Highlights
- •Different instruments have specific demands and injuries from unique ergonomics.
- •Treatment plans for of overuse injuries should be musician-centered.
- •A framework helps customize patient-centered approaches to prevention and treatment.
Abstract
Study Design
Invited Clinical Commentary
Background
Performance related musculoskeletal disorders (PRMD) are common in instrumental musicians
and often affect the upper extremities. These overuse injuries typically result from
inadequate attention to the musculoskeletal demands required for the high-level performance
of musician-students and experienced instrumentalists.
1
PRMDs often interfere with career trajectory, and in extreme cases, can be career
ending. Many clinicians and healthcare practitioners treating upper extremity injuries
are not familiar with the specific demands faced by instrumental musicians and how
to tailor treatment and prevention strategies to the specific risks and occupational
needs of each instrumental group.Purpose of the study
This paper describes an evidenced-based framework for the assessment, prevention,
and treatment of musculoskeletal musician injuries to provide clinicians with an instrument-specific,
and musician-centered guide for practice. We synthesized available literature on instrumental
ergonomics, biomechanical demands, and upper extremity injuries to highlight the risks
and common upper-extremity pathologies, focusing on the specific demands of instrumental
groups: piano, high strings (violin and viola), low strings (cello and bass), percussion,
woodwinds, and brass. Targeted assessment, prevention, and treatment strategies are
reviewed in this context to provide healthcare providers with an evidence-based framework
to approach the treatment of PRMD to mitigate incidence of injury during practice
and performance.
Methods
A comprehensive search of electronic databases was conducted including all study designs.
Results
This review describes risk factors for PRMD in instrumental musicians, strategies
to prevent misuse and performance injury, and musician-centered interventions to allow
playing while reducing risk of misuse.
Conclusion
The suggested assessment and treatment framework can assist clinicians with a customized
patient-centered approach to prevention and treatment by addressing the gap in clinical
knowledge with the goal of ultimately reducing the incidence and severity of PRMD
in musicians.
Keywords
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JHT Read for Credit
Quiz: # 761
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.Unfortunately on occasion a PRMD may result in
- a.surgery to relieve TOS
- b.the premature end to a musician's career
- c.litigation against the orchestra company
- d.missing an important concert engagement
- a.
- # 2.The authors recommend taking into consideration
- a.prevention strategies
- b.musician-centered interventions
- c.risk factors
- d.all of the above
- a.
- # 3.The patient management strategy was developed in part on
- a.ASHT guidelines for treating PRMD
- b.the Philadelphia Hand Rehabilitation Center program for musician performance
- c.evidence-bases data
- d.the London Symphony experience
- a.
- # 4.The authors’ team model often includes the musician, a surgeon, a therapist, the music teacher, and
- a.an insurance company representative (case coordinator)
- b.a physiatrist
- c.the patient's spouse
- d.an engineer who designs instruments
- a.
- # 5.The authors suggest use of the MPHQM
- a.true
- b.false
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: April 13, 2021
Accepted:
April 5,
2021
Received:
January 31,
2021
Footnotes
Competing Interest: None
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
