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 » Fri Jul 28, 2017 8:00 am

guit-box wrote:
Thu Jul 27, 2017 7:03 pm
These articles and videos would be helpful for any guitarist working on right hand technique, but I find them especially helpful for players who have dystonia and/or need to unlearn bad techniques. (such as focusing attention on plucking from the main knuckle joint)


http://philiphii.com/2011/07/walking-fingers-video/
http://philiphii.com/2010/10/walking-the-fingers/

I find your studies fascinating but occasionally I like to discuss some of your assertions. When you assert that focusing attention on plucking from the knuckle is bad I actually fundamentally disagree with you. I say this based on my own playing and the injury I sustained from playing with the tips of my fingers.

I play with what you call collapsed tips and always have done but one thing I have noticed and had pointed out to me by several teachers is that when you play predominantly from the fingers you do not seem to get the proper exchange of flexor and extensor muscles in the forearm. Instead you can develop a co contraction of both muscles and this is a recipe for muscle strains and tendon injuries. I ran this idea by my consultant and by a guy who was a consultant in nerve studies and they both agreed that this kind of co contraction is likely to cause problems.

If you roll your sleeves up and initiate the plucking motion from the maon knuckles you can clearly see the correct exchange of muscles taking place. Next, wiggle your fingers concentrating on the tips and you can see that the muscles in the arm are really not engaged in the same way.

I can only Speak from personal experience and my own anatomy but for sure after nesrly two years and thousands of pounds getting to the bottom of my injury it is clear that I have strained finger tendons and set up elbow injury through co contraction.

I am re training my hand and playing much better now I am thinking about generating the stroke from my main knuckle whilst keeping my fingere loose. I feel I am more secure in doing this as well.

I perhaps agree that what teachers say and what they do is perhaps not accurate but what no one can ever determine is how the thought process determines action. I think main knuckles and yet I am probably not exclusively using the main knuckle to pluck because that is physically impossible. But the thought generates the chain reaction which might generate the correct action.

What do you think ?
"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 » Fri Jul 28, 2017 8:07 am

Sorry for double post
"Never believe what an artist says, only what they do" - Walter Sickert

Dofpic
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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Fri Jul 28, 2017 1:45 pm

My own opinion is it is very much like walking. We do not need videos to learn how to walk. We just do it. and when we walk the main energy starts from the Hip. However we cannot walk well without the knee and ankle working together. If you see anyone with a bad hip or knee or ankle they cannot walk with ease. The same goes for playing guitar. We need to use together Main knuckle mid joint and fingertip for maximum efficiency. A lot of these videos etc are overthinking. Serap says to use the fingertips like shock absorbers in order to get beautiful tone. Roll a chord and get beautiful tone and this is what happens. You also initiate from the main knuckle and the mid joint follows as well. If one does not work together with the others then you have a problem.
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Jack Douglas
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Re: Focal Dystonia and Retraining the Hand

Post by Jack Douglas » Fri Jul 28, 2017 8:48 pm

Dofpic wrote:
Thu Jul 27, 2017 10:14 pm
First of all she does not advertise she is a FD practitioner. She told me flat out she has only one student that was totally cured and it was someone at Peabody and they caught it early. There were no promises of any kind. Being a medical doctor as well as an occupational therapist plus a masters degree in guitar from Peabody where she studied with both Julian Grey and Manuel Barrueco are credentials are impossible to find in one person. Someone else on this forum suggested her to me after hearing a lecture on avoiding injuries for musicians. So you can criticize all you want but the results I am seeing I am extremely happy about. That is all that matters. I have a masters degree in classical guitar from the early 80's. I am only posting here so that someone who has this awful affliction might find her helpful to their recovery. I certainly have. A long way to go but in 8 weeks lots of progress at a cost no more than for regular guitar lessons from an excellent teacher with masters degree credentials.

No upfront cost no promises no hype just great help.
I'm so glad Serap is helping you. I'm hoping to get up to see her in September for a left thumb evaluation. To find someone with her credentials and training is indeed rare. I was so impressed by her humility and artful playing technique.

Jack
Last edited by Jack Douglas on Sat Jul 29, 2017 8:20 pm, edited 1 time in total.
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oriventura
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Re: Focal Dystonia and Retraining the Hand

Post by oriventura » Sat Jul 29, 2017 7:23 pm

Jim I'm really happy to hear you are still fighting!!

guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Tue Aug 01, 2017 3:34 am

uptempo wrote:
Fri Jul 28, 2017 8:00 am
guit-box wrote:
Thu Jul 27, 2017 7:03 pm
These articles and videos would be helpful for any guitarist working on right hand technique, but I find them especially helpful for players who have dystonia and/or need to unlearn bad techniques. (such as focusing attention on plucking from the main knuckle joint)


http://philiphii.com/2011/07/walking-fingers-video/
http://philiphii.com/2010/10/walking-the-fingers/

I find your studies fascinating but occasionally I like to discuss some of your assertions. When you assert that focusing attention on plucking from the knuckle is bad I actually fundamentally disagree with you. I say this based on my own playing and the injury I sustained from playing with the tips of my fingers.

I play with what you call collapsed tips and always have done but one thing I have noticed and had pointed out to me by several teachers is that when you play predominantly from the fingers you do not seem to get the proper exchange of flexor and extensor muscles in the forearm. Instead you can develop a co contraction of both muscles and this is a recipe for muscle strains and tendon injuries. I ran this idea by my consultant and by a guy who was a consultant in nerve studies and they both agreed that this kind of co contraction is likely to cause problems.

If you roll your sleeves up and initiate the plucking motion from the maon knuckles you can clearly see the correct exchange of muscles taking place. Next, wiggle your fingers concentrating on the tips and you can see that the muscles in the arm are really not engaged in the same way.

I can only Speak from personal experience and my own anatomy but for sure after nesrly two years and thousands of pounds getting to the bottom of my injury it is clear that I have strained finger tendons and set up elbow injury through co contraction.

I am re training my hand and playing much better now I am thinking about generating the stroke from my main knuckle whilst keeping my fingere loose. I feel I am more secure in doing this as well.

I perhaps agree that what teachers say and what they do is perhaps not accurate but what no one can ever determine is how the thought process determines action. I think main knuckles and yet I am probably not exclusively using the main knuckle to pluck because that is physically impossible. But the thought generates the chain reaction which might generate the correct action.

What do you think ?
Part of the problem when you discuss anything by saying "move from here" or "don't move from here" is more how people interpret what you say. If you check out the videos in the slow motion thread I linked to in the first post and go watch many of those videos, there are many commonalities of joint movements in concert guitarists and there are also variabilities. One commonality is how there is an exchange of work from the MCP to the PIP joint. The MCP begins the stroke by bringing the finger to the string and then the PIP/DIP joints take over as the MCP falls off or extends. You can find all kinds of doctors who will talk about co-contraction, and perhaps that's all true information I don't know, but it doesn't matter. What matters is how concert guitarists are actually all moving their fingers. It can be seen in 100s of videos that they are all basically moving the joints in this same way with this same firing order. Of course there are variabilities in hand position and wrist angle and nail length or radius of orbit etc, but the basic movements are all the same. (And they are not moving with the pendulum MCP movement that is commonly taught). Probably the most important lesson learned from that thread is how that knuckle-centric pedagogy is so wrong and how good technique has a much wider range of possibilities. Sadly, again, people read it and interpret the opposite, they think it's just another rigid prescription but that's just the reality of public forums.
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 Aug 01, 2017 3:50 am

Dofpic wrote:
Fri Jul 28, 2017 1:45 pm
My own opinion is it is very much like walking. We do not need videos to learn how to walk. We just do it. and when we walk the main energy starts from the Hip. However we cannot walk well without the knee and ankle working together. If you see anyone with a bad hip or knee or ankle they cannot walk with ease. The same goes for playing guitar. We need to use together Main knuckle mid joint and fingertip for maximum efficiency. A lot of these videos etc are overthinking. Serap says to use the fingertips like shock absorbers in order to get beautiful tone. Roll a chord and get beautiful tone and this is what happens. You also initiate from the main knuckle and the mid joint follows as well. If one does not work together with the others then you have a problem.
Yes, but then why didn't you and I learn to play guitar perfectly by not thinking about it, just doing it? Did we just get FD out of some kind of genetics or bad luck? Given mostly musicians who practice long hours get FD and other people who do not do the work do not get it, it's more likely that massive repetition of bad technique was somehow a trigger for the dystonia.

Yes about using all the joints, there is a firing order, the MCP brings the finger to the string but then the plucking comes from the PIP/DIP flexing while the MCP is retreating. Follow directions to play as a pendulum from MCP (Tennant and Kanengeiser) or to only move all the joints in flexion together as Shearer teaches and you'll be practicing something that no professional musician does. If you can find no one who actually moves this way, why in the world would you want to practice moving this way? You wouldn't, these directions are likely to cause injury if repeated for months and years.

"A lot of these videos are overthinking" Videos can't think, they are just videos and are not much different than observing a live performance with your eyes and ears, only you can see things close-up and in slow motion and learn things that the naked eye cannot see. It's one tool, just like a good teacher. Sadly there are a lot of well-intentioned teachers who are unaware of how their own technique even works. If they can convey it in a way that helps a guitarist learn, that's a great thing, but it's important for guitarists to educate themselves about these issues in the pedagogy and become savvy consumers of information. Putting too much emphasis on the lessons from one teacher is a poor strategy.
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 Aug 01, 2017 2:51 pm

There is a term that gets thrown around that is likely being misinterpreted and/or applied incorrectly to situations where it does not apply. The term "co-contraction" gets used to say joints moving in opposite directions will cause the extensor and flexor muscles to fight against each other causing muscle tension. It may be the case that a person with focal dystonia does have problems related to co-contraction, but it's just plain wrong to say that moving joints in opposite directions will result in co-contraction. It may be that a certain amount of co-contraction is happening in the hands of concert guitarists because they are ALL moving joints in opposite directions, but the overwhelming prevalence of these movements is proof of the movement's correctness. You couldn't get out of bed in the morning without moving joints in opposite directions. You couldn't row a boat, throw a ball, shoot an arrow, push, pull, feed yourself, etc. It's a very natural movement for joints to move in opposite directions and it's just plain foolish to imply that muscles are fighting against each other when doing so. The problem is that guitarist have limited knowledge of how muscles work and they pick up on one medical term and misuse and misinterpret its meaning. It's irrelevant how guitarists think muscles and joints should work based on a limited knowledge of physiology, what matters most are the movements that concert guitarists are really doing to get the job done. We can see 100s of videos of concert guitarists all moving joints in opposite directions and zero videos of concert guitarists only flexing all the joints simultaneously or extending all the joints simultaneously. (Aaron Shearer's incorrect Principal of Uniform Direction of Movement)
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 Aug 01, 2017 11:38 pm

Dofpic wrote:
Fri Jul 28, 2017 1:45 pm
My own opinion is it is very much like walking. We do not need videos to learn how to walk.
Don't forget a lot of people walk badly, over wrong feet position, with bad body weight distribution, rigid arms, bad breathing and several other problems. Just pay attention to people in the streets and you will see a lot of variation in the walking pattern. You can also ask to see people shoes and you will see different wear patterns, including some very defective ones.

uptempo
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Re: Focal Dystonia and Retraining the Hand

Post by uptempo » Sat Aug 05, 2017 8:21 am

guit-box wrote:
Tue Aug 01, 2017 2:51 pm
There is a term that gets thrown around that is likely being misinterpreted and/or applied incorrectly to situations where it does not apply. The term "co-contraction" gets used to say joints moving in opposite directions will cause the extensor and flexor muscles to fight against each other causing muscle tension. It may be the case that a person with focal dystonia does have problems related to co-contraction, but it's just plain wrong to say that moving joints in opposite directions will result in co-contraction. It may be that a certain amount of co-contraction is happening in the hands of concert guitarists because they are ALL moving joints in opposite directions, but the overwhelming prevalence of these movements is proof of the movement's correctness. You couldn't get out of bed in the morning without moving joints in opposite directions. You couldn't row a boat, throw a ball, shoot an arrow, push, pull, feed yourself, etc. It's a very natural movement for joints to move in opposite directions and it's just plain foolish to imply that muscles are fighting against each other when doing so. The problem is that guitarist have limited knowledge of how muscles work and they pick up on one medical term and misuse and misinterpret its meaning. It's irrelevant how guitarists think muscles and joints should work based on a limited knowledge of physiology, what matters most are the movements that concert guitarists are really doing to get the job done. We can see 100s of videos of concert guitarists all moving joints in opposite directions and zero videos of concert guitarists only flexing all the joints simultaneously or extending all the joints simultaneously. (Aaron Shearer's incorrect Principal of Uniform Direction of Movement)

All I can say to this is that two consultant surgeons have alluded to this when discussing my own issues. I don't recall them talking about joint opposition as you describe, but rather, they spoke of engaging the the flexors and extensors more fully which you can easily see by rolling your sleeve up and experimenting with how you move your fingers and seeing a very obvious exchange of muscles taking place when you engage more from the main knuckle. Of course, joints move in opposition, but speaking from my own experience, there is a definitive felt sensation of tension I get if I concentrate on playing from the tips as opposed to extending my focus to feel the whole hand at work in plucking. The way I visualise my hand is to visualise that I am clapping my fingers into my palm but with very relaxed fingers and moving the fingers from the main knuckles. Now, if you filmed me in slow motion it may be the case that I am notbin fact doing what I think and sense, but the actual end result, for me, is a much more stable hand, more power for less effort, and a distinct feeling that I am not burning my finger tendons but instead my whole arm seems to be engaged.

In regard to the videos, I still feel that what we can see slowed down does not necessarily help. I say this because many years ago I was desperately trying to improve my swimming to compete better in triathlon as I was approaching elite level. I threw an awful lot of money on technical training: swimming camps with experts, under water video analysis and watching endless slo mo videos of world class swimmers' underwater technique. But what I found when actually taking to good swimmers is that they all focus on 'feeling the water' and not so much on the minutiae of the many aspects of the front crawl stroke. They used phrase such as "I imagine I'm climbing a ladder" or "I'm pulling my body over a beer barrel". Myself, I was a professional horse rider and I used to explain the correct communication with the horse's mouth on the reigns and bit was like "balancing a chair on one leg whilst holding the top of the chair in one hand". Once a horse is 'on the bit' it feels exactly like I described and nomamount of watching videos would ever reveal that feeling. I used these feelings when I taught with great success. I had my own lessons with a talented dressage rider and she used the same method of tuning your senses to feelings.

Personally, I believe much of what world class guitarist say they do is probably inaccurate regardless of videos. I have a friend who is world class on the guitar and he can't really accurately describe how he plays either. I believe that intuition comes into the matter and some people just get it.

But I do totally understand why, having FD, you would need to conduct these studies and I think they have merit for some people but not others.

I now do this with my guitar playing and it's working. I think watching videos should carry some kind of warning because slowed down might reveal discrepancies in what is said but there are other ways to achieve succes and visualising and then rembering feelings is equally valid.
"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 » Sat Aug 05, 2017 1:50 pm

Luis_Br wrote:
Tue Aug 01, 2017 11:38 pm
Dofpic wrote:
Fri Jul 28, 2017 1:45 pm
My own opinion is it is very much like walking. We do not need videos to learn how to walk.
Don't forget a lot of people walk badly, over wrong feet position, with bad body weight distribution, rigid arms, bad breathing and several other problems. Just pay attention to people in the streets and you will see a lot of variation in the walking pattern. You can also ask to see people shoes and you will see different wear patterns, including some very defective ones.
Yes they do but it doesn't necessarily mean they have or will have issues. Loads of brilliant guitar players are hunched over their instruments and have bent wrists and all sorts. I think injury is just too complex.

I had a conversation with one of my physiotherapists where he claimed that the fascia connecting every muscle innthe body ultimately means that a calf injury can show up as a pain in remote areas of the body - I found that hard to believe but more research seemed to convince me it was true.
"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 » Sat Aug 05, 2017 9:02 pm

When professionals in the focal dystonia field talk of co-contraction, it's likely what they are talking about is a co-contraction of the muscles that are flexing and extending the same joint, not separate joints. If, for instance, the MCP is simultaneously trying to extend and flex, then you'll get a fighting where you have trouble getting the fingers to naturally extend or they seem locked or they abruptly move one way or the other uncontrollably. This is probably what they are talking about and it's what we can see when watching a dystonic hand play the guitar. It's so obvious that adjacent joints have to flex and extend at the same time, it's true for every joint in our body and it's a very natural and correct movement.
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 Aug 06, 2017 2:47 pm

guit-box wrote:
Sat Aug 05, 2017 9:02 pm
When professionals in the focal dystonia field talk of co-contraction, it's likely what they are talking about is a co-contraction of the muscles that are flexing and extending the same joint, not separate joints.
Yes, this is how it was explained to me with regards to my particular issue.
"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 » Mon Aug 07, 2017 2:11 pm

Okay, maybe I misunderstood you since it's been suggested to me several times that extending one joint while flexing another will cause muscles to fight against each other (co-contraction), but I believe those people are misunderstanding co-contraction. Aaron Shearer even came up with his Principle of Unified Direction of Joint Movement where he insists that the best movements are when all three joints of the hand either flexion together or extension together but never flexion while extension. He's wrong, concert guitarists are all flexing and extending joints together.

There's no question in my mind that no matter what methods of re-learning to play the guitar after contracting focal dystonia that you use, you need to make correct movements. You need to follow the movements that concert guitarists are doing and not rigidly follow the incorrect pedagogy that tells you not to pull up on the string or to focus on playing from the large knuckle joint. That is also incorrect. Lastly, I don't think you can baby your hands and relax your way to playing the guitar. It's necessary to make correct and strong movements to regain strength and coordination. Being relaxed is important in the sense of not using unneeded tension, but strong and coordinated movements with correct joint usage is the way to proceed. Using play-relax technique alone is a misguided instruction technique in my opinion.
An eyewitness will often only see what he already believes to be true.

oriventura
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Re: Focal Dystonia and Retraining the Hand

Post by oriventura » Tue Aug 15, 2017 4:33 pm

Dofpic wrote:
Fri Jul 28, 2017 1:45 pm
My own opinion is it is very much like walking. We do not need videos to learn how to walk. We just do it. and when we walk the main energy starts from the Hip. However we cannot walk well without the knee and ankle working together. If you see anyone with a bad hip or knee or ankle they cannot walk with ease. The same goes for playing guitar. We need to use together Main knuckle mid joint and fingertip for maximum efficiency. A lot of these videos etc are overthinking. Serap says to use the fingertips like shock absorbers in order to get beautiful tone. Roll a chord and get beautiful tone and this is what happens. You also initiate from the main knuckle and the mid joint follows as well. If one does not work together with the others then you have a problem.
I couldn't agree with you more Jim - I think over thinking about the movements - and the therapist from Institutart always say this - can lead to dystonia. Too much use of "left brain".. trying to force a certain movement.. etc. It should be like walking - natural movement.

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