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Extent of Playing-Related Musculoskeletal Problems in the Irish Traditional Music Community: A Survey
Abstract
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.
... Some studies evaluated predictive factors of PRMD (not specifically performance-related pain), and found anxiety [28] and sudden increase in playing time [14] as predictors. Some cross-sectional studies also found that age [11,[67][68][69], playing string instruments [15,16,20,26,70], elevated arms [53,54], being female [16,29], higher BMI [3,16,69], number of performing hours per week [3,11,15,18,29,30,[67][68][69] and per day [68], years of experience [22], lack of physical cool-down exercises [30], lower levels of physical activity [67,68,71], fatigue [22,23,26], perfectionism [22,23], lower levels of quality of life [68,72,73], performance-related anxiety [11,18,[74][75][76], social support [31,32,70,75], workload [15,74], stress resulting from job demands [15,16,32,72,77,78], rivalry [74], and job insecurity [18,74] are factors associated with PRMD. However, as previously mentioned, performancerelated pain and PRMD do not reflect the same outcome; therefore, the comparative results should be avoided or carefully considered. ...
... Some studies evaluated predictive factors of PRMD (not specifically performance-related pain), and found anxiety [28] and sudden increase in playing time [14] as predictors. Some cross-sectional studies also found that age [11,[67][68][69], playing string instruments [15,16,20,26,70], elevated arms [53,54], being female [16,29], higher BMI [3,16,69], number of performing hours per week [3,11,15,18,29,30,[67][68][69] and per day [68], years of experience [22], lack of physical cool-down exercises [30], lower levels of physical activity [67,68,71], fatigue [22,23,26], perfectionism [22,23], lower levels of quality of life [68,72,73], performance-related anxiety [11,18,[74][75][76], social support [31,32,70,75], workload [15,74], stress resulting from job demands [15,16,32,72,77,78], rivalry [74], and job insecurity [18,74] are factors associated with PRMD. However, as previously mentioned, performancerelated pain and PRMD do not reflect the same outcome; therefore, the comparative results should be avoided or carefully considered. ...
... Some studies evaluated predictive factors of PRMD (not specifically performance-related pain), and found anxiety [28] and sudden increase in playing time [14] as predictors. Some cross-sectional studies also found that age [11,[67][68][69], playing string instruments [15,16,20,26,70], elevated arms [53,54], being female [16,29], higher BMI [3,16,69], number of performing hours per week [3,11,15,18,29,30,[67][68][69] and per day [68], years of experience [22], lack of physical cool-down exercises [30], lower levels of physical activity [67,68,71], fatigue [22,23,26], perfectionism [22,23], lower levels of quality of life [68,72,73], performance-related anxiety [11,18,[74][75][76], social support [31,32,70,75], workload [15,74], stress resulting from job demands [15,16,32,72,77,78], rivalry [74], and job insecurity [18,74] are factors associated with PRMD. However, as previously mentioned, performancerelated pain and PRMD do not reflect the same outcome; therefore, the comparative results should be avoided or carefully considered. ...
Purpose
We aimed to evaluate factors associated with performance-related pain among musicians with different backgrounds, comparing music students and professional musicians.
Methods
We performed a multicenter cross-sectional study in a stratified random sample consisting of music students (294) and professional musicians (291). The main outcome was performance-related pain (PRP), measured by the Performance-related Pain among Musicians Questionnaire (PPAM). Factors associated with the outcome were measured using PPAM, International Physical Activity Questionnaire, Modified Fatigue Impact Scale, 10-item Kessler Psychological Distress Scale, Frost Multidimensional Perfectionism Scale, and Medical Outcomes Study Short Form 36 Health Survey.
Results
From the 585 musicians included (response rate of 82.4%), 322 (55.0%) reported PRP. Professional musicians presented a significantly higher lifetime prevalence of PRP (57.5%, p < 0.001); however, music students reported higher levels of fatigue, anxiety and depression, and lower quality of life. Multivariate logistic regression defined a model with 16 factors significantly associated with higher probability of PRP. Additionally, we describe 25 self-perceived factors reported by musicians as being associated with PRP.
Conclusion
We present the first study thoroughly describing and assessing factors associated with PRP among musicians, using a validated tool, including musicians with different backgrounds, and distinguishing music students and professional musicians. We also explore self-perceived factors associated with PRP. The relevant insights coming from this and future studies on factors associated with PRP will contribute to developing more effective preventive programs and improving evidence-based guidance and management of musicians affected by PRP.
... 8 Porter et al. reported a 36.7% point prevalence among Irish traditional musicians, with 34.2% of participants reporting a previous history of PRMDs. 9 Prior to this study, the prevalence of PRMDs among classical musicians in Ireland had not been investigated. Consequently, a comparison of PRMDs between classical and Irish traditional musicians had not taken place. ...
Aim This study aims to assess playing-related musculoskeletal disorders (PRMDs) among classical and Irish traditional third level music students in Ireland. Methods All Irish third level music departments were invited to participate, and questionnaires were distributed. Analyses utilised a combination of frequency distributions and contingency tables. Hypotheses were tested using chi-square and Fisher's exact tests. Results 120 participants responded: 85 (71%) of whom were female. 103 participants were classical and 17 traditional musicians. The median age was 19 years. Classical The most common instruments were keyboard (47; 46%) and string (30; 29%). 63 (61%) reported a history of PRMDs. 37 (36%) reported a one-week prevalence. Lifetime prevalence affected string players more than keyboardists (83% versus 51%; p<0.05). Females were more frequently affected (67% versus 47%, p<0.05). Neck involvement was associated with instrument (50% strings versus 15% keyboardists; p<0.01). A history of PRMDs was associated with playing difficulty (85% versus 45%; p<0.001) and restricted practice time (p<0.05) within the last week. Traditional Twelve (71%) of this cohort were female. Twelve different instruments were reported. Nine (53%) respondents had experienced PRMDs. Discussion High rates of PRMDs were reported, with increased prevalence among string instrumentalists. PRMDs caused negative consequences for musicians, indicating the need for targeted interventions.
... In the initial phase, determine the repertoire for recording; in the middle phase, formally record performances by inheritors and professional teachers, ensuring that the audio and video meet industry standards; in the final phase, refine and artistically process the recorded audio and video, creating a library of audio segments that can be creatively combined to form complete musical pieces. Due to the distinct and personalized performance styles of Jiangnan Silk and Bamboo musicians, the recording process involves continuous exploration of various recording styles and formats, ultimately resulting in a logically structured and effective audio and video library [14] . ...
p>In the metaverse environment, establish an immersive human-computer interaction system for Chinese traditional music based on virtual reality technology. Design the system’s functionality according to the Y model, and construct a four-layered system architecture. Collect high-quality instructional audio and utilize polygon modeling technology to create contextualized scenes of Chinese traditional music, as well as high-fidelity models of characters and instruments. Implement motion capture through inertial sensor technology for performance action data mapping. Utilize a metaverse engine platform to realize interactive functions and conduct performance optimization. The system is capable of eliciting learners’ intrinsic experiences, enabling interactive self-directed learning and creative exploration of Chinese traditional music performance, demonstrating significant practical value.</p
... At present, foreign music culture continues to pour into the country. In guiding students to accept the diversity of music culture, teachers also need to mobilize students to keep the enthusiasm of the soul of traditional music culture and participate in the inheritance and innovation of the action [1][2][3]. ...
The diffusion degree of traditional music in music teaching is analyzed by constructing an information diffusion model based on traditional music knowledge. Combine the information flow window to analyze the path process of integrating traditional music culture and music teaching. Combine the kernel function to calculate the degree of similarity between traditional music culture and music teaching. Analyze the students’ preference for traditional music culture content in music teaching by calculating the traditional music theme preference value. The results show that music teaching that incorporates traditional music culture has a better diffusion effect on teaching content, teaching method and teaching form, with the diffusion degree in the interval of [0.45, 0.85), and the diffusion degree interval of teaching information that does not incorporate traditional music culture is in the interval of [0.25,0.35). This study contributes to the integration of traditional music culture and music teaching to a certain extent and enhances the effect of music teaching in colleges and universities.
... The items that were considered for inclusion in the optional module of predictive factors are described in Table 2. We also included a question related to the perceived risk factors, like other authors [15,16,29,76], since ...
We aim to present the first psychometric evaluation of the Performance-related Pain among Musicians Questionnaire (PPAM), the first questionnaire specifically designed to evaluate performance-related pain among musicians with different musical backgrounds, based on a multicenter validation study. The psychometric evaluation was performed in a validation sample of 458 musicians, at baseline and after seven days. We assessed the applicability, reliability, internal consistency, construct validity and factor structure of the PPAM. The Cronbach's α coefficients for the three subdimensions of PPAM - "pain intensity", "pain interference in general" and "pain interference in performance" - were 0.834, 0.864, and 0.930, respectively, suggesting a high degree of internal consistency. Test-retest reliability coefficients were substantial for all subscales of the PPAM Questionnaire. Exploratory factor analysis indicated a three-factor structure (pain intensity, interference in general activities and interference in performance) that explained 62% of the variance. Both convergent and divergent validity were well demonstrated, confirming more than 95% of the previously defined hypotheses regarding correlations with other measures. PPAM is the first validated questionnaire to evaluate pain among musicians with different musical backgrounds. This online self-reported questionnaire is a valid and reliable tool suitable for both clinical research and clinical practice, with excellent psychometric properties, both in terms of internal consistency, test-retest reliability, factor analysis, and construct validity. It will allow the development of more robust studies on pain and disability among musicians, comparative studies between different subgroups of musicians and the evaluation of predictive factors of pain development. PERSPECTIVE: This article presents the psychometric properties of the first questionnaire to evaluate pain among musicians (in general), the "Performance-related Pain among Musicians Questionnaire" (PPAM). This valid and reliable tool, composed by three constructs (pain intensity, interference in general activities and interference in performance), will improve the pain assessment among musicians.
... Music students in higher education acquire high levels of skills after many years of extensive practice, often from a very young age (Philippe et al., 2019). As students and later as professional musicians, they practice intensively in order to be able to perform at a professional level (Paarup et al., 2011;Wilson et al., 2014;Porter et al., 2018;Alessandri et al., 2020). Even though performing music at high professional level can be rewarding, research has shown that musicians and music students are at risk of physical and mental health problems . ...
Introduction
Music students in higher education experience health-related challenges linked to practice and performance, while an understanding of these challenges and access to resources to deal with them are required to promote the students´ health. Health literacy and health education are integral parts of health promotion and resources for health, which encompasses health-related knowledge and competence aiming to improve health. The aim of this study was to explore Norwegian music students’ perceptions and experiences of resources and challenges for health and address the following research question: What health-related challenges do music students in higher music education meet, and what health promoting resources do they need and use to deal with these challenges and promote their health?
Methods
We conducted a qualitative study including three focus group interviews with 13 music students aged between 19 and 31 years studying classical, folk, jazz or rhythmic genres from five different music departments in Norwegian universities. The Salutogenic model of health was used as theoretical framework and a few questions regarding the concept of health literacy were included in the interviews. We used thematic network analysis to analyze the data.
Results
Main health challenges were related to performance pressure and difficulties implementing good health habits in the students` daily lives. Furthermore, the findings revealed several resources that promoted the students’ health: (1) Personal resources included situational understanding, using adequate coping strategies, high motivation and participating in regular physical activity. (2) Social resources involved an understanding of the importance of social support from peers and teachers and synergy created between themselves and the audience through sharing of music. (3) Environmental resources were linked to access to good rehearsal rooms. The music students expressed a need for increased competence in health promoting routines during practice and performance and suggested that health-related topics should be an integrated part of education.
... The items that were considered for inclusion in the optional module of predictive factors are described in Table 2. We also included a question related to the perceived risk factors, like other authors [15,16,29,76], since ...
Aim
To develop and perform the expert’s content validation and pretesting of the first questionnaire specifically designed to evaluate performance-related pain among musicians with different backgrounds.
Methods
The development of the Performance-related Pain Among Musicians Questionnaire (PPAM) was carried out in 4 phases: (1) item generation, (2) experts’ panel evaluation and content validation (3) pretesting, and (4) conceptualization of the final version. For item generation we conducted two systematic reviews to identify the existing tools evaluating similar constructs and the predictive factors of performance-related pain. Four expert panel meetings and three pilot tests were performed, with a total of 94 musicians.
Results
From the 1154 articles initially found in the literature search, 153 were included (65 related to pain tools and 88 related to predictive factors) and a pool of 115 items were created. After expert panel evaluation and pretesting, a final self-report questionnaire was defined, comprising 33 core items to evaluate 3 constructs (pain intensity, pain interference in general activities and pain interference in performance), as well as 32 additional items (optional module – predictive factors).
Conclusions
The PPAM Questionnaire is specifically designed and validated for musicians and can be applied for all types of musicians (professional, amateur and music students), allowing the development of comparative studies between musicians. It is a new enriched tool, easy to respond and disseminate to large, multicentre, and international samples. PPAM is suitable for research and clinical practice purposes and will allow the improved assessment and monitoring of pain in this occupational context.
... Looking at the application fields of probability theory and mathematical statistics, it can be found that its main value lies in the ability to analyze the gap between things in time [19,20]. In the comparison of the development status of Chinese pop music and traditional music, the application of probability theory and mathematical statistics can intuitively analyze the differences between the two and give data explanations for subsequent predictions and experiments. ...
In real life and activities, music is everywhere. With the development of the times, Chinese pop music and traditional music have also continued to develop and present new characteristics. However, there is no fixed law in the development of music, and traditional analysis methods cannot capture the current situation of music development in time. Probability theory and mathematical statistics is a subject that studies possibility, which contains many analytical methods. To this end, the article takes the current situation of music teaching development as an example. From the perspective of probability theory and mathematical statistics, the correlation coefficient is introduced and incorporated into the analysis of the development status of popular music and traditional music. In this study, first the general methods of probability theory and mathematical statistics are analyzed, then related experiments from the mathematical level are designed, and a series of investigations are carried out. Finally, starting from the four groups of schools, teachers, parents, and students, the article raises the field of comparison from the campus to the society and focuses on comparing the comprehensive development status of Chinese popular music and traditional music. After a series of experiments and analysis, it can be concluded that the correlation between the students’ interest level and the development status of popular music reaches 7.33, and the correlation with the development status of traditional music reaches 7.61. At the same time, after analysis, it is found that most of the students prefer popular music, but they know little about Chinese traditional music. This fully shows that the comparison of the status quo of Chinese popular music and traditional music based on probability theory and mathematical statistics can intuitively describe the development status of the two, which is very important for promoting the national music and creating a good music environment.
... It can vary from carpal tunnel syndrome and different forms of arthritis (polyarthritis, periarthritis) to myositis and tendovaginitis. 3 Diseases observed in musicians usually relate to problems with hands. Today, the overexertion incidence among musicians remains quite high, and, according to some data, it can range from 76 to 85%, which means it is characteristic of almost every person involved in music as an occupation. 1 Overexertion syndrome is of particular relevance among students of music schools and universities as, during the acquisition of musical skills, the student must spend from 5 to 7 h in rehearsals, and the period of such a tight schedule can range from 5 to 11 years. ...
Background:
The aim is to analyze the structure of occupational diseases in first-third year piano students studying.
Methods:
A total sample of 300 individuals participating in the research process underwent a complete medical examination at the end of each academic year.
Results:
Among piano students, number of those distributed to special medical groups for health reasons grew from 14 to 38% (p ≤ 0.02). The incidence of diseases of the muscular system increased from 58 to 71% (p ≤ 0.05), with the sharpest rise during the transition from the second to the third year of study. Similar tendencies were obtained for the incidence of hand-related diseases-their overall frequency advanced from 17 to 23% (p ≤ 0.05). The surge of morbidity in the transition from the second to the third year of study can be attributed to the increased educational load experienced by students during this period, as they begin to practice music intensively after theoretical classes. Сorresponding measures directed at preventing occupational diseases, bettering physical education, expanding the rest intervals between piano lessons are to be taken.
Conclusions:
The research results indicate that the main occupational diseases of piano students are those related to hands and muscular system.
Impact:
The obtained data suggest that the range of diseases is likely to progress throughout the musical training. The main diseases of piano students are those related to hands and muscular system. The sharpest rise was during the transition from the 2nd to the 3rd year of study.
Introduction
repeated instrumental practice represents a risk factor for the appearance of playing-related musculoskeletal disorders (PRMD).
Aim
to compare the prevalence and characteristics of PRMD based on location, pain characteristics and number of hours of instrumental practice, in musicians who play one or more musical instruments.
Methodology
observational study conducted with music university students in Spain using a questionnaire.
Results
a total of 178 musicians (41%) played a second instrument. Musicians who played only one instrument had a slightly lower mean number of pain sites ( = 3.25, SD 1.93; = 3.44, SD 2.27). On the contrary, pain intensity ( = 2.72 points, SD 2.03; = 2.23, SD 1.78), pain interference on mood, quality of life and instrumental practice ( = 3.04 points, SD 2.29; = 2.80, SD 2.24), as well as the number of hours devoted to instrumental practice ( = 21.18 hours/week, SD 10.47; = 20.03, SD 12.54) is slightly higher in musicians playing a single instrument.
Conclusion
pain intensity is the only variable of those analysed that presents statistically significant differences when comparing musicians who play a single instrument with those who play a second instrument, being higher in mono instrumental musicians.
Objective:
: to determine the prevalence and regions of the body in which musculoskeletal injuries occur in musicians, as well as to identify risk factors related to their occurrence.
Methodology:
: A search was carried out in the Pubmed, Scopus, Web of Science and Cinahl databases for publications between 2006 and 2020. Observational studies on the prevalence of musculoskeletal injuries or their risk factors in musicians aged 18-65 years were eligible for inclusion, and the methodological quality and risk of bias were assessed.
Results:
: 31 studies on multiple instruments and 17 on individual instruments were included. Quality was rated as high in 65% of the studies. Lifetime prevalence of injuries ranged from 46-90% and current prevalence from 9-63%. The most common region of pain was the neck, being present in all instrument families. Being female is a predisposing factor to the appearance of musculoskeletal problems in musicians.
Conclusions:
: Musicians suffer frequently musculoskeletal injuries. The most common regions of the body in which these injuries occur are the neck and shoulders. Numerous risk factors were found to be predisposing to musculoskeletal injuries. We note that there are fewer studies on specific instruments.
Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction, with high hospital mortality rates ∼80 %. The incidence of cardiogenic shock among myocardial infarction patients is approximately 7 %. Cardiogenic shock patients are found that pre-existing diabetes is associated with an increased risk of cardiogenic shock and it worsens outcomes, with a longer hospital stay. Cardiogenic shock develops approximately twice as often among diabetics as among nondiabetic patients with acute myocardial infarction. Diabetes mellitus and left bundle branch block are predictors of cardiogenic shock complicating acute myocardial infarction. Except for bad prognosis, left bundle branch block can be a marker of a slowly progressing, degenerative, ischemic or non-ischemic cardiac disease, affecting not only the muscle but also the heart conduction system. Immediate diagnosis and management are required. In this article, a clinical case of acute posterior myocardial infarction complicated by complete left bundle branch block and cardiogenic shock in the patient with concomitant diabetes mellitus type 2 is demonstrated. This article emphasizes the priority of referring patients with left bundle branch block to primary percutaneous coronary intervention, usage of more specific ECG criteria for acute coronary syndrome, the role of myocardial infarction biomarker including sensitive assays for cardiac troponins, and bedside echocardiography which may improve diagnostic accuracy and result in timely intervention in such patients. This article also underlines the role of mechanical circulatory support, urgent reperfusion therapy, and strict control of glycemia in the acute phase of myocardial infarction which may contribute to clinical stability of patients with diabetes mellitus and myocardial infarction complicated by cardiogenic shock.
Key words: left bundle branch block, acute myocardial infarction, cardiogenic shock, diabetes mellitus type 2, mechanical circulatory support
Musculoskeletal symptoms, including pain, are often experienced by musicians at all levels. These symptoms may have a detrimental impact on musicians’ personal and work lives, and may also impact upon the ensembles they work within. Providing musicians with appropriate, evidence-based advice regarding pain management is therefore paramount. In this review, we aim to improve the advice given to musicians regarding playing when in pain, by answering the question ‘should musicians play in pain?’. This multidisciplinary narrative review draws upon contemporary pain science, including factors associated with poorer prognoses for those in pain, as well as the reported experiences of musicians with pain (including those who have taken time off from playing). Our current understanding of pain science provides further support for the potential for consequences related to avoiding activities due to pain. Pain is modulated by a number of neuro-immunological processes and is influenced by a range of psychosocial factors. Taking time off from playing might therefore not have any benefit. Importantly, one of the leading causes of a transition from acute to chronic pain is fear-avoidance behaviour (e.g. not playing when in pain); hence, encouraging such behaviour cannot be supported. Musicians who have taken time off from playing due to pain have experienced a range of consequences, including emotional and financial consequences. These experiences indicate that there are potential negative consequences related to taking time off from playing which need to be weighed against any benefits. We conclude that musicians should not necessarily be advised to take time off from playing to manage their pain, in keeping with current best practice for pain management. Instead, we recommend that musicians be educated on contemporary pain science and when to seek treatment from a health professional for individualised advice to reduce the burden of musicians’ pain.
Methods:
Out of 183 professional orchestra players, 101 took part in the study (55% response rate) and completed the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM).
Results:
Lifetime prevalence of PRMPs was 77.2%, 1-year prevalence was 45.5%, and point prevalence was 36.6%. Of the PRMP group, 43% reported having pain in three or more locations, most commonly the right upper limb, neck, and left forearm and elbow. However, predominant sites of PRMPs varied between instrument groups. The mean pain intensity score for the PRMP group was 12.4±7.63 (out of 40). The mean pain interference score was 15.2±12.39 (out of 50), increasing significantly with the number of reported pain locations (F=3.009, p=0.044).
Conclusion:
This study confirms that musculoskeletal complaints are common in elite professional musicians and that the use of an operational definition and a validated self-report instrument allows for more accurate and meaningful estimates of pain prevalence.
Background:
Although many musicians suffer from musculoskeletal disorders, aetiological factors are unclear.
Aims:
To systematically search for and synthesize the best available evidence on risk factors for musculoskeletal disorders in musicians.
Methods:
A database search was performed in PubMed, EMBASE, CINAHL, Pedro, OTseeker and Psychinfo. A manual search was conducted in the journals Medical Problems of Performing Artists and Psychology of Music. Studies with an objective to investigate determinants associated with playing-related musculoskeletal disorders were included. Papers were selected based on adequacy of statistical methods for the purpose of the study. Search, first screening and selection were performed by one author. Two reviewers independently performed the final selection using full-text reports. Methodological quality assessment was performed by two reviewers independently.
Results:
One case-control and 14 cross-sectional studies were included. Methodological quality was in general low. Large heterogeneity existed in study design, population, measurement of determinant and outcome and analysis techniques. Data were presented descriptively. Consistent results were found indicating that previous musculoskeletal injury, music performance anxiety, high levels of stress and being a female playing a stringed instrument seemed to be associated with more musculoskeletal disorders. Influence over or support at work, orchestra category/status, exercise behaviour and cigarette smoking seemed to be unrelated with musculoskeletal disorders. No conclusions could be made on causality, as the current data only represent cross-sectional associations.
Conclusions:
Because of lack of prospective studies, no causal relations could be identified in the aetiology of (playing-related) musculoskeletal disorders in instrumental musicians.
The protection of an athlete's health and preventing injuries and illnesses in sport are top priorities for the IOC and its Medical Commission. The IOC therefore partners with selected research centres around the world and supports research in the field of sports medicine. This has enabled the IOC to develop an international network of expert scientists and clinicians in sports injury and disease prevention research. The IOC wants to promote injury and disease prevention and the improvement of physical health of the athlete by: (1) establishing long-term research programmes on injury and disease prevention (including studies on basic epidemiology, risk factors, injury mechanisms and intervention), (2) fostering collaborative relationships with individuals, institutions and organisations to improve athletes' health, (3) implementing and collaborating with applied, ongoing and novel research and development within the framework and long-term strategy of the IOC and (4) setting up knowledge translation mechanisms to share scientific research results with the field throughout the Olympic Movement and sports community and converting these results into concrete actions to protect the health of the athletes. In 2009, the IOC also identified four research centres that had an established track record in research, educational and clinical activities to achieve these ambitions: (1) the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Australia; (2) the Sport Injury Prevention Research Centre (SIPRC), Canada; (3) the Clinical Sport and Exercise Medicine Research (CSEM), South Africa and (4) the Oslo Sports Trauma Research Center (OSTRC), Norway. This paper highlights the work carried out by these four IOC Centres of Excellence over the past 6 years and their contribution to the world of sports medicine.
Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.
Playing-related musculoskeletal disorders (PRMD) in professional musicians are common. Existing literature demonstrates that up to 86 % of musicians are affected. The aim of the study was to evaluate the frequency of musculoskeletal pain in professional orchestral musicians with regard to their instrument affiliation. Of special interest were pain intensity and its association with predictors such as gender, instrument group, age or stage fright. Professional orchestra players completed a self-report questionnaire to assess playing-related musculoskeletal pain and its frequency and intensity in various body regions on a numeric rating scale (NRS). Relative frequencies and prevalence ratios for different instrument groups were estimated. Out of 720 approached musicians, 408 were included in the sample (response rate 57 %); overall, 89.5 % had been affected by current or past playing-related musculoskeletal pain, 62.7 % reported pain in the previous 3 months, and 8.6 % reported current pain. Pain distribution and frequency varied between instrument groups. For all instrument groups, the neck was the most common pain region. About 43 % of musicians presented more than five pain regions, in particular violin players. Approximately 40 % of musicians indicated frequent or permanent pain. Average pain intensities increased from NRS 3.8 up to a range of 5.9 and 7.4 for frequent and permanent pain, respectively. Female gender and stage fright were proven to be predictors for musculoskeletal pain. Professional orchestral musicians are greatly affected by PRMD, often experiencing frequent or permanent pain, high pain levels and pain in various body regions. As PRMD might contribute considerably to performance disability, sick leave and the possibility of premature termination of a musicians' career, this study highlights the necessity for tailored therapeutic and preventive strategies in performing arts medicine.
This paper reports on the major findings from the questionnaire component of a cross-sectional survey of the musicians in Australia's eight fulltime professional symphonic and pit orchestras, focusing on performance-related musculoskeletal disorders (PRMDs).
All musician members of the orchestras participating in this project were invited to complete a self-report survey. The overall response rate was about 70% (n = 377). In addition to general health and experience questions, respondents who reported a current or previous PRMD were asked to report on a range of associated factors.
Of the participants, 84% had experienced pain or injuries that had interfered either with playing their instrument or participating in normal orchestral rehearsals and performances. Fifty percent reported having such pain or injury at the time of the survey, mostly with disorders perceived by the musicians to be work-related. Twenty-eight percent had taken at least 1 day off from work for such pain in the previous 18 months. The most common broad sites affected were the trunk (primarily the back), the right upper limb and neck, the left upper limb and neck, and the neck alone, but the relative proportions varied by instrument. Of those musicians who reported at least one episode of pain or injury in the past, less than 50% reported that they had completely recovered. The most commonly cited performance-related factors that had contributed to injury or pain all related to training and playing load (including practice and performance).
This study provides strong evidence that PRMDs are a common complaint in professional orchestral musicians and identifies a range of factors suggested as contributing to the occurrence or persistence of these disorders.
Objective: The flute is a highly popular instrument, yet little is known about the potential injury association with playing this instrument. Participants: Twenty autists from a major music training institution volunteered to participate in this project, and had played the ute for a minimum of ten years. Methods: A specically designed musicians' health questionnaire was used to determine injury rates in a group of skilled collegiate ute players majoring in music to examine self-reported perceptions of performance-related musculoskeletal disorder causation and approaches to managing these conditions. Results: All except one player reported suffering from a performance-related musculoskeletal disorder, with pain present for longer than 3 months in two thirds of this group. The most common approach by the autists was to take Alexander lessons rather than seeking health professional advice. Most attributed their symptoms to long hours of practice, poor posture and the presence of performance anxiety. Conclusions: Flautists in this sample reported high rates of performance-related musculoskeletal disorders with the majority having been present for longer than 3 months. The approach to management often did not involve consultation with a health professional qualied to diagnose musculoskeletal conditions.
Due to ergonomic exposure musicians are at risk of work-related musculoskeletal disorders in the neck, back, and upper extremities. The literature confirms musculoskeletal problems in these anatomic regions among orchestra musicians.
An explorative cross-sectional study among 441 musicians from six Danish symphony orchestras; 216 underwent a clinical examination constructed for the purpose. Prior to the examination the musicians rated their maximally perceived trouble within the last week on a scheme blinded to the examiner. Accessibility to the clinical examination differed between orchestras.
The aims were to assess the prevalence of 1) perceived symptoms within the previous week in the neck, back and limbs and of 2) clinical findings in the neck, back, and upper extremities, and 3) to investigate the co-existence of the perceived symptoms and clinical findings.
Symptoms and findings were most common in the neck, back, and shoulders. Due to a poor co-existence between self-reported symptoms and clinical findings musicians experiencing bodily trouble could not be identified through this clinical examination. Free accessibility to the examination was of major importance to participation.
In compliance with the purpose, perceived symptoms within the previous week and present clinical findings were assessed. Although both symptoms and findings were most frequent in the neck, back, and shoulders the co-existence of anatomically localized symptoms and findings was generally quite poor in this study.
Discrepancy between symptoms and findings might be caused by the participants currently attending work and therefore being relatively healthy, and the fluctuating nature of musculoskeletal problems. Furthermore from a comparison of different measuring units - self-reported symptoms being period prevalence rates and clinical findings point prevalence rates; a bias which may also be inherent in similar studies combining self-reported questionnaire data and clinical findings.
Musculoskeletal symptoms are common in the neck, back, and upper limbs amongst musicians. Playing-related musculoskeletal disorders have been found to range from 32% to 87% with a tendency for female musicians to have more problems than males. Studies of musculoskeletal problems in instrumentalists have generally involved pre-professional musicians or populations comprising musicians of different levels. The objective of this study was therefore to investigate the prevalence, duration and consequences of musculoskeletal symptoms in professional symphony orchestra musicians.
A cross-sectional questionnaire study. The study population comprised of 441 musicians from six Danish symphony orchestras; 342 (78%) completed the questionnaire.
During the last year 97% of the women and 83% of the men experienced symptoms in at least one of nine anatomic regions (neck, upper and lower back, shoulders, elbows, and hands and wrists). 86% of the women and 67% of the men experienced symptoms for more than seven days, while 63% of the women and 49% of the men had symptoms for more than 30 days. Woodwind players had a lower risk for musculoskeletal symptoms and a lower risk for the consequences. Among consequences were changed way of playing, reported by 73% of the musicians, difficulty in daily activities at home, reported by 55%, and difficulty in sleeping, reported by 49%. Their health behaviour included taking paracetamol as the most used analgesic, while physiotherapists and general practitioners were reported as the most consulted health care professionals concerning musculoskeletal problems.Results regarding symptoms in six anatomic regions were compared to results for a sample of the general Danish workforce. Symptoms were more frequent in musicians and lasted longer than in the general workforce. This applied to both genders.
Within the last year most symphony orchestra musicians experienced musculoskeletal symptoms in the neck, back or upper extremities. The symptoms impacted on their level of function in and outside work and were reflected in their health behaviour. Generally women had a higher risk than men and woodwind players a lower risk than other instrumentalists. Finally, symptoms were more frequent and lasted longer in the musicians than in the general workforce.
To develop questionnaire and physical examination instruments that could be used by researchers and clinicians to undertake a detailed baseline assessment of professional orchestral musicians.
The final instruments were based on a combination of areas of interest to the musicians, areas of interest to the investigators, evidence-based approaches, and approaches in common use and so likely to have standardised results that can be used for comparison.
The questionnaire content and length were found to be acceptable to the subjects. There did not appear to be any major problems with the subjects' interpretation of the questions. Most subjects found the physical examination protocol of suitable length, although some found it physically demanding. The multiple assessors were able to apply the protocol in a suitably standardised fashion and within an acceptably short time for use in large-scale studies.
The questionnaire and physical examination protocol should prove useful to researchers working with professional musicians and provide a sound basis for the development of similar instruments by other researchers.
Playing-related musculoskeletal disorders (PRMDs) are a recognized problem amongst instrumental musicians. Although pianists are prominent in data regarding prevalence of PRMDs, there is poor understanding of piano-specific risk factors associated with PRMDs.
To synthesize published literature on the prevalence of and risk factors associated with PRMDs in pianists.
Thirty-eight databases were searched. Eligible studies were those investigating prevalence of or risk factors associated with PRMDs in pianists, using an appropriate methodology according to a hierarchy of evidence. Information regarding study population, operational definition of PRMD, risk factors investigated, statistical tests used and outcomes was extracted and narratively synthesized for all eligible papers above an arbitrarily chosen quality score.
The literature search identified 482 citations. Fifty-two papers were ranked in a hierarchy of evidence; 12 were eligible for evaluation using a quality assessment tool. Common methodological limitations included sampling/measurement biases, inadequate reporting of reliability/validity of outcome measures, lack of operational definition of PRMD and no statistical significance testing. Prevalence rates for PRMDs in pianists varied widely (26-93%). Four authors demonstrated statistically significant risk factors; however, no authors combined a clear operational definition of PRMD with statistically established risk factors. There was no consensus between authors regarding risk factors.
Current evidence does not provide sufficient information regarding prevalence of and risk factors associated with PRMDs in pianists. Future studies should provide an operational definition of PRMD, use valid, reliable measurement tools, utilize a prospective cohort study design and perform appropriate statistical tests.
Musicians activate their muscles in different patterns, depending on their posture, the instrument being played, and their experience level. Bipolar surface electrodes have been used in the past to monitor such activity, but this method is highly sensitive to the location of the electrode pair. In this work, the spatial distribution of surface EMG (sEMG) of the right trapezius and right and left erector spinae muscles were studied in 16 violin players and 11 cello players. Musicians played their instrument one string at a time in sitting position with/without backrest support. A 64 sEMG electrode (16x4) grid, 10mm inter-electrode distance (IED), was placed over the middle and lower trapezius (MT and LT) of the bowing arm. Two 16x2 electrode grids (IED=10mm) were placed on the left and right erector spinae muscles. Subjects played each of the four strings of the instrument either in large (1bow/s) or detaché tip/tail (8bows/s) bowing in two sessions (two days). In each of two days, measurements were repeated after half an hour of exercise to see the effect of exercise on the muscle activity and signal stability. A “muscle activity index” (MAI) was defined as the spatial average of the segmented active region of the RMS map. Spatial maps were automatically segmented using the watershed algorithm and thresholding. Results showed that, for violin players, sliding the bow upward from the tip toward the tail results in a higher MAI for the trapezius muscle than a downward bow. On the contrary, in cello players, higher MAI is produced in the tail to tip movement. For both instruments, an increasing MAI in the trapezius was observed as the string position became increasingly lateral, from string 1 (most medial) toward string 4 (most lateral). Half an hour of performance did not cause significant differences between the signal quality and the MAI values measured before and after the exercise. The MAI of the left and right erector spinae was smaller in the case of backrest support, especially for violin players. Back muscles of violin and cello players were activated asymmetrically, specifically in fast movements (detaché tip/tail). These findings demonstrate the sensitivity and stability of the technique and justify more extensive investigation following this proof of concept.
Objective: This study aimed to systematically evaluate the available evidence on risk factors for professional instrumentalists' developing musculoskeletal (MSK) disorders. Methods: Relevant studies were identified by a search of MEDLINE, CINAHL, EMBASE, a manual search of Medical Problems of Performing Artists, and a search of the Performing Arts Medicine Association's online bibliography. Two independent reviewers assessed the methodologic quality of the selected publications using a standardized checklist. The studies' sample characteristics, findings, and quality scores were presented in an evidence table. Results: Two case,control studies and 6 cross-sectional survey designs were included in this review. The median method-score was 61%. Potential risk factors associated with developing MSK complaints included gender, years of playing experience, type of instrument played, playing related physical (long hours, over, practicing) and psychological stressors (self-pressure/academic), lack of preventive wellness behaviours (taking breaks), and previous trauma. The high degree of methodological (including sample profile) heterogeneity among the studies impeded statistical pooling of relative effect sizes such as odds ratios. Conclusion: The etiology of MSK conditions in instrumental musicians is multifactorial; however, because the majority of research designs were of a cross-sectional Survey nature, a temporal relationship between risk factors and the onset of MSK complaints Could not be established. Additional case control studies should be conducted to reveal the most relevant confounding factors, such as exposure to physical stressors during leisure time, the psychosocial environment, and musical work load. Longer-term studies should then focus on more accurately quantifying the degree of risk associated with these risk factors.
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.
This study examined the medical problems, especially of the hand and upper extremity, observed in wind instrument players from the military bands of the Japan Self-Defense Forces. The bands included 235 wind instrument players (184 men, 51 women), whose ages ranged from 18 to 57 yrs (average, 35 yrs). The length of their careers ranged from 6 to 41 yrs (average, 21 yrs). Methods: A questionnaire was distributed to the subjects for the health check. Results: From 235 wind instrument players, 71 (30% of the total players, 27% of the male players, and 41% of the female players) had hand and upper extremity problems. No relationship between the problem and the age or length of career was observed. The most common complaints were pain (49%), stiffness (19%), and numbness (7%). The upper extremities accounted for 52% of the affected sites and included the shoulder (6%), elbow (11%), forearm (4%), wrist (31%) and digit (47%). Musicians who played the flute, oboe, or clarinet were most commonly affected. The right thumb pain of clarinet and oboe players and right wrist pain of French horn players were characteristic symptoms of these instruments. Conclusion: Physicians, musicians, and administrators should be conscious of the potential for musicians to develop a wide array of physical problems directly related to the repeated use of their musical instruments.
Performance-related musculoskeletal disorders (PRMDs) are a frequent reality for practicing musicians. Many aspects of the bassoon make these players particularly susceptible to PRMDs, yet to date no study investigating PRMDs has been conducted solely in the bassoon community. The purpose of this study was to identify PRMD symptoms experienced among bassoon players, ascertain the most affected areas, and identify treatments used. Information was gathered using the International Bassoonist Questionnaire, a web-based survey designed by the author. Eighty-six percent of participants (n = 166) reported PRMDs. Pain was the most common PRMD symptom reported (78%). Thirty-one percent of bassoon players reported a medically diagnosed condition, with tendinitis being the most common diagnosis (54%). Bassoonists experienced multiple PRMD symptoms and reported numerous affected locations. PRMDs were most frequently reported in the arms and wrists (54%), and the left side had more PRMDs than the right side. Despite the number of treatment options available, bassoon players primarily used self-administered treatment, with only 31% consulting a medical doctor. Rest was the most common self-applied treatment (60%).
Playing-related musculoskeletal disorders (PRMDs) as they affect the Irish traditional music community is a topic which, to date, has received scant attention. This paper draws on data generated through a series of four focus group interview studies conducted at the Universities of Ulster and Limerick and involving 22 musicians. Specifically, this paper looks at the wider issue of identity within the Irish traditional music community and at how the complexities inherent in this have, perhaps, affected musicians in recognizing, relating to, and dealing with PRMDs. Whether or not the injuries affecting Irish traditional musicians are similar to or different from what other musicians experience, what this study shows is that the sense of self and discrete identity among the Irish traditional music community is so very strong that merely a "one size fits all" approach to addressing these issues is not likely to yield positive results. Health professionals therefore need to be sensitive to such factors when considering their management of PRMDs and to develop approaches along with the traditional music community that are cognisant of their identity as well as their needs.
Objective: To establish the types of injuries suffered by musicians. Data were analysed with descriptive statistics and displayed using graphs and tables. Methodology: An anonymous, retrospective questionnaire covering aspects of lifestyle and musical habits was distributed to 107 musicians. Sixty-two questionnaires were returned (58% response rate). Results: Of the returned questionnaires, 59 were usable. There was an age range of 16–72 years. Thirty-one were teachers, with all but 1 using either verbal or visual postural advice. Of the total population, 70% had suffered an instrument-related injury, with one third of these unable to play for a period of time. Females (72%) and string players (77%) showed a higher preponderance. Professional teachers (57%) harboured the majority of injuries. There were no injured amateurs. The homunculi drawing revealed the posterior left shoulder and upper thoracic spine to be the most prevalent site for pain and discomfort during and after playing. Hands and wrists were relatively unaffected. Conclusion: There is a high rate of injury to professional classical musicians and teachers that can be disruptive to practice and potentially threatening top careers. Females and string players were discovered to be of particular risk. The majority of injuries were to the shoulder and proximal thoracic spine and the absence of injuries in amateur players suggests a relationship to overuse. The author suggests that the incorporation of postural and ergonomic into musical education and chiropractic treatment programmes for classical musicians and teachers could be of benefit.
Playing-related musculoskeletal disorders (PRMDs) are common in musicians and interfere with the ability to play an instrument at the accustomed level. There is limited research into injuries affecting folk musicians.
To explore the Irish traditional musicians' experience of PRMDs.
Focus group interviews were conducted in 2011 and 2012, in two venues in Ireland. Data were recorded and transcribed verbatim. Data collection ended when no new findings emerged from the analysis of interviews. The inclusion criteria were: males or females aged 18 and above, and who taught or played Irish traditional music on any instrument. The data were analysed using the interpretative phenomenological method.
All participants (n=22) believed there was a link between playing music and musculoskeletal problems. The main body areas affected were the back, shoulders, arms and hands. The main theme that emerged was: 'PRMDs are an integral part of being a traditional musician', and that the musical experience was generally prioritised over the health of the musician. There were sub-themes of 'fear' and 'stresses that contributed to PRMDs'.
PRMDs are an occupational hazard for traditional Irish musicians. There is an awareness of PRMDs, but changes (technique, environment) may threaten identity.
Instrumentalists are at risk to develop upper-body musculoskeletal problems (MSKPs). Identified risk factors include age, gender, instrument played, joint laxity, and poor technique or posture. In this study, we established the prevalence of MSKPs that affect the ability to play an instrument in the population of a professional-level symphonic orchestra and the relation of these problems to gender, age, and instrument. The members of the Puerto Rico Symphony Orchestra were recruited voluntarily. A questionnaire was used to obtain information on demographics, instrument played, and history of MSKP severe enough to affect their playing ability. Questions also covered alleviating and aggravating factors, upper-body areas involved, type of symptoms, and type of treatment sought. After the questionnaire was completed, all players underwent a neuromusculoskeletal upper-body examination. Of the 75 musicians participating, 81.3% reported having had an MSKP that affected their ability to play. Of these, 83.6% reported their MSKP was directly associated to playing. Females were more commonly affected, 87.5% vs. 79.7% for males. Lower-body strings (cello, bass) players and percussionists (93.3% and 100%, respectively) and younger (22-29 yrs) and older (50-61 yrs) populations (83.3% and 90.9%, respectively) reported more MSKPs. These age groups played more hours per week (28.7 and 32.0 hrs, respectively). In all groups, low back pain was the most common complaint, present in 75.4% of those with MSKPs. Upperbody strings (violin, viola) players also reported neck and left shoulder problems. Contributing factors include hours of exposure and technical expertise. Female gender, age, and instrument played were found to be risk factors for developing MSKPs in this population.
Computer pointing devices such as the mouse are widely used. Despite this, the relationship between musculoskeletal symptoms and mouse use has not been established. The aim of this cross-sectional study was to determine whether a relationship existed between computer mouse use and musculoskeletal symptoms in a sample of 270 computer mouse users. Factors demonstrating a significant association with symptoms were entered into a step-wise multiple logistic regression, adjusting for age and sex and controlling for potential interdependence between variables. No relationship was found between hours of mouse use per day and reported symptoms. A relationship was found between the variable of arm abduction which is specific to mouse use and symptoms in the neck. Relationships were found between non-mouse-specific risk factors such as stress, screen height and shoulder elevation. The findings of this study support the hypothesis that mouse use may contribute to musculoskeletal injury of the neck and upper extremity. Mouse users are exposed to the same recognised risk factors associated with keyboard use as well as the additional risk factor of arm abduction during mouse use.Relevance to industryComputer keyboard use has been associated with musculoskeletal injuries. Most people now use a pointing device such as the mouse to supplement the computer keyboard. Additional risk factors related to mouse use have the potential to increase prevalence of computer-related injuries.
Several articles in this issue touch on some of the more athletic components of the performing arts. The article by Twitchett et al. describes fitness aspects of ballet, Gabrilo et al. discuss lung function in synchronized swimmers, and we also learn about how one flutist prepared for a very difficult piece by exercising (and practicing) in the letter by Borkowski. Of course, these are not the first articles in MPPA that look at performers as individuals who call on a variety of physical skills to create an artistic performance; examples of studies looking at both dancers and musicians dating back nearly a decade or more are easy to find. And this column has drawn on certain concepts borrowed from the world of sports medicine on more than one occasion. The connection between performing arts medicine and sports medicine is mentioned early on by Dr. Brandfonbrener in the new edition of Performing Arts Medicine. In this editorial I outline some of the similarities and differences between performing artists and athletes in an attempt to highlight opportunities for improving the health of performing artists in the future.
This study investigated the effects of fatigue on performance quality induced by a prolonged musical performance. Ten participants prepared 10 min of repertoire for their chosen wind instrument that they played three times consecutively. Prior to the performance and within short breaks between performances, researchers collected heart rate, respiratory rate, blood pressure, blood lactate concentration, rating of perceived exertion (RPE), and rating of anxiety. All performances were audio recorded and later analysed for performance errors. Reliability in assessing performance errors was assessed by typical error of measure (TEM) of 15 repeat performances. Results indicate all markers of physical stress significantly increased by a moderate to large amount (4.6 to 62.2%; d = 0.50 to 1.54) once the performance began, while heart rate, respirations, and RPE continued to rise by a small to large amount (4.9 to 23.5%; d = 0.28 to 0.93) with each performance. Observed changes in performance between performances were well in excess of the TEM of 7.4%. There was a significant small (21%, d = 0.43) decrease in errors after the first performance; after the second performance, there was a significant large increase (70.4%, d = 1.14). The initial increase in physiological stress with corresponding decrease in errors after the first performance likely indicates "warming up," while the continued increase in markers of physical stress with dramatic decrement in performance quality likely indicates fatigue. Musicians may consider the relevance of physical fitness to maintaining performance quality over the duration of a performance.
A number of neurological abnormalities associated with the playing of musical instruments have been described which can cause great difficulty for performers. However, there has been no attempt to consider this in an Irish context, a cultural setting which encompasses an unusual range of playing styles and musical instruments. We performed a retrospective assessment of musicians referred to our service for neurophysiological testing. In this series of 17 musicians, most (59%) had more than one abnormality on testing. We discovered fifteen cases of carpal tunnel syndrome, eleven cases of ulnar neuropathy, and four cases of focal dystonia. Compared to previously published reports, our series contains a greater proportion of amateur musicians, a group not well studied in the literature.
Stretching exercises are either performed alone or with other exercises as part of the athlete's warm-up. The warm-up is designed to increased muscle/tendon suppleness, stimulate blood flow to the periphery, increase body temperature, and enhance free, coordinated movement. The purpose of this paper is to review the literature regarding stretching, with the aim of defining its role during the warm-up. Implications of stretching on muscle/tendon flexibility, minimizing injury, enhancing athletic performance, and generally preparing the athlete for exercise are discussed. Physiology applied to stretching is also discussed together with different related techniques and practical aspects. A proposed model stretching regime is presented based on the literature reviewed.
Work-related musculoskeletal disorders cause pain, disability and loss of employment for many workers, including musicians. Although performing arts medicine is a growing field, the health problems of musicians remain under-recognized and under-researched. Therefore, the author undertook a systematic review of published information on the incidence and prevalence of playing-related musculoskeletal disorders (PRMDs) in classical musicians.
Seven databases were searched for the period 1980 to 1996. The main textbook and performing arts medicine journals were searched manually, as were reference lists of all relevant papers. The author also contacted individuals familiar with the literature of performing arts medicine. Studies were included for review if they reported PRMD incidence or prevalence in classical musicians. Of the 24 studies identified, 18 cross-sectional surveys and cohort studies were reviewed. The author subjectively assessed the studies using criteria modified from an existing evaluation scale and used 4 criteria for data combination. On the basis of prevalence values from the eligible studies, chi 2 tests for heterogeneity were performed.
Only one study estimated PRMD incidence. Ten of the 17 prevalence studies were ineligible for data combination, because of low response rates and other methodological problems. In the 7 eligible studies, PRMD point prevalence ranged from 39% to 87% in adult musicians and from 34% to 62% in secondary school music students. The best estimates of PRMD prevalence were derived from the 3 studies that excluded mild complaints; these studies indicated that PRMD prevalence was 39% and 47% in adults and 17% in secondary school music students respectively. Statistical combination of data across studies within each demographic category was not possible.
Available data indicate that the prevalence of PRMD in adult classical musicians is comparable to the prevalence of work-related musculoskeletal disorders reported for other occupational groups. Several recommendations for future research are outlined.
To examine the reliability and validity of a new outcome measure, the Upper Body Musculoskeletal Assessment (UBMA).
Twenty subjects physician-diagnosed as having work-related musculoskeletal disorders (WRMD) and ten healthy subjects were assessed using the UBMA on three separate occasions. All subjects with WRMD attributed their injury to equipment use on their job.
The WRMD group had significantly higher UBMA scores on the side of equipment use than on the other side (p <0.01), whereas the healthy group had similar scores on both sides (p> 0.05). UBMA scores for the WRMD group were significantly greater on both sides of the body than scores for the healthy group (p<0.01). Only one test occasion was required to produce excellent reliability coefficients (ICCs>0.88). Although group reliability was excellent, changes of 24% for patients with WRMD and 44% for healthy subjects would be required for confidence that UBMA scores for individual patients on the side of equipment use had changed from baseline.
Although testing on one occasion produced reliable UBMA scores, healthy subjects could be distinguished from patients with WRMD, and the side of equipment use could be distinguished from the other side in patients with WRMD, prediction of individual UBMA scores was poor. In its present form, the UBMA is useful for making decisions about groups but not about individual patients. Modifications of the current UBMA are required to reduce measurement error.
RULA (rapid upper limb assessment) is a survey method developed for use in ergonomics investigations of workplaces where work-related upper limb disorders are reported. This tool requires no special equipment in providing a quick assessment of the postures of the neck, trunk and upper limbs along with muscle function and the external loads experienced by the body. A coding system is used to generate an action list which indicates the level of intervention required to reduce the risks of injury due to physical loading on the operator. It is of particular assistance in fulfilling the assessment requirements of both the European Community Directive (90/270/EEC) on the minimum safety and health requirements for work with display screen equipment and the UK Guidelines on the prevention of work-related upper limb disorders.
Unlabelled:
The aim was to determine the incidence of tinnitus, impaired hearing and musculoskeletal disorders among musicians and the relation to the number of practicing hours and/or the instrument type before the onset of symptoms.
Method:
The study base consisted of students enrolled in the School of Music and Music Education at Göteborg University between the years 1980 and 1995. There were 407 of the 602 original students that answered a questionnaire (response rate of 68%). The questionnaire concerned exposure before and after the enrollment in the Music Academy, as well as onset of symptoms.
Results:
The highest incidence of symptoms was found for reported tinnitus with a rate of 10.6 per 1000 years of instrumental practice. There was a relationship between exposure to the number of hours of instrumental practice and incidence of impaired hearing. Among the musculoskeletal symptoms the highest incidences per 1000 years of instrumental practice were pain in the neck and in the left shoulder with a rate of 4.4 and 4.6 disorders per 1000 years of instrumental practice, respectively. There was 2.4 times higher incidence for musculoskeletal disorders in the right hand/wrist and a 2.2 times higher incidence in the left elbow/forearm for musicians who practiced for 20 h or more per week before the onset of disorders compared to those who practiced fewer than 20 h per week when controlling for age and gender. Musicians with a violin or a viola as the main instrument had four times the incidence for right elbow/forearm disorder and twice the incidence of neck pain, pain in the right shoulder and the left elbow/forearm compared to those who had piano as the main instrument.
Musculoskeletal injuries in musicians range from common repetitive stress injuries to unusual, sometimes career‐ending disorders. Here's how to help the patient return to making music.
It's not like I can just stop': the lived experience of pain in Irish traditional fiddlers
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