What happens in a retraining session?

In the past couple of months, I’ve been lucky enough to have personal conversations with practitioners who frequently work with musicians with MFD. For my research, I interviewed 14 medical professionals, coaches, and physiotherapists, and all of these conversations (and the following chats as well) have been super informative and interesting. I decided to share my take on the current situation. Obviously, I cannot mention names or any data without violating my ethical code, but I’ll try to give a useful summary for those who underwent different retraining therapies and found it contradictory and confusing, but also for those who are considering retraining for the first time.

Before I start to write about the retraining strategies themselves, I’d like to make one important point. There are many debates on whether to accept neurological treatment (Botulinum toxin injections or oral medication) or to find a coach who can help with the retraining. I recently found out that in certain countries, this is not a black and white choice. Some neurologist will send you to highly trained musicians who either have personal experience with MFD or are educated in some form of body-oriented technique. Botox or oral medication is available to support your retraining, but not as a first choice, and not as a solution. I’m not aware of how the system works in all countries, but it seems that retraining strategies are more and more supported by medical professionals as well, opposing the medical, symptomatic treatment.

So what are these behavioural therapies? What are the methods they are using? As I was talking to MFD coaches, I could sort their ideas in two main categories – although some strategies are the mixture of these groups.

The first type of exercises/methods rely on the fact that the original movement pattern is still existing in the brain, and with different strategies, they try to get the system to ‘reset’ that as a default. Strategies might include distraction in different forms, or try to ignore the symptoms, even pretend that everything is fine, and keep playing without caring about the outcome. Many of us had the experience of things suddenly go well, and having decreased symptoms for a short time period (this is also described in sports dystonia literature, especially with Lost Movement Syndrome, the dystonia of athletes). Based on this, many strategies try to create an emotional-cognitive state in which the body starts to ‘remember’, and ‘switch back’ to the dystonia-free functioning. This emotional-cognitive state is described in different ways, but some key ideas include ‘let go’, ‘allow the movement’, ‘don’t force anything’, and ‘observe’. Also, to help the process, the musicians are often instructed to place their focus anywhere but the affected body part. This can be the sound they are creating, their posture or breathing, or simply and an external focus-point. This process is sometimes helped with external tools, like the TV on etc.

The second type of approach is aiming to re-create the missing or dystonic movement in order to gain control over it. This type of therapy often starts away from the instrument, focusing on the right posture and breathing. Exercises based on anatomical knowledge are often included, aiming to strengthen or activate under-activated muscle groups. The approach requires intensive internal focus and meticulously practised movements. It builds up the ability bit by bit – the process is sequential to make sure that the musician is comfortable with each step. This approach also helps to rebuild a sense of control, and with that a sense of self-esteem. The emotional and cognitive state also seems to be important in this approach as well, especially since this is a slow process. The musician is encouraged to create an open, patient, relaxed mindset by different means – some suggest or use body-oriented techniques (Alexander Technique, Feldenkrais, Dispokinesis, yoga, Tai Chi) which can have an equally beneficial effect on both body and mind.

The main difference between the approaches is that the first one tries to re-activate the old pattern and a second one is building a new one. (This doesn’t mean that you have to re-learn the instrument from scratch since not all aspects of your playing are affected. Usually, it’s a handful of patterns which need to be taken care of.)

They can be combined in different ways (and most strategies use elements of both), meaning that the learning of the new movement is encouraged, but at the same time, the system is nudged to remember the old pattern as well.

I believe that there is no ‘right’ way to treat MFD. Choosing the right treatment or combination of treatments for oneself can be highly dependent on not only the nature of the symptom but also on personality traits, emotional state, cognitive functions, personal history, the job and personal situation and so much more.

I myself am a great believer of the second approach, for many different reasons. During my own retraining, I wanted to feel that I can control certain things – even though they were super simple – because I wanted to feel safe. I wanted a progress which I could trust, even if it was extremely slow. Since I couldn’t play at all because of the severity of my embouchure dystonia, I wasn’t forced to work during the process, and being a freelancer also saved me from worrying about losing my job, because it was already lost from the moment of the onset. I was in a situation where I could spend the time I needed on the matter. I understand that every life situation and dystonia is different, so the right solution might be different for everyone. Therefore, I cannot say that my method is the one and only solution, but it worked amazingly well for me and for many many of my clients. One thing that I’m sure of: there is no ‘quick fix’ for MFD, and slow progress is always more reliable.

I hope this article was helpful for those who are looking for a solution and cleared up what happens in most of the retraining therapies. I can’t speak for all of course, but these are the underlying ideas I’ve seen so far. If you have questions, want to talk about your specific case of MFD or want to book a session with me, don’t hesitate to get in touch: musicians.dystonia@gmail.com