Musician's Health
Musician’s Health
As musicians we decide for music being the center of our lives. Keeping in mind all the beautiful experiences that such a life may imply, it also means meeting high requirements on a life-long basis.
Therefore, we use our motor skills for our musical expression. A complex and emotional process where we do not only aim at expressing the music but also ourselves in an auditive way by performing the smallest possible movements, especially with the fingers, the mouth, the feet and the lower abdomen including the respiration.
There are many factors that might have an inhibitory effect on movement and thereby on our capacities to express ourselves musically. Among other things, corporal habits, instrumental position, instrumental-technical movement ideas, imagination of breath and approach, instrumental ergonomics, exercising and learning habits, mental aspects and situations typical for the profession like concerts, competitions or auditions, may have an inhibitory effect on breath and movement.
If we are incapable of distinguishing beneficial from inhibiting factors, our body nevertheless attempts to meet the challenges following our intentions. Thus inhibiting factors may result in problems where our fine motor skills entirely grind to a halt.
Aching muscles in the area of the back, the neck and shoulders or in the flexor muscles of the arms as well as nerve pain that e.g. may result in tendinitis, are typical phenomena of physical exhaustion in playing and usually represent the end of an inhibiting development.
The reason for this development is that we have to perform complex movements in order to meet the musical demands but focus more on the music itself and less on the way how we play music. This inevitably leads to the fact that we as musicians usually attempt to meet our own and musical expectations over many years of training-based practice.
In doing so, the movements we perform and that are transformed into auditory sounds by our instrument are not paid any closer attention and instead are only subconsciously perceived and lived as part of a sound experience.
In my work with musicians I dedicate myself precisely to this grey area in which music is created and focus on the functional and individual natural ways that enable us as musicians to enjoy our profession for a lifetime.
Lessons in Dispokinesis
- What is Dispokinesis?
Wouldn’t it be nice if the excitement before concerts or auditions had no negative associations because we can rely on our bodies and the particular situation would only offer the tendency to surpass ourselves.
If there was no pain or no disturbances in the movement sequence at all and if we could entirely indulge in music?
In his work with musicians, Dutch pianist and physiotherapist Gerrit Onne van de Klashorst noticed that effortlessness in fine motor skills can be experienced most likely when the person is capable of staying with their own individual and natural movements – also in complex movement material.
In the 1950s, van de Klashorst developed Dispokinesis with its “Exercises in the Primordial Forms” in order to be able to reproduce the fundamental movements humans are capable of. Looking for a way in there to let adults rediscover the ease and to meet the more complex movement requirements necessary without giving up on individual motor skills.
Dispokinesis is a fashionable word creation for the time from two different languages and refers to the disposition theory of Gerrit Onne van de Klashorst. First, the Latin word “disponere”, which is often translated as “to dispose freely of”, but in a broader sense for van de Klashorst means that the practicing artist can “dispose freely” of his/her inherent abilities on the instrument and thus of the necessary skills as well as the expressive ability.
The second part of the word comes from the Greek “kinesis” and is the more precise definition that first of all the “movement” of the human being is in the center of attention. Thus, the literal translation is: free disposal of movement.
Gastaltenlehre and „Übungen in den Urgestalten” according to G.O. van de Klashorst
The word “Gestalt” is a term frequently used in various sciences, which is defined differently depending on the scientific focus. The definition can range from a purely external form and appearance of living beings and sculptures to their presence and effect on their environment, as well as including the perception of the environment and self-perception.
In 1940 the physician and philosopher Viktor von Weizsäcker wrote his main theoretical work “Der Gestaltkreis. Theory and Unity of Perceiving and Moving,” which played a large part in shaping Klashorst’s conception of “Gestalt.” Within this model formulated by Weizsäcker, the connections of perception and movement between humans and their environment are analyzed.
In this regard, Rainer-M. E. Jacobi writes:
“With the ‘way of thinking in the Gestalt circle’ is then connected not only a new picture of man and his reality, but a new picture of the world as a whole, that is, also of the way in which we humans belong in this whole.”
G.O. van de Klashorst, during his work as a physiotherapist and musician, shared Weizsäcker’s opinion and adopted the concept of Gestalt from “der Gestaltkreis” in his designation “Urgestalt” and thereby placed the reality of musicians in the focus of his attention and asked himself, what then unites the human being with all individuality. What makes man unique in his form on the one hand and at the same time connects him by nature.
For Klashorst, the answer is standing upright and walking on two legs.
But since man cannot stand and walk from the beginning of his life, this must be the goal of a development that makes it possible for man to gain experience in order to be able to make meaningful use of the advantages in posture and movement that the human body offers him in his target form. Van de Klashorst was able to observe the individual steps that are the content of such a development in small children. What is astonishing is that these are experiential and developmental steps that each child performs independently without intellectual instruction. Because of this fact, van de Klashorst did not question this process, but came to the conclusion that every child has an inner knowledge that leads it to follow the right path for itself. Worldwide, for thousands of years.
G.O. van de Klashorst has called the figures in which man makes his first movements in order to make contact with his environment and which are necessary for him to be able to assume the posture typical of man “Urgestalten”.
They form the basis of human posture and movement and are divided by van de Klashorst into 3 postures. The lying, crawling and sitting. An important aspect is that the posture happens before the movement, because it supports the movements made from it for stabilization and energy against the earth’s gravity. It thus influences the feeling of movement, the quality of movement and the amount of force needed to perform the movement.
In order to be able to comprehend the basic movements that man is capable of as an adult again and which are necessary to meet more complex movement demands without giving up the individual motor skills, van de Klashorst has developed the „Übungen in den Urgestalten“. They reproduce the basis of human motor function and postural alignment. The meaningful and goal-oriented execution of the exercises in the Primal Shapes enables the re-experiencing of the erection reflexes and the first individual nature of the human being.
Thereby an actively perceptible encounter with muscular compensations and stereotypes, which are executed subconsciously during higher movement demands and resulting overloads, can be realized.
According to van de Klashorst, it is not the body that is trained in the exercises, but the mind that guides the body. This means that an exercise is performed a maximum of five times, rather three times, since the body already begins to guide a movement subconsciously from the fifth repetition and can thus fall back on or create problematic patterns again. Then movements are performed involuntarily and the person has no possibility to perceive and control the reactions of the body. Since the goal of the exercises is the achievement of one’s own individual nature from which one can meet the complex demands of movement in making music, there is no generally valid form of the body, no maxim that must be achieved. The function of the body and the intention to perform movements with the greatest possible ease form the core to experience one’s own individual nature again. The only instance that is of help to the human being is the same instance that he already used as a child: The feeling.
- Counseling and help with work-related tension, pain and playing problems
- Lessons for the development of preventive skills and self-perception
Pain is usually the last possibility of our body to signal an imbalance to our consciousness that affects the painful region. If no change is made to correct the issue, or if we only try to relieve the symptoms that is the pain itself, even greater problems may arise which as musicians can deprive us of the basis for making music.
Nevertheless, pain is an everyday occurrence for many musicians and it is not uncommon to occur already during studies. The usual way to stop such a development is to take a break from playing for several days, weeks or even months hoping the painful region will recover. However, the cause of the problem usually remains and, when musical activity is resumed, only leads to the reappearance of the habitual pain.
In order to take the chance to step out of this vicious circle and to experience music again as natural mean of expression, it is imperative to determine and perceive by oneself the actual cause of the problem as change can only happen when one is able to recognize and acknowledge these inhibiting patterns.
- Optimization of the players posture, movement control and instrumental ergonomics
Central to the work with musicians is the analysis of the habitual disposition while playing. As every human being is individual there is no judgement of right or wrong but an evaluation if the interaction with the instrument might be problematic. Therefore, an optimal way has to be found individually for each musician in order to express oneself freely and naturally with the instrument or the voice.
Furthermore, ergonomic support provides the opportunity of an optimal adaptation of the instrument for each musician.
- Re-education for movement disorders up to focal dystonia
Movement disorders that occur involuntarily, i.e. not consciously controlled, during a defined activity such as making music and thus represent a form of loss of control, can arise for a variety of reasons and are usually the result of problematic and inhibiting postural and movement ideas as well as implementations that have been used for years during the corresponding activity.
The symptoms are to be defined instrument-specific according to the respective movement demands of the musician and can therefore range from embouchure problems of wind instrument players caused by tension in the lip muscles to splaying fingers, which is applying to almost all instrumentalists. Depending on the severity of the symptoms, the movement disorder cannot only make the professional practice difficult but even completely impossible.
The re-educative process first of all involves giving the musician the opportunity to understand the cause of the movement disorder. For this purpose it is necessary to let the musician experience the complex movements of making music again from scratch and this time more consciously, in order to contrast inhibiting movement ideas and movement approaches with an easier and more natural way of making music for the respective musician.
In very rare cases the cause of a movement disorder may be pathological.
Focal dystonia, for example, is a neurological disorder that manifests itself in symptoms like involuntary cramps as a result of excessive muscle tension during movements used intensively over a long period of time and is mostly regarded as the most serious movement disorder of musicians. Since the symptoms can occur very differently instrument-specific and individually with musicians, medicine differentiates meanwhile in between different, more exactly defined terms as for example: Inhibitory dystonia, spasmodic dystonia, dystonic cramp and more.
Based on my own experience, I emphasize on the management and re-education of focal dystonia. In my assessment of a suspected symptom, the medical report of a neurologist is required for further working with the musician as in addition to dystonia other neurological diseases can also be considered as cause.
For a first impression you can view my testimonial to understand that I am familiar with the far-reaching consequences of such a diagnosis.
Initial interview
The initial interview is obligatory for working with musicians and does not serve to get to know each other only but also to review their motor limitations. In order to be able to put these in context with the work and life reality of the musician, a more in-depth conversation about the individual handling of the instrument is necessary.
This includes among other things:
- Practice habits
- Working conditions
- Challenges in everyday life
- Physical limitations
- Development at the instrument (musical career)
Up to a closer look at the own movements on the instrument, such as:
- Disposition at the instrument
- What does the musician actively perceive in terms of movement?
- From where is the movement initiated?
- What are the present thoughts?
Testimonial Focal Dystonia
Preface:
The following text contains a small unembellished insight into my experiences with the disorder of focal dystonia and is intended to provide other affected musicians with anonymous information and also to indicate that the diagnosis does not have to be the end of the musician’s career.
It is also important to acknowledge that the severity of the disorder can vary greatly and that my experiences do not apply to everyone in their respective scope of consequences.
Summary:
In May 2012, I was diagnosed bb Eckart Altenmüller at the Institute of Music Physiology and Musician’s Medicine in Hanover, Germany, with a neurological nerve disorder that manifests itself in involuntary cramps during long-practiced movements and is referred to as focal dystonia. 5 months earlier while practicing on January 2, my right hand had pressed into the strings of the guitar and cramped to such an extent that I was only able to release the cramp with the help of my left hand.
In the following 8 years I had to relearn my motor skills as the dystonia not only affected my guitar playing but also occurred at the mere thought of playing and thus affected everyday movements that require some form of fine motor skills such as writing, shaking hands or stirring a drink with a spoon among others. Starting in 2012, I took my first lessons in Dispokinesis with Joachim Schiefer in Wuppertal and from 2016-2019 I completed a post-academic training course in Dispokinesis at the “Society for Dispokinesis according to G.O. van de Klashorst”. Since the end of 2020 I am again able to move freely on the guitar and to make music.
Detailed report:
On January 2, 2012, while practicing, I had increasing problems using the pick to play the strings of the guitar while performing small movements. Looking down at my hand, I noticed that the ball of my thumb was pressing into the strings, the pick was pulling the strings away from the guitar, and my middle, ring, and pinky fingers were stretched out and turning away, putting more tension on the ball of my thumb. The tension in my hand was that intense that I lost the pick from my thumb and index finger without being able to influence it arbitrarily. If it had not been for the ball of my thumb hurting from the strings and the fact that I could not play a note anymore, I would not have been aware of the movement and the stiffening of my hand. Only after I had released the right hand from the strings with the help of my left hand, I was able to actively influence the movement again.
Of course I tried to play the guitar again afterwards but the result was always the same from then on. In the following days I managed to play a few notes but the focus was not on meeting any musical requirements yet simply hitting the strings at all. Sometimes I did not even manage to play a single note or two. The control over the movement faded at first right before the contact with the strings, after a few weeks even at the thought of playing the guitar itself. In order to get into contact with the instrument at all with the pick, even if it was only to touch the frame, suddenly cost full concentration and eventually resulted in the hand turning away involuntarily. I was hardly able to calm down the hand and letting go of the instrument without intervening with the left hand.
Later, the thought only was already enough to trigger similar effects on my motor skills during other activities. Turning a spoon in a cup became a torture. My handwriting and especially cursive writing, something I never had had problems with, changed in such a way that I started to write in capital letters only with as few curves as possible. A quick signature – completely unthinkable. Any activity that involved a little fine motor control could be torpedoed by the problems.
Even at that time, I still had the hope that it was a strain that would recover if I only took more breaks. And so I did just that. And then, because there was no change, I took no more breaks. The search for the cause could not have been more absurd, from leisure activities to meals, everything was questioned and tested but nothing helped. If it happened on one day that I was able to play a few notes or rather just touch the strings, this already put me in a high and a hope that the next day or a moment later it might work again, and develop from there.
Around March 2012, I contacted a medical doctor with a focus on musician’s medicine for the first time and described my problem, saying that I was able to play a few notes every now and then. I had hoped to be told that such an issue was well known and that I was the only one who had not yet heard of it, and that if I managed to consciously touch a string four times, I would have already had the worst behind me. Unfortunately, they did not tell me that yet stood by my side in my search for the cause of the problem and so it seemed – since I had to take a daily tablet due to hypothyroidism from 2011 onwards – that a possible cause of the problem was quickly found. After consulting my family doctor, I stopped taking the medication even though a recovery from my issues in playing in this context would have been unique. I had hope something would improve. And indeed, now and then I managed to touch a string with the plectrum two or three times on some days, which was the case before and after as well. Yet, in a situation in which I myself subconsciously perceived my body was involuntarily performing movements that I could not control, could not conceive or even comprehend in the least, and when you are at the mercy of the situation before you actually realize what is actually happening – every straw is something to cling on to for as long as you can.
In May, I had to acknowledge that the effects were rather getting worse than better. The fact that you cannot feel anything and watch yourself lose control, no matter how hard you try to mentally put yourself into the movement, made me furious. As if I was running against an invisible wall.
Again I contacted the doctors with a focus on musician’s medicine and was referred to Hanover, with the hint that there is a disease called “focal dystonia” which could be the cause of my problems and whose diagnosis should only be made by the colleagues in Hanover. A few days later this assumption was confirmed in Hanover. Up to this point I had still not been able to fully comprehend the name of the disease because I found it absurd to have something like that, as I thought after all that with a lot of luck I could hit the string with the pick a few times and I would be able to fix it.
At the latest when I was advised to put aside not only the career as a professional musician but also to forget about guitar playing in general as the center of my life due to my still young age and to look for something else because an improvement of the symptoms seemed to be hopeless, I became aware of the dimensions of my problems.
Focal dystonia is a neurological disorder which is characterized by involuntary spasms as a result of excessive muscle tension in movements that are intensively performed over a long period of time. Since the symptoms may occur quite differently instrument-specifically and individually with musicians, medicine differentiates meanwhile between various more exactly defined designations as for example: Inhibitory Dystonia, Spasmodic Dystonia, Dystonic Spasm and some more. Fighting the symptoms only made no sense to me as I did not want to become dependent on medication or injections, and if the cause remained, the situation would not have changed. So I had to realize later that the cause could not be remedied either because synapses in the representational finger areas in the cortex were irrevocably linked and thus strengthened with every execution of the movement.
The natural and intuitive way to music was closed by the dystonia and it was painful to observe that nothing seemed to change to the better but the symptoms gained more and more power.
True to the motto “those who don’t fight have already lost”, I began to research the Internet to see if there was a possibility to at least dare to try and find a way to be able to make music again. In my opinion, there is an astonishing amount of information about such a little-researched disorder in the editorial-free space of the Internet. Much of it is not consistent with the information I have received from the leading physicians, and most of it remains so vague that the pure information in the content is more speculation or, with variations, always takes the same text as a source.
Then there are many possibilities of help. There is mention of the concept of work, trying out and even vitamin D is supposed to play a role, but experiences? At least with and from other musicians with such a diagnosis?
There is mostly used the conjunctive and there is so much help offered that it leads to the assumption that every second musician has a dystonia and the disorder is not as rare as I heard in the musician medical institute in Hanover.
Or one tries to advertise something that sounds too good, is often described as a “worst case” and thus one can sell something to the outside world and try to present a competence in an area that one does not have and whose scope and effects one never experienced but lists for advertising purposes. A disgusting principle of which I did not want to become a part of nor a victim.
I got in touch with Joachim Schiefer, a cellist from Wuppertal to whom the same had happened and after 7 years of learning to play from scratch, is able to make music again. In his studio for musician motor skills and instrumental ergonomics he has since been helping musicians who have been limited in their ability to express themselves musically due to various problems.
It helped me already immensely to talk to a person and did not have to explain how it feels to watch yourself unlearn your musical skills. Not to mention the psychological state of mind and unemployment as a musician.
Since dystonia is not curable in the conventional sense, there is the possibility of relearning one’s own motor skills and thus the movements necessary to make music, and finding a way to perform movements without triggering the dystonia. This means having to relearn movements that have been trained and unconsciously used for years and decades in a new way that is you first have to become aware of those in order to then bypass them by new movements. Since language is not sufficient to pass on an experience, can you imagine scratching your own nose with your index finger without even knowing how the index finger should come to the nose? Any way of bringing the finger to the nose triggers the dystonia as the movement is based on the same ideas and experiences. To imagine something that is beyond one’s own experience and to perform something that is beyond one’s imagination is impossible. So you have to give your body the opportunity to gain experience, to perceive new stimuli, to make it clear to your brain that there are other, easier ways to reach the goal outside of your own frame of thinking. And this in every movement: From scratching the nose, to shaking hands, to stirring the spoon in a cup of espresso, to the highly complex movements of making music.
Joachim Schiefer had told me about it but I did not know what that would mean exactly.
I first gave myself one year in which I would successfully circumvent the dystonia in order to then be able to make music again like a phoenix from the ashes. In the first few months I realized that this plan was more foolhardy than realistic. The dystonia was noticeable even without an instrument in the most rudimentary movements and the relearning of my motor actions was more holistic than I had imagined.
In the end it took 8 years when relearning became the center of my life. Another one to regain confidence in working with the instrument and my own abilities, to be able to intuitively rely on my body when making music. Each movement had to be experienced in every possible way. From imagining the movement, to preparing it, to its performance. It makes a difference to think of one and the same movement from different perspectives. Not for fun because you had time and nothing better to do but because it is necessary to understand the movement in its entirety. The dystonia has never been foreseeable, nothing that was imminent or graspable with one’s own cognitive abilities. But everything around it could and had to be experienced.
The pathway is not easy. In such a long period of time, life goes on and the psychological pressure does not decrease because the progress is just not continuous or foreseeable. You are engaged full-time in working out the possibilities of someday moving again without dystonic symptoms and it does not help to put your head in the sand, hoping someone will help you out of the holes you fall into. You have to become active yourself and undergo the experiences you need to make progress. It can also happen that you think you have made progress and after three weeks or three months the dystonia comes back and closes the pathway. Again an experience, again something learned.
When I write progress, I mean above all a change in perception, which in the best case leads to a change in execution. Progress is not at all visible to outsiders and great progress, if at all, it is hardly visible. Joachim Schiefer was able to see it because of his own experience, he was able to put himself in my place and to offer me the necessary help at the right time.
A process that lasts so long requires openness, patience, humor and courage because you will have to deal with yourself over and over again, and in doing so you always and repeatedly reach your own limits. Yet, it also provides the opportunity to experience the interaction with the instrument and your own music anew.
Today, playing the guitar and making music means freedom for me. Before the dystonia, I was not able to differentiate whether I pick up the guitar out of desire and enthusiasm or out of habit and external pressure. Whether I play to practice or practice to play.
In retrospective it is quite amazing how much the body is capable of controlling subconsciously, just to help me have my way. Experiencing and questioning this subconscious control has shown me that the body usually activates more power than necessary and thus more muscles than actually required. To be able to experience how liberating and easy it can feel to produce a sound on an instrument because you can feel and control exactly when which movement is initiated from where and the body can also learn not to play it safe in a reflex but to do only what is necessary to create music, has helped me to see my instrument as an extension of my body.
Would I choose this pathway again?
Probably yes. The decision to put music at the center of your life cannot be explained in a rational way as little as can the decision to fight for it. The experiences I was allowed to have in the last years in dealing with my instrument go unfortunately beyond the experiences you make in the studies and I would not want to miss them because I know and feel now from my own experience what exactly I do and do not do. Since I am able to perform fine motor movements with ease, formerly training-based movement sequences nowadays happen so effortlessly in their complexity, speed or repetition that I often find myself smiling in disbelief while playing and simply being happy.
Experiencing music as an easy, natural, consciously active rather than a subconsciously trained way to express yourself is becoming more and more of a privilege today.
