Index

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●The course of symptoms in both hands 

●Botox injection treatment

●The basic technique

●Learn how to use one's body

●The distal interphalangeal joints (DIP joints)

●Stretch

●Arch in the back of the hand

●Thumbs

●Epilogue

 

 

The course of symptoms in both hands

Left hand
1999: It began with the middle finger curling inwards, which spread to the ring finger and then other fingers.
2002: Treatment began with two Botox injection sessions. The exercise by Mr. Peter Feuchtwanger was also attempted.
2007: Curling recurred in the little finger. Efforts were made to alter the method used to play the piano, through which the distal interphalangeal joints are not fixed (finger tips are hyperextended).

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Right hand
(No Botox injection treatment was sought.)

2005: Curling began in the little finger.

2009: Began playing in a way so that the distal interphalangeal joints form a shape as if they are grasping an object. This led to curling of the middle finger.

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Botox injection treatment

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If the clenching of fingers is severe, Botox injection treatment could provide some relief. My fingers were curled severely, and regardless of whether I touched piano keys or a computer keyboard, they automatically curled inward. However, Botox injection treatment suppressed the clenching.
Please contact an expert at a medical institution for more details.

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The basic technique

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Simply place your hands on the keyboard (where keys  are pressed all the way down). As you press down on the keys, they make a sound.
Minimum force is required to place one’s hands on the keyboard, and the arms should be at rest from the shoulders down.
The hands should be placed lightly without actively pressing down the keyboard or holding the whole arm from the hands to shoulders up .
It is difficult to explain with words, but if you can understand the sensation of ‘simply placing’, it should become much easier to play the piano.
This sensation can be acquired by applying the Alexander Technique.

Learn how to use one’s body

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It would be extremely effective if one were able to acquire a technique by which the maximum effect could be obtained with the minimum input through learning the correct posture; using the arms in accordance with the skeletal frame and functions of a body and linking movements between the fingertips, wrists, elbows and shoulders.
It would be beneficial to study various methods such as the Alexander Technique and Feldenkrais Method.

 

The distal interphalangeal joints

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Do you think you understand your own hands accurately?
I must admit I did not understand my own hands at all.
I became aware of something when I began rehabilitation after developing dystonia and going through the Botox injection treatments.
Children and beginners are unable to fix their distal interphalangeal joints when they start learning the piano, as their fingertips may be hyperextended or unstable.
When the nerve connection was broken by the Botox injection treatment, the force that was maintained previously to fix the distal interphalangeal joints was eliminated, returning the hands to their natural state.
I was unaware that I was using force to fix the distal interphalangeal joints before developing dystonia. In fact, I had never considered that my distal interphalangeal joints were congenitally hyperextended.
In the initial stage of learning the piano, I was actively using force. However, it is unclear how it became automatic and unconsciously maintained.
For those of us with congenital hyperextension in the distal interphalangeal joints, the state in which the distal interphalangeal joints are fixed to prevent hyperextension from the stress of striking the keys is maintained by the collaboration of the deep flexor that bends the distal interphalangeal joints and the superficial flexor that bends the proximal interphalangeal joints. In terms of dystonia symptoms, a force is constantly applied to the muscles that curl the distal and proximal interphalangeal joints, which results in curled fingers.
Many people who play the piano by fixing the distal interphalangeal joints and pointing their fingers are going through rehabilitation in order to be able to play in this manner again. However, this style of play will always lead to the impossible challenge of preventing curled fingers.
The control necessary to maintain this balance is extremely fine and is not practical. It would be easy to see how difficult it is to recover to a level where one can freely play the piano in this style if one looks into dystonia at all.

People who have developed dystonia or are susceptible to dystonia will obviously develop the same symptoms if they return to the same style of play in which the distal interphalangeal joints are fixed. I have repeated this process many times.
However, it was difficult to break through the preconception that the piano should be played with the distal interphalangeal joints fixed by pointing the fingers.
In reality, most pianists, including past masters, play with their digital interphalangeal joints fixed and have been trained to think that this is the only correct way to play the piano.

But is that true?
 

Daniil Trifonov and Nikolai Lugansky represent a style of play that does not fix the distal interphalangeal joints, which led to a solution for this long-lasting problem. Please observe how their fingertips touch the keys of the piano on YouTube and so on.
You will notice that their fingertips are hyperextended when they press the keys.
It is extremely interesting how the world’s top-class pianists use a style of play that was absolutely denied in the traditional teaching of the piano. In addition to these masters, more and more young pianists choose a style of play in which the distal interphalangeal joints are not fixed, as the most natural style for their own hands, without being trapped by preconceived ideas.

 

Let me explain a style of play that does not fix the digital interphalangeal joints. Without any pressure on the distal and proximal interphalangeal joints, completely relaxed fingers are pulled toward one’s body from the metacarpophalangeal joints, using the lumbrical muscles, to press the keys down to make the sound.
As a result, the distal interphalangeal joints are not fixed, hyperextending the distal interphalangeal joints, and keys are pressed with the whole fingertip (The degree of hyperextension depends on the range of motion in the distal interphalangeal joints, which varies among individuals. Even with fingers without any hyperextension, it is important to press the keys near the limit of the range of motion for the distal interphalangeal joints).
The deep flexors that bend the distal interphalangeal joints that cause the fingers to curl and the superficial flexors that bend the proximal interphalangeal joints are basically not used; thus, the possibility of the recurrence of dystonia symptoms is minimised, allowing for the maximum freedom in the play for people who have developed dystonia.
In the early stage of rehabilitation, the keys were pressed with the distal interphalangeal joints hyperextended; i.e., the opposite direction of curling; thus, the curling of fingers was prevented and suppressed.

 

Note 1. This is the basic style of play, and fingers may touch the keys while pointed, depending on the sound and shape of the hands. However, this is fundamentally different from the state in which there is force applied to the distal interphalangeal joints.
Note 2. People who are unaware of the pressure involved in fixing the distal interphalangeal joints may mistake the hyperextension of the distal interphalangeal joints with pressing with a strong force. However, these two states are fundamentally different. Since the joints are not fixed, any pressure can make them hyperextend.

 

Even if they appear similar, human hands are all different.

    Fingertips from the distal interphalangeal joints do not hyperextend congenitally (since the distal interphalangeal joints are fixed to begin with, no force is required to play the piano).
    There is mild hyperextension from the distal interphalangeal joints (a small amount of hyperextension does not cause any problem).
    There is severe hyperextension from the distal interphalangeal joints (fingertips are notably hyperextended when there is any force applied, and much effort is required to fix and maintain the joints).

 

As such, there are congenital variations between individuals.

Since there are individual variations in the range of motion of the distal interphalangeal joints, the angle of the fingertips when pressing the keys will vary.
The conventional thinking that ‘the piano must be played with fingertips vertical, while fixing the distal interphalangeal joints’ is the most natural style of play for people whose distal interphalangeal joints do not hyperextend congenitally.
However, people with a large range of motion in the distal interphalangeal joints with severe hyperextension will need plenty of energy to fix the distal interphalangeal joints when playing in this manner.
Even if the distal interphalangeal joints could be fixed, the difficulty of doing so will tighten muscles that are not necessary, leading to a lack of flexibility. If instantaneous power and agility are sacrificed, it would only move away from free piano play.
Since the force necessary to fix the distal interphalangeal joints, which is not related to the act of creating a sound, is maintained consciously or unconsciously, the sensation of creating a sound with the minimum effort is lost in the true sense.This in turn affects the sound itself.
 

Considering the amount of practice that pianists put in over the course of many years, unnecessary force should be eliminated as much as possible. It would be best to choose a style of play that is the most natural for the congenital characteristics of each hand.

In my case, the stability and closeness of hands and fingers on the keyboard and the sense of oneness with the piano, which I feel today after selecting a style of play that does not fix the distal interphalangeal joints, is even better than before the development of dystonia.
In other words, it is a feeling akin to having walked on tiptoes my whole life, then switching to walking on the soles of my feet.
Even if they appear similar, human hands move differently. I suggest dystonia is a result of using a style of play that does not fit one’s constitution.
In rehabilitating dystonia, it is important to identify the congenital and unique characteristics of one’s own hand first, and selecting the appropriate style of play is the key to recovery.

 

Stretch

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Every day, we hold or grasp objects by curling our fingers by contracting muscles. Pianists daily spend hours with their hands in a certain shape, moving their fingers. After a certain period of time, their hands tend to lose flexibility and become stiff.
People who have developed dystonia can stretch by hyperextending their fingers or hyperextending up to the distal interphalangeal joint to the limit of the range of motion without discomfort. These stretches are effective in relaxing the curling of fingers and regaining flexibility. These will remove the force that restricts the distal interphalangeal joints in fingers, returning them to their natural state.

 

Arch in the back of the hand

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Looking at my own case as well, I find that people who develop dystonia tend to play the piano while clenching their hands more than necessary.
It is important to retain an arch in the back of the hand to support the fingers on the keyboard.
By holding your hands in a manner that clearly shows the metacarpophalangeal joints, the excessive contraction of your hand is prevented. Thus, the independent movement of fingers is supported.

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Thumbs

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Compared to the other four fingers, thumbs have a completely different shape, function and movement while playing music, and the position of the fingertips when touching the keys is completely different.
I do not have dystonia in my thumbs, and I do not have an experience with rehabilitation, but there is one thing I would like to be paid attention on.
The distal interphalangeal joints of thumbs should not bend toward the palm unnecessarily; they should never bend toward the palm unless pressure is consciously applied.
Unconscious maintenance of pressure such as this is a trigger for dystonia.

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Epilogue

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I have provided descriptions of the approach that I took after years of struggle, but symptoms vary for each person living with dystonia. Thus, my approach may not work for everyone.
The style of play that is the basis of this approach may not be new to a small number of instructors and pianists. However, it is not a common style, and some may find it difficult to understand.
As such, I hope this approach will become well known as an option with which one can deal with dystonia and play the piano freely again.
With acknowledgement of and respect for the individual nature of the hands of each person teaching the piano, it is important to nurture their talent with flexibility, instead of uniformity.