David Leisner: On Overcoming Focal Dystonia and Learning to Play With Ease

Noa: [00:00:00] Given your multifaceted career and experiences, we probably could spend a whole afternoon or whole evening talking about a whole range of things and end up with a handful of different podcasts on composing and performing aspects of your life, teaching aspects of your life. And so on. But, but as you know, the topic that I was really curious to explore with you is your experience with focal dystonia.

Because I think that's something that a lot of folks aren't especially familiar with even nowadays myself included aside, maybe from knowing that this is what led to the long performing hiatus for pianist Leon Fleisher. And it does seem to be something that affects. Not an insignificant number of musicians nowadays, in your particular case, I read that it manifested first as a loss of speed in your playing and that you and that you practiced increasingly carefully, but as you did, so your hand responded less and less.

And so I wondered if maybe a good place to start. Would be, if you could, first off, just tell us a little bit work focal dystonia is, but then specifically how it began to affect you and how you started noticing something was amiss.

David: [00:01:09] focal dystonia is a condition where, first of all, it's, it's the only painless condition that, that musicians experience.

and it's a condition where fingers curl into the palm. Uncontrollably in some people's cases, they extend away from the palm, either in conjunction with the curling inwards or flexing inwards, and sometimes just only extending away, but, virtually everyone who has focal dystonia, in their hands, has this curling in.

What I experienced as you said at first was a lessening of speed. and then what happened... that was, toward, I think the spring part of 1984, a long time ago. And, in that summer, beginning of the summer, when the performing season was done, you know, I had fewer, tend to have fewer performances in the summer. I started to investigate more closely what I was doing and by doing so I would be watching my right hand, very closely hanging my head down, watching what my hand was doing. And of course, knowing what I know now, that was the dumbest thing I could have possibly done because all the big muscles, all the important muscles that where the functions of the hand originate are in your neck and upper back.

So by leaning my head way forward like that, I was just contracting everything in all the important places and it immediately got worse. And what happened, what started to happen at that point was a clear curling in of the fingers. The flexing inword of the fingers, it was very, very clear. I don't know how much more you want me to tell the story or whether you want to put in questions here, but... should I just keep going?

Noa: [00:03:11] I don't want to stop you if you're on a roll, but, but I am kind of curious to ask what you meant by lessening speed. I mean, was it, did it feel like a sluggishness or like a lack of fluidity or an increase in tention or like, is there a particular quality to it that you noticed?

David: [00:03:26] Well, you know, this was, almost 40 years ago, so, hard to, to recall it. Exactly, but I, I think sluggishness is a good word for it. As I remember. I know that I was playing a lot of very demanding virtuosic repertoire at the time, all in the same program. And one of the pieces that I was playing with it, were the 12 etudes of Heitor Villa-Lobos. Those etudes are extraordinarily demanding.

And if you don't have your technique in tip top shape, It's just not the same, they're just not effective. And so what I was finding was say, playing etude seven, which has fast scale passages in it, the skills would be fast, but not real clean. And they weren't real clean because of that sluggishness that we're talking about.

Noa: [00:04:25] And sorry to keep interrupting you, but, but is this something that happened in the practice room also, or primarily on stage?

David: [00:04:32] Oh, definitely in the practice room. Yes, both. Actually onstage. I don't remember it as, at that point in that Spring as being overt, it was something relatively subtle and I would notice it in practice, but didn't....

I wasn't extremely concerned about it in concert. I knew something was up, but I wasn't extremely concerned. I was extremely concerned when the Summer came around and my fingers really started not cooperating. And then I knew I was in deep trouble.

Noa: [00:05:09] Maybe it's hard to remember, but I guess I'm curious when you started to get a sense that, that this was not something that practice was going to address.

David: [00:05:21] Oh, I, well, I pretty much knew almost from the start that that was the case. It seemed like there was something, it was, there was some sinister thing that was doing its thing to me. I mean, I was hoping by observing as I was describing to you, I was hoping that I'd find a way out of it, but I, I think fairly soon the more that I did, the more I was thinking, well, this is really, really bad.

And I didn't know the full extent of that until I gave my first concert in the Fall. Which I remember was in Portland, Oregon, and the first half was a bunch of difficult repertoire. I don't remember exactly what, but at the time I was playing the Bach Chaconne and Phillip Glass, Knee Play from Einstein on the Beach.

And, and the Ginastera Sonata may have been that those things were on the first half and the second half with the 12 Villa-Lobos etudes. So somehow I managed to get through the first half fine on that concert. But in the second half of the concert, I think as soon as I started the first etude, my fingers went haywire.

And in fact, I refingered the entire set on the spot. You know, normally one with a guitarist plays with thumb and three fingers, not the, not the little finger. And I was suddenly playing with thumb and index fingers. Everything in those 12 etudes, it was an incredible feat. I don't know how the hell I did it, actually.

I really don't. And when it was over, people came up to me and congratulated me. They said they loved the concert. I just wanted to burst into tears. I, I was, I was in terrible shape because I knew I was done for awhile. I just, I just knew it. But on the other hand, you know, I was able to play well enough to fool people, so to speak.

It was clearly not possible to play that way. And then at that point I was canceling concerts one by one, trying, you know, to cancel the next concert or two, but maybe I could find somebody who could help me get out of this in time for the third or fourth concert down the line and so on and so forth. So I, I, I think the first person I turned to, was a man named Pat O'Brien.

I went to Pat because I thought I knew that he knew a lot about the body. And I didn't know exactly what I had. I didn't know that it had a name, but, and I don't remember that he knew either, but he was, very convinced that it was one thing. And worked very strongly with me on that one thing.

And I was real good about doing what he told me to do, but it clearly was not the right answer. And that was the beginning of many different people that I went to over. I think four or five years after him, I saw a chiropractor. Then I looked, for biofeedback person a medical doctor, Dr. Bijani who worked for NYU. And it went on from there. I went to various Eastern and Western medical practitioners or practitioners. I tended in general to trust the Eastern practitioners more. I, my intuition told me they knew more about these kinds of things than the Western, the, the hand doctor that I went to knew the least of anybody.

And that didn't surprise me. But at the same time, none of the people, including the Eastern practitioners really were able to help me. I went to an acupuncturist. I went to... so many people, clinical kinesiologist, myotherapists the same person who saw Leon Fleischer in Washington. And, you know, all of them gave me to understand that they could help me at least on some level.

And I was a good boy. I tried, you know, to do everything they told me to do and nothing worked. And so every time I went to somebody, my hopes, you know, rose to the skies and then dashed to the ground every single time, every single time. So after five years of this, I felt like a very spent rubber band.

And, I couldn't, I couldn't do it anymore. And by this time, of course, I had a name for it, focal dystonia, and, most people, in the performing arts medicine business, or the various practitioners that I saw, if they knew about focal dystonia, they considered it incurable. So my feeling was, well, why should I waste my time going to see people who feel this incurable?

So I just stopped seeing people for a long time. Well, stop seeing people, period. And then there was a while when I just did nothing, just kind of living with it and contemplating, what am I do? I did at some point in there begin to play with my thumb and index fingers. I never said, actually that the effected finger are the most important, effective finger was my ring finger.

The secondary finger involved was my little finger, my pinkie, and also sometimes my middle finger would curl in as well. So there were two and a half fingers, so to speak that were affected. So when I was decided to play with thumb and index fingers, I realized I could play quite a bit of the repertoire and fudge it in some way I could, I could, you know, certain arpeggios just didn't work at all.

But if I sort of reversed a note, a couple of notes in the arpeggio pattern, then I could work my way around it with thumb and index. And I just kind of cleverly found my ways around it and ended up playing some very, again, difficult pieces, like Paganini Grande Sonata, and the Richard Rodney Bennett Sonata, which remains to this day a very difficult piece for people.

And I honed it down and after a while maybe a year or so. I actually had the guts to, to go and give a public performance. I was teaching at the time a t the New England Conservatory, making the commute from New York. And I did my redebut with two fingers in the beautiful Jordan Hall that New England has and got a spectacular review from Richard Dyer at the Boston Globe.

And once again, you know, I really was fooling people, but I was able to satisfy my I heart and soul by being able to play music again, I should say that, you know, during all this time I had had the good fortune of also being a composer and I, my composition career kind of took off during this time and that allowed me at least to feel like I was continuing to be a musician. I hadn't lost my musician identity totally. But I had, of course lost my guitar, playing identity. So playing with the two fingers and even then performing again with two fingers then gave me the feeling like, Oh, maybe I can do this. You know, maybe I can even play on a professional level.

So I'm going on and on. I hope you don't. If you have questions, just jump in.

Noa: [00:13:41] No, that's fine. This is good to get your kind of the arc of your story. I am curious about what it is that you started discovering on your own that led to being, because I mean, one thing that I'm honestly curious about is whether you discovered.

That you were maybe overcompensating or compensating in some way with increased tension elsewhere. It sounds like you didn't get hurt or anything as you were playing with two fingers. But, but yeah, I'm curious about that. And then also what led to you to discover this. This other way of playing that, that actually seems to make more sense, perhaps.

David: [00:14:16] Yes. Well, more or less concurrently with this playing of the two fingers, I had the beginning of an idea, which I had gotten from a colleague at New England Conservatory. He had just begun to think about the issue of playing with larger muscles in the right hand. And so I was watching a class that he was teaching at the school and he was telling the student to do these very large exaggerated motions to strike the string.

Just, you know, starting from way far away from the string and sort of striking the string with the big lever, so to speak of, the elbow to the fingertip that that was a way of accessing larger muscles. And it was just the beginning, and this colleague, Neil Anderson was also just really at the beginning of these ideas.

And interestingly enough, he quit teaching not long after that. So he never developed those ideas himself. He went into something completely different. He went into, I think, a computer business to make real money, you know, but, I took the ball and ran with it because what happened was, as soon as he was demonstrating this and the student was doing it, a light bulb went off in my head.

I thought this is definitely something. That I can use somehow. I don't know how. So I went home and I started swinging in that way, at the guitar plucking the string, and I swear it within five minutes, my ring finger was suddenly able to pluck a string almost normally. I mean, I can't say I was cured far from being cured, but I wasn't able to do anything like that because.

If you can understand that. At this point, I had reached a point where the, the focal dystonia hadn't deteriorated so badly that I couldn't even place my hand at the string or near the strings without the finger starting to curl into the palm. So when I was in these moments at home, able to strike the string with these exaggerated large movements and not have the finger curl into the palm.

It was astonishing. It was an astonishing moment. I mean, tears were falling. I mean, I was just, it was an unbelievable moment. And of course I knew I wasn't cured, but I knew that I was onto something. So from that moment, began the process, which took four years for me to cure myself. And basically what I did was I used the knowledge that I had of anatomy, which I had learned quite a bit about from the various practitioners that I had seen over those five years. And probably even more importantly, I used my intuition, my physical intuition, which strangely enough is really good. Obviously wasn't good about something because I had focal dystonia, but in every other way, my physical intuition about playing was very good and had been proven very good.

A number of the people that I had seen over the years when they watched me play, they said, well, your technique is anatomically perfect. So, and at that point, I really didn't know a lot about the anatomy. I was just following my instinct. So. That was the instinct that I used from this moment when I was engaging the string with these large, exaggerated gestures to the time that I cured myself completely, I just followed my instinct.

I had no idea what I was doing. I had no idea if I was heading towards a cure, but I knew that the more that I worked, the better it was getting. So basically what happened was. About a year from that initial eureka moment. My middle finger, which was the least effective finger was curling in much less than almost disappeared.

That, that issue another year. And my pinky finger stopped curling in. Another year the ring finger was mostly better, but not completely better. And one more year, and it was a hundred percent. There was no, you know, one day when I said, Oh, I'm a hundred percent. It happened over time. But I knew by the end of Summer, 1996, that my hand was completely better.

And I didn't sense that I had any danger of relapse. Again, it was intuitive, but it seemed solid. So what happened in those four years is that I took that simple exaggerated idea and I refined and refined and refined it going into more and more nuance understanding as I was working the subtle and sometimes incredibly subtle things that I might do in order to.

Engage those large muscles better. And I didn't exactly know what large muscles I was aiming for, but I sensed, they were somewhere up in the area of the neck and shoulder, maybe even into the back, but I hadn't didn't really know. And then right around, I think it, I think it was about a year before I was a hundred percent cured.

It must've been '95. I began to understand that the muscles were in the armpit, deep in the armpit in the middle of the armpit. And I asked a doctor friend. What muscles are in there. And they said, well, there's a lot of complex, there's a complex web of muscles in there. It's hard to really know what exactly is there.

But probably said, you're talking about the intersection of the terres minor muscles, which are crescent shaped, smaller muscles. Or medium-sized muscles in the back, upper back and the latissimus dorsi muscles, which are the muscles that go up your side of your back that weightlifters use a lot.

So, so that was interesting. Didn't necessarily change what I was doing, but I had more of a definitive sense of which muscles they were. And about a few, just a few weeks later, I happened to have breakfast with the guitarist Pepe Romero. Great, legendary guitarist, and Pepe, as it turned out, as I discovered during this, meal had some experience,with focal dystonia, but not with himself, it was his father and it had happened much earlier in, in their lives.

And his father had apparently had focal dystonia or something, very similar and Pepe who also has great intuition about these things had worked with him and figured out that there was a spot in the armpit where everything was coming from. And I said, no. I said, show me where. And he came over from the other side of the table and put his finger right in the spot that I had pinpointed.

So we had reached the same conclusion from completely different places. I thought that was a kind of a remarkable, confirmation of, of this work. And his approach to this day with focal dystonia is different than mine. But again, you know, like the old zen saying that many paths to the top of the mountain, but the view from the top is always the same.

We had found the same view, we had found it. So. Anyway,

Noa: [00:22:53] I wonder if you could say a little bit more about the importance of the large muscles relative to the small muscles and maybe also illustrate or not illustrate visually, but, but also say a little bit about what it is that you now know that you were doing, that that may be led you down the path to where you ended up.

David: [00:23:13] Yes. So large muscles, as I've discovered must support what the smaller muscles do. And when I say smaller muscles, I'm talking about the muscles in the forearm, there are some muscles in the hand, no muscles, of course in the finger at all. But mostly the small muscles are in the forearm. And when musicians think about small muscles, if they think about them at all, they think of them as in the hand, they might think that larger muscles are the forearm, but that's just the beginning of the, the muscle trajectory as it were.

And it goes up into the middle arm, which is between the shoulder and the elbow joints. And, the, the arm actually begins at the sternoclavicular joint, which is where the sternum meets the clavicle, where the breastbone meets the collarbone. So that, that's where the upper arm is, but the larger muscles that I'm talking about, as I mentioned, reside in the armpit and it's very, very important to use them.

And for every instrument it's different. I'll give you some examples for the guitarist the right hand is completely different than the left hand, the right hand being the plucking hand for most people, left-hand being the fingering hand on the fingerboard. Some people of course are left-handed and it's reversed, but that's the basic thing.

The people for the people who have dystonia in their right hand need to engage the large muscles almost all the time. Whereas the left hand only requires the largest muscles that are appropriate for each action. That one must do in order to, to use the left hand on the guitar. There are three actions.

One is very simply. One is to get the finger to the fingerboard. The next one is to put pressure into the fingerboard. The third is to try, is to go from finger to finger. So getting to the fingerboard, these are I'm going into some detail because it gives you a sense of the difference. The nuance of the difference.

And then that also relates to the other instruments. So to get to the fingerboard one should not use the largest muscles, which would involve a sense of weight on the fingerboard because, if you use those larger muscles for that, you will then tend to squeeze the neck. Between the thumb and the fingers, which then force you to use smaller muscles and give you a lot of soreness in your hand, or can lead to focal dystonia.

When you're putting pressure into the fingerboard, you're using a little larger muscles, which actually kind of come from the armpit and it's, it's a motion that I described to people as a kind of a pushup feeling where you're pushing down into the string and pushing away from it at the same time.

Just like when you're doing a pushup, you're pushing down into the floor. But you're pushing away with your body at the same time, that's using larger muscles to get pressure on the fingerboard. The only time that you really use the full use of the large muscles is when you're going from finger to finger.

When you wanted to transfer the weight of the arm from one finger to the other. So that in a nutshell, Is what a guitarist needs to think about for each hand. Now you talk about a pianist. The pianist's approach, for example, is more like the left-hand of the guitarist's. Although when they drop their arms to the fingerboard, they need to drop with the full weight of the arms and for a pianist. It goes into the back and down into the lower back and again by doing so that helps support the smaller muscles when they want to move from key to key, let's say from white key to black key, that same thing when you're typing on a, on a keyboard, most people tend to use the smaller muscles.

And that in piano technique is very much like Glenn Gould technique, which, Glenn Gould was a genius in many ways, but his technical approach was disaster. And so many people have imitated him instead of imitating the great players from earlier in the century who knew all about large muscle technique.

They all talked about arm weight all the time. And that had been forgotten in the middle decades of the, of the 20th century. And now I think people are coming back to the old school, so to speak the school of, of using the arm weight, but then going from finger to finger. But there is something that's a little bit less than full, a full large muscle use that has something closer to do with the left-hand of the guitarist. And when you put pressure into the string, it's exactly like the, the pushup pressure of the guitarist. That same idea, push-up pressure, applies directly to wind instruments, where they have to push down a key.

If they're pushing down with that pushup feeling, then they're using larger muscles in conjunction with the smaller muscles and for a focal dystonia suffer, they have to use the large muscles as exclusively as possible. It isn't always a hundred percent possible. With a percussionist, for example, there's a dropping of the weight of the arm and there's a stabilizing of the wrist, which is also there with all the other instruments that allows you to access the larger muscles.

So these are all aspects of applying the large muscle concept to each instrument and every instrument is different and some instruments like the flute for example, are ergonomically ridiculous. I might say so, because the way they're constructed, they force the flutist to use smaller muscles. The way that the thumb is extended backward at the, at the thumb tip the way that the index finger top joint is pushed up against the flute.

Basically forces you to use smaller muscles and you have to work against that as much as you can. Those kinds of things come into play when you're dealing with each of these instruments, the violin also has some bizarre things, but you can get over them. You can accommodate the problems somehow. Whereas with the flute, they need to reinvent the making of the flute.

That's just. My opinion that's need to reinvent it.

Noa: [00:30:41] It sounds like what you discovered was that, I mean, just thinking back to when I was playing, I don't think I thought. In any sort of sophisticated way about the different muscles and how to use them. I just wanted to play in tune and make a pretty sound.

David: [00:30:54] Exactly!

Noa: [00:30:55] And it sounds like, I mean, now I've come to understand that I was doing a lot of things that were very inefficient and I was using different muscles, not for the job for which they were best suited. And it sounds like your, one of your big insights that you came to trusting your intuitive kinesthetic senses. That different muscles in your body have different roles. And you were finding ways of using the right ones for the right job in the most effective, efficient way.

David: [00:31:22] That is correct. Yes. And I would add to that, that it was very similar to you early in my playing life. I was thinking about what seemed like the most efficient way of playing, how to get the best sound.

I did think a little bit in terms of science, I thought a little bit about the physics of sound and how do you make the best sound in terms of scientific physics and so on, but I never ever thought about putting the body first putting the anatomical understanding first and thinking, okay, let's make the body of the most important thing, which is in the end it is!

Because if you want to play a long time in your life, you have to take care of your body. You have to be nice to your body. So in order to be nice to your body, you have to understand your body. How does it work? How does it function most effectively? How does it function without injury? So that is what I came to to understand and discover what it was about was learning that the body was the most important and then what it did need in order to be happy.

Noa: [00:32:34] Actually, that, that makes me think of a couple things that I, I think I read that you had said, let's see if I can get these right.

Cause it seemed like there were a few things that tied together that I'm super curious about. One had to do with, economy of movement. I mean, I think I was always, I mean, I had gotten to the sort of intuitive understanding for myself that, Oh, you know, if I move less, I can play faster and a little bit more accurately because my fingers aren't flopping all over the place.

But I did also notice maybe much later that that didn't necessarily mean that I was playing more freely, that there can actually be more tension that crops in. And because I'm like holding my fingers or my body artificially in a constrained range of motion that actually wasn't maybe as efficient as economy of movement made it sound like.

I wonder if you could get into that, cause you can talk about that much better than I can. And that to me is just seems like the way that you articulated it in whatever I read just seemed like such a, I mean that plus the whole fluidity of movement, aspect of it. I'd love for you to, to just dump some of that information.

David: [00:33:48] Sure.

Well actually you described it rather beautifully actually. Congrats you. I think you, you described it very beautifully. Yes. What I have come to feel very, very strongly about, and what is one of the most important themes of the book that I wrote on this, all these subjects, which by the way, is called "Playing with Ease."

And it's published by Oxford University Press. Is this issue. This concept really that freedom of motion or movement is far more important than economy of motion of movement. And it's exactly as you describe 99.9% of players even currently feel, that what seems intuitively obvious, the smaller movements you make, the faster you're going to go.

But the problem with that, as you mentioned, is that. When you go for that kind of accuracy and speed, what tends to happen with very, very few exceptions, and there are exceptions, there are some people who can play with tremendous economic motion and they play with great freedom, but they are the tiniest minority.

Most people when they play with such economic motion, things tend to tighten up and they even tighten up when they think about accuracy, especially of course, when they're going faster. But even when they're going at a moderate speed, if they really think about accuracy, the natural inclination for most of us is to tighten something in our hands or less, obviously further up the arm or in our neck or in our shoulder or down our backs.

We tend to tighten. And when you engage the large muscles and support with the large muscles, with the small muscles of doing, you can't tighten up, it's virtually impossible. So when you support what you're doing with larger muscles, everything frees up and you will be surprised how fast you can go with even what looks like sloppy motion.

You know, some of the fastest players that I know of on the guitar, and I think the same is true even with some pianists are people who look very sloppy in their left hand and they go, you know, a mile a minute, they're wildly fast. I can't even count myself anywhere near that. Okay. I am pretty fast, but I'm not that fast, but that's just an innate,

you know, it's just a built-in speed thing that everybody has. Everybody has their limits, but the ones who, whose limits are the bar is set that much higher. They're the ones who often look very sloppy. And I think that's because their movement is very free in their hands. Extremely free. Yeah. And, and I have seen this proven again and again and again with, players and either that I've observed or students that I've worked with, either students who have injuries or students that don't have injuries and are perfectly healthy, I've seen a proven again and again, you teach them how to use large muscles.

And start with large motions and refine it from there. And they play much faster with much greater ease and they're much more confident in the end, in the beginning. It feels weird. Does anything feel really bizarre because it's completely counter-intuitive, but that gets so much better result than when they're, they're playing with this very refined, very nuanced of a small motion thing. And they think they're being incredibly efficient, but they're usually very tight when they do that.

Noa: [00:37:55] I was watching some of your videos from the companion website to your book. And I saw the one with the helicopter shifting versus the airplane shifting thing. And I'll have to link to that. So people know what we're talking about, but when I was watching you do that, what I found fascinating, I could just be making this up, but.

It looked to me like when you were doing the faster helicopter shifting, you were utilizing more degrees of freedom in your muscles and the movement was more fluid wasn't slower than when you were doing it fast with the increased tension and the increased tension, when did look more precise, but it, it also seemed like it wasn't, well, it was definitely not as fluid.

And it also looked like instead of you perhaps preparing your muscles before making the shift and then having less work to do during the shift, it looked like there was more rigidity there. And I don't know if the,

David: [00:38:49] That's correct.

Noa: [00:38:50] I don't know if I saw correctly that you were actually preparing your arm in different ways for the shift before it happened, but, but I just thought that was such a cool visual to look at.

David: [00:39:00] I'm so glad that it translated like that to you. I don't, I'm not aware of preparing, let me think about that for a moment. I, is that what I do? I don't think so, at least it's not intentional. It's simply what the helicopter motion is, with the left hand of the guitarist, is going up first, clearing the string, then moving over and then coming back down.

So the going upward away from the string is a release. So you don't have to prepare for release, you just release it, you know? And, and then once it's released you move with that released arm to the new place, and then you bring it back to the fingerboard. And while that seems like less of a legato way of connecting, when you do it in context and you work up the speed.

It becomes so fast and so easy that in fact it gives the illusion actually of greater legato.

Noa: [00:40:02] Yeah. It looked very, when you were talking about very effective, fast players, having technique that visually looks maybe less precise it, I mean, it did look much more loosey goosey when, when you're doing it, but so much more relaxed and effortless looking, which I thought was really cool.

And this is maybe not. Exactly related, but I was also super fascinated with what you had said somewhere about. So when you're trying to take things from slow to fast, not worrying about the exaggerated motions involved. And I was just actually a few days ago watching this Brazilian jiu jitsu training video and the instructor there was teaching someone how to do something new, this new skill.

And they were completely exaggerating the motions involved and they explained that they were exaggerating the motions involved at first, just so that it's really clear what you're doing, and then you can start refining and lessening the motion and so forth. And so these two things came together and I was curious to ask you more about this, because I think a lot of times when people go from slow to fast, they struggle with various aspects of that. So I wonder if...

David: [00:41:08] Absolutely, what you're describing is, exactly right. And how refreshing to hear that someone, someone else has that similar attitude with it from a different area. But yes, my feeling is when you learn anything, absolutely anything. The first thing to do is to exaggerate it. So that just, as you described, you described it perfectly, you understand what's involved in it from moment to moment to moment, and then once you get that.

And you, your exaggeration is clear to you, then you can speed it up. You can make the motion smaller, you can speed it up, make the motion smaller. Again, speed it up until you're just working naturally. With a healthy person, that process from exaggerated motion to refined motion is very quick with somebody who has focal dystonia or some other injury.

It takes a while because they have something working against them. But even so it's the path of least resistance when they do it that way. So, yes, it's a, it's a matter of, kind of making a little, sensory recording in your system as that you're doing in slow motion, very exaggerated motion. And while you're making that recording, there's a kind of an aha moment.

Oh yeah. I see what that is. And then it becomes almost natural, at least for a healthy person to speed it up very quickly because you've understood it. And it's little gradiated moments along the way. And the brain is so incredible. It just puts those things together very quickly. And then you just do it like it's, it's been natural all your life to do it that way.

Noa: [00:43:02] Is it fair to say that that the priority is more on effortless playing and fluidity of motion with accuracy. Not that accuracy doesn't matter, but maybe accuracy, secondarily, as opposed to it being centered around accuracy first.

David: [00:43:19] Yes, it's, it's really a matter of timing of priority of timing. Accuracy, of course, ultimately is extremely important, but in the beginning when you're learning something, accuracy is not important at all.

You don't need to worry about accuracy. You need to go through the motions of doing whatever it is you're trying to do in the correct way, whatever that goal is that you're working on. And then accuracy becomes part of the refinement process. So as you, as your motions get smaller, as you get closer and closer to them, normal movement, then you can think about accuracy.

But if you think about accuracy too soon in the process, then that tension will creep back in.

Noa: [00:44:03] I mean, that makes perfect sense. When you say it like that, I feel like maybe what I would have worried about, and maybe some others too, is introducing bad habits and to playing if accuracy doesn't come first, but what's actually happening.

It sounds like if there's too much of a focus on accuracy is that you're actually reinforcing bad habits. Because you're too focused on it. That's such a weird...

David: [00:44:26] Yes ! Yes! Exactly.

That's exactly it. And that's the crux of the problem with so many players. There's so focused on accuracy, not, let's put it this way.

They're focused on not making a mistake. And if you know, psychologically that's, that's a big deal. If all you're thinking about is not making a mistake, you're going to be a very boring player. You're not going to play with musicality and passion and soul and emotion. You know, you're, if you're just thinking about not making a mistake. You're going to be a very careful player and you may be note perfect and that's fabulous, but the soul is drained out of it. So you want to find a way of being accurate that's not at the expense of all the good stuff and all the good stuff happens when you allow it to happen, which happens when you allow your body to be free and its motions.

Noa: [00:45:26] So it might be that, at least I'm, you know, for first couple of decades of my life, I was focusing on getting the right sounds to come out as opposed to getting the right sounds to come out in the right way and the most effective, effortless sort of way, which kind of, I don't know if this relates to this either.

I've sort of been in the habit of quoting people back to themselves recently, I found, but there's one thing that you said that I thought was so cool as a way of thinking about this. You said something like do not make these motions as small as possible when you're going to a faster tempo, but rather as large as you can get away with, given the tempo so that the engagement of the larger muscles is easier and clear.

That seemed like such a, an interesting way of thinking of it. Not how small can I get these motions and how quick, but how much fluidity and movement and freedom can I get away with in the constraint of that tempo? So that, yeah, it's made able to play freer that. Again, sort of like an intuitive, we obviously, when you hear it, but I don't know that that's where we start out usually.

David: [00:46:27] I can't tell you how much I appreciate you're hearing that, and noticing that. I remember when I wrote that phrase, I was very happy about it because I had, I hadn't quite articulated it until the moment that I wrote that. And then I realized, yes, that's what I've been trying to say for a long time. And it's a very, very subtle difference as you noted. And, thank you for, for noting it.

Noa: [00:46:56] Well, it actually reminds me of something that, that Leon Fleisher once said, and I'm going to completely butcher what it is that he said probably, but the, the gist was he was talking about placing notes. And when you place the notes, exactly where they ought to be, it just feels so right. And he was saying something about how you want to play the note, essentially as late as possible without it being late. At least in this particular context. And that sounds a little bit like what you were describing there, but in a motor, control perspective.

David: [00:47:26] Exactly, right. Yes, musically, I mean, that's, that's what you hear in the great pianist, especially like Fleisher, like Horowitz, like Rubinstein it's that they have that tiny bit of delayed. It's just like, and that's the moment that makes you go ahh, you know? It's just, so I, I love that musically and I, and I love it physically, too.

Noa: [00:47:51] That might be as good a place as any to wrap up, but I feel like I should ask one last thing, which is maybe if somebody is starting to experience something that they feel is maybe serious. A maybe what signs are the early signs are there to look for? And B what's the next step? I mean, who should they go to? What should they look for aside from your book and so forth? Like what your early recommendations?

David: [00:48:20] Well, the problem with answering that question is that everybody's different and every instrument is different. Every technique is different. So there are as many answers, real answers to that, experiential answers to that question as there are players, I think, you know, any time that there is something abnormal in either the playing itself, something that you can hear.

Or something that you can feel in your body. Most injuries are have pain involved or have some kind of sensation involved, focal dystonia is the only one that's pain-less. And with focal dystonia is that the fingers start acting up and that you don't have control over them in the way that you should.

So whenever any of those signs happen, you need to take it very seriously and do some investigation. I can say one thing negatively, which I think is an important thing to say, because it's something that is talked about a lot in the performing arts medicine community. They talk about Botox injections, a lot for focal dystonia suffers.

I want to highly suggest to everybody not to go the Botox direction. The problem with Botox, well, there are many problems. One is that it's a very dangerous chemical that can have all kinds of negative side effects on your body and your being. But. It has kind of miraculous effects with many people in the beginning.

And then those results diminish with almost every injection so that after the first three or four injections, there's a distinct diminishment of progress. And then it's nothing. And you wasted a lot of time, money, psychic energy. You've not done your body a favor by doing this. There is only one instance, in my experience with other people with that, Botox has been a positive thing. That was a pianist who came to me from Chicago. He did the, the normal four lessons with me. I require four lessons with people. He does the four lessons with me, went back and he may have come back for a lesson or two things had gone really, really well.

And it took him a long time to get better, a few years actually. And at one point he told me he was 98% better, but there was still that little bit left, he couldn't quite figure out how to bridge the gap. He tried Botox. And I don't remember if he did one or two shots, but that's all he needed with the one or two shots and what the Botox did at that point, when he was almost there was that it reminded his body how it used to be, how to use to work normally.

So as a reminder, the Botox is very effective, but as a cure, it's extremely ineffective. That said there are a number of practitioners out there who work with focal dystonia in the world. Not a huge number, but some, there are some well-known ones, Dr. Farias who works in Spain and also in Canada. I don't remember some of the other names that they're well-known if you look, you can find them easily, doing internet search.

The thing is, is that with any of us who work with people with focal dystonia, we have some successes. And a lot of failures. And none of these people are the cure all just because they're doctors. So. Don't necessarily trust the doctors, but the ones who have had success like Dr. Farias and some of the others who, unfortunately, I can't remember the names they're ones definitely to, to look to, but you need to investigate them.

Do some research on them, see if at least intuitively on some level or intellectually on some level make sense to you? Does it seem like it's right to you? You have to go with your instinct, your instinct may or may not be a good one for these things, but that's all you have to go on. So you, you have to trust that and you investigate the various people that are doing these kinds of work.

There's another person who's a little bit under the radar. Nancy Byl, in San Francisco. And she, her approaches has to do with the brain. And she, she works on the connection between the brain and, and focal dystonia, dystonic response. She does wonders for certain people who are at a certain stage in their focal dystonia or a certain kind of focal dystonia. And I think her work is brilliant, but it like everybody, it doesn't work for everybody. She is referring people to me, I've referred people to her, you know, when our thing doesn't work there's I think she's a physiotherapist in London or England.

I think her name is last name is Gilbert. I'm not sure, she's proven very good for a number of people. And that an area of physiotherapy that is usually not at all successful with focal dystonia. There's a fellow former student of mine, Jerry Harsher, who works with body mapping, which is related to Alexander technique.

And he has had some success with people. Very often, the Alexander technique has no success whatsoever, but Jerry Harscher has figured out a way to have success with people. So you can't say across the board that any one approach is good. Any one approaches bad with perhaps exception of Botox, all the others there's good and bad.

And you have to kind of go with your gut to see who's maybe best for you. And you probably just have to try a few. See what works for you. You'll probably at the very least learn something from everybody as I did, even if they don't help you. But there's no question that when something is wrong, don't let it go on too long.

Because when you catch any problem, whether it's painful or paying less on the early side, your chances of curing it more quickly and curing it period are much, much greater.