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PASIG MONTHLY CITATION BLAST: No. 130 September 2017
Dear Performing Arts SIG members:
This is the month to book your flight, hotel and conference for CSM in New Orleans! Registration opens on September 20, 2017! To register and for more information visit: http://www.apta.org/CSM/.
Please consider compiling Performing Arts-‐related abstracts for a citation blast this year. It is also a great way to bring your student interns, residents and fellows into the process. It’s easy to do and is a great way to get involved with PASIG! Take a look at our Performing Arts Citations and Endnotes (https://www.orthopt.org/content/special-‐interest-‐groups/performing-‐arts/citations-‐endnotes), look for what’s missing or needs an update, then email me your ideas or contribution for a future citation blast!
Please see the following for other exciting opportunities to get involved with the PASIG.
Upcoming conferences: The next Combined Sections Meeting will be held February 21-‐24, 2018 in New Orleans, Louisiana. Many of our members will be presenting at CSM. When you receive confirmation of your platform, poster, or session presentation, please let us know so we can spread the word to the PASIG membership! Contact Rosie Canizares: [email protected]
Students, if your Performing Arts poster or platform is accepted, please apply for the PASIG student scholarship. Contact Anna Saunders: [email protected]
PASIG members and leaders have been busy! There are many of us presenting at the upcoming International Association for Dance Medicine & Science 27th Annual Conference on October 12-‐15, 2017 in Houston, Texas, USA. Over the 4-‐day conference, our members and leaders are presenting didactic sessions, interactive workshops, movement sessions, round table discussions, networking events, debates, poster presentations, and more. Special Interest Days will be held during the conference, including A Day for Teacher (ADFT) on Friday October 13th and A Day for Medics (ADFM) on Saturday Oct 14th. We look forward to the evidence -‐based duels on the dancer as artist vs. athlete, cryotherapy pro vs. con, and dancer screening pro vs. con, as Annette, Rosie, and Laurel battle it out with other IADMS folks! We look forward to seeing you there! Please stop by our PASIG-‐Orthopaedic Section booth, as we are now proud sponsors of IADMS. www.iadms.org/2017
Call for Performing Arts Clinical Rotation Sites: We are currently updating the list of clinical rotation sites on our website. Please e-‐mail Rosie Canizares ([email protected]) if you take students and would like your information included on this list. Also, if your organization has been on the list in the past, please review our current list via the link below and submit any updates. http://www.orthopt.org/uploads/content_files/files/PASIG%20clinical%20sites_2017.pdf
Dancer Screening: PASIG members and leaders are also helping out with the Dance USA Screen in Houston, TX, right after IADMS! We will be screening freelance professional dancers on October 16th, from 8 AM–4 PM at MetDance. Please contact Annette Karim if you are interested in helping out with the screen. We need help! Clinicians and student DPTs, we need you! Contact [email protected] if you are available.
PASIG Pre-‐professional dancer screening is ALSO in the works! If you are interested and available after IADMS, we would like you to consider helping out. Contact Mandy Blackmon if you are available. [email protected]
Fellowship Taskforce Update! The practice analysis re-‐validation project team is working on final revisions for the upcoming publication of the Description of Fellowship Practice (DFP) for Performing Arts Physical Therapy. The Description of Advanced Specialized Practice (DASP) in Performing Arts Physical Therapy was approved by the ABPTRFE in January 2016. The DFP is currently being reviewed by ABPTRFE. This is the final phase for laying the groundwork for providing current practice guidelines in the sub-‐specialty area as well as curriculum requirements for Performing Arts PT fellowships. Please contact Mariah Nierman [email protected] or Laurel Abbruzzese [email protected] if interested.
As you can see, the PASIG is working collaboratively with many organizations to promote the well-‐being and care of our performing artists. Go team! PASIG Leadership
Annette Karim, President 2017-2020 [email protected] Lori Michener, Orthopaedic Board Liaison 2017-2020 [email protected] Rosie Canizares, Vice President/ Education Chair 2016-2019 [email protected] Andrea Lasner, Nominating Committee Chair 2015-2018 [email protected] Jessica Fulton, Nominating Committee 2016-2019 [email protected] Brooke Winder, Nominating Committee 2017-2020 [email protected] Elizabeth Chesarek, Membership Chair 2016-2018 [email protected] Laura Reising, Research Chair 2016-2018 [email protected] Mariah Nierman, Fellowship Taskforce Chair 2016-2018 [email protected] Laurel Abbruzzese, Fellowship Chair Asst. 2016-2018 [email protected] Dawn Muci, Public Relations Chair 2016-2018 [email protected] Amanda Blackmon, Dancer Screening Chair 2016-2018 [email protected] Anna Saunders, Scholarship Chair 2017-2019 [email protected] Janice Ying, ISC Chair 2017-2019 [email protected] Megan Poll, Secretary 2017-2019 [email protected]
Membership: Current PASIG members, please remember to update your membership: https://www.orthopt.org/login.php?forward_url=/surveys/membership_directory.php
Social Media: For fun PT info and related performing artists info... 1) Facebook page: (closed) If you would like to be a part of the group, email Dawn (Doran) Muci: [email protected] 2) follow PASIG on Twitter: @PT4PERFORMERS
Call for case reports: If you have a brief, clinically-‐focused case report on a performing arts PT patient, or a clinical commentary, please contact Annette Karim to submit your writing for the next Orthopaedic Physical Therapy Practice Magazine: [email protected]
WE NEED MORE CONTRIBUTORS TO OUR MONTHLY CITATION BLASTS!!!! Past Monthly citation blasts are available, with citations and EndNote file, listed on the website: http://www.orthopt.org/content/special-‐interest-‐groups/performing-‐arts/citations-‐endnotes TOPICS THAT HAVE BEEN COVERED RECENTLY INCLUDE: Shoulder Injuries in the Performing Arts (Current) Rhythmic Gymnastics – Updated Female Athlete Triad – Updated Periodization in Dance Irish Dancing Flexor Hallucis Longus Dysfunction Sacroiliac and Pelvic Dysfunction Screening Gyrotonics ® and Gyrokinesis ® for the Performing Artist Medial Tibial Stress Syndrome 2nd Tarsometatarsal Joint Injuries in Dancers Screening Tools for the Young Dancer Thoracic Outlet Syndrome and Nerve Entrapment in Instrumental Musicians Plyometric Training in Dancers HVLAT for Lower Extremity Conditions Inguinal Disruption Femoroacetabular Impingement Hand and Wrist Conditions in Gymnasts Factors in Optimal Turnout Achilles Tendinopathy Biomechanics and Posture in Musicians If you are interested in contributing by writing a citation blast or joining the research committee, contact me at [email protected]. Sincerely, Laura Laura Reising, PT, DPT, MS, OCS Research Chair, PASIG Research Committee Allegheny Health Network, Wexford Health + Wellness Pavilion Wexford, PA Home: [email protected] Work: [email protected] PASIG Research Committee members: Shaw Bronner PT, PhD, OCS, [email protected] Jeff Stenback PT, OCS, [email protected] Sheyi Ojofeitimi PT, DPT, OCS, [email protected] Susan D. Fain PT, DMA, [email protected] Brooke Winder, PT, DPT, OCS, [email protected]
Sarah Edery-‐Altas, PT, DPT Sarah.Edery-‐[email protected] (EndNote Organizer)
PERFORMING ARTS CONTINUING EDUCATION, CONFERENCES, AND RESOURCES Orthopaedic Section Independent Study Course. 20.3 Physical Therapy for the Performing Artist.
Monographs are available for: -‐ Figure Skating (J. Flug, J. Schneider, E. Greenberg),
-‐ Artistic Gymnastics (A. Hunter-‐Giordano, Pongetti-‐Angeletti, S. Voelker, TJ Manal), and -‐ Instrumentalist Musicians (J. Dommerholt, B. Collier). Contact: Orthopaedic Section at: www.orthopt.org
Orthopaedic Section-‐American Physical Therapy Association, Performing Arts SIG http://www.orthopt.org/content/special_interest_groups/performing_arts
Performing Arts Citations and Endnotes http://www.orthopt.org/content/special_interest_groups/performing_arts/citations_endnotes
ADAM Center http://www.adamcenter.net/
Publications: http://www.adamcenter.net/#!vstc0=publications Conference abstracts: http://www.adamcenter.net/#!vstc0=conferences
Dance USA http://www.danceusa.org/
Research resources: http://www.danceusa.org/researchresources Professional Dancer Annual Post-‐Hire Health Screen: http://www.danceusa.org/dancerhealth
Dancer Wellness Project http://www.dancerwellnessproject.com/
Becoming an affiliate: http://www.dancerwellnessproject.com/Information/BecomeAffiliate.aspx
Glendale Adventist Therapy and Wellness Center, Los Angeles area (Eagle Rock), CA http://www.musicianshealthcorner.com/ Healthy Musician Series -‐ Overuse Harkness Center for Dance Injuries, Hospital for Joint Diseases http://hjd.med.nyu.edu/harkness/
Continuing education: http://hjd.med.nyu.edu/harkness/education/healthcare-‐professionals/continuing-‐education-‐courses-‐cme-‐and-‐ceu Resource papers: http://hjd.med.nyu.edu/harkness/dance-‐medicine-‐resources/resource-‐papers-‐and-‐forms Links: http://hjd.med.nyu.edu/harkness/dance-‐medicine-‐resources/links Informative list of common dance injuries: http://hjd.med.nyu.edu/harkness/patients/common-‐dance-‐injuries Research publications: http://hjd.med.nyu.edu/harkness/research/research-‐publications
International Association for Dance Medicine and Science (IADMS) http://www.iadms.org/ International Association for Dance Medicine & Science 27th Annual Conference, October 12-‐15, 2017, Houston, Texas, USA. Special Interest Days will be held during the conference, including A Day for Teacher (ADFT) on Friday October 13th and A Day for Medics (ADFM) on Saturday Oct 14th. http://www.iadms.org/
Resource papers: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=186 Links: http://www.iadms.org/displaycommon.cfm?an=5 Medicine, arts medicine, and arts education organization links: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=5 Publications: http://www.iadms.org/displaycommon.cfm?an=3
Performing Arts Medicine Association (PAMA) http://www.artsmed.org/ http://www.artsmed.org/symposium.html
Interactive bibliography site: http://www.artsmed.org/bibliography.html Related links: http://www.artsmed.org/relatedlinks.html Member publications: http://artsmed.org/publications.html
(Educators, researchers, and clinicians, please continue to email your conference and continuing education information to include in future blasts.)
Shoulder Injuries in the Performing Arts I have had an influx of complaints regarding shoulder pain over the past few months. Some dancers complained of pain after lifting another dancer in a modern dance rehearsal or performance. Others complain of pain with holding their port de bra at the barre or center in ballet class or while playing their oboe. With research being done in 2013 regarding shoulder impingement, I focused my research on prevalence of shoulder pain in the performing artist. Research reports that shoulder injuries and pain are more prevalent in musicians, modern dancers, adult gymnasts, circus-‐arts, and break-‐dancers. Injuries are typically secondary to repetitive motions that can be exacerbated by unaccustomed lifting/movements, posture, apparatus, technique, altered biomechanics, and lack of cross-‐training. Case studies indicate that it is important to rule out nerve lesion and fractures when indicated. Research supports on-‐site physical therapy triage services, exercise programs, breathing techniques, and multimodal biofeedback technologies to reduce shoulder pain in the musician population. However, this could be applicable to other performing artists, as well. For musicians, additional research is needed to investigate the role of early education, playing position, muscle loading via fine-‐wire EMG, and ergonomic set-‐up to reduce playing-‐related pain. More research is needed in the dance and gymnast population for management and activity-‐specific rehabilitation. Laura Reising, PT, DPT, MS, OCS Physical Therapist Allegheny Health Network Health + Wellness Pavilion Wexford, PA Home: [email protected] Work: [email protected]
Akau CK, Harrast MA, Storm SA, Finnoff JT, Willick S. Sports and performing arts medicine: 1. Upper extremity injuries. PM R. 2009;1(13):S51-‐S59.
ABSTRACT: This self-‐directed learning module highlights upper limb sports and performing arts injuries. It is part of the study guide on sports and performing arts medicine in the Self-‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on shoulder, elbow and finger pain in athletes and wrist pain in musicians. The goal of this article is to enhance the learner’s understanding on how to approach common upper limb pain conditions and injuries in these populations.
Akuthota V, Chou LH, Drake DF, Nadler SF, Toledo SD. Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports. Arch Phys Med Rehabil. 2004;85(3 suppl 1): S52-‐8.
ABSTRACT: This self-‐directed learning module discusses classic topics and highlights new advances in this area. This article discusses upper-‐limb sports injuries as part of a section of the study guide on sports and performing arts medicine in the Self-‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on shoulder and elbow pain in the athlete. OVERALL ARTICLE OBJECTIVE: To discuss shoulder and elbow overuse injuries in sports
Chan C, Driscoll T, Ackermann B. The usefulness of on-‐site physical therapy-‐led triage services for professional orchestral musicians: a national cohort study. BMC Musculoskelet Disord. 2013;14:98. doi: 10.1186/1471-‐2474-‐14-‐98.
BACKGROUND: Australian professional orchestral musicians reported a lifetime prevalence of musculoskeletal injuries that had interfered with playing at 84%. Physical therapy-‐led triage clinics may be a practical method to manage the impact of high performance-‐related musculoskeletal disorders (PRMDs) in professional orchestral musicians. This study aimed to: a) collect information on presenting injuries, b) determine the participant's provisional diagnosis, c) evaluate uptake of an on-‐site triage service, d) measure participant satisfaction, and e) identify factors influencing attendance. METHODS: Eight triage sessions were run on a fortnightly basis during a designated lunch break between rehearsal calls in seven premier symphony orchestras in Australia; a total population of 483 musicians. The participants received one or a combination of: a) education and advice relating to their provisional diagnosis, b) basic acute management and/or c) a referral to a suitable medical practitioner or allied health professional for further consultation or treatment. A three-‐month follow-‐up questionnaire was completed and a qualitative narrative themes-‐based analysis was undertaken to summarize participant and physical therapist feedback. Uptake, participant satisfaction and factors influencing attendance were measured. RESULTS: 99 initial consultations (83 individuals) were conducted with more females (61%) utilizing the service than males (49%). The most common injury complaints were in the shoulder(22%), neck (18%), upper back (18%), and hand (8%). 66% of these were diagnosed as PRMDs. Of these injuries, 94% were considered preventable, 93% continued to affect playing, 68% were severe requiring a referral for further management, and 46% were recurrent. The advice at the triage service was rated as helpful or very helpful by 79% of the musicians, whilst 68% responded they were likely or very likely to continue to use the service if it was offered in the future. Of the participants that followed through with the referral advice, 67% reported that the referral advice was helpful or very helpful. Musicians' and physical therapists' written feedback indicated their acknowledgement for the need of
this service. The main suggestions for improving attendance were increasing the music-‐specific physical therapy knowledge of therapists and overcoming competing time demands. CONCLUSION: On-‐site health services for musicians may facilitate better injury management by providing immediate and specific health advice.
Chan C, Driscoll T, Ackermann B. Development of a specific exercise programme for professional orchestral musicians. Inj Prev. 2013;19(4):257-‐63. doi: 10.1136/injuryprev-‐2012-‐040608. Epub 2012 Dec 4.
BACKGROUND: Musculoskeletal problems are common in professional orchestral musicians, and little is known about effective prevention strategies. Exercise is suggested to help in reducing work-‐related upper limb disorders and accordingly a trial of a specific exercise programme for this population was planned. Formative and process evaluation procedures were undertaken during the development of the programme to ensure high methodological credibility. METHODS: Literature reviews on exercise interventions for musicians as well as for neck, shoulder, abdominal, lower back and hip/pelvic body regions were undertaken. Current preventative and rehabilitation models were reviewed including undergraduate curriculums, postgraduate training programmes, and opinion from academic and clinical physiotherapists. Five series of progressive exercises were developed as a result. These were reviewed by expert physiotherapists who were blinded to the proposed progression difficulty of the exercises. A revised draft was produced for further review. This final programme was pilot trialed and feedback from the participants and physiotherapist instructors were obtained. RESULTS: No evidence-‐based literature regarding an exercise programme for professional orchestral musicians was found. An exercise programme was subsequently developed with progressive stages that followed an adapted exercise prevention and rehabilitation model. The blinded ranking of each exercise series produced varied results particularly in the abdominal and shoulder series. Feedback from the participants and instructors in the pilot study resulted in changes to the exercise difficulty, and the class format and structure. CONCLUSIONS: Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice, a specific exercise programme was developed to prevent and/or reduce occupational injuries in professional orchestral musicians.
Cho CH, Song KS, Min BW, Lee SM, Chang HW, Eum DS. Musculoskeletal injuries in break-‐dancers. Injury. 2009 Nov;40(11):1207-‐11. doi: 10.1016/j.injury.2009.05.019. Epub 2009 Jun 21.
BACKGROUND: Since no epidemiologic studies have been reported about musculoskeletal injuries in break-‐dancers, there are no data on the rates and
patterns of musculoskeletal injuries in this population that clinicians can use to find ways to decrease injury rate. HYPOTHESIS: We believe that the incidence of injuries in break-‐dancers is higher than assumed and that injury rates and patterns differ between professional and amateur dancers. STUDY DESIGN: Descriptive epidemiologic study. MATERIALS AND METHODS: Of a total of 42 study subjects, 23 were professional dancers and 19 were amateur dancers. Injury frequency, site and type, along with the presence of supervised training, the use of protective devices and warm-‐up exercises done were recorded. RESULTS: Of the 42 study subjects, excluding two amateur dancers, 40 (95.2%) had had musculoskeletal injuries at more than one site. The mean number of sites per dancer was 4.60. The frequency of injury depended on the site and was as follows: wrist (69.0%), finger (61.9%), knee (61.9%), shoulder (52.4%), lumbar spine (50.0%), elbow (42.9%), cervical spine (38.1%), ankle (38.1%), foot (28.6%) and hip (16.7%). Sprain, strain and tendinitis were the most common injuries, accounting for the most cases. Of the 42 dancers, 13 (31%) had had fractures or dislocations. Eight (19.1%) learned break-‐dancing under supervised instruction, 17 (40.5%) used protective devices and 28 (66.7%) performed warm-‐up exercises before dancing. There were significant differences in age, dance career length, amount of dance training, mean number of injury sites and the presence of supervised training between professionals and amateurs (P<0.05). CONCLUSION: Clinicians must inquire thoroughly into the nature of the activities that result in both unusual and common injuries in break-‐dancers and educate them about safety. Careful screening, instruction and supervised training of break-‐dancers will help to prevent injuries.
Doyscher R, Kraus K, Finke B, Scheibel M. Acute and overuse injuries of the shoulder in sports. Orthopade. 2014;43(3):202-‐2018. doi: 10.1007/s00132-‐013-‐2141-‐x.
BACKGROUND: During sports the shoulder complex is exposed to considerable load especially where throwing is important and various pathological changes can occur. In the last two decades the shoulder in athletes has become a special term in clinical sports medicine METHODS: Selective literature review in PubMed and consideration of personal experience, research results as well as national and international recommendations RESULTS: In general acute lesions of the shoulder caused by sudden sport injuries, such as traumatic luxation, acromioclavicular (AC) joint disruption, traumatic tendon ruptures, labral lesions, cartilage defects and fractures have to be distinguished from chronic or long-‐standing pathologies due to recurrent microtrauma, such as overuse bursitis and tendinitis, as well as secondary forms of impingement along with rotator cuff tears and labral
lesions. Besides common pathological changes that can be observed in almost all overhead-‐sports, there are also injuries that are more sport-‐specific due to the particular load profile in each sport. These injuries are especially common in racquet and throwing sports (e.g. golf, tennis, handball and volleyball) as well as in individual and artistic sports (e.g. swimming, gymnastics, dancing and rowing), contact and extreme sports (e.g. judo, mixed martial arts, bodybuilding, weightlifting, motocross and downhill mountain biking). CONCLUSION: Knowledge about sport-‐specific load profiles as well as about the variety of treatment options is crucial for successful treatment of these injuries.
Gerhardt C, Doyscher R, Boschert HP, Scheibel M. The gymnastics shoulder. Orthopade. 2014;43(3):230-‐5. doi: 10.1007/s00132-‐013-‐2145-‐6.
BACKGROUND: Adult gymnasts show a high prevalence of various shoulder pathologies. Due to the specific equipment used in gymnastics and the high training schedule with weekly training times up to 32 h, the shoulders of gymnasts are mostly subjected to symmetrical bilateral weight bearing. This is in contrast to overhead throwing, racket and martial arts sport forms in which the load is mainly located on the dominant side. CAUSES OF INJURY: Structural lesions of the shoulder and shoulder girdle in male gymnasts can arise due to high repetitive support and swing forces during exercises on the six specific types of apparatus and particularly the rings. INJURY PATTERNS: These lesions particularly affect the biceps tendon anchor, the long head of the biceps tendon and the tendon of the supraspinatus muscle. Because possible pathologies can increasingly occur even in younger gymnasts, awareness of the treating physician and also the trainer should be increased. THERAPY: Early initiation of intensive conservative treatment and arthroscopic interventions in cases of failure of non-‐operative management are relevant for satisfying results. Modern arthroscopic reconstructive techniques are available for treating structural lesions. CONCLUSION: Nevertheless, in almost 30 % of the patients the occurrence of shoulder pain or the necessity for surgical interventions will prevent them from achieving the national or international level of competition. This underlines the necessity for development of prevention programs.
Hopper L, Chan C, Wijsman S, Ackland T, Visentin P, Alderson J. Torso and bowing arm three-‐dimensional joint kinematics of elite cellists: clinical and pedagogical implications for practice. Med Probl Perform Art 2017; 32(2):85–93.
BACKGROUND: Elite cello playing requires complex and refined motor control. Cellists are prone to right shoulder and thoracolumbar injuries. Research informing injury management of cellists and cello pedagogy is limited. The aims of this study were to quantify the torso, right shoulder, and elbow joint movement used by elite cellists while performing a fundamental playing task, a C major scale, under two volume conditions. METHODS: An eight degrees of freedom upper limb biomechanical model was applied to 3D motion capture data of the torso, upper arm, and forearm for 31 cellists with a mean experience of 19.4 yrs (SD 9.1). Two-‐factor ANOVA compared the joint positions between the four cello strings and two volume conditions. FINDINGS: Significant (p<0.05) effects were found for either the string and/or volume conditions across all torso, shoulder, and elbow joint degrees of freedom. The torso was consistently positioned in left rotation from 5.0° (SD 5.6) at the beginning of the scale, increasing to 16.3° (5.5) at its apogee. The greatest mean shoulder flexion, internal rotation, and abduction joint angles were observed when playing at the tip of the bow on the top string (A): 107.2° (11.6), 59.1° (7.1), and –76.9° (15.7), respectively, during loud playing. INTERPRETATION: Elite cellists use specific movement patterns to achieve string crossings and volume regulation during fundamental playing tasks. Implications of the static left-‐rotated torso posture and high degrees of combined shoulder flexion and internal rotation can be used to inform clinical and pedagogical practices.
Kauther MD, Wedemeyer C, Wegner A, Kauther KM, von Knoch M. Breakdance injuries and overuse syndromes in amateurs and professionals. Am J Sports Med. 2009 Apr;37(4):797-‐802. doi: 10.1177/0363546508328120.
BACKGROUND: Serious injuries due to breakdancing have been presented only as singular case reports to date. So far, there have been no comprehensive studies about injuries in this sport. HYPOTHESIS: Professional breakdancing might lead to a higher incidence of injuries than amateur training. Wearing safety equipment is correlated with a decreased incidence of injuries and pain. STUDY DESIGN: Descriptive epidemiology study. METHODS: The retrospective study surveyed 40 breakdance professionals and 104 amateurs by questionnaire. RESULTS: There were 1665 injuries and 206 overuse syndromes found in 380 588 hours of training, leading to a loss of 10 970.6 training days. Professionals reported significantly (P < .001) more injuries and overuse syndromes with significantly more injuries of the wrist (P < .001), knee (P < .001), hip/thigh (P = .003), ankle/foot (P = .013), and elbow (P = .033). No significant differences were found in the time lost per injury and the time lost per overuse syndrome. Pain occurred most frequently in the region of the
wrist, spine, shoulder, and ankle. A negative correlation between protective gear and injuries or frequency of pain could not be shown. CONCLUSION: Breakdancing must be considered as a potentially high-‐risk dancing sport. Even with severe injuries, dancers interrupt training only for limited periods of time. CLINICAL RELEVANCE: Breakdance injuries and overuse should not be underestimated. Physicians should be aware of the common risks in this highly acrobatic kind of dancing.
Khoury JJ, Loberant N, Jerushalmi J. Shoulder pain in a young break-‐dancer evaluated with bone scintigraphy. Clin Nucl Med. 2009 Dec;34(12):916-‐7. doi: 10.1097/RLU.0b013e3181becf53.
ABSTRACT: We report the case of an 18-‐year-‐old male break-‐dancer evaluated with bone scintigraphy for shoulder pain. Bone scintigraphy showed intense tracer uptake in both shoulders. Dance-‐related injury is well described in the literature, and classically involves the feet and ankles, but breakdance injuries, which may involve any part of the body, have been reported only infrequently. We report here a case of shoulder injury related to breakdance demonstrated on bone scintigraphy.
Kok LM, Huisstede BM, Voorn VM, Schoones JW, Nelissen RG. The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Environ Health. 2016 Apr;89(3):373-‐96. doi: 10.1007/s00420-‐015-‐1090-‐6. Epub 2015 Nov 12.
PURPOSE: This study gives a systematic overview of the literature on the occurrence of musculoskeletal complaints in professional instrumental musicians. METHODS: A systematic review. Nine literature databases were searched without time limits on June 25, 2015, also the complete index of the journal Medical Problems of Performing Artists (MPPA) until June 2015 (30;2) was searched, and citation tracking and reference checking of the selected articles were performed. The search consisted of the combination of three groups of keywords: musician (e.g., musician, violin, music student, instrument player) AND musculoskeletal (e.g., musculoskeletal, tendon, shoulder, arthritis) AND epidemiology (e.g., prevalence, incidence, occurrence). RESULTS: The initial literature search strategy resulted in 1258 potentially relevant articles. Finally, 21 articles describing 5424 musicians were included in this review. Point prevalences of musculoskeletal complaints in professional musicians range between 9 and 68 %; 12-‐month prevalences range between 41 and 93 %; and lifetime prevalences range between 62 and 93 %. Ten out of 12 studies show a higher prevalence of musculoskeletal complaints among women. Brass instrumentalists are reported to have the lowest prevalence rates of musculoskeletal complaints. The neck and shoulders are the anatomic areas most affected; the elbows are least affected.
Although some information is reported concerning age, the high risk of bias in and between these studies makes it impossible to present reliable statements with respect to this. CONCLUSION: Musculoskeletal symptoms are highly prevalent among musicians, especially among women instrumentalists. Future research concerning the epidemiology of musculoskeletal complaints among musicians should focus on associated risk factors and follow the current guidelines to optimize scientific quality.
Kok LM, Nelissen RG, Huisstede BM. Prevalence and consequences of arm, neck, and/or shoulder complaints among music academy students: a comparative study. Med Probl Perform Art. 2015 Sep;30(3):163-‐8.
OBJECTIVE: CANS (complaints of arm, neck, and/or shoulder not caused by a systemic disease or acute trauma) are a recognized problem in specific occupational groups such as musicians. This study aimed to compare the prevalence, characteristics, and consequences of CANS between music academy students and a control group of peer-‐age medical students.
METHODS: A cross-‐sectional study among music academy students and medical students. Data were collected using a web-‐based questionnaire on musculoskeletal conditions of the upper extremity in the two cohorts.
RESULTS: Students of three music academies (n=345) and one medical university (n=2,870) received the questionnaire, of which 25% (n=87) and 18% (n=503) responded, respectively. The 12-‐month prevalence of CANS was nearly twice as high among music academy students as the control group (80.7% vs 41.5%, p<0.001). Music academy students reported 2.6 times the point prevalence as medical students (47.0% vs 18.2%, p<0.001). Chronic CANS was present in 36.1% of the music students, compared to 10.3% of the medical students (p<0.001). Music academy students presented more complaints per anatomic localization and a higher number of involved anatomic localizations. Music students rated the influence of CANS on daily functioning as more severe (5.0 vs 3.1, p<0.001). Of all subjects with CANS during the last year, more music academy students (46.3%) visited a healthcare professional compared to medical students (29.8%, p=0.013).
CONCLUSION: The prevalence of CANS is high in music academy students compared to medical students. This emphasizes the necessity of effective (preventive) interventions in these high-‐demanding professionals.
Kukowski B. Suprascapular nerve lesion as an occupational neuropathy in a semiprofessional dancer. Arch Phys Med Rehab. 1993;74(7):768-‐769.
ABSTRACT: A 25-‐year-‐old semi-‐professional dancer developed painless, isolated weakness of external rotation of the right arm. Physical examination
was otherwise normal. Electromyography showed selective partial denervation of the infraspinatus muscle. Stimulation of the suprascapular nerve at Erb's point demonstrated delayed conduction to the infraspinatus muscle. Clinical and electrophysiological findings implicated a distal lesion of the suprascapular nerve. Almost complete recovery of muscle function after 4 months of suspending the training program of Latin dances supports the view that the nerve injury occurred as an occupational neuropathy. It is assumed that repetitive, forceful movements of the arm with external rotation and abduction had induced compression of the nerve at the spinoglenoid notch.
Lee SH, Carey S, Dubey R, Matz R. Intervention program in college instrumental musicians, with kinematics analysis of cello and flute playing: a combined program of Yogic breathing and muscle strengthening-‐flexibility exercises. Med Probl Perform Art. 2012;27(2):85-‐94.
ABSTRACT: College musicians encounter health risks not dissimilar to those of professional musicians. Fifteen collegiate instrumental musicians participated in the intervention program of yogic-‐breathing and muscle-‐strengthening and flexibility exercises for 8 weeks. Pre-‐ and post-‐intervention data from the Health-‐Pain-‐Injury Inventory (HPI) and the Physical & Musical-‐Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians’ physical and musical-‐performance efficacy. HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits. The pre-‐intervention PME data showed a high level of musical efficacy (i.e., awareness of music technique, tone, and flow) but a low-‐ level of physical efficacy (i.e., awareness of posture, tension, and movement flexibility). Post-‐intervention data showed that the pro-‐ gram improved physical efficacy by increased awareness of posture and tension. In 2 volunteer musicians, kinematics motion analysis was conducted for exploratory purposes. Our cellist played the scale using a larger range of motion (ROM) in right shoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program. The flutist shifted the body weight from one foot to the other more in the second playing post-‐intervention. These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality. Findings from these case scenarios provide empirically based hypotheses for further study. We share our experience so that others may use our model and instruments to develop studies with larger samples.
Lonsdale K, Laasko E, Tomlinson V. Contributing factors, prevention, and management of playing-‐related musculoskeletal disorders among flute players internationally. Med Probl Perform Art. 2014; 29(3):155–162.
ABSTRACT: 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.
McCrary JM, Halaki M, Ackermann BJ. Effects of Physical Symptoms on Muscle Activity Levels in Skilled Violinists. Med Probl Perform Art. 2016;31(3):125-‐131.
BACKGROUND: Physical symptoms present in a large percentage of instrumental musicians at all levels of expertise, yet the impact of these symptoms on patterns of muscle use and perceived exertion during performance is still unclear. PURPOSE: Quantify the effects of physical symptoms on muscle activity and perceived exertion in skilled violinists during a range of bowing actions. METHODS: Fifty-‐five professional or university (undergraduate or postgraduate) violinists performed 5 randomly ordered 45-‐second musical excerpts designed to elicit a range of right arm bowing actions. Surface electromyography data were obtained from 16 muscles of the trunk, shoulder, and right arm during each excerpt performance. Sites of current physical symptoms were reported using a pre-‐test questionnaire. Average rating of perceived exertion (RPE) for the excerpt performances was obtained immediately after the final excerpt performance. RESULTS: Right upper trapezius muscle activity levels were significantly reduced in participants reporting right shoulder symptoms (p<0.05). Violinists with right wrist symptoms displayed global increases in average muscle activity across all investigated muscles (p<0.03). RPE did not differ significantly between any groups of symptomatic and asymptomatic participants. CONCLUSION: Differential muscle activity patterns appear between right shoulder symptomatic, right wrist symptomatic, and asymptomatic violinists,
presenting the possibility of altered biomechanical responses to physical symptoms that vary with symptom location.
McCrary JM, Halaki M, Sorkin E, Ackermann BJ. Acute warm-‐up effects in submaximal athletes: an EMG study of skilled violinists. Med Sci Sports Exerc. 2016 Feb;48(2):307-‐15. doi: 10.1249/MSS.0000000000000765.
BACKGROUND: Warm-‐up is commonly recommended for injury prevention and performance enhancement across all activities, yet this recommendation is not supported by evidence for repetitive submaximal activities such as instrumental music performance.
PURPOSE: The objective of this study is to quantify the effects of cardiovascular, core muscle, and musical warm-‐ups on muscle activity levels, musical performance, and subjective experience in skilled violinists. METHODS: Fifty-‐five undergraduate, postgraduate, or professional violinists performed five randomly ordered 45-‐s musical excerpts of varying physical demands both before and after a randomly assigned 15-‐min, moderate-‐intensity cardiovascular, core muscle, musical (technical violin exercises), or inactive control warm-‐up protocol. Surface EMG data were obtained for 16 muscles of the trunk, shoulders, and right arm during each musical performance. Sound recording and perceived exertion (RPE) data were also obtained. Sound recordings were randomly ordered and rated for performance quality by blinded adjudicators. Questionnaire data regarding participant pain sites and fitness levels were used to stratify participants according to pain and fitness levels. Data were analyzed using two-‐ and three-‐factor ANCOVA (surface EMG and sound recording) and Wilcoxon matched pairs tests (RPE). RESULTS: None of the three warm-‐up protocols had significant effects on muscle activity levels (P ≥ 0.10). Performance quality did not significantly increase (P ≥ 0.21). RPE significantly decreased (P < 0.05) after warm-‐up for each of the three experimental warm-‐ups; control condition RPE did not significantly decrease (P > 0.23). CONCLUSION: Acute physiological and musical benefits from cardiovascular, core muscle, and musical warm-‐ups in skilled violinists are limited to decreases in RPE. This investigation provides data from the performing arts in support of sports medical evidence suggesting that warm-‐up only effectively enhances maximal strength and power performance.
Miller C, Moa G. Injury characteristics and outcome at a performing arts school clinic. Med Probl Perform Art. 1998;13(3):120-‐124.
ABSTRACT: This study’s objective was to document the types of musculoskeletal injuries sustained by all artists at a local performing arts school along with the treatment outcomes and effectiveness from an on-‐campus arts medicine clinic during one year. The study design was a
retrospective chart review by an independent observer. The results showed 41 total injured artists, with an incidence of 19.5% for the school year. Dancers had the most injuries, followed by musicians, then theater majors and visual artists. The most common site of injuries for dancers was the foot/ankle, then the leg, hip, knee/back, and arm/shoulder. Musicians’ most common site of injury was the elbow, followed by the neck/shoulder and then the hand/wrist. 97.6% of all injuries resolved in an average of 4.5 weeks. No students missed any academic classes for these in-‐ juries. This on-‐campus arts medicine clinic was highly successful and effective in diagnosing and treating the artists’ injuries
Munro D. Injury patterns and rates amongst students at the National Institute of Circus Arts: an observational study. Med Probl Perform Art. 2014 Dec;29(4):235.
ABSTRACT: Despite the ever-‐growing global participation in circus arts, very little research has been conducted into injuries associated with this physical discipline. To date, no studies have examined the incidence of injuries in circus training institutions and schools. In this study, data were collected over an academic year from all student injury presentations to the physiotherapy staff at one Australian circus school. A total of 351 injuries resulting in 1,948 treatments occurred in 33 female and 30 male circus students. The most common mechanisms of injury were acrobatics/tumbling (23%), handstands (12%), adagio (11%), and Chinese pole (10%). The most commonly injured body parts were the ankle (25%), lumbar spine (14%), and shoulder (12%). Interestingly, combined spinal injuries (cervical, thoracic, and lumbar) contributed to 35% of all initial injuries. Females sustained 71% of all hip injuries, but only 33% of all forearm injuries. Males accounted for 59% of all ankle injuries. There were no significant gender-‐based differences in other body areas. Results indicated that there is no gender-‐based difference in the overall rate of injury. However, females sustained significantly higher rates of hip injuries and males presented with more forearm and ankle injuries, perhaps reflecting the specific form and style of circus training and contortion undertaken. Spinal injuries had the highest overall rate of initial and follow-‐up presentations, indicating that both preventative and rehabilitative strategies could be addressed. It is suggested that the most common mechanisms of injury reflect both the amount of time spent training specific disciplines and the extreme physical difficulties and demands placed on the body.
Price K, Watson AH. Postural problems of the left shoulder in an orchestral trombonist. Work. 2011;40(3):317-‐24. doi: 10.3233/WOR-‐2011-‐1238.
ABSTRACT: Professional musicians require a disciplined and balanced regime of practice and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work-‐
related injury. If practice or performance strategies are suddenly changed, permanent damage may occur even in a player with a mature, well-‐established technique. The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions. This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury. His personal approach to practice is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices. The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians.
Prisk VA, Hamilton WG. Fracture of the first rib in weight-‐trained dancers. Am J Sports Med. 2008;36(12):2444.
ABSTRACT: The article presents a case study of male ballet dancer patients with isolated shoulder pain due to rib stress fracture due to the weight training for partnering skills. The case report aims to increase the awareness for early recognition and proper pain-‐free return to dance management. The first rib stress fracture is treated by relative rest of the affected upper extremity and avoidance of painful activities.
Rickert D, Barrett M, Halaki M, Driscoll T, Ackermann B. A study of right shoulder injury in collegiate and professional orchestral cellists: an investigation using questionnaires and physical assessment. Med Probl Perform Art. 2012;27(2):65-‐73.
PURPOSE: Cellists sustain high levels of playing-‐related injury and are particularly susceptible to right shoulder pain, yet no studies have attempted to propose a mechanism for disease or establish possible causal factors. The aim of this study was to investigate shoulder injury levels and causes in two populations: professional orchestral cellists and college-‐level student cellists. METHODS: A questionnaire and physical testing protocol was applied to both groups of participants, eliciting information on lifestyle, playing habits, and self-‐ reported injury rates as well as physical data on shoulder strength, range of motion, and signs of injury. RESULTS: Right shoulder injuries are common among both student (20%) and professional (42%) cellists and seem to be associated with measures indicating potential lack of strength in the scapular stabilizers as well as potential degenerative changes in the rotator cuff. Significant differences were found in the lifestyle and playing habits of the two groups. There were increased signs of pain and stiffness in the professionals and evidence of decreased muscular support in the students. Male cellists showed less scapular stability; female cellists, however, generally had higher levels of pain.
CONCLUSIONS: These results indicate that injuries at the shoulder, potentially involving impingement-‐type pathologies, are a common cause of pain in cellists. Based on this study, future research for cello players could focus on targeted interventions, such as exercises for the scapular stabilizers and muscles of the rotator cuff.
Rickert DL, Halaki M, Ginn KA, Barrett MS, Ackermann BJ. The use of fine-‐wire EMG to investigate shoulder muscle recruitment patterns during cello bowing: the results of a pilot study. J Electromyogr Kinesiol. 2013 Dec;23(6):1261-‐8. doi: 10.1016/j.jelekin.2013.07.013. Epub 2013 Aug 12.
ABSTRACT: The physical mechanics of music making is important both in the prevention of injuries and in guiding how music is performed and taught. Electromyography has potential as a resource in understanding the loads involved in instrumental playing; however, only a small number of projects have been undertaken, and little is understood on the muscle activity used during bowing on string instruments. This study aimed to measure the muscle activity at the bowing shoulder of a cellist during cello playing and to establish if fine-‐wire EMG is useful in understanding muscle recruitment in string players without interfering with normal playing ability. This project used a combination of fine-‐wire and surface EMG to evaluate the muscular load placed on the right shoulder of a professional cellist whilst playing a set of various bowing exercises. The results indicated that different bowing techniques produced statistically different muscle activity levels, with the supraspinatus muscle in particular maintaining higher mean contraction (20% MVC) during all bowing patterns tested. Fine-‐wire EMG was useful in measuring shoulder muscle load and did not interfere with normal playing technique of the subject. Overall, the study presents a working protocol from which future studies may be able conduct further research.
Riley K, Coons EE, Marcarian D. The use of multimodal feedback in retraining complex technical skills of piano performance. Med Probl Perform Art. 2005;20(2):82-‐88.
ABSTRACT: Piano students working to improve technique often practice the same passage over and over to achieve accuracy, increase speed, or perfect interpretive nuance. However, without proper skeletal alignment of hands, arms, and shoulders and balance between the muscles involved, such repetition may lead to difficulties with, rather than mastery of, technique and stylistic interpretation and even physical injury. A variety of technologies have been developed to monitor skeletal alignment and muscle balance that serve to help students and teachers make needed corrections during performance by providing immediate biofeedback. This paper describes and illustrates a multimodal use of these biofeedback technologies and the powerful advantages of such a multimodal approach in making the student and teacher not only aware of improper alignments and balances in real time
(or for later review) but also aware of approaches to correct them and improve musical outcome. The modalities consist of hearing playback through a Disklavier piano; simultaneous visual feedback displayed as a piano roll screen of what was played; video recording synchronized with the Disklavier and piano roll feedback; motion analysis of the arms, hands, and fingers; and electromyographic recordings of the muscle actions involved.
Sides S, Ambegaonkar J, Caswell S. High incidence of shoulder injuries in collegiate modern dance students. Athletic Therapy Today [serial online]. 2009;14(4):43-‐46. Accessed August 30, 2017.
ABSTRACT: This article discusses the high incidence of shoulder injuries to collegiate modern dance students. Studies show that the unique blend of artistry and athleticism involved in modern dance has resulted in a very high injury rate over the course of a dance season. Certain dance styles might predispose dancers to certain types of injuries to the knees, hips, and shoulders. Unusual movements and no cross-‐training can increase shoulder injuries. Upper-‐body exercises for dancers are discussed.
Sohl P, Bowling A. Injuries to dancers. Prevalence, treatment and prevention. Sports Med. 1990;9(5):317-‐22.
ABSTRACT: Studies from the USA and UK indicate that the back, neck and shoulder and the lower limb (particularly the hip, knee, ankle and foot) are the most frequent sites of injury among dancers. Most injuries are soft tissue injuries. Most dancers experience injuries at some time and about half have chronic injuries. Shoulder injuries appear to be caused by frequent or unaccustomed lifting, and are treated by rest and oral anti-‐inflammatory medication. Back injuries include sprains, prolapsed or herniated intervertebral discs, and spondylolytic stress fractures. Several risk factors, especially training error, have been identified for overuse injuries. Hip injuries include degenerative changes and osteoarthritis, stress fractures, bursitis and damage to the sciatic nerve. The most common foot injury is an anterior lateral ligament sprain, which may lead to permanent instability in the ankle. More soundly based research into the prevalence, diagnosis and treatment of injuries is needed.