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Ergonomics in violin and piano playing: A systematic review
Abstract
This systematic review aimed to evaluate whether muscle activity and playing-related musculoskeletal disorders are associated with musicians’ anthropometrics and their instrument size or set-up during violin and piano performance. Studies were retrieved systematically from six databases on 1 April 2019 combined with hand searching results. The Appraisal tool for Cross-Sectional Studies (AXIS tool) was used to evaluate the methodological quality of the included papers. A total of twenty articles were identified. Most included studies focussed on either the adjustment of the shoulder rest in violinists, or the hand size in pianists. However, methodological quality was inconsistent. The electromyography data reported by the included studies were not appropriately processed and interpreted. Studies generally reported the use of a shoulder rest changes muscle activity and smaller hand size is correlated to increased playing-related musculoskeletal disorders incidence. However, no conclusions can be drawn due to heterogeneity and low quality of methodology in the available literature.
... Since the beginning of the 20th century, Chinese piano has gone through a course of more than one hundred years; under the promotion of the older generation of musicians, the creation, education and performance of Chinese piano music have been able to develop greatly [1][2]. Especially in the middle and late 20th century, a large number of excellent piano performing artists and educators have emerged, and some excellent pianists and piano works with unique Chinese styles have gone to the world, enriching the world's piano art treasury while also setting off a Chinese piano boom [3][4]. ...
... The gesture movement's characteristics are most accurately represented by the direction of finger movement's velocity. For this reason the normalized combined velocity vector of the fingers is first found according to (3). ...
... From the following evaluation results of different fingering sequences, the total score and score rate of standard fingering sequences are very high, and the cumulative scores are in the interval of [3,42], which shows a stable upward trend with less fluctuation. The trend of the score rate fluctuates slightly but remains stable after the key sequence number 4, with a scoring rate above 0.8. ...
The practical area of “piano performance” is one of the core areas in the piano classroom, and performance skills need to be applied in the practical area of “piano performance”. In this paper, the Leap Motion algorithm is used to extract the piano gesture movements, and the frame-by-frame processing is performed to encode the velocity direction of the fingers during the piano performance. Probabilistic predictions for forward and backward algorithmic sequences of fingers during playing are generated by using the HMM algorithm. To improve piano fingering automatic labeling, we propose combining the HMM algorithm with the judgment HMM algorithm and the Viterbi improvement algorithm for prioritizing piano fingering knowledge. The quantitative evaluation system for piano performance fingering is established to evaluate fingering in piano performance and check the performance scoring of the piano. The selection process included selecting three music clips that had a scoring rate above 0.8764, a gap between them that was not more than 0.06, and superior piano fingering generation quality. In the pre-post performance scoring of each dimension, the performer’s overall performance of the work on the overall appearance of the highest score, the highest score reached 84, the average score of 72.565, the piano performance of the follow-up effect is better. The assisted piano performance practice through digital technology helps piano players improve their performance skills and provides theoretical and practical references for the exploration of piano performance.
... Since these two devices were invented, there has been much practical trial and error and discussion about how to use them to achieve an aligned working posture with less tension (Norris, 1993). Scientific evidence about how best to adjust either one remains scarce, and the methodological quality of the available studies is inconsistent (Chi et al., 2020). ...
... However, they suggested that a higher chinrest may result in lower muscle activity in the left arm and decreased left rotation and lateral flexion of the head (Kok et al., 2019). These prior studies did not include either a familiarisation period or adjustments to the individual players' anthropometrics (Chi et al., 2020). Likewise, no previous study has investigated the biomechanical changes when violinists use their usual setup compared with an attempt to improve ergonomics. ...
... This study is one of the most extensive studies conducted on a homogenous group of pain-free professional violinists compared with other research (Chi et al., 2020;Rensing et al., 2018;Schemmann et al., 2018). The standardised protocol was tested for feasibility, and the robust crossover design allowed the participants to be their own controls (Wellek and Blettner, 2012). ...
This study aimed to compare violinists' upper body kinematics and muscle activity while playing with different supportive equipment: their usual chinrest (UC) or an ergonomic chinrest (EC), each mounted on the violin. Three-dimensional motion capture and electromyographic data were acquired from the upper body while 38 pain-free professional violinists performed an excerpt of a music piece. There were only minor differences between the two set-ups tested. The EC resulted in less left rotation of the head (3.3°), slightly more neck extension (1.3°) and less muscle activity (0.5-1.0 %MVE). However, the overall high static muscle activity (4-10 %MVE across all muscles) was maintained using EC. For both setups, the head posture was left-rotated >15°, ≤6° flexed and left-bent 90% of the time. The EC did not produce a substantial difference in biomechanical load. Instead, future studies may focus on aspects other than chinrest design to lower the static workload demands.
... Zusätzlich bedingen Streichinstrumente eine spezielle körperliche Haltung und bestimmte Bewegungsabläufe, um die perfekte Klangqualität und Ausdruckskraft zu erreichen [4][5][6], wobei die Hohen und Tiefen Streicher beim Spielen verschiedene Körperhaltungen einnehmen. Aufgrund der Dauer der Übungs-, Proben-und Einsatzzeiten und der repetitiven Natur der Streichbewegungen sind Streichmusiker einem erhöhten Risiko für arbeitsbedingte Erkrankungen und Berufskrankheiten ausgesetzt [7,8]. Die repetitiven Bewegungen beim Spielen eines Instruments können zu Überlastungen von Sehnen und Gelenken führen. ...
... Das Verständnis für die Auswirkungen auf den Körper und die Feinmotorik von Händen und Fingern ist nach wie vor ein unerforschtes Gebiet [3]. So zeigen die Ergebnisse eines systematischen Reviews, dass eine kleinere Handgröße mit einer erhöhten Inzidenz spielbedingter Muskel-Skelett-Erkrankungen korreliert [7]. Die weiteren Faktoren, die bei der Entstehung dieser Störungen eine Rolle spielen, sind Asymmetrie und Ungleichgewicht im Bewegungsapparat, Muskel-Knochen-Gelenk-Interaktionen, wiederholte Überlastung und Müdigkeit [18]. ...
Zusammenfassung
Einleitung
Berufsmusiker sind aufgrund ihrer körperlichen Belastungen durch mehrstündiges Üben, Proben und Aufführungen einem erhöhten Risiko für gesundheitliche Beschwerden ausgesetzt. Die daraus resultierenden negativen Beanspruchungen können die Lebensqualität beeinträchtigen. Ziel war es, die arm- und handspezifischen Beanspruchungen von Streichern zu untersuchen.
Methoden
Von 2016 bis 2018 wurde eine prospektive Querschnittsstudie mit 60 Streichmusikern und Akademisten (43,9 ± 13,1 Jahre alt; 61,7 % Männer) aus 6 deutschen Orchestern durchgeführt. Die Belastungen und Beanspruchungen wurden mithilfe eines Fragebogenkatalogs zu soziodemografischen Daten, beruflicher Situation, sportlichen Aktivitäten sowie zur allgemeinen Gesundheit, Gesundheitsmaßnahmen, Handbelastung und handspezifischen Beschwerden (Michigan Hand Outcome Questionnaire, MHQ), Schmerzbewältigung (Fragebogen zu Schmerzverhalten) und zum angstbedingten Vermeidungsverhalten (Fear Avoidance Belief Questionnaire, FABQ) nach Instrumentenart analysiert.
Ergebnisse
Chronische Verspannungen im Schulter- und Nackenbereich wurden bei 34,8 % der Violinisten festgestellt, während 52,2 % unter akuten Schulterschmerzen litten. Die Hälfte bzw. ein Drittel von Kontrabassisten gaben an, an einer akuten bzw. chronischen Sehnenentzündung zu leiden. Die durchschnittliche Gesamtpunktzahl im MHQ lag bei 56 (eine mittlere Handbelastung). Violinisten berichteten signifikant häufiger von Nackenverspannungen und Schulterschmerzen, während Kontrabassisten und Cellisten vermehrt über Probleme im Handgelenk und den Daumen klagten. Sieben Musiker wiesen im FABQ aufgrund von Schmerzen ein erhöhtes Chronifizierungsrisiko durch Vermeidungshaltung auf.
Diskussion
Die Ergebnisse unterstreichen die erheblichen instrumentenartspezifischen Belastungen und verdeutlichen die Notwendigkeit von präventiven Maßnahmen, um die langfristige Gesundheit und Arbeitsfähigkeit zu sichern.
... Chin rest and shoulder rest modifications in upper strings, reduced size instruments, lighter tension strings in both bowed and plucked stringed instruments, lighter action keyboards and ergonomic supports are reasonable adjustments for increased comfort in musicians. Unfortunately, study heterogeneity and low-quality methodology limits concrete conclusions regarding musician anthropometrics, instrument size, set-up/modification, and impact on muscle activity and PRMD [14]. The degree of impact of pain on playing may be associated with anatomical site involved in addition to severity and frequency of pain [15,43]. ...
... A study among contemporary dance students aged 16-25 years found that 24% of the variance in a substantial injury group was explained through a multivariate model, identifying higher BMI (> 25), younger age (mean: 19.2 ± 1.5 years), and lower total coping score as risk factors [53]. Most recently, Critchley reported positive scores on left-sided one [12][13][14][15][16][17][18][19][20] and dancers by genre [21][22][23][24][25][26] leg standing, unipedal dynamic balance, and years training as protective effects in pre-professional ballet dancers [54]. ...
Purpose of Review
Performing artist-athletes have high levels of physical and mental demands with different rewards and movements when compared to sport athletes. This overview of current literature will explore the epidemiology of performance-related pain and injury in instrumentalists and dancers and highlights special considerations for artist care.
Recent Findings
High injury prevalence rates persist among performing artist-athletes. Overuse is a common mechanism of injury; however, knowledge gaps exist in the assessment and management of load and fatigue in this population. Among instrumentalists, emerging evidence associates pain patterns with posture, interference on performance, and psychosocial factors. High-intensity interval cross-training and neuromuscular warm-up may best prepare dancers for rehearsal and performance demands, as evidence suggests dance class is inadequate for cardiorespiratory fitness.
Summary
There is uncertainty in the understanding of performing artist-athlete injury and pain. While more robust prospective research is needed for conclusive findings, the use of sports medicine and exercise physiology principles, in collaboration with teachers and artistic staff, may best inform warm-up/cool-down programs and load management strategies in the performing artist-athlete.
... Studies indicate that professional musicians constitute a high-risk group for musculoskeletal disorders, with lifetime prevalence rates of injuries ranging from 46% to 90% and current prevalence rates from 9% to 63% (Rodríguez-Gude et al., 2023). Inadequate instrument set-ups and sizes that do not align with the performer's physical attributes are often mentioned as a contributing factor to the development of playing-related musculoskeletal disorders (PRMD) (Chi et al., 2020). Given these alarmingly high rates of injury and pain, it is crucial to understand how to reduce the risk of PRMD during instrument playing.The compatibility of instruments with human physical abilities and characteristics is a key principle in ergonomics, particularly in traditional musical instruments, physiological adaptability is easy to overlook. ...
This study focuses on additive manufacturing (AM) to remodel an ergonomically optimized Leiqin leg rest. To address the design deficiencies of traditional leg rests regarding playing comfort and stability, iterative optimization techniques were employed alongside the Theory of Inventive Problem Solving (TRIZ). Photosensitive resin material was chosen, and a parametric modeling approach was utilized to accurately construct the leg rest model, resulting in the successful development of a double-layer rotating arc-shaped leg rest. Systematic acoustic testing and semi-structured interviews with ten Leiqin players were subsequently conducted for evaluation. The results indicated that the redesigned leg rest significantly outperformed traditional designs in terms of both comfort and stability. This study not only validates the application value of additive manufacturing in enhancing traditional musical instruments but also offers a new technological paradigm for the ergonomic design of musical instrument accessories.
... Piano in today's music performance has played an increasingly important role [13] for the majority of the audience to bring a different visual, sensory, and auditory experience, not only helps the audience listeners to improve the overall quality but also for the audience aesthetic ability to improve the role of different degrees of promotion [14][15]. Throughout the evolution and development of the piano playing method, it can be said that it has gone through tremendous changes, from the tiny finger movements playing to the application of arms as well as body weight has been greatly improved [16][17][18]. Learning the history of the evolution of piano playing techniques enables more people to understand the era and style of the piano produced from a historical perspective; as piano players, the industry's staff need to learn and respect the methods and content contained in different excellent piano works, to provide new impetus for the development of the piano career [19][20]. ...
Piano performance represents a refined artistic expression characterized by its expressive and emotive qualities. This study focuses on research papers related to piano performance indexed in the Chinese literature database, utilizing the CiteSpace visualization tool to conduct an analysis. Employing the tool’s capabilities for word frequency, thematic, and cluster analysis, we investigate the temporal and spatial distributions, key terms, research trends, and emergent themes in the literature on piano performance. This multifaceted approach enables a deeper understanding of the developmental stages and overarching trends in the field. Our findings reveal significant shifts in thematic focus and research intensity, with notable increases in themes related to the transformation of piano performance and theoretical exploration post-2017.50, achieving an impact score exceeding 0.425. Prominent emergent keywords include “piano art” (4.9948), “piano certificate” (3.8833), “style” (3.4721), “accompaniment” (3.3155), “piano technique” (2.8888), “piano teaching” (2.6997), “emotional expression” (2.6129), and “intelligence” (2.2193). These findings indicate a trend towards the integration of modern technology and intellectual approaches in piano performance. This study provides a comprehensive overview of the evolution and current trends in piano performance research, offering insights into its future trajectory.
... However, music as an art subject, the implementation of traditional teaching has great limitations in the implementation of music teaching conditions. Music teaching not only needs to invest in a large number of music equipment and music equipment, but also needs to specialize in music teachers and teaching places, which undoubtedly limits the popularity of music teaching and promotion [3]. In recent years, computer technology and multimedia technology in the field of music have continued to deepen so that music teaching in specific conditions is no longer limited to the hardware environment, which provides an opportunity for the popularization and promotion of music teaching [4]. ...
With the advancement of contemporary technology, there is an increasing demand for sophisticated tone libraries in intelligent and digital pianos. This paper introduces a virtual piano system based on timbre simulation. Drawing upon the articulation principles of the piano, a mathematical model is formulated to derive the equation governing string vibrations. This equation facilitates a comprehensive analysis of the components constituting piano timbre and establishes a model for synthesizing these timbres using a frequency envelope algorithm. The short-time Fourier transform (STFT) is utilized to extract features from the synthesized timbre and to accomplish its digital simulation. Subsequently, the integration of the piano’s timbre features with computer programming facilitates the comprehensive design of the virtual piano system. Performance testing and evaluation of the system reveal promising results: the detection rate for each musical piece exceeds 90%, with an average detection rate of 94.81% across ten pieces and an average deviation (Mean-D) of 3.35 in the scoring of 100 music samples. This research contributes to the flexibility in timbre editing, enhances the expressiveness of intelligent and digital pianos, and aims to elevate the music industry to new heights.
... Chi, J. Y. et al. combined the AXIS tool to investigate the correlation between skeletal disorders due to muscular activity in piano players and the size setting of the piano through the literature research method. The results of the study showed a correlation between smaller hands and the prevalence of musculoskeletal disorders [10]. Campayo-Muoz, E. et al. designed a companion piano learning program for three 10-year-old piano learners. ...
In the 21st century, computer technology covers human daily life, including the field of music. This paper uses a quaternion algorithm to describe the gesture posture during piano playing. Combined with the iteratively updated and extended IU-EKF algorithm, it realizes the fusion of piano playing gestures to fix the posture. The recognized piano playing gestures are output to the chord fingering automatic annotation board, the piano audio signal data are preprocessed and input to the 3D space, the annotation area is allocated, and the chord fingering features are extracted using the Boltzmann machine. Through spectral analysis and empirical investigation, we analyze the sound quality effect of the two pianos and the audience’s listening experience. The results show that in the spectral analysis of the two pianos, the time-domain waveforms of the pianos played using the gestures proposed in this paper have durations ranging from 0.75s to 1.25s, and the waveform graphs present triangular shapes, which are better in terms of sound quality. The listeners’ melodic memory of the songs played by two pianos is the best for the two pianos of Chinese art and folk songs, Chinese art and Chinese pop, with the average difference of 5.7899 and 5.6345 respectively. The two pianos form of playing can satisfy the listener’s need of listening to the piano songs to a certain extent.
... The style and personality characteristics possessed by specific composers, performers or music literature, mostly famous figures and their works in the history of the development of Western piano art, focus on the summary of the aesthetic characteristics and artistic performance of musicians or classical works [15]. Literature [16] uses multimedia technology to realize the knowledge and skills of piano performance and analyzes the construction of an optimized competence model for skill training in piano performance teaching so that the performers play melodies with different rhythms, which helps to improve students' understanding of piano performance. ...
In this study, a new exploration of a classic problem in the field of music aesthetics was carried out through the research methods of cognitive neuroscience and the brain mechanism of the formation of artistic aesthetic value in piano performance based on the theory of multiple intelligences was analyzed. In terms of EEG signal preprocessing, an EEG signal preprocessing method based on baseline average was proposed. In terms of EEG feature extraction, a decision-level feature fusion method is proposed, which uses SVM as the base classifier to extract time-domain, frequency-domain and nonlinear features, respectively, train the base classifier, and integrate the output of multiple basic classifiers through decision fusion. A feature fusion method based on music and ERP was also proposed to predict the response of subjects after listening to a piano performance. Based on DS evidence theory, emotion recognition and classification were carried out using EEG and music features from the perspective of decision-making level fusion. The results showed that piano performance mainly activated the left inferior frontal gyrus, right precentral gyrus, left auxiliary motor area, right superior parietal gyrus, cerebellar Crus1 area, right lingual gyrus and left inferior occipital gyrus, with peak t values of 4.67, 4.8, 5.76, 5.16, 7.02, 7.12 and 8.3, respectively. The activation of auxiliary motor areas, cerebellum, inferior frontal gyrus and other areas indicates that the artistic beauty felt by listening to piano performance can enhance people’s creativity, and the activation of the right superior occipital gyrus can enhance people’s imagination.
... In the process of piano practice, it should mainly focus on several aspects such as pedal use, practice techniques and body skills, and then through repeated training from unfamiliar to familiar, mastering the basic skills of piano playing and transforming the playing process from technical to artistic, only in this way can practice making skill and skill make perfect [3][4]. In addition, it is necessary to cultivate the musical expression of the performer on this basis so that the performer has good physical and mental qualities in the process of playing so that he or she can skillfully play all the techniques of playing, proceed in the process of playing in an orderly manner and present the work perfectly to the audience [5][6]. Learners should be good at observing the playing techniques carefully when practicing piano and should not easily let go of any arc, detail or note in the process of playing, and at the same time must understand the meaning of each note during the performance, remember the position occupied by the phrase and divide the memory in a targeted way, which is the key and difficult point when practicing piano [7][8]. ...
The current hotspots of empirical analysis of piano performance skills mainly focus on the recognition of single notes, and there are some limitations in recognition accuracy and noise resistance performance. In this paper, to address this problem, firstly, on the basis of big data, we propose to realize the segmentation of the music section and noise section based on the single-port limit energy difference method and perform note onset and stop detection for the music section based on LMS adaptive filtering algorithm, using the musical characteristics of piano to identify the energy jumping point, which effectively improves the accuracy of note onset and stop detection and avoids the situation of missing and wrong diagnosis. Then the piano piece was played as an example, and the scientific evaluation of the piano performance skills was made based on the results of the determination of note types. The results showed that the errors of the eight notes of the piece were 0.9%, 0.30%, 0.24%, 0.28%, 0.34%, 0.11%, 0.63% and 0.28%. The correct rate of determining the types of notes in the performance technique of the music was 100%, and the error of determining all notes was controlled within 1%. This study provides a reference standard for evaluating the quality of music performance and has broad application prospects in the fields of family leisure, music tutoring, etc.
... Such studies are valuable for assessing the health status of elite swimmers' upper limbs, highlighting specific risks that require attention, and providing information for targeted interventions aimed at preventing EP [1,5,10,11]. However, the majority of studies in the existing literature have primarily focused on exploring the relationship between the anthropometric variables of EP athletes (such as height, weight, gender, and forearm length) and their sports performance, as well as the relevance of these factors in participant selection [12][13][14][15][16]. The emphasis has been on investigating the impact of these variables and their connections with performance rather than delving into whether these factors directly contribute to the onset of EP [17,18]. ...
Elbow pain (EP) in overhead sports is a common phenomenon. Swimming is classified as an overhead sport, but a lack of attention regarding EP in swimming has created a gap in the knowledge around elite freestyle swimming in Tianjin, China. The purpose of this study was to identify the distribution and prevalence of EP among elite freestyle swimmers in Tianjin, China. The methodology involved a total of 311 qualified participants who volunteered to undertake all measurements. The main findings showed that 183 of the elite freestyle swimmers in this study had EP (accounting for 58.84% of the total 311 participants), with 147 in slight pain and 36 in critical pain. The characteristics of a heavier body weight, taller height, longer left/right forearm length, and longer weekly average training hours serve as contributing factors to the occurrence of EP issues. Gender, age, weekly average training hours, and left/right forearm length are the primary factors correlating with and influencing the assessment scores. In conclusion, swimmers with longer weekly training hours, older ages, heavier bodyweight, and longer forearm lengths should receive greater attention in relation to EP. Regular assessments at a high frequency serve as a means to identify the risk of EP.
... Humans employ the primate corticospinal system to control individual finger and arm motions in order to master playing the piano [39,40,41], during which the nervous system activates corresponding muscles through neuromuscular junction such that the skeletal system is able to interact with the piano ( Figure 1A). The ultimate keystroke is produced by coordinated movements of the entire upper limbs including wrist flexion/extension, elbow pronation/supination, shoulder elevation, finger abduction/adduction and so on [42]. Human pianists are known to modulate movement patterns that result in different expressive dynamics-attack speed, attack touch, articulation, key sustains and releases, and tempo at the microstructural level [43,44]. ...
Understanding the coordination of multiple biomechanical degrees of freedom in biological organisms is crucial for unraveling the neurophysiological control of sophisticated motor tasks. This study focuses on the cooperative behavior of upper-limb motor movements in the context of octave playing on the piano. While the vertebrate locomotor system has been extensively investigated, the coherence and precision timing of rhythmic movements in the upper-limb system remain incompletely understood. Inspired by the spinal cord neuronal circuits (central pattern generator, CPG), a computational neuro-musculoskeletal model is proposed to explore the coordination of upper-limb motor movements during octave playing across varying tempos and volumes. The proposed model incorporates a CPG-based nervous system, a physiologically-informed mechanical body, and a piano environment to mimic human joint coordination and expressiveness. The model integrates neural rhythm generation, spinal reflex circuits, and biomechanical muscle dynamics while considering piano playing quality and energy expenditure. Based on real-world human subject experiments, the model has been refined to study tempo transitions and volume control during piano playing. This computational approach offers insights into the neurophysiological basis of upper-limb motor coordination in piano playing and its relation to expressive features.
... Shoulder and chin rests, which are placed in-between the left shoulder and the violin and in-between the violin and the left jaw, respectively, are commonly used to increase both comfort and control of the instrument (Levy et al. 1992). Effects on kinematics are however ambiguous and appear to be modulated by rest height and piece played (Chi, Halaki, and Ackermann 2020;Kok et al. 2019;Levy et al. 1992;Rabuffetti et al. 2007). Additionally, no study has shown that shoulder and/or chin rests could affect MMF. ...
Muscle fatigue is a primary risk factor in developing musculoskeletal disorders, which affect up to 93% musicians, especially violinists. Devices providing dynamic assistive support (DAS) to the violin-holding arm can lessen fatigue. The objective was to assess DAS effects on electromyography median frequency and joint kinematics during a fatiguing violin-playing task. Fifteen university-level and professional violinists were equipped with electromyography sensors and reflective markers to record upper-body muscle activity and kinematics. They played G scales with and without DAS until exhaustion. Paired t-tests assessed DAS effects on delta (final - initial) electromyography median frequencies and joint kinematics. DAS prevented the median frequency decrease of left supraspinatus, superior trapezius, and right medial deltoid, and increase in trunk rotation, left-wrist abduction, and right arm-elevation plane. DAS effects on kinematics were marginal due to maintenance of musical performance despite fatigue. However, DAS reduced fatigue of several muscles, which is promising for injury prevention.
... Risk factors for PRMD include age, gender, long durations of repetitive practice in unnatural static postures, anthropometric features such as the size of hand, and performance anxiety. 7,8,[9][10][11][12][13][14][15][16][17] The biomechanical factors that influence the physiological load on the muscles during piano playing have not been fully addressed. [18][19][20][21][22][23][24][25][26] To the best of our knowledge, only a limited number of studies on piano performance have included an EMG analysis with a tendency to concentrate on the forearm muscles. ...
Background:
Repetitive piano play may overload neck and shoulder muscles and tendons, leading to playing-related musculoskeletal disorders (PRMDs).
Methods:
In this pilot study (EMG data of the extensor carpi radialis have been published separately), surface electromyography (sEMG) activity of the upper trapezius (UT) was captured in 10 conservatory piano students while playing a fast and a slow music score selected from the individual's repertoire, each 3 minutes long. Measurements were made at baseline and again after 2 hrs and 4 hrs of rehearsal time of the piano études. The amplitude of the sEMG signal was processed by a smoothing algorithm, and the frequency component with a non-orthogonal wavelets procedure. Amplitude of the sEMG was expressed in percent of maximal voluntary contraction (%MVC) at baseline, and the frequency component using median frequency based on the frequency band powers. Statistical analysis encompassed repeated measures ANOVAs for the amplitude and frequency components of the sEMG signal (set at 5%). The students also rated the intensity of rehearsals using a visual analog scale (VAS).
Results:
The median values for the %MVC presented a global mean for the left trapezius of 5.86 (CI90% 4.71, 6.97) and 5.83 for the right trapezius (CI90% 4.64, 7.05). The rehearsals at moderate intensity increased the amplitude of %MVC of the upper trapezius by around 50% and decreased the median frequency.
Conclusions:
Playing faster presented higher magnitudes of activity of the upper trapezius. The decrease in the median frequency in response to long rehearsals may be a sign of muscle fatigue.
... They are consistent with pain in the neck, despite the specific use of the superficial and deep neck flexor muscles [20]. The study suggested that smaller hand size and the use of a shoulder rest changes muscle activity are correlated to increased incidence of playing-related musculoskeletal disorders [21]. Topdemir et al. in the randomized controlled trials of 117 violinists showed beneficial effects of Kinesio taping applied for one week. ...
Introduction and purpose
Musicians' medicine has received increasing attention recently. It is known that listening to music or playing an instrument has beneficial effects on cognitive and neural functions. Playing the string instrument demands repetitive precise movements of fingers and arms in a non-ergonomic posture that might give rise to health problems.
The study aims to present the current state of knowledge regarding different potential health problems among violinists and violists. The article reviews the 24 newest scientific publications available on PubMed and Google Scholar.
A brief description of the state of knowledge
The literature review indicated several potential health consequences of excessive playing the violin or viola, as follows: Fiddler's neck and skin allergy, Garrod’s pads, temporomandibular disorders, carpal tunnel syndrome, cubital tunnel syndrome, tennis elbow, compression of the right ulnar nerve in the ulnar (Guyon's) canal, rotator cuff tendonitis, tenosynovitis, bursitis, focal dystonia, thoracic outlet syndrome, bone asymmetry, pain in the neck, cheeks, fingers, wrist, forearm, shoulder, waist, and the back.
Conclusions
Musicians should be aware of potential health problems that occur during prolonged playing the violin or the viola. An important issue is maintaining the accurate proportions between the amount of time spent playing the instrument and resting. The first signs of neurological or musculoskeletal changes should prompt the musician to seek professional medical help to prevent the disorder's progression.
... Hand size has been highlighted as a risk factor of performancerelated musculoskeletal disorders (PRMDs) for pianists in the literature (Amaral Correa et al., 2018;Chi et al., 2020). Yoshimura et al. found that smaller hand size parameters were associated with an increased incidence of playing-related pain in 35 university piano students (Yoshimura et al., 2006;Yoshimura and Chesky, 2009). ...
The availability of keyboards with reduced key width has been recently promoted as an ergonomic aid for small-handed pianists to overcome any potential physical disadvantages that may restrict their piano repertoire. However, a lack of biomechanical data exists to support whether reduced piano key size is effective in achieving this outcome. This research investigates the effect of playing on three different key width size pianos (5.5-inch octave, 6.0-inch octave and conventional size with 6.5-inch octave) on hand, arm and shoulder muscle activity levels according to the hand size of the pianists.
Results indicate that piano key size affects the muscle activity levels of selected muscles. Furthermore, this effect of different key sizes changed according to the players’ hand spans. Small-handed pianists may benefit from using smaller-sized keyboards to reduce muscular exertion during performance. This investigation provides preliminary EMG data supporting the use of different size keyboards to improve the ergonomic fit according to the dimensions of individual pianists.
... A systematic review of ergonomics in violin and piano playing similarly noted inconsistency and low quality of ergonomic measurement. 167 Heidarimoghadam et al. 168 called for clear definitions of interventions and study methods to test the efficacy of ergonomic programs on outcomes of workers with musculoskeletal disorders, including outcomes of productivity. Stage V: Dissemination and implementation research. ...
Background
Common treatments for lateral epicondylosis focus on tissue healing. Ergonomic advice is suggested broadly, but recommendations based on biomechanical motion parameters associated with functional activities are rarely made. This review analyzes the role of body functions and activities in lateral epicondylosis and integrates the findings to suggest motion parameters applicable to education and interventions relevant to activities and life roles for patients.
Purpose
This study examines lateral epicondylosis pathology, tendon and muscle biomechanics, and population exposure outlining potentially hazardous activities and integrates those to provide motion parameters for ergonomic interventions to treat or prevent lateral epicondylosis. A disease model is discussed to align treatment approaches to the stage of LE tendinopathy.
Study Design
Integrative review
Methods
We conducted in-depth searches using PubMed, Medline, and government websites. All levels of evidence were included, and the framework for behavioral research from the National Institutes of Health was used to synthesize ergonomic research.
Results
The review broadened the diagnosis of lateral epicondylosis from a tendon ailment to one affecting the enthesis of the capitellum. It reinforced the continuum of severity to encompass degeneration as well as regeneration. Systematic reviews confirmed the availability of evidence for tissue-based treatments, but evidence of well-defined harm reducing occupational interventions was scattered amongst evidence levels. Integration of biomechanical studies and population information gave insight into types of potentially hazardous activities and provided a theoretical basis for limiting hazardous exposures to wrist extensor tendons by reducing force, compression, and shearing during functional activities.
Conclusions
These findings may broaden the first treatment approach from a passive, watchful waiting into an active exploration and reduction of at-risk activities and motions. Including the findings into education modules may provide patients with the knowledge to lastingly reduce potentially hazardous motions during their daily activities, and researchers to define parameters of ergonomic interventions.
... From a biomechanical perspective, anthropometry is important when learning a skill. Interestingly, with the exception of research on hand span and ergonomically modified keyboards (Booker & Boyle, 2011;Boyle et al., 2015;Chi et al., 2020;Deahl & Wristen, 2017;Farias et al., 2002;Lai et al., 2015;Wagner, 1988;Wristen et al., 2006;Yoshimura & Chesky, 2009), anthropometry has been overlooked in existing biomechanics research on piano performance and music pedagogy. Factors suggesting a need for more attention to anthropometry include these: (a) the keyboard is immobile and of fixed dimensions, (b) pianists must play notes according to directives in the musical score, and (c) anthropometry is largely a fixed variable for each pianist who must individualize positioning and repositioning the body to facilitate how fingers address the keyboard during performance. ...
Piano performance motor learning research requires more “artful” methodologies if it is to meaningfully address music performance as a corporeal art. To date, research has been sparse and it has typically constrained multiple performance variables in order to isolate specific phenomena. This approach has denied the fundamental ethos of music performance which, for elite performers, is an act of interpretation, not mere reproduction. Piano performances are intentionally manipulated for artistic expression. We documented motor movements in the complex task of performance of the first six measures of Chopin’s “Revolutionary” Etude by two anthropometrically different elite pianists. We then discussed their motor strategy selections as influenced by anthropometry and the composer’s musical directives. To quantify the joint angles of the trunk, shoulders, elbows, and wrists, we used a VICON 3 D motion capture system and biomechanical modeling. A Kistler force plate (1 N, Swiss) quantified center of gravity (COG) shifts. Changes in COG and trunk angles had considerable influence on the distal segments of the upper limbs. The shorter pianist used an anticipatory strategy, employing larger shifts in COG and trunk angles to produce dynamic stability as compensation for a smaller stature. Both pianists took advantage of low inertial left shoulder internal rotation and adduction to accommodate large leaps in the music. For the right arm, motor strategizing was confounded by rests in the music. These two cases illustrated, in principle, that expert pianists’ individualized motor behaviors can be explained as compensatory efforts to accommodate both musical goals and anthropometric constraints. Motor learning among piano students can benefit from systematic attention to motor strategies that consider both of these factors.
The flexible and rigid anatomy of the human foot contributes to both static and dynamic motion of the body. Foot muscles are crucial to maintaining foot-ankle posture and static balance. Intrinsic muscle activity fires more frequently to maintain balance and static posture. The principal foot mobilizers, extrinsic foot muscles, oversee ankle motion and balance control. A paucity of evidence outlines a distinct relationship between foot posture and balance, ultimately leading to gait abnormalities. Thus, this review examines the relationship between musculoskeletal disorders and foot posture, balance, and gait. It postulates that foot changes caused by any disorder may or may not affect their balance and gait. Somatosensory changes become impaired when the foot is pronated, affecting joint mobility or the surface contact area needed to maintain a stable support base. During joint motion, proprioceptive feedback depends on sensory information from the plantar sole mechanoreceptor, visual, vestibular, and proprioceptive senses. The shift in heel position impairs balance due to changes in sensory receptor participation, muscle stretch, and inactive components surrounding the ankle joint. The effects of functional postures and occupational demands are reviewed in firefighters and musicians. This review highlights the association between foot posture, balance, and gait.
Background:
This study focuses on the user experience of a novel developed ergonomic chinrest (EC), customised to accommodate the individual violinist's anthropometry and playing style. The EC was recently tested for biomechanical effect, but the violin player's motivation, usage behaviour, usability and acceptability may be equally important.
Objective:
To explore the user experience of violinists who used the novel EC with a low shoulder rest for two weeks. Through that experience, we wanted to learn about the potential user barriers and facilitators related to their motivation, usage behaviour, usability, and acceptability, when trying a new product.
Methods:
Thirty-eight professional violinists participated and evaluated motivation, user behaviour, usability and acceptance using a 5-point Likert scale and open-ended questions.
Results:
Participants showed high motivation hoping to improve posture, reduce muscle tension and enhance performance. Usage behaviour was also high, while product appearance, adjustment time, and sound impact were negatively evaluated. However, 37% planned to continue to use EC after the study.
Conclusion:
Participants showed high motivation and usage behaviour but faced challenges with product appearance, adjustment time, and sound impact compared to their usual chinrest. Incorporating user feedback and addressing design and usability challenges can enhance the user experience.
Despite the omnipresence of rhythm in music, movement, circadian cycles, and learning processes, this research topic is the first volume to offer interdisciplinary approaches the topic. Empirical research on timing and precision from the microbiological level of synapses to the macro level of elite solo and ensemble performances is presented. The volume provides results gained by the use of microscopes, motion capture systems, medical equipment such as imaging scans, as well as artistic and educational experience.
The goal of this research topic is to present current, scientific studies that examine the ways in which rhythm effects human biology, behavior, perception, and art. Reciprocally, science can learn from studies conducted with artists about how they experience, express and synchronize rhythms.
Background:
Playing the violin often requires a rotated and lateral flexed neck, leading to potential neck and shoulder problems. An ergonomic chinrest (EC) with or without a shoulder rest (SR or WSR) may enhance neutral neck positioning, but the feasibility of the EC needs to be studied.
Objective:
Our goal was to evaluate the usability of the EC for a two-week familiarisation period, including aspects such as playing performance, comfort level, and emotional response (e.g., feelings about using the product) among a group of violinists.
Methods:
A one-arm feasibility study was conducted to assess the feasibility of violinists playing with EC every day for two weeks. Six violinists who usually played with SR were included and asked to divide their daily playing time equally between SR and WSR. Feasibility outcomes were measured as adherence (days), compliance (playing hours per day) and usability (5-point Likert scale and open-ended questions). Compliance was achieved with a minimum of 25% playing time.
Results:
Daily violin playing with EC showed high adherence of 89.3%. Compliance with the 25% play time criterion was met for SR, but not for WSR. Low playing performance (median 45.8 points difference), long confidence time (two violinists failed to reach a confidence level) and mainly negative feedback (26 out of 33 comments) were found in WSR compared to SR.
Conclusions:
The feasibility of playing with WSR was low and negatively impacted playing performance. As a result, a larger-scale study will only evaluate the EC with SR due to greater feasibility.
Introduction
Despite a large number of available ergonomic aids and recommendations regarding instrument positioning, violin players at any proficiency level still display a worrying incidence of task-specific complaints of incompletely understood etiology. Compensatory movement patterns of the left upper extremity form an integral part of violin playing. They are highly variable between players but remain understudied despite their relevance for task-specific health problems.
Methods
This study investigated individual position effects of the instrument and pre-existing biomechanical factors likely determining the degree of typical compensatory movements in the left upper extremity: (1) left elbow/upper arm adduction (“Reference Angle α”, deviation from the vertical axis), (2) shoulder elevation (“Coord x”, in mm), and (3) shoulder protraction (“Coord y”, in mm). In a group of healthy music students ( N = 30, 15 m, 15 f, mean age = 22.5, SD = 2.6), “Reference Angle α” was measured by 3D motion capture analysis. “Coord x” and “Coord y” were assessed and ranked by a synchronized 2D HD video monitoring while performing a pre-defined 16-s tune under laboratory conditions. These three primary outcome variables were compared between four typical, standardized violin positions varying by their sideward orientation (“LatAx-CSP”) and/or inclination (“LoAx-HP”) by 30°, as well as the players’ usual playing position. Selected biomechanical hand parameter data were analyzed as co-factors according to Wagner’s Biomechanical Hand Measurement (BHM).
Results
Mean “Reference Angle α” decreased significantly from 24.84 ± 2.67 to 18.61 ± 3.12° ( p < 0.001), “Coord x” from 22.54 ± 7.417 to 4.75 ± 3.488 mm ( p < 0.001), and “Coord y” from 5.66 ± 3.287 to 1.94 ± 1.901) mm ( p < 0.001) when increasing LatAx-CSP and LoAx-HP by 30°. Concerning the biomechanical co-factors, “Reference Angle α”, “Coord y”, but not “Coord x”, were found to be significantly increased overall, with decreasing passive supination range ( r = −0.307, p = <0.001 for “Passive Supination 250 g/16Ncm”, and r = −0.194, p = <0.001 for “Coord y”). Compensatory movements were larger during tune sections requiring high positioning of the left hand and when using the small finger.
Discussion
Results may enable to adapt individually suitable instrument positions to minimize strenuous and potentially unhealthy compensation movements of the left upper extremity.
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted at the request of the Editors-in-Chief.
After a thorough investigation, the Editors have concluded that the acceptance of this article was partly based upon the positive advice of one illegitimate reviewer report. The report was submitted from an email account which was provided to the journal as a suggested reviewer during the submission of the article. Although purportedly a real reviewer account, the Editors have concluded that this was not of an appropriate, independent reviewer.
This manipulation of the peer-review process represents a clear violation of the fundamentals of peer review, our publishing policies, and publishing ethics standards. Apologies are offered to the reviewer whose identity was assumed and to the readers of the journal that this deception was not detected during the submission process.
Study Design
: Invited Clinical Commentary
Background
: Performance related musculoskeletal disorders (PRMD) are common in instrumental musicians and often affect the upper extremities. These overuse injuries typically result from inadequate attention to the musculoskeletal demands required for the high-level performance of musician-students and experienced instrumentalists.¹ PRMDs often interfere with career trajectory, and in extreme cases, can be career ending. Many clinicians and healthcare practitioners treating upper extremity injuries are not familiar with the specific demands faced by instrumental musicians and how to tailor treatment and prevention strategies to the specific risks and occupational needs of each instrumental group.
Purpose
: This paper describes an evidenced-based framework for the assessment, prevention, and treatment of musculoskeletal musician injuries to provide clinicians with an instrument-specific, and musician-centered guide for practice. We synthesized available literature on instrumental ergonomics, biomechanical demands, and upper extremity injuries to highlight the risks and common upper-extremity pathologies, focusing on the specific demands of instrumental groups: piano, high strings (violin and viola), low strings (cello and bass), percussion, woodwinds, and brass. Targeted assessment, prevention, and treatment strategies are reviewed in this context to provide healthcare providers with an evidence-based framework to approach the treatment of PRMD to mitigate incidence of injury during practice and performance.
Methods
: A comprehensive search of electronic databases was conducted including all study designs.
Results
: This review describes risk factors for PRMD in instrumental musicians, strategies to prevent misuse and performance injury, and musician-centered interventions to allow playing while reducing risk of misuse.
Conclusion
: The suggested assessment and treatment framework can assist clinicians with a customized patient-centered approach to prevention and treatment by addressing the gap in clinical knowledge with the goal of ultimately reducing the incidence and severity of PRMD in musicians.
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.
Self-reported height and weight, if accurate, provide a simple and economical method to track changes in body weight over time. Literature suggests adults tend to under-report their own weight and that the gap between self-reported weight and actual weight increases with obesity. This study investigates the extent of discrepancy in self-reported height, weight, and subsequent Body Mass Index (BMI) versus actual measurements in young adults. Physically measured and self-reported height and weight were taken from 1562 students. Male students marginally overestimated height, while females were closer to target. Males, on average, closely self-reported weight. Self-reported anthropometrics remained statistically correlated to actual measures in both sexes. Categorical variables of calculated BMI from both self-reported and actual height and weight resulted in significant agreement for both sexes. Researcher measured BMI (via anthropometric height and weight) and sex were both found to have association with self-reported weight while only sex was related to height difference. Regression examining weight difference and BMI was significant, specifically with a negative slope indicating increased BMI led to increased underestimation of weight in both sexes. This study suggests self-reported anthropometric measurements in young adults can be used to calculate BMI for weight classification purposes. Further investigation is needed to better assess self-reported vs measured height and weight discrepancies across populations.
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
Objective
Despite the high number of amateur musicians in the general population, little is known about the musculoskeletal health of amateur musicians. Playing a musical instrument is supposed to be a risk factor for the development of musculoskeletal complaints. This study aimed to evaluate playing-related musculoskeletal disorders (PRMDs) among amateur musicians playing in student orchestras.
Design
A cross-sectional study.
Participants
357 members of eleven Dutch student orchestras across the Netherlands were included in this study.
Intervention
A paper-based questionnaire on PRMDs was used.
Outcome measures
Sociodemographic characteristics and PRMDs were evaluated using an adaptation of the Nordic Musculoskeletal Questionnaire (NMQ) and the music module of the Disabilities of Shoulder and Hand (DASH) questionnaire.
Results
The year prevalence of PRMDs among amateur musicians was 67.8%. Female gender, younger age, higher BMI and playing a string instrument were independently associated with a higher prevalence of PRMDs. The left shoulder was affected more frequently in violinists and violists, whereas the right hand and wrist were more frequently affected in woodwind instrumentalists. Of the subjects with PRMDs during the last week, the score of the music module of the DASH was 18.8 (6.3–31.2)
Discussion
This study is the first to report on PRMDs and its associated factors in a large group of amateur musicians. The prevalence of PRMDs in amateur musicians is high, however the DASH scores reflect a confined impact of these PRMDs on their functioning as a musician. Preventive measures are needed aiming at reducing PRMDs among amateur musicians.
Resumen
Objective. To compare direct and self-reported anthropometry in Mexican women. Materials and methods. Women aged 30-72 years, participating in the Mexican Teachers’ Cohort, completed a questionnaire with their anthropometric data in 2006-2008. After eleven months (median time), technicians performed anthropometry in 3 756 participants. We calculated correlations and multivariable-adjusted mean differences between direct and self-reported anthropometric measures. Results. Correlations between direct and self-reported anthropometric measures ranged from 0.78 (waist circumference) to 0.93 (weight). On average, women over-reported their height by 2.2 cm and underreported their weight, body mass index (BMI) and waist and hip circumferences by 1.3 kg, 1.3 kg/m2, 1.8 cm and 1.9 cm, respectively. Errors in self-reported anthropometry increased with rising measured BMI and were also independently associated with age, education and socioeconomic status. Conclusion. Self-reported anthropometry is sufficiently valid for epidemiological purposes in adult Mexican women. Errors in self-reported anthropometry might result in underestimation of the prevalence of overweight and obesity.
Objectives
The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool.
Design
An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool.
Results
An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users.
Conclusions
CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making.
Self-reported weights and heights can be subject to gender, socio-economic, and other biases. On the other hand, obtaining measured anthropometric data can pose a significant respondent burden.
Seattle Obesity Study II (SOS II) participants (n = 419) provided self-reported height, weight, and demographic data through an interviewer-assisted behavior survey. Participants were then weighed and measured by trained staff. The entire process was repeated 12 months later. At the follow up visit, participants were also asked to recall their weight from 12 months ago. The concordance between measured and self-reported data was assessed using Bland-Altman plots.
Some weight underreporting by obese individuals was observed. Gender or socio-economic status (SES) did not affect self-reports. Bland-Altman plots provided 95 % limits of agreement of −3.13 to 5.83 for weight (kg), and 1.21 to 2.52 for BMI (kg/m 2 ). The concordance between measured and self-reported BMI categories was excellent (Kappa = 0.82 for men, and 0.86 for women). At the follow up visit, participants estimated their weight 12 months ago more accurately than their current weight.
Self-reported heights and weights were highly correlated with objective measures at two points in time. No gender or SES biases were observed. Minor, yet statistically significant under-reporting (<1.5 kg) was observed for obese participants. Caution should be used when using self-reported data in obese populations.
Improving the 'fit' between the performer and the instrument, in the context of the musical composition, may prove beneficial in the prevention of injury in musicians. The violin poses particular problems because it requires total support, yet both hands must be free to play. Changing the chin rest and changing the shoulder pad are common ways to modify the violin to fit the individual. The authors hypothesized that changes in chin rest and shoulder pad would result in changes in pressure and force applied over the chin rest during violin performance, and that these effects were predictable from anthropometric measures recorded at the neck and shoulder. The authors also hypothesized that different musical compositions would result in different levels of pressure and force. A sensor mat, sampling at 50 Hz, measured the peak pressure, peak force, pressure-time integral, force-time integral, and total contact area utilized over the chin rest during the performance of excerpts from a violin concerto by Max Bruch and a violin sonata by G. E Handel. Repeated-measures univariate analysis of variance revealed that chin rest and musical composition produced significant differences in all the pressure and force variables. Shoulder pads proved effective in changing the peak pressure and the total contact area utilized over the chin rest. Stepwise multiple regression indicated that neck measurements were not a significant predictor of force or pressure, but shoulder measurements were a predictor of pressuring during the Bruch concerto. These results underscore the importance of evaluating chin rests, in addition to shoulder pads, when seeking a more comfortable 'fit' for the violinist. In addition, the repertoire of the violinist should be considered a critical parameter when evaluating levels of force and pressure produced during performance. This study demonstrates that the specific musical composition may interact with the effects of chin rests. Musical composition may also influence the ability of anthropometric measures to predict the forces generated during performance.
This study evaluated the association between upper body physical measurements of skilled violin players and the presence and location of pain related to playing their instruments. To cover a range of playing styles and teaching backgrounds, volunteers were recruited from universities and orchestras. A group of 32 instrumentalists participated in this study and had their upper limb lengths and ranges of motion measured by a physiotherapist. Between-limb range comparisons revealed some significantly greater range measurements of the left hand compared with the right, which are hypothesized to represent an adaptation to years of instrument playing. Participants also completed questionnaires detailing the location and duration of any performance-related pains. Regression results identified physical attributes that may be risk factors in the development of pain problems in violin players with shorter arms. An implication of these findings is that players with right arms shorter than those of their peers may need to pay attention to the positioning of their head on the instrument and to overall instrument placement.
Hand span data was collected from 473 adult pianists and analysed using descriptive and inferential statistical methods, focusing on differences according to gender, ethnicity and level of acclaim. For comparative purposes, similar data was collected from 216 non-pianist university students and 49 children and teenagers. Gender differences are consistent with those found in earlier studies and ethnic differences are also significant but smaller in magnitude. Highly acclaimed solo performers tend to have bigger hand spans than others. 'Small hands' are defined in terms of hand span metrics, allowing estimates of the proportions of pianists with 'small hands'. The conclusion is that the current 'standard' piano keyboard is too large ergonomically for a majority of pianists. ______________________________________________________________________
Purpose:
This study gives a systematic overview of the literature on the occurrence of musculoskeletal complaints in professional instrumental musicians.
Methods:
A systematic review. Nine literature databases were searched without time limits on June 25, 2015, also the complete index of the journal Medical Problems of Performing Artists (MPPA) until June 2015 (30;2) was searched, and citation tracking and reference checking of the selected articles were performed. The search consisted of the combination of three groups of keywords: musician (e.g., musician, violin, music student, instrument player) AND musculoskeletal (e.g., musculoskeletal, tendon, shoulder, arthritis) AND epidemiology (e.g., prevalence, incidence, occurrence).
Results:
The initial literature search strategy resulted in 1258 potentially relevant articles. Finally, 21 articles describing 5424 musicians were included in this review. Point prevalences of musculoskeletal complaints in professional musicians range between 9 and 68 %; 12-month prevalences range between 41 and 93 %; and lifetime prevalences range between 62 and 93 %. Ten out of 12 studies show a higher prevalence of musculoskeletal complaints among women. Brass instrumentalists are reported to have the lowest prevalence rates of musculoskeletal complaints. The neck and shoulders are the anatomic areas most affected; the elbows are least affected. Although some information is reported concerning age, the high risk of bias in and between these studies makes it impossible to present reliable statements with respect to this.
Conclusion:
Musculoskeletal symptoms are highly prevalent among musicians, especially among women instrumentalists. Future research concerning the epidemiology of musculoskeletal complaints among musicians should focus on associated risk factors and follow the current guidelines to optimize scientific quality.
Background:
In prospective epidemiological studies, anthropometry is often self-reported and may be subject to reporting errors. Self-reported anthropometric data are reasonably accurate when compared with measurements made at the same time, but reporting errors and changes over time in anthropometric characteristics could potentially generate time-dependent biases in disease-exposure associations.
Methods:
In a sample of about 4000 middle-aged UK women from a large prospective cohort study, we compared repeated self-reports of weight, height, derived body mass index, and waist and hip circumferences, obtained between 1999 and 2008, with clinical measurements taken in 2008. For self-reported and measured values of each variable, mean differences, correlation coefficients, and regression dilution ratios (which measure relative bias in estimates of linear association) were compared over time.
Results:
For most variables, the differences between self-reported and measured values were small. On average, reported values tended to be lower than measured values (i.e. under-reported) for all variables except height; under-reporting was greatest for waist circumference. As expected, the greater the elapsed time between self-report and measurement, the larger the mean differences between them (each P < 0.001 for trend), and the weaker their correlations (each P < 0.004 for trend). Regression dilution ratios were in general close to 1.0 and did not vary greatly over time.
Conclusion:
Reporting errors in anthropometric variables may result in small biases to estimates of associations with disease outcomes. Weaker correlations between self-reported and measured values would result in some loss of study power over time. Overall, however, our results provide new evidence that self-reported anthropometric variables remain suitable for use in analyses of associations with disease outcomes in cohort studies over at least a decade of follow-up.
In this chapter, the various reasons and procedures for data normalization will be discussed. The chapter will start with a short description of what factors affect the measurement of the EMG signals. This will be followed by a discussion as to when EMG signals need to be normalized and when the non-normalized signals are acceptable. In general, when the comparison is made within a subject between conditions in a given muscle, then normalization is not critical. However, to validly compare muscle activation levels between muscles, within a given muscle on different days or between subjects normalization is critical. A search of the literature with a description of various techniques that are commonly used for EMG normalization will be summarized. The criteria for choosing a “good” reference value to which to normalize will be discussed. With these criteria in mind, the advantages and disadvantages of the various reference normalization values, i.e. maximum isometric contractions, submaximal isometric contractions, peak or average EMG during dynamic activity and M-max waves will be presented. Examples of the number of different reference tests currently used for each muscle group will be presented indicating the lack of a standard set of tests to provide normalization reference values. The lack of given sets of reference tests for the different muscle groups make comparisons between different laboratories very difficult as different laboratories use different normalization reference values. A strong argument to establish a standard set of tests for each muscle group to provide reference values to which EMG signals can be normalized, will be made.
Musculoskeletal complaints are common among violinists; tension is a probable contributor. We hypothesized that a shoulder rest would relieve some of the tension in the trapezius and sternocleidomastoid muscles and the effect of the shoulder rest would depend on the dimensions of the neck and shoulder. To test these hypotheses, we measured the rectified electromyographs (REMG) produced by 15 accomplished violinists from their left bicep brachii, anterior deltoid, trapezius, and right sternocleidomastoid while they held their violins and while they played two short musical selections. Morphometric measurements of the neck and shoulder of each subject were collected to determine their relationship to the effect of the shoulder rest on the three proximal muscles. Univariate repeated-measure analysis of variance showed significant reduction of the REMG in the trapezius (p = 0.030, and the sternocleidomastoid (p = 0.004); significant increase in the anterior deltoid (p = 0.008); and no significant change in the biceps brachii when the shoulder rest was used. Stepwise multiple regression indicated that neck and shoulder measurements were significant predictors of the effect of the shoulder rest. The distance from the mastoid to the seventh cervical vertebra (C7), alone or in combination with the distance from C7 to the acromion, accounted for at least 42% of the variance (p < 0.05) for the trapezius and some instances the sternocleidomastoid muscle. Other measurements accounted for significant portions of the variance for the sternocleidomastoid and the anterior deltoid. Generally, as neck dimensions increased, the shoulder rest was more likely to promote diminished REMG from the sternocleidomastoid, trapezius, and anterior deltoid muscles. This study demonstrates that use of a shoulder rest may decrease susceptibility to musculoskeletal injury.
OBJECTIVES: To assess the validity of self-reported weight, height, body mass index (BMI), waist circumference and blood pressure compared with standardized clinical measurements and to determine the classification accuracy in overweight/obesity and central adiposity. METHODS: This pilot study was integrated into a life-course study entitled "Hong Kong Women's Health Study" among 1,253 female nurses in Hong Kong who were aged 35 years to 65 years. Data were collected from self-administered questionnaires that were mailed to the respondents. Of these participants, we obtained the standard body measurements of 144 (11.5%) at our research center. We then compared the self-reported anthropometric variables and blood pressure with the measured data to assess validity based on the level of misreporting, percentage of agreement, consistency, sensitivity and specificity. RESULTS: The self-reported and measured values were highly correlated in terms of anthropometry and blood pressure (correlation coefficients ranged from 0.72 to 0.96). Height was overestimated at an average of 0.42 cm, and waist circumference was underestimated at 2.33 cm (both P0.05). The proportions of overweight, obesity, and central adiposity by self-reported data did not vary greatly from the measured data (all P>0.05). The self-reporting resulted in correct classifications of BMI, waist circumference, and systolic blood pressure in 85%, 78%, and 87% of women, with corresponding Kappa index values of 0.79, 0.55, and 0.82, respectively. Sensitivity and specificity were 84.6% and 95.7%, respectively, with respect to overweight/obesity detection, whereas those for central adiposity detection were 70.6% and 83.8%, respectively. CONCLUSION: In a sample of female Hong Kong nurses, the self-reported measures of height, weight, BMI, waist circumference and blood pressure were generally valid. Furthermore, the classification accuracies of overweight/obesity and central adiposity were acceptable.
The width of piano keys became standardised approximately 120 years ago, based on the needs of European male pianists. Only recently has piano keyboard size come into question, as more pianists experience the benefits of reduced-size keyboards.
There is strong evidence that small-handed pianists are more likely to suffer pain and injury than those with larger hands. Many pianists, particularly women and children, are unable to reach their full potential with the standard keyboard.
The lecture/demonstration will include statistics, literature review, live and recorded performances, and a rationale for encouraging the use of smaller piano keyboards.
Reduced-size piano keyboards are gradually becoming popular with many small-handed pianists in North America but are little known elsewhere in the world. They are also gaining favour among teachers and are the focus of research at a number of American universities.
This paper describes the results of a survey of 22 adult pianists who play smaller keyboards regularly. It describes the wide range of benefits perceived by these pianists, including relief from pain, greater technical ease, musical improvements, the expansion of accessible repertoire and greater enjoyment overall.
When the results of this small survey are put into the context of statistical data on hand spans among the general piano-playing population in relation to the demands of the piano repertoire, and the demonstrated link between small hands and performance-related pain and injury, the problems associated with the long-standing ‘one size fits all’ approach become apparent.
Prolonged and incorrect postures are one of the main risk factors for the development of musculoskeletal pathologies. The aims of this study were to study the prevalence of incorrect postures among conservatory students; to identify if the use of an asymmetric instrument represents a risk factor for developing postural disorders; and to investigate whether a correlation exists between years of study, physical activity, and prevalence of postural disorders.
The subjects were recruited among students of the Giuseppe Verdi Conservatory of Milano. All musical instruments were investigated and classified as asymmetric and symmetrical. The observed student posture was classified without instrument as "correct posture" or "postural disorder" and with an with instrument as "optimal posture" or "non-optimal posture." While playing, the postural disorder was classified as "unchanged" or "increased." The data were analyzed with chi-square and linear regression methods.
Of the 148 conservatory students entered into the study, 66.2% had a postural disorder; 73.4% had a non-optimal posture, and playing an asymmetric instrument was the only variable associated (p=0.01). While playing, the postural disorder was increased in 59.2%; playing an asymmetric instrument (p=0.01) and years of practice (p=0.007) were the significantly associated variables.
To play an asymmetric instrument exposes musicians to an increased risk of non-optimal postures and to a worsened postural disorder when present. Considering that the years of practice have an additional negative impact on postural disorders, further studies are needed to clarify the role of non-optimal postures in the development of musculoskeletal complaints among students and professional musicians.
Playing a musical instrument is a constrained motor activity; the instrument has a fixed geometry and playing technique that the performer must accommodate. Although the performer progressively adapts to the instrument during years of education, few options are available for adapting the instrument to the performer. The present work is intended to quantitatively describe the effects of using different setups of the violin shoulder rest during performance. Three conditions were considered, the maximum and minimum heights allowed by the shoulder rest and the absence of the shoulder rest. The setups allowed a height variation of < 40 mm. Fifteen skilled violin players performed a three-octave scale in G with the three rest setups. An optoelectronic motion capture system measured the positions of passive markers placed on the player's body and on the violin and bow, in order to compute, by means of mathematical models, the kinematics of the body, violin, and bow. The increase in rest height was significantly related to a reduction in head rotation (-7.0 degrees), left shoulder rotation (-8.5 degrees), and left acromion elevation (-17.2 mm) and to an increase in left shoulder flexion (+8.2 degrees) and left forearm pronation (+8.8 degrees). In general, the results demonstrate that a skilled player is able to adapt to any shoulder rest setup and can maintain the quality of sound, and that the adaptations are primarily those of the anatomical systems involved in holding the violin and not in holding the bow. Moreover, adjustment of the shoulder rest setup appears to be the individual's search for a tradeoff position, which possibly may be alleviated by adopting objective assessment and innovative shoulder rests.
The purpose of this study was to investigate the prevalence of playing-related musculoskeletal disorders (PRMDs) among Japanese female classical pianists of different age groups. The causal factors for PRMDs also were examined. A group of 203 senior pianists, including piano teachers and students with piano majors at high schools and colleges, were surveyed using questionnaires. Results showed that 77% of these pianists suffered from PRMDs in at least one of their body portions. This value was larger than those reported in Western countries. Forty-four percent of these were serious enough to warrant medical treatment, which was a lower rate than reported in Western countries. The difference in these numbers may reflect the current state of understanding of PRMDs among Japanese pianists and their educators. The prevalence of PRMDs was found to be age-dependent. In the student groups, the finger/hand had the highest rate of PRMDs, followed by the forearm and shoulder. The senior group, on the other hand, had the highest PRMD incidence at the neck/trunk, followed by the forearm and hand/finger. Care may need to be exercised for these differences. The results also indicated that prolonged daily practice (>4 hours), playing chords forcefully, eagerness about practice, and nervous traits were found to contribute to the development of PRMDs in these pianists. Hand size was, on the other hand, not a significant risk factor of PRMDs.
This review's primary objective is to identify research examining the impact of rest breaks uponaccident risk in industrial settings. In the absence of much directly relevant research, the focus isbroadened to consider the impact of rest breaks upon performance and fatige, as well asepidemioogical evidence, in both transport and non-transport settings. Relevant studies are identifiedfrom a range of electronic sources. In general, regular rest breaks can be an effective means ofmaintaining performance, managing fatigue and controlling the accumulation of risk over prolongedtask perfonmance. While two-hourly breaks are common in many industrial settings, the scheduling ofadditional micro-breaks can be beneficial under at least some circumstances. While some evidencesupports allowing workers to take rest breaks that coincide with periods of heightened fatigue,workers sometims fail to take adequate breaks when they are needed. There is little hard evidenceconcerning the optimun length of rest breaks (other than for heavy physical work), or to support thecontention that increased rest-breaks can off-set the negative inpact of extending shift durations, or tosuggest that rest breaks counteract the neptive impacts of circadian variations in alertness, unless theyinvolve taking a nap or caffeine. The scarcity of epidemiological evidence in this area highlights theneed for more research.
Based on a representative sample of the Canadian population, this article quantifies the bias resulting from the use of self- reported rather than directly measured height, weight and body mass index (BMI). Associations between BMI categories and selected health conditions are compared to see if the misclassification resulting from the use of self-reported data alters associations between obesity and obesity-related health conditions. The analysis is based on 4,567 respondents to the 2005 Canadian Community Health Survey (CCHS) who, during a face-to-face interview, provided self-reported values for height and weight and were then measured by trained interviewers. Based on self-reported data, a substantial proportion of individuals with excess body weight were erroneously placed in lower BMI categories. This misclassification resulted in elevated associations between overweight/obesity and morbidity.
Previous study on the etiology of musculoskeletal problems among elite pianists, including college piano majors, suggest that playing-related pain is traceable, in part, to intrinsic factors such as flexibility and hand size. Musculoskeletal problems among other piano groups, particularly teachers, are less understood. The purpose of this study was to investigate piano teachers and the relationships between playing-related pain and several independent variables. In a study conducted as a replication of a previous study of college pianists, results showed that 91% of piano teachers (n = 47) experience pain while playing. Data from this study support previous findings by highlighting hand size and "overall health" as important related variables. Additional findings suggest that playing-related pain among piano teachers may be positively correlated to stretching as part of warm-up and inversely related to amount of playing. Results continue to support the need for interventions that focus on changing the standard piano key size to better fit pianists with small hands.
Very few studies have analysed heart rate (HR) with regard to music playing, and the scarce evidence available is controversial. The purpose of this study was to analyse the HR response of professional musicians during their real-work activity.
Sixty-two voluntary professional musicians (20 women, 42 men), whose ages ranged between 15 and 71 years old, underwent the test while playing their instruments in real life scenarios, i.e. rehearsals, practice and public concerts. The musicians carried Sport Tester PE4000 (Polar(R), Finland) pulsometers to record their HR.In order to compare data from differently aged subjects we calculated their Maximum Theoretical Heart Rate (MTHR). Later on we found out the MTHR percentages (%MTHR) corresponding to the registered HR of each subject in different situations. The value of the MTHR for every musician was obtained by means of the 220 - age (in years) formula.
Throughout the HR recordings, we have observed that musicians present a heightened HR while playing (in soloists, mean and maximum HR were 72% and 85%MTHR, respectively). Cardiac demand is significantly higher in concerts than in rehearsals while performing the same musical piece. The HR curves corresponding to the same musician playing in repeated concerts (with the same programme) were similar.
The cardiac demand of a professional instrument player is higher than previously described, much greater than what would be expected from a supposedly sedentary activity.
To investigate the effects of body size and sociodemographic characteristics on differences between self-reported (SR) and measured anthropometric data in men and women.
This study comprises 9933 men and 11,856 women aged 39-79 years at baseline survey (1993-1997) in the EPIC-Norfolk study (Norfolk arm of the European Investigation into Cancer and Nutrition Study). The effects of sex, measured height, weight, age group, educational level and social class on differences between SR and measured weight, height, body mass index (BMI), waist, hip and waist-to-hip ratio (WHR) were examined.
There were systematic differences between SR and measured anthropometric measurements by sex, measured height, weight and sociodemographic characteristics. Height was overestimated in both sexes while weight, waist, hip, and consequently, BMI and WHR were underestimated. Being male, shorter, heavier, older, and having no educational qualifications and manual occupation were independently associated with overreporting of height, and underreporting of weight was associated independently with being female, shorter, heavier, younger age, and higher education level and social class. Underreporting of waist circumference was strongly associated with being female and higher measured waist circumference, while underreporting of hip circumference was associated with being male and higher measured hip circumference. Furthermore, there was substantial degree of misclassification of BMI and waist circumference categories for both general and central obesity associated with SR data.
These findings suggest that errors in SR anthropometric data, especially waist and hip circumference are influenced by actual body size as well as sociodemographic characteristics. These systematic differences may influence associations between SR anthropometric measures and health outcomes in epidemiological studies.
Introduction:
Self-reported height and weight may lead to inaccurate estimates of associations between BMI and health indicators. The purpose of this study is to assess anthropometric misreporting in emerging adults, compare weight classification by self-reported and direct measures, and examine associations of self-reported and direct measures with cardiometabolic biomarkers.
Methods:
Self-reported and directly measured height and weight were obtained in five waves of a nationally representative cohort study of U.S. tenth graders (n=2,785) conducted in 2010-2016; data were analyzed in 2018. Cardiometabolic biomarkers were assessed in three waves in a systematically recruited subsample (n=567). Pearson correlations (r) and Lin's concordance correlations (ρc) evaluated misreporting. Gwet agreement coefficient-1 evaluated weight classification agreement by self-reported and direct measures. Generalized estimating equations examined associations of cardiometabolic biomarkers with self-reported and direct measures.
Results:
Participants overreported height by 1.0-1.7 cm and underestimated weight by 0.6-1.7 kg. Self-reported BMI was 0.6-1.0 lower than measured. Self-reported and measured height, weight, and BMI were strongly correlated (r=0.88-0.97, 0.86-0.98, and 0.65-0.96, respectively) and concordant (ρc=0.82-0.96, 0.94-0.97, and 0.65-0.95, respectively). Agreement of weight classification by self-reported and direct measures ranged from Gwet agreement coefficient-1=0.79-0.94. Associations of ten cardiometabolic biomarkers with self-reported BMI, measured BMI, and waist circumference were similar in magnitude, direction, and precision.
Conclusions:
Self-reported and measured BMI were strongly correlated and concordant, providing substantial to near-perfect agreement in weight classification. Findings suggest self-reported BMI in U.S. emerging adults provides nearly identical estimates of associations with cardiometabolic biomarkers.
Aims:
For violinists, the shoulder rest is an ergonomic adaptation to reduce musculoskeletal load. In this study, we aimed to evaluate how the height of the shoulder rest affects the violin fixation force and electromyographic (EMG) activity of the superficial neck and shoulder muscles.
Methods:
In professional violinists, four different shoulder rest heights during five playing conditions were evaluated. Outcome variables included the jaw-shoulder violin fixation force and bilateral surface EMG of the upper trapezius (mTP), sternocleidomastoid (mSCM), and left anterior part of the left deltoid muscle (mDTA). Playing comfort was subjectively rated on a visual analogue scale (VAS). Linear regression models were estimated to investigate the influence of the shoulder rest height on muscle activity and violin fixation force as well as the muscle activity of the five evaluated muscles on violin fixation force.
Results:
20 professional violinists (4 males, 16 females, mean age 29.4 yrs) participated in this study. The shoulder rest condition had a significant effect on playing comfort (p<0.001), with higher shoulder rest conditions associated with decreased subjective playing comfort. The mean violin fixation force for each shoulder rest condition ranged between 2.92 and 3.39 N; higher shoulder rests were related to a higher violin fixation force (p<0.001).
Conclusion:
In this study, violin fixation force and muscle activity of the left mDTA increased while playing with an increasing height of the shoulder rest. As the shoulder rest influences muscle activity patterns and violin fixation force, adjustment of the shoulder rest and positioning of the violin need to be carefully optimized.
Objective:
To identify the prevalence and risk factors for musculoskeletal pain in keyboard musicians.
Design:
Systematic review METHODS: A systematic review was conducted according to the MOOSE recommendations and it was registered with the PROSPERO database under registration number CRD42016042913. We included observational studies through the electronic databases PubMed, Scopus, ScienceDirect, Web of Science, Répertoire International de Littérature Musicale (RILM), Retrospective Index to Music Periodicals (RIPM), Scielo and Google Scholar, with combinations of the keywords: "pianists", "keyboard players", "musculoskeletal pain", "muscular disease", "tendinitis", "tendinopathy", "observational", "case-control", "prevalence" and "risk factors". Data from population, information about pain and risk factors were extracted from studies that fulfilled the eligibility criteria. The methodological quality of the studies was classified through the Newcastle-Ottawa Scale. The risk of bias and quality of evidence was assessed using the GRADE system.
Results:
Twelve articles (case-controls) were included for the qualitative synthesis. The quality of the studies was classified as fair (n=6) and good (n=6). Prevalence was observed between 25.8% and 77.0% of musculoskeletal pain among keyboard musicians, with a higher prevalence in wrists and hands (13.8% to 65.8%); neck (9.8% to 64.2%); and shoulders (9.8 to 59.8%). The only consistent risk factor found in the 4 studies was being female, with OR ranging from 1.05 to 1.90. Age greater than 18 years old; weekly training over 20 hours; training for more than 60 minutes without a rest break; not having a habit of practicing sports; and playing despite the pain were also described as risks factors for musculoskeletal pain. It was not possible to perform the meta-analysis due to the heterogeneity of the studies.
Conclusion:
Keyboard musicians presented a high prevalence of musculoskeletal pain, especially in the upper extremity regions of the body. Female, ageing, playing behaviors and sedentary lifestyle showed an increased likelihood to report musculoskeletal pain.
Level of evidence:
Level II.
Aims:
Up-to-date information on the accuracy between different anthropometric data collection methods is vital for the reliability of anthropometric data. A previous review on this matter was conducted a decade ago. Our aim was to conduct a literature review on the accuracy of self-reported height, weight, and body mass index (BMI) against measured values for assessing obesity in adults. To obtain an overview of the present situation, we included studies published after the previous review. Differences according to sex, BMI groups, and continents were also assessed.
Methods:
Studies published between January 2006 and April 2017 were identified from a literature search on PubMed.
Results:
Our search retrieved 62 publications on adult populations that showed a tendency for self-reported height to be overestimated and weight to be underestimated when compared with measured values. The findings were similar for both sexes. BMI derived from self-reported height and weight was underestimated; there was a clear tendency for underestimation of overweight (from 1.8%-points to 9.8%-points) and obesity (from 0.7%-points to 13.4%-points) prevalence by self-report. The bias was greater in overweight and obese participants than those of normal weight. Studies conducted in North America showed a greater bias, whereas the bias in Asian studies seemed to be lower than those from other continents.
Conclusions:
With globally rising obesity rates, accurate estimation of obesity is essential for effective public health policies to support obesity prevention. As self-report bias tends to be higher among overweight and obese individuals, measured anthropometrics provide a more reliable tool for assessing the prevalence of obesity.
Objective:
The aim of the study was to identify and systematically categorize musculoskeletal assessments used in quantitatively based studies about posture and movement in musicians playing high string instruments (violin, viola) in order to inform further research and help to identify gaps in knowledge.
Methods:
A systematic literature search was conducted in the databases Cochrane, CINAHL, and PubMed as well as the journal Medical Problems of Performing Artists. Additional studies were searched within the reference lists of relevant articles. Sixty-four studies conducted since 1999 until May 2017 were included according to predefined inclusion criteria.
Results:
Various biomechanical measurement instruments were used in 24 of the selected studies in order to collect two- and three-dimensional kinematic data: optoelectronic systems with active and passive markers, electromagnetic systems, ultrasonic motion analysis systems, and image-based analysis of posture. In 11 studies, kinetics were measured by optoelectronic systems, force sensors, and a posturographic device. Further studies used electromyography to evaluate muscle activity (19 studies) as well as instruments to measure range of motion (2 studies). Additionally, a broad range of clinical examination techniques (35 studies) and self-reports (36 studies) were used to assess the musculoskeletal system of high string players.
Conclusion:
The identified assessments could be used both in further research and in practical work in order to evaluate posture and movement in high string players. For future research, qualitatively based studies as well as psychometrically tested quantitatively based self-report assessments are required.
Prevention of musculoskeletal disorders is one of the main goals in ergonomics. The development of methods to quantify muscle force, fatigue, and muscle involvement in a work task is important for this purpose surface electromyography (sEMG) and kinematic measurements are the main tools for the quantitative evaluation of risks related to work activity. The literature regarding the potential of sEMG techniques in ergonomic studies is extensive and concerns many applications, some of which are listed: work at display terminals and office workstations, production line workstations, work with surgical workstations and workspace optimization. Surface EMG has a remarkable potential role in the prevention, monitoring, documentation, and possibly treatment of work related disorders. Insufficient research funding and standardization efforts are still limiting its applications. Much greater research efforts are required to transform its potential into a practical technique with clinical and legal relevance and economic impact on work health.
Last year at the Performing Arts Medicine Association annual symposium in Aspen, one of the topics focused on was piano performance-related injury. I was invited to attend the symposium and give a talk on the issue of hand size and keyboard size as they may relate to injury. Although my mission to bring about the adoption of a second smaller standard size for the piano keyboard has been primarily motivated by the idea that there is great loss of potential achievement and enjoyment at the instrument for the smaller-handed pianists of the world, the idea that injury may be a greater risk for smaller hands seemed like one more reason to promote the concept. In recollecting my experience as a full-time student in a piano performance program, instances of tendinitis and other repetitive strain injuries were practically exclusively the problem of smaller-handed pianists (mostly female, of course), and it seemed to be generally accepted by students and teachers alike that this was a greater risk for these players. Yet this information is completely anecdotal, and to my knowledge, no conclusive experimental study had proved this to be true. It just seemed obvious to everybody and nobody required proof.
When string players are injured, it may be caused by structural weaknesses, irreversible inflammatory conditions, or other physical problems. The vast majority of string player injuries, however, occur because of an unsuitable fit of equipment to the player or because of faulty playing habits.
The purpose of this study was to determine the prevalence of injuries among pianists in music schools in Ireland. The main objectives of the study were to investigate the anatomical locations of these injuries, the most commonly reported symptoms, and possible risk factors for the development of playing-related injuries. A hand-delivered questionnaire was distributed to 182 students from seven participating music schools. The lifetime prevalence for a playing-related injury, which prevented piano playing for a period of 48 hours or longer, was 25.8%. The wrist was the most common location of injury (36.6%). Pain was the most commonly reported symptom among the respondents. No statistically significant difference in the rate of injury was found between the genders. It was concluded that further research is required into the prevalence of injury and to the predisposing factors of injury so that effective prevention programs can be put in place.
The diagnostic application of electromyography (EMG) and the combination of EMG and clinical biofeedback (EMG-BF) have been shown to be effective in the assessment and management of muscle tension in a wide range of activities, including sports as well as music. However, not all applications of EMG-BF have been found to be successful; indeed, some of the early reports of the benefits have been debated and disputed since the earliest applications of the technology. It is the purpose of this paper to glean a profile of research applying EMG and EMG-BF to music performance since approximately 1985--the year of my own work in this area.
Although pianists commonly report pain and musculoskeletal problems from playing, the related research literature on this topic is limited. The purpose of this study was to investigate the relationships between pain and several independent playing-related and anthropometric variables. Subjects included 35 piano majors attending a large college of music. Subjects were assessed with a questionnaire, bilateral anthropometric measurements of the upper arm and hand, and upper-extremity performance tests for range of motion, isometric strength, and rotation speed. Finger mobility, including active digit-to-digit span, was assessed using digital photography. Four questions regarding pain associated with piano were treated as dependent variables and used for correlation and regression analyses with other variables. A five-factor model emerged and each model was statistically significant. In addition to accounting for a large amount of variance associated with the dependent variables, results highlighted the importance of right 3-4 span (flexibility/mobility). This specific risk factor is rarely mentioned in the performing arts medicine literature. Additional studies are highly warranted for replication and for determining the clinical and pedagogical relevance of this finding.
This study used biomechanical techniques to objectively investigate the effects of the size of hand span and right/left hands on the kinematic and kinetic performances when playing the piano. Twenty pianists were recruited and assigned to two hand-size groups. The parameters of interest, such as ratio of maximal digit-to-digit abduction angle (RD-Dabd), range of motion (ROM) of finger and wrist flexion-extension (F/E), radial-ulnar deviation (R/U), and movement units of F/E of finger joints (MUF/E), were measured while striking the piano keys. The fingertip force was also estimated by a kinetic model. The RD-Dabd was significantly larger for the small hand-span pianists when playing both chords and octaves. The ROM of wrist F/E was significantly larger for small hand-span pianists when playing chords. There was no significant difference in the fingertip force between two groups. However, the values for MUF/E and fingertip force of the right hand were significantly larger than those of left hand. Pianists with a small hand-span should aware that they have higher exposure risks for hand injuries while playing the piano. Relevance to industry: Hand anthropometric issue might be one of potential risk factors which result in piano-related musculoskeletal disorders. This study provides preliminary evidence that can be used to aid in injury prevention and music education for pianists as well as to reconsider issues with regard to the piano design.
To determine the accuracy of self-reported anthropometric measurements in older Australian adults 60-70 years.
Self-reported anthropometric data from 103 community-dwelling participants (mean age 66 years) were compared with actual measurements. Difference and agreement were assessed using paired t-tests, correlation coefficients and Bland-Altman plots.
Underreporting occurred for weight and hip circumference, especially among men, whereas waist circumference was slightly overreported, resulting in apparent underestimations of body mass index (by 0.42 kg/m(2) ) but overestimations of waist-to-hip ratio (WHR, by 0.02). Concordance correlation coefficients were generally high except for WHR. Self-reported circumference measures appeared to be more accurate than the derived WHR. The Bland-Altman plots revealed wide limits of agreement for all measures.
Self-reported values correlated well with measured values and average discrepancies were small. However, use of self-reported anthropometric data may be preferable in population studies for describing overall distribution than for monitoring changes at an individual level.
This study examines whether the use of a 7/8 keyboard contributes to the physical ease of small-handed pianists in comparison to the conventional piano keyboard. A secondary research question focuses on the progression of physical ease in making the transition from one keyboard to the other. For the purposes of this study, the authors stipulated having a hand span of 8 in. or less as defining a “small-handed” pianist. Objective data measures were obtained through the use of surface electromyography (muscle activity measurement) and electrogoniometry (angle measurement). A questionnaire instrument was also used to examine the perception of participants as they experienced playing the 7/8-size piano keyboard in direct comparison with the conventional keyboard. Although objective data findings from this study are somewhat ambiguous, it is clear from the questionnaires that the majority of small-handed participants preferred the 7/8-size keyboard over the conventional one.
Playing-related musculoskeletal problems (PRMP) are common in adult musicians, and risk factors include gender, music exposure, and particularly instrument type. Emerging evidence suggests PRMP are common in children and adolescents and that risk factors may be similar. The aim of this study was to determine the prevalence of PRMP, both symptoms and disorders, and PRMP location in children and adolescents as well as the associations with gender, age, and music exposure factors such as type and number of instruments and playing time.
This study surveyed 731 children (460 females), aged 7 to 17 years, studying instrumental music in government schools in Perth, Australia. Lifetime and monthly symptoms, monthly disorders (inability to play an instrument as usual), and PRMP location were examined. Chi-squared analyses were used to evaluate associations between gender, age, music exposure, and PRMP outcomes. Logistic regression evaluated the independent association of these potential risk factors with PRMP prevalence and location. RESULTS) Sixty-seven percent of students reported PRMP symptoms at some point, 56% reported them within the last month, and 30% reported an inability to play as usual within the last month. After adjustment for gender and age, the type of instrument played (upper and lower strings, woodwind, and brass) was significantly associated with all PRMP (p<0.005) and playing three instruments was protective against monthly symptoms (OR 0.43, p=0.05). The right (24%) and left (23%) hand/elbow and neck (16%) were the most commonly reported PRMP locations, with females affected significantly more than males Prevalence of PRMP increased with age for neck (p<0.001), mid-back (p=0.007), low back (p<0.001), right hand/elbow (p=0.008), and mouth (p=0.011). PRMP prevalence for the left hand/elbow and right and left shoulders demonstrated high rates across all childhood ages. Odds ratios for the risk of PRMP in different locations varied by instrument played.
The high prevalence and location of PRMP are important issues for child and adolescent instrumentalists. Gender, age, and music exposure are associated with PRMP risk and need to be addressed to ensure musicians' personal well-being and musical longevity.
Abduction angles of the thumb and little finger, hand span, length of thumb, middle finger and little finger were measured using radiographs of the right hand with the thumb and the little finger abducted, in a comparative study of 220 pianists with overuse disorder and 62 unaffected pianists. Overuse disorders included tenosynovitis, lateral and medial epicondylitis, forearm flexor muscle pain, distal tendinitis of the wrist extensors and flexors and intrinsic muscle pain. Hand span or other hand size parameters showed significant differences, while abduction angles showed no difference. The patients' group had smaller hand size than the controls when analyzed for tenosynovitis, epicondylitis and muscle pain. From these results we hypothesize that pianists with small hands tend to hyper-abduct and hyper-extend the thumb to attain greater hand span. Their little finger is also stiffer and the hypothenar muscle and the wrist flexors need greater strength to resist the reaction force in each piano key.