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Musicians often suffer from disorders of the musculoskeletal system that are related to their instrument playing. Among the most frequent symptoms are complaints in the shoulder-neck area. Radial shock wave therapy is increasingly used in trigger point treatment, but only few high-level studies have examined of shock wave therapy used together with physical therapy in the treatment of musicians. METHODS: This randomized blinded study in musicians (n = 26) with nonspecific shoulder-neck problems was done to examine the effect of shock wave therapy in addition to current physical therapy on the symptoms and quality of life of the musicians as well as their habits of playing musical instruments (intervention group shock wave vs reference group placebo). The effects were documented by a pain VAS and other instruments. A questionnaire designed specifically for musicians (with initial and final questions) recorded intensity and manifestation of pain and handicaps in daily life, especially when practicing and playing. The Shoulder Pain and Disability Index (SPADI) and the Neck Pain Disability Index Questionnaire (NPDIQ) were also used. RESULTS: Both groups reported subjective improvement in pain, but significance was found only for the intervention group for the SPADI and NPDIQ. CONCLUSIONS: Trigger point treatment with radial shock wave used in combination with physical therapy makes the subjects feel temporarily relieved of neck and shoulder pains. The effects of radial shock wave without physical therapy will need to be examined in further studies.
Background
Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far.
Objective
The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee.
Methods
MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results
The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality).
Conclusions
eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence.
There is clinical evidence that cervical lateral glide (CLG) improves neurodynamics and alleviates pain in patients who suffer from neurogenic arm pain. Cervical lateral flexion (CLF) is also a treatment method and a means of testing neurodynamics. However, for both techniques nerve movement has not yet been investigated using ultrasound imaging (US). The purpose of this study was to quantify median nerve movement in the arm during CLG and CLF. For this study 27 healthy participants were recruited. Longitudinal movement of the median nerve was measured using US during CLG and CLF with the shoulder in 30° abduction in the middle and distal forearm (Fad). Data could be obtained from 11 participants (6 women and 5 men, average age 25.6 years, ±2.25) at the middle forearm (Fam) and from 9 participants (5 women and 4 men, average age 27.2 years, ±2.75) at the Fad. When applying CLF, the median nerve moved 2.3 mm (SEM ± 0.1 mm) at the Fam. At the same measuring point the median nerve moved 3.3 mm (SEM ± 0.3 mm, p = 0.005) by applying CLG. At the Fad the difference between CLF and CLF amounted to 0.6 mm (CLF: 1.9 mm (SEM ± 0.2 mm, CLG: 2.5 mm (SEM ± 0.2 mm, p ≤ 0.05). The movements during CLG are larger than during CLF. This difference is statistically significant. However, the statistical relevance cannot be extrapolated to a clinical relevance.
BACKGROUND: Muscle fatigue seems to be a risk factor in the development of performance-related musculoskeletal disorders (PRMDs) in musicians, but it is unclear how muscle activity characteristics change between musicians with and without PRMDs over a prolonged playing period.
PURPOSE: To investigate muscle activity patterns in muscles of the arms, shoulder, and back of high string musicians during prolonged performance.
METHODS: Fifteen professional or university high string musicians were divided into PRMD and non-PRMD groups. All musicians played a chromatic scale, then an individual “heavy” piece for 1 hr, and finally the chromatic scale again. Surface electromyography (sEMG) data were recorded from 16 muscles of the arm, shoulder, and trunk on both sides of the body. Two parameters were analyzed: the percentage load in relation to the respective maximum force during the chromatic scale, and the low-frequency spectrum to determine the fatigue behavior of muscles during the 1-hr play.
RESULTS: Changes in muscle activation patterns were observed at the beginning and end of the trial duration; however, these varied depending on whether musicians had PRMDs or no PRMDs. In addition, low-frequency spectrum changes were observed after 1 hr of playing in the PRMD musicians, consistent with signs of muscular fatigue.
CONCLUSION: Differences in muscle activity appear between high string musicians with and without PRMDs as well as altered frequency spectrum shifts, suggesting possible differential muscle fatigue effects between the groups. The applied sEMG analysis proved a suitable tool for detailed analysis of muscle activation characteristics over prolonged playing periods for musicians with and without PRMDs.
AIM: In this prospective longitudinal study, the physical and psychological health status of music students is assessed at the beginning of their university music study and tracked over time. Analysis strategies and interim results from the first-year cohort, including 1-year incidences, monthly prevalences, and predictors of developing musculoskeletal health complaints (MHC), are presented.
METHODS: This prospective longitudinal study is calculated to enlist a total sample of 370 participants, including musicians and non-musicians, over 5 years. Baseline measurements include a self-designed questionnaire, core strength endurance, hypermobility, finger-floor-distance, motor control, mechanosensitivity, health-related quality of life (SF36), and stress and coping inventory (SCI). The occurrence of MHC is based on monthly online questionnaires.
RESULTS: The first-year subcohort enrolled 33 music students and 30 non-music control students. The mean monthly completion rate for the questionnaire was 55.7±8.7%. At baseline, music students showed significantly more stress symptoms, reduced physical function¬ing, and increased bodily pain compared to control students. The 1-year incidence of MHC was 59% for music students and 44% for controls. Risk factors for MHC included being a music student, previous pain, reduced physical functioning, stress symptoms, reduced emotional functioning, and mechanosensitivity. Being a music student, physical functioning, sleep duration, positive thinking, and general mechanosensitivity had a predictive ability of 0.77 (ROC curve) for MHC.
CONCLUSION: A total of 63 students enrolled in the first cohort is in line with the precalculated sample size. This prospective study design enables the measurement of MHC incidence and provides insight into mechanisms in the development of MHC among music students, including the interaction of physical, psychological, and psychosocial factors.
BACKGROUND/AIMS: Research in music medicine has reported incidence rates of musculoskeletal disorders of approx. 70% in instrumental musicians. String players have the highest risk, with rates of performance-related musculoskeletal disorders (PRMDs) of 65% to 88%. Playing the violin or viola requires complex neuromusculoskeletal skills, and the high frequency of repetitive movements, dynamic and static muscle load, awkward postures, poor technique, and practice time are factors causing musculoskeletal strain. In ergonomic terms, these disorders can be categorized based on extrinsic and intrinsic loads. Identification of intrinsic loads, such as muscle utilization and joint motion, is necessary to understand factors influencing musculoskeletal disorders associated with violin playing. The aim of this study was to review the literature on musculoskeletal demands in violin and viola playing.
METHODS: A literature search was conducted in the PubMed, COCHRANE, and CINAHL electronic databases from 1999 to 2015 using the search terms violin, viola, high strings, movement, posture, and synonyms. A manual search of Medical Problems of Performing Artists was also conducted. Additional references were identified by searching the citations and reference lists of all identified relevant studies. RESULTS: The results suggest that an asymmetric playing posture, the associated muscle activity, and joint mobility may contribute to musculoskeletal problems in violin and viola players. Evidence suggests an increased load of intrinsic factors in violin/viola performance.
CONCLUSION: The identification of intrinsic loads in violin and viola playing may facilitate the development of prevention strategies and interventions.
OBJECTIVE: The aim of the study was to identify and systematically categorize musculoskeletal assessments used in quantitatively based studies about posture and movement in musicians playing high string instruments (violin, viola) in order to inform further research and help to identify gaps in knowledge.
METHODS: A systematic literature search was conducted in the databases Cochrane, CINAHL, and PubMed as well as the journal Medical Problems of Performing Artists. Additional studies were searched within the reference lists of relevant articles. Sixty-four studies conducted since 1999 until May 2017 were included according to predefined inclusion criteria.
RESULTS: Various biomechanical measurement instruments were used in 24 of the selected studies in order to collect two- and three-dimensional kinematic data: optoelectronic systems with active and passive markers, electromagnetic systems, ultrasonic motion analysis systems, and image-based analysis of posture. In 11 studies, kinetics were measured by optoelectronic systems, force sensors, and a posturographic device. Further studies used electromyography to evaluate muscle activity (19 studies) as well as instruments to measure range of motion (2 studies). Additionally, a broad range of clinical examination techniques (35 studies) and self-reports (36 studies) were used to assess the musculoskeletal system of high string players.
CONCLUSION: The identified assessments could be used both in further research and in practical work in order to evaluate posture and movement in high string players. For future research, qualitatively based studies as well as psychometrically tested quantitatively based self-report assessments are required.
Objective
Brass players are exposed to high musculoskeletal strains during their instrumental play. Various assessments can be used to measure these strains, whereby a targeted therapy can also be supported. The aim of this study was to review literature concerning assessments used in quantitatively based studies about the analysis of musculoskeletal loads of brass players.
Data sources
The Cochrane Library, PubMed, CINAHL, PEDro as well as the journal “Medical Problems of Performing Artists” were searched for relevant studies.
Study selection
Two reviewers independently applied the inclusion and exclusion criteria to select potential studies. A third reviewer was involved in the case of discrepancies.
Data extraction
Two reviewers independently extracted the data.
Data synthesis
A total of 73 studies conducted between 2004 and 2019 were included. Within a total of 30 studies, 18 assessments could be found that collect 2-dimensional or 3-dimensional kinematic data using video- or image-based analysis of posture, sonographic, optoelectronic and various electromagnetic systems. In 7 studies kinetic data were measured by force-transducers, pressure platforms, stabilizer and dynamometer. Fifteen studies used clinical examinations and additional assessments to screen individual body regions and 9 studies derived electromyography measurements from a total of 25 muscles. Thirty-one partially validated questionnaires were used to record musculoskeletal pain of brass players.
Conclusions
A variety of assessments can be used to optimize analysis and treatment procedures in research and clinical work. Future studies should both examine quality criteria of the various assessment methods and validate clinical examinations and questionnaires.
Due to new research results in the past few years, interest in the fascia of the human body has increased. Dysfunctions of the fascia are indicated by various symptoms, amongst others, musculoskeletal pain. As a result stronger focus has been put on researching therapeutic approaches in this area. The main aim of this study was to investigate the effect of Foam Roll exercises on the mobility of the thoracolumbar fascia (TLF). Study has been conducted in a randomized and controlled trial which sampled 38 healthy athletic active men and women.
The subjects were randomly assigned to a Foam Roll Group (FMG), a Placebo Group (PG) and a Control Group (CG). Depending on the assigned group the volunteers were either instructed to do exercises with the Foam Roll, received a pseudo treatment with the Foam Roll or received no treatment.
A total of three measurements were carried out. The most important field of research was the mobility of the TLF, which was determined using a sonographic assessment. In addition the lumbar flexion and the mechanosensivity of relevant muscles were determined.
After the intervention, the FMG showed an average increase of 1.7915 mm for the mobility of the TLF (p < 0.001/d = 0.756). In contrast, only an average improvement of 0.1681 mm (p = 0.397) was shown in the PG, while the CG showed a slight improvement of 0.0139 mm (p = 0.861). However, no significant changes were observed with regard to the lumbar flexion and mechanosensivity of the treated muscles.
Thus, evidence is that the use of Foam Roll exercises significantly improves the mobility of the thoracolumbar fascia in a healthy young population.
Objectives:
The purpose of this study was to determine the motor function of the abdominal muscles in singers with and without functional voice disorders and to examine them for possible differences. Additionally, the breathing behaviour and posture control was investigated.
Study Design
Observational study.
Methods:
Female subjects (n = 20) with differing levels of professional competence were used to provide the data for analysis. By using the Singing Voice Handicap Index (SVHI) the grade of dysphonia could be measured, and the subjects were organized in groups. The change of muscle thickness of the M. transversus abdominis (TVA) and the M. obliquus internus abdominis (OIA) during different singing tasks was measured by using ultrasound. The subjects were then asked to perform the Abdominal Hollowing Test (AHT) with the STABILIZER. Finally, the subjects were all filmed while singing. The videos recordings of the singing sessions were analysed by an independent clinical expert regarding breathing and secondary motor activities (SMA). For the statistical analysis, the Mann-Whitney-U Test and the Chi-Square-Test was mainly used.
Results:
The results showed a significantly thinner TVA in the group with dysphonia in comparison to the group without dysphonia. Ultrasound measurements showed significantly higher changes of muscle thickness of the TVA during singing tasks in the group with dysphonia. Regarding the AHT there was a significant difference between the two groups. The group with dysphonia was not able to increase the pressure by 15mmHg. Furthermore, the healthy subjects demonstrated abdominal breathing, while the group with dysphonia present with thoracic breathing. Additionally, it was noted that the subjects with dysphonia showed a higher level of associated movements especially at and/or on the lumbar spine, cervical spine and the left arm and shoulder.
Conclusion:
Differences in TVA-recruitment, breathing behaviour and secondary motor activities while singing were found. This study sparks new ideas for neuromusculoskeletal assessments and therapy.
Key Words
Transversus abdominis, Abdominal muscles, Dysphonia, Ultrasound, Singing voice, Singers
Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.