Performance-related Musculoskeletal Disorders Research Articles

ADLs and PRMDs

The article by Lamontagne and Bélanger in this issue of the journal describes the development of a questionnaire concerning performance-related musculoskeletal disorders (PRMDs) in musicians. It is well designed and deserves careful reading by clinicians and researchers alike. The authors are very clear in stating that their focus was strictly on musculoskeletal problems that are the result of playing an instrument. This is a perfectly reasonable approach to take in the development of a questionnaire that will be used for research purposes. It's often best to start out doing research with a relatively narrow definition of the problem, gain a solid understanding of that particular system, and then broaden the question.

Incidence of injury and attitudes to injury management in skilled flute players

The flute is a highly popular instrument, yet little is known about the potential injury association with playing this instrument. Twenty flautists from a major music training institution volunteered to participate in this project, and had played the flute for a minimum of ten years. A specifically designed musicians' health questionnaire was used to determine injury rates in a group of skilled collegiate flute players majoring in music to examine self-reported perceptions of performance-related musculoskeletal disorder causation and approaches to managing these conditions. All except one player reported suffering from a performance-related musculoskeletal disorder, with pain present for longer than 3 months in two thirds of this group. The most common approach by the flautists was to take Alexander lessons rather than seeking health professional advice. Most attributed their symptoms to long hours of practice, poor posture and the presence of performance anxiety. Flautists in this sample reported high rates of performance-related musculoskeletal disorders with the majority having been present for longer than 3 months. The approach to management often did not involve consultation with a health professional qualified to diagnose musculoskeletal conditions.

The High Prevalence of Injury Among Female Bassoonists

Performance-related musculoskeletal disorders (PRMDs) are a frequent reality for practicing musicians. Aspects of the bassoon, such as the weight of the instrument and the musician's asymmetrical body position, make bassoon players particularly susceptible to PRMDs. The International Bassoonist Questionnaire was distributed via the world wide web (n = 166; 58% male, 42% female) to investigate PRMDs in bassoon players. Great differences between genders were documented in bassoon players; females (100%) reported PRMDs more frequently than males (78%). Female bassoonists were particularly susceptible to PRMDs in the hands, arms, and wrists.

Shoulder Pain in Musicians

Professional musicians with shoulder pain and other performance-related musculoskeletal disorders have received little attention in the orthopedic literature. Musicians, who repetitively use their hands overhead such as small string instrument players and conductors, are susceptible to rotator cuff injury. Rotator cuff injuries range from an acute tendonitis to chronic tendinosis and rotator cuff tears. The rotator cuff functions as a shoulder stabilizer and assists in arm elevation and rotation. Rotator cuff injuries cause pain and may result in weakness and difficulty performing daily as well as musical activities. Treatment of rotator cuff injuries focuses on nonoperative modalities, but surgical intervention may be indicated for persistent pain. Physicians should be aware that rotator cuff injuries occur in musicians to ensure timely and appropriate treatment.

Yoga Ameliorates Performance Anxiety and Mood Disturbance in Young Professional Musicians

Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians.

High Prevalence of Performance-related Musculoskeletal Disorders in Bassoon Players

Performance-related musculoskeletal disorders (PRMDs) are a frequent reality for practicing musicians. Many aspects of the bassoon make these players particularly susceptible to PRMDs, yet to date no study investigating PRMDs has been conducted solely in the bassoon community. The purpose of this study was to identify PRMD symptoms experienced among bassoon players, ascertain the most affected areas, and identify treatments used. Information was gathered using the International Bassoonist Questionnaire, a web-based survey designed by the author. Eighty-six percent of participants (n = 166) reported PRMDs. Pain was the most common PRMD symptom reported (78%). Thirty-one percent of bassoon players reported a medically diagnosed condition, with tendinitis being the most common diagnosis (54%). Bassoonists experienced multiple PRMD symptoms and reported numerous affected locations. PRMDs were most frequently reported in the arms and wrists (54%), and the left side had more PRMDs than the right side. Despite the number of treatment options available, bassoon players primarily used self-administered treatment, with only 31% consulting a medical doctor. Rest was the most common self-applied treatment (60%).

Looking at Musicians' Health through the “Ages”

This month's editorial is based on a presentation that I did at the International Congress on Music Physiology and Musicians Medicine, which was held in Freiburg, Germany, in late March. Stimulated by some recent articles published in MPPA, I attempted to review what we know about the pattern of performance-related musculoskeletal disorders (PRMDs) among instrumental musicians over the lifespan. For the purposes of this review, I have not made any attempt to do a rigorous critique of the methods used in each study, but there are some key definitions and terminology that are relevant. Since even small differences in terminology can produce significant variation in the results, this adds to the difficulty of drawing conclusions from the studies published to date.

Assessment of Health Risks in Musicians of the Slovene Philharmonic Orchestra, Ljubljana, Slovenia

This study consisted of medical examination and comparison of results obtained in 70 musicians from the Slovene Philharmonic Orchestra, Ljubljana. The main goals of the study were to identify performance-related musculoskeletal disorders, to assess the health status and working capacity of the musicians, and to propose measures for improved protection of their health. The results were compared with results obtained in a control group of 28 marketing workers at Philip Morris Enterprise, Ljubljana. Musculoskeletal problems of the studied group of Slovene musicians were compared with problems of 109 musicians of the Berlin Opera Orchestra examined at the Institute of Occupational Health, Berlin, Germany. We identified performance-related diseases (inflammatory and degenerative skeletal disorders and minor occupational hearing impairments) that were most frequent. A significant proportion of performing musicians had overuse syndrome, caused by excessive use of the extremities and characterized by cumulative microtrauma exceeding human physiologic limits, and dermatologic problems, such as finger calluses and “fiddler’s neck.” The most frequent musculoskeletal problems were due to repetitive motion, unphysiologic postures (isometric strain on the affected muscles), and prolonged sitting position during performances. The highest level of musculoskeletal disorders was noted in the double bass and cello sections, followed by violin, viola, woodwind, and brass players. The severity of physical impairments and restricted ability to perform music were correlated with age, duration of classical music performance, and total length of service. In the group of Slovenian musicians, the incidence of health problems in general was twice as high as in the control group, whereas the incidence of musculoskeletal disorders was six times as high as that in the control group. Health status of the musicians in terms of moderate and severe physical impairments was worse than in the control group. Measures for improved health protection and better performance ability were proposed.

Strength or Endurance Training for Undergraduate Music Majors at a University?

The purposes of this study were to evaluate the effect of an exercise regimen for undergraduate music majors at a university, and to determine whether a short-term, moderate-intensity program designed to assist in their preparation for the athletic task of playing an instrument for many hours a day could be incorporated into their timetables and show strength gains. In this study, 18 volunteer university undergraduate music majors were randomly allocated into either six weeks of strength training or six weeks of endurance training of proximal upper-limb and trunk muscles. All subjects were measured over a six-week control period prior to the exercise period. Tests using both physical and self-report data were repeated on three separate occasions to determine whether training produced any effects over this period, and which form of training was the more effective. Physical testing data were collected by an independent tester who was blinded to the study condition. These data included Cybex dynamometer testing in two planes of shoulder motion, field measurements, and timing an isometric 90-degree forward flexion arm hold. Questionnaires were used to gather data on the frequency and severity of performance-related musculoskeletal disorders and on the perceived exertion of playing. Results indicated that the program produced significant strength gains in both field measurements and dynamometer testing in both exercise groups. While all field measurements of the actual exercises performed increased significantly over the exercise period, the dynamometer results showed a significant effect of the exercise program on the horizontal plane only, suggesting this group of musicians took a task-specific view of the exercises and focused more on their application of horizontal exercises, seeing the relevance in relation to playing an instrument. Vertical isokinetic measurements remained unchanged. Perceived exertion of playing was significantly reduced, with endurance training significantly better than strength training for achieving this result.