Focal Dystonia and Retraining the Hand

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
guit-box
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Focal Dystonia and Retraining the Hand

Post by guit-box » Mon Apr 17, 2017 6:21 pm

I've talked with professionals in the field of focal dystonia, and my understanding is there is no cure for dystonia in the medical definition sense of the word. In other words, you can't take a pill or do some kind of therapy that will in the short term fix the problem. The only way they say you have a chance of "recovering" is to basically re-learn how to play the guitar, utilizing the neuroplasticity of the brain to create new pathways for new finger movements. Everything short of that I have seen (botox, swinging the whole arm, etc.), is just a work-around and doesn't solve the problem. If this is the case, and I believe it is true, then you'd better make 100% sure you're spending time practicing correctly and not just reinforcing bad habits, especially if those bad habits could have been the trigger for your dystonia in the first place.

That said, I wouldn't claim to have discovered anything that is the answer for everyone with focal hand dystonia, that would be unscientific and arrogant. There's already a lot of that going around and you can find many snake oil salesman online willing to prey on your false hopes and take your money. I can say, however, that I've discovered many interesting things about the current classical guitar right hand pedagogy that appear to simply be false, and that *may have* contributed to damaging my hand. I believe these realizations have assisted me in getting back to playing at an intermediate level where before I could not play the simplest child song melodies. I'm even playing some advanced pieces again, but I'm intentionally not pushing it and I continue to work every day on music and exercises that are within my current skill level and I don't push the tempos. Every day I'm getting better, where before practicing didn't result in improvement at all.

If you have not seen this thread about Right Hand Technique & Concert Guitarist Slow Motion Videos, I highly recommend it for the content. While it's not exclusively about focal dystonia, in my opinion technique and retraining are inseparable topics. Like many of the forum topics, this one is often contentious, but it's well worth reading the whole thread for content and definitely watching the videos to come to your own conclusions. If you can't read the whole thing, check out the last 25 pages or so.

viewtopic.php?f=6&t=80875&start=915

p.s. I probably won't comment much here, so meet me over there for that discussion. Please share this with any musician with hand dystonia or technique problems who might benefit.
An eyewitness will often only see what he already believes to be true.

Luis_Br
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Re: Focal Dystonia and Retraining the Hand

Post by Luis_Br » Tue Apr 18, 2017 9:37 pm

I know a great guitarist here who recovered from FD and he helped several players with FD to get back to playing. As I've talked to him a couple times, mostly of what he does is finding another way to play, as you've said, with another brain path. When you listen to his recent recordings, they are great, but you watch him live, he uses some weird fingerings in some passages. But I am not sure it is the way you play in terms of right movement from outside. He was a great player before having FD. Some players which seem playing with good technique had FD, while others not as good didn't have it. Maybe it is a technical issue, but it is not an easy conclusion. I don't think it is a faulty movement of the finger alone, but lack of muscle dissociation control, which compromises adjacent fingers and apparently unrelated muscles.
Here an old recording from him, before FD:
https://www.youtube.com/watch?v=GcNgxlA7zPY
Unfortunately I don't know any video before FD to compare.
Here a recent concert video, after FD:
https://www.youtube.com/watch?v=Y-SrxmxX88k
His FD was in LH. What he does, as I've noticed, is mainly changing the way he press, using more KJ or not, finger with different curvature, pressing a bit from the side etc. Check carefully his LH fingers 3 and 4 in the recent concert videos.

Simon Dinnigan seems to play in "the hook way", and tip joint gives a bit, but hand overall seems a bit tense, pinky out. I haven't analysed his videos in detail to check if they agree with your analysis. Maybe you should do it. You find a few at youtube, as far as I know all of them before he got FD:
https://www.youtube.com/watch?v=8z2ptiznGMY
I've heard his FD was in RH, but I am not sure, maybe someone who knows him better could confirm that.
On the other way, I know some guitarists with a bit tense pinky, but play pretty well and haven't developed FD.

guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Tue Apr 18, 2017 11:32 pm

I've talked with PhD researchers in the field of focal dystonia and even they admit they don't know what causes it, so it wouldn't make sense for any of us to claim we know what causes it. If you find anyone who is confident or boastful they know what causes it and they claim they can help cure you, I'd suggest being very cautious because my experience is there are many charlatans out there who are ready to take advantage of your desperation and empty your pocket books in the process. I would never make any claim that I could cure someone. For myself, and several others on and off the forum, my observations about flaws in some of the English language guitar pedagogy has helped players with their techniques and some with their dystonia. I don't think that focal dystonia is a technical issue, but I think years of obsessive practice using the wrong model for techniques could be the trigger. So, no, not the cause, but possibly the trigger.

The first player you posted looks good to me, I see no technical issues. If he has focal dystonia it's not apparent to me. A lot of players like the second guy let their pinkies stick out, I have that same problem and am working to get a-c to follow each other. He may be getting the job done, but it's not how I want to play and it doesn't feel good to have that finger sticking out. I see some distal joint flexibility in his m finger, but can't tell in the others. Perhaps more relaxed distal joints in all his fingers and then focusing less on MCP flexion and more on PIP flexion would help him. I've just recently discovered for myself that it's the PIP flexion that collapses the DIP joint and not the MCP. I believe that observation alone is key to a more relaxed hand if you were taught to focus the main thrust coming from the MCP flexion. -- like Pumping Nylon and others describe.
An eyewitness will often only see what he already believes to be true.

Luis_Br
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Re: Focal Dystonia and Retraining the Hand

Post by Luis_Br » Wed Apr 19, 2017 12:36 pm

I don't know if it is wrong technique, but all I know who got the problem started after some obsessive practice. Luiz, the first one of the videos I posted, said it began after obsessive practice of Villa-Lobos Etude 10, when he was trying to control the dynamics of the LH slurs (he got FD on LH fingers 3-4). You can see his 4 finger sometimes has weird excessive curling and he adapts his playing and LH positioning to that. He claims no cure, he sais there is no cure, just helps other players live with the problem. Even him, he sais being able to live from guitar with this problem is a constant fight and he knows several pieces he will never be able to play fluently again.

I have another friend who developed it too, and both him and Luiz studied a lot the matter. One went to Spain to the famous research center and other famous research places. It is interesting it seems this is also some instrument specific. Some instruments have very few or no known cases of FD.

Luiz has been studying FD for 16 years and developed a series of exercises (with and without the guitar) he thinks that help, by his own experience and research helping others. He helped at least 17 players to be play back again (not necessarily to a extreme virtuoso level, but enough to keep living from CG). According to him, the only thing that is sure, which is the diagnosis of the disease, is that brain areas which control each finger start to overlap each other, so when you try to move one finger it interferes with another one. So he worked in exercises to develop total finger independence, and he sais, from his practical experience, they are the core to help surpassing the problem. But there is no right recipe, since the problem changes during the work, so the strategies also have to constantly adapt to it. I've learnt some of his exercises in a masterclass he gave, he uses with all his students because they help developing better finger independence which is good for overall technique, and I think they are really good for that.

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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Wed Apr 19, 2017 1:55 pm

Yes, that all seems consistent with what I've been told by dystonia researchers. For instance, the brain gets re-mapped and where there was once a discrete location for the index finger and middle finger, as an example, that area now becomes a smear that responds to both fingers. So, you no longer have separate control of the fingers. They did an fMRI on me and concluded that my brain images showed this to be true and concluded I had focal dystonia.

I've known a couple people who got it in the 3rd and 4th fingers of the left hand. It does seem that a common denominator is large amounts of practice time focused on small details. Focal dystonia in musicians doesn't occur in hobby musicians, so it would make sense to hypothesize that something about the long hours of focused practice could be the trigger. I recently heard someone describe the advice of doing slurs with the focus being on pushing the finger through the fingerboard. I had never in my life heard anyone describe it that way, but he insisted that it was commonly taught pedagogy. It sounds like horrible advice to me and would cause a person to use too much MCP flexion. I think of a hammer on as a momentum from the MCP and perhaps some PIP extension. I think of a pull-off as a simultaneous PIP flexion and MCP extension. Perhaps guitarists with FD in the left hand similarly to myself with the right hand, spent too much time over emphasizing the MCP flexion as the correct model for slurs when they should have been thinking more about the opposite, MCP extension.
An eyewitness will often only see what he already believes to be true.

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Re: Focal Dystonia and Retraining the Hand

Post by guitarrista » Wed Apr 19, 2017 5:58 pm

Luis_Br wrote:I don't know if it is wrong technique, but all I know who got the problem started after some obsessive practice.
Yes, there is evidence from scientific studies about psychological factors, for example Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors:
dyst.JPG
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guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Thu Apr 20, 2017 5:01 pm

It's clear to me there's so much that's unknown about this terrible condition, and researchers are learning more all the time. I also think there are musicians who are having some success dealing with it and getting back to playing. Perhaps there are many ways to the later. If you're reading this for the first time and haven't already seen the other thread: Right Hand Technique & Concert Guitarist Slow Motion Videos, please check it out. Many of the observations and practice techniques have helped me progress farther in the last 3 years than I had in the previous 20. Read at least the last 30 pages to get a feel for the concepts and various opinions.

Go to:
viewtopic.php?f=6&t=80875&p=1194361#p1194361
An eyewitness will often only see what he already believes to be true.

uptempo
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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Thu Apr 27, 2017 1:09 pm

guitarrista wrote:
Luis_Br wrote:I don't know if it is wrong technique, but all I know who got the problem started after some obsessive practice.
Yes, there is evidence from scientific studies about psychological factors, for example Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors:

dyst.JPG
Well as a sufferer of quite significant mental health issues I can say with some confidence that dystonia will have a psychological component. Over the last 6 years I have worked with numerous therapists to consultant level and they assure me that with the brain anything is possible. You only have to look at those poor souls who endure 'conversion disorder' to realise how the brain can interact with the body. I have a friend with conversion disorder and he made himself blind (although he wasn't) and he had incredibly serious neurological symptoms all generated by the brain.

In my own case anxiety seriously affects my hands and at times my fingers feel strange. One consultant I saw for nerve studies was undertaking a PhD on dystonia and his early theory was pointing towards a psychological aspect.

The brain is just so powerful.
"Never believe what an artist says, only what they do" - Walter Sickert

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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Thu Apr 27, 2017 1:12 pm

By the way. David Leisner cured himself - or am I wrong? I believe he is releasing a book soon on the subject.
"Never believe what an artist says, only what they do" - Walter Sickert

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Re: Focal Dystonia and Retraining the Hand

Post by Blondie » Thu Apr 27, 2017 2:35 pm

uptempo wrote:By the way. David Leisner cured himself - or am I wrong? I believe he is releasing a book soon on the subject.
You can read all about his approach and watch his video here, this stuff is decades old now:
http://davidleisner.com/articles/

I corresponded with him years ago, and nearly fell off my chair when he said what he was charging for lessons. It's great that he found a way back to playing at this level, but I have to say I have talked with many guitarists over the years with FD and have yet to hear of anyone who recovered thanks to his approach. The idea of playing guitar - fine motor control - tremolo, arpeggio etc, using the the large muscle groups that move your arm up and down is a little absurd, *but* I can see its value as a gentle start to moving the strings if your FD is so bad that are unable to do any kind of normal plucking without spasms. I can also see how it is helpful to focus your attention somewhere other than the problem area (thinking of one's whole arm etc).

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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Thu Apr 27, 2017 5:27 pm

Blondie wrote:
uptempo wrote:By the way. David Leisner cured himself - or am I wrong? I believe he is releasing a book soon on the subject.
You can read all about his approach and watch his video here, this stuff is decades old now:
http://davidleisner.com/articles/

I corresponded with him years ago, and nearly fell off my chair when he said what he was charging for lessons. It's great that he found a way back to playing at this level, but I have to say I have talked with many guitarists over the years with FD and have yet to hear of anyone who recovered thanks to his approach. The idea of playing guitar - fine motor control - tremolo, arpeggio etc, using the the large muscle groups that move your arm up and down is a little absurd, *but* I can see its value as a gentle start to moving the strings if your FD is so bad that are unable to do any kind of normal plucking without spasms. I can also see how it is helpful to focus your attention somewhere other than the problem area (thinking of one's whole arm etc).
Yes, that's my experience exactly, except that I got suckered into taking lessons. In addition to the plane ticket and stay over in NYC, he insisted that I take at least 3 lessons over several days, and was charging twice what anyone else was at the time. I can imagine it's a lot more expensive now. Trust me, it's snake oil, there's no one playing again by swinging the arm from the elbow and thinking about an area in your armpit. It was totally just a bogus scam to make money off poor desperate musicians who will do anything to play again. I tried what he taught me (which could have been taught in a 30 second video and posted online) for 3 months until I finally came to my senses and realized that no one can play the guitar this way. You can't play even the most simple beginner level classical guitar music by swinging the arm from the elbow. What you really need to do is 1. figure out exactly what the correct movement for the fingers is and 2. spend many hours carefully and slowly practicing that movement. Make sure you evaluate what you're doing now, since you likely have engrained bad habits. The whole purpose of my thread: Right Hand Technique & Concert Guitarist Slow Motion Videos is to figure out step 1. Of course you can read that thread and maybe it won't help either, but it helped me and others have told me it's helped them. Reading and studying videos is completely free, I've never tried to promote myself or sell lessons claiming I could cure anyone like Leisner is doing. It's shameful, if Leisner's method worked we'd see players on youtube showing how he helped them play again, there's none of that. The only way I know of that works involves learning to playing the guitar a second time, so ultimately if you can regain your abilities it will likely be up to how much time you put in making new pathways to the brain doing careful and correct movements. (my educated opinion)
An eyewitness will often only see what he already believes to be true.

uptempo
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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Fri Apr 28, 2017 12:49 pm

That's interesting regarding Leisner. Clearly, your experience with him was not a good one. That said, if it is true that he cured himself I wonder how he achieved that other than by how he claims. Personally, visualization, is of interest to me and correct me if I am wrong but the Alexander Technique essentiall uses a form of visualisation. Still, I thoroughly accept that FD is a very complex issue.

I don't have FD but I do have hands that are affected by anxiety so I have developed a keen interest in the power of the brain to cause problems. In another thread I describe a recent diagnosis of somataform disorder. My psychological distress manifests itself in physical pain - often in bizzare places. Numerous consultants have explained this to me but it's hard to accept. In the Classical Guitar magazine site there is a pro player who had anxiety in his hands.

How does FD affect you psychologically? Is there any element of say anxiety, or depression that may become a barrier to recovery or is this not an issue? I only ask because for years I have denied how much mental health affects the body and it's only now that I realise it.
"Never believe what an artist says, only what they do" - Walter Sickert

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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Fri Apr 28, 2017 1:04 pm

guitarrista wrote:
Luis_Br wrote:I don't know if it is wrong technique, but all I know who got the problem started after some obsessive practice.
Yes, there is evidence from scientific studies about psychological factors, for example Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors:

dyst.JPG
There seems to be a paradox in this or is it irony because It suggests that those who develop FD are perfectionists, and yet it appears that in order to recover you have to be even more perfectionists. Guit-box's incredibly detailed thread on right hand technique does tend to suggest a person who is perfectionist but it clearly works for him to be that way.
"Never believe what an artist says, only what they do" - Walter Sickert

guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Fri Apr 28, 2017 11:09 pm

uptempo wrote:
guitarrista wrote:
Luis_Br wrote:I don't know if it is wrong technique, but all I know who got the problem started after some obsessive practice.
Yes, there is evidence from scientific studies about psychological factors, for example Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors:

dyst.JPG
There seems to be a paradox in this or is it irony because It suggests that those who develop FD are perfectionists, and yet it appears that in order to recover you have to be even more perfectionists. Guit-box's incredibly detailed thread on right hand technique does tend to suggest a person who is perfectionist but it clearly works for him to be that way.
I wouldn't call myself a perfectionist. I have an engineering background, so I have some experience with statistics and proofs, and that may appear like perfectionism to some. It's really more of a process to prove a hypothesis by gathering large amounts of data and coming to conclusions about commonalities and variabilities. I can accept far less than perfection in most every area of my life. There's often a less than spirit of collaboration on these public forums, for instance, but I just accept it for what it is since I cannot change it. :-)

Whether you have dystonia or anxiety, the question is do you still want to try to play the guitar because you enjoy it? Can you accept that you may fail? All you can do about the anxiety is work with your doctors and try to find solutions or treatments. You can also try to find solutions for yourself. That's how I look at it for me. I'm too old now to be a concert guitarist or win the GFA or become a music professor, but I don't care about those things anymore, I just want to be able to play for my own enjoyment. I've already made it from not being able to play Twinkle Twinkle to playing intermediate level classical guitar repertoire. It's not always consistent, but I'm working on it and it gets better everyday. I'm not really the person to give advice, but if I had any anxiety about the guitar it was the desire to achieve a level of concert classical guitarist. I think it has helped some to have much lower expectations. -- it's just guitar playing after all, it's supposed to be fun.
An eyewitness will often only see what he already believes to be true.

guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Fri Apr 28, 2017 11:15 pm

uptempo wrote:
guitarrista wrote:
Luis_Br wrote:I don't know if it is wrong technique, but all I know who got the problem started after some obsessive practice.
Yes, there is evidence from scientific studies about psychological factors, for example Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors:

dyst.JPG
There seems to be a paradox in this or is it irony because It suggests that those who develop FD are perfectionists, and yet it appears that in order to recover you have to be even more perfectionists. Guit-box's incredibly detailed thread on right hand technique does tend to suggest a person who is perfectionist but it clearly works for him to be that way.
To be a devil's advocate, I'd also say that doctors don't know everything. I've heard that doctors just hate it when people who have things like chronic pain come to see them because they want to help them but often can't. So I think you end up with labels like Fibromyalgia or Focal Dystonia for things they don't fully understand. It may give the person an initial feeling of, great, at least now I can tell people I really do have something wrong with me. But then you end up walking through life as a person with a condition when it's really just a label for something that doctors don't fully understand. I'm not sure if that helps or hurts. Of course this is just my opinion and I could be full of it.
An eyewitness will often only see what he already believes to be true.

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