Table 3.
Characteristics and results of the included studies, cross-sectional studies
| Author (year) | Population | Cases (n) | Control (n) | Exposure | Outcomes | Results | QA (x/16 points) |
|---|---|---|---|---|---|---|---|
| Abréu-Ramos and Micheo (2007) | Orchestra musicians “Puerto Rico Symphony Orchestra”, Puerto Rico | 75 | – | Instrument playing (plus instrument group, gender, age) | “MSKPs” (musculoskeletal problems) that affect playing | Lifetime prevalence MSKPs 81% (female 87,5% vs. male 97.7%); most common back pain (75%); most common in lower strings (93%) and percussionists (100%), in younger (22–29 years, 83%) and older (50–61 years, 91%) populations; female sex, age, instrument played are risk factors | − 3 |
| Ackermann and Adams (2003) | Violinists and violists (students and orchestra musicians), Australia | 32 | – | Instrument playing (plus anthropometric measurements [length and ROM]) | “Performance-related pain”: pain in different body sites related to playing | Lifetime prevalence “Performance-related pain” 88%, most common left upper extremity (69%), thoracic spine (63%), right upper extremity (53%) and cervical spine (44%); 4 greater ROM of the left hand compared with the right; left hand anthropometrics are not related to pain but anthropometrics of the right arm seems to be a risk factor | − 5 |
| Ackermann et al. (2011) | Collegiate flute players, “Sydney Conservatorium of Music”, Australia | 20 | – | Flute playing | “PRMDs” (performance-related musculoskeletal disorders): prevalence and characteristics | Lifetime prevalence of 43 different PRMDs 95%, (37% lasting < 3 months, 63%, lasting for > 3 months), most common location: upper extremity; most common symptom: pain | − 9 |
| Amorim and Jorge (2016) | Violinists (professional and students in higher education training), Portugal | 93 | – | Violin playing | “TMD” (temporomandibular disorder) in relation to MPA level, instrument practice time, chinrest type, gender and age | Prevalence TMD 58% (n = 50), slightly higher in females (55% vs. 53%), younger players aged ≤ 30 yrs. (61% vs. 55%), musicians with < 20-year experience (55% vs. 52%), practice < 22 h/week (54% vs. 53%) over the tailpiece chinrest model (57% vs. 50% in Dresden chinrest and 44% other models); risk factor: association between the prevalence of TMD and high MPA levels (p < 0.001), the most anxious violinists 6 times (95% CI 2.51–15.33; p < 0.001) more likely to report TMD symptoms vs. least anxious violinists | 3 |
| Arnason et al. (2014) | Music students (classical vs. rhythmic music), Iceland | 74 | – | Instrument playing (plus classical vs. rhythmic music, instrument group, gender) | “PRMD” (playing-related musculoskeletal disorder): prevalence and severity of musculoskeletal disorders | Lifetime prevalence PRMD 62% (70% classical vs. 39% rhythmic music; 61% in female, 39% in male, n.s. differences between instrument groups); prevalence PRMD last 7 days 40% (n.s. differences classical vs. rhythmic music) | − 7 |
| Barton et al. (2008) | Music students, USA | 97 | – | Instrument playing (plus gender, instrument group) | “Physical symptoms”, disabilities by DASH; pain in any location | Average DASH score per person 6.62/100 (SD 8.69; range 0.0–45.0) f 8.58, m 4.67); strings higher mean DASH score than brass (mean difference = 7.98, p < 0.01) and woodwinds (mean difference = 6.50, p < 0.01); 65% current pain, (stat. sign. more f, sign diff. between instrument groups) | − 5 |
| Berque et al. (2016) | Permanently employed classical orchestra musicians from 3 orchestras, Scotland | 101 | – | Instrument playing (plus gender, age, instrument group, playing professionally in an orchestra) | “PRMPs” (playing-related musculoskeletal problems), pain intensity and pain interference on function and psychosocial variables by Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) | Prevalence PRMPs: lifetime 77.2%, 12 months 45.5%, point prevalence 36.6%, among PRMP 43% pain in ≥ 3 locations, most commonly the right upper limb, neck, left forearm and elbow, variations between instrument group; mean pain intensity in musicians with PRMP 12.4 ± 7.63 (out of 40), mean pain interference score 15.2 ± 12.39 (out of 50), increasing with the number of reported pain locations (p = 0.044); mean age in musicians with PRMP almost 5 yrs. older vs. non-PRMP (p = 0.029), average number of years of playing professionally in an orchestra with musicians with PRMP having almost 5 yrs. more vs. non-PRMP (p = 0.046) | 3 |
| Blackie et al. (1999) | Piano students, USA | 16 | – | Piano playing | Playing-related “injuries”/overuse: incidence, i.a. | Prevalence 93%, 27 playing-related injuries reported (66% in hand and wrist, among them 21% pain or discomfort impairs activities other than piano) | − 5 |
| Chan et al. (2013) | Orchestra musicians (symphony orchestra), Australia | 83 | – | Instrument playing | Musculoskeletal “injuries” incl. “PRMDs” (performance-related musculoskeletal disorders), i.a. | 99 consultations (83 individuals) among them 66% of injuries classified PRMDs (26% acute, 46% chronic recurring, 28% chronic; 93% currently affect playing, 94% preventable); most common locations shoulder (22%), neck (18%), upper back (18%), hand (8%) | − 11 |
| Crnivec (2004) | Orchestra musicians “Slovene Philharmonic Orchestra” vs. marketing-workers “Philip Morris Enterprise”, Slovenia | 70 | 28 | Instrument playing | “Performance-related musculoskeletal disorders”, i.a. | Musculoskeletal disorders most common health impairment of musicians, almost 6 times higher than control group (147 vs. 25), most high in double bass and cello players | − 9 |
| Cruder et al. (2017) | Music students at conservatories, Switzerland and UK | 158 | – | Instrument playing, instrument playing in symmetric playing position (SPP), asymmetric playing position (APP) and singing/voice | “Pain location and pain extent”, prevalence of pain according to SPP vs. APP vs. voice; pain intensity in any location (digital pain drawings); disabilities of the arm, shoulder, hand | Prevalence of pain 79.7% (n = 126) musicians, similar prevalence in musicians with SPP (75%, n = 56) and APP (78,2%, n = 78), highest prevalence in singers (95,8%, n = 24), higher prevalence in the neck and shoulders, lower back and the right arm; mean percentage of pain extent 3.1% ± 6.5%; mean QD and optional QD performing arts module score higher for musicians with pain vs. no pain (p < 0.001); positive correlation between the QD score and pain extent ((p ≤ 0.001), mean number of practice hours lower for people with pain (p = 0.002) | 1 |
| Davies and Mangion (2002) | Musicians (classical and non-classical), Australia | 240 | – | Making music (plus gender, years playing, instrument group, ergonomic problems, warm-up, rest-break provision, playing load, noise disturbance, playing-related stressors, health status, exercise behavior, playing-related muscle tension, preventive behaviors, training in prevention) | “Playing-related musculoskeletal pain and symptoms”: prevalence and severity | Lifetime prevalence: 51% with occasional recurrences; 22% with regular recurrences, 8% with permanent complaints, 7% without recurrence; 7% never had playing-related musculoskeletal pain and symptoms; positive risk factor string instrument, fewer years of playing, high muscle tension, high stress, association with frequent preventive behaviors | − 7 |
| De Smet et al. (1998) | Pianists vs. volunteers, Belgium | 66 | 66 | Piano playing (plus hypermobility, hand size, playing habits and sports activity) | “Overuse syndrome” (musculoskeletal disorders of upper extremity) | Prevalence 45% in pianists vs. 8–12% in controls; wrist most common localization in pianists; risk factors: n.s. difference between pianists with or without overuse syndrome regarding playing habits, sports activity, hypermobility; hand size sign. height in male pianists without overuse syndrome | − 11 |
| Eller et al. (1992) | Instrumentalists and opera singers “Royal Theatre”, Denmark | 91/51 | – | Making music (plus instrument playing vs. singing) | Symptoms from the musculoskeletal system, i.a. | Prevalence of symptoms equal in both groups, instrumentalists stat. sign. more symptoms upper extremity (OR 3.1, 95% CI 1.0–9.5, p = 0.047), but less in articulations of lower extremity (OR 0.2, 95% CI 0.07–0.61, p < 0.005); n.s. difference in low back pain | 1 |
| Engquist et al. (2004) | Orchestra musicians vs. actors, Sweden | 103 | 106 | Instrument playing (plus instrument group, gender, age) | “Musculoskeletal pain”: prevalence and intensity, VAS (0–20) | Point prevalence pain 61% vs.71% (OR 0.6); 12-month prevalence chronic pain 47% vs. 51% (OR 1); neck and shoulder most common, strings most often; no group difference regarding intensity of pain or risk factor gender | − 5 |
| Gasenzer et al. (2017) | Orchestra musicians, 132 German cultural orchestras, Germany | 740 | – | Making music | “Chronic pain”: prevalence; degree of impairment, pain locations per instrument group, i.a. | Prevalence 66% (n = 490) current or recurring pain, 64% (n = 470) continuous pain or pain > 3 months, most frequent in back (70%), shoulders (68%), neck (64%), hands and wrists (40%); 27% pain with high degree of impairment (Korff scale); risk factor high strings highest rate in chronic shoulder pain i.a.; mean pain maximal intensity 6.0 (SD ± 2.4) | − 5 |
| Fjellmann-Wiklund et al. (2003) | Music teachers, Sweden | 208 | – | Employed music teachers (plus Physical activity during leisure time, perceived health, physical work environment, psychosocial work environment) | “Musculoskeletal discomfort in the neck–shoulder region”: prevalence, SNQ | 12-month prevalence 82%, most common neck (59%), shoulder (55%), lower back (45%); risk factor female stat. sign. more symptoms in neck, shoulder, upper back; in female: strongest risk factors associated with neck–shoulder discomfort: high psychological demands (OR 6.0, CI 1.1–32.4), teaching many schools (OR 4.8, CI 1.0–24.4); in male: lifting (OR 8.7, CI 2.1–34.8), playing the guitar (OR 6.0, CI 1.5–23.6), low social support (OR 3.1, CI 1.0–9.7) | 5 |
| Fotiadis et al. (2013) | Orchestra musicians (symphonic orchestra) “Athens and Thessaloniki State Symphony Orchestra”, Greece | 147 | – | Instrument playing (plus gender, age, instrument group, daily instrument practice) | “Musculoskeletal disorders”: prevalence | Lifetime prevalence 82%, 66% with considerable influence on performing ability; risk factors: neck/shoulder in female stat. sign. more frequent; shoulder in string instrumentalists stat. sign. More frequent than in brass/woodwind instrumentalists; wrist/hand in musicians > 60 years. stat. sign. more frequent, hours of practice per day is a criterion for occurrence of musculoskeletal disorders | 1 |
| Fry (1986) | Orchestra musicians, Australia, USA, England | 485 | – | Instrument playing | “Overuse syndrome”: pain and prevalence with severity | Prevalence 64%, most common localization hand/wrist (41%), neck (38%), shoulder (35%) and LWS (26%) | − 9 |
| Gohl et al. (2006) | University pianists “Belmont University School of Music” and “Vanderbilt University Blair School of Music”, USA | 19 | – | Piano studies | “Median and ulnar neuropathies” in either upper extremity | Prevalence 16% electrodiagnostic evidence of early median neuropathy at or distal to the wrist, no further signs of neuropathy | − 1 |
| Heikkilä et al. (2012) | Orchestra musicians “Sinfonia Lahti” and “The Finnish Radio Symphony Orchestra”, Finland | 73 | – | Instrument playing (plus instrument group, age, gender, stress, night bruxism, day bruxism, sleep disturbances, physical exercise) | “Symptoms of TMDs and facial pain” | 1-month prevalence 56%; no difference in instrument groups; risk factors: sleep disturbances and night bruxism seem to increase TMD’s, TMDs diminish with age | 3 |
| Heredia et al. (2014) | Pop-musicians “Orquesta Buena Vista Social Club and Supporting Bands”, Kuba | 36 | – | Making music | “Musculoskeletal conditions” | 12-month prevalence 37% | − 9 |
| Hodapp et al. (2009) | Orchestra musicians (opera and symphonic orchestra vs. amateur orchestra), Germany | 122 | 28 | Instrument playing (plus professional vs. amateur musicians, work complexity, working conditions, scope of action, social stressors, number of performances and rehearsals, i.a.) | “Bodily complaints” including musculoskeletal complaints, i.a. | Prevalence musculoskeletal complaints more in professional musicians than in amateurs (M 5.24, SD 4.76 vs. M 2.71, SD = 2.21; p < 0.001); risk factors work stressors and number of performances correlate pos. with musculoskeletal complaints | − 5 |
| Kaufman-Cohen and Ratzon (2011) | Orchestra musicians (string and wind players), Israel | 59 | – | Instrument playing (plus biomechanical, environmental, psychosocial and personal risk factors, individual playing characteristics) | “PRMD” (playing-related musculoskeletal disorders): musculoskeletal pain and functional impairment during last years, severity, SNQ, DASH, RULA | 12-month prevalence PRMPD min. 1 body region 83%, > 1 body region 73%; biomechanical and postural loading, instrument weight, risk factors perceived physical environment, average playing hours per week, gender and warm-up’s correlate with PRMDs | 5 |
| Kim et al. (2012) | Traditional Korean string instrument players, Korea | 86 | – | Instrument playing (plus type of instrument, age, height, weight, BMI, years of career, gender, practice habits, exercise intensity, hobby styles, drinking and smoking habits, stretching) | “PRMDs” (playing-related musculoskeletal disorders): musculoskeletal disorders | Prevalence each > 50% in forearm, neck, back, shoulder, upper arm, wrist and knee; risk factors: various stat. sign. correlations between demographic variables and musculoskeletal disorders depending on type of instrument | − 7 |
| Ackermann et al. (2012) | Orchestra musicians, Australia | 377 | – | Instrument playing (plus instrument group) | “PRMDs” (performance-related musculoskeletal disorders, performance-related musculoskeletal pain disorders), musculoskeletal disorders | Lifetime prevalence 84%, point prevalence 50%, most common localization: lower back (14.1%), upper back (11.7%) and shoulder/upper arm (11.1%); localization varies according to instrument group | 1 |
| Kenny and Ackermann (2015) | Instrument playing (plus gender, age, depression, performance anxiety, social phobia) | Lifetime prevalence 84%, point prevalence 50%, risk factor: female, positive correlation between performance anxiety and intensity of PRMD and between depression and intensity PRMD | |||||
| Kenny et al. (2016) | Orchestra musicians, Australia | 378 | – | Instrument playing in different orchestra types: pit, stage and combined stage and pit | “PRMDs” (performance-related musculoskeletal disorders), “physical and mental health indicators”, VAS pain, i.a. | Lifetime prevalence pain or injuries caused by playing 81–95%, lifetime prevalence pain or injuries interfering with playing 85–90%, point prevalence pain or injury 46–56%, n.s. difference between 3 types of orchestras regarding lifetime or point prevalence of PRMD; 42% pit, 23% stage and 28% stage/pit musicians had time off work due to physical pain or injury last 18 months, n.s. difference in number of days taken | − 1 |
| Kochem and Silva (2017) | Violinists, Brazil | 106 | – | Instrument playing | “PRMDs” (playing-related musculoskeletal disorders): prevalence by SNQ last 12 months and last 7 days, associated factors, disabilities by DASH |
12-month prevalence: 87%, 1-week prevalence 77%, prevalence of PRMDs responsible for the temporary interruption of musical activity: 8%; most frequently affected in both time periods neck, thoracic area, right and left shoulders, left wrist/hand Prevalence > 50% for dysfunctional upper limbs according to the DASH optional module; mean DASH score 10.6 points (SD 8.6), optional DASH music module mean score of 17.6 points (19.8) Risk factors: women more likely PRMDs (OR 4.4, CI 1.9–10.0, p < 0.001); older musicians more likely pain in last 7 days (OR 3.3, CI 5.1–10.97; p = 0.04) and higher scores on DASH (OR 1.8, CI 1.1–3.1; p = 0.01); also associated with PRMD: body mass index, practice hours per week, final DASH score, i.a. |
3 |
| Kok et al. (2015) | Music students vs. medical students, Netherlands | 83 | 494 | Studying music (plus instrument group) | “CANS” (complaints of arm, neck, and/or shoulder not caused by a systemic disease or acute trauma) and gender | Point prevalence in music students vs. medical students (47% vs. 18%, p < 0.001), 12-month prevalence in music students vs. medical students (81% vs 42%, p < 0.001), chronic CANS in music students vs. medical students (36% vs. 10%, p < 0.001); music students: more complaints per anatomic localization and more localizations, music students more severe influence of CANS on daily functioning (5.0 vs. 3.1, p < 0.001); most common neck in 46% music students and 27% medical students (p = 0.001); risk factor: higher prevalence of CANS in female music students vs. male music students (84% vs. 71%, p = 0.212), higher prevalence of CANS in bachelor’s students vs. master’s students (85% vs. 55%, p = 0.018) | − 1 |
| Kok et al. (2013) | “Musculoskeletal complaints” |
Point prevalence in music students vs. medical students (63% vs. 43%, p = 0.001, OR 2.25); 12-month prevalence in music students vs. medical students (89% vs. 78%, p = 0.019, OR 2.33); in total more complaints in upper body half |
− 1 | ||||
| Kovero and Könönen (1995) | Violinists and violists “Helsinki Philharmonic Orchestra” vs. patients of Institute of Dentistry, University of Helsiki, Finland | 26 | 26 | Professional playing violine or viola, weekly playing time | “Signs and symptoms of TMD” or radiological abnormalities in the temporomandibular condyles | Frequency of temporomandibular pain 27% (musicians); musicians have more signs (but not symptoms or radiological abnormalities) of TMD than controls; pos. correlation between weekly playing time and symptoms of TMD, i.a. | − 7 |
| Leaver et al. (2011) | Orchestra musicians (symphonic orchestra), England | 243 | – | Instrument playing (plus physical activities at work, psychosocial factors of working environment, performance anxiety, instrument group, mental health, smoking, age, gender) | “Musculoskeletal pain”: prevalence and impact, relation to playing conditions, including instrument category, i.a. |
12-month prevalence of regional pain 86%, impairing pain 41%, 1-month prevalence of regional pain 71%; risk factors: positive correlation with high somatizing scores (OR 2.5) and female gender; no correlation with performance anxiety; variation of disorders according to instrument group |
5 |
| Lima et al. (2015) | Orchestra violinists, Belo Horizonte, Brazil | 18/33 | – | Instrument playing | “Functional disorders of the musculoskeletal systems”; VAS pain, BPSF | Prevalence of muscular pain 78%(n = 14) of muscular fatigue 33% (n = 6), prevalence of reported diagnoses by participants (n = 15 respondents): tendinitis in the upper extremity 28% (n = 5), pain cervical spine 17% (n = 3), back pain 17% (n = 3) i.a., VAS pain (0–10): average 5.6; Prevalence according to Wisconsin’s Pain Inventory (short form) pain in: lumbar spine 24% (n = 8); shoulders 21% (n = 7), forearms and hands 18% (n = 6); cervical spine 12% (n = 4); legs and feet 6% (n = 2); and headaches 6% (n = 2); prevalence of pain interfering with work (scale of 0–10): average rating of 7.1 (median 8.0) | − 9 |
| Logue et al. (2005) | Cello students “Belmont University School of Music” and “Vanderbilt University Blair School of Music”, USA | 14 | – | Cello studies | “Median and ulnar neuropathies”: prevalence, either upper extremity, physical examination, EMG | No evidence of median or ulnar neuropathy | 1 |
| Marques et al. (2003) | Guitarists (participants of classes about prevention of overuse), Spain | 64 | _ | Guitar playing, classical guitar vs. flamenco guitar | “Overuse syndrome”: prevalence | Point prevalence 75%, classic guitarists vs. flamenco guitarists: 66% vs. 88% | − 5 |
| Fishbein et al. (1988) | Orchestra musicians, USA | 2212 | – | Instrument playing | “Musculoskeletal problem”, i.a. | Prevalence (all localizations) 82%, most common localizations: shoulder (20%), neck (22%) and lower back (22%) | − 7 |
| Middlestadt and Fishbein (1988) | Instrument playing (plus perceived occupational stress) | Risk factor: significant relationship between number of musculoskeletal problems and perceived occupational stress | |||||
| Middlestadt (1990) | Orchestra musicians, USA | 2212 | – | Instrument playing (plus gender) | “Musculoskeletal problem”, i.a. | Prevalence (all localizations) 82%, prevalence of severe reported musculoskeletal disorders: 59% (risk factor female vs. male 70% vs. 54%) | − 7 |
| Middlestadt and Fishbein (1989) | Orchestra musicians: subgroup string players, USA | 1378 | – | Instrument playing (plus instrument group) | Prevalence of severe reported musculoskeletal problems: 66% in string players (compared to woodwind players with 48% and brass players with 32%), most common shoulder, neck and lower back; risk factor sting playing: prevalence stat. sign. higher in females vs. males | ||
| Miller et al. (2002) | Music students “Royal Northern College of Music” (string players, keyboard players) vs. nonmusicians from various hospital departments, England | 92 | 64 | Instrument playing (plus previous injury, years at college, instrument group, years playing an instrument, duration of practice periods, age, gender, various anthropometric parameters, i.a. | “Upper limb pain and dysfunction”, anatomical abnormalities | Prevalence: music students five times more likely for upper limb pain; risk factor previous injuries, years at college, instrument group, years studying instrument and practice period stat. sign. correlate with upper limb pain; anatomical abnormalities (and variations) 72% vs. 59% (n.s.) | − 5 |
| Mishra et al. (2013) | Indian tabla players, India | 85 | – | Tabla playing (folded-knee sitting posture) | “PRMDs” (playing-related musculoskeletal disorders): prevalence by NMQ | Prevalence in low back 73%, right shoulder 60%, neck 54%, left shoulder 51%, upper back 45%, right knee 45%, left knee 46%, VAS scores (no scale reported) for intensity of discomfort in different body parts 3.42 (low back) to 1.63 (right knee) | − 7 |
| Molsberger (1991) | Orchestra musicians “Deutsche Oper Berlin” and “Düsseldorfer Symphoniker”, Germany | 100 | – | Instrument playing | “Disorders of the locomotor apparatus”, i.a. | Prevalence 75%, most common: neck 35%, other parts of spinal column 16%; average disease duration 61.3 months, prevalence of impairing disorders: 45%. | − 7 |
| Monaco et al. (2012) | Orchestra musicians “Teatro dell’ Opera”, Italia | 65 | – | Instrument playing | “PRMDs” (playing-related musculoskeletal disorders), DASH | Prevalence musculoskeletal disorders in daily life (defined as ≥ 15 points in DASHi) 28%, prevalence complaints during playing 51% (DASH additional module) | − 9 |
| Moore et al. (2008) | Music students (upper string players) vs. control group, USA | 10 | 18 | Instrument playing (plus years instrument played, weekly playing time, rest time, shoulder assessment data) | “Predisposing factors for shoulder impingement syndrome” (Signs and symptoms of shoulder impingement) | Prevalence of pain while playing 70%, most common shoulders (left 50%, right 30%) and neck (left 40%, right 20%). 30% shoulder impingement vs. 0% in controls (stat. sign. correlation); risk factors: n.s. correlation with years instrument played, weekly playing time, rest time, shoulder assessment data) | − 1 |
| Navia Alvarez et al. (2007) | Orchestra musicians, Spain | 48 | – | Instrument playing | “Neck pain syndrome”: prevalence | Lifetime prevalence neck pain 69%, 12-month prevalence 63%; prevalence last 7 days 27%; lifetime prevalence tingling in upper extremity 44%, lifetime prevalence loss of sensation or force 40%; most important risk factor: labor stress, no clear relation between instrument played and the years of professional activity, neither with the sex or age | − 9 |
| Nyman et al. (2007) | Orchestra musicians, Sweden | 235 | – | Instrument playing with elevated arm position and daily playing time | “Neck–shoulder pain” | Point prevalence 26% in whole population; risk factors: neutral arm position, < 2 h per workday’: 9% vs. ‘neutral arm position, > 3 h per workday’: 19%; ‘elevated arm position, < 2 h per workday”: 30% vs. “elevated arm position, > 3 h per workday”: 35%; higher odds for subjects with neck/shoulder pain in the groups “elevated arm position, < 2 h per workday” [OR 4.15 (1.30–13.22)], and “elevated arm position, > 3 h per workday” [OR 5.35 (1.96–14.62)] compared to the group “neutral arm position, < 2 h per workday” | 5 |
| Paarup et al. (2011) | Orchestra musicians (symphonic orchestra) vs. representative sample from the Danish workforce from The Danish Working Environ- ment Cohort, Denmark | 342 | 5436 | Instrument playing (plus instrument group, gender) | “Perceived musculoskeletal symptoms”: prevalence | 12-month prevalence for disorders in min. 1 region: female 97% and male: 83% (OR 6.5), risk factor: woodwind players stat. sign. lower risk than upper string players; symptoms more frequent and lasted longer in musicians than in general workforce | 3 |
| Papandreou and Vervainioti (2010) | Percussionists (in active musical activity and students), Greece | 30 | – | Instrument playing (plus age, main musical activity [student, orchestra musicians, music teacher, solist], practice hours) | “Musculoskeletal disorders” | Prevalence 32% in upper extremities, 20% in vertebral column | − 3 |
| Raymond et al. (2012) | Classical orchestra musicians, USA | 32 | – | Instrument playing | “Occupational injury and illness”, i.a. musculoskeletal disorders | Lifetime prevalence: pain or stiffness in shoulders 94%, pain or stiffness in neck 91%, numbness and tingling in hand or arms 81%, low back pain 63%; Lifetime prevalence of diagnosed most common disorders: tendinitis 47%, musculoskeletal disorder 22%, carpal tunnel syndrome 16% | − 7 |
| Rein et al. (2010) | Organists and pianists vs. controls with no work-related increased use of their feet, Germany | 30/30 | 30 | Instrument playing | “Work-related influences on functional ankle stability” | Organists have neither increased functional ankle stability nor increased ROM of their ankle joints in comparison to controls; Pianists have increased flexion of the ankle joint on both sides in comparison to organists and on the right side in comparison to controls | − 3 |
| Rickert et al. (2012) | Cellists (orchestra musicians vs. students), Australia | 47/25 | Cello playing (plus playing habits, lifestyle factors and gender) | Right “shoulder injury levels and causes”: frequency and severity of reported “PRMDs”; physical data on shoulder strength, ROM and signs of injury | Mean age students 19 years (17–26), orchestras 42 years (24–63); 18-month prevalence of reported disorders 89% (orchestra) vs. 56% (students); disorders right shoulder 42% (orchestra) vs. 20% (students); risk factor: prevalence PRMDs stat. sign. higher in female | 1 | |
| Sakai (2002) | Pianists and piano students, seeking orthopedic consultation with the author, Japan | 200 | – | Piano playing | Differential diagnoses of “hand pain” due to “overuse”, cause of overuse (keyboard technique at the time of the onset, practice time) | Tenosynovitis and tendinitis (n = 56), enthesopathy (n = 49), muscle pain (n = 38), finger joint pain (n = 22), cubital tunnel syndrome (n = 8), carpal tunnel syndrome (n = 2), neck and scapular pain (n = 7), focal dystonia (n = 18); octaves and chords 74% of techniques practiced at onset; time of piano playing day before pain 3.7 (range 2–13) hours | − 13 |
| Schäcke et al. (1986) | Orchestra musicians (opera orchestra), Germany | 109 | – | Instrument playing (plus age and years playing) | “Musculoskeletal complaints” | Prevalence neck pain 65% (among them 40% muscle tension), low back pain 44% (among them 24% muscle tension), thoracic spine pain 22%, complaints in shoulder and arm 18%; risk factors: musicians with musculoskeletal complaints are older (46 ± 10 years vs. 37 ± 8 years) and have more years playing (23 ± 10 vs. 14 ± 8 years) than musicians without musculoskeletal complaints | − 9 |
| Shields and Dockrell (2000) | Piano students, Ireland | 159 | – | Piano playing (plus practice time per day and week, gender) | “Playing-related injuries”, interrupting playing > 48 h | Lifetime prevalence 26% (among them 37% at the wrist and 15% at the fingers; most common symptom was pain with 98%), point prevalence 7%, risk factors: n.s. difference in playing time or gender | − 1 |
| Sousa et al. (2016, 2017) | Professional orchestra musicians, 3 orchestras, Portugal | 112 | – | Instrument playing, instrument group: wind instrument vs. string instrument | “PRMDs” (playing-related musculoskeletal disorders) | Point prevalence 62.5% (among them: shoulder 27%, cervical 27% and lumbar region 24%; risk factors: string players more frequently affected by PRMDs (67.6% vs. 54.1%), pain intensity n.s. higher in wind players than in string players, pain in instrument groups listed | − 3 |
| Stanhope et al. (2014) | Woodwind students, Australia | 14 | – | Woodwind playing | “PRI” (playing-related injuries): musculoskeletal symptoms, that prevent musicians from playing at their normal level | Lifetime prevalence 62% (n = 8) (back and upper extremity most common), point prevalence 38% (neck/shoulder and upper extremity most common) | − 5 |
| Steinmetz et al. (2007, 2012) | Music students vs. pedagogy students, Germany | 36 | 19 | Music studying | “PRMD” (playing-related musculoskeletal disorders): pain and discomfort playing the instrument and musculoskeletal dysfunctions | Lifetime prevalence PRMD 81% (music students), point prevalence pain (pain during examination) 0%, in physical examination more musculoskeletal dysfunctions in music students (8.39/person vs. 4.37/person) | − 3 |
| Steinmetz et al. (2003, 2006) | Violinists, Germany | 31 | – | Signs and symptoms of craniomandibular dysfunction (CMD), muscular load masticatory and neck muscles with and without occlusal splints | Muscular load masticatory and neck muscles during violin playing (supposed to be a cause/predictor of overuse syndrome) via surface EMG with and without occlusal splints, frequency of CMD, overuse syndrome measured via questionnaire | Lifetime prevalence pain during violin playing 81%, overuse syndrome 74%, prevalence pain (in period around examination) 39%, point prevalence pain (pain during examination) 0%; oral splints decrease stat. sign. the muscular load (p ≤ 0.001 for masseter; p ≤ 0.01 for temporalis and sternocleidomastoid muscles; and p ≤ 0.1 for trapezius muscle, n.s. decrease in extensor muscles) | − 9 |
| Steinmetz et al. (2014) | Classic orchestra musicians, Germany | 408 | – | Instrument playing according to instrument group (plus symptoms of CMD) | “CMD”: frequency and its association with musculoskeletal pain | 3-month prevalence playing-related pain in teeth or jaw 19–47% and in TMG pain in 15–34%, point prevalence pain in the face indicating a painful CMD 6–10%, violin players highest prevalence of all CMD symptoms; musicians reporting with orofacial pain are 4.8 times more likely to report musculoskeletal pain in other localizations | − 1 |
| Steinmetz et al. (2015) | Classic orchestra musicians, Germany | 408 | – | Instrument playing according to instrument group | “Playing-related musculoskeletal pain”: Frequency and intensity (NRS), with regard to instrument | Lifetime prevalence 90% (pain in neck/cervical spine 73%, left shoulder 55%, left wrist 55%, right shoulder 52% and lumbar spine 51%), mean pain intensity 3.7 (SD 1.95), 3-month prevalence 63%, point prevalence 9%; risk factor female gender and stage fright were proven to be predictors for musculoskeletal pain | − 1 |
| Steinmetz et al. (2016) | 1. Music students and professional violin and viola players violin/viola players with neck pain vs. 2. music students and professional violin/viola players without neck pain vs. 3. pain-free non-musicians, Germany | 12 vs. 21 | 21 | Instrument playing | “Flexor muscle behavior in violin/viola players with and without neck pain”, pain VAS (0–10 cm), disability NDI, PSFS, EMG i.a. | Pain intensity in violinists with pain 5.1 (SD 2.5), disability (NDI) group 1: 24.7 (SD 4.7), group 2: 5.3 (SD 5.4), group 3 1.9 (SD 3.4), risk factor violin/viola players with neck pain had greater normalized SCM EMG amplitudes during craniocervical flexion test than the pain-free musicians and non-musicians (p < 0.05) | 1 |
| Wahlström Edling and Fjellman-Wiklund (2009) | Music teacher (Instrumental teacher), Sweden | 47 | – | Physical workload by instrument playing, (plus posture and playing time per week) | “Musculoskeletal disorders”, SNQ | 12-month prevalence 77% (lower back 49%, neck 47%, upper back 32%, shoulder 28%); risk factors: more in females, asymmetric playing posture correlates stat. sign. with number of more musculoskeletal disorders, n.s. correlation to playing time | − 1 |
| Woldendorp et al. (2016) | Professional and professional student double bassists and bass guitarists, Netherlands | 141 | – | Instrument playing (bass guitarists vs. double bassists) with postural stress, bowing style in double bassists | “Musculoskeletal complaints”, intensity of pain (NRS, 0–10), self-reported functioning | 3-month prevalence 74% (most frequently in back and neck, up to 55% in bassists playing both instruments), 3-month prevalence of playing impairing complaints 43%, pain intensity mostly mild (NRS ≤ 3) last week, risk factors: no association between complaints and the playing position of the left shoulder area in double bassists (p = 0.30), the right wrist area in the bass guitarists (p = 0.70), the right wrist area for the German vs. French bowing style (p = 0.59), long-lasting exposures to postural stress were not associated with musculoskeletal complaints | 3 |
| Woldendorp et al. (2017) | Instrument playing (work load bass players: multi-vs. mono-instrumentalism) | “Musculoskeletal complaints” | Risk factors: 3-month prevalence of musculoskeletal complaints in the neck, back, right shoulder area and both wrist areas did n.s. differ between bass guitarists vs. double bassists, likelihood of musculoskeletal complaints in the left shoulder area higher in multi-instrumentalists vs. mono- instrumentalists (OR 0.30, 95% CI 0.119–0.753, p = 0.010), no protective effect of multi-instrumentalism against musculoskeletal complaints | ||||
| Yeung et al. (1999) | Orchestra musicians, Hong-Kong | 39 | – | Instrument playing (plus gender, professional life years, starting age, hours practice per week, breaks during practice sessions, warm-up’s, regular exercises, trauma unrelated to music playing) | “PRMC’s” (playing-related musculoskeletal complaints) | 12-month prevalence 64%; risk factors: less professional life years and lack of regular exercises correlate to PRMC’s | − 1 |
| Yoshimura et al. (2006) | Piano students “University of North Texas”, USA | 35 | – | Instrument playing (plus age, age started piano playing, years of private lessons, height, weight, BMI, various anthropometric parameters and elements of performance) | “Piano-related pain”: musculoskeletal pain, i.a. | Finger joint mobility, particularly right 3–4 span, is a risk factor for piano-related pain | − 3 |
APP asymmetric playing position, BMI body mass index, BPSF Brief Pain Short Form, CI confidence interval, CMD craniomandibular dysfunction, DASH Disabilities of the Arm, Shoulder and Hand, EMG electromyography, f female, m male, M mean, MPA music performance anxiety, NDI Neck Disability Index, NMQ Nordic Musculoskeletal Questionnaire, NRS Numeric Rating Scale, n.s. not statistically significant, OR odds ratio, PSFS patient-specific functional scale, QA quality assessment, QD QuickDASH, stat. sign. statistically significant, ROM range of motion, RULA Rapid Upper Limb Assessment, SCM sternocleidomastoid, SD standard deviation, SNQ Standardized Nordic Questionnaire, SPP symmetric playing position, TMD temporomandibular disorder, VAS Visual Analog Scale