Prevalence and associated factors of playing-related musculoskeletal disorders among music students in Europe. Baseline findings from the Risk of Music Students (RISMUS) longitudinal multicentre study

Characteristics of musculoskeletal pain in university music students: A cross-sectional survey

BackgroundThe prevalence of playing-related musculoskeletal disorders ranges from 46% to 90% in adult musicians. This pain sometimes forces the interruption of instrumental practice.ObjectiveTo describe the prevalence and characteristics of playing-related musculoskeletal disorders in music students, relating it to gender, and the relationship between the number of hours of weekly instrumental practice and the number of pain locations.MethodsAn online questionnaire was conducted with university music students, which assesses the presence of pain, location, intensity and interference of pain comparing gender, and the number of weekly practice hours.Results435 valid responses were obtained. 93.3% of women vs. 88.3% of men (p < 0.001) report having suffered from some type of playing-related musculoskeletal disorders. Pain intensity is 2.99 points for women and 1.74 for men, and pain interference is 3.42 and 2.16 respectively (p < 0.001). The number of hours dedicated to instrumental does not influence the number of pain locations (p > 0.05).ConclusionMost music students report playing-related musculoskeletal disorders, presenting on average more than 3 body pain locations. This pain is considered mild, with low interference on mood, quality of life and instrumental practice. Women report pain more often and more intensely, however, men report pain in more anatomical regions.

Wellbeing for young elite musicians: development of a health protocol from a student perspective

Musicians' vulnerability to psychological and physical problems provides a compelling argument to include health and wellbeing training in music education. This study forms part of a larger project to design an evidence-based wellbeing protocol for young elite musicians at a pre-professional music training institute. Recommendations from the health, education, performance science, behavior change, and occupational and public health literature provided theoretical and practical foundations for the project. The aim of this study was to identify barriers to wellbeing and strengths of an existing health protocol, and provide recommendations for change from the student perspective. Four in-person focus groups were held on the same day, attended by 68% (n = 45) of the student cohort. Semi-structured discussions were recorded, transcribed and analyzed thematically. Barriers to wellbeing and recommendations for change were collated from the data and distributed to the student body to be rated in priority order. Participants appreciated the existing program for its holistic approach delivered by a range of skilled practitioners. Barriers to wellbeing included constraints in finances, leave allowances and time, pressure from interpersonal challenges and unhealthy norms in the music performance culture. Recommendations for change included updating the financial policy; having more flexible leave conditions to allow higher earnings and better access to performance opportunities; having reliably scheduled time off; collaborative planning with staff around playing rosters; more activities for musician enhancement and social bonding; exercise opportunities in-house; addressing pervasive cultural norms around practice and breaks; education regarding respectful and professional conduct; an effective complaints procedure, and more practical wellbeing sessions.

Effect of induced extrinsic and intrinsic hand and forearm muscular fatigue on the control of finger force during piano playing

This study aimed to investigate the effect of hand muscle fatigue on finger control and force efficiency during piano performance, which is crucial for skilled piano playing among professional pianists engaged in prolonged periods of high-intensity practice or concert preparation. Thirty-one professional pianists were recruited as participants. This study was divided into three sequential experimental parts: pre-fatigue test, fatigue protocol, and post-fatigue test. Each participant was assigned eight piano skills and instructed to perform two fatigue tasks: finger extension and finger grasping exercises. The study recorded and analyzed the finger force of professional pianists using a sensor-embedded kinetic assessment piano system; wrist movements were assessed using a three-dimensional motion capture system. Paired t-tests were used to determine the differences between the pre- and post-tests. The findings showed that the average peak striking force of most fingers in Chords 1, 2, 4, 5, 6, and 7 decreased significantly after the fatigue task, indicating a reduction in the finger-striking force following fatigue across the various chord fingerings. The analysis of wrist movements demonstrated strategic adjustments made by pianists after experiencing fatigue, particularly in the ulnar/radial deviation movements. This study highlights the influence of muscle fatigue on finger control and wrist movements of pianists across different fingerings. We recommend that pianists focus on strengthening the extrinsic and intrinsic muscles of the hand and the muscle groups responsible for controlling ulnar/radial movements to mitigate the effects of muscular fatigue on hand performance.

Playing-related musculoskeletal disorders among Chinese conservatoire piano students: prevalence, risk factors and preventive interventions

Introduction

Both professional musicians and conservatoire students are at significant risk of developing playing-related musculoskeletal disorders (PRMDs) during their career life. With the growing number of students pursuing a conservatory degree and graduating from music conservatory in China, the aims of this study were: (1) to identify the nature of PRMD and explore the prevalence of PRMD in Chinese conservatoire students; (2) to determine the relevant risk factors with the presence of PRMD among Chinese conservatoire students; and (3) to suggest preventive interventions for young pianists at their early career stage.

Methods

A self-reported online survey study was conducted among 363 Chinese conservatoire students who majored in piano performance.

Results

Of all respondents, 82.6% reported having had at least one PRMD. The wrist was proved to be the most affected body site, followed by the shoulder, finger and arm. Respondents who experienced PRMD reported "pain," "fatigue," and "stiffness" as the most frequent symptoms. The main risk factors associated with PRMD included gender, years of playing experiences, practice hours, warm-up habits before practice, and break-taking during practice.

Discussion

Female students, those with longer year of playing experience, those who practice longer hours, those who do not warm up before practice, and those who do not take breaks during practice were found to have more PRMD symptoms and higher level of severity. This study highlights the need to increase awareness of PRMD among conservatoire students and to understand the occurrence of PRMD; it is helpful for young pianists to prevent severe musculoskeletal disorders and implement preventive measures at early career stages. Further studies are suggested to follow up on music students who have had at least one PRMD at different stages of professional musical training.

Risk Factors and Coping Strategies of Playing-Related Musculoskeletal Disorder (PRMD) in Tertiary Student Pianists: A Phenomenological Study

Purpose

While pianists enjoy the happiness of creating music, they also face many health problems, with playing-related musculoskeletal disorder (PRMD) being one of the most common occupational diseases. Compared with professional pianists, tertiary student pianists are easy to neglect, but they also suffer from playing-related injuries and face many difficulties and challenges. This study aims to investigate the risk factors of student pianists suffering from PRMD and the strategies to cope with PRMD from their lived experience using the method of descriptive phenomenology and the social cognitive theory (SCT) as the theoretical basis.

Patients and Methods

This study's data are derived from semi-structured one-on-one interviews with twelve student pianists at seven higher education institutions in China and are analyzed using Moustakas' improved Stevick-Colaizzi-Keen (SCK) phenomenological analysis method.

Results

This study developed nine themes related to PRMD risk factors and copy strategies within the SCT framework, they are: self-efficacy, personal psychological factor, self-regulation, piano-playing factors, receive medical treatment, outcome expectation, negative effects from social relations, help from social relations and physical environment.

Conclusion

The findings identify the profound influences of personal, social, behavioral, and environmental factors on the PRMD-related experiences of tertiary student pianists and highlight the importance of improving the self-efficacy and self-regulation ability of tertiary student pianists, as well as promoting social and healthcare attention and support for them.

Performance-related pain and disability among music students versus professional musicians: a multicenter study using a validated tool

OBJECTIVE

To evaluate prevalence of performance-related pain among musicians and compare pain characteristics, associated disability and approach to pain management, between music students and professional musicians.

METHODS

A multicenter cross-sectional study was performed in a multi-stage stratified cluster random sample of 585 musicians, stratified by music students (294, among which 234 were at pre-university level and 60 at university level) and professional musicians (291). The main outcome was performance-related pain, measured by Performance-related Pain among Musicians Questionnaire (PPAM). Secondary outcomes were: pain management approach, physical activity levels, fatigue, distress, and health-related quality of life.

RESULTS

The lifetime prevalence of performance-related pain was 55.0% (n = 322), being significantly higher among professionals (57.5% vs 42.5%, P < .001). Pain intensity scores were significantly higher in professional musicians (P < .05), but pain interference in performance was higher among music students, who also reported significantly higher levels of fatigue (P = .008) and distress (P < .001), and lower quality of life (P < .001). Regardless of the high levels of pain intensity and interference, fatigue, anxiety and depression, and low levels of quality of life, 33% musicians who developed pain had never looked for healthcare (this proportion is significantly higher for music students, 57%, P < .001).

CONCLUSIONS

We present the first multicenter study on performance-related pain among musicians with different backgrounds, using a validated tool, and distinguishing music students from professional musicians. Performance-related pain is a highly prevalent and disabling condition among musicians, however, its proper evaluation and management are still often underappreciated, contributing to significant impairments and reduced quality of life.

The Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians: Assessment of Patient-Related Outcomes among Professional Orchestra Musicians in Poland-A Cross-Sectional Study

Background: Musculoskeletal pain is one of the reasons for a musician's inability to play an instrument. An assessment of the localization, intensity, and interference of those complaints is important among musicians because of the risk of occupational disease. Assessment by validated tools is especially important and serves as an indicator to take up proper preventive or treatment actions. The aim of the study was to assess the prevalence of playing-related musculoskeletal disorders (PRMDs) and the relationships with PRMDs' impact on playing musical instruments among Polish professional orchestra musicians. Methods: The study was conducted on a group of professional orchestra musicians (age 37.19 ± 9.62 years), 99 (55%) women and 83 (45%) men. Work experience in professional orchestra was 18.3 ± 9.83 years and the reported years of playing musical instrument were 31.4 ± 9.50. The study used the online version of a musician-dedicated questionnaire, Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians of the Polish Population (MPIIQM-P). Results: In the study group, 89.9% of women and 83.1% of men had experienced playing-related pain in their lifetime. The most intense pain among the group with current playing-related musculoskeletal complaints (n = 85) was located in the neck area for 19 (22.4%). Conclusions: The results of the study indicate a high prevalence of playing-related musculoskeletal problems among professional musicians.

Factors Associated with Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools

PURPOSE

We aimed to evaluate factors associated with performance-related pain among musicians with different backgrounds, comparing music students and professional musicians.

METHODS

We performed a multicenter cross-sectional study in a stratified random sample consisting of music students (294) and professional musicians (291). The main outcome was performance-related pain (PRP), measured by the Performance-related Pain among Musicians Questionnaire (PPAM). Factors associated with the outcome were measured using PPAM, International Physical Activity Questionnaire, Modified Fatigue Impact Scale, 10-item Kessler Psychological Distress Scale, Frost Multidimensional Perfectionism Scale, and Medical Outcomes Study Short Form 36 Health Survey.

RESULTS

From the 585 musicians included (response rate of 82.4%), 322 (55.0%) reported PRP. Professional musicians presented a significantly higher lifetime prevalence of PRP (57.5%, p < 0.001); however, music students reported higher levels of fatigue, anxiety and depression, and lower quality of life. Multivariate logistic regression defined a model with 16 factors significantly associated with higher probability of PRP. Additionally, we describe 25 self-perceived factors reported by musicians as being associated with PRP.

CONCLUSION

We present the first study thoroughly describing and assessing factors associated with PRP among musicians, using a validated tool, including musicians with different backgrounds, and distinguishing music students and professional musicians. We also explore self-perceived factors associated with PRP. The relevant insights coming from this and future studies on factors associated with PRP will contribute to developing more effective preventive programs and improving evidence-based guidance and management of musicians affected by PRP.

Development and Initial Validation of the First Questionnaire to Evaluate Performance-related Pain Among Musicians with Different Backgrounds: Performance-related Pain Among Musicians Questionnaire (PPAM)

AIM

To develop and perform the expert's content validation and pretesting of the first questionnaire specifically designed to evaluate performance-related pain among musicians with different backgrounds.

METHODS

The development of the Performance-related Pain Among Musicians Questionnaire (PPAM) was carried out in 4 phases: (1) item generation, (2) experts' panel evaluation and content validation (3) pretesting, and (4) conceptualization of the final version. For item generation we conducted two systematic reviews to identify the existing tools evaluating similar constructs and the predictive factors of performance-related pain. Four expert panel meetings and three pilot tests were performed, with a total of 94 musicians.

RESULTS

From the 1154 articles initially found in the literature search, 153 were included (65 related to pain tools and 88 related to predictive factors) and a pool of 115 items were created. After expert panel evaluation and pretesting, a final self-report questionnaire was defined, comprising 33 core items to evaluate 3 constructs (pain intensity, pain interference in general activities and pain interference in performance), as well as 32 additional items (optional module - predictive factors).

CONCLUSIONS

The PPAM Questionnaire is specifically designed and validated for musicians and can be applied for all types of musicians (professional, amateur and music students), allowing the development of comparative studies between musicians. It is a new enriched tool, easy to respond and disseminate to large, multicentre, and international samples. PPAM is suitable for research and clinical practice purposes and will allow the improved assessment and monitoring of pain in this occupational context.

Performance-Related Pain Among Musicians Questionnaire (PPAM): Multicenter Validation of the First Questionnaire to Evaluate Performance-Related Pain Among Musicians With Different Musical Backgrounds

We aim to present the first psychometric evaluation of the Performance-related Pain Among Musicians questionnaire (PPAM), the first questionnaire specifically designed to evaluate performance-related pain among musicians with different musical backgrounds, based on a multicenter validation study. The psychometric evaluation was performed in a validation sample of 458 musicians, at baseline and after seven days. We assessed the applicability, reliability, internal consistency, construct validity, and factor structure of the PPAM. The Cronbach's α coefficients for the 3 subdimensions of PPAM-"pain intensity", "pain interference in general", and "pain interference in performance"-were .834, .864, and .930, respectively, suggesting a high degree of internal consistency. Test-retest reliability coefficients were substantial for all subscales of the PPAM questionnaire. Exploratory factor analysis indicated a three-factor structure (pain intensity, interference in general activities, and interference in performance) that explained 62% of the variance. Both convergent and divergent validity were well demonstrated, confirming more than 95% of the previously defined hypotheses regarding correlations with other measures. PPAM is the first validated questionnaire to evaluate pain among musicians with different musical backgrounds. This online self-reported questionnaire is a valid and reliable tool suitable for both clinical research and clinical practice, with excellent psychometric properties, both in terms of internal consistency, test-retest reliability, factor analysis, and construct validity. It will allow the development of more robust studies on pain and disability among musicians, comparative studies between different subgroups of musicians and the evaluation of predictive factors of pain development. PERSPECTIVE: This article presents the psychometric properties of the first questionnaire to evaluate pain among musicians (in general), the "Performance-related Pain among Musicians Questionnaire" (PPAM). This valid and reliable tool, composed by three constructs (pain intensity, interference in general activities, and interference in performance), will improve the pain assessment among musicians.

Warm-up exercises reduce music conservatoire students' pain intensity when controlling for mood, sleep and physical activity: A pilot study

Introduction

Playing-related musculoskeletal pain is highly prevalent among classical music students, affecting them physically and psychologically. Unlike athletes or dancers, musicians' pain often goes untreated due to stigma and lack of specialised healthcare. While warm-up exercises are common practice in sports and dance, there is a lack of empirical research regarding physical warm-ups for musicians' pain. This study aimed to investigate the effects of a 2-week daily warm-up exercise intervention on conservatoire students' pain intensity, interference and psychological distress, at day 0 and after 2 weeks.

Methods

Two groups were considered: an exercise (n = 9) and a waitlist control (n = 7) group. Data were collected using online Qualtrics surveys at three different stages.

Results

2 × 2 mixed ANOVAs indicated no significant effects on any of the outcome variables. However, when controlling for sleep, anxiety, depression and physical activity, the analyses revealed a significantly greater decrease in pain intensity in the exercise group compared to the control. In addition, bivariate correlations indicated that pain interference, anxiety and depression delta scores were significantly correlated for the exercise but not the control group. Anxiety and pain intensity delta scores were significantly correlated in both groups.

Conclusions

These findings suggest that daily warm-up exercises have the potential to reduce musicians' pain intensity but only if certain variables are factored in. This pilot study highlights the multifactorial nature of musicians' pain and unveils the role that mood, sleep and physical activity level may have when assessing the efficacy of interventions based on warm-up exercises.

Measuring the usability of a novel ergonomic chinrest during violin playing: A feasibility study

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 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.

Factors associated with increased risk of playing-related disorders among classical music students within the Risk of Music Students (RISMUS) longitudinal study

Playing-related musculoskeletal disorders (PRMDs) are common among musicians but longitudinal data on risk factors are limited. The aim of the study was to longitudinally identify the factors associated with increased risk of PRMD onset among music students enrolled in different pan-European music institutions. A further goal was to assess the occurrence of PRMDs during a 12-month period. A total of 442 students without PRMDs from 56 European music universities completed a web-based questionnaire on lifestyle and practice habits, health history, physical activity, psychological distress, perfectionism, and fatigue. PRMD onset was assessed prospectively at 6 and 12 months. Logistic regression analysis showed that changes in physical activity level (6-month AOR = 2.343, 12-month AOR = 2.346), increased levels of fatigue (6-month AOR = 1.084, 12-month AOR = 1.081) and socially-prescribed perfectionism (6-month AOR = 1.102) were significantly associated with PRMD onset, which had occurred in 49% of participants during 12 months. Musculoskeletal complaints reported at baseline (6-month AOR = 0.145, 12-month AOR = 0.441) and changes to BMI (12-month AOR = 0.663) limited the onset of PRMDs. The study's novel longitudinal findings were appraised critically within the contexts of potential factors for PRMD onset and evidence-based preventive strategies to minimise the impact of PRMDs.

Musculoskeletal pain in musicians: does playing more than one instrument have more effect?

Objectives. Repeated instrumental practice represents a risk factor for the appearance of playing-related musculoskeletal disorders (PRMDs). This study aimed to compare the prevalence and characteristics of PRMDs based on location, pain characteristics and number of hours of instrumental practice, in musicians who play one or more musical instruments.Methods. An observational study was conducted with music university students in Spain using a questionnaire.Results: A total of 178 musicians (41%) played a second instrument. Musicians who played only one instrument had a slightly lower mean number of pain sites (M 3.25, SD 1.93; M 3.44, SD 2.27). On the contrary, pain intensity (M 2.72, SD 2.03; M 2.23, SD 1.78 points), pain interference on mood, quality of life and instrumental practice (M 3.04, SD 2.29; M 2.80, SD 2.24 points) as well as the number of hours devoted to instrumental practice (M 21.18, SD 10.47; M 20.03, SD 12.54 h/week) is slightly higher in musicians playing a single instrument.Conclusions. Pain intensity is the only variable of those analysed that presents statistically significant differences when comparing musicians who play a single instrument with those who play a second instrument, being higher in mono-instrumental musicians.

A Cross-Sectional Survey of Work-Related Musculoskeletal Disorders in Physiotherapists Using Orebro Musculoskeletal Pain Questionnaire (OMPQ)

Background

Physiotherapists in India are at a high risk of work-related musculoskeletal disorder (WRMSD). Faulty ergonomics and incorrect patient handling techniques are the common causes of WRMSDs. The disabilities caused due to musculoskeletal injuries are the frequent cause of absenteeism from work.

Aim and Method

The aim of this cross-sectional survey is to investigate the occurrence of WRMSDs among physiotherapists in Maharashtra using Orebro Musculoskeletal Pain Questionnaire. Responses were obtained through Google forms and analyzed. Three hundred sixty physiotherapists who fulfilled the inclusion criteria were recruited for the study. All the participants responded to the questionnaire.

Result

The prevalence of WRMSDs was found to be highest in age of 23-30 years (87.22%) and less in age of 41-50 years (2.22%). Most common affected area was neck (43.6%) and lower back (43.1%).

Conclusion

This study highlights the high incidence of WRMSDs among physiotherapists in Maharashtra.

Exploring the Impact of Occupational Adaptation-Focused Interventions on Music Student Health

Music students are at an elevated risk of playing-related musculoskeletal disorders. This study aimed to explore the impact of occupational adaptation-focused interventions on music student health. A quasi-experimental one-group pretest/posttest design was used. Music students received occupational therapy services grounded in the Occupational Adaptation model of practice. Assessment tools included the Performing Arts Module of the Disabilities of the Arm, Shoulder, and Hand (DASH) and an occupational adaptive process evaluation. Twelve music students, ages 19 to 32 years old, participated in this study. Results indicated a significant decrease in current pain intensity (Z = -2.038, p < .042), 24-hr pain intensity (Z = -2.94, p < .003), and DASH scores (Z = -2.81, p < .005). Strong correlations were found between participants' adaptive capacity and improved DASH scores and 24-hr pain. Occupational adaptation-focused interventions can improve university-level music student health by addressing body functions affecting music performance and increasing their adaptive capacity.

Identifying physical and psychological risk factors for musculoskeletal pain in student musicians to tailor the curriculum: a cross-sectional study protocol

INTRODUCTION

Insufficient identification and understanding of risk factors make musicians engaging in professional practice particularly vulnerable to musculoskeletal pain. To support positive music learning and good mental, physical, and social health, student musicians need health support tailored to their needs and their instrumental practice. However, these preventive actions must be based on sound scientific approaches that reliably identify the most relevant risk factors. MuSa is a cross-sectional study examining contextual and internal risk variables associated with playing-related musculoskeletal disorders in student musicians.

METHOD AND ANALYSIS

The design is a monocentric cross-sectional study involving student musicians in Bachelor's 1, 2, 3 and Master's 1, 2. Free-form questions will identify students' lifestyle characteristics and work habits, and validated questionnaires will evaluate the interaction between pain due to music practice and psychological and physical risk factors. All data will first be analysed descriptively. Psychological network analysis will be used to explore the overall correlational structure of the dataset. A subgroup comparative analysis will be then applied according to the instrumental subcategories and work postures, including singers.

ETHICS AND DISSEMINATION

The full protocol was approved by the Swiss Ethics Committee 'Commission Cantonale d'Ethique de la Recherche sur l'être humain de Genève' (CCER, no. 2022-02206) on 13 February 2023. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences.

Effect of manual therapy on music students with playing-related musculoskeletal disorders: a prospective study

Playing Related Musculoskeletal Disorders (PRMD) belong to the most prevalent medical ailments affecting musicians' health and career. This study documents the effect of a physiotherapeutic treatment as well as functional impairments of PRMD on the musculoskeletal system. In total, 32 music students suffering from PRMD were examined in Hanover Medical School (MHH) before and after they received twelve physiotherapeutic treatments, which were carried out over 20 min each over 6 weeks. Additionally, 32 healthy music students, matched by age and gender, were examined at one time point in the MHH to explore which musculoskeletal restrictions are associated with PRMD. The examination included the evaluation of the pain on the Visual Analogue Scale for pain (VAS), a body composition, and body posture measurement, the finger-to-floor distance, the range of motion of the cervical spine, the pressure pain and muscular hypertension examination, the temporomandibular joint-test, the Beighton score screening test, and the testing of the widespread pain score (WSP). After analyzing the data of the patient group (PG) a significant reduction of pain level on the VAS from an average pain of 6.31 to 3.53 was found (large effect). Additionally, a significant reduction of the pressure pain of the M. levator scapulae, the M. rhomboideus, the M. sternocleidomastoideus on the left side and the paravertebral muscles of the cervical spine on the right side after the treatment of the patients could be detected. Regarding the WSP, the positive testing significantly differed, showing a 28% positive testing in the patient group vs. a positive testing of 9% in the control group (CG). As hypermobility is a common phenomenon in musicians, the percentage of those being diagnosed with generalized hypermobility by using the Beighton score in both groups (PG: 37.5%; CG: 25%) was remarkably higher compared to previous studies. In this study, a short course of manual therapy, client tailored for each musician's specific problem, was shown to reduce pain levels in musicians with PRMD.

Ergonomics of E-Learning Workstations and the Prevalence of Musculoskeletal Disorders-Study among University Students

The prevalence of musculoskeletal disorders (MSD) has increased significantly in recent years. The COVID-19 pandemic has led to a fundamental change in the lifestyles, ways of learning and working patterns of the general population, which in turn, might lead to health consequences. The aim of this study was to evaluate the conditions of e-learning and the impact of the learning modality on the occurrence of musculoskeletal symptoms among university students in Poland. This cross-sectional study included 914 students who completed an anonymous questionnaire. The questions covered two time periods (before and during the COVID-19 pandemic) and were aimed at obtaining information about lifestyle (including physical activity using the modified International Physical Activity Questionnaire, 2007 (IPAQ), perceived stress and sleep patterns), the ergonomics of computer workstations (by Rapid Office Strain Assessment, 2012 (ROSA) method), the incidence and severity of musculoskeletal symptoms (by the Nordic Musculoskeletal Questionnaire, 2018 (NMQ)) and headaches. The main differences between the two periods were statistically significant according to the Wilcoxon test in terms of physical activity, computer use time, and severity of headaches. During the COVID-19 pandemic, there was a significant increase in MSD (68.2% vs. 74.6%) and their intensity (2.83 ± 2.36 vs. 3.50 ± 2.79 points) among the student population (p < 0.001). In the group of students with MSD, there was a high musculoskeletal load, due to the lack of ergonomic remote learning workstations. In future, a thorough study should be carried out, and there is an urgent need to raise students' awareness of arranging learning workstations according to ergonomic principles in order to prevent the occurrence of musculoskeletal problems.

Musculoskeletal Health Complaints and Associated Risk Factors in Freshmen Music Students

BACKGROUND

Evidence concerning the development of musculoskeletal health complaints (MHCs) among music students is limited due to inappropriate study designs. We aimed to assess the occurrences of MHCs and associated risk factors in freshmen music students compared to students from other disciplines.

METHODS

A prospective cohort study was conducted. Risk factors such as pain-related, physical, and psychosocial variables were measured at baseline. Episodes of MHCs were recorded monthly.

RESULTS

A total of 146 music students and 191 students from other disciplines were analyzed. In the cross-sectional comparison, pain-related, physical, and psychosocial variables were significantly altered in music students compared to students from other disciplines. Furthermore, music students with current MHCs differed significantly from music students without current MHCs with respect to physical health, pain, and history of MHCs. Our longitudinal analysis showed that monthly MHCs were higher in music students compared to students from other disciplines. Independent predictors for monthly MHCs in music students were current MHCs and reduced physical function. Predictors for MHCs in students from other disciplines were a history of MHCs and stress.

CONCLUSIONS

We provided insight into the development of MHCs and risk factors in music students. This may help in the creation of targeted, evidence-based prevention and rehabilitation.

Health education in conservatoires: what should it consist of? Findings from workshops with experts (Part II)

Although health education programmes have been implemented in higher music education (HME) and their evaluations published in peer-reviewed journals, guidelines as to what ought to be included in these programmes are still missing. This study aimed to document expert discussions on the content of an ideal health education curriculum for HME students in the UK, integrating critical thinking. Four interdisciplinary workshops were conducted, where 67 experts in relevant fields took part, and were asked to discuss four lists of topics and concepts created based on literature reviews (cognitive biases, logical fallacies, critical appraisal tools and health topics). Only the list on health topics is relevant here. Notes taken by the participants and ourselves were thematically analysed. Four themes were identified, two of which are reported in this paper: (i) The health education curriculum and (ii) A settings-based approach to health. Part I of this project (published elsewhere) is focussed on the critical thinking content of health education for conservatoire students. The present paper focusses on the ideal health education curriculum and its implications for the wider context of health promotion.

Are music students at 'high-risk' of experiencing musculoskeletal symptom outcomes compared with other students?

Musicians have been described as a 'high-risk' group for experiencing musculoskeletal symptoms (MSSs), yet few studies have tested this assumption. We aimed to determine whether the prevalence and profile of MSS outcomes differed between university music students and a reference group (science students). A survey was conducted with university music and science students. Reported MSS outcomes among the two groups were compared using regression analyses. The majority of participants in both groups reported experiencing MSSs in the last 12 months and 7 days. Music students reported a higher prevalence of wrist/ hand MSSs compared with science students. Compared with symptomatic science students, music students reported a higher emotional impact of MSSs. We recommend prioritising research into interventions for music students that address MSSs in the wrist/ hand region, and the emotional impact of MSSs. Addressing these MSS outcomes could reduce the MSS burden for musicians during and beyond their studies.

Musculoskeletal pain in musicians: prevalence and risk factors. A systematic review

OBJECTIVE

: to determine the prevalence and regions of the body in which musculoskeletal injuries occur in musicians, as well as to identify risk factors related to their occurrence.

METHODOLOGY

: A search was carried out in the Pubmed, Scopus, Web of Science and Cinahl databases for publications between 2006 and 2020. Observational studies on the prevalence of musculoskeletal injuries or their risk factors in musicians aged 18-65 years were eligible for inclusion, and the methodological quality and risk of bias were assessed.

RESULTS

: 31 studies on multiple instruments and 17 on individual instruments were included. Quality was rated as high in 65% of the studies. Lifetime prevalence of injuries ranged from 46-90% and current prevalence from 9-63%. The most common region of pain was the neck, being present in all instrument families. Being female is a predisposing factor to the appearance of musculoskeletal problems in musicians.

CONCLUSIONS

: Musicians suffer frequently musculoskeletal injuries. The most common regions of the body in which these injuries occur are the neck and shoulders. Numerous risk factors were found to be predisposing to musculoskeletal injuries. We note that there are fewer studies on specific instruments.

Towards a Holistic Understanding of Musician's Focal Dystonia: Educational Factors and Mistake Rumination Contribute to the Risk of Developing the Disorder

Musicians' Focal Dystonia (MFD) is a task-specific neurological movement disorder, affecting 1-2% of highly skilled musicians. The condition can impair motor function by creating involuntary movements, predominantly in the upper extremities or the embouchure. The pathophysiology of the disorder is not fully understood, and complete recovery is extremely rare. While most of the literature views the condition through a neurological lens, a handful of recent studies point out certain psychological traits and the presence of adverse playing-related experiences and preceding trauma as possible contributors to the onset. The nature and the frequency of these factors, however, are under-researched. The present quasi-experimental study aimed to compare musicians with and without MFD in terms of the frequency of various adverse psychosocial and psychological factors to explore their contribution to the onset of the condition. Professional musicians with MFD (n = 107) and without MFD (n = 68) were recruited from online platforms, musicians' unions, and organisations to fill out a survey. The survey was based on two previously conducted interview studies and included the Student-Instructor Relationship Scale (SIRS), the Mistake Rumination Scale (MRS), the Trauma History Screen, and self-constructed questions about the received music education, early success, and personal experiences. To identify potential risk factors, independent samples t-tests were conducted and found that there are significant differences in musicians with and without MFD in terms of mistake rumination, early success, and the received music education. A logistic regression showed that six factors contributed to the construct to various extents; we observed a significant model [χ2 (80) = 22.681, p < 0.001], which predicted 71.2% of the cases correctly. This exploratory study shows that psychological and psychosocial factors might play a role in the development of MFD. Understanding these in more detail could inform preventative strategies and complement the current therapeutic approaches to support this vulnerable population better.

Exploring the Impact of the Somatic Method 'Timani' on Performance Quality, Performance-Related Pain and Injury, and Self-Efficacy in Music Students in Norway: An Intervention Study

The importance of including performance-related body mechanics into music education to improve performance quality and prevent performance-related injuries has been stressed by many researchers recently. However, it is unclear how this information could be delivered most effectively. The somatic method ‘Timani’ provides a practical solution by combining expertise in music performance and functional body mechanics with the goal of achieving a more efficient playing technique. Since no in-depth study has been conducted to assess the method before, we explored the impact of this method on young musicians’ performance through an online, 4-week-long Timani intervention with a mixed-methodology design. 17 students (mean age = 19.17 years) were recruited from the Norwegian Academy of Music. They participated in two group workshops at the beginning and the end of the project and received four individual Timani sessions administered by certified teachers. We collected survey data at the workshops about performance-related pain and self-efficacy, and qualitative feedback after each session. In addition, all sessions were observed by the researcher and semi-structured interviews were conducted with the teachers about the perceived outcomes and their experiences with teaching the method online. Our findings show that the intervention had a positive impact on a physical, professional, and to some extent, psychological and behavioral level. The improvements included better posture when playing, enhanced control and dexterity in the upper extremities, and improved breathing mechanisms. The seven students who had performance-related pain pre-intervention reported a reduction in the discomfort. The positive results were achieved by the dual expertise of the teachers in music performance and functional body mechanics, the structure of the sessions, the communication, and the pedagogical tools used. Both students and teachers felt that administering the sessions online was satisfactory and produced good results. Timani is a promising method to establish healthy playing and singing habits thus improving performance quality and preventing performance-related problems and has great potential in reducing pre-existing injuries and pain. Also, it can be effectively taught online which has further implications for the logistics of delivery.

MusicCohort: Pilot feasibility of a protocol to assess students' physical and mental health in a Canadian post-secondary school of music

Objective

Music-related physical and mental health conditions are common among post-secondary music students, with many studies reporting a prevalence greater than 70%. However, there is currently no consensus on appropriate, validated assessments for this population. The aim of this pilot study was to test the feasibility of an assessment protocol developed for a German longitudinal study with Canadian post-secondary music students, and to compare the health of music students to non-music students. Using a cross-sectional design, first-semester music and non-music control students were recruited at two campuses at the same university. Both groups completed questionnaires and physical testing, including range of motion, core strength, and pressure pain threshold. Nineteen music students and 50 non-music student controls participated in this study.

Results

The German protocol is feasible in a Canadian post-secondary setting. Canadian music students demonstrated similar health outcomes to those in the parent study. All participants demonstrated poorer mental and physical quality of life than the Canadian norms, though this was not statistically significant. The results of this study should be confirmed in a larger study. Future studies with larger sample sizes can provide further insight into the health of Canadian music students, providing a basis for prevention and intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05829-9.

Hard Work and Hopefulness: A Mixed Methods Study of Music Students' Status and Beliefs in Relation to Health, Wellbeing, and Success as They Enter Specialized Higher Education

Using mixed methods, we explored new music students’ concepts of wellbeing and success and their current state of wellbeing at a university music department in Switzerland. Music performance is a competitive and achievement-oriented career. Research suggests musicians face vocation-specific challenges to physical health and mental wellbeing but has yet to investigate music students’ beliefs about wellbeing and success. With a self-report questionnaire (n = 99, Bachelor/Master students) we investigated new music students’ quality of life (WHO-5; WHOQoL-BREF) and self-efficacy (ASKU). Through qualitative workshops (17 groups, n = 5–8) we explored students’ understanding of the term “wellbeing,” and how this relates to “success.” Over half new music students (55%) believed the institution has 40–60% responsibility for their wellbeing. A simple linear regression showed that self-efficacy could predict better wellbeing, explaining 12% of the variance. Self-efficacy predicts wellbeing for new music students (β1 = 8.81, p = 0.001). The 17 flipcharts generated 121 inputs clustered into themes. Four themes solely described “wellbeing” (Health, Safety, Vitality, and Attitude) and four separately depict “success” (Achieving Objectives, Recognition, Career, and Financial Goods). Some themes intersected as elements of both constructs (Intersection: Relationships & Environment, Development, Happiness, Meaningfulness, Balance and Authenticity). Four further themes illustrated the relationship between the two (Reciprocity, Conditionality, Stability and Perspectivity). Music students believe responsibility for wellbeing is shared between themselves and their institution. As they scored low on both self-efficacy and wellbeing, these findings are an urgent call for action for school management and stakeholders of the music student population.

Patterns of pain location in music students: a cluster analysis

BACKGROUND

According to existing literature, musicians experience high rates of musculoskeletal (MSK) disorders involving different anatomical areas. The aim of the study was to identify patterns of pain location in a sample of music students enrolled in different pan-European music institutions. A further goal was to explore the association between the identified pain patterns and students' characteristics.

METHODS

A total of 340 music students (mean age 23.3 years, 66.2% female) with current MSK pain completed a web-based questionnaire including both background information (i.e. lifestyle and physical activity, practice habits) and clinical features (i.e. pain characteristics, disability, pain self-efficacy, psychological distress, perfectionism and fatigue).

RESULTS

Five patterns of pain location were identified by hierarchical cluster analysis: wrist pain (WP) representing 22.6% of the total sample, widespread pain (WSP) (16.9%), right shoulder pain (RSP) (18.5%), both shoulders pain - left concentrated (LSP) (23.2%), neck and back pain (NBP) (18.8%). Amongst the identified patterns of pain location, bivariate analysis identified the WSP cluster as containing the largest number of associated variables. Participants in this cluster reported a higher percentage of women (p < .05), a higher perceived exertion (p < .01) and psychological distress (p < .001), as well as a lower level of self-efficacy (p < .01). Similarly, a higher percentage of participants included in the WSP cluster perceived their musical activity as the main cause of their MSK pain (p < .01). Additionally, a higher level of disability in relation to playing-related activity was reported by participants included in the WP and WSP clusters (p < .001). The RSP cluster was characterised by a higher percentage of participants playing an instrument in a neutral position (p < .001) and lower levels of socially prescribed perfectionism (p < .01). A higher percentage of participants playing an instrument with both arms elevated in the left quadrant position were included in the LSP cluster and a higher percentage of singers were included in the NBP cluster (p < .001).

CONCLUSIONS

Five distinct patterns of pain location were identified and their associations with the students' characteristics were explored. These findings may be helpful in the exploration of different aetiologies of MSK pain among musicians and in the development of targeted preventive strategies and treatments.