.

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5. "Use a supportive instrument or equipment, such as a chair or music stand that promotes good posture and ergonomics."

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Why?

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• Reduced Strain and Injury Risk:  Supportive equipment is designed to promote correct posture, reduce the risk of strain or injury, and make performing more comfortable, which is fundamental for maintaining and developing good movement health.

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• Enhanced Endurance: With professional-grade equipment that encourages good posture, musicians can perform for longer periods without experiencing discomfort or fatigue. This is particularly important for musicians who might be experiencing excessive fatigue or pain, which may increase the risk of developing focal dystonia over time if left untreated.

 

• Improved Accuracy and Ease of Performance: A good posture can improve the precision and coordination of movements, which are crucial for playing an instrument. This proves beneficial in maintaining and improving good motor control.

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• Prevention of Secondary Problems: Bad posture not only exacerbates symptoms of back pain, neck strain, or other musculoskeletal conditions, it can also provoke less flexible movement which in turn can increase the risk of focal dystonia developing over time. Ergonomic equipment can help prevent these issues.​

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" Seek a qualified music teacher or therapist who can provide guidance on technique, posture,  healthy movement, and injury prevention."

 

Why?

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• Long-term well-being: Musicians are often described as "athletes of the small muscles". Unlike athletes, however, musicians do not usually have regular support from multidisciplinary teams of physiotherapists, psychologists, nutritionists, or specialist doctors. Unfortunately, most musicians need this support, maybe not on such a regular basis, but it is necessary in order to maintain our psychological, neurological, muscular, and professional well-being, and to identify problems before they progress.

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• Posture: Proper posture is crucial in ensuring there is no strain or stress on the body that might lead to long-term injuries, including focal dystonia. A qualified teacher or therapist has a keen eye for identifying bad habits and correcting them before they become problematic.

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• Injury Prevention: Incorrect technique and posture can lead to a range of physical problems including repetitive stress injuries, muscle strains, and even permanent damage. A qualified teacher or therapist can provide guidance on warming up and cooling down, regular breaks, and other habits, including specific movement exercises that can help to prevent these issues.

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• Personalized Feedback: Self-teaching, while convenient, lacks the in-person feedback that a qualified teacher or therapist can provide. A professional can monitor progress and tailor advice and training plans to the individual's unique needs.

 

• Motivation and Accountability: A good music teacher often acts as a source of motivation and should provide accountability, ensuring consistent practice and progress.

 

• Understanding of Anatomy: Music therapists, in particular, usually have a deep understanding of human anatomy and its interaction with musical instruments. They can advise musicians on muscular movements, body positions, relaxation, and other aspects of ergonomics related to their instrument.

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• Mental Health Supports: Lastly, music therapists are trained to use music strategically to support mental health, which is beneficial for musicians who may face anxieties related to performance or other aspects of their careers. These elements lead to an overall healthier, safer, and more fulfilling musical experience. 

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" Take care of your overall health and well-being, including getting enough sleep, eating a balanced diet, and staying physically active."

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Why?

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Health factors such as adequate sleep, balanced nutrition, and regular physical activities can play a crucial role in mitigating  the risk of focal dystonia for several reasons:

 

• Sleep: Quality sleep is key for the body's regeneration process. It helps strengthen the brain-body connection, consolidates memory, and aids in motor skills improvement. This is crucial for musicians as they need to constantly refine their skills.

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• Nutrition: A balanced diet supplies the essential nutrients for overall health. Certain nutrients like Omega-3 fatty acids, vitamins, and minerals also help promote brain health. For instance, these can aid neurotransmission, thus increasing the accuracy and efficiency of brain-body communication, which is vital for musicians struggling with focal dystonia.

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• Physical Activity*: Regular exercise can also improve several aspects of health, including blood flow to the brain, flexibility, strength, and coordination -- all of which could be beneficial for those dealing with focal dystonia. Exercises like yoga, which promote mindfulness and relaxation, can also help manage stress --- a factor that can exacerbate symptoms of dystonia.

Taking care of one's overall health and well-being is not a guaranteed way to avoid focal dystonia, but it can help manage the potential risk factors better. 

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"Learn to recognize the early signs of focal dystonia and seek medical attention as soon as possible if you suspect you have the condition."

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Why?

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Prompt action in consulting a neurologist or other medical professional with experience in treating musicians' problems is fundamental for several motives :

 

• Career Longevity: Focal dystonia can potentially impede a musician's ability to perform, and without treatment, it may even end a music career prematurely. Early detection and treatment can help manage symptoms and prolong a musician's ability to play.

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• Treatment Effectiveness: Treatments for focal dystonia are generally more effective when administered earlier in the course of the condition. As with many neurological conditions, early intervention can slow disease progression and enhance quality of life.

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• Manage Symptoms: Early detection may permit the use of less aggressive treatment strategies initially. Recognizing symptoms and managing them may involve things such as changing technique, altering the frequency or duration of playing, physical therapy, or even occupational therapy.

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• Avoid Further Damage: By recognizing the early signs and seeking help, musicians may prevent the condition from worsening. Unchecked, the condition can lead to more severe muscle spasms, tremors, or even pain.

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• Peer Support: By identifying and acknowledging the presence of focal dystonia, musicians can find and connect with support groups of fellow musicians who may be dealing with the same condition. These connections can provide emotional support and offer a space to share strategies for coping.

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• Public Awareness: By understanding and recognizing the condition in themselves, musicians can also increase public awareness about this less-discussed risk of the profession, possibly leading to earlier detection and treatment for others. 

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"Listen to your body and rest if you feel pain or discomfort while playing."

 

Why?.

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It's essential for all musicians to pay attention to the signs and signals their body sends them, especially pain or discomfort while playing, for several reasons:

 

• Prevention of Further Damage: Continuous practice or performance despite pain can lead to further harm, worsening the condition. Over time, this could potentially result in irreversible damage:

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• Avoidance of Reinforcement of Dystonic Movements: By continuously practicing while in discomfort or pain, musicians may inadvertently reinforce the dystonic movements, making their brains more accustomed to these incorrect movement patterns. This could intensify the severity of the dystonia and make it harder to correct or manage later.

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• Reducing Physical Stress: Rest gives the body time to heal and recover. Overworking can exacerbate symptoms and lead to other physical issues, like fatigue and reduced immunity, which can slow the body's overall recovery and affect a musician's performance.

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• Mental Health Considerations: Sustained pain and discomfort can lead to stress, anxiety, depression, or burnout. Taking time to rest and heal is crucial for maintaining not only physical health but mental and emotional health as well.

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• Long-Term Playing Capability: Consistently resting when needed can help musicians manage symptoms of dystonia effectively, preventing a premature end to their playing careers. 

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