Question: I have a client who is a violinist and has significant hand and neck pain. His physician diagnosed him with focal dystonia. What is this condition, and can massage be helpful?

Focal dystonia is a neurological disorder that, though uncommon, appears more than we might expect. Dystonia results from processing errors between the brain and neuromuscular system, and its symptom patterns can be mistaken for other conditions. This condition often presents with involuntary movements, such as muscle contractions, tremors, and spasms.

In dystonia, there is a disruption to correct neuromuscular programming that results in motor signals to the muscles becoming uncoordinated, leading to painful muscular spasms. You might think of it like a computer virus or a hard drive crash where the instructions from the central processing center are disrupted. Many times, people report the sensation of muscles “seizing.”

Generally speaking, dystonia is known to occur in people who engage in ongoing, focused motor skills and repetitive movements. Writer’s cramp is one good example. Musicians, too, often struggle with this dysfunction, which has resulted in a recognized variation of the condition called musician’s dystonia.

Focal dystonia is also seen in athletes like baseball pitchers or golfers—both activities that require fine motor control of the hand—and is commonly referred to as “the yips.”

Also called task-specific dystonia, symptoms are localized in a specific area—for example, the wrist, hand, and fingers. Because the condition is task-specific, symptoms may not appear unless the person performs particular actions, such as engaging the fine motor skills needed to play the violin.

Focal Dystonia: What Massage Therapists Need to Know

Symptoms of focal dystonia include loss of coordination, muscle pain, cramping, and twitching. Some people may also experience fatigue, depression, difficulty sleeping, and trouble focusing. The condition can worsen, becoming generalized, with the client experiencing symptoms all over the body.

Currently, the condition is idiopathic, which means its cause is unknown. There may be a hereditary component, but that has not been established. There are other contributing factors to focal dystonia onset, like medications or other substances, and the condition is more common in men than women, although the reason for that remains unknown.

Unfortunately, there is no single proven treatment for focal dystonia. Some of the common strategies used to manage the condition include acupuncture, relaxation therapy, psychotherapy, and other body therapy approaches. Local muscle spasms are often treated with botox injections. These injections can have detrimental effects on fine motor coordination, which seems contraindicated for those already experiencing difficulty in fine motor control.

Some people with dystonia have also found that wearing latex gloves while playing or working can sometimes alter the sensation associated with the touch of an instrument or tool, which creates new neural pathways. These new pathways may override the dysfunctional neurological patterns that have developed and reduce adverse symptoms.

Focal Dystonia and Massage: What Do We Know About the Benefits?

New understanding of anatomy, physiology and pain science point to the real possibility that massage therapy can be beneficial in addressing focal dystonia. More recently, pain complaints are often described as having biological, psychological, and social components.

In focal dystonia, there is a biological component that involves physiological dysfunction in the nervous system, creating symptoms that often lead to significant psychological stress.

For example, when the problematic activity is also the person’s livelihood, as is the case with professional musicians and athletes, for example, people with this condition often feel compelled to continue performing or playing. If the client is an integral part of a group, the impairment can affect others in the group as well (social impact). These stressors can seriously aggravate the condition.

The positive role massage therapy can play in helping clients with dystonia manage symptoms was explored in a 2020 case report.1 For maximum benefit for clients dealing with dystonia, massage therapists may focus their work on the general hypertonicity in the affected muscles and nearby areas. However, because focal dystonia is a processing error between the neuromuscular system and the brain, the gentle, soothing techniques of general relaxation massage may be the most helpful.

Several years ago, I spoke to a pain science physician about the role of massage in helping people better manage pain. He said that massage was one of the most effective biopsychosocial interventions for pain problems because it works on so many levels. Not only are we working to reduce hypertonicity in muscles, but the human touch has profound neurological benefits, as well.

Soothing soft-tissue manipulation helps reorganize dysfunctional neurological patterns. Additionally, the environment we create, such as the quiet room, dim lights, and relaxing music, also help settle the nervous system. So, massage is a beneficial therapy to have alongside other traditional treatments.

Muscular coordination problems in dystonia can also lead to other soft-tissue disorders, such as epicondylitis, carpal tunnel syndrome, or other cumulative trauma disorders.

Reducing tightness in associated muscles and other tissues is important to prevent these further dysfunctions. In the future, adding to existing studies exploring the benefits of massage therapy in treating dystonia would be helpful. Until then, we can continue educating people on the positive benefits of massage that make an essential contribution to treating this disabling condition.

See Also: Can Massage Therapy Help with Tendon and Ligament Injuries?