Breakthrough: How I Beat Dystonia

Volume CIX, No. 4April, 2009

Paul Loesel

As musicians, we constantly face the fear of repetitive stress injuries and hope that it never happens to us. Well, that fear came true for me four years ago when I was diagnosed with focal hand dystonia.

About a year into the run of “Wicked,” where I currently hold a keyboard chair, I was experiencing the sensation of loss of agility and strength in the fourth and fifth fingers of my right hand. In order to continue performing my part consistently, I was working even harder — forcing my fingers to move as I thought they should. This, of course, led nowhere.

With the fear of losing my job and possibly, my career, I was fortunate to find the answer with a biofeedback retraining specialist. With her help, I was able to retrain my technique, as well as my thoughts, connecting to the way I played. I now play very confidently at the show, and am working on other material with the same method.

When I first saw my specialist, I was asked for a detailed musical and medical history. My playing was recorded on a Disklavier while tension levels in my shoulder and forearm muscles were measured and video cameras filmed my overall body alignment with close up views of my fingers. I was guided through a series of basic exercises as well as asked to play repertoire, in particular passages that were causing problems. 

I learned from my specialist that many musicians are unaware of their hand and finger positions. Even those with a good technique often play with high levels of tension that they are unaware of and therefore do not always release properly. Common complaints among musicians are pain or discomfort in the neck and shoulders; excess tension in the neck and shoulders; discomfort in the back; discomfort or pain in the elbow, forearm, wrist or hand; and tiredness.

I also learned that with focal hand dystonia, the symptoms include loss of control of certain fingers. It can come on slowly — for instance, you may notice that a certain technical passage is not as clear as it once was, or that the fingers stumble over certain parts of the passage. Since pain does not accompany the symptoms, they often go unnoticed at first, often dealt with in the old school way of more diligent practice. This only continues to worsen the problem.

In retraining, I worked with surface electromyography (sEMG), which measures muscle tension. The results — along with a video of myself playing — are incorporated into a software program that displays these together for real-time feedback. It was tremendously helpful because I could see exactly when I was holding tension and the position of my hands and fingers! This program is now available to take home. 

I was put on a retraining program, which consisted of weekly sessions with my specialist. It is a slow process, but it is well worth it. Musicians who retrain their technique successfully go back to their playing commitments without problems. Those that are looking for a quick fix are only putting band aids on the problems, not finding solutions. I found the work with sEMG and video very powerful — seeing is believing! 

I’m sure there are many musicians who have dystonia and don’t know it, or have it and are afraid to say so. They should know that help is out there, and that there is nothing to be afraid or ashamed of. 

Paul Loesel is a pianist and a member of Local 802. He can be reached at This article was co-written with Dr. Kathleen Riley.