Prevalence Of Playing-related Musculoskeletal Disorders Research Articles

The Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians: Assessment of Patient-Related Outcomes among Professional Orchestra Musicians in Poland-A Cross-Sectional Study.

Background: Musculoskeletal pain is one of the reasons for a musician's inability to play an instrument. An assessment of the localization, intensity, and interference of those complaints is important among musicians because of the risk of occupational disease. Assessment by validated tools is especially important and serves as an indicator to take up proper preventive or treatment actions. The aim of the study was to assess the prevalence of playing-related musculoskeletal disorders (PRMDs) and the relationships with PRMDs' impact on playing musical instruments among Polish professional orchestra musicians. Methods: The study was conducted on a group of professional orchestra musicians (age 37.19 ± 9.62 years), 99 (55%) women and 83 (45%) men. Work experience in professional orchestra was 18.3 ± 9.83 years and the reported years of playing musical instrument were 31.4 ± 9.50. The study used the online version of a musician-dedicated questionnaire, Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians of the Polish Population (MPIIQM-P). Results: In the study group, 89.9% of women and 83.1% of men had experienced playing-related pain in their lifetime. The most intense pain among the group with current playing-related musculoskeletal complaints (n = 85) was located in the neck area for 19 (22.4%). Conclusions: The results of the study indicate a high prevalence of playing-related musculoskeletal problems among professional musicians.

High Density Surface Electromyography Activity of the Lumbar Erector Spinae Muscles and Comfort/Discomfort Assessment in Piano Players: Comparison of Two Chairs.

Introduction: At a professional level, pianists have a high prevalence of playing-related musculoskeletal disorders. This exploratory crossover study was carried out to assess and compare quantitatively [using high density surface electromyography (HDsEMG)], and qualitatively (using musculoskeletal questionnaires) the activity of the lumbar erector spinae muscles (ESM) and the comfort/discomfort in 16 pianists sitting on a standard piano stool (SS) and on an alternative chair (A-chair) with lumbar support and a trunk-thigh angle between 105° and 135°.Materials and Methods: The subjects played for 55 min and HDsEMG was recorded for 20 s every 5 min. For the quantitative assessment of the muscle activity, the spatial mean of the root mean square (RMSROA) and the centroid of the region of activity (ROA) of the ESM were compared between the two chairs. For the qualitative assessment, musculoskeletal questionnaire-based scales were used: General Comfort Rating (GCR); Helander and Zhang’s comfort (HZc) and discomfort (HZd); and Body Part Discomfort (BPD).Results: When using the A-chair, 14 out of 16 pianists (87.5%) showed a significantly lower RMSROA on the left and right side (p < 0.05). The mixed effects model revealed that both chairs (F = 28.21, p < 0.001) and sides (F = 204.01, p < 0.001) contributed to the mean RMSROA variation by subject (Z = 2.64, p = 0.004). GCR comfort indicated that participants found the A-Chair to be “quite comfortable,” and the SS to be “uncomfortable.” GCR discomfort indicated that the SS caused more numbness than the A-Chair (p = 0.05) and indicated the A-Chair to cause more feeling of cramps (p = 0.034). No difference was found on HZc (p = 0.091) or HZd (p = 0.31) between chairs. Female participants (n = 9) reported greater comfort when using the A-Chair than the SS (F = 7.09, p = 0.01) with respect to males. No differences between chairs were indicated by the BPD assessment.Conclusion: It is concluded that using a chair with lumbar support, such as the A-chair, will provide greater comfort, less exertion of the ESM and less discomfort than the standard piano stool.

Cross-Cultural Adaptation and Validation of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians of the Polish Population (MPIIQM-P).

BackgroundThe aim of the study was the cross-cultural adaptation and validation of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians.Material/MethodsThe process consisted of the following stages: forward translation, backward translation, analysis by committee of experts, pretest of Polish-language version of questionnaire, and cross-cultural validation: psychometric evaluation. In the last step, a convenience sample of 31 professional orchestra musicians (professional experience 16.7±9.5 years) was used to validate the new tool. The primary study outcome measurements were construct validity and internal consistency as measured by exploratory factor analysis (EFA) and Cronbach’s alpha, respectively.ResultsA final Polish version of the questionnaire was developed. Using EFA, the 2-factor structure (pain intensity and pain interference) was obtained, taking into account all 9 items, explaining about 76% of the total variance. The pain interference and pain intensity factors were characterized by high internal consistency (Cronbach’s alpha 0.923 and 0.784, respectively). The lifetime prevalence of playing-related musculoskeletal disorders was 87%.ConclusionsTranslation and a cross-cultural adaptation of the Polish version of the questionnaire was successfully completed. The results obtained show a correctly carried-out validation process, but further testing of the tool is suggested. The Polish-language version of the validated tool can be used in scientific and clinical practice. The next step would be to estimate cutoff values for severity of health status in orchestra musicians.

Prevalence and associated factors of playing-related musculoskeletal disorders among music students in Europe. Baseline findings from the Risk of Music Students (RISMUS) longitudinal multicentre study.

Musculoskeletal (MSK) conditions among professional musicians and music students are frequent and may have significant physical and psychosocial consequences on their lives and/or on their playing abilities. The Risk of Music Students (RISMUS) research project was set up in 2018 to longitudinally identify factors associated with increased risk of playing-related musculoskeletal disorders (PRMDs) in a large sample of music students enrolled in pan-European institutions. The aim of this cross-sectional study was to describe the prevalence of playing-related musculoskeletal disorders (PRMDs) in this novel population at baseline of the RISMUS project. A further goal was to begin to identify variables that might be associated with the self-reported presence of PRMDs among music students. Eight hundred and fifty students from fifty-six conservatories and music universities in Europe completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, health history and PRMDs, psychological distress, perfectionism and fatigue. A total of 560 (65%) out of 850 participants self-reported a positive history of painful MSK conditions in the last 12 months, 408 (48%) of whom self-reported PRMDs. Results showed that coming from West Europe, being a first- or a second-year Masters student, having more years of experience and higher rates of perceived exertion after 45 minutes of practice without breaks were factors significantly associated with self-reported presence of PRMDs. According to the authors' knowledge, a large-scale multicentre study investigating prevalence and associated factors for PRMDs among music students at different stages of their education (from Pre-college to Masters levels) has not been conducted before. The high prevalence of PRMDs among music students, especially those studying at university-level, has been confirmed in this study and associated factors have been identified, highlighting the need for relevant targeted interventions as well as effective prevention and treatment strategies.

Overuse syndrome of the hand and wrist in musicians: a systematic review.

We systematically searched medical publication databases for articles in English on upper extremity overuse syndrome in musicians. We focused on non-specific pain disorders, including diagnostic definitions, epidemiology, pathophysiology, risk factors, symptoms, treatment, and prevention. We included 42 out of 156 identified articles. The point prevalence of playing-related musculoskeletal disorders ranges from 37% to 47% in musicians with the hand and wrist among the most commonly affected areas, and the lifetime prevalence is reported as high as 89%. Leading symptoms are pain, weakness, stiffness, and loss of control. Intense repetitive use during practice, or before an audition or concert, recent changes in conductors or teachers, psychological stress, the effort of holding a weighty instrument, wrong technique, and joint laxity have all been identified as risk factors. The need for prevention is highlighted. Today's therapy is mostly based on individual rehabilitation programmes rather than on long-term rest. However, treatment remains predominantly based on beliefs rather than on evidence. The entire subject needs intensive future research.

Playing-Related Injuries and Posture Among Saxophonists.

Playing-related injuries are common among musicians, but little is known about the nature of injuries and complaints in saxophone players. This research explored playing-related musculoskeletal disorders (PRMDs) and postures among saxophonists. The aims were to: 1) investigate the prevalence of PRMDs among saxophonists; 2) determine the most problematic body parts; and 3) identify their main postural habits and determine whether these postural habits may be related to the prevalence of pain in specific body parts. An online questionnaire was used to collect data from professional and college-level saxophonists throughout North America. From 109 saxophonists who responded, 83 (76.15%) reported ever having a PRMD, 54 (50%) reported having a PRMD in the past year, 30 (27.52%) reported having a PRMD in the past month, and 23 (21.10%) reported having a PRMD in the past week. Top rated areas of pain were the right wrist, neck, mouth/jaw, and left wrist. The most common self-reported postural habits were forward head position and rounded upper back. Postures that correlated with higher pain ratings were rounded upper back and backward pelvic tilt. The rounded upper back, backward pelvic tilt, and excessive curve in low back postures were significantly correlated with the presence of PRMD problems in the right wrist. Saxophonists in this survey experienced a high prevalence of PRMDs, especially of the wrists, neck, and mouth/jaw. Certain postural habits may contribute to higher pain ratings or PRMD locations within saxophonists.

Prevalence of Playing-related Musculoskeletal Disorders in String Players: A Systematic Review

ObjectiveThis systematic review aimed to assess the methodological quality of articles about the prevalence of playing-related musculoskeletal disorders (PRMDs) in string players and to identify the rate of prevalence and associated factors of PRMD. MethodsCross-sectional studies describing data on separate string players published in 5 different languages between January 1, 1980, and January 31, 2014, were included. The following databases were searched: MEDLINE, sciELO, and LILACS. Other sources and reference lists of published papers also were searched. The Loney Scale was used by 2 independent reviewers to evaluate the methodological quality, and only studies that achieved high scores were included. ResultsOf 1910 retrieved articles, 34 cross-sectional studies were selected for methodological assessment. However, only 8 studies reached satisfactory methodological quality scores. The prevalence rate of PRMD was alarmingly high, ranging from 64.1% to 90%. Women and older musicians were more affected in comparison to other instrumentalists. There seems to be a predominance of symptoms in the left upper limb in violinists and violists, whereas cellists and bassists report injuries in the right upper limb. ConclusionsProfessional and amateur string players are subject to development of PRMD. Low response rates were the most observed source of bias, and there is still a lack of publications with high methodological quality in the literature.

The high prevalence of playing-related musculoskeletal disorders (PRMDs) and its associated factors in amateur musicians playing in student orchestras: A cross-sectional study.

ObjectiveDespite the high number of amateur musicians in the general population, little is known about the musculoskeletal health of amateur musicians. Playing a musical instrument is supposed to be a risk factor for the development of musculoskeletal complaints. This study aimed to evaluate playing-related musculoskeletal disorders (PRMDs) among amateur musicians playing in student orchestras.DesignA cross-sectional study.Participants357 members of eleven Dutch student orchestras across the Netherlands were included in this study.InterventionA paper-based questionnaire on PRMDs was used.Outcome measuresSociodemographic characteristics and PRMDs were evaluated using an adaptation of the Nordic Musculoskeletal Questionnaire (NMQ) and the music module of the Disabilities of Shoulder and Hand (DASH) questionnaire.ResultsThe year prevalence of PRMDs among amateur musicians was 67.8%. Female gender, younger age, higher BMI and playing a string instrument were independently associated with a higher prevalence of PRMDs. The left shoulder was affected more frequently in violinists and violists, whereas the right hand and wrist were more frequently affected in woodwind instrumentalists. Of the subjects with PRMDs during the last week, the score of the music module of the DASH was 18.8 (6.3–31.2)DiscussionThis study is the first to report on PRMDs and its associated factors in a large group of amateur musicians. The prevalence of PRMDs in amateur musicians is high, however the DASH scores reflect a confined impact of these PRMDs on their functioning as a musician. Preventive measures are needed aiming at reducing PRMDs among amateur musicians.

Prevalence and Associated Factors of Playing-Related Musculoskeletal Disorders in Brazilian Violin Players.

To investigate the prevalence of playing-related musculoskeletal disorders (PRMD) and associated factors among violinists from the state of Rio de Janeiro, Brazil. This cross-sectional study included 106 violinists from eight cities in the state of Rio de Janeiro. Sociodemographic and musical characteristic data, pain symptoms, and upper-limb functionality were collected using the DASH and the Standardized Nordic Questionnaires. The associations between musculoskeletal complaints and possible predictors were analyzed by binary logistic regression. Of the 106 surveyed violin players, 86.8% reported at least one painful area in the last 12 months and 77.4% in the last week. These symptoms were responsible for the temporary interruption of musical activity in 8.1% of musicians. More than 50% of violinists showed dysfunctional upper limbs according to the DASH optional module. Women were more likely to develop musculoskeletal disorders (OR 4.4, CI 1.9-10.0, p<0.001). In addition, older musicians were more likely to report pain in the last 7 days (OR 3.3, CI 5.1-10.97; p=0.04) and also had higher scores on the DASH (OR 1.8, CI 1.1-3.1; p=0.01). Other factors associated with the development of PRMD were body mass index, practice hours per week, and final DASH score. Violinists living and working in the state of Rio de Janeiro have a high prevalence of PRMD, especially women and older musicians.

음악대학 학생들의 전공악기별 연주관련 근골격계 증상에 관한 연구

Objectives: This study was conducted to investigate 1) the prevalence of playing-related musculoskeletal disorders (PRMDs) in a music college students, 2) factors associated with the PRMDs at different body sites across all instrument types, and 3) also instrument-specific risk factors. Methods: 197 out of 364 music students (54.1%) of Seoul National University majoring in piano, wind, string and Korean traditional instruments participated in the study. The self-assessment questionnaires were administered to assess the prevalence and risk factors of PRMDs. The data were analyzed by descriptive statistics and multivariate logistic regressions. Results: The prevalence of self-perceived symptoms of PRMDs was 67.0%. While there was no significant difference in prevalence by instrument types in the Chi-square test, PRMDs were significantly associated with the instrument types, between the Korean and wind groups, in multivariate analyses (p Conclusion: This study showed the difference in risk factors for PRMDs by instrument types. This understanding will facilitate the development of effective management and prevention programs for music students.

Playing-related musculoskeletal disorders among icelandic music students: differences between students playing classical vs rhythmic music.

Most research studies investigating the prevalence of musculoskeletal disorders affecting musicians and music students have focused on classical music, while less is known about their prevalence in other music genres. The purpose of this study was to document cumulative and point prevalence of playing-related musculoskeletal disorders (PRMD) among music students in Iceland and, specifically, to identify differences between those studying classical vs rhythmic music. We hypothesized that students of classical music would report more frequent and more severe musculoskeletal disorders than students involved in rhythmic music, as classical instruments and composition typically require more demanding, sustained postures during practice and performance. A total of 74 students from two classical music schools (schools A and B) and 1 rhythmic school (school C) participated in the study by answering a questionnaire assessing PRMDs. The results showed that 62% of participants had, at some point in their musical career, suffered a PRMD. The cumulative prevalence was highest in music school A (71.4%) and lowest in music school C (38.9%). A statistically significant difference was identified between the cumulative prevalence of PRMD from schools A and B combined compared to music school C (p=0.019). Over 40% of participants reported a "current PRMD," and a significant difference was identified between the three schools (p=0.011), with the highest point prevalence being registered in music school A (66.6%) and the lowest in music school C (22.2%). The prevalence of PRMDs among Icelandic music students was high. The difference found between students who play classical vs rhythmic music may be explained by different demands of the instruments and composition on playing posture.

Prevalence of Musculoskeletal Disorders Among Instrumental Musicians at a Center for Performing Arts in South Africa

The prevalence of playing-related musculoskeletal disorders (PRMD) is high in various countries of the world, but there is a paucity of literature in Africa. The aim of this study was to determine the prevalence of PRMDs among instrumentalists in South Africa, with specific objectives in determining the distribution, symptoms, and pain severity. The self-administered Nordic Musculoskeletal Questionnaire was used to collect information from the participants regarding the lifetime and current prevalence and the distribution of PRMD symptoms. A visual analog scale was used to collect information on the severity of pain, while the questionnaire designed by Blackie, Stone, and Tiernan (1999) was used to collect information on the symptoms of the PRMDs. Twenty participants took part in this study, and the respondents reported a lifetime prevalence (over a period of 12 months) of PRMDs as 14 out of 17 and the current prevalence (in the last 7 days) as 4. Pain severity was mostly mild, and the most affected region was in the upper extremities, with the shoulders being the most affected. Tightening and soreness were the most reported symptom of PRMDs. The prevalence of PRMDs among this population was high, although severity was mild, with the upper extremities being the most affected area.

The Prevalence of Playing-related Musculoskeletal Disorders of Traditional Korean Musical Instrument Player

Objective: This study was performed to investigate the prevalence of musculoskeletal disorders of traditional Korean instrument player using a variety of traditional classical instruments: Gayageum, Geomungo, Ajaeng, Haegeum, Daegeum, Piri and Samul instruments. Background: A large percentage of instrument players have suffered from the musculoskeletal pain of each body parts. However, there is no research on the prevalence of musculoskeletal disorders of traditional Korean musical instrument players. Method: Through the focus group interview, a questionnaire to investigate musculoskeletal disorders was developed. The questionnaire consisted of four parts: demographic factors, performance factors, musculoskeletal disorders symptoms, musculoskeletal disorder experience. For the survey, 118 expert players participated. The data from the survey were analyzed by correlation analysis and chi-square analysis. Results: The symptoms of musculoskeletal disorders and the severe pain from musculoskeletal disorders were observed at neck, shoulder, back and knee. The musculoskeletal experience was statistically related to the factor of body height in Gayageum and Geomungo. In addition, the musculoskeletal experience in Geomungo was related to age and career. However, the musculoskeletal experience in Ajaeng and Haegeum was only related to the factor of hobby. The musculoskeletal experience in Daegeum and Piri was related to stretching. In addition, there was a statistical significance between the musculoskeletal experience and sex in Daegum. In Samul instruments, the statistical significance was observed at age, BMI, career and stretching. Conclusion: The symptoms of playing-related musculoskeletal disorders of traditional Korean musical players were prevalently observed at neck, shoulder, back and knee. In addition, these symptoms were related to the various demographic factors such as age, body height, BMI, career, sex, hobby and stretching. Application: The results of this study can be used as the preliminary data for preventing the musculoskeletal injuries of traditional Korean musical instrument players.

Prevalence of Playing-Related Musculoskeletal Disorders in Traditional Korean String Instrument Players

This study was performed to investigate the prevalence of musculoskeletal disorders in players of a variety of traditional Korean classical instruments: gayageum, geomungo, ajaeng, and haegeum. A large percentage of these musicians suffer from musculoskeletal pain of various body parts. However, there has been no research regarding the extent of musculoskeletal disorders in players of these instruments. Through a focus group interview, a questionnaire was developed to investigate musculoskeletal disorders. The questionnaire consisted of four parts: demographic factors, performance factors, musculoskeletal disorder symptoms, and musculoskeletal disorder experiences. Eighty-six expert players participated in this survey. The data from the survey were analyzed by correlation analysis and chi-squared analysis. Musculoskeletal disorders symptoms and severe pain were reported in the neck, shoulder, back and knee. These problems were statistically related to height for players of the gayageum and geomungo. In addition, the musculoskeletal disorder experience of geomungo players was correlated with age and career length. The symptoms of playing-related musculoskeletal disorders in traditional Korean music players were reported as being mostly observed in the neck, shoulder, back, and knee. In addition, these symptoms were related to various demographic factors such as age, height, career length, and hobby styles. The results of this study can be used as preliminary data for developing guidelines to prevent traditional Korean musical instrument players from developing musculoskeletal injuries.

Letters

In their recent paper, Furuya and colleagues (Sep 2006) investigated the prevalence of playing-related musculoskeletal disorders (PRMDs) among Japanese female classical pianists of different age groups. Causal factors were also examined.

Prevalence and Causal Factors of Playing-Related Musculoskeletal Disorders of the Upper Extremity and Trunk among Japanese Pianists and Piano Students

The purpose of this study was to investigate the prevalence of playing-related musculoskeletal disorders (PRMDs) among Japanese female classical pianists of different age groups. The causal factors for PRMDs also were examined. A group of 203 senior pianists, including piano teachers and students with piano majors at high schools and colleges, were surveyed using questionnaires. Results showed that 77% of these pianists suffered from PRMDs in at least one of their body portions. This value was larger than those reported in Western countries. Forty-four percent of these were serious enough to warrant medical treatment, which was a lower rate than reported in Western countries. The difference in these numbers may reflect the current state of understanding of PRMDs among Japanese pianists and their educators. The prevalence of PRMDs was found to be age-dependent. In the student groups, the finger/hand had the highest rate of PRMDs, followed by the forearm and shoulder. The senior group, on the other hand, had the highest PRMD incidence at the neck/trunk, followed by the forearm and hand/finger. Care may need to be exercised for these differences. The results also indicated that prolonged daily practice (&gt;4 hours), playing chords forcefully, eagerness about practice, and nervous traits were found to contribute to the development of PRMDs in these pianists. Hand size was, on the other hand, not a significant risk factor of PRMDs.

The Prevalence of Playing-Related Musculoskeletal Disorders of Music College Freshmen Playing String Instruments

Objectives: This study was conducted to investigate the prevalence of playing-related musculoskeletal disorders (PRMDs) of some music college freshmen majoring in string instruments. Methods: The study subjects were 199 freshmen majoring in strings at three colleges in Seoul and surrounds. The symptom prevalence and related factors of PRMDs were surveyed with a self-administered questionnaire. The Southampton Protocol was used to diagnose PRMDs. Results: The freshmen had played for 9 years and 7 months on average. The symptom prevalence of PRMDs according to the modified-NIOSH surveillance criteria was 73.4%. The shoulder was the most prevalent symptom complaint site. The prevalence of PRMDs by the Southampton Protocol was 54.3% and myofascial pain syndrome was the most common. The instrument (violin or viola vs. cello or bass), regular breaks, self perceived evaluation of playing posture and regular computer use had a significant association with the symptom prevalence of PRMDs in univariate logistic regression analysis (p<0.05). The instrument, regular breaks and regular computer use were significant variables affecting the symptom prevalence of PRMDs in multivariate logistic regression analysis (p<0.05). Conclusions: This study suggests that music college freshmen playing strings are a high risk group for musculoskeletal disorders. Therefore, the prevention of PRMDs requires the establishment of an ergonomic playing-environment, and the education of comfortable posture and stretching program such as musical warming up and physical stretching. It is especially important to form an effective treatment and rehabilitation system based on earlier diagnosis for musicians who are suffering from the PRMDs.

A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists

Playing-related musculoskeletal disorders (PRMDs) are a recognized problem amongst instrumental musicians. Although pianists are prominent in data regarding prevalence of PRMDs, there is poor understanding of piano-specific risk factors associated with PRMDs. To synthesize published literature on the prevalence of and risk factors associated with PRMDs in pianists. Thirty-eight databases were searched. Eligible studies were those investigating prevalence of or risk factors associated with PRMDs in pianists, using an appropriate methodology according to a hierarchy of evidence. Information regarding study population, operational definition of PRMD, risk factors investigated, statistical tests used and outcomes was extracted and narratively synthesized for all eligible papers above an arbitrarily chosen quality score. The literature search identified 482 citations. Fifty-two papers were ranked in a hierarchy of evidence; 12 were eligible for evaluation using a quality assessment tool. Common methodological limitations included sampling/measurement biases, inadequate reporting of reliability/validity of outcome measures, lack of operational definition of PRMD and no statistical significance testing. Prevalence rates for PRMDs in pianists varied widely (26-93%). Four authors demonstrated statistically significant risk factors; however, no authors combined a clear operational definition of PRMD with statistically established risk factors. There was no consensus between authors regarding risk factors. Current evidence does not provide sufficient information regarding prevalence of and risk factors associated with PRMDs in pianists. Future studies should provide an operational definition of PRMD, use valid, reliable measurement tools, utilize a prospective cohort study design and perform appropriate statistical tests.