Should I Stop Playing? Rest, Practice and What Actually Helps

"The advice I've had has been completely contradictory. My doctor told me to stop playing for three months. My teacher told me the only way through was to practise it slowly, every day, until it came right. A colleague told me to change my technique entirely. I've now tried all three, and I'm no further forward — except that I've lost a season's work and I've started to dread the practice room. So which is it? Should I stop playing altogether, or shouldn't I?"

The short answer

Neither complete rest nor determined practice will resolve focal dystonia on its own, because neither addresses what is actually driving it. The question of whether to play is far less important than the question of what state you are in when you play.

That is not a way of dodging the question. It is the practical consequence of what focal dystonia is a neurological pattern, learned under particular conditions of pressure and attention, rather than an injury to the tissue.

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Why rest alone does not work

Rest is the right treatment for an overuse injury, where inflamed or strained tissue needs time to recover. It is offered so readily for focal dystonia because the two are so often confused — but the muscles and tendons in dystonia are not damaged, so there is nothing for the rest to heal.¹

This is why so many players return after three or six months away, hopeful, and find the pattern precisely where they left it. Some find it slightly worse, because the layoff has added anxiety about the return. Time away from the instrument, on its own, is not treatment. It is a pause.

That said, rest is not useless. A period away can lower a nervous system that has been running hot for years, and it can interrupt a cycle of daily failure that is reinforcing itself. What it cannot do is change the pattern.

Why practising harder makes it worse

The opposite advice — drill it, slowly, until it comes right — is more actively harmful, and it is worth understanding why.

Cortical maps are shaped by repetition and attention acting together.² Practising the failing movement while watching the hand with anxious, inward, self-monitoring attention supplies exactly the conditions under which the pattern was learned. Each repetition performed in that state does not wear the problem away. It rehearses it.

The motor-learning research is consistent on this point: attention directed inward onto the body degrades skilled movement, while attention directed outward — onto the sound, the phrase, the musical intention — supports it.³ ⁴ Most well-meaning remedial practice does the first while believing it is being conscientious.

So what does help?

Three things, in this order.

First, change the state before you change the movement. The pattern was laid down in a nervous system held in survival, and it will not release while that state persists. This is the work that has to come first: genuine safety in the body, orientation in space, the release of the holding patterns that have become second nature. Without it, everything else is technique applied to the wrong layer.⁵

Second, if you play, play differently. Not the failing passage, not slowly and repeatedly, not while watching the hand. Play what still works. Play for the sound. Keep the relationship with the instrument alive as a source of pleasure rather than a daily audit of your decline — because the association between the instrument and threat is part of what is holding the pattern in place.

Third, let the amount you play be a consequence, not a decision. As the state changes, most people find that the question resolves itself. Playing becomes possible in small quantities, then in larger ones, and the anxious calculation about how much is permitted quietly disappears.

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What about my career while I do this?

This is the real question underneath, and it deserves an honest answer rather than a reassuring one.

Some people are able to keep working through recovery, particularly if their playing is affected in a specific and avoidable domain. Others need to step back for a period. That decision belongs to your circumstances, not to a rule — and it is worth making it deliberately, with proper information, rather than by drifting into it through a series of cancelled engagements.

What is not true is that stepping back is the same as giving up, or that continuing to play is what caused this. Neither guilt is warranted, and both consume energy that recovery needs.

FAQ

Should I stop playing if I have focal dystonia?

Not necessarily. Complete rest does not resolve focal dystonia, because the tissue is not damaged. What matters more is the state you play in and the quality of attention you bring, rather than the number of hours.

Will a long break cure focal dystonia?

It is very unlikely on its own. Most people who take three to six months away find the pattern unchanged on their return. A break can lower overall stress and interrupt a discouraging cycle, but it does not change the learned pattern itself.

Does practising the affected passage help?

Usually not, and it often makes things worse. Repeating the failing movement with anxious, inward attention rehearses the very conditions in which the pattern was learned.

Can I play at all during recovery?

Most people can, and many find it valuable — provided the playing is for pleasure and sound rather than for correction, and provided it is not an anxious daily test of whether the problem has gone.

Will I lose my technique if I stop?

Deeply established motor skill is remarkably durable, and it is not lost over months. What people usually experience on return is not lost technique but returned anxiety, which is a different problem with a different solution.

Does playing through it cause more damage?

Focal dystonia is not a tissue injury, so playing does not cause structural damage. It can, however, entrench the pattern if the playing is effortful, corrective and performed in a state of threat.

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References

Distinguishing dystonia from playing-related musculoskeletal disorders: Lederman RJ. Neuromuscular and musculoskeletal problems in instrumental musicians. Muscle & Nerve. 2003;27(5):549–561.

Attention-dependent cortical reorganisation: Byl NN, Merzenich MM, Jenkins WM. A primate genesis model of focal dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys. Neurology. 1996;47(2):508–520.

Attentional focus and motor learning: Wulf G. Attentional focus and motor learning: a review of 15 years. International Review of Sport and Exercise Psychology. 2013;6(1):77–104.

Conditions that optimise motor learning: Wulf G, Lewthwaite R. Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychonomic Bulletin & Review. 2016;23(5):1382–1414.

Task-specific dystonia as a breakdown in motor skill learning: Sadnicka A, Kornysheva K, Rothwell JC, Edwards MJ. A unifying motor control framework for task-specific dystonia. Nature Reviews Neurology. 2018;14(2):116–124.