MUSCULOSKELETAL DISORDERS IN Astha Dutta.

PT

PERFORMING ARTS MPT in Musculoskeletal disorders

“ IF I DON’T PRACTISE FOR ONE DAY, I KNOW IT;
IF I DON’T PRACTISE FOR TWO DAYS, THE CRITICS Ignacy Jan Paderewski.
KNOW IT; IF I DON’T PRACTISE FOR THREE DAYS,
THE AUDIENCE KNOWS IT”
PERFORMANCE RELATED MUSCULOSKELETAL
DISORDERS

Pain, weakness, numbness, tingling, or other

symptoms that interfere with (their) ability
to perform (their) art at the level (they)
are accustomed to.
 Prevalence of Medical Problems
EPIDEMIOLOGY ICSOM Study (Fishbein et al., 1988)

Location Side Problem Severe

50% of all musicians suffer from Problem
musculoskeletal injury (Part 2: Musicians.
Hand Right 9% 5%
Preventing Musculoskeletal Injury (MSI)
Left 14% 10%
For Musicians And Dancers: A Resource
Shoulder Right 20% 13%
Guide)
Left 20% 11%

Neck Right 21% 13%

Left 22% 12%

Low back Right 22% 13%

Left 22% 11%
Stage fright 24% 16%
 EPIDEMIOLOGY
It is said that 90% of the dancers would face any
musculoskeletal related pain.
One such study on bharatnatyam dancers showed
that an injured dancer had high hamstring
tightness that led to musculoskeletal disorders,
with the female dancers having more complaints in
knee, low back area and foot/ankle. While the
male dancers had more pain in the knee and feet.
(Anbarasi et. al. 2012)
Several literatures shows that 64 - 80% of ballet
injuries happen in the lower extremity such as
muscles strain and tear, about 64 - 75% of these
injuries affect the muscles and soft tissues. (Shan
et. al. 2005)
IMPACT…
Loss of speed,
Loss of control of major motions,
Loss of control of fine motions
Loss of power (forte)
Loss of finger span,
Other.
RELEVANT ANATOMY

Cartilages and
Joints
Ligaments

Tendon &
Muscle
Tendon sheath

Nerves
and Bursae
Vessels
FACTORS CAUSING OCCUPATIONAL DISORDERS

intrinsic extrinsic
New technique,
rapid progression,
Age, gender, etc.
repeated
movements, etc.

cannot be
Can be modified
modified
 • Pain occurs after class, practice, rehearsal, or performance, but the individual is able to
Level 1 perform normally.

• Pain occurs during class, practice, rehearsal, or performance, but the individual is not
Level 2 restricted in performing.

• Pain occurs during class, practice, rehearsal, or performance, and begins to affect some
Level 3 aspects of daily life. The individual must alter technique or reduce the duration of activity.

• Pain occurs as soon as the individual attempts to participate in class, practice, rehearsal,
Level 4 or performance, and is too severe to continue. Many aspects of daily life are affected.

• Pain is continuous during all activities of daily life, and the individual is unable to
Level 5 participate in class, practice, rehearsal, or performance.

Progression of MSI signs & symptoms in performers (SHAPE Preventing MSI for Musicians and Dancers. A Resource
Guide, 2002)
 MUSCULOSKELETAL DISEASES IN MUSICIANS
Pathologies of Disorders symptoms Common affected Preferred treatment
structure involved musicians
Muscle & tendon unit Lateral epicondilytis Pain on the outer Harp, Oboe, rest, splinting,
pathologies portion of the elbow Keyboard, percussion, physiotherapy,
clarinet and trombone nonsteroidal
drugs, corticosteroid
Golfers elbow Pain on the inner Harp, Oboe, injection
portion of the elbow Keyboard, percussion,
clarinet and trombone

Rotator cuff tendinitis Pain on the tip of the Violin, viola, cello,
shoulder while lifting String, bass, Bassoon
and doing overhead (Chong et al1989,
activities Zaza1998 )
De Queirvain’s disease Pain just below the Oboe, clarinet, flute,
thumb due to drummer, keyboard,
inflammation and tabla
swelling of tendons of
thumb
 MUSCULOSKELETAL DISEASES IN MUSICIANS
Pathologies of Disorders symptoms Common affected Preferred treatment
structure involved musicians
Nerve entrapment Carpal tunnel Pain, pins and needles in the hand, String players Modification of activity,
syndromes syndrome thumb, index and middle fingers; steroid injections, surgery,
symptoms at night. physiotherapy
Cubital tunnel Numbness, Violinist or guitarist Modification of activity,
syndrome Tingling, pain or loss of steroid injections, surgery,
coordination in 4th & 5th fingers, Pain physiotherapy
at elbow

Thoracic outlet pain on inner Violinist, violist, flute Posture correction, activity
syndrome side of forearm, ring and players, keyboard modification,
little fingers, pins & players, guitarist physiotherapy, surgery,
needles. medications
Cervical nerve root neck pain; Violinist, flute rest, splinting,
impingement radiating down the arm; physiotherapy,
pins & needles; weakness. nonsteroidal
drugs, corticosteroid
injection
 MUSCULOSKELETAL DISEASES IN MUSICIANS
Pathologies of Disorders symptoms
structure involved
Focal dystonia Loss of fine motor
control/coordination of
individual finger
movements. Usually
involving 3rd to 5th digits.
Common affected Preferred treatment
musicians
Pianists, wind players, temporary and
guitarists, string palliative.
players, pipers.

Lumbar spine Low back pain Pain in lower back going String players, flute Physiotherapy, surgery,
down to the legs players, tabla body awareness
programs, posture
correction
Head and face Temporomandibular Face & neck pain & Wind instruments & Medications, relaxation
joint pain head aches Instruments that require techniques.
Careful and sustained
Jaw positioning
MUSICIANS AND POSTURE
POSTURE CORRECTION
PREVENTION
Musical “neuro-muscular” warm-up
Stretches can be used as a cool-down, but need to be appropriately performed,
Inclusion of breaks every 20-30 minutes during practice sessions
Pacing: gradual increase of practice before concerts, recitals, competitions,
Variety of content of the practice session: styles of music, types of exercises,
Cognitive rehearsal: away from the instrument,
Body awareness and control techniques: Alexander, Feldenkreis, Yoga
Stress and anxiety management.
MUSCULOSKELETAL INJURIES IN
DANCERS
Musculoskeletal injury (MSI) is the most frequently reported medical
problem among classical and modern dancers.

The majority (60–80%) of dancers have reported at least one

injury that has affected their dancing or kept them from dancing
(Bowling 1989; Hamilton et al. 1992; Milan 1994; Guierre 2000),
and approximately half of dancers report at least one chronic
injury (Bowling 1989).
LONG TERM AND CHRONIC INJURIES
Many dancers report long-term and chronic injuries because minor injuries go
unreported and untreated for long periods.

By the time these dancers finally report an injury or seek treatment, the damage has
intensified to a level that requires major rehabilitation.

Dancers self-treat and delay medical intervention for various reasons

DELAYED ONSET OF MUSCLE SORENESS VS INJURY
Delayed-onset muscle soreness is muscle stiffness that may develop 24 to 36 hours after
intense or unaccustomed physical activity

It does not usually limit further activity and subsides within a few days

Muscle, tendon, or ligament injuries typically have a more rapid and localized onset of pain
and require much longer (weeks or months) for full recovery

Because dancers commonly experience delayed-onset muscle soreness, there is a danger that
they may not recognize pain caused by injury as such
OTHER FACTORS
Injuries because of faulty technique tend to recur even when rest and rehabilitation
are successful in treatment of the initial injury.
Each time a dancer resumes dancing with incorrect technique, the dancer may be
reinjured.
Stress levels
Proprioception is important for dancers who are trying to coordinate difficult
choreography and to balance in difficult positions. Postural stability requires
adequate proprioception from the ankle joint, which is affected after injury due to
rest
OTHER FACTORS
Approximately two-thirds of dance injuries are overuse and misuse injuries to the soft
tissue (Bowling 1989; Milan 1994).
The majority of soft tissue dance injuries occur at performances or rehearsals. This
suggests that the environmental, psychological, and physical factors affecting the
dancer during performance or rehearsal increase the risk and incidence of injury.
Dancers may also experience high levels of physical and mental anxiety that result in
tight muscles.
Inadequate warm-up contributes to an increased risk of injury.
Environmental factors that may affect dancers are the types of floors and
temperatures in theatres.
ROLE OF PHYSIOTHERAPY IN PERFORMING
ARTS…
Biomechanical assessment while performing
Manual therapy: faster relief in pain, earlier return to activity
Taping: allowing an artist to perform even after injury
Ergonomic correction of faulty technique
Strengthening certain group of muscles (for eg: shoulder, knee and ankle stabilizers,
core muscles) while stretching others for proper alignment.