When Dystonia Strikes: Symptoms and Strategies

May 1, 2026

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Musicians are especially prone to focal dystonia, a debilitating condition that is caused by the loss of muscle control in highly practiced movements.

For pianists and guitar players it’s usually the ring finger of the right hand that’s stricken. Experts now speculate that Glenn Gould, famous for his irregular posture at the piano, likely had dystonia. Symptoms described in his diaries present a classic textbook case in his left hand and arm, and a middle finger of his right hand that he hardly used.

Composer Robert Schumann used a weighted device to strengthen a rogue finger. But it was American pianist Leon Fleisher who brought widespread attention to the condition. Afflicted early in his career, he reckoned it was from practicing some seven to eight hours a day. He played music written exclusively for the left hand, particularly the catalog of works by Ravel, Prokofiev, and others, including a repertoire composed for pianist Paul Wittgenstein, who lost his right arm in World War I.

Movement Behind the Brain

Focal dystonia can best be described as your brain sending garbled signals to your hands and fingers, causing reflexive movements: Pianists may note a subtle loss of control in fast passages, a lack of precision, curling of fingers, or fingers “sticking” to keys. String players note an involuntary flexing of their bowing thumb.

The problem is almost always painless and task specific. With doublers, it may only occur on one particular instrument. Some woodwind doublers report their dystonia may be present while playing the clarinet but not while playing the saxophone. It’s also subject to sensory input, with some pianists reporting symptoms only when playing on ivory keys (versus plastic). Embouchure dystonia in brass and woodwind players causes the lips to tremble or the jaw to lock, or otherwise impact the face, mouth, and tongue.

Eckart Altenmüller, a German classical flutist and a leading researcher in the field of neurophysiology and neuropsychology of musicians, cites several factors that contribute to focal dystonia. Two major dynamics are fatigue and overuse of the same fingering, often the result of forcing yourself to overcome a particular muscular weakness. There is evidence to suggest that psychological pressure contributes to the onset. When we perceive stress, the adrenal glands release the hormone cortisol, which destabilizes motor memories and weakens self-repair neuronal circuits in the brain.

Treatment and Research

According to the Dystonia Medical Research Foundation, about 1% of professional musicians are afflicted with dystonia, but the number is likely larger as many musicians living with symptoms go undiagnosed. Almost all individuals with musician’s dystonia are classically trained and most are male; up to 25% have a family history of dystonia.

At present, there is no cure for dystonia. Anticholinergic drugs, which affect the transmission of messages from the brain to the muscles, can be effective. Botulinum toxin injections have also proven beneficial, though temporarily, and are currently approved by the FDA for blepharospasm and cervical dystonia. Botulinum compels the body to create new pathways by blocking nerve impulses to the muscles that are contracting. They work by weakening the muscles so the spasm is reduced. Patients usually notice the effects three days to two weeks following treatments. After about three months, the effects of the injection will diminish.

The ultimate goal of treatment is to establish new sensory motor programs to accomplish the tasks that have become challenging. Altering posture or key positions could help. Sensory tricks, like playing while wearing a latex glove or stimulation applied to affected areas, can reduce symptoms.

Sensory re-education attempts to reverse the changes in the cortex through repetitive exercises and/or visualization. In sensory motor retuning (constraint induced movement therapy) nonaffected fingers are immobilized in a splint while performing repetitive coordination exercises. This may facilitate freer, more independent movement patterns from a dystonic finger, for example.

Jazz flutist Andrea Brachfeld of Local 161-710 (Washington, DC) discovered in 2005 that she had focal dystonia and was told that she would never play again. But Brachfeld, armed with newfound healing strategies, resumed her career and recording schedule, which includes eight records.

“I learned through my process of recovery that my focal dystonia was caused by an intense emotional event which caused the neurons in my brain related to playing my flute to be destroyed,” says Brachfeld. She has not only returned to her career as a professional musician, but after acquiring certifications in the field of energy medicine, she is now a practitioner helping others incapacitated by the condition. “By doing very deep emotional healing using energy medicine, and recognizing that neuroplasticity existed in the brain, I was able to create new neurons in order to play my flute. I am playing better than ever,” says Brachfeld.

Additional Resources

More research is being conducted to explain neuromuscular mechanisms behind motor control of musicians’ dystonia and to develop novel neurorehabilitation techniques. Individual clinics focus on causes, diagnosis, and management. There are several specialized clinics in North America dedicated to movement disorders and dystonia, as well as foundations that promote awareness, education, and support.

For more information and support, visit:

• www.dystoniacanada.org
• www.dystoniarecoveryprogram.com/dystonia-treatment-in-usa
• www.michaeljfox.org/news/dystonia
• www.hopkinsmedicine.org/neurology-neurosurgery/specialty-areas/movement-disorders/dystonia
• my.clevelandclinic.org/services/dystonia-treatment

Note: These resources are for educational use only and does not imply AFM endorsement. It is not a substitute for professional medical advice. Always consult with a licensed physician or practitioner regarding medical treatments and research.

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