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Musculoskeletal and General Health Problems of Acoustic Guitar, Electric Guitar, Electric Bass, and Banjo Players


Abstract and Figures

The aim of this cross-sectional study was to describe self-reported problems among guitarists and to examine differences associated with type of guitar played. Data for the study were extracted from the University of North Texas Musician Health Survey (UNT-MHS) data set. Subjects for the present study (n = 520) were included if they identified acoustic guitar, electric guitar, electric bass or banjo as their primary instrument. Prevalences for musculoskeletal problems were determined for the total group, by guitar-specific groups, and by gender. Prevalences for nonmusculoskeletal, overall health problems were established for the whole guitar group and by instrument. Of the total subjects, 81% reported one or more musculoskeletal problems. The acoustic guitar group reported the highest prevalence (83%), followed by the banjo (78%), electric bass (77%), and electric guitar groups (74%). The highest site-specific prevalences for the whole group were the left fingers (32.9%), left wrist (29.8%), and left hand (24.7%). Regarding non-musculoskeletal problems, 66% of the total group perceived stress due to work environment as a moderate to high problem. The total group reported mostly problems with fatigue, depression, headache, and eye strain. The overall findings of the study show that musculoskeletal problems as well as stress-related health problems are a major concern for the guitar community.
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December 2006 169
Abstract—The aim of this cross-sectional study was to describe self-
reported problems among guitarists and to examine differences
associated with type of guitar played. Data for the study were
extracted from the University of North Texas Musician Health
Survey (UNT-MHS) data set. Subjects for the present study (n =
520) were included if they identified acoustic guitar, electric guitar,
electric bass or banjo as their primary instrument. Prevalences for
musculoskeletal problems were determined for the total group, by
guitar-specific groups, and by gender. Prevalences for nonmuscu-
loskeletal, overall health problems were established for the whole
guitar group and by instrument. Of the total subjects, 81% reported
one or more musculoskeletal problems. The acoustic guitar group
reported the highest prevalence (83%), followed by the banjo (78%),
electric bass (77%), and electric guitar groups (74%). The highest
site-specific prevalences for the whole group were the left fingers
(32.9%), left wrist (29.8%), and left hand (24.7%). Regarding non-
musculoskeletal problems, 66% of the total group perceived stress
due to work environment as a moderate to high problem. The total
group reported mostly problems with fatigue, depression, headache,
and eye strain. The overall findings of the study show that muscu-
loskeletal problems as well as stress-related health problems are a
major concern for the guitar community. Med Probl Perform Art
Guitarists represent one of the largest and fastest growing
groups of musicians. According to the Music Trades
Magazine industry census,1guitar is the number one selling
instrument. In the year 2000, 1.6 million guitars were sold,
which has more than doubled since 1992. Total piano sales
were second to guitar at about 107,000 with guitar outnum-
bering piano with more than 15 to 1. The American Federa-
tion of Musicians (AFM), who represents union musicians in
the U.S. and Canada, reported that in the year 2002, over
16,000 out of approximately 100,000 union members were
guitarists (
Similar to musicians playing other instruments, guitarists
experience work-related musculoskeletal problems that affect
the upper extremity and back. One study included a random
sample of 1000 U.S. residents and found the highest preva-
lence of upper-extremity pain in keyboardists (33%) and gui-
tarists (30 %)2. A cross-sectional study on work-related mus-
culoskeletal and psychosocial health among music teachers
indicated that teachers who reported guitar as their primary
and most played instrument had an increased risk for having
neck and shoulder disorders.3A report from a hand surgical
practice that included 167 instrumentalists showed that gui-
tarists presented mostly left-sided or bilateral strains distal to
the elbow, inflammatory conditions, and nerve problems
such as focal dystonia in the hand and fingers, and carpal
tunnel syndrome.4Medical problems of guitarists have been
highlighted in case studies and included guitar-string der-
matitis and other skin conditions,5–7 tuft finger fractures8,
and acro-osteolysis as evidenced by shortening of the distal
phalangeal finger bones due to mechanical stress on the fin-
gers while playing the guitar.9,10
Some reports indicate that classical guitarists are among
the guitarists most likely to suffer from musculoskeletal prob-
lems related to playing.11,12 However, a study of muscu-
loskeletal problems in guitarists playing popular music
showed that many of these musicans also experience playing-
related pain in the left hand and wrist, back, and neck.13 The
musculoskeletal problems of banjo players also have to some
extent been reported, showing cases of overuse syndrome and
focal dystonia.14,1 5 The prevalence of nonmusculoskeletal
problems in musicians, relevant to guitarists, reflect concerns
for stress, fatigue, sleeping problems, depression, anxiety,
stage fright, and substance abuse.16 ,17
The reasons for work-related musculoskeletal problems
among guitarists are not fully understood. Physical demands
such as non-neutral postures while working, repetitive arm
and finger movements, and required force for performing any
work task have been proposed.18–20 Extreme working postures
and working techniques that include repetitive movements
and static muscle work are easily found in guitar playing.21,22
However, research is needed to better understand the relative
importance of these factors.
Guitars come in many shapes and sizes and involve vari-
ous performance techniques. General categories include
Musculoskeletal and General Health
Problems of Acoustic Guitar,
Electric Guitar, Electric Bass,
and Banjo Players
Anncristine Fjellman-Wiklund, R.P.T., Ph.D., and Kris Chesky, Ph.D.
Dr. Fjellman-Wiklund is Senior Lecturer at the Department of Community
Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå,
Sweden, and is a Visiting Scholar at the Texas Center for Music & Medi-
cine, University of North Texas, College of Music, Denton, TX. Dr. Chesky
is Director of the Texas Center for Music & Medicine, University of North
Texas, College of Music, Denton, TX.
Address correspondence and reprint requests to: Dr. Anncristine Fjellman-
Wiklund, Department of Community Medicine and Rehabilitation, Phys-
iotherapy, Umeå University, Umeå, Sweden. Tel 46.90786-9756; email
170 Medical Problems of Performing Artists
acoustic guitar, electric guitar, and electric bass. In addition
to the obvious differences due to sizes and shapes, character-
istics of string size and strength may influence levels of force
to depress, pluck, pull, or bend strings. Influences also may
include the number of strings used and the overall weight of
the instrument.
Another instrument in the guitar family is the banjo,
widely used in folk, bluegrass, and early jazz, this instrument
includes challenging technique that can involve a high fre-
quency of finger movements for extended periods of time
under certain conditions that require great precision.15 There
are different types of banjos, including those with different
sizes and number of strings. Greene21 suggested that the
shape of the banjo and the positions necessary to support it
are important factors that may lead to nerve compressions.
Clearly, guitarists are at risk for medical problems. How-
ever, past reports have grouped guitarists into one homoge-
nous population. To our knowledge, no study has described
patterns or types of medical problems across subgroups. The
aim of this study was to describe self-reported problems
among guitarists and to examine differences associated with
type of guitar played. The study was approved by the Univer-
sity of North Texas Institutional Review Board.
The University of North Texas Health Survey
Data for this study were extracted from the University of
North Texas Musician Health Survey (UNT-MHS) data set.
The Survey was created to examine medical problems among
a large heterogeneous group of musicians (n= 4017).23 It was
developed to recruit subjects and to collect information over
the Internet and involved discussion groups, advertisements
in professional publications, and notices by professional soci-
eties and organizations. Several research articles have resulted
from this effort and suggest that the respondents to the UNT-
MHS compared well to the U.S. population regarding demo-
graphic and socioeconomic profiles.23 The online aspect of
the survey has been addressed in one study comparing two
samples of flautists, which showed similar demographics and
responses to questions about musculoskeletal problems.24
Study Population and Assessments
Subjects for the present study were included if they iden-
tified acoustic guitar, electric guitar, electric bass, or banjo as
their primary instrument. Data were coded, entered, and
analyzed using the Statistical Package for the Social Science
(SPSS) for Windows (version 13.0, SPSS Inc., Chicago, IL).
Descriptive statistics for both the total and guitar-specific
groups included questions regarding age, gender, height,
weight, marital status, primary instrument, years of formal
college music instruction, hours of practice per day, smoking
status, and hours of weekly physical exercise.
The survey list of bilateral body locations was used to deter-
mine musculoskeletal problems.25 Prevalence rates for one or
more musculoskeletal problem were calculated for the total
group and by guitar-specific groups. Site-specific prevalence
rates were calculated for the whole guitar group, by instrument-
specific groups, and by gender and for comparisons, between
classical and nonclassical guitarists. For guitarists who reported
problems at specific sites, average pain severity levels were cal-
culated from responses to a five point scale by Fry.26
Nonmusculoskeletal questions included several health
problems common in musicians. Prevalence rates for these
problems were calculated for the whole guitar group and by
instrument-specific groups. The Pearson chi-square test (95%
significant level) was used for testing group differences in
prevalence rates.
Demographic Profile
Out of the total UNT-MHS sample, 520 subjects (62
women, 458 men) reported guitar as their primary instru-
ment. Table 1 shows the demographic data for the total
TABLE 1. Demographics for the Total Guitar Group
Acoustic Guitar Electric Guitar Electric Bass Banjo Total Guitar
Demographics* (n= 213) (n= 185) (n= 108) (n= 14) (n= 520)
Age, yrs 37.12 (11.62) 31.11 (11.21) 33.14 (10.58) 48.14 (9.67) 33.04 (13.05)
Gender, % male 78 97 91 78 88
Height, in 69.9 (3.7) 70.4 (3.6) 70.4 (3.2) 68.5 (2.9) 69.8 (3.4)
Weight, lbs 183.4 (37.1) 178.7(36.4) 184.8 (40.3) 206 (68.8) 188.2 (45.7)
Marital, % married 51 38 45 71 51
Yrs of music college instruction 1.7 (2.3) 4.1 (2.9) 1.8 (2.6) 0.3 (0.8) 1.2 (2.2)
Practice per day, hrs 2.2 (1.6) 2.6 (1.7) 2.1 (1.4) 1.6 (1.1) 2.1 (1.4)
Earning 50% of income from music
performance, % 19 21 13 7 18
Classical guitarist in group, % 9 0.5 3.7 6
Smoker, % 13 21 18 14 16.5
Physical exercise, hrs/wk 3.3 (3.4) 4.4 (5.5) 3.7 (5.2) 3.8 (4.2) 3.8 (4.6)
*Data, where appropriate, are expressed as mean (SD)
December 2006 171
guitar group and for guitar-specific instrument groups.
Gender distribution was significantly male dominated for all
guitar groups (p= 0.01). Classical guitar was played by 6% of
the total group. The mean number of years of college music
instruction was 1.2 (SD 2.2) for the total group. The gui-
tarists reported a mean practice time of 2.1 hrs/day (SD 1.4)
and a mean physical exercise time of 3.8 hrs/wk (SD 4.6).
Eighteen percent of the total group reported that 50% or
more of their total income came from music performance.
Musculoskeletal Problems
Total Guitar Group
Of the total group, 81% reported having musculoskeletal
problems in one site or more. The highest site-specific preva-
lence rates for the whole group were for the left fingers
(32.9%), left wrist (29.8%), and left hand (24.7%) (Table 2).
Comparisons of prevalence rates by gender for the guitar
group and subgroups showed consistently higher prevalence
rates for female guitarists than males (Table 2). In some cases,
the prevalence was twice or three times as high for female gui-
tarists. Severity levels in many cases were higher for sites with
higher prevalence rates (Table 3).
Acoustic Guitar
Acoustic guitar represented the largest subgroup (n=
213) (Table 1), with 83% reported having musculoskeletal
problems in one site or more. Acoustic guitarists reported
most problems in the left fingers (34.9%), left wrist (34%),
and left hand (27.4%) (Table 2). About one forth of the
group were females, reporting problems especially in the
left fingers (46.5%) (Table 2). Specific severity levels showed
that for the acoustic guitar group, the highest severity levels
were found in the right shoulder (2.63) and left lower back
(2.65) (Table 3). Comparisons between classical and non-
classical guitarists showed that classical guitarists reported
significantly more musculoskeletal problems (p= 0.027).
Electric Guitar
Electric guitarists were the second largest subgroup (n=
185) (Table 1) with the lowest total prevalence (74%) of mus-
culoskeletal complaints of the guitar groups. Highest preva-
lence sites for electric guitarists included the left wrist
(28.7%) and left hand (23.4%) (Table 2). Representing a
small group (3%), female electric guitarists reported prob-
lems at the left hand (66.7%), left wrist (50%), and right
wrist (50%). The electric guitar group reported highest sever-
ity levels in the left shoulder (2.92), right lower back (2.88),
and left lower back (2.83) (Table 3).
Electric Bass
Electric bass players represented about a fifth of the total
guitar group (n= 108) (Table 1). The total prevalence of mus-
culoskeletal complaints for the group was 77%. Electric bass
players reported problems at the left finger (31.2%), right
lower back (25.7%), left lower back (23.9%), and right fingers
TABLE 2. Prevalence Rates (%) for Musculoskeletal Problems across Gender, Specific Guitar Groups, and the Total Guitar Group
Acoustic Guitar Electric Guitar Electric Bass Banjo Total Guitar
Body Region Female/Male/Total Female/Male/Total Female/Male/Total Female/Male/Total Female/Male/Total
Right finger 30.2 / 24.7 / 26 33.3 / 22.2 / 22.3 30.0 / 23.5 / 23.9 0 / 27.3 / 21.4 29.0 / 23.5 / 24.1
Left finger 46.5 / 31.9 / 34.9 33.3 / 32.8 / 33 50.0 / 29.6 / 31.2 0 / 18.2 / 14.3 43.5 / 31.4 / 32.9
Right hand 18.6 / 18.7 / 18.1 50.0 /14.4 / 15.4 40.0 / 17.3 /19.3 0 / 9.1 / 7.1 24.2 / 16.5 / 17.1
Left hand 30.2 / 27.1 / 27.4 66.7 / 21.7 / 23.4 50.0 / 21.4 / 23.9 0 / 9.8 / 7.1 35.5 / 23.3 / 24.7
Right wrist 23.3 / 22.3 / 21.9 0 / 22.2 / 21.8 30.0 / 19.4 / 20.2 33.3 / 27.3 / 28.6 22.6 / 21.8 / 21.7
Left wrist 25.6/ 37.3 / 34 50.0 / 28.3 / 28.7 50.0 / 22.4 / 24.8 33.3 / 18.2 / 21.4 32.3 / 30.1 / 29.8
Right forearm 4.7 / 8.4 / 8.4 16.7 / 16.7 / 16.5 30.0 / 12.2 / 13.8 0 / 18.2 / 14.3 9.7 / 12.7 / 12.5
Left forearm 9.3 / 15.1 / 14.4 16.7 / 14.4 / 14.4 40.0 / 11.2 / 13.8 0 / 18.2 / 14.3 14.5 / 14.1 / 14.3
Right elbow 14.0 / 7.8 / 8.8 0 / 13.3 / 12.8 0 / 8.2 / 7.3 0 / 0 / 0 9.7 / 9.9 / 9.7
Left elbow 11.6 / 9.6 / 9.8 0 / 7.2 / 6.9 10.0 / 9.2 / 9.2 0 / 0 / 0 9.7 / 8.4 / 8.4
Right shoulder 27.9 / 16.9 / 20.0 16.7 / 14.4 / 14.9 40.0 / 15.3 / 17.4 0 / 18.2 / 14.3 27.4 / 15.6 / 17.5
Left shoulder 32.6 / 15.7 / 20.0 33.3 / 16.1 / 16.5 30.0/ 23.5 / 23.9 33.3 / 36.4 / 35.7 32.3 / 18.0 / 20.0
Right side of neck 27.9 / 12.0 / 15.8 33.3 / 13.3 / 13.8 40.0 / 12.2 / 14.7 0 / 18.2 / 14.3 29.0 / 12.7 / 14.8
Left side of neck 23.3 / 10.2 / 13.5 33.3 / 10.0 / 10.6 40.0 / 9.2 / 11.9 33.3 / 9.1 / 14.3 27.4 / 9.9 / 12.2
Right upper back 14.0 / 6.6 / 8.8 0 / 13.3 / 12.8 20.0 / 13.3 / 13.8 33.3 / 27.3 / 28.6 14.5 / 11.2 / 11.8
Left upper back 14.0 / 6.6 / 8.8 0 / 9.4 / 9.0 30.0/11.2/12.8 0/18.2/14.3 14.5 /9.0 / 9.9
Right middle back 9.3 / 10.2 / 9.8 0 / 8.9 / 8.5 20.0/11.2/11.9 0 / 9.1 / 7.1 9.7 / 9.9 / 9.7
Left middle back 4.7 / 8.4 / 7.4 0 / 7.8 / 7.4 20.0/9.2/10.1 0 / 9.1 / 7.1 6.5 / 8.4 / 8.0
Right lower back 25.5 / 15.1 / 17.7 33.3 / 22.2 / 22.3 30.0/25.5/25.7 0 / 36.4 / 28.6 25.8 / 20.7 / 21.3
Left lower back 14.0 / 10.8 / 12.1 16.7 / 22.8 / 22.3 30.0/23.5/23.9 0 / 27.3 / 21.4 16.1 / 18.7 / 18.4
172 Medical Problems of Performing Artists
(23.9%) (Table 2). Females represented about 10% of the
group and reported problems at the left fingers (50.2%), left
hand (50.2%), left forearm (40.2%), right hand (40.2%),
right shoulder (40.2%), and left shoulder (40.2%), and right
side of the neck (40.2%) (Table 2). The highest severity levels
reported by the group were left elbow (2.90) and right lower
back (2.57) (Table 3).
Banjo players was the smallest group (n= 14) (Table 1),
and they had a total prevalence about the same as electric
bass players (78%). Banjoists reported most problems in the
left shoulder (35.7%), right wrist (28.6%), and right upper
and lower back (28.6%) (Table 2). The highest prevalence
rates for female banjo players included the right wrist
(33.3%), left wrist (33.3%), left shoulder (33.3 %), left side of
the neck (33.3 %), and right upper back (33.3 %) (Table 2).
The highest severity levels included the right hand (4.0), left
wrist (3.0), and right fingers (2.67) (Table 3).
Nonmusculoskeletal Problems
Regarding nonmusculoskeletal problems, 66.2% of the
total guitar group perceived stress due to work environ-
ment as a moderate to high problem. The total guitar
group reported problems with fatigue (39.7%), depression
(36.1%), headache (32.1%), and eye strain (31.2%) (Table
4). Acoustic guitarists reported most problems with fatigue
(36.7%), headache (34%), and stage fright (33%), which
was significantly greater than other guitar groups (p=
0.006). Problems with highest prevalence rates by electric
guitarists included fatigue (44.7%), depression (39.4%),
and eye strain (30.9%). Electric bass players reported prob-
lems with fatigue (40.4%), depression (36.7%), hearing
loss (34.9%), and headache (33.0%). Banjo players
reported problems with depression (42.9%), weight
(42.9%), sleep disturbance (35.7%), eye strain (35.7%),
and hearing loss (35.7%).
Musculoskeletal Problems
The aim of the present study was to examine and compare
medical problems of musicians who play the guitar. The results
indicated that many guitarists experience musculoskeletal
problems. Compared to other instrument-specific results from
the UNT-MHS data, the prevalence rates for musculoskeletal
TABLE 3. Severity Levels by Musculoskeletal Body Regions across Guitar Groups and for the Total Guitar Group*
Body Region Acoustic Guitar Electric Guitar Electric Bass Banjo Total Guitar
Right finger 2.0 (1.19) 1.86 (1.14) 1.58 (0.90) 2.67 (1.53) 1.96 (1.10)
Left finger 2.07 (1.14) 2.02 (1.12) 1.88 (1.07) 2.50 (0.70) 1.98 (1.30)
Right hand 2.08 (1.31) 2.03 (1.24) 1.62 (0.86) 4.00 (–) 2.15 (1.14)
Left hand 2.27 91.11) 2.05 (2.0) 1.92 (0.89) 3.00 (–) 2.11 (1.17)
Right wrist 2.15 (1.10) 2.30 (1.21) 2.32 (1.25) 1.75 (0.96) 2.29 (1.20)
Left wrist 2.37 (1.15) 2.54 (1.34) 2.26 (1.10) 1.67 (1.15) 2.23 (1.17)
Right forearm 2.22 (1.35) 2.10 (1.19) 1.67 (1.11) 1.50 (0.71) 2.11 (1.11)
Left forearm 2.06 (1.18) 2.52 (1.12) 2.13 (1.25) 1.00 (0.00) 2.00 (1.10)
Right elbow 2.11 (1.15) 2.29 (1.33) 2.00 (1.20) 2.27 (1.23)
Left elbow 2.33 (1.0) 2.38 (1.39) 2.90 (1.45) 2.34 (1.27)
Right shoulder 2.63 (1.18) 2.25 (1.27) 2.47 (1.39) 2.50 (0.71) 2.30 (1.17)
Left shoulder 2.40 (1.05) 2.92 (1.14) 1.92 (1.16) 1.60 (1.34) 2.23 (1.15)
Right side of neck 2.24 (1.21) 2.19 (1.13) 2.06 (1.29) 2.00 (1.41) 2.23 (1.13)
Left side of neck 2.24 (1.18) 2.35 (1.09) 1.15 (1.14) 1.00 (0.00) 2.25 (1.14)
Right upper back 2.26 (0.87) 2.00 (1.18) 2.07 (1.22) 2.50 (1.29) 2.13 (1.10)
Left upper back 2.05 (1.03) 2.41 (1.23) 2.29 (1.14) 2.50 (0.71) 2.19 (1.10)
Right middle back 2.33 (0.91) 2.25 (1.06) 2.08 91.32) 2.00 (0.00) 2.10 (1.10)
Left middle back 2.56 (0.89) 2.57 (0.85) 2.27 (1.35) 2.00 (0.00) 2.11 (1.09)
Right lower back 2.47 (1.20) 2.88 (1.17) 2.57 (1.43) 2.25 (1.26) 2.45 (1.22)
Left lower back 2.65 (1.29) 2.83 (1.12) 2.19 (1.36) 2.33 (1.53) 2.45 (1.22)
*Pain severity levels, from 1-5, were calculated for subjects who reported having pain in one site or more.=
Grade 1: Pain while playing; should be consistent rather than occasional: pain ceases when not playing.
Grade 2: Pain while playing; slightly physical signs of tenderness; may have transient weakness or loss of control: no interference with
other uses of this location.
Grade 3: Pain while playing; pain persists away from instrument; some other uses of this location cause pain; may have weakness, loss of
control; loss of muscular response or dexterity.
Grade 4: As for Grade 3; all common uses of the location cause pain (housework, driving, writing, turning knobs, dressing, washing,
etc.) but these are possible as pain is tolerated.
Grade 5: As for Grade 4; including loss of use of location due to disabling pain.
December 2006 173
problems for guitarists were similar to those reported for bas-
soon players27 and higher than those for oboists,27 brass play-
ers,28 and pianists.29 Prevalence rates of guitarists in this study
compared well to those reported in other studies of muscu-
loskeletal problems of guitar-specific groups12 and in general
music populations that included guitarists.2,3
The present study did show a distinct trend for left-sided
problems for guitarists. Acoustic guitarists, electric guitarists,
and electric bass players all reported highest prevalence rates
for the left fingers and left hand (Fig. 1–3) while banjo play-
ers reported left shoulder problems (Fig. 4). Guitarists
reported highest pain severity levels in the left wrist and fin-
gers, and banjoists reported highest pain severity levels in the
right wrist.
Upper-extremity musculoskeletal problems reported by gui-
tarists do seem to reflect the general biomechanics, postural,
and other playing demands including repetitive movements
together with static muscle work. Certain playing techniques
have been discussed to address poor posture, especially exces-
sive wrist deviation and wrist flexion.21 The importance of
keeping the finger joints in a neutral position for timing and
for controlling the sound was stressed in one study.30 Other
studies have discussed how the fingers of the left hand may
perform repetitive movements at extreme flexion and depend-
ing on playing posture, together with ulnar or radial devia-
tion, while at the same time forearms, elbows and shoulders
at both sides are stabilizing and positioning the hands.12,13,22
When left wrist is held in maximum flexion, the maximal
strength used in the flexor muscles may be decreased, possibly
creating repetitive and static strain and maximum carpal
tunnel pressure. Brandfonbrener31 has found from clinical
practice that it is largely the hyper-flexed wrist positions that
TABLE 4. Prevalence Rates (%) for Nonmusculoskeletal Problems across Specific Guitar Groups and the Total Guitar Group*
Nonmusculoskeletal Problem Acoustic Guitar Electric Guitar Electric Bass Banjo Total Guitar
Fatigue 36.7 44.7 40.4 14.3 39.7
Depression 32.6 39.4 36.7 42.9 36.1
Headache 34.0 29.8 33.0 28.6 32.1
Eye strain 33.0 30.9 27.5 35.7 31.2
Weight problems 30.2 29.8 27.5 42.9 29.8
Sleep disturbances 31.2 26.1 27.5 35.7 28.7
Stage fright 33.0 23.4 16.5 14.3 25.7
Hearing loss 14.9 28.2 34.9 35.7 24.3
Acute anxiety 18.1 19.7 19.3 21.4 19.0
Respiratory allergy 17.7 20.2 14.7 21.4 18.1
Earaches 12.1 17.6 22.0 21.4 16.1
Asthma 16.3 11.7 15.6 0 14.1
Blackout/dizziness 10.7 16.5 14.7 7.1 13.5
Chest discomfort 12.1 14.4 9.2 14.3 12.4
Hemorrhoids 12.6 9.6 15.6 14.3 12.2
High blood pressure 9.3 8.0 6.4 7.1 8.2
TMJ syndrome 8.8 5.3 9.2 0 7.4
*Prevalence is in ranked order from highest to lowest rate for the total group.
FIGURE 1. Musculoskeletal problems in left versus right side for acoustic guitar (n= 213).
174 Medical Problems of Performing Artists
generate musculoskeletal disorders and that playing with neu-
tral wrist position generates fewer problems.
Another interesting trend was that banjo and electric bass
players reported musculoskeletal problems in the right fin-
gers and right wrist. Perhaps this finding is associated with
the demands associated with plucking. Plucking may increase
muscle effort in the right hand and fingers. Finger flexion
seems to be necessary for the plucking of the strings, but
there seems to be no reason for moving the wrist in extreme
flexion at the same time, provoking carpal tunnel syn-
drome.21 A playing technique that includes bringing the
hand closer to the strings through adjustments at the elbow
and shoulder might decrease the wrist flexion during pluck-
ing, which could prevent wrist problems. Plucking the strings
via a small and very thin plectrum includes a precision grip,
which also may increase the muscle tension in the fingers and
hand. Motion analysis of banjo finger-picking suggested that
extreme flexion of the distal interphalangeal joint and abduc-
tion of the index finger joint may be risk factors for finger
problems in banjo players.15
Prevalence rates for back problems found in the present
study may be related to holding the instrument’s consider-
able weight, sometimes for hours in a slightly flexed and
twisted position. Musicians routinely lift and move their
instrument(s) and other music equipment from one place to
another. Although the epidemiology literature is limited,
cumulative physical loading of the spine tissues, particularly
with high peak forces and adverse trunk postures and move-
ments, is an assumed risk factor for low back pain.32 In recent
epidemiologic reviews, lifting and carrying, as well as bending
and twisting, were found to be risk factors for back pain.18,19,33
Manual handling as a work task is common in working
life.18–20 It is regarded as a complex task requiring strength,
endurance, balance, and experience. Studies on manual han-
dling have found that men lift more than women in working
life, under experimental conditions, and during leisure
FIGURE 2. Musculoskeletal problems in left versus right side for electric guitar (n= 185).
FIGURE 3. Musculoskeletal problems in left versus right side for electric bass (n= 108).
December 2006 175
time.34 Men often handle heavier loads, while women do
lighter, more repetitive lifting. It seems plausible that manual
material handling, which causes high loads on the body, may
lead to musculoskeletal disorders.19
The prevalence rates for musculoskeletal problems were
higher for female guitarists compared with males. Although
consistent with rates reported in studies of other instrumen-
tal groups,27–29 occupations, and populations,18,19,33 these
findings must be considered with caution because of the
small percentage of female guitarists in this study.
Classical guitarists in our study reported significantly
more musculoskeletal problems than nonclassical guitarists.
One previous study of classical and flamenco guitarists
reported that musculoskeletal disorders are a frequent health
problem and suggested that hand and arm problems were
more frequent in flamenco guitarists and possibly attributa-
ble to a plucking technique (i.e., plucking requires greater
muscle effort and a need to produce high volumes when play-
ing in groups).12 Sounds from a classical guitar are typically
more exposed and not combined with other instruments.
Mistakes are easily recognized. Additional research is needed
to help explain why classical guitarists report more muscu-
loskeletal problems than nonclassical guitarists. Research
should include both the physical demands and the psy-
chosocial working conditions as potential determinants.
Nonmusculoskeletal Problems
More than 60% of the total guitar group in the present
study perceived stress due to work environment as a problem.
The highest prevalence rates for nonmusculoskeletal prob-
lems included fatigue, depression, headache, eye strain, and
sleep disturbance. A high level of these general health prob-
lems could be regarded as symptoms reflecting elevated levels
of stress and poor psychosocial work environment. A study of
orchestral musicians has shown that overall health symptoms
(similar to the nonmusculoskeletal symptoms reported in
this study) and musculoskeletal problems were associated
with psychosocial work factors such as work content35: the
more satisfied a musician was with the work content, the
lower level of musculoskeletal and nonmusculoskeletal symp-
toms. Further, a high influence over work conditions and
good social support from colleagues and supervisors led to
less overall health problems.
Psychosocial work factors and hearing disorders have been
investigated in rock and jazz musicians, showing that the
musicians did not generally experience themselves as stressed
at work.36 However, they often felt tired and had difficulties
relaxing after work, and the job was often psychologically
demanding. A difficulty to relax after work was associated
with tinnitus and hyper-acusis.
Methodological Considerations
The strength of the present study is that the data are part
of a large epidemiologic survey that included a large sample of
professional and educated guitarists. Limitations associated
with the cross-sectional and convenience sampling preclude
the possibility of assessing cause-effect relationships and could
have introduced recall bias. Guitarists with medical problems
may have been more likely to report exposure in terms of prac-
tice and performance time, in an attempt to explain or under-
stand the symptoms, while guitarists without problems were
less likely to remember an exposure because of less meaning
or importance of the symptoms to them. The use of the Inter-
net for recruitment of the sample may have introduced self-
selection bias that could affect the validity and reliability of
the responses. However, as mentioned earlier in this article,
two studies23,24 that have compared data from the UNT-MHS
with other samples have suggested that the UNT-MHS respon-
dents compared well to other samples regarding demographic
profiles as well as socioeconomic data reported.
FIGURE 4. Musculoskeletal problems in left versus right side for banjo (n= 14).
176 Medical Problems of Performing Artists
The results of the present study show that the prevalence
rates of musculoskeletal and general health problems in
musicians playing acoustic guitar, electric guitar, electric bass,
and banjo are at a high level, which calls for further investi-
gations. Differences found in the results across the guitar sub-
groups could reflect the specific demands, including biome-
chanics, force, and ergonomics of playing the guitar, as well
as psychological demands. Together with the fact that gui-
tarists represent one of the largest group of musicians, impli-
cations from this research indicate that additional study is
warranted and suggest a need for targeting risk factors impor-
tant to both physical demands and psychosocial work envi-
ronment for a more holistic health approach.
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... Health concerns related to musicians and music performers have gained growing attention in recent years with the growth of the music industry. Within the musician population, the rise of the number of guitar players has placed them as the largest population of musicians [15]. As such, the guitar-playing community is the largest group at risk of developing PRMD. ...
... As such, the guitar-playing community is the largest group at risk of developing PRMD. The most frequently identified painful anatomical areas were the wrist, used to play chords (fretting hand) (41.8%), back (17.2%), and the strumming hand (13%) [15]. Since there are differences between guitarists in various factors, e.g., number of playing instruments and type of guitar mastered, the effect of these factors on the type and frequency of the PRMD should be explored. ...
... Guitar playing is a challenging and arduous process that involves hours of practice and a range of physical abilities, such as unnatural body posture, repetitive arm, wrist and finger movements [15,17]. While playing, guitar players adopt different body postures, depending on the type of guitar they are using. ...
Full-text available
Background The guitar-playing community is the largest group at risk of developing playing related musculoskeletal disorders. A thorough investigation of the relationships between the various risk factors and players’ report on musculoskeletal pain using objective and accurate means of assessment has yet to be reported. Purpose (a) to explore the correlations between demographic characteristics, anthropometric measurements, playing habits, and personal habits of guitar player and their complaints of musculoskeletal pain, (b) explore the correlations between the upper body kinematics of guitar players during playing the guitar and their complaints of musculoskeletal pain, and (c) compare the upper body kinematics of guitar players during playing the guitar while sitting versus standing. Methods Twenty-five guitar players (27.5±4.6 years old) filled out questionnaires regarding their guitar-playing habits, and the Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms. Kinematics of their torso and upper limbs were tracked while they played a tune twice, once while sitting and once while standing. Results We found moderate correlations between the number of painful joints in the last year and factors, such as physical comfort while playing, years of playing, and position during playing. During standing, lower back pain severity correlated with the rotation range of the torso, while during sitting, it moderately correlated with the average radial-ulnar deviation of the right wrist. During sitting, we found higher anterior and right tilt of the torso, combined with greater abduction of the right shoulder, higher flexion in the left shoulder and higher radial deviation in the left wrist. Conclusion Our results point to several risk factors, related both to playing habits but also to playing posture, which should be considered by the guitar players in order to prevent playing-related musculoskeletal disorders.
... Although this strategy may reduce local pain intensity in short term, it may elicit pain in different spine regions. In fact, guitar players often report pain in different spine regions Sanchez-Padilla et al, 2012;Fjellman-Wiklund and Chesky, 2006). Thus, better understanding about the relationship between spine pain intensity and trunk posture while playing may improve interventions targeting postural modification to attenuate spine pain in guitar players (Baadjou et al, 2014;Lo´pez, and Martı´nez, 2013). ...
... , health related(Fjellman-Wiklund and Chesky, 2006), psychosocial(Souza and Mont'Alvão, 2014), physical and work-related factors might contribute to the development of spine pain in guitar players. Between the work-related factors, amount of playing experience(Zazá, 1997; Roset-Llobet, Rosines-Cubells and Salo-Orfila, 2000; Yoshimura et al 2006), weekly hours of practice ( Hiner et al, 1987; Harmes, 2010; Sanchez-Padilla et al, 2013, Marques et al, 2003) and trunk posture while playing (Blanco-Piñeiro, Díaz-Pereira and Martínez, 2017; Wahlstrom and Fjellman-Wiklund (2009), Ramella, Fronte e Converti, 2014; Steinmetz, Seidel e Muche, 2010) may play a central role in the development of spine pain in professional guitar players. ...
... For example, it possible that trunk posture in guitar players with cervical pain is different than the trunk posture of guitar players with low back pain. Nonetheless, considering the difficulty to find guitar players with pain at only one spine region(Rigg, Marrinan e Thomas, 2003; Sanchez-Padilla et al, 2012;Fjellman-Wiklund and Chesky, 2006), we decided to include individuals with pain at different spine regions. In addition, we only had male participants. ...
Full-text available
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.
... In this article, the emphasis is put on the impact of physical therapy since epidemiology shows that the highest number of functional disorders in instrumentalists is from (neuro-) musculoskeletal (Fry, 1986;Fishbein and Middlestadt, 1988;Middlestadt and Fisbein, 1989;Brown, 1997;Dawson, 2002;Engquist et al., 2004;Bragge et al., 2005;Fjellman-Wiklund and Chesky, 2006;Abréu-Ramos and Micheo, 2007;Bruno et al., 2008;Hincapié et al., 2008;Ackermann et al., 2012;Gembris and Heye, 2014;Baadjou et al., 2016;Kok et al., 2016), a clinical field where physical therapists are acknowledged as skilled and autonomous practitioners for a long time (Chan et al., 2013a;. ...
Full-text available
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.
... Lastly, one subject adopted a pattern of elbow extension coupled with wrist ulnar deviation during the strum phase. Previous kinematic studies of guitar playing focused on the finger movements of the fretting hand [35] because of increased rates of musculoskeletal injury of this effector in professional guitarists [36]. However, no detailed biomechanical study of within-and across-limb coordination of arm movements during guitar playing exists to the best of our knowledge. ...
Conference Paper
Full-text available
Recent research indicates that music-supported therapies may offer unique benefits for rehabilitation of motor function after stroke. We designed an adapted guitar and training task aimed to improve coordination between rhythmic and discrete movements because individuals recovering from stroke have greater difficulty performing discrete vs. rhythmic movements. In this paper, we report a feasibility study on training to play this adapted guitar in healthy young adults. Subjects (N = 10) practiced two rhythmic strumming patterns over three consecutive days using their non-dominant hand guided by an audiovisual metronome (60 bpm). They were also instructed to press a foot pedal while maintaining the strumming movement. Elbow and wrist kinematics were estimated using wireless inertial measurement units. Results showed positive mean asynchrony between strum onsets and metronome onsets, and a decrease in the standard deviation of mean asynchrony over practice. In early practice, participants slowed the strumming movement when they pressed the foot pedal, but this interference decreased on days two and three. Smoothness of the elbow movement during the strum phase, which includes the contact with the strings, increased over practice, while smoothness of the return phase did not change over practice. The predominant joint coordination pattern used for the strum phase consisted of elbow extension coupled with elbow pronation, wrist extension, and ulnar deviation. We discuss how these results fit into current music-based rehabilitation literature and outline directions for future applications of this music-supported intervention.
... The movements that guitar players perform are often unnatural and they present an example of highly skilled and sophisticated task performance. It is almost certain that all guitarists will experience an episode of problems that will affect the upper extremity, back and neck during their career [2,3]. The 1-year prevalence of pain varied from 26% to 93%, examined in symphonic orchestras and pianists. ...
Full-text available
Many musicians such as guitarists have to practice in very unnatural positions for several hours while making repetitive movements. Specific for guitar players, problems can occur in the long term, at the wrists, shoulders, neck, and low back. Based on user feedback, questionnaires and observations, two types of ergonomic adaptations have been proposed and implemented by (semi) professional instrument builders, while maintaining the original sound quality. The aim of this study is to assess the differences in body kinematics (neck, shoulder, right and left wrist) playing three different kinds of guitars (classical guitar and two adapted guitars) in order to monitor the ergonomic effect on two different players preventing injuries and a decrease of performance. The 3D human movements of two professional guitar players (more than 40 years of experience), one female (age: 53y, body height: 1.64 m) and one male (age: 60y, body height: 1.77 m), were measured using a Vicon motion capturing system while playing the same piece two times on three different guitars (one normal and the two ergonomic adapted guitars).
Objective: : to determine the prevalence and regions of the body in which musculoskeletal injuries occur in musicians, as well as to identify risk factors related to their occurrence. Methodology: : A search was carried out in the Pubmed, Scopus, Web of Science and Cinahl databases for publications between 2006 and 2020. Observational studies on the prevalence of musculoskeletal injuries or their risk factors in musicians aged 18-65 years were eligible for inclusion, and the methodological quality and risk of bias were assessed. Results: : 31 studies on multiple instruments and 17 on individual instruments were included. Quality was rated as high in 65% of the studies. Lifetime prevalence of injuries ranged from 46-90% and current prevalence from 9-63%. The most common region of pain was the neck, being present in all instrument families. Being female is a predisposing factor to the appearance of musculoskeletal problems in musicians. Conclusions: : Musicians suffer frequently musculoskeletal injuries. The most common regions of the body in which these injuries occur are the neck and shoulders. Numerous risk factors were found to be predisposing to musculoskeletal injuries. We note that there are fewer studies on specific instruments.
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Background: Musician is wizard who spread the fragrance of joy by absorbing the woes in the form of playing related musculoskeletal disorder. Establishment and implementation of a validated and reliable outcome measurement still lags behind to assess the playing related musculoskeletal disorder and risk factor more precisely among musician. Objective: The aim of the study is to construct and validate a tool to assess playing related musculoskeletal disorder among amateur and professional musician. Methodology: Based upon literature review and interview which was conducted regarding risk factors and musculoskeletal disorders among amateur players, professional players and music teachers The questionnaire was circulated among senior physiotherapist with 10 years of experience for content validation and among amateur, professional players for face validation. Result & Conclusion: This study concludes that the questionnaire is widely accepted as a valid tool to assess the playing related musculoskeletal disorder among amateur and professional musician after content and face validation.
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For any skilled performer to deliver their optimal performance, preparation must extend beyond task-specific skill development to include psychological skills training, physical conditioning, and injury prevention. The keynote lecture upon which this article is based (delivered at the International Symposium on Performance Science 2021) explored current research that demonstrates the importance of physical conditioning and injury prevention for drummers (i.e., percussionists who play the drum kit). Early results revealed that professional drummers’ heart rates during live performances can reach similar levels to those of other professional athletes during competitions. They also established that playing-related musculoskeletal disorders (PRMDs) are very common in drummers, particularly those affecting the upper limbs such as tendinitis and carpal tunnel syndrome. Evidence from laboratory-based studies supports non-neutral postures, repetitive movements, and exposure to hand-arm vibration as risk factors for the development of these injuries in drummers. Embedding injury prevention education within drum kit curricula is a promising strategy for reducing the rates at which drummers report experiencing PRMDs, and the barriers and facilitators that drum kit educators encounter when attempting to do so are currently under investigation. When drummers include both physical conditioning and injury prevention within their overall preparation regimen, they will maximize their potential to deliver their peak performance.
Der ideale Auftritt mit dem perfekten Klang des Instruments und dem fehlerfreien Spiel steht bei Musikerinnen und Musikern eindeutig im Mittelpunkt. Diesem Ziel ordnen sie oftmals die eigene Gesundheit unter. Muskuloskelettale Beschwerden sind daher häufig und haben vielfältige und sehr individuelle Ursachen, weshalb ein guter Clinical-Reasoning-Prozess von zentraler Bedeutung ist. Dieser kann durch moderne Technologie, etwa die sensorgesteuerte Bewegungsanalyse, unterstützt werden.
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This study examined the medical problems of musicians who primarily perform on a brass instrument. Data for this study (N = 739) were extracted from the University of North Texas Musician Health Survey data set. Subjects were included if they indicated either trumpet, trombone, French horn, or low brass as their primary instrument. Prevalence rates for one or more musculoskeletal problems were determined for the whole group and by instrument. For those subjects who reported problems at specific sites, average severity levels were derived from responses to a five-point grading scale. Additional prevalence rates for non-musculoskeletal problems were established for the whole group and by instrument. About 60% of the brass musicians reported having one or more musculoskeletal problems. The trombone group reported the highest rate (70%), followed by French horn and low brass (62%), and then trumpet (53%). Results suggest unique physical performance requirements and risks across the four main brass instrument groups and that future studies should examine each brass instrument group individually.
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The purpose of this study was to analyze the prevalence of overuse syndrome in classical and flamenco guitarists from Andalucia (Spain). Of the 64 professional guitarists who participated in the study, 75% showed symptoms of overuse syndrome. Considering the fact that classical and flamenco are two distinct styles of guitar playing, 62.5% of the classical guitarists who took part in the study were affected by some kind of overuse syndrome, versus 87.5% of the flamenco guitarists (p = 0.021). Among the guitarists affected by overuse syndrome, a total of 50% of the classical and 82.1% of the flamenco guitarists reported deterioration in their playing ability (p = 0.018). The specific symptom for which there was a difference in distribution in the two groups was tension in the upper extremities, reported more frequently by the flamenco guitarists. The higher incidence of problems and the greater perception of tension among the flamenco guitarists are attributed mainly to the plucking technique they use, which requires greater effort from the extensor muscles of the fingers, as well as the need to produce a higher volume of sound due to the nature of playing in groups.
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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.
The authors performed a behavioral study of the complexity of left-hand finger movements in classical guitar playing. Six professional guitarists played movement sequences in a fixed tempo. Left-hand finger movements were recorded in 3 dimensions, and the guitar sound was recorded synchronously. Assuming that performers prefer to avoid extreme joint angles when moving, the authors hypothesized 3 complexity factors. The results showed differential effects of the complexity factors on the performance measures and on participants' judgments of complexity. The results demonstrated that keeping the joints in the middle of their range is an important principle in guitar playing, and players exploit the available tolerance in timing and placement of the left-hand fingers to control the acoustic output variability.
An experiment was conducted to determine movement patterns in the index fingers of four professional banjo players. The index finger involved in picking the string (the right-hand index finger) was investigated. Banjo players were chosen as subjects due to their ability to sustain high- frequency finger movement under conditions requiring great precision. The purpose of the study was to determine the prevalence in highly-skilled stringed-instrument players of movement patterns hypothesized to be associated with a movement disorder known variously as 'focal dystonia,' 'painless incoordination syndrome,' 'musician's cramp,' or 'occupational cramp,' which can occur when sustained repetitive movement is performed on a regular basis. The movement patterns under investigation were 1) extreme flexion of the distal interphalangeal (DIP) joint, 2) simultaneous flexion of the proximal interphalangeal (PIP) joint and extension of the metacarpophalangeal (MCP) joint, and 3) abduction of the index finger. Joint markers were placed on the right hand and each participant was videorecorded while performing a standard fingerpicking pattern. Individual frames were digitized, resulting in two-dimensional position data. The data were analyzed graphically and numerically. The results of the analysis of this experiment show that 1) flexion of the DIP joint during the fingerstroke is very moderate during string contact in each of the four players, 2) simultaneous flexion of the PIP joint and extension of the MCP joint is common to all four players, and 3) abduction of the index finger is uniformly absent. Thus as models of good technique, the movement patterns of these four musicians suggest that extreme flexion of the DIP joint and abduction of the index finger joint may be risk factors for the development of movement disorder, and simultaneous flexion of the PIP joint and extension of the MCP joint is unlikely to be a risk factor for the development of movement disorder.
A pilot population-based telephone survey was performed to obtain estimates of the number of people playing musical instruments and of the prevalence of hand, arm, and neck pain of musicians. Of the 954 respondents, 209 (21.9%, 95% confidence interval of 18.9-24.9%) indicated that they played musical instruments. Of those who played instruments, keyboards (44.8%, CI 35.6-54.0%) and guitar (28.1%, CI 20.8-35.8%) were by far the most commonly played instruments. Of those respondents who played instruments, 35.3% indicated that they played 5 hours or more a week, with 9.1% playing 20 hours or more. Overall, 29% (CI 21.4-37.0%) of all musicians indicated significant pain. The highest rates were among those who played 5-9 hours per week (48%), followed by 20 hours or more (42%), 0-4 hours (24%), and 10-19 hours (18%). The study indicates that playing a musical instrument may be second only to computer use in prevalence as a possible risk factor for cumulative trauma disorder, and that more extensive research is needed.
This study was undertaken to obtain information on the prevalence of music-related upper-extremity problems peculiar to a specific instrument or group of closely-related instruments, and to help determine what problem types are most common or characteristic for players of specific instruments. Music-related problems in 167 performers from a hand surgical practice were reviewed retrospectively. The musicians ranged in age from 9 to 83 years; 41.9% were males. Nearly 90% were professional performers, teachers, collegiate music students, or dedicated amateurs. More than 75% played strings or keyboard instruments. Multiple diagnoses were found in 37.7% of musicians. Data from the six largest instrumental groups revealed that muscle-tendon strain diagnoses were most common, occurring principally among pianists, violinists and violists, guitarists, and reed instrumentalists. Other common diagnoses included inflammatory disorders (tenosynovitis and the like), hypermobility, masses, and arthritic problems. Of the pianists, 54.7% developed strains, 17.4% inflammatory conditions, and 12.8% nerve problems. Violinists and violists as a group had 64.4% strains and 6.7% inflammatory conditions. Guitarists presented with 37.5% strains, 21.9% inflammatory conditions, and 15.6% nerve problems. Flutists had 25% strains and 45% inflammatory conditions. Other woodwind musicians developed 68.2% strains and 13.6% inflammatory conditions. Percussionists had 36.4% strains and 36.4% inflammatory conditions. Only one musician developed an upper-extremity problem that could be considered unique to playing a specific instrument. Statistically significant occurrence rates were found only in pianists under age 30 with strain diagnoses and in those above age 30 with inflammatory problems. These categories seem to be related to repetitive and/or forceful upper-extremity movements, and the resulting specific pathological processes.
The current study was undertaken to identify factors that enhance functioning in orchestral groups playing classical music. The underlying hypothesis was that work-task quality (functioning) correlates with psychosocial environment and health factors. From among members of 12 Swedish classical orchestras, 50% of the musicians were asked to complete a questionnaire; the response rate was 78%. Bivariate correlation and multiple linear regression methods were used to analyze the results. Dependent variables were three different health aspects: total sum score, musculoskeletal symptoms, and well-being. The most important work-quality factor that was significantly related to the three health aspects was work content. Social support was significantly related to two health aspects, and instrument group, gender, orchestra status, and systematic work with work environment each related to some of the health aspects. The relationship between health and psychosocial factors indicates that health promotion should be undertaken together with organizational interventions focused on improving these aspects.
Playing a musical instrument involves the repetitive use of muscles, often at their extreme range of motion. Consequently, musicians in general are at an increased risk for the development of pain syndromes related to nerve or musculoskeletal damage. Acoustic and electric guitars are among the most popular instruments in the world today, with a large population of musicians at risk of injury. This article examines the results of a survey completed by 261 professional, amateur, and student guitarists to determine the most common anatomic locations of playing-related pain and its relationship to possible etiologic factors. A survey of 15 questions was distributed to professional, amateur, and student guitarists who play the musical genres of rock/blues, jazz, and folk across the United States and Canada. The questions addressed type of guitar played, style of music performed, playing posture, picking technique, anatomic location of pain, history of formal training, presence of playing-related pain in the past 12 months, history of trauma to the affected area, and history of other nonrelated medical problems. Playing-related pain was reported by 160 (61.3%) of 261 guitarists who completed the survey. The most often reported location was the fretting hand, with 109 (41.8%) of 261 subjects reporting the presence of playing-related pain in the previous 12 months. The back and neck were the next most reported sites of playing-related pain, with 45 (17.2%) of 261 subjects reporting back pain and 39 (14.9%) of 261 subjects reporting neck pain in the previous 12 months. The results suggest that a substantial number of guitarists playing various styles of popular music are experiencing playing-related pain.