TADPOLE MUSIC STUDIO

PIANO INJURY

Muscle fatigue? Repetitive strain? Cumulative trauma? Focal dystonia? Even the doctors don't know the answers. Sometimes your fingers just don't move the way they're supposed to after years of abuse at a computer keyboard, or even a piano keyboard.

This is a problem I have been dealing with for several years now. I first noticed a muscle spasm in my right thumb when I was writing; a problem called "writer's cramp." I then noticed it in other fine motor skills, most notably playing the piano.

The cause is uncertain. Several years of intensive work as an accompanist could be to blame, especially considering some of the awful pianos found in rehearsal studios. It may be the result of trauma suffered in a bicycle accident 15 years ago in which I landed on my shoulder and broke a finger. It could even be genetic.

Practicing more did not help, and taking a break from practicing produced no results. A hand surgeon diagnosed it as a trigger finger but that was evidently a misdiagnosis.

Dr. Pascarelli at Columbia Presbyterian Medical Center diagnosed the problem as Focal Dystonia. In the sports medicine department there, and previously as founder of the Miller Institute, he has worked extensively with musicians and patients in the computer field with problems under the wider terms Repetitive Stress Injuries (RSI) and Cumulative Trauma Disorders (CTD).

Dr. Pascarelli was recommended by Bill Gordon, a pianist who has recovered from focal dystonia, and is now playing better than ever. Bill was also helped by John Kella, who now has an ergonomic company with the New York Times as their principal client.

I've been exploring alternative treatments for my dystonia, and have seen some slight but positive results for myself in the last several months. I am now embarking on a program of stretching, exercise, relaxation and retraining of the muscles involved. I have been to several physical therapists as well as piano instructors for retraining. I have also started Feldenkrais lessons with practitioner Mary Ziminski. The Feldenkrais method helps to re-educate the body to move more efficiently and with less effort. A Feldenkrais practitioner teaches more efficient ways to move your body, not just the hands but the arms, shoulders, torso and pelvis. Most of the movements are done on the floor very slowly and relaxed. Jonas Sen has written a very informative paper on focal dystonia, and mentions Feldenkrais as being very helpful, especially finger rotation exercises.

I have read a great book on retraining the way one plays called "The Art of Practicing" by Madeline Bruser. I have also called her up and been taking piano lessons with her in New York City. She offers valuable insights into the basic mechanics of playing, moving away from just fingertip movements and involving larger muscle groups from the wrist to the forearm and up to the shoulder for producing music. She also says to notice how your fingers, hands and arms feel as you play, and let them rest frequently. At the outset, play slowly and let the finger muscles settle down between notes. Meditation can also be helpful. Take some time to breathe deeply and relax before and after you play.

I have also been to several physical therapists. The best I have found is James Wang in New York who was mentioned in Madeline's book. He incorporates acupuncture and neuromuscular massage into his practice and comes from an eastern medicine philosophy and thus is more holistic than other PTs.

In the past year I have been to two chiropractors. Because hand and arm movements originate from the neck and back I thought they would be helpful. The first was not familiar with focal dystonia and I was not making progress with his treatment. The second was Dr Harold Briks who was recommended by Madeline Bruser. Dr. Briks is a chiropractor who specializes in Applied Kinesiology. His approach is to test muscles and detect structural or nutritional imbalances and correct them with adjustments or health supplements. My back definitely feels better since seeing Dr. Briks, but I'm still waiting to see how my hands will be affected.

The most promising research I have heard about recently is by Dr. Nancy Byl in the Physical Therapy Dept. at UC San Francisco. I have included links to several articles about her treatment method. She has found that an overlapping of the sensory map in the cerebral cortex causes the cramping of the finger muscles. Her treatment restores normal functioning by doing exercises to restore the sensitivity in the fingers. I will update this page with any additional information I find, so please check back periodically. I would also like to hear from others with RSI injuries. Please e-mail me at beckner@tadmusic.com.

Contact Tadpole Music Studio at:

Thomas Beckner
Tadpole Music Studio
516-939-0717
beckner@tadmusic.com

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