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Playing-Related Musculoskeletal Disorders Among Icelandic Music Students Differences Between Students Playing Classical vs Rhythmic Music


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Most research studies investigating the prevalence of musculoskeletal disorders affecting musicians and music students have focused on classical music, while less is known about their prevalence in other music genres. The purpose of this study was to document cumulative and point prevalence of playing-related musculoskeletal disorders (PRMD) among music students in Iceland and, specifically, to identify differences between those studying classical vs rhythmic music. We hypothesized that students of classical music would report more frequent and more severe musculoskeletal disorders than students involved in rhythmic music, as classical instruments and composition typically require more demanding, sustained postures during practice and performance. A total of 74 students from two classical music schools (schools A and B) and 1 rhythmic school (school C) participated in the study by answering a questionnaire assessing PRMDs. The results showed that 62% of participants had, at some point in their musical career, suffered a PRMD. The cumulative prevalence was highest in music school A (71.4%) and lowest in music school C (38.9%). A statistically significant difference was identified between the cumulative prevalence of PRMD from schools A and B combined compared to music school C (p=0.019). Over 40% of participants reported a "current PRMD," and a significant difference was identified between the three schools (p=0.011), with the highest point prevalence being registered in music school A (66.6%) and the lowest in music school C (22.2%). The prevalence of PRMDs among Icelandic music students was high. The difference found between students who play classical vs rhythmic music may be explained by different demands of the instruments and composition on playing posture.
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74 Medical Problems of Performing Artists
Most research studies investigating the prevalence of muscu-
loskeletal disorders affecting musicians and music students
have focused on classical music, while less is known about
their prevalence in other music genres. The purpose of this
study was to document cumulative and point prevalence of
playing-related musculoskeletal disorders (PRMD) among
music students in Iceland and, specifically, to identify differ-
ences between those studying classical vs rhythmic music. We
hypothesized that students of classical music would report
more frequent and more severe musculoskeletal disorders
than students involved in rhythmic music, as classical instru-
ments and composition typically require more demanding,
sustained postures during practice and performance. A total
of 74 students from two classical music schools (schools A
and B) and 1 rhythmic school (school C) participated in the
study by answering a questionnaire assessing PRMDs. The
results showed that 62% of participants had, at some point in
their musical career, suffered a PRMD. The cumulative preva-
lence was highest in music school A (71.4%) and lowest in
music school C (38.9%). A statistically significant difference
was identified between the cumulative prevalence of PRMD
from schools A and B combined compared to music school C
(p=0.019). Over 40% of participants reported a “current
PRMD,” and a significant difference was identified between
the three schools (p=0.011), with the highest point prevalence
being registered in music school A (66.6%) and the lowest in
music school C (22.2%). The prevalence of PRMDs among Ice-
landic music students was high. The difference found between
students who play classical vs rhythmic music may be
explained by different demands of the instruments and com-
position on playing posture. Med Probl Perform Art 2014;
Musical performance, whether it is in the form of
singing or playing a musical instrument, is a physi-
cally demanding activity, and musculoskeletal problems
often affect a musician‘s ability to perform.1Playing-
related musculoskeletal disorders (PRMDs) have been
defined as any pain, weakness, numbness, or other physi-
cal symptom that interferes with one’s ability to play a
musical instrument in the manner one is accustomed to.1
Studies documenting the cumulative prevalence (suffer-
ing from a PRMD at some point in the career) of PRMDs
among musicians indicate that up to 87% of participants
have, at some point in their career, dealt with a PRMD,2,3
and nowadays studies have included both professional
musicians and music students. A study by Ranelli et al.
included students between 7 and 17 years of age and
showed a PRMD cumulative prevalence of 67%,4while
79% of 330 music university freshmen reported having suf-
fered from a PRMD at some point in their musical career
in a study by Brandfonbrener.5These numbers are quite
high considering that participants were generally young
and healthy, but now several studies have been published
showing that the cumulative prevalence of PRMDs among
music students is between 32 and 93%.5–7 Numerous phys-
ical and mental factors may contribute to this high cumu-
lative prevalence of PRMDs among musicians.8,9 Factors
like repeated movements, age, gender, static loading in
muscles, and poor posture are all identified risk factors.10
Studies have also shown that poor physical fitness can be
a risk factor, especially for young musicians.8Although
some studies indicate that the cumulative prevalence for
PRMDs is higher among women,1,10,11 others have shown
similar results for the two genders.5
Musicians, especially music students, often continue
playing their instrument despite experiencing symptoms of
pain. A study by Britsch showed that 35% of participants
thought this was acceptable,8while a recent study by Ack-
ermann and Driscoll showed that 50% of participating par-
ents of children from a musically selective school seemed
to accept that feeling pain while playing an instrument was
normal.12 Music students, parents, teachers, and profes-
sional musicians must be aware that suffering, whether it
is physically or mentally, is not acceptable when it comes
to playing music.13 This may, in part, be due to insufficient
health promotion and injury prevention awareness as part
of students‘ curricula, although some music schools now
offer specific PRMD-prevention courses. Zander et al.
investigated the efficacy of a PRMD-prevention and
health promotion course on students‘ physical and mental
health.14 The results indicated that the course had a posi-
tive influence and the authors concluded, as did Chesky et
al.,15 that these kind of courses should be a part of the cur-
Playing-Related Musculoskeletal Disorders
Among Icelandic Music Students
Differences Between Students Playing Classical
vs Rhythmic Music
Kári Árnason, PT, BSc, Árni Árnason, PT, PhD, and Kristín Briem, PT, PhD
Mr. Kári Árnason is a physical therapist at the National University
Hospital and at MT–stofan, Reykjavik, Iceland; and Dr. Árni Árnason
and Dr. Kristín Briem are associate professors at the Department of
Physical Therapy at the University of Iceland School of Health Sciences,
Research Center of Movement Science, Reykjavik, Iceland.
Address correspondence to: Mr. Kári Árnason, The University of Ice-
land, Sæmundargata 2, 101 Reykjavik, Iceland. Tel +354 697 8114, fax
+354 525 4008.
© 2014 Science & Medicine.
riculum in all music schools. Another recently published
study by López and Martínez evaluated the effectiveness of
a course on health and the prevention of PRMDs for supe-
rior-grade students at the High Conservatory of Music of
Salamanca, Spain.16 The results indicated that 91% of the
participants in the experimental group thought that the
course had a positive influence on their body awareness,
and the injury frequency decreased by 78% compared to no
improvements in the control group.16 These authors also
concluded that these kind of courses should be an inte-
grated part of the curriculum in music schools.
The great majority of studies that have documented the
cumulative prevalence of PRMDs have focused on classical
musicians, and a search of the literature revealed no studies
comparing the cumulative prevalence of PRMDs between
those who play classical music and those who play rhyth-
mic music (jazz, pop, rock, etc.) Therefore, the overall pur-
pose of the study was to document the prevalence, both
cumulative and current (present for the last 7 days), of
PRMDs among music students in Iceland, and specifically,
our aim was to identify differences between those studying
classical vs rhythmic music. We hypothesized that due to
the stringent and demanding postures typically required for
performance of classical composition, these students would
report more frequent and more severe musculoskeletal dis-
orders than students involved in rhythmic music, who may
have greater possibility for postural variability.
The total number of participants was 74 music students
drawn from 3 music schools in Reykjavik (2 classical,
called music schools A and B, and 1 rhythmic, called music
school C). Prior to participation, the students received
information about the purpose of the study and what par-
ticipation involved, after which a formal consent form was
presented for them to sign. The study was assessed and
approved by the National Bioethics Committee and
reported to the National Data Protection Authority.
The participants voluntarily answered a questionnaire,
specially designed to document both the cumulative and
current prevalence, as well as the severity, of PRMD
among musicians.17 The questionnaire had previously
been published in the original and slightly changed ver-
sions.17,18 Prior to recruiting participants for the study, the
questionnaire was translated into Icelandic by two individ-
uals fluent in both languages, and a consensus reached
where discrepancies occurred. The Icelandic version was
then translated back to English by another two individuals
and compared to the original English version. The final-
ized Icelandic version of the questionnaire was then pre-
tested by asking 6 musicians, who did not participate in
the study, to answer it and indicate whether they felt the
questions were clear. Some final changes were then made
to improve clarity. A few questions from the original ver-
sion were altered with the authors’ permission in order to
better suit music students, as the original questions were
designed for professional musicians, not students. In addi-
tion to general information (age, gender, physical activity,
and years of musical education), the questionnaire is
designed to acquire more specific information about fre-
quency of injuries and their severity.
The variables of interest for the present study related to
frequency and severity of symptoms and what affected
them, in addition to information regarding education
relating to injury prevention. Participants were asked to
rate on a 100-mm visual analog scale (VAS)19 their per-
ceived frequency of PRMDs and the severity of the worst
PRMD they suffered. Participants were also asked to
choose one or more items from a list of factors that could
in their view potentially have influenced the development
of their PRMD. Each chosen factor was given a number
from 0 to 10 on a numeric rating scale (NRS)20 in regard to
how much influence they felt it had. The NRS was also
used when participants were asked rate the impact that the
PRMD had on their daily activities.
Statistical Analysis
Data analysis was done with SAS Enterprise Guide 4.3
and Microsoft Excel. Chi-square tests were used to identify
differences in the distribution of individuals with and
without PRMD between groups based on gender, school,
classical vs rhythmic music, regarding practice time and
regarding gender distribution between the schools. Inde-
pendent t-tests were used to identify differences between
the schools in how often the participants suffered from
PRMDs and how severe the worst PRMDs were. Statisti-
cally significant differences were identified as p< 0.05.
Demographic Information
Seventy-four music students, 57% male and 43% female,
took part in the study, and their age ranged from 16 to 36
years (Table 1). Music school A (57% male vs 43% female)
and music school C (67% male vs 33% female) included a
greater number of male participants, but in music school B
there was more equal gender distribution (48% male vs 52%
female) (p=0.488). The mean age in each music school was
quite similar, between 20 to 23 years. The mean (SD) time
of musical education was 11.6 (4.7) years, and the partici-
pants had played their main instrument for on average
11.2 (4.9) years. A number of participants (13.5%) also
worked as music teachers, with a mean (SD) weekly work-
load of 6.5 (4.2) hours. Participants practiced on their
instrument on average 6 days/week, twice a day, for 74
minutes per session, and the minimum rest between ses-
sions was 39 minutes. The largest proportion, or 32%, of
participants, played a string instrument (viola, cello,
acoustic and electric guitar, double and electric bass), while
23% played woodwind and brasswind, 23% were pianists,
19% vocalists, and 4% percussionists.
June 2014 75
76 Medical Problems of Performing Artists
Cumulative Prevalence of PRMD
At some point of their careers, 62% of the participants had
dealt with a PRMD. No statistically significant difference
was identified between the 3 schools (p=0.063). However,
when the 69.9% combined cumulative prevalence of
PRMD among participants from music schools A and B
(both classical) was compared to the 38.9% found among
participants from music school C (rhythmic), a statistically
significant difference was identified (p=0.019, Fig. 1). The
cumulative prevalence of PRMDs was significantly higher
among female participants, 61% compared to 39% among
male participants (p<0.001).
Frequency of PRMD occurrence was rated on a VAS
from 0 (never) to 100 (all the time), and a significant differ-
ence of scores was identified between schools A and C
(p=0.02). The mean (SD) frequency score from music
school A was 50 (26), from music school B 38 (23), and
from music school C 23 (17).
Magnitude of the worst PRMD that musicians had suf-
fered from was rated on a 0- to 100-mm VAS, and a signif-
icant difference of scores was identified between schools A
and C (p=0.01) and B and C (p=0.048). The mean (SD) mag-
nitude ratings from music schools A, B, and C were 56 (24),
51 (29), and 27 (17), respectively.
Point Prevalence PRMD
A “current PRMD“ was defined as a PRMD that had been
present for at least the last 7 days, and this was reported in
40% of participants. A statistically significant difference
was identified between the three schools (p=0.011). The
point prevalence of PRMD was highest in music school A
(66.6%) and lowest in music school C (22.2%), while the
prevalence in music school B was 34.4%. When combined
reports of current PRMD from the classical music schools
were compared to those from the rhythmic school, how-
ever, no statistically significant difference was identified
between the two groups (p=0.069).
The participants were also asked to evaluate the magni-
tude of the current PRMD on the VAS, and the mean (SD)
overall score for the current PRMD was 38.2 (30). Of those
participants reporting a current PRMD, 73% had dealt
with this for at least 3 months, 27% for 4 to 12 weeks, and
17% for <4 weeks. Some participants reported more than 1
PRMD, and in those cases some PRMDs had been present
more at least 3 months, another for 4 to 12 weeks, and etc.
Therefore the total score is higher than 100%.
PRMD Cumulative Prevalence Between Instrument
The cumulative prevalence of PRMDs was similar
between most of the instrument groups, although none of
the 3 participating percussionists had any history of
PRMD (Table 2). The mean score for how often partici-
pants suffered from PRMDs ranged from 33 (vocal) to 47
(piano), and the mean magnitude of the worst and current
PRMD was similarly rated between groups, as rated on the
VAS (Table 3).
Practice Time
Participants were asked to document how often per week
they practiced, how many practice sessions there were per
day, and how long each session was. The results regarding
sessions per week, sessions per day, and length of each ses-
sion were similar between the three schools and no signif-
icant statistically difference was found between the
schools regarding any factor (Table 4).
Health and PRMD Prevention Education
Participants were asked if they had received any formal
health and PRMD prevention education. Most of them had
TABLE 1. Demographic Information
Male (n=42) Female (n=32) All (n=74)
Age (yrs) 22.6 (4.7) 22.2 (3.5) 22.4 (4.2)
Height (cm) 180 (6.3) 170 (6.7) 176 (9.6)
Weight (kg) 76.9 (13.8) 61.5 (8.8) 70.2 (14.1)
Body mass index
(BMI) 23.2 (4) 21.8 (3.1) 22.6 (3.7)
Data given as mean (SD).
FIGURE 1. Cumulative prevalence of PRMD: A, classical music schools A and B combined; B, rhythmic music school (music
school C).
June 2014 77
received either none or little health and PRMD prevention
education, while very few had received a lot of it (Fig. 2), and
the results were similar across music schools (Fig. 3).
Potential Risk Factors
Participants were asked to choose one or more items from
a list of risk factors that in their view could potentially
have influenced the development of their PRMD. Each
chosen factor was given a number from 0 to 10 on the
NRS (0 = no influence, 10 = greatest influence) in regard to
how much influence they felt it had on the development of
their PRMD. Poor posture was the factor that received the
highest rating (Table 5).
Effects of PRMD on Daily Activities
Participants were asked to evaluate the effect that the
PRMD they had suffered had on their daily activities on
the NRS (0 = no effect at all, 10 = greatest effect). The mean
score for all three music schools was 2.1 (2.3).
The purpose of this study was to document both the cumu-
lative and point prevalence of PRMD among Icelandic
music students. As noted earlier, contrasting PRMD
between musicians of classical vs rhythmic music genres is
an understudied area, and therefore, this was our primary
aim. We hypothesized that due to vulnerability of students
of classical music, regarding, for example, demanding pos-
tures typically required for classical instruments and strin-
gent composition, classical music students would report
more frequent and more severe musculoskeletal disorders
than students involved in rhythmic music.
Overall, 62% of the participants had at some point in
their career dealt with a PRMD, and 40% reported disor-
ders that had been present for the last 7 days, and this is
consistent with previous findings.4–7 Music school C
(rhythmic) compared favorably when the cumulative
prevalence of PRMD was contrasted to the combined rate
of the classical music schools, and furthermore, the point
prevalence of PRMDs was lowest in music school C. These
results, combined with the fact that the mean scores for
frequency and magnitude of PRMD were also lowest in
music school C, support our “apriori” hypothesis.
One of the differences between the performance of clas-
sical and rhythmic music is that in rhythmic music there is
more “musical freedom” regarding performance, composi-
tion, and interpretation. The music does not have to be
played exactly as it is written, and so there is more freedom
to choose what notes to play, when to play them, and how
to play them. Rhythmic musicians are also in a better posi-
tion to move while playing compared to classical musi-
cians, who typically sit for long periods while playing,
sometimes in very crowded places. More “musical free-
dom” may involve less physical stress due to more breaks,
tempo changes, etc., and this may, in part, explain the dis-
parity found between schools in both the cumulative and
current prevalence of PRMDs.
FIGURE 2. The amount of formal education participants had
received on health and PRMD prevention.
TABLE 2. Cumulative Prevalence of PRMDs between
Different Instrument Groups
Instrument Group No.* Rate of PRMD
Vocal 9/14 64%
Woodwind and brass 10/17 59%
Strings 16/24 67%
Piano 11/16 69%
Percussion 0/3 0%
TOTAL 46/74 —
*Number of participants out of the total number in each
TABLE 3. Frequency (How Often) of PRMDs, Magnitude
of the Worst PRMD, and Magnitude of “Current PRMD”
of Different Instrument Groups
Mean Mean
Mean Magnitude Magnitude
Instrument Frequency of Worst of “Current
Vocal (n=9) 33 (20.7) 46 (31.5) 40 (21.9)
Woodwind and brass
(n=10) 40 (28.7) 48 (27.4) 33 (23.5)
Strings (n=16) 39 (23.7) 49 (25.1) 40 (23.8)
Piano (n=11) 47 (21.9) 50 (28.7) 40 (25.2)
Evaluated on the VAS (0–100). Data given as mean (SD).
TABLE 4. Mean Practice Time for Instrument Sessions
Music Music Music
School A School B School C p-Value
Days/week 5.1 (2.0) 5.9 (1.3) 6 (1.1) 0.09
Minutes/session 69 (54) 84 (48) 72 (31) 0.50
Sessions/day 2 (1.4) 1.7 (0.9) 2.4 (1.4) 0.32
Data given as mean (SD).
78 Medical Problems of Performing Artists
The demands of technical excellence are great in the
classical music world, and students who are determined to
succeed have to spend a great amount of time practicing to
have a possibility to reach their goal. Surprisingly, no dif-
ference was found between the classical vs rhythmic music
students regarding practice time. The ergonomic environ-
ment that classical music students practice in, however,
may be considered more physically stressful due to the
required body posture and the shape of the instruments.
There were also a higher number of female participants
from the classical schools, and our results are consistent
with other reports that indicate higher PRMD prevalence
among females.1,10,11 These factors may contribute to the
high cumulative prevalence of PRMD found among classi-
cal musicians.
Some participants from music school B reported that
their main study was music composition, not instrument
playing. As they had a background in music and played a
musical instrument on a regular basis, they were included
in the study. This may, however, have led to a slightly
lower rate of PRMD for that school, as music composition
students probably spend less time playing their instru-
ments than other music students. Notably, vocalists in the
present study recorded the same PRMD prevalence as the
instrumentalists. This is consistent with a previous report
by Eller et al.21 whose results indicated that disorders
reported by singers were predominantly from the mouth,
lips, and throat, while instrumentalists reported problems
in other body regions.
The large number of participants reporting a current
PRMD and who had suffered from these symptoms for
over 3 months is worrisome considering that the partici-
pants were generally young and healthy. A possible expla-
nation for this high point prevalence of PRMDs is limited
health promotion within the school system. Greater
awareness in this area might lead to a decrease in reported
symptoms, as indicated by the results reported by López
and Martínez, where injury frequency decreased by 78%
after students attended of a course on health and the pre-
vention of PRMD.16 The high cumulative prevalence of
disorders reported in the present and other studies is
hardly acceptable in light of the fact that some, if not
many, of them are preventable. A large amount of physical
and mental stress comes with being a music student, and
this will likely increase as the students further their music
careers and education, in particular if they will have the
opportunity to work as professional musicians.
Special health education and PRMD prevention
courses have been established in some music schools, and
studies have shown that these courses can be very effec-
tive.14–16 PRMD prevention and health promotion should
start in the very beginning of musical training, so that the
students will be prepared for the physical and mental stress
which comes with being a music student and a profes-
sional musician.14 Physical problems that arise early on
can develop into chronic problems and have very serious
consequences if they are ignored. Taking regular breaks,
being aware of good body posture, warming up appropri-
ately, gradually increasing the time spent on instrumental
playing, and monitoring physical and mental health are
factors that should therefore never be underestimated.
Although students from music school C reported the
highest frequency of getting no preventive education yet at
the same time had the lowest prevalence of PRMD, the
authors believe that health promotion and PRMD preven-
tion are important. The relatively low prevalence of
PRMDs reported by the rhythmic music students may have
lead to a lower priority of preventive education within that
school and funds being allocated toward other projects.
Health promotion and PRMD prevention may be par-
ticularly important for classical musicians, as they may be
more vulnerable for developing PRMD for reasons previ-
ously noted. All musicians, classical and rhythmic alike,
may have a tendency to adapt their body posture to the
instrument but not vice versa. Classical instruments like
the violin or cello, however, were hardly designed with the
best ergonomics in mind, while rhythmic musicians are
notably less bound to demanding postures when playing
their instruments.
The risk factors that participants in this study reported
as influencing their PRMD could possibly be addressed by
improving body awareness and by promoting good physi-
cal and mental health. Musculoskeletal problems associ-
ated with playing a musical instrument are nonetheless as
FIGURE 3. The amount of formal health and PRMD prevention education participants from each music school had received
(music schools A, B, and C).
June 2014 79
inevitable as musculoskeletal problems are in the sports
world. The results demonstrated that over 50% of students
had received little or no formal health education and
PRMD prevention and thereby strongly indicate that
there is room for improvement. Traditionally, musicians
tend to adhere to their schedules and play their instru-
ments despite experiencing pain.22 This tendency may be
countered by improving awareness of professional musi-
cians, as well as students and their parents, as to the
importance of good physical and mental health. Musicians
and music students must also know how to react to
PRMDs and where to seek assistance if needed.
A limitation to this study includes the fact that all of the
data are self-reported, which render them susceptible to
recall bias. Furthermore, respondents may have misinter-
preted some questions and some answers may therefore be
inaccurate. Due to the relatively small sample size, subgroup
analyses were not feasible, and as participants all came from
a single city, the study‘s external validity is reduced.
In conclusion, the results of the study demonstrated
that rates of PRMDs reported by music students were high,
although a clear disparity was found between schools
teaching classical vs rhythmic music, indicating a vulnera-
bility of students of classical music. Improving education
may increase awareness in the area of physical and mental
health and thereby lower the risk of injury and thereby
lower the risk of PRMDs and improve recovery.
1. Brusky P. The high prevalence of injury among female bassoon-
ists. Med Probl Perform Art 2010;25(3):120–125.
2. Zaza C. Playing-related musculoskeletal disorders in musicians: a
systematic review of incidence and prevalence. Can Med Assoc
J 1998;158(8):1019–1025.
3. Ackermann B, Driscoll T, Kenny DT. Musculoskeletal pain and
injury in professional orchestral musicians in Australia. Med
Probl Perform Art 2012;27(4):181–187.
4. Ranelli S, Straker L, Smith A. Playing-related musculoskeletal
problems in children learning instrumental music: the associa-
tion between problem location and gender, age, and music expo-
sure factors. Med Probl Perform Art 2011;26(3):123–139.
5. Brandfonbrener AG. History of playing-related pain in 330 uni-
versity freshman music students. Med Probl Perform Art 2009;
6. Ackermann B, Adams R, Marshall E. Strength or endurance
training for undergraduate music majors at a university? Med
Probl Perform Art 2002;17(1):33–41.
7. Blackie H, Stone R, Tiernan A. An investigation of injury pre-
vention among university piano students. Med Probl Perform
Art 1999;14(3):141–149.
8. Britsch L. Investigating performance-related problems of young
musicians. Med Probl Perform Art 2005;20(1):40–47.
9. Yeung E, Chan W, Pan F, et al. A survey of playing-related mus-
culoskeletal problems among professional orchestral musicians
in Hong Kong. Med Probl Perform Art 1999;14(1):43–47.
10. Abréu-Ramos AM, Micheo WF. Lifetime prevalence of upper-
body musculoskeletal problems in a professional-level sym-
phony orchestra: age, gender and instrument-specific results.
Med Probl Perform Art 2007;22(3):97–104.
11. Burkholder KR, Brandfonbrener AG. Performance-related
injuries among student musicians at a specialty clinic. Med Probl
Perform Art 2004;19(3):116–122.
12. Ackermann B, Driscoll T. Attitudes and practises of parents of
teenage musicians to health issues related to playing an instru-
ment. Med Probl Perform Art 2013;28(1):24–27.
13. Brandfonbrener AG. Healthier music students: can medicine
and music prescribe in concert? [editorial]. Med Probl Perform
Art 2004;19(1):1–2.
14. Zander MF, Voltmer E, Spahn C. Health promotion and preven-
tion in higher music education: result of a longitudinal study.
Med Probl Perform Art 2010;25(2):54–65.
15. Chesky KS, Dawson WJ, Manchester R. Health promotion in
schools of music: initial recommendations for schools of music.
Med Probl Perform Art 2006;21(3):142–144.
16. López TM, Martínez JF. Strategies to promote health and pre-
vent musculoskeletal injuries in students from the High Conser-
vatory of Music of Salamanca, Spain. Med Probl Perform Art
17. Ackermann B, Driscoll T. Development of a new instrument for
measuring the musculoskeletal load and physical health of pro-
fessional orchestral musicians. Med Probl Perform Art 2010;
18. Rickert D, Barrett M, Halaki M, et al. A study of right shoulder
injury in collegiate and professional orchestral cellists: an inves-
tigation using questionnaires and physical assessment. Med
Probl Perform Art 2012;27(2):65–73.
19. Carlsson AM. Assessment of chronic pain: I. Aspect of the reli-
ability and validity of the visual analogue scale. Pain 1983;16:87–
20. Ornetti P, Dougados M, Paternotte S, et al. Validation of a
numerical rating scale to assess functional impairment in hip
and knee osteoarthritis: comparison with the WOMAC func-
tional scale. Ann Rheum Dis 2011;70:740–746.
21. Eller N, Skylv G, Ostri B, et al. Health and lifestyle characteris-
tics of professional singers and instrumentalists. Occup Med
22. Pak CH, Chesky K. Prevalence of hand, finger, and wrist muscu-
loskeletal problems in keyboard instrumentalists: the University
of North Texas musician health survey. Med Probl Perform Art
TABLE 5. Risk Factors that Participants Thought Had
Influenced the Development of their PRMD
How Often
Mean Each Factor
Risk Factor Score (SD) Was Chosen (46)
Poor posture 7.7 (2.5) 40
Long practice sessions 7.4 (2.3) 41
Excess muscle tension 7.4 (2.2) 41
Instrument set up issue 7.1 (2.5) 35
Sudden playing increase 7 (2.4) 35
Insufficient rest 6.8 (2.5) 37
Stress 6.6 (2.4) 35
Evaluated on NRS (0 = no effect at all, 10 = greatest effect at
... Experts emphasize that knowledge in the field of health education regarding the mechanisms of the formation and prevention of musculoskeletal disorders related to playing an instrument is insufficient among musicians and should be implemented from an early age of learning to play an instrument [25,26]. ...
... Icelandic researchers have shown that the level of knowledge on the prevention of musculoskeletal disorders related to playing an instrument among music school students is insufficient. Only over half of the respondents had knowledge of the prevention of musculoskeletal disorders [25]. ...
... Factors favoring the development of musculoskeletal disorders, in addition to the real ergonomic factors related to body posture while playing an instrument, may be long hours of work, especially if it is performed without breaks or adequate warm-up [25,27]. ...
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Introduction: This study aimed to assess pain in professional musicians playing various instruments, as well as to analyse the relationships between the intensity and frequency of pain and the duration of playing the instrument and somatic variables. Materials and methods: A cross-sectional study was conducted between 60 professional musicians, who were divided into 3 groups: cellists, violinists, and musicians playing wind instruments. Pain intensity was assessed using the visual analogue scale (VAS). The respondents also assessed the frequency of musculoskeletal disorders, the location of pain, the number of hours of playing the instrument per week, and the playing experience in years. In addition, body weight and height were measured and the body mass index (BMI) was calculated. Results: Musculoskeletal disorders occurred among 83.33% of musicians, including: cellists (n = 20; 100%), violinists (n = 18; 90%), and musicians playing wind instruments (n = 12; 60%). The pain was more often localised in the lumbar and cervical spine, and less frequently in the upper and lower limbs. Cellists and violinists experience the most intense pain (appropriately Me = 4.50, IQR = 4.00 and Me = 5.00, IQR = 3.50) and of greater frequency (appropriately Me = 3.00, IQR = 2.00 and Me = 3.00, IQR = 6.00) in contrast to musicians who play wind instruments (Me = 1.00, IQR = 2.00); p < 0.01. Conclusions: Musculoskeletal pain is very common among musicians, especially among string players. There is a need for greater awareness and knowledge among musicians of strategies to prevent pain and overload. Playing stringed instruments, including many hours of practice per week and a longer experience in playing the instrument, is conducive to greater intensity and frequency of pain in the musculoskeletal system.
... Second, the value of health and injury prevention education may not be appreciated by young students. 15 Over half the participants in our study reported no pain at the start of the festival. Despite these challenges, the students who responded to recruitment efforts demonstrated a high rate of participation, willingness to be randomized, and high compliance with the program suggesting that once recruitment challenges are overcome, an injury prevention program is feasible to implement. ...
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.
... Second, the value of health and injury prevention education may not be appreciated by young students. 15 Over half the participants in our study reported no pain at the start of the festival. Despite these challenges, the students who responded to recruitment efforts demonstrated a high rate of participation, willingness to be randomized, and high compliance with the program suggesting that once recruitment challenges are overcome, an injury prevention program is feasible to implement. ...
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.
... Similarly, the contemporary literature offers a large heterogeneity of methods amongst small samples that limit generalisations and meta-analytical synthesis of the evidence of music students' MSK conditions [30,46]. This is despite a growing literature regarding MSK among music students [10,11,25,28,[32][33][34][35][36][37][38][39] and a proliferation of preventive courses as well as short-term health education programs during the last twenty years [40][41][42][43][44][45]. Furthermore, in contrast to the literature on MSK conditions in the general population, scientific evidence is scarce concerning prevalence rates and associated factors in subgroups of age and different identifying or sensitive participants' information and disclosure to third parties has been prohibited by the QMU Ethics Committee. ...
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Musculoskeletal (MSK) conditions among professional musicians and music students are frequent and may have significant physical and psychosocial consequences on their lives and/or on their playing abilities. The Risk of Music Students (RISMUS) research project was set up in 2018 to longitudinally identify factors associated with increased risk of playing-related musculoskeletal disorders (PRMDs) in a large sample of music students enrolled in pan-European institutions. The aim of this cross-sectional study was to describe the prevalence of playing-related musculoskeletal disorders (PRMDs) in this novel population at baseline of the RISMUS project. A further goal was to begin to identify variables that might be associated with the self-reported presence of PRMDs among music students. Eight hundred and fifty students from fifty-six conservatories and music universities in Europe completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, health history and PRMDs, psychological distress, perfectionism and fatigue. A total of 560 (65%) out of 850 participants self-reported a positive history of painful MSK conditions in the last 12 months, 408 (48%) of whom self-reported PRMDs. Results showed that coming from West Europe, being a first- or a second-year Masters student, having more years of experience and higher rates of perceived exertion after 45 minutes of practice without breaks were factors significantly associated with self-reported presence of PRMDs. According to the authors’ knowledge, a large-scale multicentre study investigating prevalence and associated factors for PRMDs among music students at different stages of their education (from Pre-college to Masters levels) has not been conducted before. The high prevalence of PRMDs among music students, especially those studying at university-level, has been confirmed in this study and associated factors have been identified, highlighting the need for relevant targeted interventions as well as effective prevention and treatment strategies.
... Unfortunately, many participants in this research perceived having received little or no education in their formative years regarding practice habits and their role in preventing playing-related discomfort/pain. This finding supports those of Britsch (2005); Raymond, Romeo, and Kumke (2012) and Arnason, Arnason, and Briem (2014). Several students were subsequently able to link an initial increase in discomfort/pain in the first semester of their studies at this institution to the correction of perceived 'incorrect' playing techniques such as poor posture and inefficient bow holds. ...
This article draws on qualitative data collected over a five-year period as part of a longitudinal mixed methods research project at a tertiary music institution in Australia. Forty tertiary string students consistently identified factors specific to the one-on-one instrumental teaching environment as influencing their perceptions as to the nature and causes of their playing-related discomfort pain. Student perceptions of individual teacher’s attitudes to pain and injury, experiences with regards to asking and receiving advice and the perceived influence of the first instrumental teacher are discussed using six examples. The paper concludes with several recommendations for instrumental music teachers and music institutions.
... Studies show that health problems related with playing musical instruments more often concern women [1,5,7]. In addition, research shows that health problems also affect children learning to play instruments [8,9] and students [10][11][12]. Pain among artists is often recognized as chronic and occur as a result of cumulative, long-lasting overload [11] but it also can be an acute pain that is especially related to a sudden increase in instrument practice [13]. Analysis of these aspects shows that for young people in music schools and universities, the specific prevention programs that would guide musicians how to avoid pain and injury could be of great benefit for their condition and performance. ...
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Due to the occurrence among musicians of musculoskeletal problems associated with playing a musical instrument, it is necessary to use prophylaxis. The aim of the study was to compare the effectiveness of two physioprophylaxis methods: chair massage and an original set of exercises. The study lasted four weeks and consisted of eight 15-min meetings (chair massage/exercises). The study was conducted on 44 music students assigned to three groups (chair massage/exercise program/control group). The algometric measurements and questionnaire were conducted. Health problems associated with playing an instrument was reported by 86.4% of the participants. The largest changes in pain threshold concerned the trigger points of the muscles with the highest pain sensitivity, i.e., upper part of trapezius ones, and reached 25-34% in relation to the initial values. For the trigger points of the levator scapulae and lower part of trapezius, the increase in the pain threshold was between 20 and 28%. Raising the pain threshold was observed both after each session and meeting by meeting, and these differences were most visible in the massage group. This effect was particularly visible from the fourth treatment. Chair massage and exercise should be used regularly, and significant results can be obtained after two weeks.
We aimed to evaluate and compare the prevalence and profile of musculoskeletal symptom (MSS) outcomes across cohorts of university music students with different ‘majors’: (i) performance and nonperformance students, and (ii) classical and non-classical performance students. Data were collected using a cross-sectional questionnaire survey, and regression analyses were used to compare the groups. Of the 166 participating students, 92.5% reported experiencing MSSs in the last 12 months, and 72.6% in the last 7 days. Few significant differences were identified between groups. Musculoskeletal symptoms are a problem for all types of university music students, and all should have access to support to prevent and manage their MSSs, regardless of their majors.
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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As literaturas estrangeira e nacional registram a frequência de queixas e sintomas musculoesqueléticos em músicos: dor, rigidez, tensão, fadiga e formigamento. A região lombar e a cervical são as mais acometidas, seguidas pelos ombros e mãos. Os instrumentistas de cordas, principalmente os violonistas, apresentam maior frequência de sintomas e de queixas. A cronificação da dor é frequente e interfere na saúde e no trabalho desses profissionais. Buscou-se avaliar o impacto de um Protocolo de Autogerenciamento da Saúde do Músico (PASM) em violonistas profissionais com queixas musculoesqueléticas com o objetivo de: 1) descrever o Programa de Atenção Integral à Saúde do Artista de Performance do Serviço Especializado em Saúde do Trabalhador do Hospital das Clínicas da Universidade Federal de Minas Gerais (SEST-HC/UFMG) que originou o Protocolo PASM; 2) investigar a relação da postura do tronco durante a atividade de tocar o violão com a intensidade da dor, tempo de experiência e horas de prática com o instrumento em violonistas com dor nas colunas cervical, torácica e lombar; 3) descrever e analisar o perfil clínico ocupacional dos violonistas estudados e sua percepção sobre os riscos de adoecimento presentes no trabalho; 4) identificar mudanças na intensidade da dor, interferência da dor na vida diária, autopercepção de saúde, desempenho nas atividades com o violão e satisfação com o desempenho após a conclusão do protocolo. Os métodos utilizados variaram de acordo com o objetivo específico trabalhado. Para a descrição do Programa de Atenção Integral à Saúde do Artista de Performance do SEST-HC/UFMG e do processo de construção do protocolo PASM, apresentada no artigo 1, utilizaram-se análise documental, projetos e relatórios anuais de membros da equipe, registros em prontuários e banco de dados do serviço desde sua criação, dezembro de 2009, até maio de 2015. Para a investigação da relação entre a postura do tronco durante a atividade de tocar o violão com a intensidade da dor, o tempo de experiência e as horas de prática, foi realizado um segundo estudo, descrito no artigo 2. Empregaram-se dados biomecânicos de 17 violonistas profissionais, do sexo masculino, média de idade de 35 anos, com queixas de dor nas colunas cervical, torácica e lombar, coletados em três posições: postura ortostática, postura sentada estática e tocando o violão. Utilizou-se o sistema de análise de movimento Qualisys Pró-Reflex, com oito câmeras infravermelhas (Qualisys MEDICAL AB, Gotemburgo, Suécia) e duas câmeras digitais. Foram considerados 39 marcadores passivos refletivos de 8mm posicionados na pelve, na coluna lombar, no tronco, na cabeça e nos membros superiores. A redução dos dados foi realizada por meio do programa Visual 3D (C-motion, Inc., Rockville, USA). A postura do tronco nos três planos de movimento foi calculada da seguinte maneira: flexão do tronco (eixo médio-lateral), flexão lateral do tronco (eixo ântero-posterior) e rotação do tronco (eixo longitudinal) em relação ao sistema de coordenadas laboratoriais. Para a descrição e a análise do perfil clínico ocupacional dos 19 violonistas participantes do estudo 3 e sua percepção sobre as inter-relações entre diferentes dimensões do trabalho e riscos de adoecimento, foram utilizados dados da ficha de anamnese clínico-ocupacional, adotada no SEST-HC/UFMG, um questionário estruturado para auxiliar a identificação do modo operatório com o violão e do Inventário de Trabalho e Risco de Adoecimento (ITRA). Para a avaliação das mudanças após a conclusão do protocolo, foi realizado estudo prospectivo (estudo 3), com três mensurações (início, 30 e 75 dias, T1, T2 e T3, respectivamente), de agosto de 2016 a junho de 2017, em 19 violonistas com queixas musculoesqueléticas, selecionados por conveniência, a partir dos registros clínicos e dos dados da ficha de anamnese clínico-ocupacional. A intervenção constou de oito encontros de um protocolo de exercícios e educação em saúde. Foram utilizados a Escala Visual Analógica (EVA) para avaliar a intensidade da dor nos últimos 15 dias; o Brief Pain Inventory-short form para avaliar a intensidade e a interferência da dor na vida diária; a Medida Canadense de Desempenho Ocupacional (COPM) para avaliar o desempenho e a satisfação com o desempenho nas atividades laborais e a pergunta “De modo geral, como você considera o seu estado de saúde?” para conhecer a autopercepção da saúde. Esses instrumentos foram aplicados nos três momentos de avaliação (T1, T2 e T3). A análise dos aspectos específicos de viabilidade considerou as fichas semanais de registro diário para identificar a frequência de prática dos exercícios domiciliares e um questionário final, elaborado em formato de perguntas objetivas, que buscou identificar a percepção dos violonistas sobre o protocolo e sua possível contribuição na prevenção do adoecimento. Foram realizadas análises descritivas e, para testar as mudanças ao longo do tempo (T1, T2 e T3) , utilizou-se o teste anova de medidas repetidas. A melhora na intensidade da dor e sua interferência na vida diária foi considerada relevante quando, além de significativa, ocorresse uma redução nos escores finais de 30% ou mais. Os dados foram analisados com o pacote estatístico SPSS (Statistical Package for Social Science) versão 21.0 e, em todas as análises, foi considerado o nível de significância alfa=0,05. As amostras dos estudos 2 e 3 foram independentes. O detalhamento do terceiro estudo encontra-se no artigo 3 da tese. Quanto aos resultados, o Programa de Atenção Integral à Saúde do Artista de Performance do SEST/HC/UFMG vem realizando diferentes ações como: avaliação clinico-ocupacional , incluindo análise da atividade com o instrumento musical; visitas técnicas aos locais de trabalho; assistência individual e atividades em grupo; ações educativas e preventivas desenvolvidas pela equipe interdisciplinar. De dezembro de 2009 a maio de 2015, foram atendidos 122 músicos, a maioria instrumentista, do sexo masculino, com média de idade de 32 anos. Os sintomas apresentados foram: dor (89%), fadiga muscular (30%), movimento involuntário (11%) e rigidez (7%), sendo que a maioria apresentava mais de um sintoma. Na avaliação clínica, a maioria (75%) dos músicos apresentou algum distúrbio postural primário sendo os mais frequentes: projeção de cabeça, alteração no grau de cifose torácica e lordose lombar e desnivelamentos (básculas) nas cinturas escapular e pélvica. A intervenção em grupo passou a ser utilizada como estratégia assistencial e preventiva possibilitando a criação do PASM. Esse protocolo foi sistematizado com o detalhamento das intervenções e técnicas utilizadas no trabalho em grupo e foi avaliado no estudo 3 da tese. Quanto aos resultados do estudo 2, dos 17 violonistas estudados, três tocavam repertório clássico, oito tocavam popular e seis tocavam ambos os estilos. Sete participantes queixavam-se de dor cervical, 12, de dor torácica e 13, de dor lombar. A intensidade da dor na coluna vertebral nos últimos 15 dias e a pior dor na coluna vertebral, nas últimas 24h, correlacionaram-se positivamente com a flexão lateral do tronco. A presença de dor na coluna no momento da coleta foi negativamente correlacionada com a flexão do tronco. A variável anos de experiência apresentou correlação positiva com a flexão lombar, e as horas semanais de prática correlacionaram-se positivamente com a flexão de tronco. Sobre a adoção do Protocolo, os resultados do estudo 3 revelaram que a maioria dos participantes (95%) completou o treinamento e todos reportaram alta satisfação com o protocolo. Observou-se redução da intensidade (p<0,001) e da interferência da dor na vida diária (p=0,013), melhora no desempenho das atividades como violonista (p<0,002) e na satisfação com tal desempenho (p<0,001). Não foi encontrada diferença significativa na autopercepção de saúde. Pode-se concluir que as reavaliações e os relatos dos trabalhadores assistidos no SEST-HC/UFMG demonstraram que os objetivos do programa foram alcançados, principalmente, o autogerenciamento das estratégias de enfrentamento dos riscos de adoecimento no trabalho. A avaliação biomecânica identificou que os ajustes posturais para se tocar um instrumento musical parecem favorecer o surgimento de dores na coluna e se associam com as horas semanais de prática e com o tempo de experiência como instrumentista, mas a confirmação dessa associação só foi obtida com os violonistas participantes do estudo 2. A avaliação das ações grupais mostrou que o protocolo (PASM) favoreceu o autogerenciamento da saúde e foi efetivo na redução das queixas e dos sintomas dos violonistas, com impacto positivo na satisfação e no desempenho das tarefas laborais. Além de tais benefícios, o protocolo propiciou o aumento da consciência crítica sobre o processo e a organização do processo de trabalho auxiliando na construção de estratégias para superar e enfrentar os problemas identificados. Palavras-chave: Saúde do Trabalhador. Dor musculoesquelética. Biomecânica. Educação em Saúde.
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HPSM recognizes fundamental challenges in responding to the health risks associated with learning and performing music. In addition to current research showing that young musicians enter college with existing problems, the underlying physiological and psychological mechanisms for performance injuries are multidimensional and involve both individual and music-related variables as well as a myriad of social, environmental, and cultural factors. Because of this complexity, HPSM recommends Prevention Education and Intervention as the primary approach for schools of music to address these problems. HPSM recognizes the need for a common and unifying framework that consolidates an academic agenda that focuses on individual knowledge, responsibility, and action with a coherent and integrated continuum of experiences for students. In order to be effective, Prevention Education must go beyond simply "delivering" instruction or "disseminating" information and must address issues that affect music students' values, beliefs, and motivations. Recommendations for a Health Promoting framework were corroborated by the Board of Directors of the Performing Arts Medicine Association in the fall of 2005 and then presented to and reviewed by the Executive Committee of the National Association of Schools of Music in fall of 2005 and again in the spring of 2006. The following HPSM consensus-based declarations and recommendations provide the basis for action. The materials are designed for consideration by schools of music administrators and faculty as suggestions for creating better environments and improved educational practices with regard to professional health of music students and the prevention of performance injuries.
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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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Musculoskeletal problems are considered significant health factors for performing artists, especially instrumentalists. Although numerous studies exist that document the extent to which musicians experience these problems, serious consideration has not been given to musicians who play the keyboard, or the type of music played by each instrumentalist. Furthermore, although the Internet is an emerging tool for research, epidemiologists have been surprisingly slow in adapting to this novel way to conduct surveys. Using data derived from the University of North Texas Musician Health Survey (UNT-MHS) conducted over the Internet, this study assessed the prevalence of upper-extremity musculoskeletal problems among 455 keyboard instrumentalists and the association with musician type, daily playing time, gender, and age. Age and gender were found to be significant risk factors, while musician type and daily playing time did not show statistical significance.
Understanding which musicians are most at risk for injury, how frequently injuries occur as well as why and when, and how to treat and prevent musicians’ symptoms is the bailiwick of so-called “music medicine.” Data to provide answers to these questions are limited, although they are gradually growing in quantity, quality, and scope. As a result, there is a modest but increasing volume of data in scientific publications, along with a wider array of material in nonmedical publications. Much of the latter is written by musicians who themselves have a history of playing-induced injuries.
The purpose of this descriptive study was to investigate the educational background, practice habits, and incidence of injury among piano students from a liberal arts university in Washington State. A survey was completed by 16 of 25 piano students aged 18 to 24 years. Results of this study revealed that many participants did not receive or use injury prevention education. The prevention principles with the most reported use were proper posture and body mechanics and decreasing the length of practice when fatigued. The average amount of time spent practicing per weekday was 117 minutes. Fifteen (93%) of the participants sustained 27 playing-related injuries, and ten (62%) reported more than one injury. Twenty-one percent reported that their injuries restricted their participation in everyday activities. The results of this study suggest that aspiring musicians may not be receiving injury prevention education and/or not applying injury preventive techniques to practice. More research needs to be devoted to examining the introduction and application of injury prevention concepts among young musicians.
To understand what factors may contribute to the problems experienced by conservatory/music school students, we surveyed incoming freshman music students about their history of playing-related pain from four consecutive entering classes at a midwestern university school of music. A total of 330 students (46% male, 54% female) participated in the study and completed a 22-item questionnaire. Seventy-nine percent of students reported a history of playing-related pain. Pain frequency varied by instrument class, ranging from 61% among voice students to 100% for percussionists, but for strings, keyboards, woodwinds, and brass players, it was consistently 84 to 87%. There was no significant association between frequency of pain history and gender (76% for males vs 81 % for females), years of instrument study, participation in regular exercise, or occurrence of performance anxiety. Although this study was unable to identify factors linked to playing-related pain, it does indicate that in a population of incoming freshmen, who are young people presumably in otherwise good health and with a "clean slate," the majority had already encountered music-induced pain as high school students or younger.
Many investigators have expressed concern about the paucity of research literature on the subject of younger musicians, particularly adolescents, and little is known about their performance-related injuries. This study was undertaken to explore this neglected area. Ninety-seven students in four youth orchestras in a mid-sized midwestern city were surveyed to examine the relationships between such factors as practice time and pain, to explore what students do when they experience pain while playing, and to determine whether students have been exposed to any injury prevention education. Few reported accepting the belief of playing through pain, while performance anxiety was reported at a higher-than-expected rate. The older students had more awareness of possible causes of playing-related pain and strategies for its elimination than did the younger students. The older students also discussed their pain with teachers more frequently than did the younger students. It appeared that those students who sought help from teachers for their performance-related problems received information that was beneficial in reducing or solving the problem. Two statistically significant relationships were found; one between amount of practice time and grade of pain reported in the youngest orchestra, and the other comparing females by age and grade of pain reported.
The purpose of this study was to determine the relative frequency of performance-related injuries in patients age 18 and younger who presented to a specialized performing arts clinic. A total of 314 student musicians age 18 and younger were seen at the specialty clinic between its inception in 1985 and November 2002. Retrospective chart review and analysis of the resulting data were conducted. Information collected included presenting complaint, problem location, and diagnosis. Data were analyzed with respect to gender, instrument played, and ligamentous laxity. The upper extremity was the most common injury location. The lateralization and anatomic location of the injuries were influenced by the instrument played. The most frequent problems were musculoskeletal pain syndrome and excessive muscle tension. Lack of physical conditioning and poor instrumental technique also were commonly noted. Ligamentous laxity of the wrist and fingers was found in a proportion higher than in that of the general population and was related to the number and the type of physical diagnoses made. Laxity was more common in girls. Other diagnoses that were more frequent among female musicians included lack of conditioning, intrinsic hand muscle weakness, and scoliosis. In boys, carpal tunnel syndrome and tendinitis were more common. The findings suggest that young age is not a protective factor against playing-related injuries. Physicians caring for musicians in this age group should have an awareness of the problems and risk factors related to playing musical instruments.
The aim of this study was to investigate the prevalence and possible risk factors of playing-related musculoskeletal complaints (PRMCs) among musicians of the symphony orchestras in Hong Kong. Only professional orchestral musicians who have regular practices and public performances were surveyed. The survey instrument consisted of questions designed to identify possible risk factors related to PRMCs. The questionnaire was validated and pretested prior to administration. These were then distributed to the musicians during their regular rehearsal sessions and collected within 14 days. The results indicated a one-year PRMC prevalence of 64%, comparable with the findings from previous studies elsewhere. The study musicians with PRMCs during the preceding 12 months were relatively young in age (26.32 ± 5.43 years) and in playing experience (8.89 ± 4.59 years). Stepwise logistic regression identified two factors predictive of PRMCs: less experience in playing and lack of regular exercise. However, due to the small sample size, there may have been insufficient power to detect other important determinants in the development of PRMCs. Hypothesis testing on a larger sample needs to be formulated.
Instrumentalists are at risk to develop upper-body musculoskeletal problems (MSKPs). Identified risk factors include age, gender, instrument played, joint laxity, and poor technique or posture. In this study, we established the prevalence of MSKPs that affect the ability to play an instrument in the population of a professional-level symphonic orchestra and the relation of these problems to gender, age, and instrument. The members of the Puerto Rico Symphony Orchestra were recruited voluntarily. A questionnaire was used to obtain information on demographics, instrument played, and history of MSKP severe enough to affect their playing ability. Questions also covered alleviating and aggravating factors, upper-body areas involved, type of symptoms, and type of treatment sought. After the questionnaire was completed, all players underwent a neuromusculoskeletal upper-body examination. Of the 75 musicians participating, 81.3% reported having had an MSKP that affected their ability to play. Of these, 83.6% reported their MSKP was directly associated to playing. Females were more commonly affected, 87.5% vs. 79.7% for males. Lower-body strings (cello, bass) players and percussionists (93.3% and 100%, respectively) and younger (22-29 yrs) and older (50-61 yrs) populations (83.3% and 90.9%, respectively) reported more MSKPs. These age groups played more hours per week (28.7 and 32.0 hrs, respectively). In all groups, low back pain was the most common complaint, present in 75.4% of those with MSKPs. Upperbody strings (violin, viola) players also reported neck and left shoulder problems. Contributing factors include hours of exposure and technical expertise. Female gender, age, and instrument played were found to be risk factors for developing MSKPs in this population.