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Zão A, Altenmüller E, Azevedo L. Development and Initial Validation of the First Questionnaire to Evaluate Performance-related Pain Among Musicians with Different Backgrounds: Performance-related Pain Among Musicians Questionnaire (PPAM). JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:216-237. [PMID: 37584755 DOI: 10.1007/s10926-023-10130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
AIM To develop and perform the expert's content validation and pretesting of the first questionnaire specifically designed to evaluate performance-related pain among musicians with different backgrounds. METHODS The development of the Performance-related Pain Among Musicians Questionnaire (PPAM) was carried out in 4 phases: (1) item generation, (2) experts' panel evaluation and content validation (3) pretesting, and (4) conceptualization of the final version. For item generation we conducted two systematic reviews to identify the existing tools evaluating similar constructs and the predictive factors of performance-related pain. Four expert panel meetings and three pilot tests were performed, with a total of 94 musicians. RESULTS From the 1154 articles initially found in the literature search, 153 were included (65 related to pain tools and 88 related to predictive factors) and a pool of 115 items were created. After expert panel evaluation and pretesting, a final self-report questionnaire was defined, comprising 33 core items to evaluate 3 constructs (pain intensity, pain interference in general activities and pain interference in performance), as well as 32 additional items (optional module - predictive factors). CONCLUSIONS The PPAM Questionnaire is specifically designed and validated for musicians and can be applied for all types of musicians (professional, amateur and music students), allowing the development of comparative studies between musicians. It is a new enriched tool, easy to respond and disseminate to large, multicentre, and international samples. PPAM is suitable for research and clinical practice purposes and will allow the improved assessment and monitoring of pain in this occupational context.
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Affiliation(s)
- Ana Zão
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
- Center for Health Technology and Services Research and Health Research Network (CINTESIS@RISE), Porto, Portugal.
- Chronic Pain Unit and Physical and Rehabilitation Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
- International Center of Arts Medicine, CUF Porto Institute, Porto, Portugal.
| | - Eckart Altenmüller
- Institute of Music Physiology and Musician's Medicine, University of Music, Drama, and Media, Hannover, Germany
| | - Luís Azevedo
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Center for Health Technology and Services Research and Health Research Network (CINTESIS@RISE), Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) at FMUP, Porto, Portugal
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Winkler S, Lohs A, Zinn-Kirchner ZM, Alotaibi M, Caffier PP. Tribute to the Flute: A Literature Review of Playing-Related Problems in Flautists. J Multidiscip Healthc 2024; 17:649-671. [PMID: 38375525 PMCID: PMC10875341 DOI: 10.2147/jmdh.s448301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
Playing musical instruments places unusually high demands on specific parts of the human body. Relative to the instruments they play, musicians may experience instrument-related symptoms, as recorded in flute players. The objective was to provide an overview of the study findings addressing medical problems in flautists to better understand their complaints and pave the way for more personalized healthcare. Several electronic databases (PubMed, Embase, Cochrane Library) were systematically searched in July 2022. Furthermore, the references of all included articles were reviewed for additionally relevant sources. The resulting set of studies was summarized in a table, with quality assessment according to the SIGN grading system. From an initial 433 hits, the search yielded 95 studies with a total of 32,600 musicians, including at least 2134 flautists. Among the latter, evidence was found for musculoskeletal, neurological, dermatological, temporomandibular, and hearing complaints, overuse and reflux symptoms, velopharyngeal insufficiency, as well as upper and lower airway impairment. Other specialists may be consulted equally often and should be sensitive to the particular medical problems in flautists. Future studies would ideally contain specific outcome analyses on an international scale and consider flautists as an individual subgroup within a larger number of total participants.
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Affiliation(s)
- Silvia Winkler
- Berlin Center for Musicians Medicine (BCMM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
- Department of Audiology and Phoniatrics; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
| | - Anne Lohs
- Department of Audiology and Phoniatrics; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
| | - Zahavah M Zinn-Kirchner
- Berlin Center for Musicians Medicine (BCMM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
- Department of Audiology and Phoniatrics; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
| | - Moonef Alotaibi
- Department of Audiology and Phoniatrics; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
- King Fahad Medical City, Department of Otorhinolaryngology, Head and Neck Surgery, Riyadh, Kingdom of Saudi Arabia
| | - Philipp P Caffier
- Berlin Center for Musicians Medicine (BCMM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
- Department of Audiology and Phoniatrics; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, D-10117, Germany
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Macovei G, Minea R, Dumitraș IT, Precup CA, Baroiu L, Nechifor A, Armencia AO, Lese AC. Changes in Dento-Facial Morphology Induced by Wind Instruments, in Professional Musicians and Physical Exercises That Can Prevent or Improve Them-A Systematic Review. Life (Basel) 2023; 13:1528. [PMID: 37511903 PMCID: PMC10381963 DOI: 10.3390/life13071528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study is to highlight the changes that occur regarding dento-facial morphology, facial, and masticatory muscles in musicians who play wind instruments. Anatomical and functional changes may occur after the long-term use of each type of wind instrument. We considered studies of the impact of playing the wind instrument on the masticatory muscle activity and the resulting modifications. Both children and adults can be affected by playing wind instruments in regard to tooth positioning and facial morphology. These changes relate to the type of wind instruments, the type of vowels and tones used by instrumentalists. There most valuable breathing techniques have been identified that improve the redistribution of pressure, with a minimizing effect on the morphological changes in the oral cavity and cephalic extremity, implicitly on the masticatory functional disorders. In addition to these beneficial effects on the stomatognathic system, these breathing techniques favorably increase lung capacity. Furthermore, a series of toning exercises for neck muscles-which are actively involved and overworked by wind instrument-playing artists-was identified. The study concludes that less experienced instrumentalists demonstrate increased facial muscle engagement, possibly leading to excessive strain, while experienced instrumentalists exhibit more optimized patterns of muscle activity. The novelty of this research lies in its interdisciplinary approach to understanding the influence of wind instruments on dento-facial morphology, addressing preventive and corrective measures to mitigate undesirable outcomes.
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Affiliation(s)
- Georgiana Macovei
- Department of Oral and Dental Diagnostics, "Gr. T. Popa" University of Medicine and Pharmacy Iaşi, No. 16, Universității Street, 700115 Iași, Romania
| | - Raluca Minea
- Department of Art History, Artistic Anatomy, Faculty of Visual Arts and Design, "George Enescu" National University of the Arts Iaşi, No. 189, Sărărie Street, 700451 Iaşi, Romania
| | - Iarina Teodora Dumitraș
- Department of Oral and Dental Diagnostics, "Gr. T. Popa" University of Medicine and Pharmacy Iaşi, No. 16, Universității Street, 700115 Iași, Romania
| | - Cosmin Andrei Precup
- Department of Balneology, Medical Recovery and Rheumatology, "V.Babeş"University of Medicine and Pharmacy Timişoara, No. 2,Piața EftimieMurgu Street, 300041 Timișoara, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy," Dunărea de Jos" University of Galați, No.47, Domneasca Street, 800008 Galaţi, Romania
- Infectious Diseases Department, "Sf. Cuv. Parascheva" Clinical Hospital of Infectious Diseases Galaţi, No. 393, Traian Street, 800179 Galaţi, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy," Dunărea de Jos" University of Galați, No.47, Domneasca Street, 800008 Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research Center (MICDIR), "Dunărea de Jos" University of Galați, No. 47, Domneasca Street, 800008 Galaţi, Romania
| | - Adina Oana Armencia
- Department of Oral and Dental Diagnostics, "Gr. T. Popa" University of Medicine and Pharmacy Iaşi, No. 16, Universității Street, 700115 Iași, Romania
| | - Ana Cristina Lese
- Department of Design, Faculty of Visual Arts and Design, "George Enescu" National University of the Arts Iaşi, No. 189, Sărărie Street, 700451 Iaşi, Romania
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Nair R, Tanikawa C, Ferreira JN. Orofacial Pain, Musical Performance and Associated Coping Behaviors, Psychological Distress and Disability among Asian Young Adults. J Clin Med 2023; 12:jcm12041271. [PMID: 36835807 PMCID: PMC9961199 DOI: 10.3390/jcm12041271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Musicians often report orofacial pain (OFP) and performance-related psychological distress related to occupational neuromuscular overuse, but to date, no study has been performed in Asian musicians to assess these factors. This study evaluated OFP, psychological distress, coping behaviors, and disability among Asian musical performers. A total of 201 participants in Singaporean music ensembles were surveyed from which 159 met the inclusion criteria for vocalists or instrumentalist musicians (mean age 20.26 ± 2.20 years). Self-administered questionnaires assessed musical practices, jaw/neck pre-conditioning exercises, pain-related temporomandibular disorders (TMD), OFP descriptors, pain chronicity and disability, coping behaviors and psychological distress. Univariate and multi-variate analyses were carried out. OFP, while performing, was more than two-fold higher in instrumentalists when compared to vocalists (41.4-48% vs. 17.2%, p = 0.002). A similar trend occurred for OFP that progresses while playing (p = 0.035) and for persistent OFP that reduces playing (p = 0.001). There were no differences in psychological distress, pain coping and disability between groups. Vocalists were found to practice jaw/neck pre-conditioning exercises more frequently (75% vs. 4-12.9% in instrumentalists, p < 0.0001). While performing, Asian vocalists reported less OFP when compared to instrumentalists. Future prospective studies are needed to confirm if pre-conditioning exercises play a protective role against OFP in vocalists.
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Affiliation(s)
- Rahul Nair
- Department of Dentistry—Quality and Safety of Oral Healthcare, Radboud University Medical Centre, Radboud Institute for Health Sciences, 6525 Nijmegen, The Netherlands
- Faculty of Dentistry, National University of Singapore, Singapore 119085, Singapore
| | - Chihiro Tanikawa
- Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry, Osaka University, Osaka 565-0871, Japan
| | - Joao N. Ferreira
- Faculty of Dentistry, National University of Singapore, Singapore 119085, Singapore
- Avatar Biotechnologies for Oral Health and Healthy Longevity Research Unit, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence:
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Steinmetz A. [Orofacial and musculoskeletal disorders of professional musicians - Frequency and therapy principles]. Laryngorhinootologie 2023; 102:100-103. [PMID: 36543224 DOI: 10.1055/a-1057-3436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Playing-related musculoskeletal disorders are frequently found in the upper extremety and the spine. Moreover, orofacial pain syndromes and craniomandibular dysfunctions are important in upper string players and wind players. The treatment of musicians is based on a diagnostic process including the evaluation of specific musical aspects, a functional manual medicine examination and an evaluation of postural and movement characteristics while playing the musical instrument.
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Affiliation(s)
- Anke Steinmetz
- Physikalische und Rehabilitative Medizin Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin
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Rodríguez-Gude C, Taboada-Iglesias Y, Pino-Juste M. Musculoskeletal pain in musicians: prevalence and risk factors. A systematic review. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2022; 29:883-901. [PMID: 35678565 DOI: 10.1080/10803548.2022.2086742] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE : to determine the prevalence and regions of the body in which musculoskeletal injuries occur in musicians, as well as to identify risk factors related to their occurrence. METHODOLOGY : A search was carried out in the Pubmed, Scopus, Web of Science and Cinahl databases for publications between 2006 and 2020. Observational studies on the prevalence of musculoskeletal injuries or their risk factors in musicians aged 18-65 years were eligible for inclusion, and the methodological quality and risk of bias were assessed. RESULTS : 31 studies on multiple instruments and 17 on individual instruments were included. Quality was rated as high in 65% of the studies. Lifetime prevalence of injuries ranged from 46-90% and current prevalence from 9-63%. The most common region of pain was the neck, being present in all instrument families. Being female is a predisposing factor to the appearance of musculoskeletal problems in musicians. CONCLUSIONS : Musicians suffer frequently musculoskeletal injuries. The most common regions of the body in which these injuries occur are the neck and shoulders. Numerous risk factors were found to be predisposing to musculoskeletal injuries. We note that there are fewer studies on specific instruments.
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Affiliation(s)
- Clara Rodríguez-Gude
- Department of Functional Biology and Health Sciences, University of Vigo, Pontevedra, Spain.,Research Group on Education, Physical Activity and Health (GIES10), Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain;
| | - Yaiza Taboada-Iglesias
- Research Group on Education, Physical Activity and Health (GIES10), Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain; .,Department of Special Didactics, University of Vigo, Pontevedra, Spain
| | - Margarita Pino-Juste
- Research Group on Education, Physical Activity and Health (GIES10), Galicia Sur Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain; .,Department of Didactics, School Organization and Research Methods, University of Vigo, Pontevedra, Spain
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Herrmann N, Just M, Zalpour C, Möller D. Musculoskeletal and psychological assessments used in quantitatively based studies about musicians' health in brass players: A systematic literature review. J Bodyw Mov Ther 2021; 28:376-390. [PMID: 34776167 DOI: 10.1016/j.jbmt.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/06/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Noëla Herrmann
- Department of Physiotherapy, Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Germany
| | - Melissa Just
- Department of Physiotherapy, Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Germany
| | - Christoff Zalpour
- Department of Physiotherapy, Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Germany
| | - Dirk Möller
- Department of Physiotherapy, Faculty of Business Management and Social Sciences, Osnabrück University of Applied Sciences, Germany.
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Tooth Position in Wind Instrument Players: Dentofacial Cephalometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084306. [PMID: 33921609 PMCID: PMC8073265 DOI: 10.3390/ijerph18084306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
Background: Specific dentofacial characteristics in wind instrumentalists should be taken in consideration when analyzing physiological and anatomical issues regarding the musician’s embouchure, posture, and biomechanics during musical performance. Objectives: To compare tooth cephalometric characteristics between wind instrument players and string players (overjet, overbite, lower facial height, facial convexity, lower incisor inclination, and interincisal angle). Methods: In total, 48 wind instrumentalists (67%) and 24 string instrumentalists (33%). These musicians performed lateral tele-radiography and the correspondent linear and angular measurements of the dentofacial cephalometric analysis. Statistical comparison of wind and string instrumentalists was made by using an independent t-test. Results: Small variations on the analyzed parameters were found between the wind and string instrument groups. Based on the cephalometric analysis the variable interincisal angle was statistically significant (p < 0.05), when comparing the wind and string instrument group. Conclusions: Knowledge of the overjet and overbite value permits a substantial analysis on the tooth position of wind instrument players, where both of these parameters are increased and greater than the norm value. The cephalometry was an added value on the interpretation of possible factors that lead to the position of the central incisors of wind instruments. Till some extent in this group of musicians the applied forces during the embouchure mechanism on the anterior teeth and the existing perioral forces promote an equilibrium on the vector of forces. This study findings demonstrate that when evaluating the two samples, wind and string instruments there are different dentofacial configurations, however the only statistically significant differences that were found are related to the interincisal angle (p < 0.05).
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Campos LGN, Pedrosa BH, Cavalcanti RVA, Stechman-Neto J, Gadotti IC, de Araujo CM, Taveira KVM. Prevalence of temporomandibular disorders in musicians: A systematic review and meta-analysis. J Oral Rehabil 2021; 48:632-642. [PMID: 33474771 DOI: 10.1111/joor.13150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the prevalence of temporomandibular disorders (TMD) in musicians. MATERIALS AND METHODS Electronic database searches and a manual search were performed. Qualitative and quantitative analysis including risk of bias was performed for studies that met the inclusion criteria. A meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored according to the moderating variable through subgroup analysis and metaregression. The certainty of the evidence was assessed using the GRADE tool. RESULTS A total of 13 articles were included for the meta-analysis. Pooled prevalence estimate was 52.8% (CI 95%; 33.4%-71.7%) for wind instruments, 53.9% (CI 95%; 42.4%-65.2%) for string instruments and 53.9% (CI 95%; 23.5%-82.7%) for string and wind instruments. The average time of use of the musical instrument explained 82.38%, the heterogeneity between the sizes of the effects observed in the analysis (R2 = 82.38%; P < .0001). For prevalence of TMD, the GRADE criteria were considered very low. CONCLUSION The overall combined prevalence of TMD in musicians was approximately 53.9%, and musicians who use their instruments daily and for a long period of time may have a higher prevalence of TMD. CLINICAL SIGNIFICANCE Due to the high prevalence of TMD in musicians, health professionals must be careful not to underestimate signs and symptoms and correctly diagnose these cases.
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Affiliation(s)
- Larissa Gabriely Nogueira Campos
- Unfinished Postgraduate Program of Multiprofessional Residency on Healthcare to Disabled People, Santos Dumont Institute, Macaiba, RN, Brazil
| | | | | | - José Stechman-Neto
- Post-graduate Program in Communication Disorders, Tuiuti University of Paraná, Curitiba, PR, Brazil
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Infrared thermography of the crânio-cervico-mandibular complex in wind and string instrumentalists. Int Arch Occup Environ Health 2020; 93:645-658. [PMID: 32020282 DOI: 10.1007/s00420-020-01517-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Musculoskeletal disorders can be common in wind and string instrumentalists. The musical gesture technique associated to musical performance can promote an asymmetrical isometric contraction with the hyperactivity of specific muscular groups and the overload of articular surfaces which can cause discomfort or pain. The aim of this investigation was to assess specific anatomical regions of interest within the cranio-cervico-mandibular complex in order to determine and evaluate the presence of muscular hyperactivity associated to musical performance. METHODS An infrared imaging camera, FLIR®, was used to record the regions of interest in wind (n = 48) and string instrumentalists (n = 29). Bilateral temperature differences were considered as thermal asymmetries with a conventional threshold of 0.3 ºC to distinguish pathological from healthy states. The regions of interest (ROI) were the anterior triangle of the neck, the sternocleidomastoid and trapezius muscles regarding the postural and stabilizing muscles of the head and neck. On the orofacial region, the anatomical sites were the anterior temporal muscle, the masseter muscle and the temporomandibular joint. A Pearson chi-square test was performed to compare the assessed areas. RESULTS Between 30-37% of all participants showed ROI in an asymmetric pattern. The most affected sites were the temporal muscle and the TMJ for both groups. The anterior triangle of the neck showed statistical differences (p = 0.044) between string and wind instrumentalists, while the temporal (p = 0.034) and trapezius muscle (p = 0.028) when comparing large and small mouthpieces of brass instruments. Although female participants showed a higher prevalence of asymmetrical patterns regarding the ROI, no statistical differences were found between genders. CONCLUSIONS Infrared thermography exhibited significant differences between wind and string instruments within the CCMC. Regarding the issue of occupational health in performing arts, it is an advantage being able to quantify asymmetrical patterns sites of the CCMC to understand the underlying physiological responses to repetitive movements, overloading and muscular hyperactivity that occur during musical performance.
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Rotter G, Noeres K, Fernholz I, Willich SN, Schmidt A, Berghöfer A. Musculoskeletal disorders and complaints in professional musicians: a systematic review of prevalence, risk factors, and clinical treatment effects. Int Arch Occup Environ Health 2020; 93:149-187. [PMID: 31482285 PMCID: PMC7007903 DOI: 10.1007/s00420-019-01467-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/19/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Musicians' practice and performance routines reportedly lead to musculoskeletal complaints and disorders (MCD) that impact their wellbeing and performance abilities. This systematic review aims to assess the prevalence, risk factors, prevention and effectiveness of treatments for MCD in professional musicians and consider the methodological quality of the included studies. METHODS A systematic literature search was performed in December 2017 using electronic databases and supplemented by a hand search. Case-control studies, cohort studies, cross-sectional studies, interventional studies and case reports investigating the prevalence, risk factors, prevention or treatment effects of MCD in professional musicians or music students (age ≥ 16 years) were included. Quality assessments of the included studies were performed using an adapted version of the "Study Quality Assessment Tools" from the National Heart, Lung, and Blood Institute. RESULTS One case-control study, 6 cohort studies, 62 cross-sectional studies, 12 interventional studies and 28 case reports were included and assessed for methodological quality. The study designs, terminology, and outcomes were heterogeneous, as the analyses mostly did not control for major confounders, and the definition of exposure was often vague. Therefore, evidence that being a professional musician is a risk factor for MCD as well as the causal relationship between these factors remains low despite the fact that a large number of studies have been performed. CONCLUSIONS Studies with high internal and external validity regarding the prevalence, risk factors and effectiveness of the prevention or treatment of MCD in professional musicians are still missing. Further high-quality observational and interventional studies are required.
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Affiliation(s)
- Gabriele Rotter
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany.
- Kurt-Singer-Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin and University of the Arts Berlin, Charlottenstrasse 55, 10117, Berlin, Germany.
- Berlin Center for Musicians' Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 10117, Berlin, Germany.
| | - Katharina Noeres
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany
| | - Isabel Fernholz
- Kurt-Singer-Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin and University of the Arts Berlin, Charlottenstrasse 55, 10117, Berlin, Germany
- Berlin Center for Musicians' Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 10117, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany
- Berlin Center for Musicians' Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 10117, Berlin, Germany
| | - Alexander Schmidt
- Kurt-Singer-Institute for Music Physiology and Musicians' Health, Hanns Eisler School of Music Berlin and University of the Arts Berlin, Charlottenstrasse 55, 10117, Berlin, Germany
- Berlin Center for Musicians' Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 10117, Berlin, Germany
- Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 10117, Berlin, Germany
| | - Anne Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany
- Berlin Center for Musicians' Medicine, Charité - Universitätsmedizin Berlin, Luisenstrasse 13, 10117, Berlin, Germany
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van Selms MKA, Wiegers JW, Lobbezoo F, Visscher CM. Are vocalists prone to temporomandibular disorders? J Oral Rehabil 2019; 46:1127-1132. [PMID: 31321795 PMCID: PMC6899656 DOI: 10.1111/joor.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/18/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND As vocalists demand high physical strains of the masticatory system, singing is frequently mentioned as a risk factor for temporomandibular disorders (TMDs). OBJECTIVES This study investigated whether vocalists report a higher prevalence of two types of TMDs (viz., TMD pain and temporomandibular joint sounds) compared with instrumentalists who do not load their masticatory system while performing. In addition, we examined which risk indicators are associated with the presence of these TMDs among musicians. METHODS A total of 1470 musicians from 50 different music ensembles completed a questionnaire. Of these musicians, 306 were vocalists (mean age ± SD 37.5 ± 17.7 years; 63.9% female) and 209 musicians enrolled the control group (mean age ± SD 42.7 ± 18.0 years; 40.7% female). RESULTS The prevalence of self-reported TMD pain among vocalists was 21.9%, as compared to 12.0% in the control group. 20.0% of the vocalists reported TMJ sounds versus 15.1% of the controls. The multiple regression models indicated that being a vocalist was not a risk indicator for the presence of self-reported TMD pain nor for self-reported TMJ sounds. Instead, it appeared that the report of TMD pain among musicians was positively associated with female gender, next to the level of physical workload, depicted as frequency of oral behaviours and the hours of daily practice. Musicians' report of TMJ sounds was associated with oral behaviours. CONCLUSION This study shows that singing is not associated with the reports of TMD pain and TMJ sounds, after adjusting for potentially confounding variables included in the models.
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Affiliation(s)
- Maurits K. A. van Selms
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jetske W. Wiegers
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Corine M. Visscher
- Department of Orofacial Pain and DysfunctionAcademic Centre for Dentistry Amsterdam (ACTA)University of Amsterdam and Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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van Selms MKA, Wiegers JW, van der Meer HA, Ahlberg J, Lobbezoo F, Visscher CM. Temporomandibular disorders, pain in the neck and shoulder area, and headache among musicians. J Oral Rehabil 2019; 47:132-142. [PMID: 31520546 PMCID: PMC7004094 DOI: 10.1111/joor.12886] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/20/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022]
Abstract
Background Uncertainties still exist about the role of playing musical instruments on the report of musculoskeletal complaints and headache. Objectives To evaluate the prevalence of and risk indicators for symptoms of temporomandibular disorders, pain in the neck or shoulder, and headache among musicians. Methods A questionnaire was distributed among 50 Dutch music ensembles. Results The questionnaire was completed by 1470 musicians (response rate 77.0%). Of these, 371 musicians were categorised as woodwind players, 300 as brass players, 276 as upper strings players, 306 as vocalists and 208 as controls; nine musicians had not noted their main instrument. The mean age was 41.6 years (standard deviation [SD] 17.2), and 46.5% were male. Irrespective of instrumentalist group, 18.3% of the musicians reported TMD pain, 52.5% reported pain in the neck and shoulder area, and 42.5% reported headache. Of the functional complaints, 18.3% of the musicians reported TMJ sounds, whereas a jaw lock or catch on opening or on closing was reported by 7.1% and 2.4%, respectively. TMD pain was associated with playing a woodwind instrument, whereas pain in the neck and shoulder was associated with playing the violin or viola. For each complaint, oral behaviours were found as risk indicator, supplemented by specific risk indicators for the various complaints. Conclusions The current finding that pain‐related symptoms varied widely between instrumentalist groups seems to reflect the impact of different instrument playing techniques. Playing a musical instrument appears not the primary aetiologic factor in precipitating a functional temporomandibular joint problem.
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Affiliation(s)
- Maurits K A van Selms
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jetske W Wiegers
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hedwig A van der Meer
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Stanhope J, Pisaniello D, Tooher R, Weinstein P. How do we assess musicians' musculoskeletal symptoms?: a review of outcomes and tools used. INDUSTRIAL HEALTH 2019; 57:454-494. [PMID: 30555103 PMCID: PMC6685794 DOI: 10.2486/indhealth.2018-0065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Recent reviews of musicians' musculoskeletal symptoms (MSS) have reported heterogeneity in the outcomes reported and data collection tools used, making it difficult to compare and synthesise findings. The purpose of this present review was to improve the consistency of future research, by documenting the outcomes reported in recent studies of musicians' MSS and the data collection tools used. All English language, peer-reviewed studies, published 2007-2016 that reported musicians' self-reported MSS outcomes were identified. Details of the types of outcomes reported and the tools used were extracted, and synthesised descriptively. A range of MSS outcomes were reported, including MSS with a temporal relationship to activities performed, and the consequences of symptoms. Only 24% of studies used standardised questionnaires, with the Nordic Musculoskeletal Questionnaire (NMQ) being the most commonly used. To improve the homogeneity of outcomes and data collection tools when investigating musicians' MSS, we recommend using the NMQ, where appropriate. Recall periods of 12-months and 7-d are the most appropriate for prevalence, and 7-d recall periods for ratings. Importantly, outcomes and the tools used to collect data should be reported in sufficient detail to ensure that the study can be replicated, critiqued, and accurately interpreted.
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Affiliation(s)
| | - Dino Pisaniello
- School of Public Health, The University of Adelaide, Australia
| | - Rebecca Tooher
- School of Public Health, The University of Adelaide, Australia
| | - Philip Weinstein
- School of Biological Sciences, The University of Adelaide, Australia
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Barros A, Mendes J, Moreira A, Vardasca R, Pais Clemente M, Pinhão Ferreira A. Thermographic Study of the Orofacial Structures Involved in Clarinetists Musical Performance. Dent J (Basel) 2018; 6:E62. [PMID: 30388769 PMCID: PMC6313761 DOI: 10.3390/dj6040062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Wind instrumentalists like clarinetists, may present a muscular hyperactivity on certain groups of the cranio-cervico-mandibular complex, due to their musical activity. Therefore, the use of infrared thermography can be used to assess and characterize the orofacial structures involved in clarinet performance. AIM The objective of this study was to analyze and record the thermal patterns using the thermographic camera Flir® E60sc to evaluate anatomically and physiologically certain orofacial structures of the cranio-cervical-mandibular complex, such as the masticatory muscles and the region of the temporomandibular joint. METHODOLOGY A sample of 30 clarinetists completed an individual questionnaire composed of two components (musical and clinical history of the participant), and were subjected to a clinical examination. Four thermographic images were taken of the cranio-cervical-mandibular complex at a rest position with frontal, right lateral, left lateral and anterior dentoalveolar components views. Each musician performed a piece of music for an uninterrupted period of 10 min. New thermographic images were captured with the same incidences, after the performance, respecting the same protocol. RESULTS There were statistically significant differences in the areas corresponding to the left temporal muscle, the orbicularis muscle (labial component), the left and right perioral teguments, as well as in the upper central incisors. There was also statistical evidence regarding the initial and final temperature asymmetries regarding temporal muscle and orbicular muscles (labial and marginal components). CONCLUSION Infrared thermography has been shown to be an effective complementary diagnostic tool in the monitorization of the cranio-cervical-mandibular complex of clarinetists.
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Affiliation(s)
- Ana Barros
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal.
| | - Joaquim Mendes
- INEGI-LAETA, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal.
| | - André Moreira
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal.
| | - Ricardo Vardasca
- INEGI-LAETA, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal.
| | | | - Afonso Pinhão Ferreira
- Department of Orthodontics, Faculty of Dental Medicine; University of Porto, 4200-393 Porto, Portugal.
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Kochem FB, Silva JG. Prevalence of Playing-related Musculoskeletal Disorders in String Players: A Systematic Review. J Manipulative Physiol Ther 2018; 41:540-549. [DOI: 10.1016/j.jmpt.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 10/28/2022]
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van Selms MKA, Ahlberg J, Lobbezoo F, Visscher CM. Evidence-based review on temporomandibular disorders among musicians. Occup Med (Lond) 2018; 67:336-343. [PMID: 28472414 DOI: 10.1093/occmed/kqx042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Playing a musical instrument that loads the masticatory system has frequently been linked to temporomandibular disorders (TMDs). Previous literature reviews on this topic do not conform to the current standards of evidence-based medicine. Aims To investigate the effects of playing a musical instrument (i.e. violin/viola and wind instruments) or singing on the presence of TMDs, based on evidence derived from observational studies. Methods Databases of Medline, Web of Science and Google Scholar were searched using MeSH and other relevant terms. For each study, a quality assessment was undertaken using a modified version of the Newcastle-Ottawa Scale (NOS). Results Fifteen relevant papers were identified for inclusion in this review. Of the seven possible points that could be scored with the NOS, the majority of these studies scored under half. Based on the available evidence, the purported relationship between the playing of specific musical instruments and TMDs was not as evident as reported in previous literature reviews. Conclusions There is limited evidence to conclude that playing a wind instrument is a hazard to the temporomandibular system. Furthermore, there is no available evidence to suggest that vocalists experience more TMDs than controls. The studies that investigated the presence of TMDs among violists and violinists yielded ambiguous outcomes; some studies reported no association between the playing of these instruments and the presence of signs and symptoms of TMDs, whereas in studies where a clinical examination was performed (though of lower methodological quality), an association was found.
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Affiliation(s)
- M K A van Selms
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - J Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, PO Box 41, Mannerheimintie 172, FIN-00014, Helsinki, Finland
| | - F Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| | - C M Visscher
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
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Santos BFD, Fragelli TBO. Prevalence of temporomandibular joint disorders and neck pain in musicians: a sytematic review. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.004.ar02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The instrumental practice for a long time, the high performance level, the strict technique and the specific shape of each musical instrument can take musicians to overcome their physiological limits, giving a high prevalence of musculoskeletal injuries. Objective: Investigate the prevalence of temporomandibular joint disorder and neck pain in musicians. Methods: Between August and September 2015 were reviewed five databases: LILACS, SciELO, Medline / PubMed, Scopus and Web of Science. The articles were read and evaluated by the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), items, that obtained a percentage above of 50 percent, were considered in the analysis of this work. Results: 15 articles attended the inclusion criteria. Among all musicians the prevalence of TMJ pain ranged from 10 - 81% and the prevalence of neck pain ranged from 29 - 80%. Conclusion: In this study was observed that the musicians showed both, temporomandibular joint disorders and neck pain, watching a high prevalence especially in violinists and the horn players. In the risk factors identified in the literature for the emergence of painful symptoms in musicians, stand out the biomechanical factors involved in maintaining anti-physiologic postures.
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Raya CR, Plaza-Manzano G, Pecos-Martín D, Ferragut-Garcías A, Martín-Casas P, Gallego-Izquierdo T, Romero-Franco N. Role of upper cervical spine in temporomandibular disorders. J Back Musculoskelet Rehabil 2017; 30:1245-1250. [PMID: 28800304 DOI: 10.3233/bmr-169620] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Temporomandibular disorders (TMDs) are prevalent multifactorial pathologies in which the actual role of the cervical region position is controversial. OBJECTIVE To analyze the relationship between the position of the upper cervical rachis and the symptoms of TMD. METHODS Sixty women were recruited to this study. All of them completed a questionnaire and were subjected to a temporomadibular exploration to create two different groups: a TMD Group (n= 30) - women who suffered TMD symptoms according to the evaluation; and a control group (n= 30) - women who were free from TMD symptoms. Two X-ray examinations were performed in all the women: a lateral one and a frontal one with mouth open to assess the C1-C0 distance and the craniocervical angle. RESULTS ANOVA showed that the TMD and control women had similar C1-C0 distances and craniocervical angles (p> 0.05). Pearson correlation did not indicate any relationship between the craniocervical position and the symptomatology of TMD (r=- 0.070). CONCLUSIONS TMD symptomatology is unrelated to alterations in craniocervical position (C0-C1 distance and craniocervical angle). Women with and without TMD showed a similar prevalence of alteration in the craniocervical position.
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Affiliation(s)
| | - Gustavo Plaza-Manzano
- Departamento de Medicina Física y Rehabilitación, Hidrología Médica, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain.,Physiotherapy and Pain Group, University of Alcalá, Madrid, Spain
| | - Daniel Pecos-Martín
- Physiotherapy Department, University of Alcalá, Madrid, Spain.,Physiotherapy and Pain Group, University of Alcalá, Madrid, Spain
| | | | - Patricia Martín-Casas
- Departamento de Medicina Física y Rehabilitación, Hidrología Médica, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain
| | - Tomás Gallego-Izquierdo
- Physiotherapy Department, University of Alcalá, Madrid, Spain.,Physiotherapy and Pain Group, University of Alcalá, Madrid, Spain
| | - Natalia Romero-Franco
- Physiotherapy and Nursery Department, University of the Balearic Islands, Palma de Mallorca, Spain
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McBride D. In the virtual issue on the occupational health of musicians. Occup Med (Lond) 2016. [DOI: 10.1093/occmed/kqw124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jang JY, Kwon JS, Lee DH, Bae JH, Kim ST. Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists. Yonsei Med J 2016; 57:1500-7. [PMID: 27593881 PMCID: PMC5011285 DOI: 10.3349/ymj.2016.57.6.1500] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively. MATERIALS AND METHODS A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis. RESULTS Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours. CONCLUSION The results indicate that playing instruments can play a contributory role in the development of TMD.
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Affiliation(s)
- Jae Young Jang
- Department of Orofacial Pain & Oral Medicine, Yonsei University College of Dentistry, Seoul, Korea
| | - Jeong Seung Kwon
- Department of Orofacial Pain & Oral Medicine, Yonsei University College of Dentistry, Seoul, Korea
| | - Debora H Lee
- School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Jung Hee Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Seong Taek Kim
- Department of Orofacial Pain & Oral Medicine, Yonsei University College of Dentistry, Seoul, Korea.
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Amorim MIT, Jorge AIL. Association between temporomandibular disorders and music performance anxiety in violinists. Occup Med (Lond) 2016; 66:558-63. [PMID: 27405486 DOI: 10.1093/occmed/kqw080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Professional violin playing has been associated with a predisposition to develop temporomandibular disorder (TMD). There are a number of risk factors, including physical trauma from the playing posture and the presence of parafunctional habits. Music performance anxiety (MPA) may also be a factor, as it has been associated with playing-related musculoskeletal disorders (PRMD). AIMS To evaluate a possible association between the presence of TMD and the level of MPA in violin players. METHODS An observational study using a written questionnaire that retrieved data related to TMD symptoms (Fonseca Anamnestic Questionnaire), MPA level (Kenny Music Performance Anxiety Inventory, K-MPAI), instrument practice time, chinrest type, sex and age. Descriptive, bivariate and logistic regression analyses were conducted. RESULTS Ninety-three professional or semi-professional violinists performing in and around Lisbon, Portugal, completed the questionnaire (73% response rate). TMD was present in 50 violinists (58%). There was a statistically significant association between the presence of TMD and high MPA levels (P < 0.001) and the most anxious violinists were six times (95% confidence interval 2.51-15.33; P < 0.001) more likely to report TMD symptoms when compared with the least anxious players. CONCLUSIONS Violin players had a high prevalence of reported TMD symptoms, which was significantly associated with high MPA levels. It may therefore be necessary to address psychological and physical factors simultaneously in musicians who do not improve with physical therapy alone.
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Affiliation(s)
- M I T Amorim
- Integrated Clinic of Dentistry Post-graduation, Faculdade de Medicina Dentária da Universidade de Lisboa, Cidade Universitária, 1649-003 Lisboa, Portugal,
| | - A I L Jorge
- Department of Occlusion, Faculdade de Medicina Dentária da Universidade de Lisboa, Cidade Universitária, 1649-003 Lisboa, Portugal
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Stanhope J, Milanese S. The prevalence and incidence of musculoskeletal symptoms experienced by flautists. Occup Med (Lond) 2015; 66:156-63. [DOI: 10.1093/occmed/kqv162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Steinmetz A. Kraniomandibuläre Dysfunktionen im Kontext Instrumental-spielassoziierter muskuloskeletaler Schmerzsyndrome. MANUELLE MEDIZIN 2015. [DOI: 10.1007/s00337-015-1185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hussain T. In this issue of Occupational Medicine. Occup Med (Lond) 2014; 64:1. [PMID: 24389898 DOI: 10.1093/occmed/kqt170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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