Musculoskeletal Demands in Violin and Viola Playing: A Literature Review.

Abstract

Research in music medicine has reported incidence rates of musculoskeletal disorders of approx. 70% in instrumental musicians. String players have the highest risk, with rates of performance-related musculoskeletal disorders (PRMDs) of 65% to 88%. Playing the violin or viola requires complex neuromusculoskeletal skills, and the high frequency of repetitive movements, dynamic and static muscle load, awkward postures, poor technique, and practice time are factors causing musculoskeletal strain. In ergonomic terms, these disorders can be categorized based on extrinsic and intrinsic loads. Identification of intrinsic loads, such as muscle utilization and joint motion, is necessary to understand factors influencing musculoskeletal disorders associated with violin playing. The aim of this study was to review the literature on musculoskeletal demands in violin and viola playing. A literature search was conducted in the PubMed, COCHRANE, and CINAHL electronic databases from 1999 to 2015 using the search terms violin, viola, high strings, movement, posture, and synonyms. A manual search of Medical Problems of Performing Artists was also conducted. Additional references were identified by searching the citations and reference lists of all identified relevant studies. The results suggest that an asymmetric playing posture, the associated muscle activity, and joint mobility may contribute to musculoskeletal problems in violin and viola players. Evidence suggests an increased load of intrinsic factors in violin/viola performance. The identification of intrinsic loads in violin and viola playing may facilitate the development of prevention strategies and interventions.