Musicians Clinic

Music - Medical Myths and Legends


Focal Dystonia

(Abridged from the Dystonia association website)
Professional musicians are susceptible to a number of occupational conditions, including task-specific focal dystonia.

The term focal indicates that the dystonia affects a single, specific area of the body.

The term task-specific indicates that the symptoms only occur when the individual is completing a particular task, such as playing a musical instrument.

Experts estimate that 1-2% of professional musicians are affected by dystonia, but there are likely large numbers of musicians living with symptoms who remain unidentified. Almost all individuals with musician’s dystonia are classically trained, and most are male.

The first signs of musician’s dystonia are lapses in the usually instinctive ability to perform on the instrument. Musicians may perceive the early symptoms of dystonia as a result of faulty technique or insufficient preparation. Musician’s dystonia is triggered by playing the instrument and does not typically affect other activities.

The top three musical instruments associated with musician’s dystonia are piano, guitar, and brass instruments.
Pianists typically develop symptoms in the right hand, often affecting the fingers. String players usually experience symptoms in the left hand. Guitarists and percussionists may develop symptoms in either hand. Woodwind players may develop symptoms in the hands, face, or mouth. Brass players are usually affected in the corners of the mouth and jaw.

There is typically no pain associated with musician’s dystonia.
Because musician’s dystonia is a neurological disorder, the aim of treatment is to help the nervous system relearn the ability to complete specific movement tasks without triggering dystonia.

The origins of musician’s dystonia are being researched by scientists around the world.

Hand dystonia is seen in pianists, string players, guitarists, percussionists, and woodwind players. Symptoms of hand dystonia may include subtle loss of control in fast passages, lack of precision, curling of the fingers, fingers “sticking” to keys, involuntary flexion of the thumb in strings, and tremor.

My view

There are a million subtleties involved in playing an instrument. Sometimes we lose that 'edge' that crispness, the speed. This ruins what we are playing. The audience may not perceive much wrong, but we do most definitely.

We must warm up, build up the speed and strengths required each time we play our instrument. When the forearm and hand muscles are tired and tense they run out of steam very quickly. This produces aching, loss of speed and accuracy. However, when such tensions are not sufficent to trigger aching they will still affect the finer hand tasks. A scale once played rapidly can now only be played at 3/4 speed because one fingertip is not behaving itself by curling in to the palm or not moving sideways properly. So, we repeat the practice until we have regained speed and accuracy. This can take a few minutes. But when it takes hours or never re-appears as a skill we will panic. Our life is music. The first place to look is in the forearm and hand muscles. Check for dense/tense muscles and if present stretch and massage them.

With true focal dystonia the problem persists and can be due to cerebellar involvement. This part of the brain controls co-ordination. It is very vulnerable to damage from alcohol and nicotine, cells can die and with them go our abilities. All to often the diagnosis of Focal Dystonia is not appropriate without first assessing the tension patterns in the areas named above. This can only be done by a specialist due to the fundamentally tactile nature of such an examination. Mere words cannot constitute a good diagnosis. I have found that working specifically on the muscles involved results in great improvement.

Hypermobility syndrome/ Ehlers-Danlos syndromes

(Abridged from the NHS website)
Hypermobile EDS (hEDS) is often thought to be the same as or very similar to another condition called joint hypermobility syndrome.

People with hEDS may have:
joint hypermobility
loose, unstable joints that dislocate easily
joint pain and clicking joints

Currently, there are no tests to confirm whether someone has hEDS. The diagnosis is made based on a person's medical history and a physical examination.

My view

A lot of physical therapists seem to love to condemn a person's condition by labelling them as hypermobile. This is ignorant and an example of lazy thinking and minimal experience in actually helping people. It is a dismissive term. The reality is quite the opposite. Most conditions related to muscles and joints are due to hypo-mobility in other words lack of mobility. It seems that many therapists don't know the difference and they have also been partially brainwashed. My Mother was a contortionist and never suffered from problems due to her hypermobility. She lived until 90. I too am hypermobile, bendy. When I fell down the stairs three years ago and ripped the hell out of my right knee which twisted up behind me, my hypermobility saved me. I ended up with a moderate avulsion fracture which rapidly healed under my efforts. So do not be fobbed off with a hypermobility diagnosis.

Polymyalgia rheumatica

(Abridged from the NHS website)
Meaning: Many muscle pain and joint ache
A condition that causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.
The main symptom is muscle stiffness in the morning that lasts longer than 45 minutes. It may also cause other symptoms, including:
extreme tiredness
loss of appetite
weight loss

My view

The definition of this pseudo-disorder is so vague from the NHS as to apply to the majority of the adult population. As such it is a useless diagnosis, little more than something to fill in on a form to be passed on to some other 'expert' in the field. A rheumatologist will then supply their experimental drugs and some physio. It is a helpful as a mechanic telling you that there is something wrong with your car which may or may not get better. A true mechanic looks at the structure and functions of the body and applies physical, hands-on treatment to the affected areas.


(Abridged from the NHS website)
Fibromyalgia, also called fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body.

As well as widespread pain, people with fibromyalgia may also have:
increased sensitivity to pain
fatigue (extreme tiredness)
muscle stiffness
difficulty sleeping

Anyone can develop fibromyalgia, although it affects around 7 times as many women as men. The condition typically develops between the ages of 30 and 50, but can occur in people of any age, including children and the elderly. It's not clear exactly how many people are affected by fibromyalgia, although research has suggested it could be a relatively common condition. Some estimates suggest nearly 1 in 20 people may be affected by fibromyalgia to some degree.
One of the main reasons it's not clear how many people are affected is because fibromyalgia can be a difficult condition to diagnose.
There's no specific test for the condition, and the symptoms can be similar to a number of other conditions.

My view

This is another 'rubbish bin' diagnosis into which a patient is placed in the abscence of any other diagnosis. Each patient must be physically and competently assessed especailly when they are a musician.


An interesting article on the musicians brain development.
Almost 60% of professional musicians have suffered from a psychological issue and almost half have experienced problems with alcohol, according to a survey by Help Musicians UK. Focused on health and wellbeing, the research finds that anti-social working hours are the biggest concern for musicians, and speculates that this could lead to the psychological issues, loneliness and relationship difficulties that the majority of musicians report suffering from.

My view

A lot of patients that have been passed through the usual system may have had counselling and CBT which tells them to accept the problem and it will fade away. In the prescence of actual physical causes such advice can be abhorrent. If I sprain my ankle it does not help to be told to get used to it! I need help, a proper diagnosis, some way of helping myself. The first stop on any diagnosis is the proper examination of the structures involved and the associated functions and their possible over-use.


I have frequently helped patients out of pain when they have been given these flimsy, generalised diagnoses by professionals who don't know any better. Look at the nuts and bolts before you write-off people without first having established physical evidence.


Some brave souls who persisted to greatness

Glenn Gould

Gould suffered many pains and ailments, though he was something of a hypochondriac (admitting it himself on at least one occasion), and his autopsy revealed few underlying problems in areas that often troubled him. He was highly concerned about his health throughout his life, worrying about everything from high blood pressure (which in his later years he recorded in diary form) to the safety of his hands. (Gould rarely shook hands with anyone and usually wore gloves).
As mentioned above, early in his life Gould had suffered a spine injury. His physicians prescribed, usually independently, an assortment of analgesics, anxiolytics, and other drugs. Gould's increasing use of a variety of prescription medicines over his career may have had a deleterious effect on his health. It reached the stage that "he was taking pills to counteract the side effects of other pills, creating a cycle of dependency". It has been stated that Gould took a lot of antidepressant medication, which was blamed for his deteriorating mental state.
The astounding story of Glenn Gould pdf.

The Goldberg Variations (note the dreadful posture).

Jaqueline Du Pre

In 1971, du Pré's playing declined as she began to lose sensitivity in her fingers and other parts of her body. She was diagnosed with multiple sclerosis in October 1973. Her last recording, of sonatas by Chopin and Franck (the latter originally for violin), was made in December 1971. She went on sabbatical from 1971 to 1972, and performed only rarely. She started performing again in 1973, but by then her condition had become severe. For her January tour of North America, some of the less-than-complimentary reviews were an indication that her condition had worsened except for brief moments when her playing was without noticeable problems. Her last London concerts were in February 1973, including the Elgar Concerto with Zubin Mehta and the New Philharmonia Orchestra.

Multiple sclerosis and Elgar, amazingly beautiful.

Itzak Perlman

Perlman first became interested in the violin after hearing a classical music performance on the radio. At the age of three, he was denied admission to the Shulamit Conservatory for being too small to hold a violin. He instead taught himself how to play the instrument using a toy fiddle until he was old enough to study with Rivka Goldgart at the Shulamit Conservatory and at the Academy of Music in Tel Aviv, where he gave his first recital at age 10. He moved to the United States to study at the Juilliard School with the violin pedagogue Ivan Galamian and his assistant Dorothy DeLay.

Perlman contracted polio at age four and has walked using leg braces and crutches since then and plays the violin while seated.

Django Rheinhardt

"Before he had a chance to start with the band, however, he nearly lost his life when the caravan he and his wife lived in caught fire when he knocked over a candle on his way to bed. His wife made artificial flowers from extremely flammable celluloid. They caught fire, engulfing the wagon in flames almost immediately. Reinhardt dragged himself and his wife through the fire to safety, but suffered extensive burns on his left hand and other areas. He received first- and second-degree burns over half his body. His right leg was paralyzed, and the fourth and fifth fingers of his left hand were badly burned. Doctors believed that he would never play guitar again, and they intended to amputate one of his legs. Reinhardt refused to have the surgery and left the hospital after a short time; he was able to walk within a year with the aid of a cane.

Two of his fingers remained paralyzed. By sheer will, he taught himself to overcome his now permanent handicap by using only his thumb and two fingers. His brother, Joseph Reinhardt, also an accomplished guitarist, bought Reinhardt a new guitar. With rehabilitation and practice, he re-learned his craft in a completely new way. He played all his guitar solos with only the index and middle fingers and used the two injured fingers only for chord work."

Rare footage of this amazing musician

In conclusion, try for the impossible and you just might achieve the possible