True or false: Contradictory advice in focal dystonia retraining

I recently ran across an interesting comment in an online Musician’s Focal Dystonia support group. The entry quotes seemingly contradictory pieces of advice from coaches and sufferers on how to retrain from MFD. As I read through the advice, I realized that I used much of this advice in my coaching sessions, despite them appearing contradictory. In the following paragraphs I offer an explanation on how these pieces of advice can be true, and how can one use them successfully in a retraining process.

You should never play with a dystonic feeling ever again.
You should just let the spasms happen and try not to control them.

I absolutely agree with the first quote – this is of course the ideal. But even if you’re extremely careful, negative feelings can be present and spasms can happen. This is because you practised certain mental and physical habits incorrectly for too long. These habits lead to symptoms, and as the saying goes, “old habits die hard”.

So my advice is this: Try to play very simple things while keeping your mind calm, and your body relaxed. Try to observe and let go of these bad habits, and play without the dystonic feeling. But if spasms occur, don’t freak out, and don’t try to stop them from happening, as this will only increase tension. Just relax your body and keep a cool head.

You need to go below the threshold and play slowly.

This is also true and important. The core of MFD is fear – fear of being judged, of not playing perfectly, fear of failure. The level of fear varies depending on how hard the task is. If your gut tells you that something is hard to play (whether it is actually difficult or not), you will be more likely to experience symptoms. Therefore, playing slowly and avoiding technical challenges is the best way to approach recovery. If you’re convinced that the task is ridiculously easy, your body has less of a reason to react with the MFD symptoms, and relaxes more easily. But be careful: your gut feeling of the hard and easy levels might change from day to day, depending on your mood, sleep, etc. Don’t push yourself to do the same things every day. Less is sometimes more.

Never practise more than 3 x 10 minutes a day
Play many repetitions as long as there are no spasms

Again, there’s seems to be conflict between these quotes. To understand why both of them can be true at the same time, we have to think about the underlying idea: you must be focused while practising. Giving yourself a limit on your practice time is probably a good idea, since we often have a tendency to keep trying and forcing a movement, making ourselves upset and depressed in the process.

If you limit yout practise time, you’re going to use that time more efficiently. If you do have a bad day, stopping early can prevent you from creating further emotional pain (which is obviously not helping) and from reinforcing bad movements and habits, both emotional and physical.

On the other hand, the whole idea of the retraining is repeating the symptom-free movement in order to strengthen the right neuro-associations. So do try to keep practise sessions short. But don’t be afraid to play a little longer than originally intended IF you experience a nice relaxed feeling while playing.

Don’t be afraid and try to enjoy and focus on sending out correct intentions.
Distract yourself by reading or doing maths etc. etc. and just let the fingers do what they want.

Your focus is crucial while retraining from MFD. Some coaches say to focus on the movements, some say to distract yourself. Which one is true? All I can say is that it depends.

If you want to hold an object in your hand, there’s an optimal amount of power you need to use in order to hold it efficiently. If you work too little, you drop the object. Too much and you’re overworking your muscles, which leads to pain and loss of control.

The same applies to focus: too much of it can increase psychological pressure, especially if you know what ‘should’ be happening but don’t experience it. In this case you need to distract yourself a bit, and allow the system to work on its own without you disturbing it.

On the other hand, if you’re not giving the right intentions to your body to start with, and you’re running on ‘autopilot’, the body will be more likely to repeat the dystonic movement, because that’s what it has repeated before. Sadly it’s not going to correct itself on its own.

How to decide which type of focus you need? By thinking about how your concentration works and by observing which approach creates better results for you.

The retraining process is like putting together a big jigsaw puzzle without the picture. Some pieces seem to belong to an entirely different puzzle, but they’re all going to be useful at the end.

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