"... in addition to being an art, playing a musical instrument is a sport in the sense that musicians often begin younger than athletes, training in the expert use of muscles from childhood to adulthood."--David Rivinus, violin maker (1)
Musicians, like athletes, require physical conditioning and preparation to perform at their best, and like athletes, they can develop physical problems as a result of their practice. Throughout the centuries, performing artists generally have kept physical problems and injuries to themselves. Musicians were, and still are, told to "play through the pain" Although health care providers do not have a good understanding of the physical and psychological injuries that can occur, musicians still need, and seek, quality treatment. PAs should be familiar with injuries in musicians, whether they care for professional musicians or not. Professional musicians are not the only persons afflicted; children and adults who are active in music may be seen in family practice, urgent care, orthopedic, or neurology clinics.
Medical problems that can afflict musicians include contact dermatitis, hearing loss, pneumothorax, increased intraocular pressure, gastroesophageal reflux disease, performance anxiety, focal dystonia, and various musculoskeletal disorders. The simplest injuries can take a musician "out of the game" long enough to result in psychological problems, another area that may need to be addressed. This article focuses on the musculoskeletal disorders that may develop in musicians, including repetitive strain injuries (RSIs); carpal tunnel syndrome (CTS); back pain; and focal dystonia of the hands, forearms, and mouth.
In some cases, an injury can end a career or have a severe negative economic impact because the musician must rest the injured extremity or area. In a national survey of orchestral musicians, 76% of respondents had to take time off from performing because they developed a serious injury during their career. (2) Some small studies have found that 50% of treated musicians were unable to return to their career at all. (3) PAs caring for members of this unique patient population should understand their patient's passion for music, aspirations and fears related to being a performer, and stresses being dealt with both in and out of the performance hall.
According to the Bureau of Labor Statistics, approximately 264,000 musicians were employed in the United States in 2006. (4) Given that musculoskeletal injuries are reported by 50% to 76% of professional musicians, the problem is substantial. (4) Schuele and Lederman identified 8.5 episodes of injuries per 100 university music performance majors. (5) In a University of Texas study, the prevalence of musculoskeletal injuries among players of brass instruments--the French horn, trombone, trumpet, or tuba--was 61%. (6) Trombone players had the highest rate of injury, and female trombonists, in particular, sustained injuries involving mainly the left upper extremity and upper back. (6) Female musicians may be more susceptible to musculoskeletal injuries than male musicians. (7) In a study conducted by the International Conference of Symphony and Opera Musicians, 70% of the women and 52% of the men had a performance-related musculoskeletal problem. Women may sustain...