Health problems of orchestral musicians from a life-span perspective : Results of a large-scale study

Professional musicians have high rates of musculoskeletal pain, but few studies have analysed risks by work activities or the psychosocial work environment. To assess the prevalence and impact of musculoskeletal pain, and its relation to playing conditions, mental health and performance anxiety, in musicians from leading British symphony orchestras. Musicians from six professional orchestras completed a questionnaire concerning their orchestral duties and physical activities at work, mental health (somatizing tendency, mood, demand, support and control at work, performance anxiety) and regional pain in the past 4 weeks and past 12 months. Prevalence rates were estimated by anatomical site and associations with risk factors assessed by logistic regression. Responses were received from 243 musicians (51% of those approached), among whom 210 (86%) reported regional pain in the past 12 months, mainly affecting the neck, low back and shoulders. Risks tended to be higher in women, in those with low mood, and especially in those with high somatizing scores. Only weak associations were found with psychosocial work stressors and performance anxiety. However, risks differed markedly by instrument category. Relative to string players, the odds of wrist/hand pain were raised 2.9-fold in wind players, but 60% lower in brass players, while the odds of elbow pain were 50% lower among wind and brass players. Musculoskeletal pain is common in elite professional musicians. A major personal risk factor is somatizing tendency, but performance anxiety has less impact. Risks differ substantially by instrument played, offering pointers towards prevention.

Musculoskeletal disorders in humans may originate from biomechanical, environmental, psychosocial and personal risk factors encountered in the working environment. These disorders in musicians are designated as playing related musculoskeletal disorders (PRMD). To investigate the correlation between biomechanical, environmental, psychosocial and personal risk factors and potential incidence of PRMD arising in professional classical musicians. Fifty-nine orchestral classical musicians were observed: They also filled out questionnaires providing information regarding musculoskeletal symptoms, psychosocial factors and demography. Clinical observation using the Rapid Upper Limb Assessment (RULA) showed significantly higher scores in string musicians compared with woodwind and brass players (right RULA score F = 4.77, P < 0.05; left RULA score, F = 3.90, P < 0.05). A multivariate regression model showed statistical significance for five of the six dependent variables regarding prevalence of painful joints, severity of musculoskeletal symptoms and functional limitation. The regression analysis revealed that biomechanical risk factors, perceived physical environment risk factors, instrument weight and average playing hours per week, were the main predictors of PRMD. The biomechanical risk factors that predict PRMD are mainly associated with the upper limbs. A high association between PRMD and clinical observation emphasizes the need for further investigation of these risk factors and to study possible implementations in order to define 'prevention strategies' for musical routines and patterns, as used by classical musicians.

Playing-related musculoskeletal disorders (PRMDs) are a recognized problem amongst instrumental musicians. Although pianists are prominent in data regarding prevalence of PRMDs, there is poor understanding of piano-specific risk factors associated with PRMDs. To synthesize published literature on the prevalence of and risk factors associated with PRMDs in pianists. Thirty-eight databases were searched. Eligible studies were those investigating prevalence of or risk factors associated with PRMDs in pianists, using an appropriate methodology according to a hierarchy of evidence. Information regarding study population, operational definition of PRMD, risk factors investigated, statistical tests used and outcomes was extracted and narratively synthesized for all eligible papers above an arbitrarily chosen quality score. The literature search identified 482 citations. Fifty-two papers were ranked in a hierarchy of evidence; 12 were eligible for evaluation using a quality assessment tool. Common methodological limitations included sampling/measurement biases, inadequate reporting of reliability/validity of outcome measures, lack of operational definition of PRMD and no statistical significance testing. Prevalence rates for PRMDs in pianists varied widely (26-93%). Four authors demonstrated statistically significant risk factors; however, no authors combined a clear operational definition of PRMD with statistically established risk factors. There was no consensus between authors regarding risk factors. Current evidence does not provide sufficient information regarding prevalence of and risk factors associated with PRMDs in pianists. Future studies should provide an operational definition of PRMD, use valid, reliable measurement tools, utilize a prospective cohort study design and perform appropriate statistical tests.