Musculoskeletal pain in elite professional musicians from British symphony orchestras

doi:10.1093/OCCMED/KQR129

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Musculoskeletal pain in elite professional musicians from British symphony orchestras

Journal Article•DOI•

Musculoskeletal pain in elite professional musicians from British symphony orchestras

R. Leaver¹, E. C. Harris¹, Keith T Palmer¹•Institutions (1)

University of Southampton¹

01 Dec 2011-Occupational Medicine (Oxford University Press)-Vol. 61, Iss: 8, pp 549-555

TL;DR: Musculoskeletal pain is common in elite professional musicians, a major personal risk factor is somatizing tendency, but performance anxiety has less impact, and risks differ substantially by instrument played.

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Abstract: Background Professional musicians may have high rates of musculoskeletal pain, but few studies have analysed risks by work activities or the psychosocial work environment.

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Journal Article•DOI•

Musculoskeletal pain and injury in professional orchestral musicians in Australia.

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Bronwen J. Ackermann¹, Tim Driscoll¹, Dianna T. Kenny¹•Institutions (1)

University of Sydney¹

01 Dec 2012-Medical Problems of Performing Artists

TL;DR: There is strong evidence that PRMDs are a common complaint in professional orchestral musicians and a range of factors suggested as contributing to the occurrence or persistence of these disorders are identified.

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Abstract: This paper reports on the major findings from the questionnaire component of a cross-sectional survey of the musicians in Australia’s eight fulltime professional symphonic and pit orchestras, focusing on performance-related musculoskeletal disorders (PRMDs). METHODS: All musician members of the orchestras participating in this project were invited to complete a self-report survey. The overall response rate was about 70% (n = 377). In addition to general health and experience questions, respondents who reported a current or previous PRMD were asked to report on a range of associated factors. RESULTS: Of the participants, 84% had experienced pain or injuries that had interfered either with playing their instrument or participating in normal orchestral rehearsals and performances. Fifty percent reported having such pain or injury at the time of the survey, mostly with disorders perceived by the musicians to be work-related. Twenty-eight percent had taken at least 1 day off from work for such pain in the previous 18 months. The most common broad sites affected were the trunk (primarily the back), the right upper limb and neck, the left upper limb and neck, and the neck alone, but the relative proportions varied by instrument. Of those musicians who reported at least one episode of pain or injury in the past, less than 50% reported that they had completely recovered. The most commonly cited performance-related factors that had contributed to injury or pain all related to training and playing load (including practice and performance). CONCLUSION: This study provides strong evidence that PRMDs are a common complaint in professional orchestral musicians and identifies a range of factors suggested as contributing to the occurrence or persistence of these disorders. Med Probl Perform Art 2012; 27(4):181–187.

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139 citations

Journal Article•DOI•

The occurrence of musculoskeletal complaints among professional musicians: a systematic review

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Laura M. Kok¹, Bionka M. A. Huisstede², Bionka M. A. Huisstede¹, Veronique M. A. Voorn¹, Jan W. Schoones¹, Rob G H H Nelissen¹ - Show less +2 more•Institutions (2)

Leiden University Medical Center¹, Utrecht University²

01 Apr 2016-International Archives of Occupational and Environmental Health

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.

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Abstract: Purpose This study gives a systematic overview of the literature on the occurrence of musculoskeletal complaints in professional instrumental musicians.

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125 citations

Cites background or methods or result from "Musculoskeletal pain in elite profe..."

...However, brass instrumentalists were reported to have the lowest prevalence rates of musculoskeletal complaints (Arnason et al. 2014; Leaver et al. 2011; Paarup et al. 2011; Abreu-Ramos and Micheo 2007; Kaneko et al. 2005; Roach et al. 1994; Kok et al. 2013a; Fishbein et al. 1988; Ackermann et al. 2012; Steinmetz et al. 2015)....
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...2011; Kaufman-Cohen and Ratzon 2011) used the questions based on the standardized Nordic Questionnaire (Leaver et al. 2011; Kuorinka et al. 1987; Fotiadis et al. 2013; Paarup et al. 2011; Engquist et al. 2004)....
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...A uniform definition of musculoskeletal complaints in the included studies was lacking; some authors used the definition of playing-related musculoskeletal complaints by Zaza et al. (1998) and Ackermann et al. (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. 2011; Kuorinka et al. 1987; Fotiadis et al. 2013; Paarup et al. 2011; Engquist et al. 2004)....
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...7 (0 .7 –4 .2 ) 1 3 Also the 12-month prevalence of 89 % among music academy students in the study of Kok et al. was comparable to the prevalence rates of orchestra musicians of Leaver et al. (2011) and Paarup et al. (2011), 86 and 88 % respectively....
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...Some authors reported no total prevalence rate split for instrument groups, only body-area-specific prevalence rate split for instrument groups (Leaver et al. 2011; Paarup et al. 2011; Roach et al. 1994)....
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Journal Article•DOI•

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Dianna T. Kenny¹, Bronwen J. Ackermann¹•Institutions (1)

University of Sydney¹

01 Jan 2015-Psychology of Music

TL;DR: The complex relationships identified between PRMD, TPP, depression and MPA may have important implications for PRMD management in professional musicians.

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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...

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107 citations

Cites background or methods or result from "Musculoskeletal pain in elite profe..."

...…such as music performance anxiety, depression and tendency to somatize, i.e., to express psychological distress through somatic symptoms, on the presence of musculoskeletal symptoms is unclear, with contrasting results reported in the literature (Davies & Mangion, 2002; Leaver et al., 2011)....
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...Consistent with other recent research (Leaver et al., 2011), the majority (84%) of elite professional musicians in this study reported having experienced performance-related musculoskeletal Figure 1....
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..., to express psychological distress through somatic symptoms, on the presence of musculoskeletal symptoms is unclear, with contrasting results reported in the literature (Davies & Mangion, 2002; Leaver et al., 2011)....
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...Most studies assessing pain in musicians have reported pain perception only and have not included an objective measure of pain (Leaver et al., 2011) such as trigger points, which have been used extensively in work settings to assess pain related to acute overload and overwork fatigue (Simons,…...
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...A larger study of 243 orchestral musicians, of whom 86% reported PRMD in the previous 12 months, used standardized psychological tests such as the Brief Symptom Inventory to assess somatization and the Short Form-36 (SF-36) to assess mood (Leaver et al., 2011)....
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Journal Article•DOI•

Frequency, severity and predictors of playing-related musculoskeletal pain in professional orchestral musicians in Germany.

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Anke Steinmetz¹, I. Scheffer, E. Esmer¹, Karl-Stefan Delank¹, Ingrid Peroz² - Show less +1 more•Institutions (2)

Martin Luther University of Halle-Wittenberg¹, Humboldt University of Berlin²

01 May 2015-Clinical Rheumatology

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.

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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.

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98 citations

Cites background or result from "Musculoskeletal pain in elite profe..."

...Nevertheless, the prevalence rate of musculoskeletal pain is comparable to previous studies with similar [3] or higher response rates [9, 21]....
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...PRMD might contribute considerably to performance disability, sick leave and the possibility of premature termination of a musician’s career [3, 9, 29]....
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...demonstrated that musculoskeletal symptoms [21] and musculoskeletal pain [3] in most anatomical regions were significantly associated with female gender....
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...(66 % string players, 13 % woodwind players, 14 % brass players and 7 % other instruments), the instrument affiliation of our participants was close, despite a small underrepresentation of string players [3]....
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...Playing-related musculoskeletal disorders in professional classical musicians mainly affect the neck and upper extremity locations as well as the lumbar spine [1, 3, 7, 9, 21]....
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Journal Article•DOI•

The Alexander Technique and musicians: a systematic review of controlled trials.

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Sabine D. Klein¹, Claudine Bayard¹, Ursula Wolf¹•Institutions (1)

University of Bern¹

24 Oct 2014-BMC Complementary and Alternative Medicine

TL;DR: Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians, and future trials with well-established study designs are warranted to further and more reliably explore the potential of AT in the interest of musicians.

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Abstract: Musculoskeletal disorders, stress and performance anxiety are common in musicians. Therefore, some use the Alexander Technique (AT), a psycho-physical method that helps to release unnecessary muscle tension and re-educates non-beneficial movement patterns through intentional inhibition of unwanted habitual behaviours. According to a recent review AT sessions may be effective for chronic back pain. This review aimed to evaluate the evidence for the effectiveness of AT sessions on musicians’ performance, anxiety, respiratory function and posture. The following electronic databases were searched up to February 2014 for relevant publications: PUBMED, Google Scholar, CINAHL, EMBASE, AMED, PsycINFO and RILM. The search criteria were “Alexander Technique” AND “music*”. References were searched, and experts and societies of AT or musicians’ medicine contacted for further publications. 237 citations were assessed. 12 studies were included for further analysis, 5 of which were randomised controlled trials (RCTs), 5 controlled but not randomised (CTs), and 2 mixed methods studies. Main outcome measures in RCTs and CTs were music performance, respiratory function, performance anxiety, body use and posture. Music performance was judged by external experts and found to be improved by AT in 1 of 3 RCTs; in 1 RCT comparing neurofeedback (NF) to AT, only NF caused improvements. Respiratory function was investigated in 2 RCTs, but not improved by AT training. Performance anxiety was mostly assessed by questionnaires and decreased by AT in 2 of 2 RCTs and in 2 of 2 CTs. A variety of outcome measures has been used to investigate the effectiveness of AT sessions in musicians. Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians. Effects on music performance, respiratory function and posture yet remain inconclusive. Future trials with well-established study designs are warranted to further and more reliably explore the potential of AT in the interest of musicians.

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88 citations

Cites background from "Musculoskeletal pain in elite profe..."

...Most frequently reported are musculoskeletal disorders such as back and neck pain, inflammation of the tendon sheets, muscular overuse syndromes and neuropathy in the upper limbs, depending on the instrument played [1,2]....
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References

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Journal Article•DOI•

The Brief Symptom Inventory: an introductory report.

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Leonard R. Derogatis¹, Nick Melisaratos¹•Institutions (1)

Johns Hopkins University School of Medicine¹

01 Aug 1983-Psychological Medicine

TL;DR: The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale, and factor analytic studies of the internal structure of the scale contribute evidence of construct validity.

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Abstract: This is an introductory report for the Brief Symptom Inventory (BSI), a brief psychological self-report symptom scale. The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale. Both test--retest and internal consistency reliabilities are shown to be very good for the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like dimensions of the MMPI provide good evidence of convergent validity, and factor analytic studies of the internal structure of the scale contribute evidence of construct validity. Several criterion-oriented validity studies have also been completed with this instrument.

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6,153 citations

Journal Article•DOI•

Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms.

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I. Kuorinka, B. Jonsson¹, A. Kilbom, H Vinterberg, Fin Biering-Sørensen², G. Andersson³, Kurt Jørgensen² - Show less +3 more•Institutions (3)

Umeå University¹, University of Copenhagen², Rush University Medical Center³

01 Sep 1987-Applied Ergonomics

TL;DR: Standardised questionnaires for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context are presented and specific characteristics of work strain are reflected in the frequency of responses to the questionnaires.

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4,470 citations

Journal Article•

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Christine Zaza¹•Institutions (1)

University of Western Ontario¹

21 Apr 1998-Canadian Medical Association Journal

TL;DR: Information from a systematic review of published information on the incidence and prevalence of playing-related musculoskeletal disorders (PRMDs) in classical musicians indicates that the prevalence of PRMD in adult classical musicians is comparable to the prevalences reported for other occupational groups.

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Abstract: BACKGROUND: Work-related musculoskeletal disorders cause pain, disability and loss of employment for many workers, including musicians. Although performing arts medicine is a growing field, the health problems of musicians remain under-recognized and under-researched. Therefore, the author undertook a systematic review of published information on the incidence and prevalence of playing-related musculoskeletal disorders (PRMDs) in classical musicians. METHODS: Seven databases were searched for the period 1980 to 1996. The main textbook and performing arts medicine journals were searched manually, as were reference lists of all relevant papers. The author also contacted individuals familiar with the literature of performing arts medicine. Studies were included for review if they reported PRMD incidence or prevalence in classical musicians. Of the 24 studies identified, 18 cross-sectional surveys and cohort studies were reviewed. The author subjectively assessed the studies using criteria modified from an existing evaluation scale and used 4 criteria for data combination. On the basis of prevalence values from the eligible studies, chi 2 tests for heterogeneity were performed. RESULTS: Only one study estimated PRMD incidence. Ten of the 17 prevalence studies were ineligible for data combination, because of low response rates and other methodological problems. In the 7 eligible studies, PRMD point prevalence ranged from 39% to 87% in adult musicians and from 34% to 62% in secondary school music students. The best estimates of PRMD prevalence were derived from the 3 studies that excluded mild complaints; these studies indicated that PRMD prevalence was 39% and 47% in adults and 17% in secondary school music students respectively. Statistical combination of data across studies within each demographic category was not possible. INTERPRETATION: Available data indicate that the prevalence of PRMD in adult classical musicians is comparable to the prevalence of work-related musculoskeletal disorders reported for other occupational groups. Several recommendations for future research are outlined.

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263 citations

Journal Article•DOI•

Musicians' playing-related musculoskeletal disorders: an examination of risk factors.

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C. Zaza¹, Vernon T. Farewell²•Institutions (2)

McMaster University¹, University College London²

01 Sep 1997-American Journal of Industrial Medicine

TL;DR: This study suggests that females and string players were at a higher PRMD risk, and warming up before and taking breaks during practice sessions protected the subject from a PRMD.

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Abstract: Several studies have shown that playing-related musculoskeletal disorders (PRMDs) present a significant health problem for musicians. To examine physiological, psychological, and behavioral risk factors of musicians' PRMDs, data for a case-control analysis were collected from classically-trained professional and university student musicians in the Canadian province of Ontario in 1994. Two-hundred and eighty-one subjects completed a self-report questionnaire and hypermobility and hand-span measurements. Cases were identified according to an operational PRMD definition developed by musicians and health care professionals in a qualitative study. Logistic regression was used to compare data from 44 prevalent PRMD cases who had no previous history of a PRMD, and 90 controls who had never experienced a PRMD. Data from all subjects were analyzed to examine the role of a prior PRMD on the risk of a current PRMD. This study suggests that females and string players were at a higher PRMD risk. A number of other individual characteristics were also important determinants of the development of a PRMD. Warming up before and taking breaks during practice sessions protected the subject from a PRMD. Given the high proportion of musicians who experience PRMDs, prevention programs are warranted.

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178 citations

Journal Article•DOI•

Group therapy for somatization disorders in general practice: effectiveness of a short cognitive-behavioural treatment model.

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J. Lidbeck

01 Jul 1997-Acta Psychiatrica Scandinavica

TL;DR: In this paper, the authors evaluated the effect of a short cognitive behavioural group therapy (CBG) for patients with somatization disorder in primary care, focusing on patient education and stress relaxation.

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Abstract: The objective of this study was to evaluate the effect of a short cognitive behavioural group therapy programme for somatization disorder in primary care. The treatment model was focused on patient education and stress relaxation. A controlled and prospective study design was used with repeated assessments of the patients' perception of their psychosocial problems, psychological distress and medication usage. The results were analysed up to 6 months after treatment and showed the treated patients to be moderately but significantly improved with respect to physical illness and somatic preoccupation, hypochondriasis, and medication usage. In a control group of untreated patients no such improvements were observed. In summary, the short group treatment programme used in this study may be beneficial for patients with somatization disorders. With some modifications it might be useful to practitioners in primary care for the management of psychosomatic disorders.

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122 citations