Arts Medicine Journal N°92 Prevention and health of the musician

Recent studies on the integration and cognition of musical, and in particular rhythmic, stimuli point to the benefit of combining work on balance with playing an instrument. The single-leg stance is a low-energy solution for working on the musician’s sense of balance. The inherent imbalance generated by the single-leg stance leads to interesting postural adjustments, such as increased activation of the stabilising muscles, improvement of the axial tonus or more general enhanced proprioception.

In addition, it has recently been shown that this dual task may be beneficial to learning. That is why incorporating a focus on balance into the instrumentalist’s daily musical practice could improve the integration of music, its basic rhythmic elements and resulting subdivisions, but also improve stage expression and the relationship with the audience in order to maintain a sense of a shared musical experience.

This study focuses on the links between cranio-mandibular disorders and playing a wind instrument. The main types of cranio-mandibular disorders, in particular with respect to condylar kinematics, explain the induction of secondary pathologies, and certain types of mouthpiece may contribute to temporomandibular joint disorders. A treatment protocol for patients complaining of muscular or musculo-articular pain around the temporomandibular joints is proposed. The first, crucial step is to establish an accurate diagnosis by performing the various types of examinations available, the main one being axiographic analysis. Depending on the diagnosis, treatment may involve an occlusal brace. The musician’s stress is a common cause for the onset or aggravation of pain related to temporomandibular joints and this is something that should also be addressed with the musician.

String instrument players (upper strings) are among the most vulnerable to playing-related musculoskeletal disorders (PRMD). However, there is very little data on the underlying causes. Research is needed to explore the impact of playing the violin on the musician’s musculoskeletal system. The purpose of this study is to evaluate the balance, strength, and endurance of the shoulder rotator cuff muscles in professional violinists compared to a control group using an isokinetic dynamometer. The control group and group of violinists are homogeneous in terms of age, weight, sex ratio, height, and Quick-dash score. The concentric action of the internal and external rotator muscles was measured at speeds of 60°/s and 180°/s. The chosen parameters are peak torque normalised by weight, and the external rotator/internal rotator ratio. Endurance was measured at 240°/s with the calculation of a fatigue index.

No significant differences were found between the dominant shoulder and non-dominant shoulder in the concentric strength of the internal and external rotator muscles in violinists, or between the sample of violinists and the control group. Intensive playing of the violin is not associated with a muscular imbalance or a weakness of the rotator cuff muscles in musicians who are in good health. Other prospective studies are needed to compare the muscular balance and muscular endurance of musicians, with or without a medical condition. An understanding of the role of these specific factors will, without doubt, be of great value in future prevention strategies and the treatment of musicians with PRMD.

Musicians are exposed to health problems and yet very few of them practise risk prevention. This study explores the factors that motivate musicians to use means of prevention. It is based on a questionnaire completed online by 211 musicians. The participants, all over the age of 18, have all played an instrument for at least 10 years, 77% of them are from a conservatoire of music, 55% are amateurs and 45% professionals. Over 90% of the musicians questioned said that safeguarding their health was important to them, but they use few means of prevention. For over 80% of the musicians questioned, the main motivational factors are: better knowledge of the specialist products and organisations, better awareness of the institutions (conservatoire directors, conductors) and themselves. The youngest musicians are starting to take better care of their health but the use of means of prevention is still low and mainly follows a health problem. Regular awareness-raising programmes need to be implemented to inform all musicians about risk prevention. These interventions will be more effective if the improvement in musical performance is highlighted when discussing means of prevention. The involvement of all stakeholders is key to motivating as many musicians as possible: teachers, conservatoire directors, conductors, concert organisers, music shops, instrument makers, famous musicians. Furthermore, so that physical or mental preparation does not feel like an additional task, professors must integrate it into learning from the outset so that it becomes automatic. Lastly, funding would help establish these interventions.

Key words: musicians; amateurs; professionals; risk prevention; motivating factors; health.