Should musicians play in pain?

Factors Associated with Performance-Related Pain Among Musicians: A Multicenter Study Using Validated Tools

PURPOSE

We aimed to evaluate factors associated with performance-related pain among musicians with different backgrounds, comparing music students and professional musicians.

METHODS

We performed a multicenter cross-sectional study in a stratified random sample consisting of music students (294) and professional musicians (291). The main outcome was performance-related pain (PRP), measured by the Performance-related Pain among Musicians Questionnaire (PPAM). Factors associated with the outcome were measured using PPAM, International Physical Activity Questionnaire, Modified Fatigue Impact Scale, 10-item Kessler Psychological Distress Scale, Frost Multidimensional Perfectionism Scale, and Medical Outcomes Study Short Form 36 Health Survey.

RESULTS

From the 585 musicians included (response rate of 82.4%), 322 (55.0%) reported PRP. Professional musicians presented a significantly higher lifetime prevalence of PRP (57.5%, p < 0.001); however, music students reported higher levels of fatigue, anxiety and depression, and lower quality of life. Multivariate logistic regression defined a model with 16 factors significantly associated with higher probability of PRP. Additionally, we describe 25 self-perceived factors reported by musicians as being associated with PRP.

CONCLUSION

We present the first study thoroughly describing and assessing factors associated with PRP among musicians, using a validated tool, including musicians with different backgrounds, and distinguishing music students and professional musicians. We also explore self-perceived factors associated with PRP. The relevant insights coming from this and future studies on factors associated with PRP will contribute to developing more effective preventive programs and improving evidence-based guidance and management of musicians affected by PRP.

Tribute to the Flute: A Literature Review of Playing-Related Problems in Flautists

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.

Factors associated with increased risk of playing-related disorders among classical music students within the Risk of Music Students (RISMUS) longitudinal study

Playing-related musculoskeletal disorders (PRMDs) are common among musicians but longitudinal data on risk factors are limited. The aim of the study was to longitudinally identify the factors associated with increased risk of PRMD onset among music students enrolled in different pan-European music institutions. A further goal was to assess the occurrence of PRMDs during a 12-month period. A total of 442 students without PRMDs from 56 European music universities completed a web-based questionnaire on lifestyle and practice habits, health history, physical activity, psychological distress, perfectionism, and fatigue. PRMD onset was assessed prospectively at 6 and 12 months. Logistic regression analysis showed that changes in physical activity level (6-month AOR = 2.343, 12-month AOR = 2.346), increased levels of fatigue (6-month AOR = 1.084, 12-month AOR = 1.081) and socially-prescribed perfectionism (6-month AOR = 1.102) were significantly associated with PRMD onset, which had occurred in 49% of participants during 12 months. Musculoskeletal complaints reported at baseline (6-month AOR = 0.145, 12-month AOR = 0.441) and changes to BMI (12-month AOR = 0.663) limited the onset of PRMDs. The study's novel longitudinal findings were appraised critically within the contexts of potential factors for PRMD onset and evidence-based preventive strategies to minimise the impact of PRMDs.

Are music students at 'high-risk' of experiencing musculoskeletal symptom outcomes compared with other students?

Musicians have been described as a 'high-risk' group for experiencing musculoskeletal symptoms (MSSs), yet few studies have tested this assumption. We aimed to determine whether the prevalence and profile of MSS outcomes differed between university music students and a reference group (science students). A survey was conducted with university music and science students. Reported MSS outcomes among the two groups were compared using regression analyses. The majority of participants in both groups reported experiencing MSSs in the last 12 months and 7 days. Music students reported a higher prevalence of wrist/ hand MSSs compared with science students. Compared with symptomatic science students, music students reported a higher emotional impact of MSSs. We recommend prioritising research into interventions for music students that address MSSs in the wrist/ hand region, and the emotional impact of MSSs. Addressing these MSS outcomes could reduce the MSS burden for musicians during and beyond their studies.

Hard Work and Hopefulness: A Mixed Methods Study of Music Students' Status and Beliefs in Relation to Health, Wellbeing, and Success as They Enter Specialized Higher Education

Using mixed methods, we explored new music students’ concepts of wellbeing and success and their current state of wellbeing at a university music department in Switzerland. Music performance is a competitive and achievement-oriented career. Research suggests musicians face vocation-specific challenges to physical health and mental wellbeing but has yet to investigate music students’ beliefs about wellbeing and success. With a self-report questionnaire (n = 99, Bachelor/Master students) we investigated new music students’ quality of life (WHO-5; WHOQoL-BREF) and self-efficacy (ASKU). Through qualitative workshops (17 groups, n = 5–8) we explored students’ understanding of the term “wellbeing,” and how this relates to “success.” Over half new music students (55%) believed the institution has 40–60% responsibility for their wellbeing. A simple linear regression showed that self-efficacy could predict better wellbeing, explaining 12% of the variance. Self-efficacy predicts wellbeing for new music students (β1 = 8.81, p = 0.001). The 17 flipcharts generated 121 inputs clustered into themes. Four themes solely described “wellbeing” (Health, Safety, Vitality, and Attitude) and four separately depict “success” (Achieving Objectives, Recognition, Career, and Financial Goods). Some themes intersected as elements of both constructs (Intersection: Relationships & Environment, Development, Happiness, Meaningfulness, Balance and Authenticity). Four further themes illustrated the relationship between the two (Reciprocity, Conditionality, Stability and Perspectivity). Music students believe responsibility for wellbeing is shared between themselves and their institution. As they scored low on both self-efficacy and wellbeing, these findings are an urgent call for action for school management and stakeholders of the music student population.

Musculoskeletal symptoms in university music students: does major matter?

We aimed to evaluate and compare the prevalence and profile of musculoskeletal symptom (MSS) outcomes across cohorts of university music students with different 'majors': (i) performance and nonperformance students, and (ii) classical and non-classical performance students. Data were collected using a cross-sectional questionnaire survey, and regression analyses were used to compare the groups. Of the 166 participating students, 92.5% reported experiencing MSSs in the last 12 months, and 72.6% in the last 7 days. Few significant differences were identified between groups. Musculoskeletal symptoms are a problem for all types of university music students, and all should have access to support to prevent and manage their MSSs, regardless of their majors.

What do musicians think caused their musculoskeletal symptoms?

Objectives. The purpose of this study was to determine the factors that university music students and professional musicians believe caused their musculoskeletal symptoms (MSSs). Methods. Data were collected using a questionnaire distributed to university music students and professional musicians. Using a musician-driven data collection approach, musicians with MSSs were asked to nominate their top three perceived causes of their symptoms. Responses were categorized, and percentages reported for the main categories. Results. Of the 213 musicians, 37.6% reported biological factors, 21.1% reported external, physical factors, 93.9% reported behavioural factors, 18.8% reported psychosocial factors and 9.9% reported 'other' factors (e.g., accidents) as the perceived causes of their MSSs. Conclusion. This study is the first to investigate perceived causes of musicians' MSSs across a diverse range of musicians, using musician-driven methods. By using open response data collection strategies, a comprehensive, unbiased list of perceived causes of MSSs was compiled. Perceived causes not identified in previous research included manual handling, physical activity and sleep problems. Future research should consider the association between perceived causes and MSSs, and barriers and enablers of behaviour changes that may prevent MSSs. This research may guide the development of new strategies to reduce the burden of MSSs in musicians.

Patterns of pain location in music students: a cluster analysis

BACKGROUND

According to existing literature, musicians experience high rates of musculoskeletal (MSK) disorders involving different anatomical areas. The aim of the study was to identify patterns of pain location in a sample of music students enrolled in different pan-European music institutions. A further goal was to explore the association between the identified pain patterns and students' characteristics.

METHODS

A total of 340 music students (mean age 23.3 years, 66.2% female) with current MSK pain completed a web-based questionnaire including both background information (i.e. lifestyle and physical activity, practice habits) and clinical features (i.e. pain characteristics, disability, pain self-efficacy, psychological distress, perfectionism and fatigue).

RESULTS

Five patterns of pain location were identified by hierarchical cluster analysis: wrist pain (WP) representing 22.6% of the total sample, widespread pain (WSP) (16.9%), right shoulder pain (RSP) (18.5%), both shoulders pain - left concentrated (LSP) (23.2%), neck and back pain (NBP) (18.8%). Amongst the identified patterns of pain location, bivariate analysis identified the WSP cluster as containing the largest number of associated variables. Participants in this cluster reported a higher percentage of women (p < .05), a higher perceived exertion (p < .01) and psychological distress (p < .001), as well as a lower level of self-efficacy (p < .01). Similarly, a higher percentage of participants included in the WSP cluster perceived their musical activity as the main cause of their MSK pain (p < .01). Additionally, a higher level of disability in relation to playing-related activity was reported by participants included in the WP and WSP clusters (p < .001). The RSP cluster was characterised by a higher percentage of participants playing an instrument in a neutral position (p < .001) and lower levels of socially prescribed perfectionism (p < .01). A higher percentage of participants playing an instrument with both arms elevated in the left quadrant position were included in the LSP cluster and a higher percentage of singers were included in the NBP cluster (p < .001).

CONCLUSIONS

Five distinct patterns of pain location were identified and their associations with the students' characteristics were explored. These findings may be helpful in the exploration of different aetiologies of MSK pain among musicians and in the development of targeted preventive strategies and treatments.