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Journal ArticleDOI

Prevalence and consequences of musculoskeletal symptoms in symphony orchestra musicians vary by gender: a cross-sectional study

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.

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Citations
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Journal ArticleDOI
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 from "Prevalence and consequences of musc..."

  • ...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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  • ...…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.…...

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Journal ArticleDOI
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 "Prevalence and consequences of musc..."

  • ..., who investigated musculoskeletal symptoms in 342 (78 % of the 441 approached musicians) Danish symphony orchestra players [21]....

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  • ...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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  • ...demonstrated that musculoskeletal symptoms [21] and musculoskeletal pain [3] in most anatomical regions were significantly associated with female gender....

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  • ...Numbers for these smaller instrument groups in our study population are comparable to previous studies [3, 9, 21], but it is possible that inconsistent pain patterns between different studies might be caused by this phenomenon....

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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 ArticleDOI
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

Journal ArticleDOI
TL;DR: Solo/lead performers, vocalists, keyboard instrument players and musicians playing within the traditional music genre reported the highest prevalence of anxiety and depression symptoms, and psychological distress was more prevalent among musicians than in the total workforce sample.
Abstract: In order to investigate mental health problems among professional musicians, we estimate the prevalence of symptoms of anxiety and depression (psychological distress) among musicians compared to the general workforce. A total sample of 1,607 musicians from the Norwegian Musicians Union answered an online questionnaire about demographic characteristics, lifestyle and symptoms of anxiety and depression. They were compared to a sample of the Norwegian workforce (n = 2,550) drawn from the Norwegian survey of level of living 2012. Based on logistic regression analysis adjusting for age, sex, education level, smoking status, alcohol usage, use of drugs, physical exercise and financial status, we compared anxiety and depression symptom levels in musicians to a variety of professions. Psychological distress was more prevalent among musicians than in the total workforce sample. Solo/lead performers, vocalists, keyboard instrument players and musicians playing within the traditional music genre reported the highest prevalence. Further research needs to map the psychosocial and personal factors contributing to the higher degree of depression and anxiety symptoms among musicians, as well as establishing evidence-based preventative measures.

73 citations

Journal ArticleDOI
TL;DR: The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes.
Abstract: Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favourable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.

66 citations


Cites background or methods from "Prevalence and consequences of musc..."

  • ...Injury rates are globally reported to be high in this profession (Middlestadt and Fishbein, 1989; Leaver et al., 2011; Paarup et al., 2011; Ackermann et al., 2012), and are thought to relate to the repetitive physical loads reflecting the particular demands of the instrument played....

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  • ...For example, shoulder injuries occur frequently in violin and viola players (Leaver et al., 2011; Paarup et al., 2011; Ackermann et al., 2012), while orofacial and embouchure problems are common in brass players (Iltis and Givens, 2005; Fletcher, 2008; Frucht, 2009)....

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  • ...The literature on common body regions of PRMDs experienced by musicians was used to identify target regions for strengthening (Roset-Llobet et al., 2000; Wu, 2007; Leaver et al., 2011; Paarup et al., 2011; Ackermann et al., 2012)....

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References
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Journal ArticleDOI
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.

4,470 citations


"Prevalence and consequences of musc..." refers methods or result in this paper

  • ...Questions regarding musculoskeletal symptoms were adapted from the Nordic Musculoskeletal Questionnaire [24-26]....

    [...]

  • ...Questions on musculoskeletal problems were mainly built on known questionnaires in order to have standardised results which could be compared to other groups [24,25,27]....

    [...]

  • ...Dickinson CE, Campion K, Foster AF, Newman SJ, O’Rourke AM, Thomas PG: Questionnaire development: an examination of the Nordic Musculoskeletal Questionnaire....

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Journal ArticleDOI
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

Journal ArticleDOI
TL;DR: Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities.
Abstract: Objective This systematic review was designed and conducted in an effort to evaluate the evidence currently available for the many suggested risk factors for work-related musculoskeletal disorders. Methods To identify pertinent literature we searched four electronic databases (Cinahl, Embase, Medline, and The Cochrane Library). The search strategies combined terms for musculoskeletal disorders, work, and risk factors. Only case–control or cohort studies were included. Results A total of 1,761 non-duplicated articles were identified and screened, and 63 studies were reviewed and integrated in this article. The risk factors identified for the development of work-related musculoskeletal disorders were divided and organized according to the affected body part, type of risk factor (biomechanical, psychosocial, or individual) and level of evidence (strong, reasonable, or insufficient evidence). Conclusions Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities. The most commonly reported biomechanical risk factors with at least reasonable evidence for causing WMSD include excessive repetition, awkward postures, and heavy lifting. Additional high methodological quality studies are needed to further understand and provide stronger evidence of the causal relationship between risk factors and work-related musculoskeletal disorders. The information provided in this article may be useful to healthcare providers, researchers, and ergonomists interested on risk identification and design of interventions to reduce the rates of work-related musculoskeletal disorders. Am. J. Ind. Med. 2009. 2009 Wiley-Liss, Inc.

1,135 citations


"Prevalence and consequences of musc..." refers background in this paper

  • ...Hence, symphony orchestra musicians are likely to acquire work-related musculoskeletal problems, as static and repetitive work characteristics in many occupational settings have been associated with musculoskeletal disorders in the neck, back and upper extremities [16-20]....

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Journal ArticleDOI
TL;DR: A significant number of improvements was identified in the Nordic Musculoskeletal Questionnaire, especially concerning its wording, layout and administration, which has led to a standardized version being produced for use in studying the prevalence of reported symptoms in many types of occupational groups.

320 citations


"Prevalence and consequences of musc..." refers methods or result in this paper

  • ...Questions regarding musculoskeletal symptoms were adapted from the Nordic Musculoskeletal Questionnaire [24-26]....

    [...]

  • ...Questions on musculoskeletal problems were mainly built on known questionnaires in order to have standardised results which could be compared to other groups [24,25,27]....

    [...]

  • ...Dickinson CE, Campion K, Foster AF, Newman SJ, O’Rourke AM, Thomas PG: Questionnaire development: an examination of the Nordic Musculoskeletal Questionnaire....

    [...]