Focal Dystonia

By Dr. Greg Werner

comes because a critical point in their career has been reached, and intense technical work has been undertaken to break through to a higher level. Occasionally, a musician starts a program with the goal of overcome a particular problem that has a long history and is definitely stubborn. The problem can

start after changing to a drum technique or new instrument (for you multi talented players who play more than drums), when loss of finger control can start abruptly. When the new instrument is abandoned, the musician finds out he can no longer play the old instrument either.

For the diagnosis of focal dystonia there needs to be a thorough examination by your physician. If it is in the hand they will rule out of other problems like carpal tunnel. When you are examined you will be asked if there are other members of your family that have a dystonia, (dystonias can affect all different parts of the body). Genetic screening for DYT gene abnormalities and genetic counseling is important for patients with an onset of primary dystonias at younger than 30 years or those who have an affected relative. You will be observed to see if muscle contractions causing twisting and abnormal hand posture. Test to evaluate the nerves will also be performed (EMG/NCV). There also will be a scan of your brain to rule out any primary brain problems. Treatment of focal dystonias can be various medications, botulism toxin, in some cases surgery. The more conservative approach would be physical therapy touching the affected area that may reduce the symptoms in the area of the dystonia. There are certain braces that also mimic the touch and help the patient. Physical therapist will also do stretching exercises for the dystonia. From a chiropractic point of view we do not cure any type of dystonia, although an adjustment might help the nervous system function better. If this happens maybe the communication to the affected muscles will help reduce the contractions. In Table 1 you can see that the goal of any therapy is to get back to stage 5.

Of course always consult your healthcare provider for any medical conditions. Do not forget if you have any health issues that need to be addressed you may contact me at drgreg@drumheadmag.com.

Happy drumming!

fo cal

adjective of or relating to the center or main point of interest.

• (of a disease or medical condition) occurring in one particular site in the body.

dys to ni a

noun a state of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy.

First of all I would like to thank you for all of your e mails. It is a

pleasure to hear from you with all of your questions. I try to answer all

of the e mails so please be patient. I had a very interesting e mail from

a fellow drummer about a condition that affects many drummers and

other musicians, focal dystonia. His happened to be a dystonia of the

hand, a very common one for drummers.

 

Focal dystonia is a condition of sustained muscle contractions causing twisting and abnormal postures. Musicians are affected in a proportion of 1/500, much more than in other professions requiring skilled hand movements, as watchmakers, dentists and surgeons. Initially this condition is hard to describe. Symptoms frequently start with holding the drum stick or musical instrument but become exaggerated when playing begins. Adverse biomechanics, particularly inflexibility of the hand, constitute an important predisposing factor. Musicians are very talented and ambitious people. They also tend to be somewhat fanatic in their work habits. During the period when the problem begins, they are usually in a particular hurry or working unusually hard. In some musicians, the burst of activity

Classification of Tubiana et al
from focal dystonia in musicians.
Stage 1 Plays several notes but stops
because of blockage or lack of
facility.
Stage 2 Plays short sequences without
rapidity and with unsteady
fingering.
Stage 3 Plays easy pieces but is unable
to perform more technically
challenging pieces
Stage 4 Plays almost normally but
difficult passages for fear of
motor problems.
Stage 5 Returns to concert
performances

Practicing chiropractic in New York City since 1995, Dr. Gregory Werner is a graduate of Palmer Chiropractic College West in San Jose, CA. His practice has enabled him to assist many professional musicians, entertainers and sports figures with their career. A graduate from the Swedish Institute of Massage in NYC, Dr. Werner practiced massage therapy prior to becoming a practicing Chiropractor.

Portions of this article are exact wording of FOCAL DYSTONIA OF THE HAND by Marcos Sanmartin. 1. Leijnse JN, Bonte JE, Landsmeer JM, Kalker JJ, Van der Meulen JC, Snijders CJ. Biomechanics of the finger with anatomical restrictions--the significance for the exercising hand of the musician. J Biomech 25(11): 1253-64, 1992. 2. Wilson F, Wagner C, Volker H. Biomechaical abnormalities in musicians with occupational cramp/focal dystonia. J Hand Ther 6(4): 298-307, 1993.).

3. Elizabeth A Moberg-Wolff, MD, Dystonias, http://www.emedicine. com/pmr/ topic235.htm July 21, 2006