Focal Dystonia in Pipers – Management of the Condition Offers a Bleak Outlook

To recap: Musician’s Focal Dystonia (MFD), as experienced by pipers, is characterised by the inability to perform specific transitions from one note to another, the relevant finger (or fingers) refusing to carry out straightforward demands.

First of all, it is quite definite that the affliction cannot be relieved by practice. This simply makes it more entrenched. 

Medication: Attempts to treat MFD with medication have met with little success. Drugs such as Botulinum toxin (by injection) and Trihexyphenidyl (Arkane), quite extensively used, have shown no lasting benefit. Anxiolytic drugs such as Diazepam (Valium) are illogical since MFD is not caused by anxiety.

  by Norman Matheson MBE

In addition, such drugs are cerebral depressants. Alcohol is in a similar category. Who would condemn pipers who take a preliminary dram to settle their nerves – but it has no definite effect on MFD. Beta adrenergic blocking drugs (e.g. propranolol), deserve consideration. It is known that many professional musicians, including pipers, regularly take a small dose of a beta-blocker before a performance.

Beta-blockers have no effect on anxiety but they do block its autonomic effects, most significantly tremor. Should tremor be a problem, that may be a benefit in relieving related anxiety but it has no relevance to MFD, on which beta-blockers are very unlikely to have any effect. Bluntly, there are no drugs of known benefit.

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The web: In recent years, the most wide-ranging impact on management has depended on the wealth of relevant information on the internet. In terms of self-help, charitable organisations such as the Dystonia Medical Research Foundation (with an official journal), now exist.

Numerous online support groups have sprung up on Facebook, including the Musicians with Dystonia Support Forum. A search of the web discloses individuals who claim resolution by using various applications of elastic bands on the fingers, an option appealing in terms of simplicity, though lacking in conviction for a condition dependent on destructive changes in neuro-plasticity.

Scientific research: The results of extensive scientific research was considered in depth by Chiaramonta & Vecchio, published by in 2021. Their critical review, which contains much interesting material, concludes: having defined the several techniques for the treatment of dystonia in musicians, there are no specific guidelines.

Brain retraining: The above negative prediction reflects the official viewpoint regarding MFD, which is that it is incurable. Nonetheless, any progress will certainly depend, in the broadest terms, on some method of brain retraining. In this respect, the recent work of Ruth Chiles is relevant.

Chiles who was based in Granada in Spain, claimed a 95% success rate in dystonia of various types and severity. Her management involved sessions lasting up to two hours, after which, resolution was once achieved in a ‘record time’ of 25 weeks.


Success was claimed to depend on regeneration of previously abnormal neurological pathways. That credible theory has the ring of truth, but how to achieve it is far from explicit. Quoting from a number of case studies, Chiles claimed to help the client to ‘go inside’ their brain to experience the erroneous neural connections.

She wrote that her treatment ‘responds to deeper neuro-plasticity and neuro-genesis techniques’. Although it is never clarified, the basis of her management sessions appears to amount to ill-defined psychotherapy, couched in pseudo-scientific terms.

Outlook: In short, the prospect, in terms of a ‘cure’, is bleak, even if there were pipers prepared to go to Spain for six months or longer, participating in multiple psycho-therapeutic sessions, no doubt at significant expense.

Sufferers from MFD may obtain insight and self-help from the huge amount of information on the internet. However, as a fundamental attitude, perfectionists should recognise the challenging expectations of the repeated high achievement to which they are exposing themselves.

And, difficult though it may be, they should try to consciously cultivate a more relaxed approach in which enjoyment in playing is more important than technical perfection and competitive success.

  • Read the first part of this article here.

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