Correlation between risk factors and musculoskeletal disorders among classical musicians.
TL;DR: A high association between PRMD and clinical observation emphasizes the need for further investigation of these risk factors and to study possible implementations in order to define 'prevention strategies' for musical routines and patterns, as used by classical musicians.
Abstract: Background Musculoskeletal disorders in humans may originate from biomechanical, environmental, psychosocial and personal risk factors encountered in the working environment. These disorders in musicians are designated as playing related musculoskeletal disorders (PRMD). Aims To investigate the correlation between biomechanical, environmental, psychosocial and personal risk factors and potential incidence of PRMD arising in professional classical musicians. Methods Fifty-nine orchestral classical musicians were observed: They also filled out questionnaires providing information regarding musculoskeletal symptoms, psychosocial factors and demography. Results Clinical observation using the Rapid Upper Limb Assessment (RULA) showed significantly higher scores in string musicians compared with woodwind and brass players (right RULA score F = 4.77, P < 0.05; left RULA score, F = 3.90, P < 0.05). A multivariate regression model showed statistical significance for five of the six dependent variables regarding prevalence of painful joints, severity of musculoskeletal symptoms and functional limitation. The regression analysis revealed that biomechanical risk factors, perceived physical environment risk factors, instrument weight and average playing hours per week, were the main predictors of PRMD. Conclusions The biomechanical risk factors that predict PRMD are mainly associated with the upper limbs. A high association between PRMD and clinical observation emphasizes the need for further investigation of these risk factors and to study possible implementations in order to define 'prevention strategies' for musical routines and patterns, as used by classical musicians.
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TL;DR: Symptoms were more frequent and lasted longer in the musicians than in the general workforce and generally women had a higher risk than men and woodwind players a lower risk than other instrumentalists.
Abstract: Musculoskeletal symptoms are common in the neck, back, and upper limbs amongst musicians. Playing-related musculoskeletal disorders have been found to range from 32% to 87% with a tendency for female musicians to have more problems than males. Studies of musculoskeletal problems in instrumentalists have generally involved pre-professional musicians or populations comprising musicians of different levels. The objective of this study was therefore to investigate the prevalence, duration and consequences of musculoskeletal symptoms in professional symphony orchestra musicians. A cross-sectional questionnaire study. The study population comprised of 441 musicians from six Danish symphony orchestras; 342 (78%) completed the questionnaire. During the last year 97% of the women and 83% of the men experienced symptoms in at least one of nine anatomic regions (neck, upper and lower back, shoulders, elbows, and hands and wrists). 86% of the women and 67% of the men experienced symptoms for more than seven days, while 63% of the women and 49% of the men had symptoms for more than 30 days. Woodwind players had a lower risk for musculoskeletal symptoms and a lower risk for the consequences. Among consequences were changed way of playing, reported by 73% of the musicians, difficulty in daily activities at home, reported by 55%, and difficulty in sleeping, reported by 49%. Their health behaviour included taking paracetamol as the most used analgesic, while physiotherapists and general practitioners were reported as the most consulted health care professionals concerning musculoskeletal problems. Results regarding symptoms in six anatomic regions were compared to results for a sample of the general Danish workforce. Symptoms were more frequent in musicians and lasted longer than in the general workforce. This applied to both genders. Within the last year most symphony orchestra musicians experienced musculoskeletal symptoms in the neck, back or upper extremities. The symptoms impacted on their level of function in and outside work and were reflected in their health behaviour. Generally women had a higher risk than men and woodwind players a lower risk than other instrumentalists. Finally, symptoms were more frequent and lasted longer in the musicians than in the general workforce.
138 citations
TL;DR: Musculoskeletal symptoms are highly prevalent among musicians, especially among women instrumentalists, and future research concerning the epidemiology of musculoskletal complaints among musicians should focus on associated risk factors and follow the current guidelines to optimize scientific quality.
Abstract: Purpose
This study gives a systematic overview of the literature on the occurrence of musculoskeletal complaints in professional instrumental musicians.
125 citations
Cites background or methods or result from "Correlation between risk factors an..."
...Most professional musicians will suffer from musculoskeletal complaints during their life; some of them will stop playing their instrument due to these complaints (Kaufman-Cohen and Ratzon 2011; Parry 2003; Kaneko et al. 2005)....
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...Three studies used a validated outcome measure (Leaver et al. 2011; Kaufman-Cohen and Ratzon 2011; Engquist et al. 2004; Fotiadis et al. 2013), compared to 14 studies which used non-validated outcome measures or non-validated modifications of existing questionnaires....
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...(2012) (‘any pain, weakness, numbness, tingling, or other symptoms that interfere with your ability to play your instrument at the level you are accustomed to’), whereas others (Engquist et al. 2004; Leaver et al. 2011; Paarup et al. 2011; Kaufman-Cohen and Ratzon 2011) used the questions based on the standardized Nordic Questionnaire (Leaver et al....
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...…ability to play your instrument at the level you are accustomed to’), whereas others (Engquist et al. 2004; Leaver et al. 2011; Paarup et al. 2011; Kaufman-Cohen and Ratzon 2011) used the questions based on the standardized Nordic Questionnaire (Leaver et al. 2011; Kuorinka et al. 1987;…...
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...One study (Kaufman-Cohen and Ratzon 2011) only stated ‘no significant difference’ without presenting the data, and another study (Davies and Mangion 2002) reported a higher prevalence among female compared with male strings players, but a lower prevalence among females playing another instrument....
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TL;DR: The complex relationships identified between PRMD, TPP, depression and MPA may have important implications for PRMD management in professional musicians.
Abstract: We examined self-reported frequency and severity of performance-related musculoskeletal pain disorder (PRMD), trigger point pain (TPP) and depression, social phobia (SPIN) and music performance anxiety (MPA) using the Kenny Music Performance Anxiety Inventory (K-MPAI) in a cross-sectional survey of 377 professional orchestral musicians. Most (84%) musicians had experienced performance-impairing pain; 50% reported current pain. Females reported more performance-impairing pain and more current pain than males. Cluster analysis indicated a complex relationship between depression and PRMD severity. Three clusters showed the hypothesized relationship (i.e., more depression, more pain). Musicians in the fourth cluster denied depression but reported the most severe pain, suggesting a group who somatize their psychological distress. Cluster analysis also revealed a strong relationship between PRMD severity and MPA. Clusters with higher scores on K-MPAI reported higher scores on PRMD severity. TPP was not associat...
107 citations
Cites background from "Correlation between risk factors an..."
...Kaufman-Cohen and Ratzon (2011) reported on the relationships between biomechanical function (DASH), musculoskeletal symptoms (Standardized Nordic Questionnaire; SNQ and the Rapid Upper Limb Assessment; RULA), job stress (Generic Job Stress Questionnaire) and personal information (BMI, medical…...
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...%) of self-reported musculoskeletal pain (Ackermann & Adams, 2003; Ackermann, Kenny, & Fortune, 2011; Bragge, Bialocerkowski, & McMeeken, 2006; Fry, 1986; Hoppman, 2001; Kaufman-Cohen & Ratzon, 2011; Leaver, Harris, & Palmer, 2011; Zaza, 1998)....
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TL;DR: Female gender and stage fright were proven to be predictors for musculoskeletal pain, and the necessity for tailored therapeutic and preventive strategies in performing arts medicine is highlighted.
Abstract: Playing-related musculoskeletal disorders (PRMD) in professional musicians are common. Existing literature demonstrates that up to 86 % of musicians are affected. The aim of the study was to evaluate the frequency of musculoskeletal pain in professional orchestral musicians with regard to their instrument affiliation. Of special interest were pain intensity and its association with predictors such as gender, instrument group, age or stage fright. Professional orchestra players completed a self-report questionnaire to assess playing-related musculoskeletal pain and its frequency and intensity in various body regions on a numeric rating scale (NRS). Relative frequencies and prevalence ratios for different instrument groups were estimated. Out of 720 approached musicians, 408 were included in the sample (response rate 57 %); overall, 89.5 % had been affected by current or past playing-related musculoskeletal pain, 62.7 % reported pain in the previous 3 months, and 8.6 % reported current pain. Pain distribution and frequency varied between instrument groups. For all instrument groups, the neck was the most common pain region. About 43 % of musicians presented more than five pain regions, in particular violin players. Approximately 40 % of musicians indicated frequent or permanent pain. Average pain intensities increased from NRS 3.8 up to a range of 5.9 and 7.4 for frequent and permanent pain, respectively. Female gender and stage fright were proven to be predictors for musculoskeletal pain. Professional orchestral musicians are greatly affected by PRMD, often experiencing frequent or permanent pain, high pain levels and pain in various body regions. As PRMD might contribute considerably to performance disability, sick leave and the possibility of premature termination of a musicians' career, this study highlights the necessity for tailored therapeutic and preventive strategies in performing arts medicine.
98 citations
Cites background or result from "Correlation between risk factors an..."
...Kaufman-Cohen and Ratzon investigated risk factors and musculoskeletal disorders in 59 classical orchestra musicians (66 % of the 93 approached musicians), indicating that 83 % of participating musicians reported symptoms in at least one body regionwithin the past 12 months [20]....
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...Recent studies investigating musculoskeletal disorders and pain in professional orchestral musicians show comparable results [3, 9, 20, 21]....
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TL;DR: Musculoskeletal complaints are significantly more common among musicians compared to non-musicians, mainly due to a higher number of upper extremity complaints.
Abstract: Research comparing the frequency of musculoskeletal complaints between musicians and non-musicians is scarce. The aim of this study was to compare the prevalence of musculoskeletal complaints between musicians and non-musicians. A cross-sectional study in 3215 students from three music academies (n = 345) and one medical school (n = 2870) in The Netherlands was performed, using an electronic questionnaire. The questionnaire included socio-demographic characteristics, use of music instruments and the occurrence of musculoskeletal complaints in six body regions. Questions were related to musculoskeletal complaints over the last twelve months and at the time of the questionnaire. Chi-square, t-tests and Kruskal-Wallis tests were used for comparison between the two groups. The association between musculoskeletal complaints and possible predictors was analyzed using a logistic and Poisson regression. Eighty-seven music academy students and 503 medical students returned the questionnaire, of which respectively eighty-three and 494 were included in the study. Seventy-four music academy students (89.2%) reported one or more musculoskeletal complaints during the last twelve months, compared to 384 (77.9%) medical students (p = 0.019). Moreover 52 music academy students (62.7%) and 211 medical students (42.7%) reported current musculoskeletal complaints (p = 0.001). The Odds ratio (OR) for the development of musculoskeletal complaints during the last twelve months in music academy students versus medical students is 2.33 (95% CI 1.61–3.05, p = 0.022). The OR at the time of the questionnaire is 2.25 (95% CI 1.77–2.73, p = 0.001). The total number of complaints have been modeled by employing a Poisson regression; the results show that non-musicians have on average less complaints than musicians (p = 0.01). The adjusted means are 2.90 (95% CI 2.18–3.63) and 1.83 (95% CI 1.63–2.04) respectively for musicians and non-musicians. Regarding the localization of complaints, music academy students reported more complaints concerning the right hand, wrists, left elbow, shoulders, neck, jaw and mouth in contrast to medical students. Musculoskeletal complaints are significantly more common among musicians compared to non-musicians, mainly due to a higher number of upper extremity complaints.
81 citations
References
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TL;DR: The goal is to produce a brief, self-administered measure of symptoms and functional status, with a focus on physical function, to be used by clinicians in daily practice and as a research tool.
Abstract: This paper describes the development of an evaluative outcome measure for patients with upper extremity musculoskeletal conditions. The goal is to produce a brief, self-administered measure of symptoms and functional status, with a focus on physical function, to be used by clinicians in daily practice and as a research tool. This is a joint initiative of the American Academy of Orthopedic Surgeons (AAOS), the Council of Musculoskeletal Specialty Societies (COMSS), and the Institute for Work and Health (Toronto, Ontario). Our approach is consistent with previously described strategies for scale development. In Stage 1, Item Generation, a group of methodologists and clinical experts reviewed 13 outcome measurement scales currently in use and generated a list of 821 items. In Stage 2a, Initial Item Reduction, these 821 items were reduced to 78 items using various strategies including removal of items which were generic, repetitive, not reflective of disability, or not relevant to the upper extremity or to one of the targeted concepts of symptoms and functional status. Items not highly endorsed in a survey of content experts were also eliminated. Stage 2b, Further Item Reduction, will be based on results of field testing in which patients complete the 78-item questionnaire. This field testing, which is currently underway in 20 centers in the United States, Canada, and Australia, will generate the final format and content of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Future work includes plans for validity and reliability testing.
4,351 citations
TL;DR: RULA (rapid upper limb assessment) is a survey method developed for use in ergonomics investigations of workplaces where work-related upper limb disorders are reported.
2,653 citations
TL;DR: The basis for selecting the three criteria (biomechanical, physiological, and psychophysical) that were used to define the 1991 equation are provided, and the derivation of the individual components are described.
Abstract: In 1985, the National Institute for Occupational Safety and Health (NIOSH) convened an ad hoc committee of experts who reviewed the current literature on lifting, recommend criteria for defining lifting capacity, and in 1991 developed a revised lifting equation. Subsequently, NIOSH developed the documentation for the equation and played a prominent role in recommending methods for interpreting the results of the equation. The 1991 equation reflects new findings and provides methods for evaluating asymmetrical lifting tasks, lifts of objects with less than optimal hand-container couplings, and also provides guidelines for a larger range of work durations and lifting frequencies than the 1981 equation. This paper provides the basis for selecting the three criteria (biomechanical, physiological, and psychophysical) that were used to define the 1991 equation, and describes the derivation of the individual components (Putz-Anderson and Waters 1991). The paper also describes the lifting index (LI), an index of relative physical stress, that can be used to identify hazardous lifting tasks. Although the 1991 equation has not been fully validated, the recommended weight limits derived from the revised equation are consistent with or lower than those generally reported in the literature. NIOSH believes that the revised 1991 lifting equation is more likely than the 1981 equation to protect most workers.
1,819 citations
Journal Article•
TL;DR: There was a greater risk for poor sperm quality among welders than among men not employed in welding, and the risk forpoor sperm quality was increased for those welders who worked with stainless steel.
Abstract: The purpose of this study was to investigate whether men employed in the metal industry have sperm of poorer quality than men in other types of work. A postal questionnaire was sent to men employed in the metal industry, certain other types of nonmetal industries, and other types of employment in which the factors suspected to influence sperm quality were not present. By means of this questionnaire survey, it was hoped to define the possible influences of the work environment on sperm quality. Out of the total of 3,119 men included in the investigation, 2,517 (81%) filled out the questionnaire satisfactorily. Semen analysis was performed for all 3,119 men. There was a greater risk for poor sperm quality among welders than among men not employed in welding. The risk for poor sperm quality was increased for those welders who worked with stainless steel. Welding in general, and specifically with stainless steel, is connected with a risk of reduced sperm quality.
509 citations