Focal Dystonia and Retraining the Hand

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
uptempo
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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Sat Apr 29, 2017 7:58 pm

Correct Guit-box. I am one of those who has medically explained symptoms despite countless tests up to brain scan.

My view, after much research and discussing these issues with consultants' is that medically unexplained symptoms most certainly are psychological in nature. I mentioned in another thread about 'conversion disorder' and I know a person who has it and recovered. I have somataform disorder, a label, yes, but it's real pain I feel brought on by anxiety.

When my anxiety was at its highest: panic attacks, I had symptoms of stroke and more so it always makes me wonder if people underestimate what stress and anxiety cause symptom wise.

FD is probably totally different but perhaps when recovery is not forthcoming anxiety or stress makes recovery that much harder.
"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 » Sun Apr 30, 2017 3:09 am

uptempo wrote:Correct Guit-box. I am one of those who has medically explained symptoms despite countless tests up to brain scan.

My view, after much research and discussing these issues with consultants' is that medically unexplained symptoms most certainly are psychological in nature. I mentioned in another thread about 'conversion disorder' and I know a person who has it and recovered. I have somataform disorder, a label, yes, but it's real pain I feel brought on by anxiety.

When my anxiety was at its highest: panic attacks, I had symptoms of stroke and more so it always makes me wonder if people underestimate what stress and anxiety cause symptom wise.

FD is probably totally different but perhaps when recovery is not forthcoming anxiety or stress makes recovery that much harder.
What are the physical symptoms on the guitar? Plucking or fretting hand? Were you ever taught to focus on playing with the main thrust coming from the large knuckle joint?
An eyewitness will often only see what he already believes to be true.

Dofpic
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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Sun Apr 30, 2017 4:09 am

As someone who has worked with Leisner I agree that it is mostly snake oil and he has made it a way to make money versus actually help people. I have also been to Spain and Switzerland for treatment but I gave up as it did not work. The Spain program I have to say started to work for me but after 4 months I was having decent success but went off the rails of my own doing as I violated what they told me not to do.
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guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Sun Apr 30, 2017 1:24 pm

Dofpic wrote:As someone who has worked with Leisner I agree that it is mostly snake oil and he has made it a way to make money versus actually help people. I have also been to Spain and Switzerland for treatment but I gave up as it did not work. The Spain program I have to say started to work for me but after 4 months I was having decent success but went off the rails of my own doing as I violated what they told me not to do.
So that begs the questions: What exactly were they teaching you in Spain and what exactly did you do that was "off the rails"? Then the most important questions is: How much money did they take you for?
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 » Sun Apr 30, 2017 4:55 pm

guit-box wrote:
uptempo wrote:Correct Guit-box. I am one of those who has medically explained symptoms despite countless tests up to brain scan.

My view, after much research and discussing these issues with consultants' is that medically unexplained symptoms most certainly are psychological in nature. I mentioned in another thread about 'conversion disorder' and I know a person who has it and recovered. I have somataform disorder, a label, yes, but it's real pain I feel brought on by anxiety.

When my anxiety was at its highest: panic attacks, I had symptoms of stroke and more so it always makes me wonder if people underestimate what stress and anxiety cause symptom wise.

FD is probably totally different but perhaps when recovery is not forthcoming anxiety or stress makes recovery that much harder.
What are the physical symptoms on the guitar? Plucking or fretting hand? Were you ever taught to focus on playing with the main thrust coming from the large knuckle joint?
Middle finger felt numb at the tip but before long both my hands felt tingly, hot, and stiff. I know that there has been some ulnar nerve issue but numerous nerve conduction studies, plus MRI scans on head and neck revealed absolutely nothing. Physio revealed nothing and nor did chiropractic.

What I did know was that anxiety mimics nerve symptoms and as I read and researched more it became obvious what was going on. My hands are much better but not right.

Yes, I was taught to play with the large Knuckle. I might add that Jack Sanders has been a massive help to me. Via Skype he really did show me a lot about how relaxed one should be whilst playing. I'm slowly working my way back, but anxiety has played havoc with my body.
"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 » Sun Apr 30, 2017 5:14 pm

uptempo wrote:
guit-box wrote:
uptempo wrote:Correct Guit-box. I am one of those who has medically explained symptoms despite countless tests up to brain scan.

My view, after much research and discussing these issues with consultants' is that medically unexplained symptoms most certainly are psychological in nature. I mentioned in another thread about 'conversion disorder' and I know a person who has it and recovered. I have somataform disorder, a label, yes, but it's real pain I feel brought on by anxiety.

When my anxiety was at its highest: panic attacks, I had symptoms of stroke and more so it always makes me wonder if people underestimate what stress and anxiety cause symptom wise.

FD is probably totally different but perhaps when recovery is not forthcoming anxiety or stress makes recovery that much harder.
What are the physical symptoms on the guitar? Plucking or fretting hand? Were you ever taught to focus on playing with the main thrust coming from the large knuckle joint?
Middle finger felt numb at the tip but before long both my hands felt tingly, hot, and stiff. I know that there has been some ulnar nerve issue but numerous nerve conduction studies, plus MRI scans on head and neck revealed absolutely nothing. Physio revealed nothing and nor did chiropractic.

What I did know was that anxiety mimics nerve symptoms and as I read and researched more it became obvious what was going on. My hands are much better but not right.

Yes, I was taught to play with the large Knuckle. I might add that Jack Sanders has been a massive help to me. Via Skype he really did show me a lot about how relaxed one should be whilst playing. I'm slowly working my way back, but anxiety has played havoc with my body.
Maybe a different sitting position or standing. I put a strap on my guitar and sometimes stand for low back pain reasons. I want to get one of the Luva arm sleeves with the rigid insert but they are hard to find.

I'm investigating the tip joints more than ever and I believe they are the key to relaxation and good tone. I had originally only thought about collapsing them or letting them slightly extend. Now I'm starting to think they also have the power to pluck (flexion) or release the string. So they are not just a shock absorber, but more of a strut system that has both shock absorbing but also spring loading to send forces in both directions.
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 » Sun Apr 30, 2017 6:48 pm

I got my Luva pad direct from Luva. Came to Uk quickly.

I like it because it takes the stress of the tendons and possibly the ulnar nerve.

My work at the moment is concerned with total tension free playing using the minimum force in order to get a decent sound. This is very much working. I must admit I have never analyzed which joints do what. When I play now my hand just feels like a unit and the fingers are very very loose, but controlled. In fact now that I am playing like this I realise how much fighting I was doing previously.
"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 » Sun Apr 30, 2017 9:39 pm

uptempo wrote:I got my Luva pad direct from Luva. Came to Uk quickly.

I like it because it takes the stress of the tendons and possibly the ulnar nerve.

My work at the moment is concerned with total tension free playing using the minimum force in order to get a decent sound. This is very much working. I must admit I have never analyzed which joints do what. When I play now my hand just feels like a unit and the fingers are very very loose, but controlled. In fact now that I am playing like this I realise how much fighting I was doing previously.
It sounds like a good way to start and come back to. I do see some players who play with tiny movements, but mostly for things that are pianissimo . Most concert players are moving their middle joint much more than I was, and I think for someone who was taught to just play from the main knuckle joint, that's an important element, as is finer control over the tip joint tension.

Was the Luva sized as you would expect it to be?
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 » Tue May 02, 2017 2:10 pm

Yes the Luva was sized as expected. In fact contrary to what others have said I found it easy to get used too.

Regarding the hands. I'm convinced that tension is the number one killer of technique. The trouble is that it's a difficult concept to discuss because it is a felt thing. All I can say is that my right hand feels limp when I play but clearly there is muscular effort involved for position and plucking.

I concentrate on maintaining that feeling rather than which knuckle is taking the lead, but I appreciate everyone is different in their approach to solving issues - especially complex ones like FD.

I take it you have looked at the London Hand Therapy Clinic ?
"Never believe what an artist says, only what they do" - Walter Sickert

uptempo
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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Tue May 02, 2017 2:45 pm

Interestingly, today I tried to think about the role each knuckle plays and I found it impossible to isolate or promote a single knuckle joint over another. I actually found that any attempt to do so has brought immediate tension. It must be me but I am the opposite: I focus on the hand as a unit and close my eyes and feel for the relaxation and movement.

I know your ongoing lengthy thread has its supporters and detractors, but out of ignorance, is isolation to this degree the established method of treatment/retraining?

By the way, my hands started getting better when I stopped doing loads of stretches designed for guitarists. Again an orthopedic surgeon, with an interest in pianists, told me hiw easy it is to overstretch and do more harm than good.

It's an interesting issue for sure.
"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 » Tue May 02, 2017 3:10 pm

uptempo wrote:
Tue May 02, 2017 2:45 pm
Interestingly, today I tried to think about the role each knuckle plays and I found it impossible to isolate or promote a single knuckle joint over another. I actually found that any attempt to do so has brought immediate tension. It must be me but I am the opposite: I focus on the hand as a unit and close my eyes and feel for the relaxation and movement.

I know your ongoing lengthy thread has its supporters and detractors, but out of ignorance, is isolation to this degree the established method of treatment/retraining?

By the way, my hands started getting better when I stopped doing loads of stretches designed for guitarists. Again an orthopedic surgeon, with an interest in pianists, told me hiw easy it is to overstretch and do more harm than good.

It's an interesting issue for sure.
Why would you want to isolate or promote a single knuckle joint? That's a very odd, but common interpretation when talking about joints.
Last edited by guit-box on Tue May 02, 2017 3:36 pm, edited 1 time in total.
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 » Tue May 02, 2017 3:20 pm

uptempo wrote:
Tue May 02, 2017 2:10 pm
Yes the Luva was sized as expected. In fact contrary to what others have said I found it easy to get used too.

Regarding the hands. I'm convinced that tension is the number one killer of technique. The trouble is that it's a difficult concept to discuss because it is a felt thing. All I can say is that my right hand feels limp when I play but clearly there is muscular effort involved for position and plucking.

I concentrate on maintaining that feeling rather than which knuckle is taking the lead, but I appreciate everyone is different in their approach to solving issues - especially complex ones like FD.

I take it you have looked at the London Hand Therapy Clinic ?
Yes, I think we're talking about the same thing. For me, and many who I've talked with who were taught to push through the string from the large knuckle joint, we end up getting stuck and feeling tense. By letting that initial impulse from the main knuckle joint fall away as the other joints take over, there is less tension, probably because we were taught incorrectly to focus on that one joint and it has become engrained. It's a firing order that's MCP to PIP to DIP with some overlap of forces, no single joint is "isolated or promoted" as more important than any others, it's a system that works together, much like your whole arm uses all the joint to scoop ice cream or your joints in your legs all work together in a specific way to ride a bicycle or row a boat, etc. If thinking about joints like this stresses you out, then likely you need to find your own way. But, this is just based on my observations of how concert guitarist's hands work though slow motion video analysis.
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 » Tue May 02, 2017 4:38 pm

Another thing that someone with a tense hand probably shouldn't avoid is thinking about the variability of relaxation in the tip joints. I have a retired age student who complains of a tense right hand and we're working on using some shock absorbing in the tip joints. The thing with him is that it's so engrained in his technique for decades that even if he thinks he's letting the tips bend backwards some, he usually isn't. It's very difficult to change habits when they've been trained into your hand over decades. The only way this particular change will happen is with very slow practice watching the joints as you play single fingers and then moving forward from there to more complex things like simple arpeggios or alternation. Relaxing the tip joints is more complicated than just relaxation, though, it's also about whether or not the tip joint, once collapsed, can then add some flexion to release the string. I've been working with this more than ever lately and it's definitely helping to make my hand more relaxed, but maybe even more important, to gain finer control over how I pluck and the sound I get. I couldn't do it without thinking about and looking at my tip joints, maybe someone else can, but I don't know why you'd want to.
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 » Tue May 02, 2017 6:14 pm

Good reply - thanks.

This is where Leisner is perhaps pitching his remedy: that he discovered that his plucking actually came from a complex system but as I understand it he describes a situation much the same as many sports people do; they gain power and fluidity from muscles in the back. I'm certainly not defending him but it actually sounds logical.

But yes, everyone will be different in how they analyse and implement the findings of their research on technique. It's a fascinating topic and I hope that your research truly does provide benefit.
"Never believe what an artist says, only what they do" - Walter Sickert

renlute
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Re: Focal Dystonia and Retraining the Hand

Post by renlute » Sat May 20, 2017 10:11 am

While I do not purport to be an authority on focal dystonia myself, I am currently collecting and editing a series of articles by and about Patrick O'Brien, the late New York City guitar and lute teacher who cured himself of severe tendinitis in the early 1970s and spent much of his subsequent 40-year teaching career coaching guitarists and other musicians who had acquired FD, tendinitis, carpal tunnel syndrome and similar disorders. Several articles will constitute testimonies about successful FD therapies of his -- in the patients' own words. Pat believed the afflictions were usually acquired by faulty technique. He told me (in 2012) that he had observed distal flexion -- overuse of the tip joints of the right hand -- to be the cause of FD upwards of 80-90% of the time. He spoke from a perspective of observing hundreds of his student patients during four decades, and referred to the legendary pianist Glenn Gould, who inadvertently ended his career with FD by sitting lower and lower on the bench and thus engaging the DIP joints excessively. Pat's success rate was not perfect, but was apparently better than the low estimates I read about in neurological journals.
One of our testimonies is from a guitarist whose very complex case improved very substantially under Pat's guidance, but recovered still more years later with David Leisner. Leisner's therapeutic technique is remarkably distinct from Pat's, but once explained (though I admittedly understand it only vaguely), it seems to make sense. The mere fact that Leisner had become disabled but has recovered to the point that he plays as astonishingly well as he does now, indicates that he must have an understanding of the issues that has to be respected, even if it does not work for everyone. The method itself is not always the cause of failure in an individual case, whether it be O'Brien's or Leisner's, since there are other factors involved that are still being researched.
The series of articles I refer to will be published in the Journal of the Lute Society of America starting within the next couple months. The clinical studies won't be in the first memorial issue for Patrick, but in it, Pat lays out his most fundamental understanding of the anatomy of the hand and the reasons why distal flexion and a couple other fairly common technical mistakes can cause harm.
Douglas Alton Smith, Consulting Editor, JLSA

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