Journal of Bodywork and Movement Therapies
Volume 13, Issue 4 , Pages 311-319 , October 2009

Performing arts medicine – Instrumentalist musicians Part I – General considerations

  • Jan Dommerholt, PT, DPT, MPS

      Affiliations

    • Corresponding Author InformationTel.: +1 301 656 5613; fax: +1 301 654 0333.

Received 24 November 2008 ,Revised 11 February 2009 ,Accepted 12 February 2009.

References 

  1. Abréu-Ramos AM, Micheo WF. Lifetime prevalence of upper-body musculoskeletal problems in a professional-level symphony orchestra: age, gender, and instrument-specific results. Med. Probl. Perform. Art. 2007;22:97–104
  2. Ackermann B, Adams R. Physical characteristics and pain patterns of skilled violinists. Med. Probl. Perform. Art. 2003;18(2):65–71
  3. Ackermann BJ, Adams R. Finger movement discrimination in focal hand dystonia: case study of a cellist. Med. Probl. Perform Art. 2005;20(2):77–81
  4. Amadio PC, Russoti GM. Evaluation and treatment of hand and wrist disorders in musicians. Hand Clin. 1990;6(3):405–416
  5. Axelsson A, Lindgren F. Hearing loss in classical musicians. Acta Otolaryngol. 1981;377:3–74
  6. Behar A, MacDonald E, Lee J, Cui J, Kunov H, Wong W. Noise exposure of music teachers. J. Occup. Environ. Hyg. 2004;1(4):243–247
  7. Behar A, Wong W, Kunov H. Risk of hearing loss in orchestra musicians: review of the literature. Med. Probl. Perform. Art. 2006;21(4):164–168
  8. Bejjani FJ, Gross MS, Brown P. Occupational hand disorders in musicians. J. Hand Surg. Ann. 1984;9:295
  9. Bejjani FJ, Kaye GM, Benham M. Musculoskeletal and neuromuscular conditions of instrumental musicians. Arch. Phys. Med. Rehabil. 1996;77(4):406–413
  10. Bejjani FJ, Stuchin S, Brown P. Occupational disorders of string players, pianists, harpists and guitarists. J. Bone Joint Surg. 1984;8:133
  11. Berque P, Gray H. The influence of neck-shoulder pain on trapezius muscle activity among professional violin and viola players. Med. Probl. Perform. Art. 2002;17:68–75
  12. Bischof RO. Drum and bugle corps: medical problems and issues. Med. Probl. Perform. Art. 1994;9:131–136
  13. Blackie H, Stone R, Tierman A. An investigation of injury prevention among university piano students. Med. Probl. Perform. Art. 1999;14:141–149
  14. Blum, J., Ahlers, J., 1995. Verletzungen und Rehabilitation. Medizische Probleme bei Musikern. J. Blum. Georg Thieme Verlag. Stuttgart, pp. 163–175.
  15. Brandfonbrener AG. In:  Sataloff RT,  Brandfonbrener AG,  Lederman RJ editor. The Etiologies of Medical Problems in Performing Artists. Performing Arts Medicine. San Diego: Singuler Publishing Group; 1998;p. 19–45
  16. Brandfonbrener AG. In:  Tubiana R,  Amadio C editor. Epidemiology and Risk Factors. Medical Problems of the Instrumentalist Musician. London: Martin Dunitz; 2000;p. 171–194
  17. Brandfonbrener AG. Special issues in the medical assessment of musicians. Phys. Med. Rehabil. Clin. N. Am. 2006;17(4):747–753
  18. Britsch L. Investigating performance-related problems of young musicians. Med. Probl. Perform. Art. 2005;20(1):40–47
  19. Brok AGMF. Muziekmaken is niet altijd een genoegen. Mens melodie. 1979;8:266–270
  20. Brown AN. Musculoskeletal misuse among youth symphony string players. Med. Probl. Perform. Art. 1997;12:15–18
  21. Burkholder KR, Brandfonbrener AG. Performance-related injuries among student musicians at a speciality clinic. Med. Probl. Perform. Art. 2004;19(3):116–122
  22. Byl NN. Aberrant learning in individuals who perform repetitive skilled hand movements: focal hand dystonia – Part 1. J. Bodywork Movement Ther. 2006;10:227–247
  23. Byl NN. Aberrant learning in individuals who perform repetitive skilled hand movements: focal hand dystonia – Part 2. J. Bodywork Movement Ther. 2006;10:261–265
  24. Byl NN, Nagajaran S, McKenzie AL. Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series. Arch. Phys. Med. Rehabil. 2003;84(10):1505–1514
  25. Caldron P, Calabrese LH, Clough JD, Lederman RJ. A survey of musculoskeletal problems encountered in high-level musicians. Med. Probl. Perform. Art. 1986;1:136–139
  26. Cameron DMA, McCutcheon J. Experiences of guitar students who begin to study piano as a second instrument. Med. Probl. Perform. Art. 1992;7:75–82
  27. Candia V, Elbert T, Altenmuller E, Rau H, Schafer T, Taub E. Constraint-induced movement therapy for focal hand dystonia in musicians. Lancet. 1999;353(9146):42
  28. Candia V, Rosset-Llobet J, Elbert T, Pascual-Leone A. Changing the brain through therapy for musicians' hand dystonia. Ann. N. Y. Acad. Sci. 2005;1060:335–342
  29. Candia V, Schafer T, Taub E, Rau H, Altenmuller E, Rockstroh B, et al. Sensory motor retuning: a behavioral treatment for focal hand dystonia of pianists and guitarists. Arch. Phys. Med. Rehabil. 2002;83(10):1342–1348
  30. Chen SM, Howard RW. Musical instruments choice and playing history in post-secondary level music students: some descriptive data, some causes and some background factors. Music Educ. Res. 2004;6(2):217–230
  31. Crnivec R. Assessment of health risks in musicians of the Slovene Philharmonic Orchestra, Ljubljana, Slovenia. Med. Probl. Perform. Art. 2004;19(3):140–145
  32. Črnivec R. Assessment of health risks in musicians of the Slovene Philharmonic Orchestra, Ljubljana, Slovenia. Med. Probl. Perform. Art. 2004;140–145
  33. Crtichley M, Henson RA. Music and the Brain: Studies in the Neurology of Music. London: Heinemann; 1977;
  34. Dawson WJ. Upper extremity injuries in high level instrumentalists: an end-result study. Med. Probl. Perform. Art. 1990;5:109–112
  35. Dawson WJ. Experience with hand and upper extremity problems in 1,000 instrumentalists. Med. Probl. Perform. Art. 1995;10:128–133
  36. Dawson WJ. Upper extremity problems of the mature instrumentalist. Med. Probl. Perform. Art. 1999;14:87–92
  37. Dawson WJ. Upper extremity difficulties in the dedicated amateur instrumentalist. Med. Probl. Perform. Art. 2001;16:152–156
  38. Dawson WJ. The bibliography of performing arts medicine: a five-year retrospective review. Med. Probl. Perform. Art. 2003;18:27–32
  39. Dawson WJ. The bibliography of performing arts medicine: a 10-year retrospective review (part II). Med. Probl. Perform. Art. 2007;22:153–159
  40. Dommerholt J. In:  Tubiana R,  Amadio P editor. Posture. Medical Problems of the Instrumentalist Musician. London: Martin Dunitz; 2000;p. 399–419
  41. Dommerholt J, Norris RN. Physical therapy management of the instrumental musician. Physical therapy for the performing artist, part II; Music and dance. In:  Gallagher SP editors. Orthop. Phys. Ther. Clinics N. Am. vol. 6:Philadelphia: W.B. Saunders Company; 1997;p. 185–206
  42. Engquist K, Ørbaek P, Jakobsson K. Musculoskeletal pain and impact on performance in orchestra musicians and actors. Med. Probl. Perform. Art. 2004;19:55–61
  43. Fehm L, Schmidt K. Performance anxiety in gifted adolescent musicians. J. Anxiety Disord. 2006;20(1):98–109
  44. Fishbein MM, Middlestadt SE, Ottati V, Straus S, Ellis A. Medical problems among ICSOM musicians: overview of a national survey. Med. Probl. Perform. Art. 1988;3:1–8
  45. Fjellman-Wiklund A, Chesky K. Musculoskeletal and general health problems of acoustic guitar, electric bass, and banjo players. Med. Probl. Perform. Art. 2006;21(4):169–176
  46. Forbes WS. The liberating of the ring finger in musicians, by dividing the accessory tendons of the extensor communis digitorum muscle. Md. Med. J. 1885;12:171–173
  47. Fry HJH. Occupational maladies of musicians: their cause and prevention. Int. J. Music Ed. 1984;4:59–63
  48. Fry HJH. Incidence of overuse syndrome in the symphony orchestra. Med. Probl. Perform. Art. 1986;2:51–55
  49. Fry JHH. Overuse syndrome of the upper limb in musicians. Med. J. Aust. 1986;144:182–185
  50. Fry HJH. Overuse syndrome in clarinetists. Clarinet. 1987;14:48–50
  51. Fry HJH. Prevalence of overuse in Australian music schools. Br. J. Ind. Med. 1987;44:35–40
  52. Fry HJH, Ross P, Rutherford M. Music-related overuse in secondary schools. Med. Probl. Perform. Art. 1998;3:133–134
  53. Furhmeister ML, Wiesenhütter E. Metamusik; Psychosomatik der Ausübung zeitgenössischer Musik. München: JF Lehmanns Verlag; 1973;
  54. Furuya S, Nakahara H, Aoki T, Kinoshita H. Prevalence and causal factors of playing-related musculoskeletal disorders of the upper extremity and trunk among Japanese pianist and piano students. Med. Probl. Perform. Art. 2006;21:112–117
  55. Grieco A, Occhipinti E, Colombini D, Menoni O, Bulgheroni M, Frigo C, et al. Muscular effort and musculo-skeletal disorders in piano students: electromyographic, clinical and preventive aspects. Ergonomics. 1989;32(7):697–716
  56. Guptill C, Zaza C, Paul S. An occupational study of physical playing-related injuries in college music students. Med. Probl. Perform. Art. 2000;15:86–90
  57. Hagglund KL. A comparison of the physical and mental practices of music students from the New England Conservatory and Boston University Music School. Med. Probl. Perform. Art. 1996;11:99–107
  58. Hagglund KL, Jacobs K. Physical and mental practices of music students as they relate to the occurrence of music-related injuries. Work. 1996;6:11–24
  59. Haider M, Groll-Knapp E. Psychophysiologische Untersuchung über die Belastung des Musikers in einem Symphonieorchester. Streß und Kunst. Gesundheitliche, psychissche, soziologische und rechtliche Belastungsfaktoren im Beruf des Musikers eines Symphonieorchesters. Vienna: M. Pieperek; 1971;
  60. Harman SE. Medical problems of marching musicians. Med. Probl. Perform. Art. 1993;8:132–135
  61. Harman SE. In:  Sataloff RT,  Brandfonbrener AG,  Lederman RJ editor. The Evolution of Performing Arts Medicine. Performing Arts Medicine. San Diego: Singular Publishing Group; 1998;p. 1–18
  62. Havas K. Stage Fright, its Causes and Cures with Special Reference to Violin Playing. London: Bosworth; 1989;
  63. Heming MJE. Occupational injuries suffered by classical musicians through overuse. Clin. Chiropractic. 2004;7:55–66
  64. Hochberg FH, Leffert RD, Heller MD, Merriman L. Hand difficulties among musicians. JAMA. 1983;249(14):1869–1872
  65. Hopmann RA. In:  Sataloff RT,  Brandfonbrener AG,  Lederman RJ editor. Musculoskeletal Problems in Instrumental Musicians. Performing Arts Medicine. San Diego: Singular Publishing Group; 1998;p. 205–229
  66. Hoppmann RA, Patrone NA. A review of musculoskeletal problems in instrumental musicians. Semin. Arthritis Rheum. 1989;19(2):117–126
  67. Jabusch HC, Altenmuller E. Three-dimensional movement analysis as a promising tool for treatment evaluation of musicians' dystonia. Adv. Neurol. 2004;94:239–245
  68. Jarvholm U, Palmerud G, Karlsson D, Herberts P, Kadefors R. Intramuscular pressure and electromyography in four shoulder muscles. J. Orthop. Res. 1991;9(4):609–619
  69. Jarvholm U, Palmerud G, Styf J, Herberts P, Kadefors R. Intramuscular pressure in the supraspinatus muscle. J. Orthop. Res. 1988;6(2):230–238
  70. Juman S, Karmody CS, Simeon D. Hearing loss in steelband musicians. Otolaryngol. Head Neck Surg. 2004;131(4):461–465
  71. Kähäri KR, Axelsson A, Hellstrom PA, Zachau G. Hearing assessment of classical orchestral musicians. Scand. Audiol. 2001;30(1):13–23
  72. Kähäri K, Zachau G, Eklof M, Moller C. The influence of music and stress on musicians' hearing. J. Sound Vib. 2004;277:627–631
  73. Kähäri K, Zachau G, Eklöf M, Sandsjo L, Möller C. Assessment of hearing and hearing disorders in rock/jazz musicians. Int. J. Audiol. 2003;42(5):279–288
  74. Kähäri KR, Axelsson A, Hellstrom PA, Zachau G. Hearing development in classical orchestral musicians. A follow-up study. Scand. Audiol. 2001;30(3):141–149
  75. Kaneko Y, Lianza S, Dawson WJ. Pain as an incapacitating factor in symphony orchestra musicians in São Paulo, Brazil. Med. Probl. Perform. Art. 2005;20:168–174
  76. Kenny DT, Davis P, Oates J. Music performance anxiety and occupational stress amongst opera chorus artists and their relationship with state and trait anxiety and perfectionism. J. Anxiety Disord. 2004;18(6):757–777
  77. Knishkowy B, Lederman RJ. Instrumental musicians with upper extremity disorders. Med. Probl. Perform. Art. 1986;1:85–89
  78. Kreutz G, Ginsborg J, Williamon A. Music students' health problems and health-promoting behaviours. Med. Probl. Perform. Art. 2008;23:3–11
  79. Laitinen HM, Toppila EM, Olkinuora PS, Kuisma K. Sound exposure among the Finnish National Opera personnel. Appl. Occup. Environ. Hyg. 2003;18(3):177–182
  80. Larsson SE, Bengtsson A, Bodegard L, Henriksson KG, Larsson J. Muscle changes in work-related chronic myalgia. Acta Orthop. Scand. 1988;59(5):552–556
  81. Lederman RJ. AAEM minimonograph #43: neuromuscular problems in the performing arts. Muscle Nerve. 1994;17(6):569–577
  82. Lee J, Behar A, Kunov H, Wong W. Musicians' noise exposure in orchestra pit. Appl. Acoustics. 2005;66:919–931
  83. Lie-Nemeth TJ. Focal dystonia in musicians. Phys. Med. Rehabil. Clin. N. Am. 2006;17(4):781–787
  84. Lockwood AH. Medical problems in secondary school-aged musicians. Med. Probl. Perform. Art. 1988;3:129–132
  85. Manchester RA. The incidence of hand problems in music students. Med. Probl. Perform. Art. 1988;3:15–18
  86. Manchester RA, Flieder D. Further observations on the epidemiology of hand injuries in music students. Med. Probl. Perform. Art. 1991;6:11–14
  87. McBride D, Gill F, Proops D, Harrington M, Gardiner K, Attwell C. Noise and the classical musician. Br. Med. J. 1992;305(6868):1561–1563
  88. Meinke WB. A proposed standardized medical history and physical form for musicians. Med. Probl. Perform. Art. 1995;10:137–139
  89. Menuhin Y. The Complete Violinist. New York: Summit Books; 1986;
  90. Middlestadt SE, Fishbein M. Health and occupational correlates of perceived occupational stress in symphony orchestra musicians. J. Occup. Med. 1988;30(9):687–692
  91. Molsberger AE, Hille E, Molsberger F, Schulitz KP. Der Künstler als orthopädischer Patient. Deutsches Ärzteblatt. 1989;33:A2292–A2295
  92. Newmark J, Lederman R. Practice doesn't necessarily make perfect: incidence of overuse syndromes in amateur instrumentalists. Med. Probl. Perform. Art. 1987;2:142–144
  93. Newmark J, Salmon P. Playing-related complaints in nonclassical instrumentalists: a pilot questionnaire survey. Med. Probl. Perform. Art. 1990;5:106–108
  94. Newmark J, Weinstein MS. A proposed standard music medicine history and physical examination form. Med. Probl. Perform. Art. 1995;10:134–136
  95. Norris RN, Dommerholt J. Applied ergonomics; adaptive equipment and instrument modification for musicians. Orthop. Phys. Ther. Clinics. N. Am. 1996;5:159–183
  96. Önder M, Cosar B, Öztas MO, Candansayar S. Stress and skin diseases in musicians: evaluation of the beck depression scale, general psychologic profile (the brief symptom inventory [BSI]), beck anxiety scale and stressful life events in musicians. Biomed. Pharmacother. 2000;54(5):258–262
  97. Ortmann O. The Physical Basis of Piano Touch and Tone. New York: E.P. Dutton; 1925;
  98. Ortmann O. The Physiological Mechanics of Piano Technique. New York: E.P. Dutton; 1929;
  99. Osborne MS, Kenny DT. Development and validation of a music performance anxiety inventory for gifted adolescent musicians. J. Anxiety Disord. 2005;19(7):725–751
  100. Pak CH, Chesky K. Prevalence of hand, finger, and wrist musculoskeletal problems in keyboard instrumentalists. Med. Probl. Perform. Art. 2001;16:17–23
  101. Palmerud G, Forsman M, Sporrong H, Herberts P, Kadefors R. Intramuscular pressure of the infra- and supraspinatus muscles in relation to hand load and arm posture. Eur. J. Appl. Physiol. 2000;83(2–3):223–230
  102. Parasuraman S, Purohit YS. Distress and boredom among orchestra musicians: the two faces of stress. J. Occup. Health Psychol. 2000;5(1):74–83
  103. Park A, Guptill C, Sumsion T. Why music majors pursue music despite the risk of playing-related injuries. Med. Probl. Perform. Art. 2007;22:89–96
  104. Poore GV. Clinical lecture on certain conditions of the hand and arm which interfere with the performance of professional acts, especially piano-playing. Br. Med. J. 1887;1:441–444
  105. Potter PJ, Jones IC. Musculoskeletal symptoms associated with the great highland bagpipe. Med. Probl. Perform. Art. 1993;8:81–83
  106. Pratt RR, Jessop SG, Niemann BK. Performance-related disorders among music majors at Brigham Young University. Int. J. Arts Med. 1992;1:7–20
  107. Quarrier NF. Performing arts medicine; an evolving specialty. J. Orthop. Sports Phys. Ther. 1993;17:90–95
  108. Raeburn SD. Occupational stress and coping in a sample of professional rock musicians (first of two parts). Med. Probl. Perform. Art. 1987;2:41–48
  109. Raeburn SD. Occupational stress and coping in a sample of professional rock musicians (second of two parts). Med. Probl. Perform. Art. 1987;2:77–82
  110. Rintelman WF, Borus JF. Noise-induced hearing loss in rock and roll musicians. Arch. Otolaryngol. 1968;88:377–385
  111. Roach KE, Martinez MA, Anderson N. Musculoskeletal pain in student instrumentalists: a comparison with the general student population. Med. Probl. Perform. Art. 1994;9:125–130
  112. Roset-Llobet J, Rosinés-Cubell D, Saló-Orfila JM. Identification of risk factors for musicians in Catalonia (Spain). Med. Probl. Perform. Art. 2000;15:167–174
  113. Rosset-Llobet J, Candia V, Fabregas S, Ray W, Pascual-Leone A. Secondary motor disturbances in 101 patients with musician's dystonia. J. Neurol. Neurosurg. Psychiatry. 2007;78(9):949–953
  114. Sakai N. Hand pain attributed to overuse among professional pianists: a study of 200 cases. Med. Probl. Perform. Art. 2002;17:178–180
  115. Sataloff RT, Brandfonbrener AG, RJ Lederman. In:  Sataloff RT,  Brandfonbrener AG,  Lederman RJ editor. Preface. Performing Arts Medicine. San Diego: Singular Publishing Group; 1998;p. xi
  116. Schmidtke H. In:  Blum J editors. Die Arbeitswelt des Orchestermusikers. Medizische Probleme bei Musikern. Stuttgart: Georg Thieme Verlag; 1995;
  117. Shafer-Crane GA. Repetitive stress and strain injuries: preventive exercises for the musician. Phys. Med. Rehabil. Clin. N. Am. 2006;17(4):827–842
  118. Shields N, Dockrell S. The prevalence of injuries among pianists in music schools in Ireland. Med. Probl. Perform. Art. 2000;15:155–160
  119. Shoup D. Survey of performance-related problems among high school and junior high school musicians. Med. Probl. Perform. Art. 1995;10:100–105
  120. Singer K. Diseases of the Musical Profession: a Systematic Presentation of their Causes, Symptoms and Methods of Treatment. New York: Greenberg; 1932;
  121. Spahn C, Ell N, Seidenglanz K. Psychosomatic findings in musician patients at a department of hand surgery. Med. Probl. Perform. Art. 2001;16:144–151
  122. Spahn C, Richter B, Zschocke I. Health attitudes, preventive behavior, and playing-related health pro-blems among music students. Med. Probl. Perform. Art. 2002;17:22–28
  123. Speaks C, Nelson D, Ward WD. Hearing loss in rock-and-roll musicians. J. Occup. Med. 1970;12(6):216–219
  124. Sternbach D. Addressing stress-related illness in professional musicians. Md. Med. J. 1993;42(3):283–288
  125. Sternbach DJ. Stress in the lives of musicians – on stage and off. In:  Bejjani FJ editors. Current Research in Arts Medicine. Chicago: A Capella Books; 1993;p. 475–478
  126. Stoeber J, Eismann U. Perfectionism in young musicians; relations with motivation, effort, achievement, and distress. Pers. Individ. Dif. 2007;43:2182–2192
  127. Svendsen SW, Bonde JP, Mathiassen SE, Stengaard-Pedersen K, Frich LH. Work related shoulder disorders: quantitative exposure-response relations with reference to arm posture. Occup. Environ. Med. 2004;61(10):844–853
  128. Tubiana R. Prolonged neuromuscular rehabilitation for musician's focal dystonia. Med. Probl. Perform. Art. 2003;18(4):
  129. Turner WA. A case of cornet players’ cramp. Lancet 1. 1893;995
  130. Wagner C. Physiologische und pathophysiologische Grundlagen des Musizierens. In:  Blum J editors. Medizinische Probleme bei Musikern. Stuttgart: Georg Thieme Verlag; 1995;p. 2–29
  131. Wesner RB, Noyes R, Davis TL. The occurrence of performance anxiety among musicians. J. Affect. Disord. 1990;18(3):177–185
  132. Westmore GA, Eversden ID. Noise-induced hearing loss and orchestral musicians. Arch. Otolaryngol. 1981;107:761–764
  133. Wilson FR. Acquisition and loss of skilled movement in musicians. Semin. Neurol. 1989;9(2):146–151
  134. Winspur I. Advances in objective assessment of hand function and outcome assessment of the musician's hand. Hand Clin. 2003;19(3):483–493
  135. Wolff J. The treatment of writer's cramp and allied muscular affections. Br. Med. J. 1890;2:165–166
  136. Wynn Parry CB. In:  Winspur I,  Wynn Parry CB editor. The Musician's Hand and Arm Pain. The Musician's Hand. London: Martin Dunitz; 1998;p. 4–12
  137. Yoshimura E, Paul PM, Aerts C, Chesky K. Risk factors for piano-related pain among college students. Med. Probl. Perform. Art. 2006;21:118–125
  138. Zaza C. Playing-related health problems at a Canadian music school. Med. Probl. Perform. Art. 1992;7:48–51
  139. Zaza C. Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ. 1998;158(8):1019–1025
  140. Zaza C, Charles C, Muszynski A. The meaning of playing-related musculoskeletal disorders to classical musicians. Soc. Sci. Med. 1998;47(12):2013–2023
  141. Zaza C, Farewell VT. Musicians' playing-related musculoskeletal disorders: an examination of risk factors. Am. J. Ind. Med. 1997;32(3):292–300
  142. Zetterberg C, Backlund H, Karlsson J, Werner H, Olsson I. Musculoskeletal problems among male and female music students. Med. Probl. Perform. Art. 1998;13:160–166

PII: S1360-8592(09)00014-X

doi: 10.1016/j.jbmt.2009.02.003

Journal of Bodywork and Movement Therapies
Volume 13, Issue 4 , Pages 311-319 , October 2009