Performance-related Musculoskeletal Disorders Research Articles

An investigation of thermal patterns in guitarists performing a musician-specific exercise program

Several musicians suffer from musculoskeletal problems during their career. These injuries are referred to as performance-related musculoskeletal disorders (PRMDs). Through the use of exercise programs, PRMDs can be prevented. Exercise programs aim to strengthen musicians' upper limbs and supporting muscles, which can correct and improve postural control during performance and thereby prevent PRMDs. In this study, a musician-specific exercise program was carried out by guitarists. Thermal imaging was used to observe and monitor the effect of the program. Thermal data was collected from 14 guitarists who played their instrument for at least 7 hours a week. Data was gathered from the trapezius, shoulder, upper arm, forearm, wrist, and digits for a period of 20 minutes whilst the guitarists were playing. The participants followed the exercise program throughout a period of 6 weeks, after which the process of thermal data collection was performed again. While existing studies that evaluate musicians through thermal imaging mostly observe thermal asymmetries, in this work we also looked at absolute and relative temperature changes over time, both before and after the exercise program. The results show that one of the main and most consistent effects of the musician-specific exercise program was the reduction of thermal asymmetries within the shoulder region. This is indicative that the musician-specific exercise might be beneficial to avoid or reduce the effect of PRMDs in guitarists. Keywords: infrared thermography, musculoskeletal, instrumentalist, guitarists, thermal patterns, exercise program

A Study on Performance-Related Musculoskeletal Disorders During Chinese Opera Training

The goal of this research approach is to achieve training effectiveness as great as in olden times using modern methods of performance-related musculoskeletal disorders (PRMDs), mental models, and ergonomic analysis. The purpose of this study explored the situation of PRMDs among Chinese opera performers and assessed the severity, frequency, continuance, and locations of PRMDs. This study also identified the treatments used for PRMDs, contributing factors to PRMD development, and the perceptions of the Chinese opera community regarding PRMDs. This research used a questionnaire modified from the Nordic Musculoskeletal Questionnaire (NMQ). The questionnaire involved a total of 108 responses from 43 professionals and 65 students. For the nonparametric methods, independent-samples kruskal-wall is test, a one-way ANOVA (k samples), was used at multiple comparisons (all pairwise) significance level of .05. Chi-square tests were used to distinguish differences and relationships among the variables in self-report questionnaires between participants. Cross tabulations were applied to describe the univariate relationships among the items of independent and dependent variables for comparison of nominal and interval variables. For the parametric methods, the independent sample t-test was used at a two-tailed significance level of .05 for comparison of nominal and interval variables. One-way ANOVA and linear regression analysis was used to identify the relationship among variables and predicted factor between regions of the body with PRMDs and other self-report independent variables. The results indicate the most significant and frequent PRMD symptoms experienced after training and working for the nine body regions (neck: increased 41.7%, shoulders: increased 46.3%, upper back: increased 33.3%, elbows: increased 24.1%, wrists/hands: increased 50.0%, lower back/hips: increased 44.4%, thighs: increased 24.1%, knees: increased 52.8%, ankles/feet: increased 25.9%). According to our knowledge, this is the first research to examine the relationship among the self-reports severity and frequency of PRMDs in Chinese opera population. Therefore, the Chinese opera performing arts population requires more information regarding PRMDs for developing treatment and prevention strategies according to scientific methods. Hopefully, the PRMD-related problems from traditional Chinese opera training and work places reported in this study can be mitigated in the near future.

Occupational Injuries in Musicians: A Literature Review.

The U.S. Department of Defense employs more musicians than any other organization in the USA with over 6,000 musicians employed. Musculoskeletal pathologies, behavioral health disorders, hearing loss, and dystonias account for the majority of reasons a musician seek medical care. The aim of this study is to review recent medical literature documenting occupational hazards in musicians. Authors performed a literature review of publications related to musician performance-related musculoskeletal disorders (PRMDs) and performance-related pain (PRP), behavioral health disorders, dystonias, and hearing loss, published from 2004 to 2019 PubMed. The search returned 174 possible articles which, after review and exclusion, yielded 88 articles. Medical literature suggests several risk factors for multiple disease categories. Practice time and history of PRMD/PRP were both associated with development of PRMD/PRP and focal dystonia. A history of behavioral health disorder was associated with development of focal dystonia. Clinicians should counsel their musician patients on strategies to minimize risks, and additional research is needed to identify specific causes of illnesses in musician populations.

Leveraging implementation science to prevent and reduce musculoskeletal overuse injury in musicians: A proposal for the study of a conceptual framework

BackgroundMusician health and wellness, a fundamental requirement for safe, effective and optimal musical performance, is not guaranteed. Performance related musculoskeletal disorders (PRMD) affect between 60% and 90% of all musicians, and have serious consequences on musculoskeletal health, performance ability and the overall healthcare burden of musculoskeletal injury. The high prevalence of PRMD in musicians can be prevented and reduced via health-education programs designed to address risk factors and practice habits. Multiple studies demonstrate the efficacy of education and instructional exercises in reducing PRMD symptoms in musicians. Despite the awareness of risk and the substantial consequence of non-adherence, implementation of health-education programs is complex and challenging and is rarely offered in music institutions. For successful adoption of musculoskeletal health programs, it is important to identify system level barriers and facilitators and it is important to develop and pilot effective strategies to guide successful implementation of musculoskeletal health programs for musicians. PurposeThis paper proposes a conceptual framework using implementation science methodology to study the factors that influence adoption of musician health education programs to prevent performance related injury. The overall goal of this methodology is to identify determinants of implementation by engaging key stakeholders, developing strategies for adoption of injury prevention programs and generate hypotheses for future studies. MethodsThe research plan is designed to accomplish the specific aims of this study. Through a mixed-method study we will use qualitative and quantitative methods to address potential barriers, and design and test implementation feasibility of health-education programs for musicians. Results/ConclusionsOur findings will inform the development of a large-scale participant randomized hybrid trial to assess effectiveness and implementation outcomes of health education programs and ultimately reduce injury and promote musculoskeletal longevity and performance in musicians

Feasibility and impact of a musculoskeletal health for musicians (MHM) program for musician students: A randomized controlled pilot study

BackgroundThere is a high incidence of performance-related musculoskeletal disorders in musicians that may be reduced via education programs. However, the efficacy of formalized injury prevention programs has not been rigorously studied. PurposeTo assess the feasibility and effect of a formalized injury prevention education workshop on incidence and severity of musculoskeletal pain in a cohort of musician-students attending an intensive summer music festival compared to controls. Study designRandomized-controlled-pilot trial. MethodsMusicians at an 8-week long intensive summer festival were randomized to an intervention (workshop) or control group. Workshop attendees participated in a 90-minute session of injury prevention strategies. Musculoskeletal outcome data were collected at the start and end of the festival. Outcomes included presence of musculoskeletal pain, adherence level, and sub-scales of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians. ResultsA total of 57 musician-students (ages 17-30, 23 females) participated in the study, and 48(84%) completed the study. Seventy-five percent of workshop participants reported adherence over 8 weeks. At baseline, 84% of participants reported a history of playing-related pain, and 47% recent or current pain. Participants played a range of instruments (50% string, 34% piano, 16% woodwind/brass). At baseline, average weekly reported playing time was 39 hours (±11). At follow-up, reported pain decreased by 32% in the intervention group and increased by 8% in controls (P < .01). Pain interference scores were lower (Post – Pre = -4.58, 95% CI -9.26 to 0.11, P = .055). There was no statistically significant difference between groups for pain intensity. ConclusionsThe high compliance and willingness to participate suggests that injury prevention education implementation is feasible. Our preliminary findings suggest a positive effect on pain incidence and pain interference in the intervention group. Future studies will examine the relationship between adherence levels and injury rates in a larger cohort and identify obstacles to implementation.

Physical Activity, Sedentary Behavior, Anxiety, and Pain Among Musicians in the United Kingdom.

Context and AimsAlthough some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders (PRMDs) among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity (PA), their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.MethodsFollowing a cross-sectional correlational study design, both standardized and ad hoc measurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form (IPAQ-SF)], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control (CDC); Determinants of Physical Activity Questionnaire (DPAQ)]; sedentary behavior [Sedentary Behavior Questionnaire (SBQ)]; pain [36-Item Short Form Survey Instrument (SF-36)] and PRMDs (frequency and severity); reported physical exertion (RPE); anxiety [Hospital Anxiety and Depression Scale (HADS)]; practice behaviors (e.g., practice time; taking breaks frequency; warming up); and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.ResultsDemographic information was obtained from 111 respondents, mostly undergraduate students (UGs) from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information (by 43% of respondents), and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” (RPE) on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.ConclusionThe relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged.

The prevalence of performance-related musculoskeletal disorders in fine arts faculty students and academics.

While professional musicians may have a high incidence of musculoskeletal pain, there are few studies on the performance-related musculoskeletal disorders (PRMD) in visual artists. To assess the prevalence and probable risk factors of PRMD in visual artists. The study population comprised the students and academics of fine arts faculty. The Rapid Entire Body Assessment (REBA) and the Cornell Musculoskeletal Discomfort Questionnaires were used to evaluate posture and pain, respectively. The study included 197 participants (140 women, 57 men). The mean REBA score was 5.2. The sculptors who worked in marble sculpting had the highest REBA scores. Of the participants, 88.8% reported musculoskeletal pain. The pain severity of 64.0% of the participants was 3 (very uncomfortable with a reduction in activity) and/or 4 (pain interferes with the ability to work). The PRMD prevalence was 64.0%, and significantly higher in women than in men (p < 0.05). Musculoskeletal pain in visual artists is extremely prevalent. Mean REBA score of 5.2 corresponds to a medium risk assessment accompanied by guidance to "further investigate, change soon." The policy makers in fine arts faculties who are responsible for student and employee health should prioritize strategies to prevent and manage musculoskeletal pain.

CARING PROFESSIONAL HEALTH: A POWERFUL OF YOGA

INTRODUCTIONHealth professionals and medical science students have high levels of stress, anxiety and performance‐related musculoskeletal disorders. Long workloads and strenuous shifts, feelings of empathy for the suffering of patients and families, demands for cleanliness and hospital conduct, and the need for many hours of study cause mood swings and emotional instability, diminish immune system function and increase psychosomatic diseases in students and health professionals.The goal of this study was to evaluate the effects for health professionals and students that participated in YogaSanta Program, an opened and free program of Yoga.MATERIAL and METHODSThe World Health Organization Quality of Life assessment (WHOQOL‐BREF) was sent by e‐mail for health professional as well as for Medicine, Nursing e Speech Therapist students from Santa Casa de São Paulo School of Medical Sciences(São Paulo – Brazil). Who have shown WHOOQL‐BREF score under 50% were invited to participate of “YogaSanta Program”. YogaSanta aims “to take care of people who care for people” and offer free Yoga sessions for all. We selected 22 adults that practice one‐hour yoga session twice a week for 3 months consecutively. The sessions included Pranayama (breathing exercises), Asanas (postures), Yoganidra (relaxation) and Dhyana (meditation). All participants completed Visual Analogue Scale (VAS) for assessing stress‐level in two different moments: (VAS after = VAS‐A) immediately after Yoga class and (VAS before = VAS‐B) just before Yoga class. VAS varies from zero to 10 where “zero” corresponds to “no stress” and “10” corresponds to the “worst stress level”. VAS‐B and VAS‐A were compared through the t‐paired test and the results are shown in this study.RESULTSFrom 22 participants, 6 occupied administrative functions the hospital, 13 were students and two were faculty members. The mean ± standard deviation (SD) of participants age was 32.3 ± 12.2 yrs (Range: 22 – 60 yrs). The mean ± SD of VAS‐B and VAS‐A were compared (EVA‐B 3.34 ± 1.4 vs. VAS‐A 1.89 ± 1.4) and showed a low correlation = 0.574 with p&lt;0.001.DISCUSSION and CONCLUSIONSome previous articles suggest that physiological benefits like muscle strength, flexibility, blood circulation and oxygen uptake, hormone functions and the relaxation induced by meditation helps to stabilize the autonomic nervous system and this help yoga practitioners become more resilient to stressful conditions and reduce a variety of important risk factors for different diseases, especially cardio‐respiratory disorders.Based on this and the results presented above, we believe that the YogaSanta program is an efficient option for producing improvements in psychological well‐being and decreasing mood disorders in health professionals and health students, thus contributing to improving performance and quality of life and help to stress reduction.

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

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.

Potential Relevance of Altered Muscle Activity and Fatigue in the Development of Performance-Related Musculoskeletal Injuries in High String Musicians.

Muscle fatigue seems to be a risk factor in the development of performance-related musculoskeletal disorders (PRMDs) in musicians, but it is unclear how muscle activity characteristics change between musicians with and without PRMDs over a prolonged playing period. To investigate muscle activity patterns in muscles of the arms, shoulder, and back of high string musicians during prolonged performance. Fifteen professional or university high string musicians were divided into PRMD and non-PRMD groups. All musicians played a chromatic scale, then an individual "heavy" piece for 1 hr, and finally the chromatic scale again. Surface electromyography (sEMG) data were recorded from 16 muscles of the arm, shoulder, and trunk on both sides of the body. Two parameters were analyzed: the percentage load in relation to the respective maximum force during the chromatic scale, and the low-frequency spectrum to determine the fatigue behavior of muscles during the 1-hr play. Changes in muscle activation patterns were observed at the beginning and end of the trial duration; however, these varied depending on whether musicians had PRMDs or no PRMDs. In addition, low-frequency spectrum changes were observed after 1 hr of playing in the PRMD musicians, consistent with signs of muscular fatigue. Differences in muscle activity appear between high string musicians with and without PRMDs as well as altered frequency spectrum shifts, suggesting possible differential muscle fatigue effects between the groups. The applied sEMG analysis proved a suitable tool for detailed analysis of muscle activation characteristics over prolonged playing periods for musicians with and without PRMDs.

Effect of a rehabilitation program on performance-related musculoskeletal disorders in student and professional orchestral musicians: a randomized controlled trial

Objective: To explore the feasibility of a rehabilitation program and its effect on the performance-related musculoskeletal symptoms and functional limitations of orchestral musicians. Design: Single-blind pilot randomized controlled trial with exercise group and control group. Setting: Workplace of professional symphony orchestra and tertiary-level conservatory orchestral musicians. Participants: Professional and student orchestral musicians with or without performance-related musculoskeletal disorders. Interventions: A rehabilitation program including an educational presentation, an 11-week home exercise program and three supervised exercise sessions, versus no intervention. Measures: Feasibility measures included adherence and drop-out rate. The Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians (MPIIQM) measured symptom intensity and functional limitations, while the Nordic Musculoskeletal Questionnaire (NMQ) measured symptom prevalence and frequency. Results: A total of 30 participants were recruited (n = 15 per group). Exercise group adherence was 97.7% for the supervised sessions and 89% for the home exercise program. There were no drop-outs. Significant group-time interactions were obtained for both the pain intensity (partial η2 = 0.166; P = 0.025) and pain interference (partial η2 = 0.186; P = 0.017) sections of the MPIIQM. Mean (standard deviation) pain intensity score changes from baseline to 11 weeks were control group: 0.40 (5.04); P = 0.763; partial η2 = 0.007; and exercise group: –4.07 (5.31); P = 0.010; partial η2 = 0.386. For pain interference, mean score changes were control group: 0.20 (9.10); P = 0.933; partial η2 = 0.001; and exercise group: –9.00 (10.73); P = 0.006; partial η2 = 0.430. NMQ analyses revealed no significant interaction (P > 0.05). Conclusion: Results suggest that the studied program is feasible and effective in decreasing the intensity and functional impact of musicians’ symptoms. However, no significant medium-term effect on the prevalence and frequency of symptoms was shown.

Resistance Training for Professional String Musicians: A Prospective Intervention Study

Many professional musicians report performance- related musculoskeletal disorders (PRMDs). Evidence shows that resistance training programs are preventive for musculoskeletal disorders, but only a few studies have been performed among musicians. The aim of this study was to evaluate whether a functional resistance training program can increase isometric back endurance and isometric strength in the neck, shoulder, and wrist for professional string musicians and affect their perceived performance during instrumental play, as well as their muscle and joint mobility and the occurrence and intensity of pain. 24 professional string musicians from three Swedish symphony orchestras participated in the study, performing individually designed exercise sessions twice a week over an 11-week period. Isometric strength and isometric back endurance were measured pre- and postintervention with a hand-held dynamometer and the Biering-Sorensen test, respectively. A web-based questionnaire was used for assessing perceived performance during instrumental play, as well as mobility and occurrence and intensity of pain. After the training period, the group showed an 11% to 19% increase in isometric strength for neck and upper extremities and 25% improved isometric endurance in back extensors (p<0.05). Moreover, 29% to 59% of the group showed improvements in mobility, performance during instrumental play, and PRMDs, although these improvements did not reach statistical significance. This functional resistance training program seems to be a non-harmful and advantageous exercise method for professional string musicians, but randomized and controlled studies are needed to confirm the results.

Effects of Aging on Musical Performance in Professional Orchestral Musicians.

The physical and psychological demands of playing a musical instrument are likely to be affected by age-related decline in function, including physical, cognitive, psychological, and organ-related changes. However, the complex neurophysiological demands of playing a musical instrument may delay many normal aging-related changes. This study compared professional classical musicians of different ages, using a range of physical and psychological measures, to discover how increasing age might affect work performance and to identify possible risk and protective factors for physical and psychological health as the musicians age. 377 professional orchestral musicians from eight Australian orchestras (70% response rate), ages 18 to 68 yrs (mean 42.1). Multiple standardized physical and psychological tools were used to evaluate the impact of age on a range of physical and mental health variables. Age was not statistically associated with frequency or severity of performance-related musculoskeletal disorders, ratings of perceived exertion, QuickDASH scores, use of beta-blockers, workplace satisfaction, and most psychological tests. Differences were observed on SPIN (social anxiety) scores, with lowest scores in the oldest age group (10.66 in 55+ yrs vs 17.83 in 18-30 yrs, p=0.016). Older musicians had higher BMIs and fewer practice sessions per day than younger musicians and also were more likely to consume alcohol on 5+ days/wk (44% vs 9%, p=0.003). Advancing age does not appear to exert undue negative impacts on physical and psychological health or performance capacity of professional orchestral musicians. However, dwindling numbers in the older age groups may suggest a "survivor" effect, whereby those who develop significant age-related decrements may cease professional performance at earlier ages. Longitudinal studies on the professional trajectories of professional orchestral musicians are needed to explore this question further.

Is Playing in the Pit Really the Pits?: Pain, Strength, Music Performance Anxiety, and Workplace Satisfaction in Professional Musicians in Stage, Pit, and Combined Stage/Pit Orchestras.

Typically, Australian orchestral musicians perform on stage, in an orchestra pit, or in a combination of both workplaces. This study explored a range of physical and mental health indicators in musicians who played in these different orchestra types to ascertain whether orchestra environment was a risk factor affecting musician wellbeing. Participants comprised 380 full-time orchestral musicians from the eight major state orchestras in Australia comprised of two dedicated pit orchestras, three stage-only symphonic orchestras, and three mixed stage/pit orchestras. Participants completed a physical assessment and a range of self-report measures assessing performance-related musculoskeletal disorders (PRMD), physical characteristics including strength and perceived exertion, and psychological health, including music performance anxiety (MPA), workplace satisfaction, and bullying. Physical characteristics and performance-related musculoskeletal profiles were similar for most factors on the detailed survey completed by orchestra members. The exceptions were that pit musicians demonstrated greater shoulder and elbow strength, while mixed-workload orchestra musicians had greater flexibility Significantly more exertion was reported by pit musicians when rehearsing and performing. Stage/pit musicians reported less physical exertion when performing in the pit compared with performing on stage. Severity of MPA was significantly greater in pit musicians than mixed orchestra musicians. Pit musicians also reported more frequent bullying and lower job satisfaction compared with stage musicians. There were few differences in the objective physical measures between musicians in the different orchestra types. However, pit musicians appear more psychologically vulnerable and less satisfied with their work than musicians from the other two orchestra types. The physical and psychological characteristics of musicians who perform in different orchestra types have not been adequately theorized or studied. We offer some preliminary thoughts that may account for the observed differences.

Effect of a musicians' exercise intervention on performance-related musculoskeletal disorders.

To evaluate the effect of a purpose-designed exercise program on performance-related musculoskeletal disorders (PRMDs) and associated risk factors in a sample of professional orchestral musicians. A 10-week exercise program was made available to full-time musicians employed by the eight premier symphony orchestras of Australia. Questionnaires were administered before, immediately after (T1), and 6 months after interventions (T2) containing questions relating to change in frequency and severity of PRMDs, ratings of perceived exertion (RPE) during rehearsal, private practice, and performance, as well as nine performance-related factors. Participants were also asked to rate whether these performance-related factors affected their overall playing capacity during different playing situations. A comparative control group of musicians had no intervention and completed a modified questionnaire at the same time points. Exercise participants (n=30) reported a reduction in frequency (p<0.05) and severity (p<0.05) of PRMDs at T1 but not at T2 compared to controls (n=23). The exercise group reported a significant improvement in RPE during private practice at T1 (p<0.01) and T2 (p<0.01), but not during rehearsal and performance. At T1, the intervention was rated to be moderately to highly effective for three performance-related factors: strengthening muscles that support playing, learning techniques that support playing, and posture. Further, participants reported an intervention effect on overall playing capacity during rehearsal at T1 and T2. A tailored exercise program for musicians was effective at managing PRMDs, especially in reducing the frequency and severity of PRMDs. Physical therapy exercises should be considered in modifying performance-related factors that have been reported to be predictors of PRMDs.

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians.

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.

Hypermobility and proprioception in the finger joints of flautists.

Ergonomically, the flute is especially complex among wind instruments, and flautists may therefore be at particular risk of performance-related musculoskeletal disorders. Yet little is known about injury prevalence among flute players, and even less in those flautists who are also hypermobile. Recent research has found hand and wrist pain to be common complaints among flautists. Understanding of the predictors of injury and pain is therefore crucial as the presence of pain decreases performance quality and causes unnecessary time loss. There is a strong relationship between hypermobility and impaired proprioception, although many musicians may acquire greater proprioception than the average population. We have compared flexibility and proprioception of the hand in a study of flautists. Twenty flautists took part in the study. General hypermobility, the passive range of motion of the 3 specific joints most involved in flute playing, and proprioception acuity were all measured accurately for the first time in this awkward instrument that needs high levels of dexterity. Flautists' finger joints have a greater range of movement than in the general population. This group of flute players had especially large ranges of movement in the finger joints, which take the weight of the instrument. Although flautists have hypermobile finger joints, they are not generally hypermobile elsewhere as measured by the Beighton Scale. Flautists, even with very mobile finger joints, have very accurate proprioception, which may be acquired through training. The study of instrumentalists may provide an ideal model for study of the interaction between localized joint flexibility and joint proprioception, both inherited and acquired.

Exercise DVD effect on musculoskeletal disorders in professional orchestral musicians

Professional musicians report a high prevalence of performance-related musculoskeletal disorders (PRMDs). Excessive muscle tension and fatigue have been reported as important factors contributing to PRMDs. To evaluate feasibility and effectiveness of a specific exercise programme delivered via a digital video disc (DVD) targeting PRMDs and associated risk factors. Volunteers from eight Australian symphony orchestras undertook two or more sessions per week over 12 weeks. Questionnaires were administered pre- and post-intervention with items including the frequency and severity of PRMDs, perceived exertion during different playing situations, per formance effects of the DVD and satisfaction rates. Musicians who had also participated in an equivalent face-to-face programme prior to this DVD trial compared the two interventions. One hundred and forty-four out of 576 musicians volunteered (25% uptake), and 50 participants completed a mean 2.1 (SD 0.42) sessions over the 12 week period (41% compliance). PRMD frequency and severity were significantly reduced post-intervention (P < 0.01). Participants reported benefits of the DVD on strengthening muscles, increasing ease of movement and improving flexibility related to playing. Despite this, perceived exertion levels during private practice, rehearsal and performance remained the same (not significant). Seventy-eight per cent of participants scored their overall experience of the use of the DVD as good or excellent. Owing to its convenience and detailed exercise demonstrations, the DVD was rated as better or much better overall than the face-to-face classes by 55% of participants who had experienced both. An exercise DVD was well received and appeared to be effective, convenient and safe in managing occupational-specific musculoskeletal disorders in musicians.

The usefulness of on-site physical therapy-led triage services for professional orchestral musicians – a national cohort study

BackgroundAustralian professional orchestral musicians reported a lifetime prevalence of musculoskeletal injuries that had interfered with playing at 84%. Physical therapy-led triage clinics may be a practical method to manage the impact of high performance-related musculoskeletal disorders (PRMDs) in professional orchestral musicians. This study aimed to: a) collect information on presenting injuries, b) determine the participant’s provisional diagnosis, c) evaluate uptake of an on-site triage service, d) measure participant satisfaction, and e) identify factors influencing attendance.MethodsEight triage sessions were run on a fortnightly basis during a designated lunch break between rehearsal calls in seven premier symphony orchestras in Australia; a total population of 483 musicians. The participants received one or a combination of: a) education and advice relating to their provisional diagnosis, b) basic acute management and/or c) a referral to a suitable medical practitioner or allied health professional for further consultation or treatment. A three-month follow-up questionnaire was completed and a qualitative narrative themes-based analysis was undertaken to summarise participant and physical therapist feedback. Uptake, participant satisfaction and factors influencing attendance were measured.Results99 initial consultations (83 individuals) were conducted with more females (61%) utilizing the service than males (49%). The most common injury complaints were in the shoulder (22%), neck (18%), upper back (18%), and hand (8%). 66% of these were diagnosed as PRMDs. Of these injuries, 94% were considered preventable, 93% continued to affect playing, 68% were severe requiring a referral for further management, and 46% were recurrent. The advice at the triage service was rated as helpful or very helpful by 79% of the musicians, whilst 68% responded they were likely or very likely to continue to use the service if it was offered in the future. Of the participants that followed through with the referral advice, 67% reported that the referral advice was helpful or very helpful. Musicians’ and physical therapists’ written feedback indicated their acknowledgement for the need of this service. The main suggestions for improving attendance were increasing the music-specific physical therapy knowledge of therapists and overcoming competing time demands.ConclusionOn-site health services for musicians may facilitate better injury management by providing immediate and specific health advice.Trial registrationACTRN12612000220864

Musculoskeletal Pain and Injury in Professional Orchestral Musicians in Australia

This paper reports on the major findings from the questionnaire component of a cross-sectional survey of the musicians in Australia's eight fulltime professional symphonic and pit orchestras, focusing on performance-related musculoskeletal disorders (PRMDs). All musician members of the orchestras participating in this project were invited to complete a self-report survey. The overall response rate was about 70% (n = 377). In addition to general health and experience questions, respondents who reported a current or previous PRMD were asked to report on a range of associated factors. Of the participants, 84% had experienced pain or injuries that had interfered either with playing their instrument or participating in normal orchestral rehearsals and performances. Fifty percent reported having such pain or injury at the time of the survey, mostly with disorders perceived by the musicians to be work-related. Twenty-eight percent had taken at least 1 day off from work for such pain in the previous 18 months. The most common broad sites affected were the trunk (primarily the back), the right upper limb and neck, the left upper limb and neck, and the neck alone, but the relative proportions varied by instrument. Of those musicians who reported at least one episode of pain or injury in the past, less than 50% reported that they had completely recovered. The most commonly cited performance-related factors that had contributed to injury or pain all related to training and playing load (including practice and performance). This study provides strong evidence that PRMDs are a common complaint in professional orchestral musicians and identifies a range of factors suggested as contributing to the occurrence or persistence of these disorders.