- •Musicians’ clinical presentation as well as their relationship to injury is complex and would benefit from a clinical model that supports a musician-centered approach in alignment with the phenomenology of music performance.
- •Ecology of Musical Performance is a novel clinical model that promotes musician-centered holistic care in the clinical setting and facilitates collaborative goal setting.
- •A musician with playing related musculoskeletal disorders reported significant increase in hand function in daily activities and on the piano as measured by Quick Disabilities of Arm, Shoulder and Hand, numeric pain rating and hand strength following evaluation and treatment using the EMP model.
- •The patient increased pain-free practice and performance tolerance and was able to leverage gains in therapy for successful return to play.
Musicians with playing related musculoskeletal disorders (PRMD) require complex decision making to interpret examination findings and develop a holistic treatment approach that considers the unique interaction with their instrument. The Ecology of Musical Performance (EMP) model is a novel comprehensive clinical model designed to provide guidance for musician-centered evaluation, goal setting, and intervention planning for musicians with PRMD.
Purpose of the study
To describe the application of EMP in the evaluation and treatment of a pianist with PRMD.
Clinical documentation and the patient's symptom logs provided data for this study. Special considerations unique to musicians in the initial evaluation as well as a timeline of interventions are presented to illustrate the application of the EMP model for a holistic approach to treatment.
Results and discussion
The pianist showed an increase in grip strength and self-reported hand function both in daily activities and in piano performance and training. Pain free practice tolerance increased and the patient successfully returned to participation in piano training and performance.
This case demonstrates how a treatment program can be customized to benefit musicians taking into consideration the complexity introduced by their relationship with music making as a primary meaningful occupation. EMP may support a person-centered approach to musicians with PRMD by aligning with the phenomenology of musical performance and facilitating collaborative goal setting and problem solving.
Abreviations:PRMD (Playing related musculoskeletal disorder(s)), EMP (Ecology of Musical Performance), MIRC (The Musician-Instrument-Repertoire Complex), IC (Immediate Context), PC (Peripheral Context), ECU (Extensor Carpi Ulnaris muscle), Q-DASH DSS (Quick Disabilities of Arm Shoulder Hand Disability and/or Symptom Score), S and/or PAMS (Q-DASH Sports and/or Performing Arts Module Score)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hand Therapy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The occurrence of musculoskeletal complaints among professional musicians: a systematic review.Int Arch Occup Environ Health. 2016; 89: 373-396https://doi.org/10.1007/s00420-015-1090-6
- Musculoskeletal disorders and complaints in professional musicians: A systematic review of prevalence, risk factors, and clinical treatment effects.Int Arch Occup Environ Health. 2020; 93: 149-187https://doi.org/10.1007/s00420-019-01467-8
- Overuse syndrome of the hand and wrist in musicians: A systematic review.J Hand Surg (European. 2020; 45: 636-642https://doi.org/10.1177/1753193420912644
- Nerve entrapment syndromes in musicians.Clin Anat. 2014; 27: 861-865https://doi.org/10.1002/ca.22377
- Preface.in: Sataloff RT Brandfonbrener AG Lederman RJ Performing Arts Medicine. 3rd ed. Science & Medicine, 2010: xi-xii
- Physical performance and musculoskeletal disorders: Are musicians and sportspeople on a level playing field?.Perform Enhanc Heal. 2016; 4: 18-26https://doi.org/10.1016/j.peh.2015.11.004
- Perceptions of playing-related musculoskeletal disorders (PRMDs) in Irish traditional musicians: A focus group study.Work. 2014; 49: 679-688https://doi.org/10.3233/WOR-131737
- The lived experience of professional musicians with playing-related injuries: A phenomenological inquiry.Med Probl Perform Art. 2011; 26: 84-95
- Injured professional musicians and the complex relationship between occupation and health.J Occup Sci. 2012; 19: 258-270https://doi.org/10.1080/14427591.2012.670901
- Therapeutic management of the Performing Artist.in: Saunders R Astifidis R Burke SL Higgins J McClinton MA Hand and Upper Extremity Rehabilitation: A Practical Guide. 4th ed. Elsevier, 2016: 513-524
- Performing Arts Medicine in Clinical Practice.Springer, 2016https://doi.org/10.1007/978-3-319-12427-8
- Assessment and treatment principles for the upper extremities of instrumental musicians.in: Skirven TM Osterman AL Fedorczyk J Amadio PC Rehabilitation of the Hand. 6th ed. Elsevier, 2011: 1855-1880
- Performing arts medicine – Instrumentalist musicians, Part II – Examination.J Bodyw Mov Ther. 2010; 14: 65-72https://doi.org/10.1016/j.jbmt.2009.02.004
- Assessing the instrumentalist interface: Modifications, ergonomics and maintenance of play.Phys Med Rehabil Clin N Am. 2006; 17: 893-903https://doi.org/10.1016/j.pmr.2006.08.003
- Hand therapy for the musician: Instrument-focused rehabilitation.Hand Clin. 2003; 19: 287-301https://doi.org/10.1016/S0749-0712(02)00095-1
- Development of the QuickDASH: Comparison of three item-reduction approaches.J Bone Jt Surg - Ser A. 2005; (Published online)https://doi.org/10.2106/JBJS.D.02060
- Tapping performance and underlying wrist muscle activity of non-drummers, drummers, and the world's fastest drummer.Neurosci Lett. 2009; 459: 69-73https://doi.org/10.1016/j.neulet.2009.04.055
- Precision finger pressing force sensing in the pianist-piano interaction.in: 13th Sound and Music Computing Conference (SMC2016). 2016https://doi.org/10.5281/ZENODO.851211
- Flexibility of movement organization in piano performance.Front Hum Neurosci. 2013; 7: 173
- Individuality that is unheard of: Systematic temporal deviations in scale playing leave an inaudible pianistic fingerprint.Front Psychol. 2013; 4: 134https://doi.org/10.3389/fpsyg.2013.00134
- The musical instrument as a natural extension of the musician.in: Castellengo M. Genevois H. Music and Its Instruments. Editions Delatour, 2013: 467-484
- It's not (only) the mean that matters: Variability, noise and exploration in skill learning.Curr Opin Behav Sci. 2018; 20: 183-195https://doi.org/10.1016/j.cobeha.2018.01.004
- Repetition without repetition: Challenges in understanding behavioral flexibility in motor skill.Front Psychol. 2020; 11: 2018https://doi.org/10.3389/fpsyg.2020.02018
- Personality related traits as predictors of music practice: Underlying environmental and genetic influences.Pers Individ Dif. 2015; 74: 133-138https://doi.org/10.1016/j.paid.2014.10.006
- The gold standard.Peak: Secrets from the New Science of Expertise. First Mariner. 2017: 84-114
- Return to play after injury: Strategies to support a musician's recovery.Work. 1996; 7: 89-93https://doi.org/10.3233/WOR-1996-7203
- Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH).J Orthop Sports Phys Ther. 2013; 44https://doi.org/10.2519/jospt.2014.4893
- QuickDASH -.DASH QuickDASH - Disabil Arm, Shoulder Hand Outcome Meas e-Bulletin Fall. 2012. 2012: 1-11 (Published onlineAccessed December 11, 2020)
- The use of psychosocial services post hand and upper limb injury and trauma: A pilot study.HAND. 2018; 13: 529-537https://doi.org/10.1177/1558944717725373
- Fifteen years of explaining pain: The past, present, and future.J Pain. 2015; 16: 807-813https://doi.org/10.1016/j.jpain.2015.05.005
- Managing Stage Fright : A Guide for Musicians and Music Teachers.Oxford University Press, 2017
- Testing motivational theories in music education: The role of effort and gratitude.Front Behav Neurosci. 2019; 13 (172): 1-9
- In this issue. https://www.frontiersin.org/articles/10.3389/fnbeh.2019.00172/full. doi:10.3389/fnbeh.2019.00172.
- A phenomenology of occupation-based hand therapy.Aust Occup Ther J. 2015; 62: 177-186https://doi.org/10.1111/1440-1630.12192
- Occupational therapists working in hand therapy: the practice of holism in a cost containment environment.Work. 2002; 19: 35-45
- A systematic review of the benefits of occupation-based intervention for patients with upper extremity musculoskeletal disorders.J Hand Ther. 2019; 32: 141-152https://doi.org/10.1016/j.jht.2018.04.001
JHT Read for Credit
Quiz: # 760
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.The study design is
- b.case series
- c.case report
- # 2.The patient treatment was developed using the
- a.EMP model
- b.Peabody Musicians Program
- c.Mayo Clinic PRMD method
- d.JHU Curtis Hand Center approach
- # 3.In the Ecology of Musical Performance, interface effectors include
- a.mechanical demands of the instrument
- b.biomechanical efficiency
- c.repertoire demands
- d.all of the above
- # 4.The patient's primary instrument was the
- d.bass guitar
- # 5.The authors advocate a person-centered approach
- a.not true
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: May 12, 2021
Accepted: April 30, 2021
Received in revised form: April 25, 2021
Received: January 20, 2021
© 2021 Elsevier Inc. All rights reserved.