Article

History of Playing related Pain in 330 University Freshman Music Students

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Abstract

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.

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... [6][7][8][9] Occupational musculoskeletal pain related to instrument playing has been reported among professional musicians. [10][11][12][13][14][15][16][17][18][19][20] Studies have shown that playing-related pain (PRP) symptoms in musicians are already present in adolescent pre-professional music students, mainly during secondary and tertiary education. 10,11,16,18,[20][21][22][23][24] The prevalence for music students affected by PRP, who comprise the main group of interest in the current study, has been estimated to range from 24.8% to 88.9% depending on the standard of prevalence. ...
... [10][11][12][13][14][15][16][17][18][19][20] Studies have shown that playing-related pain (PRP) symptoms in musicians are already present in adolescent pre-professional music students, mainly during secondary and tertiary education. 10,11,16,18,[20][21][22][23][24] The prevalence for music students affected by PRP, who comprise the main group of interest in the current study, has been estimated to range from 24.8% to 88.9% depending on the standard of prevalence. 11,16,20,25 In order to succeed, music students frequently tend to disregard pain symptoms by adopting the attitude of "no pain, no gain." ...
... 10,11,16,18,[20][21][22][23][24] The prevalence for music students affected by PRP, who comprise the main group of interest in the current study, has been estimated to range from 24.8% to 88.9% depending on the standard of prevalence. 11,16,20,25 In order to succeed, music students frequently tend to disregard pain symptoms by adopting the attitude of "no pain, no gain." 12,20 PRP symptoms are frequently related to the musculoskeletal system 11,21 ; their etiology is multifactorial and various risk factors have been found to be involved. ...
Article
Objectives: Playing-related pain (PRP) is a common problem among music students. We retrospectively assessed epidemiological factors that contributed to the manifestation of PRP and evaluated the efficacy of treatment methods used by affected music students. The long-term course of PRP symptoms was also examined, along with current (today) levels of trait anxieties. Methods: Demographic and epidemiological data of 186 music students who visited the musicians' outpatient clinic over a 5-year period were retrieved. Of these students, 122 had been diagnosed with PRP and were invited to participate (response rate 61.5%) in a follow-up online survey to: a) estimate the long-term course of their PRP symptoms, b) assess the efficacy of treatment methods they used, and c) assess their current trait anxiety (general and performance-related) using two standardized psychodiagnostic questionnaires. Results: Two-thirds of music students who sought medical care were affected by PRP, with most being affected during their first year of studies, and with 69% having acute rather than chronic pain. The sudden increase in practice time was the main triggering factor for PRP (but not for non-PRP-related problems). Concerning the course of PRP, almost all students recovered or improved significantly. Students reported that "active" treatment methods (e.g., physical activities) were more effective than "passive" methods (e.g., oral medications). Psychodiagnostic questionnaires indicated that about 40% of PRP-affected students currently had increased levels of trait anxieties (music and non-music related), possibly warranting further medical assistance. Conclusions: PRP in music students occurs mainly at the beginning of their studies and has a good prognosis, although recovery may be lengthy. It is necessary to provide students with early information about PRP and about the multidimensional treatment framework that allows for individualized care of PRP in affected music students.
... (10) Literature shows that up to 93% of professional musicians experience PRMDs at some point during their career. (8,(11)(12)(13)(14) These studies indicate that PRMDs are a very common health issue in musicians. ...
... (10)(11)(12)14,15,(18)(19)(20) Unfortunately, as was shown by Kok et al. (2016) (8) the methodological quality of most of these studies is low, containing no or limited information on the used questionnaires or questions or contain low or response rates, consequently risking a selection bias. (10)(11)(12)(13)(14)18,19) Therefore in this review only four studies with a focus on the specific population of conservatoire students were included. (14,(20)(21)(22) None of these four studies focus on both PRMD and mental health. ...
... pain intensity and interference of pain with playing a musical insument are lacking in a group of conservatoire students. (13) After the review by Kok, several studies have been published focusing on PRMD in professional musicians, specific instrument groups and conservatoires students, but only two of these studies focus on both PRMD and mental health in the population of conservatoire students. (15,23) However, these studies measure different items of mental health like stress symptoms and anxiety, which makes it difficult to compare mental health status of conservatoire students in these studies. ...
Article
Full-text available
Objective: To gain insight into the prevalence and characteristics of physical health problems and mental health problems in first-, second- and third-year conservatoire students of the classical music department. Also, differences in mental health and general health were investigated between students with playing-related musculoskeletal disorders (PRMDs) and students without PRMDs. Methods: Eighty-nine classical music students of Codarts Rotterdam, University of the Arts, were asked to complete a questionnaire targeting PRMDs (components derived from Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians, MPIIQM), mental health (Mental Health Inventory-5), and self-rated general health (SF-1 from Short Form health survey SF-12). Results: The response rate was 52% (n=46). Of all participants, 17.8% (n=8) had experienced PRMDs in the past 12 months and 45.7% (n=21) of the students reported poor mental health (MHI-5≤60). Students experiencing PRMDs in the past 12 months reported poorer general health compared to students without PRMDs (43.8 vs 67.1 [range 0-100], p=0.012). No significant difference was found between the groups with regard to mental health (62.0 vs 66.5 [range 0-100], p=0.522). Conclusion: The burden of PRMD complaints in this population of conservatoire students seems relatively low. However, the number of students facing mental problems in this population is a cause for concern. Conservatoires should focus on the subject of mental health in their curricula to increase more awareness and prevent mental problems. To investigate possible causality between PRMDs and general health, prospective studies are needed.
... 9-11,17-24 Therefore, affected music students may become more vulnerable to developing further injuries during their professional career. [8][9][10][11]17,18,20,25 The more information we have concerning the origin of these PRP syndromes in adolescents, the better we will be able to protect future professional musicians from unwanted physical impairments. ...
... Similar to athletes, musicians frequently suffer from various mild or severe musculoskeletal disorders, peripheral nerve problems and focal dystonias (also known as musician's cramps). [1][2][3] Extensive practicing (overuse), instrumental constraints, 4,5 posture abnormalities, 6 inappropriate/"poor" technique, 3,7 stressful psychosocial constraints (e.g., performance anxiety), [8][9][10][11] previous injuries, age, 12,13 and genetic predispositions 8 are some of the risk factors contributing to the development of PRP disorders. 5,7,14,15 Many studies have underlined the severity of PRP problems among professional musicians. ...
... 12 Nevertheless, findings suggest that PRP problems among musicians occur as early as during tertiary, secondary, or even earlier levels of education. [9][10][11][17][18][19][20][21][22][23][24] Therefore, affected music students may become more vulnerable to developing further injuries during their professional career. [8][9][10][11]17,18,20,25 The more information we have concerning the origin of these PRP syndromes in adolescents, the better we will be able to protect future professional musicians from unwanted physical impairments. ...
Article
The current study examined the severity of playing-related pain (PRP) problems among music students at the Prague State Conservatoire, as well as the various treatment methods used by these students and how they approach and deal with these phenomena while studying. In total, 180 instrumental students participated and completed a paper questionnaire. Of these, 88.9% reported that they had experienced PRP at least once in their lives, with 12.6% experiencing pain every time they play. The onset of PRP seemed to coincide with the transition period on entry to the conservatoire and was associated with the increase in hours of practice. Specific body regions associated with playing each particular instrument were most frequently affected, with females being more susceptible than males to the development of PRP. An alarming 35% of the affected students tended not to seek help at all, whereas those who did tended to seek advice first from their instrument tutor and second from medical doctors. Most students who visited doctors reported that medical treatments only partially helped them to overcome PRP problems. The most frequent treatment methods used were resting, gel or creams, and physical exercises. Students believed that inappropriate posture played a key role in the development of their PRP problems. Finally, students indicated a willingness to be aware of and educated about PRP issues during their studies. Further exploration of PRP problems among student musicians is warranted. Better understanding of differing attitudes toward, use of, and efficiency of various treatment methods after the occurrence of PRPs will provide additional insight for prevention and treatment.
... 4 Playing the violin, viola, cello, and double bass (strings) are triggering elements for this type of problem 4-6 compared to non-string instruments, other than keyboard instruments. 4 Moreover, students playing a string instrument begin their training at a younger age 5,7 compared to other instruments requiring advanced physical development. 5,8 String music students are therefore exposed early on to potential playing-related symptoms. ...
... 4 Moreover, students playing a string instrument begin their training at a younger age 5,7 compared to other instruments requiring advanced physical development. 5,8 String music students are therefore exposed early on to potential playing-related symptoms. ...
... 11 The prevalence of playing-related pain is mainly reported in College or University students. 5,[11][12][13][14][15][16] Only a few studies have documented this symptom in younger students (i.e., high school and elementary school). 17,18 Studies regarding 'elite' music students remain scarce. ...
Article
Background: String music students suffer from playing-related musculoskeletal pain. However, until now, no studies have documented this specific problem in ‘elite’ string students, whom are susceptible to carry this experience of pain (and its consequences) into their future careers as professional musicians. Aim: This study describes the experience of playing-related pain in ‘elite’ bowed string music students. Method: String music students enrolled in three summer music camps offering higher education programs [were conveniently recruited] using the Tailored Design Method (n = 132). Participants were required to complete a questionnaire designed for the study and inquiring about their experience with playing-related pain, their playing habits, and the impact of playing-related pain on their musical activities. Results: Participants were 16.3 ± 3.9 years old on average and played on average [16.1 hours per week] during the school year. A high prevalence of pain was observed (94.7%). The neck, shoulders, and thoracic area of the spine were the most painful locations. Maximum pain intensity was 33.6 ± 26.2 mm on the visual analogue scale. It took a median of 30 minutes for the pain to resolve. Playing-related pain had an impact on the participants’ perceived ability to play. Discussion: The results of this study highlight the extent of the pain experience in young string music students. This information is helpful to support targeted treatment and prevention activities of playing related musculoskeletal pain in this group of musicians. © W. S. Maney & Son Ltd and the British Institute of Musculoskeletal Medicine 2015.
... 4 Playing the violin, viola, cello, and double bass (strings) are triggering elements for this type of problem 4-6 compared to non-string instruments, other than keyboard instruments. 4 Moreover, students playing a string instrument begin their training at a younger age 5,7 compared to other instruments requiring advanced physical development. 5,8 String music students are therefore exposed early on to potential playing-related symptoms. ...
... 4 Moreover, students playing a string instrument begin their training at a younger age 5,7 compared to other instruments requiring advanced physical development. 5,8 String music students are therefore exposed early on to potential playing-related symptoms. ...
... 11 The prevalence of playing-related pain is mainly reported in College or University students. 5,[11][12][13][14][15][16] Only a few studies have documented this symptom in younger students (i.e., high school and elementary school). 17,18 Studies regarding 'elite' music students remain scarce. ...
Article
Background: During their training, musicians must develop good work habits that they will carry on throughout their professional career in order to avoid potential chronic health problems, such as musculoskeletal pain. The effect of sudden changes in instrument playing-time on the development of playing-related musculoskeletal pain (PRMP) has not been thoroughly investigated in music students playing bowed string instruments (BSI), even though they are regularly exposed to such changes to perfect their playing skills. Objective: To explore the association between sudden changes in instrument playing-time and changes in PRMP in BSI players. Methods: A prospective cohort study was completed with BSI students attending a summer music camp offering high-level training. Participants completed a self-administered 23-item questionnaire designed for the study upon arrival at camp (T1) and then 7 days later (T2). Results: Ninety-three BSI students (16±4 yrs old) completed the questionnaires, for a 23% response rate. Their playing-time increased by 23±14 hrs between T1 and T2. Complaints in pain frequency (e.g., from never to most of the time) and intensity (19±24 mm on VAS) significantly increased between T1 and T2 and were correlated with an increase in playing-time. Conclusion: A sudden increase in playing-time, such as that experienced by elite BSI students attending an intensive music camp, was related to an increase in PRMP. However, in this study, changes in pain characteristics were only partly explained by the change in playing-time.
... 176 -179 Published, peer-reviewed studies include surveys of symphony musicians, opera musicians, younger students, collegians, and military groups. 2,29,[180][181][182][183][184][185][186][187] The primary designs of these original publications have been crosssectional surveys, 2,167 specialty patient case series, [188][189][190][191][192] and case reports, 193,194 but few controlled studies. ...
... 2,29 High rates of playingrelated disorders were not only found in professional instrumentalists but also in young musicians during their training years. 182,183 Common risk factors for playing-related overuse disorders included playing time, technique, demanding repertoire, posture at the instrument, larger instrument size, gender, and age. 174,182,183,205 The highest injury rates have been reported to occur approximately mid-career, and it has been postulated that this is a result of peak family and financial responsibilities. ...
... 182,183 Common risk factors for playing-related overuse disorders included playing time, technique, demanding repertoire, posture at the instrument, larger instrument size, gender, and age. 174,182,183,205 The highest injury rates have been reported to occur approximately mid-career, and it has been postulated that this is a result of peak family and financial responsibilities. 172 No reviews of survivor bias or other research design factors were found, but a study of retired orchestra musicians did not indicate that retirement was caused by physical problems. ...
Article
Objective: Workplace hazards in the performing arts cause injuries, disabilities, and deaths every year. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute to efforts to reduce them. This article reviews current health issues in the performing arts and highlights opportunities for occupational health contributions. Methods: Recognized experts in performing arts medicine were consulted and articles illustrating performing arts health issues were reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles. Results: Resources discussing hazards and health issues in theater, dance, voice, and instrumental musicians were located and reviewed. Conclusions: Treatment providers have a history of involvement with segments of the performing arts. The occupational health approach to workplace health issues can effectively complement these efforts. Sources of further information on performing arts health concerns are available.
... Playing-related musculoskeletal disorders (PRMDs) in musicians are a serious problem with prevalence rates of up to 87% [1]. Various authors have investigated PRMDs in specific instrument groups and have found a high percentage of injury in violinists and upper strings (range 45% -90.3%) [2,3,4,5,6,7]. The reasons given for these very high figures are the physical demands associated with the many hours of practice required to reach a high level of performance, performance itself, associated fatigue, the size and weight of the instrument, the (often asymmetric) posture required to play the instrument, the repetitive nature of the muscular activity often involving rapid, end-range movements, and life-style, i.e. working nights, weekends, part-time, and often more than one job to supplement income [3,8,9,10]. ...
... Much of the literature related primarily to classical musicians categorising orchestra instrument groups [4,11], specific instruments such as the flute [12, 10 and bassoon [13] or were generalist in respect of instrument type [1,3,14,5]. In recent years, some authors have highlighted that PRMDs are also a problem for Irish traditional musicians [15][16][17][18]. ...
... The findings represent all students and faculty who play the fiddle and are directly involved in Irish traditional music on the island of Ireland (Republic of Ireland and Northern Ireland). We found that PRMDs are common among Irish traditional fiddle players, and that the extent of the problem is similar to, or greater than, findings by other authors who included violin players in their study and found prevalence figure of between 30.3% and 86% [3,2,5]. Thus, Irish traditional fiddle players are equally as, or more, susceptible to PRMDs as their classical counterparts. ...
Article
Background: The literature related to playing-related musculoskeletal disorders (PRMDs) primarily includes classical musicians and instrument-specific studies. Previous work by our team identified that PRMDs are an issue for Irish traditional fiddle players; however, the extent of the problem was not known. Objective: To identify the type and extent of PRMDs in the Irish traditional music population, specifically fiddle players. Methods: A questionnaire was developed and administered to faculty and students related to all Irish traditional music courses in all higher education institutions in Ireland. Results: Seven institutions were included. The response rate was 77.5% (n=79 of 102 possible respondents). A fifth of respondents never had a PRMD, 36.7% (n=29) currently had a PRMD, and 34.2% (n=27) had a previous experience of a PRMD. The main symptoms were pain (62%, n=49), stiffness (41.8%, n=33), and tingling (35.4%, n=28). There was a positive association between the development of PRMDs and increased hours of play (p=0.017). Conclusions: PRMDs are a problem for Irish traditional fiddle players, especially during times of intense playing such as festivals.
... On average, 79% of university freshman performing arts students indicate pain each year [31], with up to 100% of students reporting pain among percussionists, followed by woodwinds and brass players (84%-87%) and dancers (61%). Of all music students, 37% reported experiencing performance anxiety. ...
... Consistent with studies by Brandfonbrener [31] and Rickert et al. [32], the students also had relatively high rates of physical symptoms and depression [33]. ...
Chapter
Performers frequently struggle with physical and emotional health issues that are at times debilitating. Numerous studies have documented the importance of health interventions for performing artists to prevent injuries and illnesses. In this report, a review of the current literature is discussed, with an emphasis on the primary health problems including musculoskeletal pain and injuries, anxiety and depression, eating disorders, and heart disease. Risk factors include irregular work hours, frequent travel, increased physical and emotional demands, overuse of muscle groups, poor physical activity, and inadequate dietary habits. Though performers’ awareness of health issues and preventive practices has improved in the past 30 years, many risk factors persist. The upside is that most of the risk factors are preventable. Since health problems typically surface when performers are in the stages of rigorous preparation, health promotion efforts should begin in the training programs that can set the tone for positive health habits throughout professional careers. Logical initiatives could include the development, analysis, and evaluation of professional training curricula to address health issues specific to this target population.
... In the extant PRMD literature, percussionists frequently appear within surveys of broader groups of instrumental musicians. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The number of percussionists included in these samples of musicians is often small (i.e., n≤30 1,3-7,10-18 ), which makes establishing rates and patterns of injuries challenging. In the largest study focusing specifically on percussionists to date, Sandell et al. 20 analyzed survey responses from 279 percussionists, who were divided into three subgroups (keyboard, auxiliary, and membranophone percussionists, the latter of which included drummers and timpanists). ...
... Furthermore, the participant populations of most of the studies to date have primarily consisted of classically trained percussionists. 2,[4][5][6][8][9][10][11][12][13][14]16,18,19 Very few have considered other musical genres, 7,15,22 and thus, the rigours of being a professional, non-orchestral percussionist (e.g., studio work, tours, etc.) and the differences in physical demands among music genres (e.g., speed metal vs hip-hop vs easy listening) are under-represented in the extant literature. Therefore, an examination of PRMDs and their risk factors that is more representative of the drummer population is warranted. ...
Article
Full-text available
Aims: Playing-related musculoskeletal disorders (PRMDs) are a significant health concern for percussionists. Although many of the known risk factors for PRMDs likely apply to all percussion subgroups (e.g., weekly practice hours, warm-ups/cool-downs, etc.), the rates and injury patterns in drummers (herein defined as 'percussionists who play the drum set') may differ due to differences in physical demands from those of other percussion subgroups. The goal of this study was to determine the drummer-specific rates and patterns of PRMDs. Methods: An electronic survey including questions on respondent demographics, history and patterns of PRMDs, and potential drummer-specific risk factors for reporting PRMDs was distributed via social media using a snowball sampling technique. The target population included individuals aged 18 years or older who exclusively played the drum set (minimum 5 hrs/wk). The rates of PRMDs were analyzed by body region (e.g., upper/lower limb, etc.) and by location within body regions (e.g., shoulder, knee joint, etc.). Results: The lifetime history of PRMDs in the study sample (n=831) was 68%, and 23% reported currently experiencing a PRMD. Most respondents reported multiple PRMDs (59%). The upper limb was the most commonly-affected body region (59%). The wrist joint (25%) and low back (24%) were the most commonly affected locations within body regions. Conclusions: Drummers' reporting of multiple PRMDs is consistent with previous findings in percussionists, but differences in the lifetime histories and patterns of injury supports the notion that risk factors may differ between percussion subgroups. Analysis of survey responses pertaining to drummer-specific risk factors is currently underway.
... These figures are consistent with prevalence rates for other occupations in which repetitive motion is a factor (Zaza, 1998). More recently, however, Brandfonbrener (2009) found in a study of 330 college freshmen, that 86 percent of string players had a history of playing-related pain, though she did not have them rate severity of pain. ...
... With the high rates of pain and injury among secondary and college music students (e.g., Lockwood, 1988;Brandfonbrener, 2009;Palac, et al., 2009, Zander, et al., 2010, it is apparent that prevention programs should begin early in their playing careers. For her dissertation, Rardin (2007), planned, implemented, and evaluated such a program with a group of students in a high school second orchestra (N=130, evenly split between control and intervention). ...
... A wide range of complaints and symptoms can impede a wind player's embouchure. 1,2,[14][15][16] These complaints may be interpreted in terms of injuries caused by "overuse" or "misuse." 2,15,[17][18][19] They refer to a wide spectrum of softtissue related diagnoses such as tendinitis, tenosynovitis, (compression) neuropathies, and musician's dystonia. ...
... 1,2,[14][15][16] These complaints may be interpreted in terms of injuries caused by "overuse" or "misuse." 2,15,[17][18][19] They refer to a wide spectrum of softtissue related diagnoses such as tendinitis, tenosynovitis, (compression) neuropathies, and musician's dystonia. 17,20 Various medical specialists interpret and label these situations with reference to different etiologies, according to their specific frame of reference. ...
Article
Full-text available
Brass players may experience problems producing an optimal sound (or range of sounds) in their instrument. Assessing and treating dysfunctional embouchure requires knowledge of functional embouchure, but peer-reviewed literature on dysfunctional and functional embouchure is scarce. Objective: This study aimed to provide a narrative overview of embouchure based on information from different scientific and clinical fields. This should be regarded as a first step in constructing a reliable, valid, and practical multi-item method to assess embouchure for brass players. Methods: Literature reviews were conducted concerning: 1) the definition of embouchure, 2) physics and acoustics of embouchure, 3) functioning of embouchure-related structures, and 4) instruments to assess embouchure. Also, embouchure experts (clinicians, scientists, and elite wind players) were consulted for information and discussion. Results: A proposal for a new definition of embouchure, an overview of the relevant physics and acoustics, functions of embouchure-related body structures, and the main methods to measure embouchure in brass playing are presented. Conclusion: Peer-reviewed information about the fundamentals of dysfunctional embouchure is scarce and sometimes contradictory. A new definition for embouchure is proposed: embouchure is the process needed to adjust the amount, pressure, and direction of the air flow (generated by the breath support) as it travels through the mouth cavity and between the lips, by the position and/or movements of the tongue, teeth, jaws, cheeks, and lips, to produce a tone in a wind instrument. An integrative overview is presented which can serve as a transparent foundation for the present understanding of functional and dysfunctional embouchure and for developing an evidence-based multi-item assessment instrument.
... 1,2 PRMDs do not only trouble professional musicians, but as well they affect music students and recreational players. A study by Brandfonbrener (2009) 3 showed that 79% of 330 music university freshmen had at some point in their career already dealt with a PRMD. Studies have also shown a high prevalence of PRMDs among children down to age 7. 4,5 PRMD can have serious consequences and even jeopardize the musician's career. ...
... 1,2 PRMDs do not only trouble professional musicians, but as well they affect music students and recreational players. A study by Brandfonbrener (2009) 3 showed that 79% of 330 music university freshmen had at some point in their career already dealt with a PRMD. Studies have also shown a high prevalence of PRMDs among children down to age 7. 4,5 PRMD can have serious consequences and even jeopardize the musician's career. ...
Article
Background: Studies show a high cumulative prevalence of musculoskeletal disorders among musicians. Increased emphasis is needed on studying the effectiveness of education and prevention courses in music schools. Objectives: To investigate the effects on music students of an education and prevention course on body awareness and their attitude toward health and prevention. Methods: 23 music students participated in this prospective descriptive comparative study, with 13 students taking the course and serving as a prevention education group (PG) and 10 students serving as a comparison group (CG). The course met once weekly for 2 semesters and included lectures and practical sessions. Before and after the course, participants answered a questionnaire about their level of physical activity, warm-up exercises prior to musical performance, health-promoting activities, and subjective body awareness during musical performance and during activities of daily living (ADL). Results: Over the 9-month study period, the PG group increased, and the CG lessened, the amount of warm-up prior to music performance, showing a significant group difference after the course (p=0.036). Significant interactions were seen for subjective body awareness scores (between groups over time) during practice (p=0.026) and during ADLs (p=0.004), as the PG group had greater positive change over time. No group differences were found in students' subjective rating of body awareness during live performance. Conclusions: Participation in a prevention and education course may be beneficial for music students due to improved subjective body awareness and attitude toward prevention strategies.
... Posture has been described as stillness, movement, and balance (Rosário, 2014), and the orientation of body components (Fortin, Feldman, Cheriet, & Labelle, 2011;Winter, 1995). Musicians and health professionals view posture as a factor contributing to the high prevalence of PRMP affecting musicians of all ages (Ackermann & Adams, 2004;Brandfonbrener, 2009;Brockman, Tubiana, & Chamagne, 1992;Lopez & Martinez, 2013;Ranelli, Straker, & Smith, 2008). Most research on posture has focused on biomechanics, with few studies investigating concerns of musicians, such as how posture affects movement quality and performance (Blanco-Piñeiro, 2013). ...
Article
Full-text available
Posture influences music technique, and poor posture is associated with performance-related problems in musicians. Student musicians rely on music teachers, physiotherapists, and Alexander Technique teachers for advice about posture and performance-related problems. However, it is unknown whether these professional groups share a common understanding of optimal posture, or if posture management strategies align with performance goals. The aim of this study was to develop an interdisciplinary theory of posture to support musicians’ health and performance. This qualitative study used constructivist grounded theory as its methodological framework. Purposive sampling recruited four heads of university instrumental departments, three university physiotherapy lecturers and three heads of Alexander Technique teacher training schools to participate in semi-structured interviews. Interview transcripts were analyzed using grounded theory, and results were discussed applying the Theory of Planned Behaviour. The overarching theory of posture for musicians was Minding the Body, suggesting mind-body coordination. Subprocesses included rebalancing the self with the instrument and performance environment (Finding balance); minimizing effort (Maintaining ease); addressing adverse habits (Challenging habits); overcoming traditional perspectives to optimize performance (Expanding the framework), and addressing barriers to optimal posture (Barriers to change). This interdisciplinary theory presents posture as dynamic mind-body coordination to facilitate health and performance.
... Before that, Larsson (1993) found that 67% of the music students and staff surveyed at a music college reported PRMD, and up to 62% of high school musicians had been injured. More recent research supports earlier findings, indicating similar rates of PRMD for both tertiary students (Ajidahun and Phillips 2013;Lopez and Martinez 2013;Zander, Voltmer and Spahn 2010;Brandfonbrener 2009) and professionals (Fotiadis, Fotiadou, Kokaridas and Mylonas 2013;Ackermann et al. 2012). ...
Article
Full-text available
The high statistics of musicians’ performance-related pain and injury are well documented. Research shows that tertiary level musicians’ occupational health education is imperative, and internationally more and more institutions are proactively incorporating innovative preventative educational programmes as part of their coursework. However, there are no courses in musicians’ health offered in any of the music departments of South African universities. In this article we will explore a model towards musicians’ occupational health education, based on the research done by Judy Palac, a specialist in performing arts medicine education. Her collaborative and interdependent model for a musicians’ health intervention has three components: health professionals diagnose and treat musicians with music-related physical or psychological disorders; music teachers provide pedagogy that is founded on sound musical, psychological and biomechanical principles; movement and somatic specialists provide knowledge of the body in music making. Our aim is to demonstrate how this framework is applicable in South Africa. Brief recommendations for possible implementation strategies in the South African context are made.
... 14 A recent systematic review by Silva at al. 12 estimated that about 75% of college and professional musicians experience pain; however, only three studies (n=411) in the review included college musician responses, and all but 5 subjects were pianists. Brandfonbrener 15 reported in 2009 that 83% of college freshmen have a history of pain prior to beginning their college careers. ...
Article
Objectives: Studies over recent decades have demonstrated significant performance-related pain among professional musicians. However, there have been no largescale studies to evaluate pain among college musicians. The aim of this study was to determine the prevalence and anatomical locations of performance-related pain among students and faculty at the college level and learn what musicians do when they have pain. Methods: Cross-sectional data were collected using an online survey distributed to colleges across the United States. Data were analyzed using REDCap electronic data capture tools and Microsoft Excel. Results: We received 1,007 survey responses and found that 67% of musicians at colleges experienced performance-related pain. The highest prevalence of pain was in woodwind musicians, with 83% reporting performance-related pain. The most common locations of pain were upper back (27%), lower back (26%), and fingers of the right hand (25%). Many student musicians with pain seek help from their teacher, but almost as many do not seek help at all. Less than 25% see a medical professional. Conclusions: Most musicians at colleges experience performance-related pain in a variety of anatomical locations depending upon instrument/voice. Performing arts health organizations can increase awareness of treatment options for musicians suffering from performance-related pain, which may lead to improved quality of life and increased career longevity for college musicians.
... M usicians' health concerns, such as playing-related musculoskeletal problems, hearing loss, and performance anxiety, have been well documented in the literature since the 1980s. [1][2][3][4][5] Studies on musician health have been conducted in western countries such as the US, 3,6,7 Australia, 8,9 Brazil, 10 Germany, 11,12 Italy, 13 UK, 11,14 Greece, 15 and Canada. 16 While some studies have focused on musician populations in Asian countries such as Hong Kong, 17 Japan, 18 and Korea, 19 little is known about the prevalence of playing-related health concerns among Malaysian musicians of any level, including students. ...
Article
Aims: This study aimed to investigate playing-related health problems among student musicians at a university in Malaysia as well as their knowledge and awareness of playing-related health problems. Methods: Instrumental music students enrolled in undergraduate and post-graduate university music courses (n=98) participated in a self-report online survey which addressed aspects such as educational background, playing experience, knowledge and awareness of musicians' health issues, history of physical problems, lifestyle factors, and prevention and management strategies. Results: Of the total participants, 28.9% reported that they were currently experiencing playing-related pain in a body part, and 46.4% had experienced playing-related pain at some time. More than half (56.7%) felt that they have not received enough information or advice on playing-related health during their current studies. Musicians who experienced playing-related pain, tension, and discomfort reported the main problem sites to be the fingers and hands, arms, neck, and shoulders. Conclusions: The study results demonstrate that Malaysian university music students are affected by similar types of playing-related physical problems as their counterparts around the world. A greater awareness and knowledge of injury prevention and management strategies is needed so that these music students can sustain healthy playing careers.
... That a large proportionas high as 75%of musicians and music students experience some form of playing-related musculoskeletal disorders is well established in the research on musical health and wellness (Fishbein et al. 1988;Brandfonbrener 2009). Add hearing loss, vocal issues, and psychological disorders to the list, and numbers of affected musicians are even higher. ...
... Until this point, I had never had any trouble with playing my instrument (the oboe), though unbeknownst to me, some of my colleagues likely already had. In a 2009 study of students entering first-year university, Brandfonbrenner found that 79% had a history of playing-related pain, while 37% reported a history of performance anxiety (Brandfonbrenner, 2009). ...
... Literature revealed that there are intrinsic and extrinsic factors for the causation of disorders. Some of the intrinsic factors include age, (Dawson, 2005) gender, (Roach et al, 1994;Lederman, 2004;Brandfonbrener, 2009) hyper mobility, size (Larsson et al ,1993;Shoup ,1995). The extrinsic factors mainly include duration of playing, technique of playing and awkward posture. ...
... The demanding and repetitive nature of the physical actions undertaken by young string players can cause physical discomfort, which may lead to injury or attrition. Researchers have found that string players encounter music-induced pain as early as high school students or younger (Brandfonbrener, 2009). Based on the growing evidence that younger musicians can experience musculoskeletal pain, it behooves string teachers to find strategies to mitigate the discomfort of their students in order to foster a life-long participation in music as well as avoid possible injury. ...
... Such cultural differences should be considered in making earplug-related recommendations to avoid any overprotection, which could lead to the playing of louder music. Playing the music louder (e.g., hitting the drums or piano keys harder) can exacerbate upper extremity musculoskeletal problems (Yoshimura et al, 2008;Brandfonbrener, 2009). We also found a significantly larger DR2 for the music played by Filipino musicians than the music played by Caucasian musicians. ...
Article
Background: Some musicians may play the music louder while using earplugs thus reducing the effectiveness of the hearing protection offered by earplugs. In addition, the dynamic range (DR) of the music may be altered because of the use of earplugs with negative impact on perceived quality of music. There are some cultural differences in attitudes toward loudness, which may lead to differences in the loudness of music played by musicians from different cultures. Purpose: To investigate the effect of the use of two different types of earplugs on the loudness and DR of music played by musicians of Caucasian and Filipino origins. Research design: Quasi-experimental repeated measures design. Study sample: Thirty six musicians with normal hearing within the age range of 18-49 yr. Fifteen were of Caucasian (eight men and 7 women) origin and 21 were of the Filipino (nine men and 12 women) origin. Intervention: All participants received a brief educational session, which included information on music-induced hearing loss, the benefit of using earplugs, and the correct procedures for inserting and removing earplugs. They played music in five different conditions (three min each): Trial 1 of conventional and musicians' earplugs in random order, no earplug, and trial 2 of conventional and musicians' earplugs in random order. Data collection and analysis: Maximum, minimum, average (average sound level measured over the measurement period; LAVG), and peak levels were recorded using a dosimeter while playing music in each of the five conditions. The DR was derived by subtracting the minimum values from the maximum values. A different measure of the dynamic range 2 (DR2) was derived by subtracting the LAVG value from the peak value. Mixed analyses of variance (ANOVA) (Cultural origin and Gender as nonrepeated variables) was performed on LAVG, DR, and DR2. Results: Based on the LAVG levels yielded by them, 42-61% of the musicians may be at risk for hearing loss. The mixed ANOVA revealed some main effects of culture and some significant interactions involving cultural origin, the plug conditions, type of earplugs, and trial number. Conclusions: Use of earplugs may vary the overall loudness of music, the DR, or the DR2 in some musicians depending on the type of earplugs and cultural origin, and the effect may change with practice.
... Education and interventions at conservatoires usually focus on addressing physical and mental health problems, rather than preventing and coping with the challenges of making music . It has therefore been recommended that conservatoires should equip their music students with the knowledge and tools regarding health issues, preferably at the start of the program, when students will most likely begin to increase their playing hours (Brandfonbrener, 2009;Kochem and Silva, 2017;Perkins et al., 2017). Considering the number of complaints, awareness of physical and mental health seems essential in both professional and pre-professional violinists to facilitate healthy performance. ...
Article
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Musculoskeletal complaints are common in pre-professional and professional classical violinists and these complaints can affect violinists’ performance. Therefore, it is important to identify the factors that contribute to healthy performance in this population. Qualitative studies with a variety of stakeholders are able to provide insights from different perspectives into factors influencing healthy performance for the pre-professional and professional classical violinist. In the current small-scale, exploratory study, semi-structured interviews were conducted with various stakeholders; two classical violin students, one classical violin teacher, a physiotherapist, a professional classical violinist, who is also a performance coach, and a health specialist who also graduated as a professional classical violist. Thematic analysis was conducted using Atlas.ti 9. We identified six themes that were indicated as important by the participants in terms of ensuring healthy performance for the pre-professional and professional classical violinist. The themes were: (1) physical aspects (involved in playing the violin); (2) practice routine and techniques; (3) interaction between physical and mental aspects; (4) culture; (5) role of the main subject teacher; and (6) preventive measures. Furthermore, when asked specifically about the development of a physical screening tool, the participants indicated that such a tool should include multiple factors covering various regions of the body, the inclusion of a questionnaire on risk-factors, and follow-up measurements. Also, collaborations between health professionals and main subject teachers were recommended as part of the screening tool to increase commitment of participating students. The results of the current study are based on the opinions, attitudes, and ideas of a small, selected group of participants only and cannot be generalized to a wider group of violinists. More research is needed regarding factors influencing healthy performance, before conservatoires and professional orchestras can develop programs for a healthy playing environment for pre-professional and professional violinists.
... Although music performance majors practiced more than one hour more per day as compared to music education majors, both groups show a similar occurrence of pain syndromes and performance anxiety. However, compared to the large studies of Spahn et al. (2004), Kreutz et al. (2009), andBrandfonbrener (2009), the students assessed their overall health status and their mental health status at the beginning of their first semester better and mainly as good. ...
Article
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Objective Well-being of music students has been an increasing matter of concern since studies show that up to 50% of beginners suffer from playing-related pain or anxiety. The aim of this longitudinal study was to examine health status, health-related attitudes, behaviors, knowledge, skills, and coping strategies of students at the beginning of their education at a music university and at the end of their second semester. Methods Based on a longitudinal online survey conducted among students at a German music university since 2017, we investigated mental and physical health status, health-related attitudes, knowledge, skills, behaviors, and coping strategies of music students at the beginning of their first year ( n = 205). We analyzed differences between performance and music education majors and between students playing different main instruments. In a subsample ( n = 62), we additionally analyzed changes between the beginning of the music students’ first and the end of their second semester, also depending on whether they attended courses on musicians’ health. Results Music students are already in demand when they enter a music university, practicing on average almost 3 h daily. Compared to other body regions, pain in shoulders/back is most prevalent in first-year students, especially in those playing string instruments. Performance majors reported better knowledge about health risks and protective measures for musicians, better coping abilities, and practiced more than music education majors. First-year students assessed their overall and mental health status at the beginning of their first semester mainly as good, but we found a decrease in mental health status at the end of the second semester. After two semesters, students attending courses on musicians’ health showed increased knowledge and skills regarding different aspects of musicians’ health. Conclusion The health status of music students when they first enter a music university is still a concern. Information and practical courses enabling students to prevent overuse and cope with performing anxiety and other stressors are important components of a comprehensive study program. Knowledge about music students’ needs can help conservatories better respond to the requirements and develop courses and measures supporting students from the beginning of their education.
... Aside from the fact that many music students find it difficult to distance themselves from music-making, it appears that there is a misperception that pain and discomfort is acceptable in musicians (17,18). Injury rates in this population have been found to be comparable to professional musicians According to Brandfonbrenner, various factors contribute to injury prior to entering tertiary music studies and the risk factors are associated with instrument played (19). Of the 330 participants (46% men and 54% women), 79% reported a history of playing-related pain, which varied by instrument. ...
... learning practical skills, development of social confidence, social relationships or motivation to study on one side [8], but also to some adverse effects, with inappropriate posture development or pain syndromes of different origin [31]. Activities demanding prolonged sitting position (e.g. during learning, watching TV, playing computer games), participation in different sports, music (instrument playing) or dance activities are the only few possible causes of perceived back pain -especially of musculoskeletal origin [4,10,14,24,27]. Back pains are recently one of the major health problems and causes of pain-related functional limitations (during physical activity, sitting, learning) in youth, with syndromes usually increasing with age [13,16,31]. ...
Article
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Introduction. Back pain syndromes occur in 30-40% of kids and adolescents, aged 7-17 years, with prolonged sitting position or leisure time activities as usually mentioned possible causes. Sailing is a multifaceted sport, with relatively long periods of static positions and quasi-isometric muscle overload. Back pain in sailing results from either sailing it-self or from boat-related activities. Aim of Study. The aim of this study was to investigate the back pain epidemiology and etiology in Optimist dinghy sailing. Material and Methods. Eighty four optimist sailors (60 boys and 24 girls; 11 to 15 years) and their 18 coaches were surveyed, using 23 and 9 points questionnaires, respectively. Results. As much as 43% of analyzed Optimist sailors sensed back pain during the sailing season. Mainly thoracic and lumbosacral pain occurred during on-land boat-related activities and while sailing. On average, the sensed pain was occasional, lasting usually more than three months, of stabbing or radiating type and intensity of 2-6 on 10-point scale. Only six respondents underwent adequate physical examination and treatment. All trainers declared caring about their sailors’ need for healthy development, however 85% of them do not recommend, as a recovery strategy, the use of physio- or kinesio-therapy, and 30% omit implementing special exercises related to spinal pain prophylactics and/or compensation. The trainers are not informed or informed occasionally about pain sensed by their trainees. Conclusions. There is the considerable need for the development of educational program of preventive and/or compensatory character to introduce in polish Optimist sports clubs.
... Vinci et al., 2015) * e Height and size of upper limbs(Ackermann and Adams, 2003;Sakai and Shimawaki, 2010) * e Size and curvatures of the spine(Blanco-Piñeiro et al., 2017) Genetic predispositions(Schaefer and Speier, 2012;Jankovic and Ashoori, 2008) * e Non-musculoskeletal disorders as vision, dental, skin problems(Harper, 2002) * e Notion of master eye and ear Posture Slouched posture (Chan and Ackermann, 2014; Blanco-Piñeiro et al., 2017) Fixed posture (Watson, 2009) Elevation of the arm (Nyman et al., 2007) Forward head posture (Watson, 2009; Spahn et al., 2014) * e Sitting position (Spahn et al., 2014; Price et al., 2014) BiomechaincsHypermobility(Vinci et al., 2015) Hypo-mobility(Rickert et al., 2012) * e Inadequate motor control in many body locations or functions: face (lips, jaws), spine, upper limbs, breath( Price et al., 2014;Silva et al., 2018;Steinmetz et al., 2012;Brandfonbrener, 2009) * e,m Physical fatigue related to biomechanical challenge( Chan et al., 2000;Araújo et al., 2017) Injury management ...
Article
Introduction Playing an instrument could lead to various disorders and several musicians report problems during their career. As there is no existing one, the aim of this study was to build a comprehensive model of injury prevention and risk factors in musicians by combining literature with interviews of musicians and experts. Methods The initial model has been based on literature. This model identified nine categories of risk factors. Then, interviews were conducted with 15 Royal Liverpool Philharmonic Orchestra musicians and 9 experts in musicians’ health to develop the final version. Results Eighty percent of the RLPO instrumentalists experienced at least once PRMDs in their career. Postural and workload issues were mentioned most frequently. Experts agreed broadly with the initial model and added interesting items that should be taken into account in assessing musicians’ health. Discussion This theoretical framework provides perspectives in terms of assessment, treatment and prevention in musicians, whether they are currently suffering from PRMDs or not.
... A study of Australian professional orchestral musicians showed that 84% had experienced pain or injuries that interfered with playing their instrument and/or participating in rehearsals/performances (Ackermann, Driscoll, & Kenny, 2012). Similarly high figures of pain and injury have been replicated around the globe (Leaver, Harris, & Palmer, 2011;Sousa et al., 2016), including in studies of tertiary students (Brandfonbrener, 2009;Steinmetz et al., 2012;Ioannou & Altenmüller, 2015) and school-aged children (Nawrocka et al., 2014;Vinci, Smith, & Ranelli, 2015). ...
Article
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.
... Given these findings, it is not surprising that research also paints a picture of diminished health for students beginning formal study in tertiary music courses, the transition point between childhood participation and professional performance or teaching careers (Fry, 1987;Cayea and Manchester,1998;Guptill et al., 2000;Britsch, 2005;Kreutz et al., 2008;Brandfonbrener, 2009;Steinmetz et al., 2010;Hildebrandt et al., 2012;Baadjou et al., 2015;Spahn et al., 2014). At the point of entry, a majority of tertiary music students increase their risk of injury due to a dramatic increase in the daily volume of time spent practicing and performing. ...
Article
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Australia lacks consistent provision of essential health education for musicians, and research shows an unacceptably high prevalence of performance-related health problems among musicians of all ages. This paper advocates for effective health promotion to be embraced in the policies and practices of Australian music performance organisations and educational bodies. It argues that a cultural shift is required, recognizing that a settings-based approach to health literacy is as fundamentally important for musicians as it is for any other occupation or athletic activity. Embedding health education into the delivery of music education will not only help to prevent injury over the lifespan of Australian musicians, it will support and sustain their capacity to contribute towards societal wellbeing and public health outcomes.
... Kári Árnason, Árni Árnason og Kristín Briem gerðu rannsókn á íslenskum tónlistarnemum árið 2014 og sýndu niðurstöður þeirra fram á að 62% nemenda á efri stigum tónlistarnáms voru að kljást við meiðsli eða verki sem tengdust hljóðfaeraleik, en 40% á þeim tíma þegar rannsóknin var gerð (Kári Árnason o.fl., 2014). Sambaerileg rannsókn, sem gerð var á 330 bandarískum háskólanemum, leiddi í ljós enn alvarlegri stöðu, en þar sögðust 79% nemenda stríða við afleiðingar meiðsla og verki vegna hljóðfaeraleiks (Brandfonbrener, 2009). Tölurnar eru sláandi, sérstaklega þegar litið er til þess að hér er um ungt og almennt hraust fólk að raeða. ...
Article
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Í þessari grein verður fjallað um viðtekna kennsluhætti í tónlistarnámi, ekki síst á efri skólastigum, og litið til fræðilegra skrifa um þetta efni á sviði tónlistarfræða og tónlistarmenntunar. Horft verður til kennsluhátta og samskipta í tónlistarmenntun á efri stigum og skoðað hvaða markmið liggja til grundvallar tónlistarnámi. Rýnt verður í fræðigreinar um áhrif valdaójafnvægis og viðtekinna kennsluhátta í tónlistarnámi á tónlistarnemendur og mögulegar afleiðingar fyrir atvinnutónlistarmenn og þar með tónlistarlífið í heild. Um er að ræða yfirlitsgrein þar sem rýnt er í ólíkar rannsóknir um þetta efni á sviði tónlistarfræða og menntunarfræða tónlistar.Leitað verður í smiðju fræðimanna á sviði heimspeki tónlistarmenntunar sem og almennra menntunarfræða varðandi framtíðarsýn fyrir tónlistarmenntun sem geti alið af sér heilsteypt, skapandi tónlistarfólk og heilbrigt tónlistarlíf, samfélaginu og einstaklingum til heilla.Fórnarkostnaður af neikvæðri reynslu úr tónlistarnámi getur verið umtalsverður og haft alvarlegar afleiðingar, bæði fyrir einstaklinga og tónlistarlífið í heild. Margir tónlistarmenn þjást af vinnutengdum kvillum, bæði andlegum og líkamlegum. Sviðsskrekkur, kvíði og álag er viðvarandi vandamál hjá mörgum tónlistarmönnum og lyfjanotkun er algeng í tónlistarlífinu.Í greininni er bent á mikilvægi þess að tónlistarkennarar og skólakerfið spyrji sig hvort hlutverk þeirra sé að mennta nemendur til að ganga inn í tiltekna hefð eða hvort leitast eigi við að mennta sjálfstæða einstaklinga sem geti haft áhrif á viðteknar hefðir og unnið að því að móta nýtt og betra samfélag. Nauðsynleg framþróun krefst þekkingar á því sem á undan er gengið og ígrundunar á þeim rannsóknum sem farið hafa fram á sviði tónlistarmenntunar. Markmið þessarar greinar er að varpa ljósi á ríkjandi starfshætti og fyrirkomulag tónlistarkennslu sem lítil umræða hefur verið um og hefur hingað til lítið verið gagnrýnt.
... That train of thought is further supported by Brandfonbrener's work that demonstrated many students have performance-related pain even before starting college. 6 When reviewing the most common sites for pain, many of our subjects demonstrated pain in the wrist and fingers of the right hand as well as the upper back. These results are fairly similar to those by others. ...
... Among all musicians, pianists are most commonly affected by MSD, with prevalence varying from 50% to 77% [7,[19][20][21][22]. Studies report that as many as 87% of college piano students were injured before their enrollment in the university, suggesting that the majority of MSD began when these students were teenagers or children [6,23,24]. Furthermore, specific surveys revealed that 62% to 73% of piano students experienced MSD when playing at least one selected piano technique [25]. This high prevalence of MSD in piano students is attributed to some of the biomechanical factors, e.g. ...
Article
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Objective We aimed to investigate the correlations between Upper Extremity Musculoskeletal Symptoms (MSD) and joint kinematics while playing the piano, as well as correlations between MSD and psychosocial, professional and personal habits, and bio-demographic risk factors of piano students. Method This cross-sectional study included 15 piano students. The research tools included 3D motion capture, anthropometric measurements, and questionnaires for obtaining data about MSD, psychological, and personal factors. Results The piano students recruited for this study experienced a variety of MSD during the past 12 months, with a particularly high prevalence of neck pain (80%). Extreme wrist extension and/or elbow flexion while playing the piano also correlated with MSD. Additionally, this study identified correlations between MSD and hand span (r = -.69, p≤.004) and number of playing hours per week (r = .58, p≤.024). Conclusions Anthropometric factors and playing patterns should be considered together with well-known MSD risk factors, like extreme and repetitive movements. However, considering each joint singularly might not be sufficient to prevent the development of MSD when instructing the piano player; accordingly, joint synchronization should also be considered.
... Between 25 and 43% of music students at university level, admitted that they had experienced PRMDs before starting their degree course [9] or had experienced a health problem related to their activity as musicians during the early stages of their education [10]. Brandfonbrener [11] reported a prevalence of playing-related pain to be approximately 85% among first year music students at university level and found that the majority had already experienced PRMDs as pre-college students, or when even younger. ...
Article
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Background The achievement and improvement of skills in musical techniques to reach the highest levels of performance may expose music students to a wide range of playing-related musculoskeletal disorders (PRMDs). In order to establish effective solutions for PRMDs and to develop future preventive measures, it is fundamental to firstly identify the main risk factors that play a significant role in the development of musculoskeletal conditions and symptoms. The aim of the study is to identify those factors associated with increased risk of PRMDs among music students. A further goal is to characterise this population and describe the clinical features of PRMDs, as well as to determine the evolving course of PRMDs in music students during their training. Methods One hundred and ninety schools have been invited to participate in this study, sixty of which have already confirmed officially their support for the investigation’s recruitment procedures, by means of a subsequent distribution of the link to a web-based questionnaire to their student groups (total potential student numbers available: n = 12,000 [based on ~ 200 students per school on average, and 60 volunteering schools]; expected number of students: n = 3000 [based on a 25% response rate from the 12,000 students attending the 60 volunteering schools]). The web-based questionnaire includes questions about any PRMD that students have experienced during their training, and different potential risk factors (i.e. lifestyle and physical activity, practice habits, behaviour toward prevention and health history, level of stress, perfectionism, fatigue and disability). Overall recurrence or new onsets of PRMDs will be assessed at 6 and 12 months after the first data collection to investigate and record the development of new incidents within a period of a year and to enable characterisation of the nature and the evolving course of PRMDs. Discussion To the best of our knowledge, no other longitudinal studies on risk factors for PRMDs among music students have been conducted so far. Therefore, this study can be considered as an opportunity to begin filling the gaps within current research in this field and to generate new knowledge within musical contexts in education and employment. Trial registration ClinicalTrials.gov (NCT03622190), registration date 09/08/2018. Electronic supplementary material The online version of this article (10.1186/s12891-019-2440-4) contains supplementary material, which is available to authorized users.
... Two studies used the term 'music-related' 112,138) . Some terms were used interchangeably 132,134,139,141,145,147,149) , although in the case of Wood 132) the author made it clear that the term performance-related musculoskeletal disorders included both practice and performance. ...
Article
Open access https://doi.org/10.2486/indhealth.2018-0065 Recent reviews of musicians’ musculoskeletal symptoms (MSS) have reported heterogeneity in the outcomes reported and data collection tools used, making it difficult to compare and synthesise findings. The purpose of this present review was to improve the consistency of future research, by documenting the outcomes reported in recent studies of musicians’ MSS and the data collection tools used. All English language, peer-reviewed studies, published 2007–2016 that reported musicians’ self-reported MSS outcomes were identified. Details of the types of outcomes reported and the tools used were extracted, and synthesised descriptively. A range of MSS outcomes were reported, including MSS with a temporal relationship to activities performed, and the consequences of symptoms. Only 24% of studies used standardised questionnaires, with the Nordic Musculoskeletal Questionnaire (NMQ) being the most commonly used. To improve the homogeneity of outcomes and data collection tools when investigating musicians’ MSS, we recommend using the NMQ, where appropriate. Recall periods of 12-months and 7-days are the most appropriate for prevalence, and 7-day recall periods for ratings. Importantly, outcomes and the tools used to collect data should be reported in sufficient detail to ensure that the study can be replicated, critiqued, and accurately interpreted.
... 13 The concept of PRMD is any "pain, weakness, lack of control, numbness, tingling, or other symptoms that interfere with your ability to play your instrument at the level you are accustomed to." 14 Recent studies have indicated high prevalence rates of PRMD ranging from 44.7% to 93%, especially in string players. [15][16][17][18][19][20] Symptoms begin to appear when the musician increases the intensity and duration of his or her musical practice. Usually, pain is the artist's first symptom. ...
Article
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Objective This systematic review aimed to assess the methodological quality of articles about the prevalence of playing-related musculoskeletal disorders (PRMDs) in string players and to identify the rate of prevalence and associated factors of PRMD. Methods Cross-sectional studies describing data on separate string players published in 5 different languages between January 1, 1980, and January 31, 2014, were included. The following databases were searched: MEDLINE, sciELO, and LILACS. Other sources and reference lists of published papers also were searched. The Loney Scale was used by 2 independent reviewers to evaluate the methodological quality, and only studies that achieved high scores were included. Results Of 1910 retrieved articles, 34 cross-sectional studies were selected for methodological assessment. However, only 8 studies reached satisfactory methodological quality scores. The prevalence rate of PRMD was alarmingly high, ranging from 64.1% to 90%. Women and older musicians were more affected in comparison to other instrumentalists. There seems to be a predominance of symptoms in the left upper limb in violinists and violists, whereas cellists and bassists report injuries in the right upper limb. Conclusions Professional and amateur string players are subject to development of PRMD. Low response rates were the most observed source of bias, and there is still a lack of publications with high methodological quality in the literature. Key Indexing Terms Musculoskeletal Diseases Prevalence Occupational Diseases
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Objective: CANS (complaints of arm, neck, and/or shoulder not caused by a systemic disease or acute trauma) are a recognized problem in specific occupational groups such as musicians. This study aimed to compare the prevalence, characteristics, and consequences of CANS between music academy students and a control group of peer-age medical students. Methods: A cross-sectional study among music academy students and medical students. Data were collected using a web-based questionnaire on musculoskeletal conditions of the upper extremity in the two cohorts. Results: Students of three music academies (n=345) and one medical university (n=2,870) received the questionnaire, of which 25% (n=87) and 18% (n=503) responded, respectively. The 12-month prevalence of CANS was nearly twice as high among music academy students as the control group (80.7% vs 41.5%, p<0.001). Music academy students reported 2.6 times the point prevalence as medical students (47.0% vs 18.2%, p<0.001). Chronic CANS was present in 36.1% of the music students, compared to 10.3% of the medical students (p<0.001). Music academy students presented more complaints per anatomic localization and a higher number of involved anatomic localizations. Music students rated the influence of CANS on daily functioning as more severe (5.0 vs 3.1, p<0.001). Of all subjects with CANS during the last year, more music academy students (46.3%) visited a healthcare professional compared to medical students (29.8%, p=0.013). Conclusion: The prevalence of CANS is high in music academy students compared to medical students. This emphasizes the necessity of effective (preventive) interventions in these high-demanding professionals.
Article
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.
Article
Objective Brass players are exposed to high musculoskeletal strains during their instrumental play. Various assessments can be used to measure these strains, whereby a targeted therapy can also be supported. The aim of this study was to review literature concerning assessments used in quantitatively based studies about the analysis of musculoskeletal loads of brass players. Data sources The Cochrane Library, PubMed, CINAHL, PEDro as well as the journal “Medical Problems of Performing Artists” were searched for relevant studies. Study selection Two reviewers independently applied the inclusion and exclusion criteria to select potential studies. A third reviewer was involved in the case of discrepancies. Data extraction Two reviewers independently extracted the data. Data synthesis A total of 73 studies conducted between 2004 and 2019 were included. Within a total of 30 studies, 18 assessments could be found that collect 2-dimensional or 3-dimensional kinematic data using video- or image-based analysis of posture, sonographic, optoelectronic and various electromagnetic systems. In 7 studies kinetic data were measured by force-transducers, pressure platforms, stabilizer and dynamometer. Fifteen studies used clinical examinations and additional assessments to screen individual body regions and 9 studies derived electromyography measurements from a total of 25 muscles. Thirty-one partially validated questionnaires were used to record musculoskeletal pain of brass players. Conclusions A variety of assessments can be used to optimize analysis and treatment procedures in research and clinical work. Future studies should both examine quality criteria of the various assessment methods and validate clinical examinations and questionnaires.
Article
Objective: Musicians are often compared to athletes because of the physical exertion required to play music. The aim of this study was to explore the physical activity level of music students and to study its relationship with musculoskeletal complaints. A second goal was to assess associations between physical activity and pain, quality of life, and disability. Methods: This cross-sectional study among third- and fourth-year music students used an electronic survey including measures for physical activity (SQUASH-Short Questionnaire to Assess Health-enhancing physical activity), musculoskeletal complaints (DMQ-Dutch Musculoskeletal Questionnaire), disability (DASH-Disability Arm, Shoulder, Hand questionnaire) and quality of life (Short Form-12). Students were classified as compliers or non-compliers with moderate- and vigorous-intensity physical activity recommendations. Statistical analysis was done using (non)parametric tests (t-test, Pearson chi-square test, Mann-Whitney U-test) and correlational testing. Results: Participants were 132 students, 63.6% female, with a median age of 23 yrs (range 21.3-25.0). 67% reported musculoskeletal complaints in the past 7 days. Their median physical activity level was 6,390 MET-min/wk, and 62% and 10% of the students accomplished recommendations for moderate-intensity and vigorous-intensity physical activity levels, respectively. No significant differences were found in prevalence of musculoskeletal complaints between students who met moderate- or vigorous-intensity physical activity recommendations and students who did not. Physical activity level was not associated with musculoskeletal complaints (r=0.12, p=0.26). Higher pain intensity was associated with a lower quality of life (r=-0.53 p<0.01) and higher disability (r=0.43, p<0.01). Conclusions: Music students are mainly involved in light- to moderate-intensity physical activities and rarely in vigorous-intensity activities. No correlation was found between physical activity level in the past months and musculoskeletal complaints in music students.
Article
Background: A validated method to assess sitting and standing posture in a clinical setting is needed to guide diagnosis, treatment and evaluation of these postures. At present, no systematic overview of assessment methods, their clinimetric properties, and usability is available. Objective: The objective of this study was to provide such an overview and to interpret the results for clinical practice. Methods: A systematic literature review was performed according to international guidelines. Two independent reviewers assessed risk of bias, clinimetric values of the assessment methods, and their usability. Quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE). Results: Out of 27,680 records, 41 eligible studies were included. Thirty-two assessment instruments were identified, clustered into five categories. The methodological quality of 27 (66%) of the articles was moderate to good. Reliability was most frequently studied. Little information was found about validity and none about responsiveness. Conclusions: Based on a moderate level of evidence, a tentative recommendation can be made to use a direct visual observation method with global posture recorded by a trained observer applying a rating scale.
Article
This month's editorial is based on a presentation that I did at the International Congress on Music Physiology and Musicians Medicine, which was held in Freiburg, Germany, in late March. Stimulated by some recent articles published in MPPA, I attempted to review what we know about the pattern of performance-related musculoskeletal disorders (PRMDs) among instrumental musicians over the lifespan. For the purposes of this review, I have not made any attempt to do a rigorous critique of the methods used in each study, but there are some key definitions and terminology that are relevant. Since even small differences in terminology can produce significant variation in the results, this adds to the difficulty of drawing conclusions from the studies published to date.
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There is evidence supporting the social and cognitive benefits of music education. However aspects of music practice, such as an increase in frequency and intensity of practice, are associated with playing-related musculoskeletal problems in adult musicians, though with limited evidence in children. The aim of this study was to describe the music practice of child instrumentalists and determine their associations with playing-related musculoskeletal problems (PRMP), accounting for gender and age. A total of 731 children learning musical instruments (460 females) ranging in age from 7 - 17 years were surveyed; music experience, music practice and intrinsic factors (e.g. the experience of butterflies in stomach before a concert/exam) were investigated. Logistic regression evaluated the independent association of these potential correlates with PRMP. Music experience (number of years playing main instrument) was significantly negatively associated with PRMP (OR 0.88, p =.003). Pattern of playing was significantly associated with PRMP, specifically playing less than usual (OR 2.1, p =.002) and playing more than usual for longer and more often (OR 2.7, p <.001), compared to playing about usual. The experience of butterflies in the stomach during exams/competitions most times (OR 2.1, p =.029) and always (OR 2.4, p =.027) compared to never, was significantly associated with PRMP. Music inexperience, changed pattern of practice and performance anxiety are associated with playing-related problems in child instrumentalists and are therefore important issues for music education. Evidence-based guidelines may be recommended to help prevent problems and optimize music performance and music education development.
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Very little research has assessed the physical activity (PA) of university students in in Finland, and their associations with self-reported health complaints (HCs), whilst simultaneously accounting for a range of other potential confounders. Students at the University of Turku (1177) completed an online health and wellbeing questionnaire that assessed 22 physical and somatic HCs, and students' achievement of the international guidelines of four forms of PA (moderate, vigorous, moderate-to-vigorous and muscle strengthening PA; MPA, VPA, MVPA, MSPA respectively). We also explored the associations between HCs and PA, controlling for sociodemographic and health confounders (age, sex, year of study, marital status, accommodation during semesters, health awareness). Factor analysis reduced the HCs into three factors (psychological, pains/aches, circulatory/breathing). Bivariate relationships (no controlling for confounders) between these 3 factors and four forms of PA guideline achievement showed significant effects of achieving the PA guidelines against various groups of HCs, where more strenuous PA was associated with significantly less HCs in a stepladder pattern. Multiple regression analyses (controlling for confounders) showed that achievement of PA guidelines was significantly independently associated with self-reported HCs scores in most cases. Psychological HCs were negatively associated with achieving any type of PA; pains/aches were negatively associated with achieving two types of PA or with achieving MSPA guidelines; and circulatory/breathing HCs were negatively associated with achieving the VPA guidelines only. This is the first study in Finland to examine such relationships, and highlights the critical role of PA for the health of these young adults. Programs and policies to strengthen and improve the PA of university students would be beneficial, recognizing the benefits of instilling lifelong PA habits among this group of young adults.
Article
Résumé Introduction La pratique régulière et intensive d’un instrument peut exposer le corps au développement de troubles musculosquelettiques liés à l’exécution musicale. De nombreuses études épidémiologiques ont déclaré que plus de 80 % des musiciens souffraient au moins une fois dans leur vie de ces troubles. L’objectif de cette pré-étude est de démontrer que la prévention de ces troubles n’est pas suffisante dans les conservatoires (ici celui de Paris) puis d’interroger les étudiants sur ce qu’ils voudraient voir instaurer pour améliorer ce point et les suivre au quotidien. Méthodes Cette pré-étude a été réalisée sur 20 sujets, étudiants au Département Jazz du Conservatoire National Supérieur de Paris, par le biais d’un entretien au cours duquel ils ont rempli un questionnaire, le MPIIQM, et répondu à 6 questions ouvertes concernant la place de la prévention des troubles musculosquelettiques liés à l’exécution musicale au cours de leurs études. Résultats Il a été observé au sein de la population une forte lacune concernant la prévention des troubles musculosquelettiques liés à l’exécution musicale au cours de leurs études. Pour aider à améliorer ce point, les étudiants ont proposé différentes solutions dont majoritairement celle de créer une petite équipe médicale au sein même du conservatoire ou encore celle d’instaurer des cours de prévention obligatoires. Conclusion Cette pré-étude conclut à un manque réel en matière de prévention concernant les troubles musculosquelettiques liés à l’exécution musicale au sein d’un des plus grands conservatoires d’Europe et amène à une réflexion concernant les aménagements à instaurer afin d’amé-liorer la connaissance des étudiants de ces problématiques et leur prise en charge éventuelle. Niveau de preuve 5.
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Objective: To investigate the prevalence of playing-related musculoskeletal disorders (PRMD) and associated factors among violinists from the state of Rio de Janeiro, Brazil. Methods: This cross-sectional study included 106 violinists from eight cities in the state of Rio de Janeiro. Sociodemographic and musical characteristic data, pain symptoms, and upper-limb functionality were collected using the DASH and the Standardized Nordic Questionnaires. The associations between musculoskeletal complaints and possible predictors were analyzed by binary logistic regression. Results: Of the 106 surveyed violin players, 86.8% reported at least one painful area in the last 12 months and 77.4% in the last week. These symptoms were responsible for the temporary interruption of musical activity in 8.1% of musicians. More than 50% of violinists showed dysfunctional upper limbs according to the DASH optional module. Women were more likely to develop musculoskeletal disorders (OR 4.4, CI 1.9-10.0, p<0.001). In addition, older musicians were more likely to report pain in the last 7 days (OR 3.3, CI 5.1-10.97; p=0.04) and also had higher scores on the DASH (OR 1.8, CI 1.1-3.1; p=0.01). Other factors associated with the development of PRMD were body mass index, practice hours per week, and final DASH score. Conclusion: Violinists living and working in the state of Rio de Janeiro have a high prevalence of PRMD, especially women and older musicians.
Article
Recent resting-state fMRI studies associated extensive musical training with increased insula-based connectivity in large-scale networks involved in salience, emotion, and higher-order cognitive processes. Similar changes have also been found in chronic pain patients, suggesting that both types of experiences can have comparable effects on insula circuitries. Based on these observations, the current study asked the question whether, and if so in what way, different forms of experience-dependent neuroplasticity may interact. Here we assessed insula-based connectivity during fMRI resting-state between musicians and non-musicians both with and without chronic pain, and correlated the results with clinical pain duration and intensity. As expected, insula connectivity was increased in chronic pain non-musicians relative to healthy non-musicians (with cingulate cortex and supplementary motor area), yet no differences were found between chronic pain non-musicians and healthy musicians. In contrast, musicians with chronic pain showed decreased insula connectivity relative to both healthy musicians (with sensorimotor and memory regions) and chronic pain non-musicians (with the hippocampus, inferior temporal gyrus, and orbitofrontal cortex), as well as lower pain-related inferences with daily activities. Pain duration correlated positively with insula connectivity only in non-musicians, whereas pain intensity exhibited distinct relationships across groups. We conclude that although music-related sensorimotor training and chronic pain, taken in isolation, can lead to increased insula-based connectivity, their combination may lead to higher-order plasticity (metaplasticity) in chronic pain musicians, engaging brain mechanisms that can modulate the consequences of maladaptive experience-dependent neural reorganization (i.e., pain chronification).
Article
Musicians are at high risk of developing playing-related health problems. A considerable number of musicians suffer from severe health issues even during their university education. In previous studies using similar music student populations, health status and preventive health behavior could be classified into three groups. The first group of students did not report playing-related health problems and did not engage in preventive activities. The second group of students experienced rather low-level playing-related health problems and practiced preventive activities. The third group reported a rather high frequency of playing-related health problems and all of them were taking medication. These results were obtained from studies done at one German university of music. In order to compare these results with a nationwide sample of music students, a multicenter study at five German universities of music was performed. A total of 288 music students participated in the first survey at the beginning of their university education, 142 in the second survey at the start of their third semester and 75 in the third survey at the start of the last year of their university education. The data was analyzed using the same methods as the prior studies. The results confirmed the group classifications identified in previous studies. While approximately half the students indicated that they participated in preventive health behavior in the first survey, in the following two surveys more than three-quarters of the students reported practicing such activities during the course of their university education. Nevertheless, in all three surveys a large number (about a third) of music students reported playing-related health problems.
Article
The purpose of this study is to gain a better understanding of the perceived impact of personal circumstances, past and present learning environments, and musical culture on the development of playing-related pain and injury among tertiary string students. The study used a multi-phased mixed-methods methodology with elements of both quantitative and qualitative research. Forty eligible Bachelor of Music string majors at a tertiary music institution in Australia completed questionnaires/interviews twice annually, totalling 181 sessions. Due to attrition of 11, the number of participants decreased to 29 (14 violinists, four violists, 11 cellists) of whom 17 took eight semesters to complete their programmes. Results showed students consistently reported a high incidence of playing-related discomfort/pain. Further analysis revealed key groups of contributing factors, including the Major Study course, orchestral rehearsals, practice, technique and non-playing-related activities. The qualitative data revealed the complexity, subjectivity, and individuality of student experiences and the extent to which they vary according to a number of complex and overlapping risk factors. The research suggests the need for education institutions to adopt a range of preventative strategies as part of a multifaceted approach to addressing the issue of playing-related pain and injury.
Article
Research in musicians’ health in the last 30 years reveals that anywhere from 37 to 87 percent of both adults and students suffer pain related to the practice of their craft; nearly as often as athletes do. ASTA was one of the first professional organizations to recognize the problem. But how much do we really know about performance injuries and their prevention? Musicians, music educators, and movement and medical scientists have all investigated these issues. String researchers have been particularly active in studying the biomechanics of playing and in testing preventions and interventions, and they are uniquely qualified to contribute to understanding in these and other aspects of music wellness.
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Professional musicians receive little attention in pain medicine despite reports of high prevalence of musculoskeletal complaints. This study aims to investigate the association between work-related postures and musculoskeletal complaints of professional bass players. Participants were 141 professional and professional student double bassists and bass guitarists. Data about self-reported functioning, general and mental health status, location and intensity of musculoskeletal complaints and psychosocial distress were collected online with self constructed and existing questionnaires. Logistic regression analyses were performed to analyse associations between work-related postural stress (including type of instrument and accompanying specific exposures) and physical complains, adjusted for potential confounders. Logistic regression analyses revealed no association between complaints and the playing position of the left shoulder area in double bassists (p = 0.30), the right wrist area in the bass guitarists (p = 0.70), the right wrist area for the German versus French bowing style (p = 0.59). All three hypotheses were rejected. This study shows that in this sample of professional bass players' long-lasting exposures to postural stress were not associated with musculoskeletal complaints. This challenges a dominant model in pain medicine to focus on ergonomic postures. © 2015 European Pain Federation - EFIC®
Article
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.