Focal Dystonia - An Outline of My History.
The first sign was a problem getting my 4th finger (RH) over my thumb without a bump in a descending E flat major scale. The more I tried to practise it out the worse it got. Soon all descending scale passages were compromised, and then ascending scales too. Close observation showed that the problem was in my 3rd finger trying to play at the same time as my 4th finger. Although my 3rd finger could still work independently, my 4th finger couldn’t. To put it another way, I could get a clean signal through to my 3rd finger, but not to my 4th (and eventually my 5th). Movements – and even intentions of movements – in those fingers triggered the involvement of my 3rd finger.
When my 3rd finger began to get involved with my 5th finger I lost my clean octaves, and chord playing became problematic.
If I rested my hand on a table with all the fingertips touching the tabletop, I simply could not raise my 3rd finger at all unless I raised the 4th finger at the same time. My playing lost its clarity, evenness, and I was exhausted after only a few minutes. Through all this there was no pain, only dysfunction.
After extensive nerve conduction tests two neurologists separately confirmed focal dystonia as the diagnosis. Both agreed it was incurable and could not recommend any way for me to treat it. (Ultimately our team concluded that I must have been on the verge of developing FD for some time and it just took some particularly obsessive practising – Chopin Op.10 No.2 – to kick it in. We cannot think it came suddenly out of nowhere.)
I went to see a sports doctor who found many trigger points in the muscles of my forearm. He referred me to a physiotherapist/acupuncturist who gradually began to undo the damage done by 30-plus years of hard piano playing without so much as a single massage. An osteopath then came on board and I underwent a series of quite painful treatments as the deeper knots were removed. It took well over a year of treatment before my muscles and postural alignment approximated a normal condition.
Periodically there would be a roundtable discussion when these three gentlemen, myself, plus another MD who had treated many musicians, would look at all the available information on FD and try to plot a course of action. There were two basic approaches: 1) using splints, and 2) sensory retraining (with my eyes closed I would ‘read’ dominoes with my fingertips. I also learned the basic Braille A-Z).
I had splints made which cradled the 3rd finger and allowed me to work the other fingers without its interference. I did this for months.
We experimented with taping the hand, putting rubber bands on the hand, changing posture, using mirrors, covering the sound of the piano with white noise. Everything worked, alleviated the condition to some degree, even if only mildly and briefly, and gave us confidence that the answer lay in the idea of MAKING CHANGES.
A book ‘Mind Sculpture’ by Ian Robertson had a big influence on both my understanding and my confidence. I developed an exercise regime, swimming and exercycling, and began to seriously practice Qigong. (A treatment by a Chinese Qigong master in Sydney was a revelation). Eventually I/we settled on the idea that the involuntary movements could only be countered through relaxation and that this was primarily a mental matter. And the changes which needed to be made had to be made at the piano.
So I showed my playing to a respected and trusted colleague who gradually guided me to a remodelling of my RH technique. We freed up my elbow, realigned my arm and hand, lowered my wrist, changed the way I raise my fingers. I learned how to release what was not in use. This took a long time and required a lot of patience, as indeed had all the treatments. Five years after the first signs of FD I played my first full solo recital.
Fundamental through all this is the quality of the people involved. The brilliant skills and dedication of my ‘treatment providers’ allowed everything else. They gave me confidence and my optimism.
Dale Speedy, my primary consultant and guiding hand, is a master sports doctor (instrumentalists are athletes) who loves to play the piano.
Jonathan Kuttner, my secondary consultant, was a GP who became a muscular/skeletal specialist. He plays a flute and the cello.
Getting around FD requires both logical and lateral thinking and these gentlemen were in their element. They both contain devout and compassionate spirits.
Simon Loudon, my physiotherapist/acupuncturist, was the first person ever to lay healing hands on me. I trusted him totally and I found we could talk. This was vital in the working through of the many psychological issues that are part and parcel of FD. Like me, Simon has an East/West mind, and I embraced acupuncture wholeheartedly because of him. Simon has healing warmth in his hands, an entirely sympathetic spirit, and great intuition with his needles. His treatment (he would not call it that, perhaps) was holistic and absolutely perfect for me.
Glenn Williams, my osteopath, had to some degree the toughest job to do as he had to break down the biggest knots and this could not be done without considerable discomfort. I was constantly amazed at the accuracy and skill of his hands, and his sense of humour got me through the toughest moments. Both Glenn and Simon showed me how to stretch and maintain myself between treatments. I continue to see Glenn when I can. He usually has to soften up my shoulder and forearm and put my wrist back in place.
Rae de Lisle was the final piece in the puzzle. It was not easy for a man of my experience to yield a technique that had ‘paid the bills’ for 30 years. But Rae’s beautiful gentle manner, her deep understanding of the mechanics of piano playing, her quick and accurate eye, her ability to listen to countless ‘wrong ones’ in the search for the ‘right one’ – this all enabled a gradual and powerful remodelling of the way I use my RH, a remodelling from which I could not easily slip backwards.
A word about the psychological issues: ‘classic’ FD is an affliction that seems to go with a certain type of personality – perfectionist, somewhat obsessive, and unduly hard on itself. I can’t argue with this. It is necessary to find a way to modify these traits without denaturing oneself. For me this has involved the development of a certain quality of self-forgiveness, as well as the rediscovery of a happiness in simply playing the piano. It has also been necessary to develop a more relaxed and philosophical attitude to the unpleasant aspects of a professional musician’s life. They won’t go away (although it is easier to say “no” now) but they no longer need to get me down or make me angry.
MICHAEL HOUSTOUN 20 November 2005