Dr. Teresa Dybvig, Director

Questions on article about focal hand dystonia and other involuntary movements in pianists

This page is dedicated to questions that arose from my article on habits I have seen in pianists with dystonia, essential tremor, and other, undiagnosed, involuntary movements. The article appeared in the February 2007 issue of Clavier magazine, under the rather unrevealing title, "Moving Naturally". You will probably need to read the article for any of these questions and answers to make sense. I don't have permission to reproduce the article here, but you may be able to find it in your local university or neighborhood library. You can also contact Clavier Companion and ask if they would send you a copy of that issue.

Augmenting the information in the article, I created a poster, Habits Common to Pianists with Dystonia and Other Involuntary Movements, to present at the 2007 National Conference on Keyboard Pedagogy showing many of the physical alignment problems I have observed in these pianists, side by side wth more coordinate alternatives.

This page deals only with the questions I received after the article was published. You can visit this page to read more about retraining and dystonia.

If you have more questions or comments about the article, please contact me. If they seem to be of general interest, I will add them, and my responses, to this page. -- Teresa Dybvig.

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1. I can tell that I have many of the movement and alignment habits you described in the article. Does this mean I will get dystonia?

Answer: No! I have no idea why some pianists with these habits end up with involuntary movements, but I can tell you that many pianists I have seen with these habits have NO involuntary movements -- and some had been playing for decades. I am not saying that I'm sure an involuntary movement will not be in your future. It may be possible for you to consult a scientific study that tells the usual age of onset of focal hand dystonia. The first journal I would suggest you consult to find out is Medical Problems of Performing Artists. While there are no guarantees, you may be able to find out if you are statistically unlikely to develop focal hand dystonia at your age.

I cannot predict the future, though. To be safe, I would consider preventing it by tending to those movement and alignment issues with an excellent Taubman teacher. Your playing can only improve.

Learn healthy movement at The Well-Balanced Pianist
New York
June 2019

2. I didn't understand your diagram of the best angle for the wrist. What is at a 15° angle? Is it the wrist that's at a 15° angle from the arm? A related comment was: I was confused because the two photographs were printed at a 90° angle and on top of one another. It would be more helpful to see photographs of the hand at the right angle, and the wrong angle, side by side.

Answer: First, I want to say that it doesn't matter if you understand the 15° idea or not. The important point is that it is not a good idea to create a synthetic straight line from the inside or outside of the forearm through the tip of ANY finger. It is best to move the wrist within its mid-range of motion. Several situations resulting from trying to force the wrist or a finger into a "straight" line will create unwanted and possibly dangerous tension: molding the hand so any finger is "straight" with the forearm when you look down at the hand on the piano; pulling the hand to the inside so the outside of the wrist is "straight" when you look down at the hand on the piano (the habit of everyone whom I have seen with an involuntary movement), and pulling the hand to the outside so the inside of the wrist is "straight" when you look down at the hand on the piano.

Happily, the natural mid-range of motion in the wrist is usually easy to see: people can almost always discover the natural mid-range of motion of their wrist by letting their hand and arm hang to the side and viewing it in a mirror (without moving it to see it better!). Many people are surprised that neither side of the wrist is "straight." It can be challenging to move to the piano and keep the hand and arm in their natural alignment; it is difficult to discriminate between the natural and the habitual. If you have trouble maintaining the natural, tension-free alignment of your wrist, I suggest you consult a Taubman teacher.

One thing I have learnd from people's questions is that musicians don't know much about degrees or angles! If you think you may be unclear about angles, check out the chart to the right. If you still don't understand what 15° is after looking at the chart, skip to the pictures below! The visual will probably help you understand alignment better than the geometry.

For those of you who still want to know: when viewed from above, the 15° angle is between the second (index) finger and an imaginary line drawn from the inside of the forearm to approximately the length of the long fingers. You will not see a 15° angle in your hand or wrist! The 2nd finger is merely 15° off the imaginary line.

In the first (left) picture below, the 15° angle is the angle between the solid line, drawn parallel to the second finger, and the dashed line, drawn parallel to the inside of the forearm. The point is that the wrist is affected by whether or not we keep the hand in its natural alignment with the arm. The wrist doesn't really pull itself out of alignment; it is affected by whether we pull the hand out of its alignment with the arm one way or the other -- in other words, when we pull the hand toward or away from the body when playing the piano). One reason people pull the hand out of its natural alignment, thus angling the wrist in an incoordinate manner, is a mistaken idea that the second (index) or third (middle) finger should be in a straight line with the wrist.

I want to add that I use this 15° angle only to illustrate natural alignment, and as a problem-solving and attitude-changing tool for teachers and students. The pitfall of keeping track of the 15° angle is that people try to hold the hand and wrist in the "right" place. This is self-defeating. Even if the hand was held in its best alignment, the holding itself would render coordinate motion impossible. Developing a sense of the side-to-side mid-range of motion in the wrist is vastly preferable to putting and holding the hand in the "right" place. Although the 15° angle can be used as a visual aid in the beginning, the kinesthetic sense needs to be gradually developed and refined so it can teach the visual what to look for. Relatedly, the best angle cannot be found with a protractor. The best angle is found by developing awareness of the mid-range of motion in the wrist, where there is no sense of muscular tension on either side. Being aware of the 15° angle helps people open their mind to the idea of not letting a false idea of alignment pull their hand to the inside or outside.

The photographs below show first, a hand in its natural alignment, then three examples of misalignment. Both of these people had involuntary movements for which they had not sought a diagnosis. One of them has been playing without involuntary movements for quite a while. The other's involuntary movement was cleared up a few months after this photo was taken at his first Taubman lesson. Both of these pianists play professionally.

What is a 15º angle?

The angle between horizontal and vertical is called the right angle, and is 90°. So, the 15° is 1/6th of the right angle between the horizontal and vertical.

The small hand of a (non-digital) clock is at a 15° angle from vertical at 12:30.

1. An arm, wrist, and hand in its natural alignment. There is a 15° angle between the arm (dashed red line) and the 2nd finger (solid red line).

2. The same arm, wrist, and hand when the hand is pulled toward the body. The solid red line shows the straight line many pianists with involuntary movements mistakenly hold. You can see that there is more tension in the hand when it's molded like this, than in picture no. 1.

3. The same arm, wrist, and hand when the hand is pulled away from the body. The solid red line is here for reference to the other photographs. I didn't include photos of this misalignment in the article, because this is not part of the basic misalignment that people with involuntary movements share. However, sometimes people with involuntary movements correct their misalignment to an extreme, and this is what happens. They don't want to stay here! This incoordinate misalignment can cause stiffness, fatigue, and pain in the wrist and forearm.

4. This is another person's arm, wrist, and hand when the hand is pulled toward the body (as in photo number 2). Because the photo is taken at a different angle, we couldn't insert the red line. This picture is included because it shows the hand angled toward the body from a different perspective.

3. You suggest to consult a trained professional if I have trouble implementing some of the ideas in your article. I study with a teacher who is a major concert artist, but he doesn't seem to be able to help me. I also consulted a music medicine specialist, who said the best thing I could to was to quit piano now and change careers.

Answer: I suggest you consult a trained Taubman teacher. You can get teacher recommendations by going to the contact page of trustworthy sites like The Well-Balanced Pianist, the Golandsky Institute, and the Taubman Institute.

4. How long does it take to play again after having dystonia?

Answer: This is a difficult question to answer. Everybody's experience is different. As with all retraining, it comes down to clarity of mind and your ability to direct your body. I would set aside a minimum of two years, and arrange to study with an excellent Taubman teacher. If you can manage to free yourself from all other playing obligations, you will probably have greater clarity of mind when you practice, and you will not reinforce old unwanted movements while trying to learn new and different ones. The more frequently you can have lessons, the better you will do. By the time an incoordinate alignment or movement brings a person to injury, the habit is usually very entrenched. Frequent reinforcement and coaching of the new ideas is therefore invaluable. Your retraining may take longer than two years. Some people have taken somewhat longer, and others have taken quite a bit longer. As we teachers have improved, the time it takes to retrain a student with a difficult problem has become shorter, and we are always looking for ways to help people improve faster.

If two to four years sounds unbearable, consider that many music medicine physicians suggest that dystonia is incurable. Compared to incurable (never), even four years is a bargain. I do not want to imply that we ask people to set aside that time casually. No teacher does that. Many Taubman teachers made the decision to set aside time to attend to problems in their own playing at one time, so we know the pain of having a seemingly insurmountable problem, and the pain of being separated from our artistic outlet. Furthermore, if you choose that route you will work very hard during those years. I think I never used my brain as fully as when I was retraining. But you can look at it this way: it's two to four years of increasing understanding of your body, and increasing confidence and hope.

5.Will the Taubman Approach definitely cure my dystonia?

Answer: I am sorry to say there is no guarantee. I can tell you, however, that I only know of one person with an involuntary movement who has been studying the Taubman approach for a considerable length of time who has not fully recovered the use of the hand. I know of several who are playing well, and of some who are on their way to playing well. Incidentally, I would not speak in terms of "curing" dystonia. Since we are not physicians, we are not in the business of diagnosing and curing. Instead, we are in the business of helping people return to their own natural alignment, movement, and balance. In the process, we play better and gradually rid ourselves of unwanted sensations and movements in our playing.

6. Your article has helped me a great deal. I have a friend who also has tension in his playing. I'm going to give it to him too.

Answer: This is very flattering, and I'm glad the ideas helped you. However, your friend should be aware that there are seemingly infinite combinations of coordinate and incoordinate habits. If your friend's tension comes from habits other than those discussed in the article, the solutions therein will not help him. As a matter of fact, the wrong solution could even be painful. If your friend does not have reason to believe he has those particular incoordinate habits, he should not apply the solutions in the article.

Copyright © 2007-2017 Teresa Dybvig