The effect of standing and sitting postures on breathing in brass players

Assessing posture while playing in musicians - A systematic review

INTRODUCTION

Playing a musical instrument can potentially lead to musculoskeletal disorders. Postural loads are different considering the instrument they play; for example violin and flute require elevation from both upper limbs, asymmetrical postures are common and instrument weight can be significant. The aim was to explore how musicians' postures are investigated, and potentially if there is evidence of an association between postural impairments and pain.

METHODS

A systematic search was performed in several databases, combined with manual search. Study inclusion, data extraction and quality assessment were performed independently by two reviewers.

RESULTS

Twenty seven relevant studies were included in this review covering musicians with the full range of playing experience (professionals, students, teachers, amateurs). The main considered methods to investigate postures are visual assessment and three dimensional analysis using videography.

DISCUSSION

This review provides a synthesis of the different methods used to monitor posture in musicians and provides information in order to build protocols which will allow comparison with previous work.

Associations Between Ancillary Body Movements and Acoustic Parameters of Pitch, Dynamics and Timbre in Clarinet Playing

When playing an instrument, there are two main categories of body movements: instrumental movements, which are necessary for the sound production, and ancillary movements, which are associated with individual musical intentions and expressions. In this study, the particular purpose of ancillary movements of clarinet player was investigated especially in respect to how these movements were related to the musical structure of the piece and to specific audio parameters. 3D motion capture data of 19 clarinet players performing the same piece were analyzed regarding common motion patterns during the performance and in accordance with acoustic features related to pitch, dynamics (RMS energy) and timbre (spectral centroid and flux). A focus of the body movements was on the arms and the knees. The results showed that there were certain motion patterns performed by the players depending on specific musical structures. When playing a melodic part, the players often did so by bending their knees. At musical transitions, however, the knees were mainly stretched. Similarly, arm movements were more pronounced during playing melodious parts. At transitions, the arms were put closer to the torso. Considering the connection with the acoustics, a larger range of knee motions was correlated with a larger variation of the timbre. Moreover, at specific moments during the performance, when some players strongly bent their knees or lifted the arms, the RMS energy of the signal was significantly higher. The correlations of the body movements and the acoustic features showed that some players synchronized their movements with particular audio parameters more than others did. In summary, the ancillary movements of the clarinetists pursued both musical expressive intentions and physiologically necessary movements and tended to be performed with individual differences in terms of visual and auditory expression.

Multiple Factors Influencing Healthy Performance for Pre-professional and Professional Classical Violinists: An Exploratory Study Focusing on Physical Health

Musculoskeletal complaints are common in pre-professional and professional classical violinists and these complaints can affect violinists' performance. Therefore, it is important to identify the factors that contribute to healthy performance in this population. Qualitative studies with a variety of stakeholders are able to provide insights from different perspectives into factors influencing healthy performance for the pre-professional and professional classical violinist. In the current small-scale, exploratory study, semi-structured interviews were conducted with various stakeholders; two classical violin students, one classical violin teacher, a physiotherapist, a professional classical violinist, who is also a performance coach, and a health specialist who also graduated as a professional classical violist. Thematic analysis was conducted using Atlas.ti 9. We identified six themes that were indicated as important by the participants in terms of ensuring healthy performance for the pre-professional and professional classical violinist. The themes were: (1) physical aspects (involved in playing the violin); (2) practice routine and techniques; (3) interaction between physical and mental aspects; (4) culture; (5) role of the main subject teacher; and (6) preventive measures. Furthermore, when asked specifically about the development of a physical screening tool, the participants indicated that such a tool should include multiple factors covering various regions of the body, the inclusion of a questionnaire on risk-factors, and follow-up measurements. Also, collaborations between health professionals and main subject teachers were recommended as part of the screening tool to increase commitment of participating students. The results of the current study are based on the opinions, attitudes, and ideas of a small, selected group of participants only and cannot be generalized to a wider group of violinists. More research is needed regarding factors influencing healthy performance, before conservatoires and professional orchestras can develop programs for a healthy playing environment for pre-professional and professional violinists.

Unexpected Cardiovascular Oscillations at 0.1 Hz During Slow Speech Guided Breathing (OM Chanting) at 0.05 Hz

Slow breathing at 0.1 Hz (i.e., 6 cycles per minute, cpm) leads to strong cardiovascular oscillations. However, the impact of breathing below 6 cpm is rarely addressed. We investigated the influence of OM chanting, an ancient Indian mantra, with approx. 3 respiratory cpm (0.05 Hz) on the synchronisation of heart period (RR), respiration (RESP) and systolic blood pressure (SBP). Nine healthy, trained speech practitioners chanted three sequences of five subsequent OM with 2 min pauses in between. Each single OM chanting consisted of taking a deep breath and a long “OM” during expiration and lasted approx. 20 s. ECG, respiration and blood pressure were recorded continuously, of which the RR tachogram, RESP and SBP were derived. Synchronisation between the signals was computed using the phase difference between two signals. During OM chanting synchronisation among the oscillations of RR, SBP and RESP was significantly increased compared to rest. Furthermore, OM chanting at breathing frequencies between 0.046 and 0.057 Hz resulted in 0.1 Hz oscillations in RR and SBP. In conclusion, OM chanting strongly synchronized cardiorespiratory and blood pressure oscillations. Unexpected oscillations at 0.1 Hz in SBP and RR appear at breathing frequencies of approx. 0.05 Hz. Such frequency doubling may originate from an interaction of breathing frequency with endogenous Mayer waves.

Musculoskeletal and psychological assessments used in quantitatively based studies about musicians' health in brass players: A systematic literature review

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.

Does breaking up prolonged sitting improve cognitive functions in sedentary adults? A mapping review and hypothesis formulation on the potential physiological mechanisms

Background

Prolonged (excessive) sitting is detrimentally associated with cardiovascular, metabolic and mental health. Moreover, prolonged sitting has been associated with poor executive function, memory, attention and visuospatial skills, which are important cognitive aspects of work performance. Breaking up prolonged sitting with standing or light-intensity exercises at the workplace is recognized as a potential measure in improving cognition. However, preliminary evidence, primarily from acute laboratory experiments, has enabled formulating hypothesis on the possible mechanistic pathways. Hence, the aim of this mapping review is to gather preliminary evidence and substantiate possible physiological mechanisms underpinning the putative effects of breaking prolonged sitting on improving cognitive function among sedentary office workers.

Mapping method

We searched four databases to identify relevant studies that explored the effects of uninterrupted sitting on cognitive function. First, we introduce how prolonged sitting increases the risks of hyperglycemia, autonomic stability, inflammation, adverse hormonal changes and restrictions in cerebral blood flow (CBF) and alters cognitive function. Second, we elucidate the direct and indirect effects of breaking up prolonged sitting time that may prevent a decline in cognitive performance by influencing glycaemic variability, autonomic stability, hormones (brain derived neurotrophic factor, dopamine, serotonin), vascular functions, and CBF. We highlight the importance of breaking up prolonged sitting on metabolic, vascular and endocrine functions, which in turn may improve cognitive functions and eventually foster work productivity. Improved synaptic transmission or neuroplasticity due to increased brain glucose and mitochondrial metabolism, increased endothelial shear and CBF, increased brain neurotrophic factors (dopamine) and accelerated anti-inflammatory functions are some of the hypothetical mechanisms underpinning improved cognitive functions.

Conclusion

We postulate that improving cognitive function by breaking up prolonged sitting periods is biologically plausible with the myriad of (suggested) physiological mechanisms. Future experimental studies to ascertain the aforementioned hypothetical mechanisms and clinical trials to break sedentary behavior and improve cognitive functions in sedentary office workers are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04136-5.

Infrared thermography of the crânio-cervico-mandibular complex in wind and string instrumentalists

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.

[Influence of posture in musicians. A literature review]

Playing-related musculoskeletal disorders represent a commitment to the health and competence of musicians. This review aimed to analyse how musician's posture influences instrumental practice and the appearance of musculoskeletal disorders related to musical performance. To do this, a literature search was carried out in the Medline, CINAHL and Web of Science, and Pubmed databases, obtaining 14 valid articles after application of the inclusion and exclusion criteria. Several authors analysed posture during instrumental practice, posture and interpretive quality, and the appearance of musculoskeletal disorders related to musical performance and postural quality, based on distinct variables such as the instrument and interpretive anxiety. Posture seems to be one of the most important risk factors, influencing both musculoskeletal and interpretive levels. Physiotherapy could be effective for prevention and treatment.

The influence of power posing on cardiac vagal activity

The effects of power posing on hormonal reactions such as testosterone and cortisol have been widely investigated, however, its effects on the autonomic nervous system are rather unknown. Consequently, the aim of this study was to investigate the influence of power posing on cardiac vagal activity (CVA), as indexed by heart rate variability. It was hypothesized that high power poses (HPP) would increase CVA, whereas low power poses (LPP) would decrease CVA, given power posing is expected to decrease stress. Participants (N = 56) performed a total of four power poses, a combination of two power conditions (high vs. low) and two body positions (sitting vs. standing) for 1 min each, in a randomized order. In addition, for each power pose participants were given a role description. Contrary to our hypothesis, CVA decreased significantly during HPP in comparison to the resting measures before and after HPP, and CVA did not change during LPP. Moreover, while holding the power pose, CVA was higher in the LPP than in the HPP condition. Regarding subjective measures our hypotheses were confirmed, felt power was significantly higher after HPP than after LPP. Additionally, perceived stress was higher after LPP than after HPP. Taken together, these results suggest that the immediate impact of PP on the autonomic nervous system is more likely to influence a higher state of activation within the body instead of increasing resources to cope with stress as indexed by CVA, which may be seen only on a more long-term basis.

Use of accelerometers for automatic regional chest movement recognition during tidal breathing in healthy subjects

Recognition of breathing patterns helps clinicians to understand acute and chronic adaptations during exercise and pathological conditions. Wearable technologies combined with a proper data analysis provide a low cost option to monitor chest and abdominal wall movements. Here we set out to determine the feasibility of using accelerometry and machine learning to detect chest-abdominal wall movement patterns during tidal breathing. Furthermore, we determined the accelerometer positions included in the clusters, considering principal component domains. Eleven healthy participants (age: 21 ± 0.2 y, BMI: 23.4 ± 0.7 kg/m², FEV₁: 4.1 ± 0.3 L, VO₂: 4.6 ± 0.2 mL/min kg) were included in this cross-sectional study. Spirometry and ergospirometry assessments were performed with participants seated with 13 accelerometers placed over the thorax. Data collection lasted 10  min. Following signal pre-processing, principal components and clustering analyses were performed. The Euclidean distances in respect to centroids were compared between the clusters (p < 0.05), identifying two clusters (p < 0.001). The first cluster included sensors located at the right and left second rib midline, body of sternum, left fourth rib midline, right and left second thoracic vertebra midline, and fifth thoracic vertebra. The second cluster included sensors at the fourth right rib midline, right and left seventh ribs, abdomen at linea alba, and right and left tenth thoracic vertebra midline. Costal-superior and costal-abdominal patterns were also recognized. We conclude that accelerometers placed on the chest and abdominal wall permit the identification of two clusters of movements regarding respiration biomechanics.

Does peak expiratory flow measured sitting differ from that measured standing? A cross-over study in primary care in Barbados

Background

Several authorities recommend measuring peak expiratory flow (PEF) standing. Limited evidence suggests that PEF obtained sitting is similar in magnitude but there are no studies in African populations.

Aim

To determine in adults aged 18–60 years if PEF measured sitting differs from that measured standing.

Design & setting

Crossover design with alternating position of initial measurement in people attending primary care clinics in Barbados.

Method

Quota sampling by age, sex, and clinic of adults aged 18–60 years was done and an interviewer-administered questionnaire was completed. PEF sitting and standing was measured with an European Union (EU) scale Mini-Wright® meter. The highest of three readings in each position was used and the difference in means tested for significance using the paired sample t-test.

Results

Characteristics of the 199 participants were 44% male; 96.5% of African descent; mean age 37 years (standard deviation [SD] 12.8); 22% with an asthma diagnosis; 23% tobacco users; and 22% marijuana users. Mean PEF standing was 438.4 versus 429.7 lmin^–1 sitting, mean difference 8.7 (95% confidence interval [CI] = 3.6 to 13.8). For men, mean PEF standing was 518.7 versus 506.3 lmin^–1 sitting, mean difference 12.4 (95% CI = 3.3 to 21.5). For women, mean PEF was 374.7 standing versus 368.9 lmin^–1 sitting, mean difference 5.8 (95% CI = 0.11 to 11.5). A Bland-Altman plot accounting for trend and a Lin’s correlation coefficient of 0.935 demonstrated good agreement between standing and sitting PEF.

Conclusion

PEF measurements are reduced when performed sitting compared to standing. The difference is small and unlikely to alter clinical management in most cases.

Duchenne muscular dystrophy with platypnea-orthodeoxia from Chilaiditi syndrome

INTRODUCTION

Chilaiditi syndrome is a rare pathophysiology in which the colon or other organs are interposed between the diaphragm and liver, and respiratory or digestive symptoms sometimes manifest. Although there have been some cases of Chilaiditi syndrome complicating neuromuscular disorders, none have described resulting respiratory or digestive symptoms.

CASE PRESENTATION

Our patient was a 20-year-old man with DMD who had been receiving noninvasive positive-pressure ventilation during the night. He experienced respiratory distress when changing from a supine to sitting position. Ventilator adjustment did not relieve the respiratory distress. Abdominal computed tomography revealed marked constipation and interposition of the transverse colon between the diaphragm and liver, indicating Chilaiditi syndrome. The right side of the diaphragm was elevated by the interposed transverse colon when the respiratory distress was present on chest radiograph, but not when symptoms were absent. The patient was diagnosed with platypnea-orthodeoxia attributed to Chilaiditi syndrome. The respiratory distress was improved by the relief of constipation, in addition to the usage of the ventilator throughout the day.

CONCLUSION

The rare symptoms and pathophysiology of DMD complicated by Chilaiditi syndrome are reported and discussed herein.