Scientific/Clinical Article| Volume 34, ISSUE 2, P208-216, April 2021

A musician-centered approach to management of performance-related upper musculoskeletal injuries

Published:April 13, 2021DOI:


      • 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.


      Study Design

      Invited Clinical Commentary


      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.
      • Brandfonbrener A.G.
      Musculoskeletal problems of instrumental musicians.
      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.


      A comprehensive search of electronic databases was conducted including all study designs.


      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.


      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.


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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 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
      • # 2.
        The authors recommend taking into consideration
        • a.
          prevention strategies
        • b.
          musician-centered interventions
        • c.
          risk factors
        • d.
          all of the above
      • # 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
      • # 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
      • # 5.
        The authors suggest use of the MPHQM
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.