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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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Development of a specic exercise programme
for professional orchestral musicians
Cliffton Chan,
Tim Driscoll,
Bronwen Ackermann
Discipline of Biomedical
Science, Sydney Medical
School, The University of
Sydney, Lidcombe, Australia
School of Public Health,
Sydney Medical School,
The University of Sydney,
Camperdown, Australia
Correspondence to
Cliffton Chan, Discipline of
Biomedical Science, Sydney
Medical School, The University
of Sydney, PO Box 170,
Lidcombe, NSW 1825,
Accepted 2 November 2012
Published Online First
4 December 2012
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 specic 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 difculty of the
exercises. A revised draft was produced for further
review. This nal 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 difculty,
and the class format and structure.
Conclusions Using available evidence on exercise
prescription in collaboration with clinical consensus and
current best practice, a specic exercise programme was
developed to prevent and/or reduce occupational injuries
in professional orchestral musicians.
Musicians suffer a high incidence and severity of
performance-related musculoskeletal disorders
National and international surveys
document the lifetime prevalence of PRMDs in
professional orchestral musicians as anywhere
between 39% to 87%, depending on the survey
methodology, and a current playing-related pain
point prevalence of 50% in Australian professional
orchestral musicians.
Professional orchestral
musicians develop highly selective patterns of
neuromuscular activation in response to the
precise playing demands occurring over extensive
periods of time.
This ongoing cumulative load on
the musculoskeletal and neuromuscular systems
may result in adaptive changes including postural
imbalances and asymmetrical strength and mobil-
ity, especially of the trunk and upper limbs.
Despite this, there has been little investigation of
healthcare approaches to the management of these
PRMDs, and there is a need for research to provide
better evidence of how to effectively manage
In occupational health literature, exercise is
recommended as an appropriate preventative inter-
vention for work-related injuries.
However, there
is little evidence to support the use of exercise for
effective injury prevention or management in pro-
fessional orchestral musicians.
One small study
involving professional musicians from one orches-
tra found benets in reduced PRMD incidence and
severity following the implementation of a
15-week intervention package including some
generic exercises.
Three other studies investigated
the effect of exercise programmes on university
music students. These studies included generic
strength, postural or aerobic exercises and were
reported to reduce the presence, frequency and
intensity of PRMDs and to improve instrumental
playing posture.
It was decided that while
concepts of core stability would be retained, as
this appeared to be a common feature associated
with the positive outcomes of these trials, it
would be worth developing much more specic
and targeted exercises to implement in the current
This paper describes the development of a pro-
gramme aimed to adapt or create exercises specic-
ally targeted for professional orchestral musicians
based on the problematic regions identied in
PRMD literature and analysis of the loading
created by instrumental movements and postures.
As no available evidence on best practice existed,
an exercise programme was developed that had
high face validity and could be implemented con-
sistently when trialled nationally.
The article reported here has three aims:
A. To present the methods used to develop an
evidence-based exercise programme that targets
prevention of common injuries in professional
orchestral musicians
B. To describe the components of the programme
C. To trial the programme.
Phase 1. Development of the exercise programme
The exercise programme was developed by inte-
grating evidence obtained from a comprehensive
literature review, national physiotherapy under-
graduate and postgraduate courses, and common
exercise prescription approaches. The resulting
Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608 257
Original article
draft programme was then subjected to an external formative
evaluation process.
A literature search was conducted in April 2010 using
Medline, Cochrane Clinical Trials, PEDro, CINAHL and AMED.
The search terms included musician with exercise,prevention,
rehabilitation and programme using orand andas Boolean
operators that yielded ve studies suitable for inclusion
(gure 1). A broader literature search was also carried out to
include combinations of exercise interventions and body
regions. The search terms included exercise programme,prevention,
management,rehabilitation and stabilisation with neck, cervical
spine,lower back, lumbar spine,shoulder, glenohumeral,abdominal,
hip and pelvis using orand andas Boolean operators from
which 68 studies were included as potential resources for this
project (gure 2). The latter terms were chosen as these were
common injury regions identied through previous literature
reviews, and through a large-scale baseline assessment of the
premier symphony orchestras of Australia as part of the Sound
Practice study.
Limits on both literature searches included
human studiesand English.
To identify best practice in exercise programme implementa-
tion, physiotherapists nationally-acknowledged as experts in
the eld of exercise prescription were interviewed. Current
teaching practice from two well-established undergraduate
physiotherapy curriculums and six post-graduate sports exercise
courses in Australia were also incorporated. Five series of exer-
cises with progressive stages were developed to target the
common problematic PRMDs in the orchestral musician
Four physiotherapists (each with over 20 years of experience)
were invited to participate in a formative evaluation process.
These physiotherapists had worked with musicians and were
known for their use of exercise in rehabilitation. Two also
worked in an academic environment. The illustrated series of
proposed exercises and instructions were presented to each of
the physiotherapists individually in a randomised order. They
were instructed to rank each series from easiest to most chal-
lenging so that the best order of progression is achieved, and
provide feedback on the exercises. The physiotherapists were
also asked whether they felt any other exercises should be
Figure 1 Flowchart of literature
search results of musician exercise
intervention literature in Medline,
Cochrane, PEDro, CINAHL and AMED
Figure 2 Flowchart of a literature
search of exercise interventions for
different body regions in Medline,
Cochrane, PEDro, CINAHL and AMED
258 Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608
Original article
added or replaced in the programme. Discrepancies between the
physiotherapistssuggested order and the initial order of pro-
gressions were considered along with the detailed comments
about the exercise choice. A nal draft was produced by the
authors after discussing the changes with two of the phy-
siotherapists involved in the initial ranking process.
This programme was designed to be trialled at a national level
and hence involved the recruitment of experienced physiothera-
pists from around Australia to run programmes. To improve the
reliability of programme delivery, a detailed manual was pro-
duced to instruct both physiotherapists and participants in how
to perform the exercise programme. A training session for par-
ticipating physiotherapists was conducted to encourage a stan-
dardised approach to delivery of the programme and adherence
to the research protocol. This involved learning the exercises,
reviewing the exercise instructions, reinforcing the safety pre-
cautions and procedure of progression through each series, and
outlining the class format and structure. The physiotherapists
were required to observe one class run by one of the course
developers before conducting an exercise class themselves. The
physiotherapists were required to have Clinical Pilates training
to further improve the consistency of their approach, particu-
larly for the early stages of each exercise series.
The exercise classes were conducted at one orchestras prem-
ises, outside of work hours (before rehearsal, in the lunch hour
or after rehearsal) to make the programme as convenient and
accessible as possible. This was decided in collaboration with
orchestral management, whose support was important to
ensure programme viability, improve participation and reduce
attrition. Each class was proposed to be 40 min long: 5 min
each of warm-up and cool-down, and 30 min of exercises. The
programme was designed to run over 8 weeks, with two classes
per week. This was expected to produce changes in neuromus-
cular patterning and strength gains as a result of neural and
physiological adaptations.
14 15
For cost effectiveness reasons, a group setting was chosen as
the delivery method. At the initial exercise class, the partici-
pants did warm-ups, cool-downs and Stage One of each series
together. From week two, participants were instructed to use
the exercise manual to continue exercises from Stages One to
Six with physiotherapist guidance and supervision.
Phase 2. Pilot trial of the exercise programme
A trial was undertaken with professional musicians from one
of the symphony orchestras to evaluate the different elements
of the exercise programme. This included the ratio of physio-
therapist to participants, exercise instructions, class times and
length, and overall class structure. Participants were supplied
with a record sheet to monitor the dosage performed for each
exercise and the progress of the stage in each exercise series.
This record also allowed the physiotherapist to track progress
over the course of the programme. A comments section was
included in the record to allow the physiotherapist to write
exercise reminders for the participant. Participants and phy-
siotherapists were able to provide feedback to the authors
throughout the trial and at the end of the trial via semi-
structured interviews. A decision would be made by the
authors (CC and BA) whether the feedback necessitated
changes to be made to the programme.
Five articles related to musicians and exercise therapy were
identied from the literature review (gure 1).
912 16
A larger
number of exercise therapy clinical trials and systematic
reviews were found for non-musician populations (gure 2).
Exercise programmes were excluded if they had insufcient
detail to replicate the trial, exercises were functionally unsuit-
able for musicians, and the exercise programme was a compo-
nent of a series of concurrent interventions.
An exercise model was developed to best integrate existing evi-
dence and strategies identied by clinicians and researchers
(gure 3). Most of the programme was based on fundamental
sports rehabilitation principals resulting in a programme that
consisted of: (1) activating the muscles concerned with stability
and satisfactory postural control of the region in the early
stages; (2) added external perturbations or resistive loads in the
middle stages; and in the late stages; (3) exercises were used that
both increased muscle endurance demands and were applied in a
specic functional position relating to common patterns of
movement during instrumental performance.
Other exercise
design considerations to take account of the musiciansnormal
work demands included the need to reduce load on the wrist
joints by leaning on the forearms in upper limb weight-bearing
positions, and using loops in the resistance band rather than
having to grip the band with the hand when performing the
Neck series
Progressions of cervical spine exercise therapy strengthening the
deep neck exors and extensors were adapted for musicians.
21 22
Figure 3 Adaptation of common
elements in early, mid and end-stages
of injury prevention/rehabilitation
exercise programmes.
Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608 259
Original article
In the nal stages, varying degrees of resistance was applied to
the neck from a variety of angles to load the deep neck muscle
system in an attempt to replicate the challenges of maintaining
a healthy neck position while sustaining the weight of
Shoulder series
A progressive series of scapular stability and rotator cuff exer-
cises were included focusing on restoring shoulder muscle
balance and movement control.
This progressed to stages that
added resistance and increased the functional context of the
exercises into instrumental performance biomechanical
Spinal series
The early stages of the spinal series consisted of low load acti-
vation of the lumbar multidis.
Later stages progressively
integrated the lumbar multidus into a range of more func-
tional activities with appropriate use of load and a variety of
external perturbations to mimic the movements used during
26 27
Abdominal series
A focus on activation of the abdominal muscles during com-
monly prescribed Clinical Pilates exercises was included, pro-
gressing into more difcult stages using an unstable base of
28 29
Finally, these exercises were adapted into more
functional activation patterns in both sitting and standing.
Hip series
A focus was placed on the endurance and strength of the
gluteal muscle group, including hip abduction and external
rotation exercises.
The intermediate stages combined these
exercises with upper body movement.
The nal stage incor-
porated the elements in the previous exercises in all three
planes of movement.
Warm-up and cool-down
A warm-up component was included involving diaphragmatic
breathing, and large body movements such as spinal curl
downs, neck and shoulder rolls, and thoracic and lumbar rota-
A cool-down component repeated some of the exercises
in the warm-up component, with the addition of sustained
stretches (of the upper trapezius, levator scapulae, quadratus
lumborum, oblique abdominis and hamstrings).
A summary of the ranking scores from the expert phy-
siotherapistsrandomised review process is shown in table 1.
The physiotherapistsranking of difculty for the exercises
were similar in the hip series, and moderately similar in the
neck and spinal series. The results that differed most between
the physiotherapists related to the abdominal and shoulder
series. In reference to the selection of exercises, one reviewer
commented I have seen many musicians with pain who have
too much stability and cant relax these musclesin relation to
the abdominal and spinal series. The abdominal, spinal and
shoulder series of the exercise programme were subsequently
modied in particular, exercises early in the series that were
considered too difcult were adjusted to provide more support
and those considered too easy or too much stabilitylater in
the programme had more dynamic movement elements added.
Pilot trial
A total of 13 musicians, nine females and four males, partici-
pated in this trial with a mean age of 44.7 years (SD 10.3). The
participantsmean years of professional playing time was
21.8 years (SD 13.0). String instruments were the most com-
monly played by the musicians (table 2). Comments received
during the trial and at the semi-structured interviews indicated
resistance band difculties in the shoulder series and a need for
more resistance in the abdominal series; and that class structure
and schedule, and a small number of exercise instructions in
the exercise manual, needed minor modications.
The levels of resistance band were upgraded in the intermedi-
ate stages of the abdominal exercises, and downgraded for the
shoulder exercises. The class structure was modied because
participants required more assistance in the early stages of the
exercisesthe group class format was increased from 1 week to
2 weeks, and the individualised progression format was
initiated from week three. A physiotherapist to participant
ratio of 1 : 6 appeared to be the best compromise to provide sat-
isfactory supervision and allow maximum participation. The
highest attendance rate occurred when the class was held
during the lunch break between rehearsals. The duration of the
exercise class had to be reduced to allow adequate time for
musicians to prepare to return to rehearsal, leaving 25 min for
Table 1 Proposed order of progression of series, by reviewers
Series of exercise
Author proposed order of
exercise progressions
Neck Shoulder Spinal Abdominals Hip
Reviewer Reviewer Reviewer Reviewer Reviewer
2 *212212*22342232222
3 *3544353*31154521333
4 *4431445*64666445444
5 *6352534*4643354565
6 *5263626*5555663656
*Denotes the physiotherapist reviewer did not provide a numerical response.
Denotes the reviewer suggests a change to this exercise.
Table 2 Instruments played by the musicians in the pilot trial
Instrument Count (n=13)
Violin 2
Viola 3
Cello 3
Double Bass 1
Flute 1
Clarinet 1
Oboe/Cor Anglais 2
260 Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608
Original article
the exercise component and 5 min for each of the warm-up and
cool-down. The nal structure and content of the programme
are shown in table 3.
The use of formative and process evaluation methods to
develop a novel and targeted exercise programme for profes-
sional orchestral musicians appeared to be an effective strategy.
The programme described here incorporated current fundamen-
tal sports rehabilitation principals, and adapted existing exercise
therapy evidence in a logical and informed manner.
exercises and progressions chosen were based on those
commonly taught and practiced in Australia in general physio-
therapy modied to apply functionally to music performance.
While the current study has been targeted specically for pro-
fessional orchestral musicians, this model for designing an exer-
cise programme may help other researchers develop suitable
programmes for other musician populations.
Musicians have a high reported incidence of neck problems
across the instrumental groups.
The research in cervical spine
rehabilitation by Jull and colleagues inuenced the inclusion of
deep neck stabilisation and joint position sense principles in this
series of exercises.
21 22
There was also an emphasis on improving
muscle efciency by reducing commonly hypertonic muscles (ie,
sternocleidomastoid, levator scapulae, upper trapezius) as well
as decreasing overuse of breath control muscles (ie, scalenes).
Scapular stabilisation and rotator cuff endurance exercises are
frequently-used approaches in the early stages of shoulder
rehabilitation and shoulder instability programmes.
23 24
exercises were considered important for musicians because
shoulder pain and dysfunction are commonly reported, and
proximal stability at the shoulder has been shown to be
important for increasing hand dexterity and strength.
There is published evidence that the trunk muscles, in par-
ticular the deeper layers of the lumbar multidus, are import-
ant for segmental spinal control and that these muscles may be
inhibited in their control by the presence of low back pain
25 26
Optimising function of the lumbar multidus
reduces recurrence of acute LBP and disability.
27 37
As LBP is
relatively common in the professional musician population it
was considered useful to include a series of exercises strength-
ening and challenging the lumbar multidus in all three planes
of movement. Large variations in the type of exercises used and
the optimal mechanisms by which to activate these muscles
exist in the literature. The rehabilitation strategies of
Richardson and colleagues were adopted and modied as appro-
priate for musicians.
and Pilates trials and is well summarised elsewhere.
28 29
There is
evidence to support the re-training of proper transversus abdom-
inis and internal oblique activation, especially when wind and
brass players use abdominal musculature as an integral part of
their breath control. It is likely that all musicians should use a vari-
able degree of abdominal muscle activity to support a dynamic
sitting and standing playing posture. Hence, a series of exercises
incorporating the core abdominal muscles in different positions
and a number of different external perturbations were included.
Lumbo-pelvic control is important to support dynamic upper
body movements, such as those involved in instrumental playing.
In this hip series, focus was placed on strengthening the gluteal
muscle group to increase proprioceptive feedback and control of
lower limb alignment.
31 32
These elements were further challenged
by integrating these exercises with upper body movements. To
improve dynamic postural control during standing, the nal stage
used a combination of neuromuscular characteristics such as lower
extremity proprioception, balance, exibility and strength.
The warm-up component encouraged large full body move-
ments associated with playing an orchestral instrument and
was based on recommendations from the sports literature.
The cool-downs included moving the joints and muscles used
in the exercise programme throughout range.
Some static
stretches were included for muscles that were considered to be
hypertonic in musicians based on their patterns of use.
The most agreement in exercise progression and choice
between the physiotherapist reviewers was for the hip series, and
the least agreement was for the abdominal and shoulder series.
The higher variance in reviewer feedback may indicate the large
variety of prevention and rehabilitation approaches currently in
practice, and the wide spectrum of strategies used for different
populations, mostly arising from the sports literature. Two of the
reviewers also commented that they typically only prescribed
individualised sport/activity-specic programmes and felt it was
difcult to comment on a generic group exercise programme.
The formative evaluation processes were vital in ensuring the
programme was highly credible and likely to produce progressive
and functional strengthening goals, with only some minor pro-
gramme elements requiring further change during the process
evaluation phase of the pilot trial. Working closely with orchestra
management staff was necessary for the programme to be
designed in a way that was compatible with the context and prac-
ticalities of the orchestral environment and schedules.
Table 3 List of exercises in final exercise programme
Series Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6
Neck Deep neck
flexor in supine
Deep neck flexor and
extensor co-activation
in supine
Deep neck flexor and
extensor co-activation with
cervical movements in 4
point kneel
Deep neck flexor and
extensor activation with
cervical rotation in 4 point
Deep neck stabilisation
with cervical movements
under constant light
Deep neck stabilisation
with cervical movements
under changing resistance
Shoulder Middle and
lower trapezius
Serratus anterior
activation in Weight
Bearing position
Scapular stability with
thoracic movements
Supported scapular
Stability with resisted
arm movements
Unsupported dynamic
scapular stability with arm
and trunk movements
Unsupported dynamic
scapular stability with arm
and full body movement
Spinal Prone leg lift Swimming arm and
Single leg slide in 4 point Superman arm and legs Sitting on dura disc forward
Sitting or standing on dura
disc forward lean in multi
Abdominals Single leg fall
Single leg circles Opposite leg and arm fall out
on unstable surface
Opposite leg and arm
circles on unstable
Abdominal activation with
resistance in sitting
Abdominal activation with
resistance in standing
Hip Deep hip
external rotator
Deep hip external
rotator activation with
sit to stand
Deep hip stabilisers with
resisted stepping and hip
Single leg stance with
upper body movement
Brolga with upper body
Star excursion balance
Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608 261
Original article
During the pilot study, the feedback from participants indi-
cated that exercises chosen did focus on areas where musicians
had poor strength and control and did not overload structures
already used during instrumental playing. There were self-
reported positive changes in their posture and playing. The musi-
cians indicated that the physiotherapist supervision was useful in
teaching and rening basic exercise class components and techni-
ques, enabling them to perform the exercises as well as possible.
They reported enjoying the programme, and appreciated that the
programme was available within the work schedule because
many of them did not have enough time outside work to attend
such classes. To play music at an elite level requires efciency of
effort as in any other high performance domain. There were con-
cerns initially expressed by some musicians about developing
muscle fatigue that may affect their practice or performance.
Once the musicians realised that this exercise programme focused
on movement control and increasing strength of supporting mus-
culature in a functional context without negative effects on per-
formance, they participated enthusiastically.
Feedback from physiotherapist instructors indicated that
they felt that the exercises were at an appropriate level of dif-
culty for this population. They were surprised at the poor base-
line strength of most of the targeted muscle groups in this elite
population. These physiotherapists had considerable experience
in prescribing exercises in other populations, usually in sports
domains. They recognised there was a noticeable difference in
the physical demands of music performance and understood
the need for the specic approach adopted for this study.
Using a formative and process evaluation approach allowed the
development and revision of a novel evidence-based exercise
programme for professional orchestral musicians. The nal pro-
gramme incorporated available published evidence, clinical
experience and expert feedback to design and test a proposed
intervention thoroughly before widespread implementation and
assessment. This exercise programme aims to optimise compli-
ance and cost-efcacy that could accommodate a demanding
orchestra schedule. This programme is currently being trialled
with a large group of professional orchestral musicians as part
of the Sound Practice project to evaluate its effectiveness in
addressing the incidence and intensity of PRMDs, and changes
to the musiciansplaying postures and effort levels.
Acknowledgements The authors would like to acknowledge the physiotherapists
who assisted with the pilot trial exercise classes and the review processes involved
in developing this programme.
Contributors CC, TD and BA have all made substantial contributions to the
following: (1) the conception and design of the study, or acquisition of data, or
analysis and interpretation of the data, (2) drafting the article or revising it critically
for important intellectual content, and (3) the nal approval of the attached
Funding This work was supported by Australian Research Council, Australian Council
of the Arts and the eight participating orchestras (Australian Opera and Ballet
Orchestra, Sydney Symphony, Melbourne Symphony Orchestra, Orchestra Victoria,
Adelaide Symphony Orchestra, Queensland Symphony Orchestra, Tasmanian
Symphony Orchestra, West Australian Symphony Orchestra) (LP0989486).
Competing interests None.
Patient consent Obtained.
Ethics approval The University of Sydney Human Research Ethics Committee
approved this project (HREC 12523).
Provenance and peer review Not commissioned; externally peer reviewed.
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What is already known about this subject
Professional orchestral musicians experience a high lifetime
prevalence of performance-related musculoskeletal disorders
There are limited evidence-based intervention strategies for
What this study adds
A novel exercise programme was specically designed for
professional orchestral musicians to target the PRMDs
reported in this occupational group by incorporating clinical
experience, expert feedback and available published evidence
Special considerations in the prescription of prevention and
rehabilitation programmes for professional orchestral musi-
cians, such as specic types of exercises and exercise
262 Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608
Original article
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WHO launches Global Alliance for Care of the Injured
Alert readers will recall that tertiary prevention involves caring for already injured victims in
such a way that the consequences of their injuries are minimised. Consequently, WHO has
launched a Global Alliance to address the millions of injury victims who suffer lifelong disability.
This is a special problem in low-income countries where people with life-threatening but surviv-
able injuries are six times more likely to die (36% mortality) than in high-income settings (6%
mortality).To diminish such inequalities, WHO launched Global Alliance for Care of the Injured
(GACI) at the 66th World Health Assembly. GACI is a network of organisations and professional
societies that collaborate to improve care for the injured. It now operates in 12 member
Building booms and regulatory gaps raise vulnerability to tornadoes and other
We do not often think of tornadoes as the cause of preventable injuries, but as FairWarning
points out, this is not necessarily true. It suggests that many in parts of Americas tornado hot
zone face dangers due to population growth and a tendency to discount threats. The centre of
the latest disaster, Moore, Oklahoma, has seen its population surge since the 1960s, and much
of the tornado-prone areas has not taken into account the dangers. Building codes do not
require safe rooms despite research demonstrating how a few thousand dollars can save lives
(The New York Times, Economics of Natural Hazards).
Injury Prevention 2013;19:257263. doi:10.1136/injuryprev-2012-040608 263
Original article
... Studies have emphasized that prevention and education, as well as physical exercise and physiotherapy treatments, are essential not only to prevent manifestations of musculoskeletal pain but also to improve the condition of affected musicians. [26][27][28][29][30][31][32][33] Recent studies by Zalpour et al. (2021) 34 confirm the importance of musician-specific physiotherapy in the management of musculoskeletal pain. The authors argue that psychological factors should be addressed as a potential contributor to musculoskeletal disorders to ensure the development of an individualized and comprehensive approach to pain management. ...
... In view of the high workload that music students are facing in some study phases, and the high prevalence of pain in the general musician population, it was not surprising that two controls developed playing-related pain. The exercise-based physiotherapy treatment approach, which has previously been demonstrated to be effective in pain reduction, [30][31][32][33][34][35][36][37] was also beneficial for our strongly affected music students with chronic pain, who reported an improvement of pain intensity and a reduction of pain frequency. In this regard, we were able to accept our first hypothesis. ...
Objective: Musculoskeletal pain is a common problem among professional musicians as well as music students. Studies have emphasized the effectiveness of music-specific physiotherapy for affected musicians. This study was designed to evaluate if physiotherapy treatment of pain-affected music students had an impact on pain perception as well as psychological well-being. To explore the possible development of musculoskeletal pain, depression, and anxiety, a second sample of pain-free music students, matched for age and gender, was examined twice at identical time intervals. Methods: A convenience sample of 31 university music students with moderate to severe musculoskeletal pain and 31 pain-free music students, matched in age and gender, were included in the study. Both groups were examined physically and completed biographical, music-related, and psychological questionnaires. Perceived pain intensity was assessed with a visual-analogue scale (VAS), and depression and anxiety symptoms were assessed with the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HAD). Music students with pain received a series of 12 sessions of musician-specific physiotherapy, while controls waited for the same amount of time for retesting. Results: On the 10-cm VAS, music students with pain reported an average improvement in pain intensity from a baseline of 6.25 (SD 1.95) to 2.7 (2.03) after the intervention, while the controls (music students without pain) did not change. Furthermore, music students with pain indicated higher depression and anxiety scores as compared to the control group before and after therapy. After intervention, music students with pain with higher BDI-II scores demonstrated clinical improvement concerning depression, but no significant improvement in mental health was found in the pain group taken as a whole. Conclusion: Physiotherapy was effective in reducing pain symptoms in music students affected by chronic musculoskeletal pain. However, physiotherapy did not improve mental health in pain-affected music students. Additional psychotherapeutic interventions may be needed to support music students with psychological comorbidities such as depression and anxiety.
... 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.
Résumé Introduction: Les musiciens d’orchestre professionnels souffrent fréquemment de troubles musculo-squelettiques liés à leurs conditions de travail. Au printemps 2020, le confinement et l’arrêt des activités professionnelles liés à la pandémie de la COVID-19 pouvait présenter une opportunité de récupération mais également augmenter leur incertitude professionnelle et être source d’émotions négatives. Objectif: Le premier objectif est d’évaluer l’évolution des troubles musculo-squelettiques des musiciens professionnels liée à l’arrêt des activités professionnelles provoqué par la COVID-19. Le second est d’examiner l’impact de l’incertitude professionnelle générée par la pandémie et le confinement sur la pratique instrumentale, en fonction des émotions qu’elle a provoquées. Méthode: Un questionnaire sur la pratique instrumentale et les troubles musculo-squelettiques a été renseigné par 439 musiciens d’orchestres français en 2019 (période d’activité professionnelle). Pendant le confinement (avril 2020), un second questionnaire portant sur ces variables ainsi que sur l’incertitude professionnelle, les émotions, l’épuisement émotionnel et le vécu du confinement a été renseigné par 172 musiciens. Résultats: La pratique instrumentale et la prévalence des troubles musculo-squelettiques ont chuté entre les périodes d’activité et de confinement. L’incertitude professionnelle pendant le confinement corrélait aux émotions négatives. L’épuisement émotionnel médiatisait les relations entre l’incertitude et l’effort perçu à pratiquer son instrument, d’une part, et le plaisir ressenti, d’autre part. Conclusion: Pour les musiciens d’orchestre confinés, l’incertitude était associée aux émotions négatives. Jouer de son instrument demandait plus d’effort et n’était pas un facteur de bien-être, soulignant les difficultés pour une reprise de l’activité professionnelle dans des conditions qui limiteraient le risque de blessures.
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.
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
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.
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.
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 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.
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.
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.
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.
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].
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