By Nora Krohn | From the July-August 2022 issue of Strings magazine
I remember the first time it happened. I was alone in a practice room at Edinboro University, getting ready for a concert at the end of the week. I’d barely slept, and all I could think about was how to survive a slew of master classes and the recital tour in Canada I would begin in just a few days.
Something wasn’t right—that much I knew. Ever since coming back from a short vacation the previous month, I’d been toying with changes to my technique, which had seemed promising at first. I’d felt able to move around the viola quickly and with ease, gripping the instrument less and enjoying a newfound sense of freedom. But after a couple of days, something had felt off. A bad day, I’d assumed—who hasn’t had one of those? I’d figured I was on my way to accommodating a new way of moving and would feel better in no time.
But things hadn’t improved. Passages that used to feel fleet and unencumbered now seemed sluggish and uncoordinated, and I couldn’t understand why. It was worrisome, but I wasn’t sure what to do other than keep moving forward.
By the time I’d arrived at a cherished musicians’ meditation program hosted by the university a few weeks later, my anxiety had begun to wind tighter and tighter. As I snuck into the practice room after lunch, cadging an hour before afternoon classes to run through the firecracker solo viola piece I’d recently recorded, I clung to the hope that familiarity would see me through, but it wasn’t going well. And then, the worst happened.
Shifting into third position on the A string, I watched as my third and fourth fingers curled back all by themselves. I tried again, and they did it again. With effort, I could straighten them, but soon they started curling more and more. I was losing control of my hand.
I was almost too terrified to admit it to myself, but later that day, through sobs, I confessed to a friend what I finally knew:
“I have focal dystonia. My career is over.”
Despite dystonia being the third most common neurological condition (behind Parkinson’s and essential tremor), most people have never even heard of it, let alone know what it is. Broadly defined, it’s a loss of movement control, but there is no consensus yet on what exactly is happening in the brain. In fact, according to dystonia researcher Anna Sadnicka, “a longstanding debate continues as to whether the dystonias represent a single disease entity with shared pathophysiology or whether each dystonia subtype is distinct.” In other words, while dystonia can manifest in many different areas of the body, it’s unclear whether this loss of control present in various types of dystonia represents the same condition or is merely a shared symptom.
The category of dystonias that most often arise for musicians (and other performers or athletes) are known as task-specific focal dystonias, meaning they’re isolated to a particular part of the body and most often to a particular task. For string players, the most common area is the left hand, but the bow arm can also be affected.
The precise cause of musician’s focal dystonia (MFD), which impacts approximately 1–2 percent of professional musicians, is even less clear. According to Sadnicka, in addition to possible genetic factors and the unique demands of playing classical music (endless repetition of extremely precise, rehearsed movements under pressure), there seem to be cognitive and emotional elements as well: “Compared to unaffected musicians, those with task-specific dystonia are six times more likely to exhibit elevated anxiety, perfectionism, and evidence of stress, and such characteristics seem to predate the onset of dystonia.” That certainly rang true in my case.
Luckily for me, knowledge of focal dystonia has increased significantly since pianist Leon Fleisher was infamously struck down by it in 1964. And, thanks to the internet, that knowledge is increasingly available to musicians who want to help themselves. Shortly after returning from my recital tour in Canada (which I somehow survived via sheer desperation), I made some doctor’s appointments and started Googling.
At first, I found plenty of sources insisting MFD was incurable and touting Botox injections as the only treatment. To be sure, many musicians have relied on this solution to keep themselves afloat, and we’re all free to make our own choices. But the prospect of injecting a toxin into my muscles regularly, without addressing the root cause, flew in the face of everything I’d learned through meditation and the Alexander Technique about the deep and complex interaction of psychology, the nervous system, and the body. I sensed that, however difficult and painful the recovery process might be, focal dystonia had something to teach me about myself.
Without much digging, I found stories of musicians who themselves had been diagnosed with MFD and recovered—fully—through a combination of movement-based rehabilitation and reconditioning of their nervous systems. The science on how this type of rehabilitation works is still out, although a meta-analysis of studies by Ashley Enke and Gail Poskey published in 2018 concluded that “there is moderate evidence to support the effectiveness of neuromuscular re-education programs on reducing abnormal movements during instrument play in musicians with focal hand dystonia.” But the accounts of musicians who, through a herculean undertaking of trial and error, had found their way to recovery, spoke for themselves. There was another way: that was all I needed to know.
Over the course of the next 14 months, I forged a path for myself. First, I got a proper diagnosis. Then I attended a workshop on neuroplastic movement therapy and followed the regimen for about nine months. There was some notable improvement, but in spite of everyone’s insistence that my case was so mild I was likely to recover within a year, I still didn’t feel ready to return to work. Then, in a stroke of serendipity, I connected with a friend of a friend navigating the same murky territory.
I called him, prepared to commiserate and offer the same collection of names and catchwords that had been circling in my head ever since I’d Googled “focal dystonia.” And so it went: we’d tried many of the same approaches, with similar results. “But you know, now that I think about it,” he said, a hopeful note in his voice, “there was one person whom I found really helpful.”
And that’s how I found violinist Sophie Till.
The approach was refreshingly commonsense, like a more refined, instrument-specific version of the Alexander Technique I’d been practicing for nearly a decade. But I soon discovered it went even deeper—the alien logic governing my movements at the instrument turned out to be intricate and pervasive. When I began working with Sophie, I figured I was mere months away from returning to the professional life I longed to get back to. But soon the reality set in that the generic finger exercises I’d been doing for almost a year—and had staked my recovery on—hadn’t really worked. We needed to build a new technique from the ground up, erasing all of the familiar habits I’d relied on my entire career. I felt more fragile and vulnerable than ever.
And yet, I could feel the rightness of the approach. And furthermore, I didn’t see any better options.
So I dug in, but not in the way I always had before, by pushing and forcing. One of the hardest things to accept was that, to a large extent, I wasn’t in control of the process—my brain was. According to Sophie, “When we truly understand how the brain and body learn and process movement, we can work within the boundaries of that system rather than fighting it. But there are numerous factors both in our musical tradition and in the general culture (bigger, better, faster, more) that make it hard for many of us to be at ease in the retraining process.” And I was not at ease: I fretted constantly that I wasn’t recovering fast enough, and I doubted the work more or less continually. But my brain continued moving along at its own stubborn pace. Learning a new system of playing was step one, but rooting it in my neural structure was a process my brain undertook on its own, requiring just the right amount of information, repetition, rest, and time.
What’s transpired since then has been pretty astonishing. I’ve returned to professional playing with a newfound sense of ease and comfort, knowing there are practical answers to every problem that could come my way—musical, technical, or otherwise. Now that I have better tools, I don’t have to become a different person to overcome self-doubt and step onstage. And as I look to the future—helping this information develop, applying it to music I love, sharing it with others—I know the best is yet to come.