“I’ve become a sort of poster child for focal dystonia,” the eminent New York-based guitarist, composer, and teacher David Leisner mentioned in an ema il early on in our correspondence about this article. Indeed, though an untold number of classical guitarists—including many who preceded him—have been afflicted, sometimes unknowingly, with FD, Leisner was one of the first to publicly speak out about his battle—and he is also one of the few who seems to have fully beaten this crippling condition that kept him off concert stages for 12 years (1984–1996). The proof is in the playing: In the past couple of years alone, Leisner has kept a busy schedule of solo and chamber concerts, master classes, and released a critically acclaimed CD called Facts of Life, and another with cellist Zuill Bailey, Arpeggione, all the while teaching at the Manhattan School of Music and writing musical pieces for guitar and also various chamber configurations.
The first part of the narrative below was edited from an interview Leisner did with Classical Guitar editor Colin Cooper (1926–2012) in late 1996, when he was just on the other side of his troubles with focal dystonia. It originally appeared in the June 1997 issue of CG. Then, last fall (2016), I asked Lesner if he would update his story, to fill us in a bit on the two decades since his remarkable recovery.
In 1984, I had the beginnings of a hand condition, now known as focal dystonia. It is the same condition that the [classical] pianists Leon Fleischer and Gary Graffman have; they made this condition famous. It’s a condition where the fingers—the ring and pinkie in my case—curl into the palm without control and without pain. No pain is the distinguishing factor. You don’t know where the problem is. It could be in the hand, it could be in the arm, the shoulder, the back. If you have no pain to pinpoint it, it isvery elusive and difficult to fix. And, in fact, no one until now has cured focal dystonia. It is the performance problem that has stumped the performing arts medicine community and the musical community.
When it happened to me, I gradually cancelled concerts one by one, and finally stopped everything. I went to experts, doctors, and alternative specialists of all sorts. I went from one to the other, doing exactly what they told me to do, all telling me they could help me. And each time my hopes were raised and then dashed down to the ground.
I did five years of this. I went to different cities around the country; I spent a good deal of money, time, and psychic energy, and at the end of the five years, I felt like a spent rubber band in every way. The last treatment I underwent, an eclectic Eastern kind of treatment, did me damage. And I thought, “I’m fed up with this, it’s not worth it.”
I had found out by that time that, in fact, it was well known in the performing arts medicine community that nobody knew how to cure this condition. So I stopped everything. I didn’t even try to continue on my own to try to make it better. For a while, I tried playing with mostly two fingers—thumb and index. About a year later, I gravitated intuitively towards the idea of involving the larger muscle groups, in the upper arm and shoulder, in the stroke. Something my colleague at the time, Neil Anderson, said one day made me wonder what would happen if I just swing at the string. I came home that day and started to do that with these large motions that were involving my upper arm.
Within five minutes of doing this, I was able to use my ring finger, which I hadn’t used for eight years. Five minutes! Now, you have to understand that until this time I couldn’t even place my right hand at the strings without the fingers curling in. At this moment, not only was I able to put my hand at the strings but I was able to actually use the ring finger to pluck the string independently. I knew I was on to something. I proceeded to refine these ideas, and I came to find out—and I’m quite sure of this now—that the focal dystonia place is here, in the armpit, at the apex of where the arm meets the torso.
I started to feel, as I plucked the strings, the contact with the armpit area and also the triceps area in the upper arm. I would think of my hand as a big nothing, a big blob attached to my arm by way of a stabilized wrist. And the wrist, being stabilized, made the arm and the hand move as one piece. And I moved this large lever from the elbow down, from the string up towards my face in this large motion. As I grabbed the string, I would feel the string’s tension in those large muscle groups in the armpit. And I would pull it towards me.
Sure enough, within a year I was able to use my middle finger much more, and in another year I was able to use my ring finger in concert, and as of this year  my hand is one hundred per cent. I’m very excited about it, of course, not only for myself but also for other people. There are many, many guitarists and pianists, and a number of bowed string players and other instrumentalists, who have exactly the same problem and do not know how to fix it. I think I have at least the beginnings of a sense of how to fix it.
The basic understanding is very simple, and that is the beauty and probably the rightness of the whole thing. It’s an important, far-reaching, and basic understanding of how the arm works. It’s something that I teach all my students. None of my students ever have any hand problems, and I want to prevent them from having problems in the future. A very nice additional effect of this whole thing is that one gets a bigger sound and a more beautiful sound with less effort.
This is, in fact, a 20th century problem that has to do with larger concert halls, more pressure to play faster, louder, more often, more difficult repertoire. And what we are beginning to find out is that the technique that instrumentalists in general have developed is not up to those tasks.
So we learn as we go along. People like me have to fall down and pick themselves up again, but maybe to the advancement of the whole thing.
20 Years On
It has been over 20 years since I fully cured myself of focal dystonia. Amazingly, there are people who, for some reason, believe that I still have the dystonia, despite the fact that every symptom of it disappeared completely in the summer of 1996, and that this is what I (truthfully) reported in every public interview and statement since then. Such is the power of the stigma attached to this dreaded condition. It is probably why, to this day, there are a number of well-known guitarists who have the condition and will not discuss it publicly. This is understandable, but unfortunate, given the fact that knowledge of how to cure focal dystonia is still in its early stages. More well-known players emerging into the field of discussion might be very helpful.
Certainly, there has been a lot of progress since 1996. A few people in the medical profession, like Dr. Joaquin Farias and Dr. Nancy Byl, have made substantial contributions to the cure of this condition, as well as a number of practitioners in alternative, non-medical fields like Alexander Technique, physical therapy, music teaching, and so on. I have cured and helped many people from all over the world in private lessons, having refined my understanding of one approach to cure. I have seen people with FD in the various fingers of both the right and left hands, guitarists and other plucked instrumentalists, bowed string players, pianists, woodwind players, and percussionists. Every case is different.
Botox injections, an early source of hope for many, have apparently proved largely unsuccessful in the end, as their positive effect seems to diminish over time. The one time I have seen a significantly positive effect of Botox was with a pianist who worked with me. He had almost reached full cure working with my technique, but wasn’t able to achieve 100 percent cure until a couple of Botox injections “reminded” his arms how they worked before. After those injections, he was finally rid of the dystonia.
In my own personal story, it took me a few years to regain my composure onstage. After all, I had the condition for 12 years, a very long time to be out of practice playing in public. Once I had found my confidence again, I began playing at a level unmatched, I believe, by my playing before FD. My ideas about engaging the large muscle groups gave me a deeper understanding of how to play with less effort and greater freedom. This had always been the goal of my technical pursuits on the guitar, but my self-cure led me to an area of knowledge that I hadn’t had before. The culmination of all these ideas will be in the book I have recently written called Playing with Ease: A Healthy Approach to Guitar Technique, which will be published by Oxford University Press, hopefully in late 2017 or early 2018.