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Background: Musculoskeletal problems are common in professional orchestral musicians, and little is known about effective prevention strategies. Exercise is suggested to help in reducing work-related upper limb disorders and accordingly a trial of a specific exercise programme for this population was planned. Formative and process evaluation procedures were undertaken during the development of the programme to ensure high methodological credibility. Methods: Literature reviews on exercise interventions for musicians as well as for neck, shoulder, abdominal, lower back and hip/pelvic body regions were undertaken. Current preventative and rehabilitation models were reviewed including undergraduate curriculums, postgraduate training programmes, and opinion from academic and clinical physiotherapists. Five series of progressive exercises were developed as a result. These were reviewed by expert physiotherapists who were blinded to the proposed progression difficulty of the exercises. A revised draft was produced for further review. This final programme was pilot trialed and feedback from the participants and physiotherapist instructors were obtained. Results: No evidence-based literature regarding an exercise programme for professional orchestral musicians was found. An exercise programme was subsequently developed with progressive stages that followed an adapted exercise prevention and rehabilitation model. The blinded ranking of each exercise series produced varied results particularly in the abdominal and shoulder series. Feedback from the participants and instructors in the pilot study resulted in changes to the exercise difficulty, and the class format and structure. Conclusions: Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice, a specific exercise programme was developed to prevent and/or reduce occupational injuries in professional orchestral musicians.
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... Recently, exercise programs have been used increasingly to manage musculoskeletal problems in musicians [17][18][19]. Certain strategies including exercise approaches have been developed to prevent such problems [20,21]. These studies were conducted on orchestra musicians playing viola, violin, cello, contrabass (string), woodwinds, brass and percussion. ...
... Consistent with our findings, the cervical exercise program consisting of various stretching and strengthening exercises has been found to be effective for relief of pain and improved posterior tilt of the neck and functionality level in violin players with neck pain [10,23]. It has been emphasized that strengthening the deep neck muscles ensures proper cervical posture, reduces the tone of the hypertonic muscles (sternocleidomastoid, levator scapulae, upper trapezius), and even decreases the overuse of breath control muscles (i.e., scalene muscles) for musical performance in orchestral musicians [17]. ...
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To investigate the effect of a structured exercise training program on pain, functional status, physical function and quality of life (QoL) in string and woodwind players with nonspecific cervical pain. This study had a prospective cohort design and conducted on 40 musicians (26 male, 14 female) aged between 18 and 65 years with persistent nonspecific neck pain in the previous 3 months. Forty musicians were assigned to either violin (n = 20, median age; 26.5 year, height; 1.67 m, body mass; 65 kg, BMI; 23.04 kg/m2) or ney group (n = 20, median age; 27.5 year, height; 1.81 m, body mass; 75 kg, BMI; 23.35 kg/m2) and followed the same structured exercise program (3 days/per week for 8 weeks). The primary outcome was neck pain intensity and assessed on a visual analog scale (VAS). Secondary outcomes; cervical range of motion (ROM) was measured using a goniometer, the jaw-to-sternum and jaw-to-wall distances were used for the assessment of cervical mobility, neck, shoulder and back muscles strength were assessed with a hand-held dynamometer, the Northwick Park Neck Pain and Short Form 36 (SF-36) questionnaires were also used. Normality of data distribution was checked using the Kolmogorov–Smirnov test. For evaluating the training effectiveness on outcome measures, Mann–Whitney U and Wilcoxon test were used compare pre-test and post-test values with/within groups, respectively. The primary outcome (pain intensity) was lowered %33 in both groups. However, the mean change was found similar (median mean changes; −2 for both groups) (p > 0.05). The secondary outcomes; cervical mobility, cervical flexion ROM, disability and muscle strength of the left middle trapezius, left hand grip, anterior and middle parts of the right deltoid, and cervical flexors also significantly improved in both groups (p < 0.05). Only the mean changes of right serratus anterior, middle trapezius and cervical flexor muscles were higher in violin group than ney group (p < 0.05). There was no significant difference in the cervical extension, right rotation, left rotation, right lateral flexion and left lateral flexion after the treatment in both groups (p > 0.05). There was no significant difference between the groups after the exercise program in terms of pain, mobility, range of motion and SF-36 subdomains (p > 0.05). Specific exercise program had similar positive effects on pain, cervical mobility, cervical fexion ROM and disability in string and woodwind players. Although several muscles showed similar improvements in strength, some muscle groups recovered differently. Physical needs specific to the instrument and performance should be taken into account when prescribing exercises to musicians having the same problem, but playing different instruments.
... • genre of playing • pain during playing • subjective description of the primary complaint and its location Also, the therapist decides the type of treatment (e.g., physiotherapy, osteopathy, manual therapy) and how many appointments are needed. Fry, 1986;Fishbein and Middlestadt, 1988;Middlestadt and Fisbein, 1989;Schuppert and Altenmüller, 1999;Liu and Hayden, 2002;Sakai, 2002;Rosety-Rodriguez et al., 2003;Moraes and Papini, 2012;Paarup et al., 2012; Ackermann et al., 2002;de Greef et al., 2003;Barton and Feinberg, 2008;Chan et al., 2013aLópez and Martínez, 2013;McCrary et al., 2016 Manual therapy, therapeutic exercises, education and advice (e.g., about performance posture, practice habits, possible injury risks etc.), music performance biomechanics feedback, ergonomic considerations Ackermann et al., 2002;de Greef et al., 2003;Shafer-Crane, 2006;Rabuffetti et al., 2007;Barton and Feinberg, 2008;Chan et al., 2013b;López and Martínez, 2013;McCrary et al., 2016 Mobility dysfunction Fishbein and Middlestadt, 1988;Middlestadt and Fisbein, 1989;Larsson et al., 1993;Gannon and Bird, 1999;Schuppert and Altenmüller, 1999;Brandfonbrener, 2002;Liu and Hayden, 2002;Sakai, 2002;Day et al., 2011;Driscoll and Ackermann, 2012 ...
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Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.
... Therefore, during the adolescent growth spurt, specific stabilizing and stretching exercises could promote better muscular stabilization mechanisms and correct alignment of the spine [58]. Due to the incorrect postural exposure and the age at which young musicians suffer pain, the Pilates method combined with therapeutic exercise could be beneficial in reducing pain, improving posture, and increasing adherence to the instrument practice [63]. ...
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Background: Inappropriate posture in children while playing some string instruments can cause back pain and alterations of the spine. To date, there is no research on the effect of exercise on children who play a musical instrument, although it is known that transversus abdominis muscle control through the Pilates method has shown pain reduction and posture improvement in this population. Objective: To assess the effectiveness of the Pilates method combined with therapeutic exercise with respect to therapeutic exercise exclusively in reducing pain and improving postural alignment in children playing string instruments applying a protocol of low dose to increase children's adherence to training. Methods: A randomized controlled pilot study was designed with two parallel intervention groups. Twenty-five children (10-14 years old) were randomized in two intervention groups: Pilates method with therapeutic exercise (experimental) and therapeutic exercise (control) for 4 weeks (50 min per day, one day per week). Two assessments were performed (before and after treatment) to assess back pain and shoulders and hips alignment using a visual analog scale and the Kinovea program. Results: Statistically significant differences were obtained for pain reduction before (p = 0.04) and after (p = 0.01) playing the instrument in the experimental group. There were no significant changes in alignment improvement in any of the two groups. Conclusion: The application of a low dose of the Pilates method combined with therapeutic exercise could be a beneficial intervention for pain reduction before and after musical practice in children who play string instruments.
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Obwohl sich die Anforderungen im Sport und dem Musizieren ähneln, ist die Musikerphysiotherapie längst nicht so entwickelt wie die Sportphysiotherapie. Dabei lassen sich die sogenannten „Performance-Related Musculoskeletal Disorders“ erfolgreich mit Manueller Therapie oder Physiotherapie, z. B. mit Hilfe einer Bewegungsanalyse, therapieren. Prof. Dr. med. Christoff Zalpour gibt einen Überblick über das Feld der Musikerphysiotherapie, deren Potenzial noch lange nicht vollends erschlossen ist.
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BACKGROUND :Musician health and wellness, a fundamental requirement for safe, effective and optimal musical performance, is not guaranteed. Performance related musculoskeletal disorders (PRMD) affect between 60-90% 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. PURPOSE : This 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. METHODS : The 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/CONCLUSIONS : Our 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
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Background : There 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. Purpose : To 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 Design : Randomized-Controlled-Pilot Trial Methods : Musicians 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. Results : A total of 57 musician-students (ages 17-30, 23 females) participated in the study, and 48(84%) completed the study. 75% 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<0.01). Pain interference scores were lower (Post – Pre = -4.58, 95% CI -9.26 to 0.11, p=0.055). There was no statistically significant difference between groups for pain intensity. Conclusions : The 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.
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Objective To explore the facilitators and barriers to implementation of a pilot workplace rehabilitation and global wellness program for orchestral musicians. Design Qualitative study comprising focus groups and interviews. Setting: Workplace of conservatory and orchestral musicians and administrators. Participants Musicians, administrators and a conductor from two professional orchestras; tertiary-level orchestral students and an administrator from a conservatory of music. Interventions We held four focus groups and two interviews to document the perspectives of the participants concerning the implementation determinants of a pilot workplace rehabilitation and wellness program (exercises and health-related education). Meetings consisted of questions based on the Consolidated Framework for Implementation Research. Thematic content analysis was conducted using this same framework, with subcoding according to the Theoretical Domains Framework. Results Fourteen musicians and five administrators participated. Results suggest that the implementation determinants for the pilot and future programs rely mainly on the Inner Setting, that is, what musicians refer to as ‘the music world’, specifically cultural elements such as pain beliefs (e.g. no pain no gain) and lack of resources and time (barriers). Characteristics of Individuals such as social influences amongst colleagues and beliefs about the consequences of self-care or lack thereof, and Intervention Characteristics such as complexity can be facilitators or barriers. All emerging themes have an undercurrent that lies in the Inner Setting. Conclusion Musicians’ culture, currently a barrier, is a crucial determinant of rehabilitation and wellness program implementation in the orchestral musicians’ workplace. A focus on musicians’ workplace environment is necessary to optimise implementation and intervention impacts.
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Study Design : Invited Clinical Commentary Background : Performance related musculoskeletal disorders (PRMD) are common in instrumental musicians and often affect the upper extremities. These overuse injuries typically result from inadequate attention to the musculoskeletal demands required for the high-level performance of musician-students and experienced instrumentalists.¹ PRMDs often interfere with career trajectory, and in extreme cases, can be career ending. Many clinicians and healthcare practitioners treating upper extremity injuries are not familiar with the specific demands faced by instrumental musicians and how to tailor treatment and prevention strategies to the specific risks and occupational needs of each instrumental group. Purpose : This paper describes an evidenced-based framework for the assessment, prevention, and treatment of musculoskeletal musician injuries to provide clinicians with an instrument-specific, and musician-centered guide for practice. We synthesized available literature on instrumental ergonomics, biomechanical demands, and upper extremity injuries to highlight the risks and common upper-extremity pathologies, focusing on the specific demands of instrumental groups: piano, high strings (violin and viola), low strings (cello and bass), percussion, woodwinds, and brass. Targeted assessment, prevention, and treatment strategies are reviewed in this context to provide healthcare providers with an evidence-based framework to approach the treatment of PRMD to mitigate incidence of injury during practice and performance. Methods : A comprehensive search of electronic databases was conducted including all study designs. Results : This review describes risk factors for PRMD in instrumental musicians, strategies to prevent misuse and performance injury, and musician-centered interventions to allow playing while reducing risk of misuse. Conclusion : The suggested assessment and treatment framework can assist clinicians with a customized patient-centered approach to prevention and treatment by addressing the gap in clinical knowledge with the goal of ultimately reducing the incidence and severity of PRMD in musicians.
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The objective of this systematic review was to determine the safety and effectiveness of any public health intervention designed to prevent and/or manage musculoskeletal symptoms (MSSs) in any type of musician. A total of 14 studies were included. Studies investigated exercise and/or education programs, and changes to equipment, with a range of musicians. There was some evidence to suggest that smaller piano keyboards, and exercise programs may be effective. Studies suggesting a benefit of exercise programs typically had lower level designs and higher risk of methodological bias, compared with those that reported no benefit. Future research should use more robust methods to reduce bias and come to definitive conclusions regarding the safety and effectiveness of interventions prior to implementation, to reduce the burden of MSSs for musicians.
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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.
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It is generally accepted that neural factors play an important role in muscle strength gains. This article reviews the neural adaptations in strength, with the goal of laying the foundations for practical applications in sports medicine and rehabilitation. An increase in muscular strength without noticeable hypertrophy is the first line of evidence for neural involvement in acquisition of muscular strength. The use of surface electromyographic (SEMG) techniques reveal that strength gains in the early phase of a training regimen are associated with an increase in the amplitude of SEMG activity. This has been interpreted as an increase in neural drive, which denotes the magnitude of efferent neural output from the CNS to active muscle fibres. However, SEMG activity is a global measure of muscle activity. Underlying alterations in SEMG activity are changes in motor unit firing patterns as measured by indwelling (wire or needle) electrodes. Some studies have reported a transient increase in motor unit firing rate. Training-related increases in the rate of tension development have also been linked with an increased probability of doublet firing in individual motor units. A doublet is a very short interspike interval in a motor unit train, and usually occurs at the onset of a muscular contraction. Motor unit synchronisation is another possible mechanism for increases in muscle strength, but has yet to be definitely demonstrated. There are several lines of evidence for central control of training-related adaptation to resistive exercise. Mental practice using imagined contractions has been shown to increase the excitability of the cortical areas involved in movement and motion planning. However, training using imagined contractions is unlikely to be as effective as physical training, and it may be more applicable to rehabilitation. Retention of strength gains after dissipation of physiological effects demonstrates a strong practice effect. Bilateral contractions are associated with lower SEMG and strength compared with unilateral contractions of the same muscle group. SEMG magnitude is lower for eccentric contractions than for concentric contractions. However, resistive training can reverse these trends. The last line of evidence presented involves the notion that unilateral resistive exercise of a specific limb will also result in training effects in the unexercised contralateral limb (cross-transfer or cross-education). Peripheral involvement in training-related strength increases is much more uncertain. Changes in the sensory receptors (i.e. Golgi tendon organs) may lead to disinhibition and an increased expression of muscular force. Agonist muscle activity results in limb movement in the desired direction, while antagonist activity opposes that motion. Both decreases and increases in co-activation of the antagonist have been demonstrated. A reduction in antagonist co-activation would allow increased expression of agonist muscle force, while an increase in antagonist co-activation is important for maintaining the integrity of the joint. Thus far, it is not clear what the CNS will optimise: force production or joint integrity. The following recommendations are made by the authors based on the existing literature. Motor learning theory and imagined contractions should be incorporated into strength-training practice. Static contractions at greater muscle lengths will transfer across more joint angles. Submaximal eccentric contractions should be used when there are issues of muscle pain, detraining or limb immobilisation. The reversal of antagonists (antagonist-to-agonist) proprioceptive neuromuscular facilitation contraction pattern would be useful to increase the rate of tension development in older adults, thus serving as an important prophylactic in preventing falls. When evaluating the neural changes induced by strength training using EMG recording, antagonist EMG activity should always be measured and evaluated.
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This text provides a comprehensive, practical, evidence-based guide to the field. It covers each stage of the rehabilitation process from initial assessment, diagnosis and treatment, to return to pre-injury fitness and injury prevention. Presenting a holistic approach, this text also addresses the nutritional and psychological aspects of the rehabilitation process for the amateur sports enthusiast as well as elite athletes. Divided into five parts, Parts I, II and III cover screening and assessment, the pathophysiology of sports injuries and healing and the various stages of training during the rehabilitation process. Part IV covers effective clinical decision making, and Part V covers joint specific injuries and pathologies in the shoulder, elbow wrist and hand, groin and knee. Key features: Comprehensive. Covers the complete process from diagnosis and treatment to rehabilitation and prevention of injuries. Practical and relevant. Explores numerous real world case studies and sample rehabilitation programmes to show how to apply the theory in practice. Cutting Edge. Presents the latest research findings in each area to provide an authoritative guide to the field.
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Objective: This study aimed to systematically evaluate the available evidence on risk factors for professional instrumentalists' developing musculoskeletal (MSK) disorders. Methods: Relevant studies were identified by a search of MEDLINE, CINAHL, EMBASE, a manual search of Medical Problems of Performing Artists, and a search of the Performing Arts Medicine Association's online bibliography. Two independent reviewers assessed the methodologic quality of the selected publications using a standardized checklist. The studies' sample characteristics, findings, and quality scores were presented in an evidence table. Results: Two case,control studies and 6 cross-sectional survey designs were included in this review. The median method-score was 61%. Potential risk factors associated with developing MSK complaints included gender, years of playing experience, type of instrument played, playing related physical (long hours, over, practicing) and psychological stressors (self-pressure/academic), lack of preventive wellness behaviours (taking breaks), and previous trauma. The high degree of methodological (including sample profile) heterogeneity among the studies impeded statistical pooling of relative effect sizes such as odds ratios. Conclusion: The etiology of MSK conditions in instrumental musicians is multifactorial; however, because the majority of research designs were of a cross-sectional Survey nature, a temporal relationship between risk factors and the onset of MSK complaints Could not be established. Additional case control studies should be conducted to reveal the most relevant confounding factors, such as exposure to physical stressors during leisure time, the psychosocial environment, and musical work load. Longer-term studies should then focus on more accurately quantifying the degree of risk associated with these risk factors.
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The goal of the present study was to investigate the effectiveness of a course offered to students at the Zürich Conservatory for the prevention of playing-related health problems. It was hypothesized that the course offered would have a positive effect (1) on the psychological and physical health of the music students, and (2) on their work as musicians in training. Twenty-two musicians each in the test and control groups participated in an evaluation study with pre and post measurements. The students had to fill in questionnaires before the beginning and at the end of the course. Throughout the semester, the test group was offered a weekly course in "Physiology of Music and Performing Arts Medicine," consisting of a double hour combining lectures and practical exercises with preventive topics relevant to musicians. Based on the pre-to-post measurements in the test group, playing-related symptoms, general symptom frequency, and emotional disturbances and anxiety level decreased; general coping with work as a musician and security in performance situations improved. The effects measured in this study need to be confirmed by further studies with a randomized design.
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In celebration of MPPA’s 20 years of publication, we are looking back at some of the notable articles that appeared in the early issues. This series of three papers, authored by Prof. Raoul Tubiana and colleagues, explores the functional anatomy of arm, hands and fingers and the effects of arm positioning on the general posture of musicians. Originally published in September 1988 [1988;3(3):83-87], December 1988 [1988;3(4):123-128], and June 1989 [1989;4(4):83-76].
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Instrumental musicians are at risk for upper extremity performance related musculoskeletal disorders (PRMD). Increased trunk muscle endurance and neuromuscular control may allow the musician more effective management of the upper extremity work‐ load. The purpose of this preliminary study was to investigate and compare the efficacy of two therapeutic exercise approaches directed toward increasing trunk and proximal upper extremity muscle endurance and neuromuscular control, and to determine if these changes affect instrumental performance. This study was an interrupted time‐series, two‐group, pre‐post‐test experimental design. Participants included 14 university‐level instrumental musicians who were assigned either to a Pilates mat exercise program, or a conventional trunk endurance exercise program. Trunk endurance and seven selected aspects of instru‐ mental playing were measured at the beginning of the study, after the six‐week baseline (no intervention) period, and after the two concurrent six‐week exercise interventions. Fol‐ lowing both interventions, there was a significant increase in trunk extensor and lateral muscle endurance. The participants reported a significant decrease in pain, fatigue, and perceived level of exertion while playing an instrument. There was no significant difference in trunk endurance when comparing the two exercise groups; therefore, the Pilates method was equally as effective as the conventional trunk and proximal upper extremity endurance exercise program. Musician education and wellness programs should include exercise pro‐ grams that improve trunk muscular endurance and neuromuscular kinesthetic control, thereby allowing the musician to improve the physical aspects of their performance and achieve their highest level of musicality. KEY WORDS: Musician injuries, musician wellness, therapeutic exercise, instrumentalists' exercise
Chapter
Introduction Early Stage Rehabilitation Knee Rehabilitation Concerns and Concepts Quadriceps Inhibition and Muscle Atrophy Generic Knee Rehabilitation Concepts Effects of Proximal Muscles on Knee Function and Injury Models and Levels of Sensorimotor Control Proprioception Neuromuscular Control Between-Sex Differences Proposed Knee Exercise Rehabilitation Balance and Perturbation Training Deceleration Training Plyometrictraining Agility-Biased Running Drills Anterior Knee Pain, Differential Diagnosis and Treatment Summary References