Dystonia Disproportionately Effects Musicians

“Almost every night before bed, Alex Klein, one of the world’s most famous oboe players and a principal in the Chicago Symphony Orchestra, goes through the same routine. He begins by leaning his left side against a living room wall in his Riverside condo, his left arm stretched out behind him. He stays like this for 30 seconds before turning around and repeating the same movement with his right arm. When finished, he reaches both arms in front of him. With his right hand, he pulls down on his left fingers as a group, then works them one at a time, tugging hard, as though he were trying to yank them from their joints.

After that, Klein moves to the kitchen for phase two. He gathers ice cubes from the freezer and neatly folds a small pile into a washcloth. Sitting at a table cluttered with papers and mail, he drapes the washcloth over his left wrist and keeps it there for about five minutes.

On particularly grueling days, Klein also performs a kind of do-it-yourself electrotherapy. He spreads a gel on his left arm, then attaches two square white pads. These pads connect to a small black box, about the size of a tinderbox, ominously called a transcutaneous electrical nerve stimulation device. It shoots electrical pulses to arouse the nerves and activate the muscles. Klein generally sets the machine for 30 minutes, during which he relaxes—often to the point of sleeping—as his fingers twitch relentlessly from the pulses.

This is Klein’s reality now, the reality of living with a rare neurological and movement disorder known as focal dystonia. The condition limits his control over his left hand, leaving two of his fingers misshapen, a particularly cruel twist for someone who makes his living with those fingers. It also leaves him in chronic, intense pain—a side effect of torturing his body to get it to perform the way he needs it to.”

“In the medical field, dystonia is something of a mystery. For more than half a century, it was considered a psychological disorder rather than a neurological and physical one. Neurologists now know that dystonia involves the basal ganglia, a tiny area inside the brain that controls movement. Misfiring neurons there send the body conflicting messages, resulting in a variety of problems, including tremors, contorted muscles, and the inability to control certain muscles. In the case of focal dystonia, the mouth and fingers are mostly affected, which for a musician can make performing a familiar task, such as playing the oboe, incredibly arduous and painful.

There are a few hypotheses for what causes dystonia. One is that it is genetic. Another is that simple overuse is to blame, which would help explain why dystonia afflicts musicians in disproportionately high numbers. “They train and train and abuse their muscles and their brain,” says Jan Teller, chief scientific officer at the Dystonia Medical Research Foundation in Chicago. Klein estimates that he was practicing and performing as much as 50 hours a week. Paradoxically, though, professionals in certain other fields that require repetitive movement—such as barbers or tennis players—rarely develop dystonia. Which is what makes the condition so perplexing.

Unlike Parkinson’s and Huntington’s diseases and other movement disorders, dystonia is not degenerative, so early intervention can allow patients to fully recover their mobility. “It’s more like a radio receiver out of tune,” explains Teller. “You just have to readjust, and sometimes you don’t know what button to press. Maybe you move a little to the left and walk by the window and extend the antenna.” The problem for musicians is, they often don’t recognize dystonia when it first hits. Looking back, Klein recalls a moment in 1998 when he felt a searing pain in his sternum, a sensation he now believes was the result of his muscles beginning to tighten. But that possible warning sign, more than two years before his diagnosis, went unrecognized.”

To read the entire article from Chicago Magazine follow the link: http://www.chicagomag.com/Chicago-Magazine/February-2017/Oboe-Alex-Klein/