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Contributing factors, prevention, and management of playing-related musculoskeletal disorders among flute players internationally

Lonsdale K, Laakso EL, Tomlinson V

Med Probl Perform Art, 2014 Sep;29(3):155-62.
PMID: 25194113

Major studies have shown that flutists report playing-related pain in the neck, middle/upper back, shoulders, wrists, and hands. The current survey was designed to establish the injury concerns of flute players and teachers of all backgrounds, as well as their knowledge and awareness of injury prevention and management. Questions addressed a range of issues including education, history of injuries, preventative and management strategies, lifestyle factors, and teaching methods. At the time of the survey, 26.7% of all respondents were suffering from flute playing-related discomfort or pain; 49.7% had experienced flute playing-related discomfort or pain that was severe enough to distract while performing; and 25.8% had taken an extended period of time off playing because of discomfort or pain. Consistent with earlier studies, the most common pain sites were the fingers, hands, arms, neck, middle/upper back, and shoulders. Further research is needed to establish possible links between sex, instrument types, and ergonomic set up. Further investigation is recommended to ascertain whether certain types of physical training, education, and practice approaches may be more suitable than current methods. A longitudinal study researching the relationship between early education, playing position, ergonomic set-up, and prevalence of injury is recommended.
Playing-Related Musculoskeletal Disorders Among Classical Piano Students at Tertiary Institutions in Malaysia: Proportion and Associated Risk Factors

Ling CY, Loo FC, Hamedon TR

Med Probl Perform Art, 2018 06;33(2):82-89.
PMID: 29868681 DOI: 10.21091/mppa.2018.2013

Musicians are prone to performance injuries due to the nature of musical practice, and classical pianists are among the groups at high risk for playing-related musculoskeletal disorders (PRMDs). With the growing number of classical pianists in Malaysia, this study aimed to investigate the proportion of PRMDs occurring among classical piano students in tertiary institutions in Malaysia. Associations between gender, practice habits, diet, sports involvement, and PRMD were investigated. A survey was conducted among classical piano students (n=192) at tertiary institutions of Kuala Lumpur and Selangor. Results showed that 35.8% (n=68) students reported having PRMD. The shoulder was the most commonly affected body site, followed by the arm, finger, and wrist. Pain, fatigue, and stiffness were the most cited symptoms by those who suffered from a PRMD. Chi-square analysis showed a significant relationship between the occurrence of PRMD and practice hours (p=0.031), the habit of taking breaks during practice (p=0.045), physical cool-down exercises (p=0.037), and special diet (p=0.007). Multivariate logistic regression analyses confirmed the independent correlation between PRMDs and the lack of taking a break during practice, physical cool-down exercises, and special diet. Because PRMDs are reported at various severity levels, this study should increase awareness of PRMD among classical piano students and encourage injury prevention in musicians in the future to ensure long-lasting music careers.
Knowledge of Playing-Related Musculoskeletal Disorders Among Classical Piano Students at Tertiary Institutions in Malaysia

Ling CY, Loo FC, Hamedon TR

Med Probl Perform Art, 2016 12;31(4):201-204.
PMID: 27942698

Performance injuries among musicians have been widely discussed for decades. However, despite the growing number of classical pianists, this is still a new issue in Malaysia. Therefore, this study aimed to investigate the level of knowledge of playing-related musculoskeletal disorders (PRMDs) among tertiary music students in Malaysia. A survey was conducted among classical piano students at tertiary institutions of Kuala Lumpur and Selangor. Out of 192 respondents, 76% knew that piano playing can cause PRMDs. Slightly over three-quarters of respondents (77.1%) learned about PRMDs from music educators. The survey revealed that the belief in "no pain, no gain" was still ingrained in their minds, as 50.5% respondents believed that pain experienced while playing the piano was normal and 51.6% of them considered that pain must be experienced to improve their piano skill. The respondents were also scored on questions on terminologies of pianist injury and specific PRMD examples: 7.8% of respondents scored high in the questions on the general terminology, while 99.5% of them scored low in the questions on the specific examples of PRMDs. This finding indicated a lack of knowledge of specific musicians' injuries among classical piano students. The attitudes to pain and the level of understanding of the significance of potential injuries indicate that increasing PRMD awareness and introducing courses on PRMD prevention at tertiary institutions are warranted.
Challenges Faced by Woodwind Players in Malaysia While Fasting During Ramadan: A Case Study

Lonsdale KA, Abadi FH

Med Probl Perform Art, 2018 09;33(3):191-197.
PMID: 30204825 DOI: 10.21091/mppa.2018.3027

While numerous studies have investigated associations between Ramadan fasting and sports performance, as well as general health, little is known about the experiences of musicians who play while fasting. This exploratory case study aimed to gain a better understanding of the experiences of tertiary-level woodwind players who practice, rehearse, and perform while fasting. Sixteen undergraduate woodwind players from two Malaysian university music faculties completed an 11-item questionnaire, as well as a 7-day food and playing diary, which formed the basis for a semi-structured interview. Their experiences were compared with previous studies of fasting athletes. Many participants stated that practicing from noon to 3:00 pm was difficult due to feeling thirsty, hungry, tired, and exhausted, with some experiencing a dry mouth and/or lips. By 3:00 to 6:00 pm, some had difficulty focusing and felt tired, dizzy, or lacked energy to practice. Many felt more comfortable playing after breaking the fast or after eating sahur. The majority experienced positive impacts such as increased focus and efficiency while practicing. This study suggests that fasting woodwind players would benefit from practicing in the morning and after sunset, limiting their practice time in the afternoon, not skipping sahur, and ensuring adequate hydration during sunset and sunrise.
Playing-Related Health Problems Among Instrumental Music Students at a University in Malaysia

Lonsdale K, Boon OK

Med Probl Perform Art, 2016 Sep;31(3):151-9.
PMID: 27575291 DOI: 10.21091/mppa.2016.3028

Musicians from a wide range of backgrounds experience playing-related health problems including musculoskeletal disorders, hearing loss, and performance anxiety. Few studies have focused specifically on the health concerns of musicians in Malaysia.
AIMS: This study aimed to investigate playing-related health problems among student musicians at a university in Malaysia as well as their knowledge and awareness of playing-related health problems.
METHODS: Instrumental music students enrolled in undergraduate and post-graduate university music courses (n=98) participated in a self-report online survey which addressed aspects such as educational background, playing experience, knowledge and awareness of musicians' health issues, history of physical problems, lifestyle factors, and prevention and management strategies.
RESULTS: Of the total participants, 28.9% reported that they were currently experiencing playing-related pain in a body part, and 46.4% had experienced playing-related pain at some time. More than half (56.7%) felt that they have not received enough information or advice on playing-related health during their current studies. Musicians who experienced playing-related pain, tension, and discomfort reported the main problem sites to be the fingers and hands, arms, neck, and shoulders.
CONCLUSIONS: The study results demonstrate that Malaysian university music students are affected by similar types of playing-related physical problems as their counterparts around the world. A greater awareness and knowledge of injury prevention and management strategies is needed so that these music students can sustain healthy playing careers.