Examination and interface with the musician

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.

Advances in objective assessment of hand function and outcome assessment of the musician's hand

Doctors have made great strides in the past 20 years in the analysis of musicians' medical problems; we realize they suffer the same medical conditions as the general population but the manifestations may be different and hence the diagnosis more difficult; we realize that many of the conditions glibly attributed to overuse and repetition are no more common in this group than the general public engaged in much less repetitive activity; we realize that many of musicians' symptoms may not represent inflammation or injury but are a manifestation of misuse or mismatch to the instrument and of fatigue; we realize many of these symptoms may be related to technical problems alone; we realize that as a group musicians respond well to appropriate care and that surgery does not inevitably end a musician's career. To diagnose and treat this group properly requires a complete and full analysis of the musician, the interface, and the instrument from the outset. Anything less produces an incorrect or incomplete analysis and the poor results that have bedeviled musicians' medical care to date. Such analysis requires a basic understanding of musicians' problems, detailed knowledge of many of the specific syndromes they suffer, and time for a complete and thorough assessment. It is this lack of time and the lack of facilities to examine the musician while playing that currently causes the greatest number of mistakes in the medical care of this unique and demanding group of individuals.