Practice behaviors as trigger factor for the onset of Musicians' Dystonia

Musician's Dystonia (MD) is a task-specific movement disorder that results in an involuntary cramping of muscles involved in playing an instrument such as the upper limbs or the embouchure. It is usually painless and occurs in general only at the instrument. The pathophysiology of MD is not completely understood. The present study aimed at assessing differences in practice behaviors between pianists affected by MD and Healthy Controls (HC) in the years preceding the onset of the disease. Thus, we investigated to what extent practice quantity can be considered a trigger of Musicians' Dystonia. The results showed that despite comparable practice behaviors in childhood, MD pianists incremented the amount of daily practice to a greater extent than their healthy colleagues, especially in the second and in the third decade of life. Thus, subsequent logistic regression analysis showed that high amounts of daily practice might significantly increase the risk of developing MD. Furthermore, gender-related differences in practice behaviors across groups were identified, indicating that male pianists from the MD group might not have practiced significantly more than HC male pianists before the onset of the disease. To the authors' knowledge, these are the first empirical evidence of the role of dysfunctional practice behaviors in triggering MD, which has clinical and educational implications.