Focal Hand Dystonia: A Complex Problem With A Simple Solution?

Of all the dystonias I come across in my coaching work, focal hand dystonia is the most common. This type of Musician’s Focal Dystonia occurs most often in guitarists, drummers, string players, and pianists, although several woodwind and brass players I have met have also been affected.

Focal hand dystonia is indeed a complex problem, and can even affect other professions (where it is commonly referred to as writer’s cramp) but is there a simple solution?

focal hand dystonia

Analysis in practise

As musicians, we are so used to identifying a problem, analysing it in fine detail, and trying to work through it to achieve improvement. For example, if we’re having difficulty learning a new scale pattern, we might slow down part of the scale passage, practise certain notes out of context, try different rhythms, and so on. We look at the problem from all sorts of angles, apply hard work, and somehow (hopefully) get better.

With guitarists, pianists, and drummers, the hands are an easily visible part of the playing system. (In wind and brass players, the playing system is not only external, but primarily internal in terms of breathing, air pressure, tonguing etc). Because the hands are so easily visible, conscious attention is often focused on this area of the body. So when a hand or finger starts experiencing tension or dystonic symptoms, we actually look at this part of the body, and tend to apply the same principle: work harder.  However, working harder, or fighting through it, only aids in increasing focal hand dystonia symptoms.

Tension, hard work, distress, and dystonic symptoms

As mentioned above, with focal hand dystonia, ‘working harder’, only makes the problem worse. Focussing on the issue – a cramping finger or hand – becomes a self-fulfilling prophecy, and increases not only physical tension, but emotional distress.

When we start to feel frustrated or worried, we do what we’ve always done: apply even more hard work and effort to the problem, and the dystonic movement in the hand simply gets worse, until we decide to give up because it’s a ‘bad day’.

Focal hand dystonia and focus

Are you aware of all of the muscles that are engaged in say plucking a guitar string, striking a drum, or pressing a piano key? Of course not. The movement is far too complex to be consciously aware of everything our hands, fingers, arms, shoulders and torso are doing. So by working hard to try to fight through finger or hand tension, we are focussing on one small area of the body, and missing the bigger picture.

But surely if there is a problem with the hand or fingers, we should focus on this area of the body and try to fix it?

The short answer to this question is: No.

If you’ve been playing the guitar, drums, or any instrument for several years, it is safe to assume that you already know how to play. The problem is that you have learned to get in your own way by introducing physical or mechanical inefficiencies, felt trepedation or resistance to playing perhaps over a long period of time (eg. fear or anxiety), and sent conflicting signals to your body because of this. If you’re experiencing focal hand dystonia, you have, in effect, learned how to do so.

What can we do about solving the problem?

Dystonia and the tension key

Firstly, you must trust in the practise and experience you’ve accrued over many years. You know how to play your instrument. You then need to look at your body use.

Is your body being used as efficiently as possible when sitting and standing? How do you know you’re being efficient? (This is where it can be interesting and beneficial to have an outside observer.) How is your breathing? Do you stop breathing when playing?

A locking down in your breathing system will increase overall tension in your body, and increase focal hand dystonia symptoms. Yes, breathing affects your hands and fingers too!

Please see this free webinar for more information on breathing and Musician’s Focal Dystonia.

If you’ve seen the webinar in the link above, you will start to understand the area of the body that acts like a tension key. To release the tension key, bring down the overall tension level in the body, and thereby reduce focal hand and finger dystonia symptoms, we must:

  • Be sure that the body is set up mechanically for efficiency
  • Learn how to send clean and efficient movement signals to the body
  • Re-associate what playing the instrument means to you on an emotional level

This is where individual coaching can speed up the recovery process. In coaching, I help you become aware of your body use, and show you ways to reduce overall tension and muscular work in your playing system. I show you how to send clean and efficient signals to your hands and fingers. And finally, I help you to start having fun with your instrument again – an all-important factor.

Focal Hand Dystonia: A Complex Problem With A Simple Solution? Conclusion

Focal hand and finger dystonia are complex issues. We can try to understand all of the neurological and physical processes invovled in the problem, but I believe this is not particularly helpful for performing musicians. There are so many complex neurological and physiological aspects involved in playing a musical instrument that we cannot hope to be able to consciously focus on all of these at once.

Rather, what we can do is focus on allowing the whole body to move freely (not just the ‘problem area’) – removing the handbrake as it were – and trusting in the practise and experience that we have already gained over many years of playing.

If we can learn to do this, whilst gaining efficiency in the three points listed above, focal hand dystonia, and in fact all types of Musician’s Focal Dystonia, can be overcome.

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