Performing Under Pressure: What Athletes Can Teach Us About Dystonia
Oct 26, 2025
On January 22, 2023, Dallas Cowboys kicker Brett Maher missed a record four PAT kicks in a playoff game—right after his best regular season ever. What happened? The pressure got to him. A task he’d performed thousands of times automatically suddenly became tense and overthought. His body froze under stress.
Even if you’re not an athlete, you’ve felt this: the tightness before a big presentation, the shaking before a recital, the fear of failing when it matters most. Many with dystonia experience the same pattern.
- The runner whose symptoms worsen in public.
- The woman with cervical dystonia who trembles when speaking on Zoom.
- The musician whose hand stiffens before performing.
These moments share the same root cause—an autonomic nervous system response. Stress triggers elevated heart rate, sweating, shaking, negative thoughts—and in dystonia, worsened symptoms. It can feel inevitable, but both athletes and people with dystonia can learn strategies to calm the body, refocus the mind, and regain control.
Don’t Make It Bigger Than It Is
One of my patients with runner’s dystonia felt intense anxiety walking through parking lots or crowds. His thoughts spiraled: “Everyone’s watching… it’s going to get bad.” Like a kicker fearing his next miss, he gave too much power to one moment.
His breakthrough came when he reframed his fear: “I’ve had symptoms before, and it’s never made me worse. If I don’t walk well this time, I’ll do better next time.”
That shift reduced his emotional load and improved his movement. By removing the pressure to “perform,” he stayed present and mindful—key steps toward better regulation and recovery.
Thrive vs. Survive
Many athletes and patients benefit from seeing challenges as opportunities, not threats. One woman was terrified to run again after months of retraining. Her mindset changed everything when she told herself, “I’m grateful I’ve improved enough to try.”
Each step in your recovery represents progress. Viewing difficult moments as growth opportunities helps you stay calm and engaged rather than fearful.
Self-Talk
Words and thoughts have power. Negative self-talk (“I can’t control my symptoms”) reinforces stress responses and can worsen dystonia. Replace these with positive affirmations like, “I’ve trained for this—I’m ready.”
Noticing and reframing negative thoughts takes practice, but repetition builds new neural pathways. Over time, your inner voice can shift from critic to coach.
Nervous System Regulation
When stress ramps up, simple nervous system tools become your best ally. Mindfulness, box breathing, prolonged exhalation, and grounding exercises like 5-4-3-2-1 help calm the sympathetic response. They also redirect your attention from fear to the present moment—where movement can happen more freely.
Simplicity
In stressful moments, complicated plans overwhelm the brain. Stick to short, simple cues that you’ve practiced.
- For a runner: “Knee forward.”
- Before a Zoom call: slow breathing and a light hand weight.
Simplicity reduces overthinking and helps you feel in control.
Game Plan
Consistency builds confidence. Have a short pre-performance routine—stretching, breathing, visualization, or self-talk—that you can rely on before challenging situations. Repetition tells the nervous system you’re prepared, lowering anxiety and improving performance.
Sports psychologist Robyn Trocchio offered this advice to Brett Maher:
“Let’s talk about times when things were going right. What were you doing? Thinking? Feeling? A lot of times it’s, ‘Oh, I really wasn’t thinking—I was just kicking.’ Let’s get back to that.”
You’ve had normal movement before, and those connections still exist. With practice and the right mindset, you can access them again.
(Note: I’m a physical therapist, not a psychologist—but these are strategies we use at Re+active every day to help patients retrain both body and brain.)
Did you like this post? Do you want more content to help you get the most out of your dystonia recovery, and start making progress? Join our Dystonia Class! A weekly class for all types of dystonia with practical tips and strategies to understand your symptoms and take control of your recovery - linked below!!!
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- Or if you’re ready to commit to treatment: apply for a program on our website
- and share this article with anyone you know with dystonia!
Dr. Lincoln Beal, PT, DPT, NCS
Physical Therapist
Board-certified Neurologic Clinical Specialist
Dystonia Program Director
re+active Therapy and Wellness
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