Drummer’s lower limb dystonia

Abstract

Dear Sirs,Musician’s dystonia is an occupational focal dystoniacharacterized by loss of motor control and coordination,generally affecting particularly demanding tasks on over-used body parts. The right hand is generally involved inpianists and guitarists, left hand in violinists, and embou-chure in trumpeters [1]. Drummers can develop upperextremity dystonia but there are no prior reports of lowerlimb dystonia (LLD) even though both feet also becomeengaged in repetitive, stereotyped, and skilled movements.Here we report two cases.A 23-year-old jazz percussion student presented with a4-month coordination problem of his left foot when heplayed the left pedal. He started playing at age 16, and hadbeen playing 5 h/day during the past 4 years. Six monthsprior to onset of symptoms he had switched to a raised heelplaying technique. There were no symptoms during dailylife activities. When playing, he developed involuntarytension at left toes, ankle, and knee muscles. This provokedankle and knee blocking and extension of toes, mainly thefirst one, during drum playing. The left hip and right legwere not involved. The patient underwent reeducation basedon Sensory Motor Retuning experiencing progressiveimprovement [2]. After 1 year oftailored work at ourcenter,he has resumed conservatorium classes, and is finishing hisrehabilitation process.A 22-year-old semiprofessional hard rock drummerpresented with a 2-year history of playing difficulties. Hehad played 3 h/day since he was 17 years old. He alsoworked as a bulldozer driver for 10 h/day. He had beenintensively practicing the double bass pedal techniqueincreasing the kick speed progressively (both feet alter-nately push their own pedal to kick the bass drum). Hefirst noticed incoordination when playing sixteenths atC160 beats/min. The problem progressively worsened andhe became unable to coordinate alternating leg movementat 60 beats/min (Fig. 1). This was associated with invol-untary tension at knee and ankle muscles in both legs.Alternating flexion and extension of the ankle was difficultand, as he played, flexion of the toes and rising of the heelsappeared. He had no symptoms during daily activities, ordriving the bulldozer. When kicking with only one of thepedals problems were of less intensity. During the follow-up,symptomspersistedfor1 yearand,afterthat,heexperiencedamild improvement secondary to modifications in practiceroutines during 1 year more.In both cases, ancillary tests, including brain MRI, elec-tromyogram, and nerve conduction studies were normal.