Several studies as well as my phenomenological experience suggest that there is a direct connection between Musician´s Focal Dystonia, perfectionism and stress. (Altenmüller E, 2010).

In our culture we focus in a false and unhealthy way on innate musical talent and genius as if they make a person special and give them more intrinsic personal value than others. We emphasise and value innate talent over learned abilities and technical skill. Often young musicians develop the impression that their worth as a person and as a musician rests on an invented idea of innate genius more than on the level of technical ability that they will learn over time with patient and constant practice. This means that musicians experience a very specific type of stress in which their sense of personal worth and personal identity frequently feels threatened.

In the article Causes of Focal Dystonia: Demanding Perfectionism I described how perfectionists base their measure of worth or even worthiness on being perfect, which is of course an impossible objective to have. They learned this belief and behaviour from their family environment or from their early music teachers. Once it is installed any mistake, humiliation and feelings of being judged or compared to others feels like a direct threat to the integrity of their sense of self.

How Stress Affects the Nervous System of Musicians with Focal Dystonia

In this article I have brought together investigations on the effect on the brain of this type of stress. It is fascinating that the brain processes it in the same way as it processes real physical threats (Corrigan F, 2013). The response to this type of stress and to threats has been clearly defined and follows the following sequence: arousal, activity arrest, sensory alertness, muscular adjustments, scanning, locating in space, identifying, evaluating, taking action and reorganizing (Ogden P, 2006). The problems for the musician with Focal Dystonia is that they have repeatedly cut this sequence off part way through as they have been required to endure criticism, judgement, comparisons, humiliations and the personalisation of the natural errors of the learning process without being able to “defend” themselves. This has often occurred from a very young age and leads to a stored physiological activation in the nervous system which is left unresolved in the brain and in the body (Corrigan F, 2013). In extreme cases it leads to the development of Musicians Focal Dystonia, however, it is worth noting that the majority of professional musicians suffer from emotional and physical tensions and it is estimated that as many as 80% of all musicians suffer from physical pain (Burt, October 2015).

The Process of Stored Physiological Activation

It is highly valuable for musicians and teachers to understand in detail this process of stored physiological activation. The reaction to emotional stress and threat is a survival mechanism and therefore occurs automatically in the involuntary and subconscious parts of the brain (the midbrain and brainstem). There are 3 specific parts of the process which is most relevant in understanding the brain changes that occur in musicians with Focal Dystonia and in understanding how to reverse the process:


The eyes move towards the threat (Anderson EJ, 2008) and the gaze becomes fixed to assess it (Klier EM, 2003). This fixation occurs in the midbrain (in the superior colliculi) (Choi WY, 2006) (Munoz DP, 1991). When it is a physical threat this eye fixation allows the person to take in the maximum amount of information in order to react in the most effective way. However, the brain uses this same survival mechanism in the face of threatening sounds (Smith SD, 2018), emotional and social pain. In the case of emotional pain, the eyes do not necessarily turn towards the cause of their pain; however, the visual receptor (superior colliculi) of the midbrain is activated in the same way, as if the eyes were looking at it. (Corrigan F, 2013)


This eye fixation directly activates the neck muscles to cause them to contract to create a reflex movement of the head. It is sent directly from the visual receptor (superior colliculi) in midbrain to the brain stem nuclei and to the tectospinal tracts of the spine, especially to the motor neurons of certain neck muscles (Crawford JD, 2003), which mediate this reflex movement. It has been discovered that the information goes directly to the neurons of the central nervous system found in the neck (vertebras C1–C8) that activate tension in the scalp, neck, shoulders and upper limbs (Lee, McPhee, & Stringer, 2008), bypassing completely the higher brain functions.


Involuntary, reflexive messages are sent to the muscles in order to direct the body towards the threat if the involuntary response is to fight against it; away from the threat if it is to flee or alternatively to create a freeze response like a rabbit trapped in the headlights of a car (Frühholz, Trost, & Kotz, 2016), (Corrigan F, 2013). Other parts of the midbrain and brainstem (specifically the basal ganglia and the cerebellum) aid in this process. It has been demonstrated that in musicians with Focal Dystonia, their basal ganglia sends erroneous messages that over stimulate the body´s muscle responses when they are playing their instrument.

This fight-flight response is well documented and some of the specific physiological functions and changes include:

  • Increased blood flow to the muscles, increased blood pressure, heart rate, blood sugars, and fats in order to supply the body with extra energy.
  • Increased muscle tension in order to prepare the body to fight or flee and to give it extra speed and strength.
  • When the involuntary response is to freeze, there is a complete absence of movement except for movements associated with respiration. The muscles of the body become completely tense in order to create this absence of movement (Fanselow, 1994).

Involuntarily Stored Muscle Tension in Musicians with Focal Dystonia

So the most recent research on the body´s motor response to negative emotions is indicating that the midbrain sends messages downwards to the brainstem and directly to the cervical spinal cord as a form of “action preparedness” that would allow the individual to make a rapid and efficient response to a threatening stimulus (Coombes S.A., 2009) (Van Loon A.M., 2010).

It also seems that these changes in brainstem and spinal cord activity could be associated with a “freezing” response. Freezing involves tensing muscles throughout the body in order to reduce or eliminate any movement that could be detected by a predator (Fanselow, 1994). It is interesting to note that in musicians with Focal Dystonia the wrist muscles tense just in this way, as I described in my previous article “The Neurological Causes of Musician´s Focal Dystonia”.

This means that the body´s physiological reaction at a time of threat and emotional pain is largely without conscious cortical control. The decisions are being considered deep in the midbrain-thalamus-basal ganglia- midbrain loops. This means that the brainstem is likely to take control and create involuntary motor responses. We know that repeated traumatic experiences can alter muscle tone in groups of muscles, as well as baseline blood pressure, heart rate and breathing rate. What has been less considered is that the brain and body respond in the same way to the specific type of stress that musicians experience. In fact, before I have had the chance to explain this process, my musician clients will describe in detail their personal experience of these exact same muscular tensions.

Therefore, we can see that the repeated emotional stress caused by fear of making a mistake, of being judged, compared or humiliated feels like a real emotional threat to the musician with perfectionist tendencies, as their sense of self-worth and identity is under threat. They are repeatedly unable to complete and resolve the necessary neurological and physiological sequence that this stress initiates, leaving a residual physiological activation in their nervous system. This physiological activation is involuntary, beyond the control of the musician and affects muscle tension, especially in the neck, scalp, shoulders and upper limbs. It is logical to hypothesise that the accumulation of these residual physiological activations can lead to developmental changes in the areas of the brain involved in motor control; the basal ganglia, motor cortex and somatosensory cortex. These are just the areas that have developed or function erroneously in musicians with Focal Dystonia as I described in “The Neurological Causes of Musician´s Focal Dystonia”.

In the next article I will explain some of the neuroplasticity techniques that I use with my clients to cure their Musician´s Focal Dystonia, along with the neurological research that shows how they reverse the process that I have described in this article.


Altenmüller E, J. H. (2010). Focal Dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art., 25(1):3-9.
Anderson EJ, H. M. (2008). Human intraparietal sulcus (IPS) and competition between exogenous and endogenous saccade plans. NeuroImage, 40: 838-51.
Burt, T. (October 2015). Chronic Pain and the Working Musician. Reverb,
Choi WY, G. D. (2006). Responses of collicular fixation neurons to gaze shift perturbations in head – unrestrained monkey reveal gaze feedback control. Neuron, 491-505.
Coombes S.A., T. C. (2009). Emotion and motor preparation; a transcranial magnetic stimulation study of corticospinal motor tract excitability. Cogn. Affect. Behav. Neurosci., 9, 380-388.
Corrigan F, G. D. (2013). Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation. Medical Hypotheses, 80: 759-766.
Crawford JD, M.-T. J. (2003). Neural control of three-dimensional eye and head movements. Curr Opin Neurobiol, 13:655-62.
Fanselow, M. (1994). Neural organization of the defensive behaviour system responsible for fear. Psychon. Bull. Rev. 1, 429-438.
Frühholz, S., Trost, W., & Kotz, S. (2016). The sound of emotions – towards a unifying neural network perspective of affective sound processing. Neurosci. Biobehav. Rev., 68, 1-15.
Klier EM, M.-T. J. (2003). Neural control of 3-D gaze shifts in the primate. Prog Brain Res, 142: 109-24.
Lee, M., McPhee, R., & Stringer, M. (2008). An evidence-based approach to human dermatomes. Clin. Anat., 21, 363-373.
Munoz DP, G. D. (1991). Control of orienting gaze shifts by the tectoreticulospinal system in the head-free cat: II.Sustained discharges during motor preparation and fixation. J Neurophysiol, 66:1624-41.
Ogden P, M. K. (2006). Trauma and the body: a sensorimotor approach to psychotherapy. New York: Norton.
Smith SD, K. T. (2018). Lateralized Brainstem and Cervical Spinal Cord Responses to Aversive Sounds: A Spinal fMRI Study. Brain Sciences, 8, 165.
Van Loon A.M., V. d. (2010). Emotional stimuli modulate readiness for action: A transcranial magnetic stimulation study. Cogn. Affect. Behav. Neurosci., 10, 174-181.