Bronwen J. Ackermann

Psychological well-being in professional orchestral musicians in Australia: A descriptive population study:

We report the major findings from the psychosocial questionnaire component of a cross-sectional population survey of the musicians in Australia’s eight full-time professional symphonic and pit orchestras. The response rate was 70% (n = 377). Female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians (<30 years) were significantly more anxious compared with the oldest musicians (51+). The youngest female musicians were most affected by music performance anxiety. Music performance anxiety was lowest for the older musicians (51+ years). Thirty-three per cent of musicians may meet criteria for a diagnosis of social phobia. Twenty-two per cent answered in the affirmative to a question screening for post-traumatic stress disorder. Thirty-two per cent returned a positive depression screen; this subgroup had higher scores on the anxiety measures. Linear regression analysis identified the State-Trait Anxiety Inventory (STAI-T), the Social Phobia Inventory (SPIN), the Anxiety and Depression Detector (ADD) and age as independent predictors of music performance anxiety severity. Significant numbers of musicians drank alcohol in a manner outside the National Health and Medical Research Council (NHMRC) alcohol guidelines (2009); only 6% were current smokers. This study has identified a significant pattern of anxiety, depression and health behaviours that require attention in occupational health and safety policies and programmes for this workforce.

Performance-related musculoskeletal pain, depression and music performance anxiety in professional orchestral musicians: A population study

We examined self-reported frequency and severity of performance-related musculoskeletal pain disorder (PRMD), trigger point pain (TPP) and depression, social phobia (SPIN) and music performance anxiety (MPA) using the Kenny Music Performance Anxiety Inventory (K-MPAI) in a cross-sectional survey of 377 professional orchestral musicians. Most (84%) musicians had experienced performance-impairing pain; 50% reported current pain. Females reported more performance-impairing pain and more current pain than males. Cluster analysis indicated a complex relationship between depression and PRMD severity. Three clusters showed the hypothesized relationship (i.e., more depression, more pain). Musicians in the fourth cluster denied depression but reported the most severe pain, suggesting a group who somatize their psychological distress. Cluster analysis also revealed a strong relationship between PRMD severity and MPA. Clusters with higher scores on K-MPAI reported higher scores on PRMD severity. TPP was not associated with self-reported PRMD frequency or severity. There was a significant linear relationship between TPP and MPA for females, but males scoring the highest MPA reported lower TPP than those with milder MPA. Neither SPIN nor beta blocker use was associated with PRMD frequency or severity. The complex relationships identified between PRMD, TPP, depression and MPA may have important implications for PRMD management in professional musicians.

Sound Practice- Improving occupational health and safety for professional orchestral musicians in Australia

The Sound Practice Project is a 5-year study involving baseline evaluation, development, and implementation of musician-specific work health and safety initiatives. A cross-sectional population physical and psychological survey and physical assessment were conducted at the same time, with an auditory health assessment conducted later. The results were used to guide the development of a series of targeted interventions, encompassing physical, psychological, and auditory health components. This paper provides an overview of the project but focuses on the health findings arising from the cross-sectional survey. Three hundred and seventy-seven musicians from the eight professional symphony orchestras in Australia took part in the cross-sectional study (about 70% of eligible musicians). Eighty-four percent (84%) of musicians reported past performance-related musculoskeletal disorder (PRMD) episodes; 50% were suffering a current PRMD. Of the 63% who returned hearing surveys, 43% believed they had hearing loss, and 64% used earplugs at least intermittently. Noise exposure was found to be high in private practice, although awareness of risk and earplug use in this environment was lower than in orchestral settings. Improved strategic approaches, acoustic screens and recently developed active earplugs were found to provide effective new options for hearing protection. With respect to psychosocial screening, female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians were significantly more anxious compared with the oldest musicians. Thirty-three percent (33%) of musicians may meet criteria for a diagnosis of social phobia; 32% returned a positive depression screen and 22% for post-traumatic stress disorder (PTSD). PRMDs and trigger point discomfort levels were strongly associated with increasing severity of psychological issues such as depression and music performance anxiety.

A systematic review of the effects of upper body warm-up on performance and injury

Purpose This systematic review was conducted to identify the impact of upper body warm-up on performance and injury prevention outcomes. Methods Web of Science, MEDLINE, SPORTDiscus, PsycINFO and Cochrane databases were searched using terms related to upper extremity warm-up. Inclusion criteria were English language randomised controlled trials from peer-reviewed journals in which investigation of upper body warm-up on performance and injury prevention outcomes was a primary aim. Included studies were assessed for methodological quality using the PEDro scale. A wide variety of warm-up modes and outcomes precluded meta-analysis except for one group of studies. The majority of warm-ups were assessed as having ‘positive’, ‘neutral’, ‘negative’ or ‘specific’ effects on outcomes. Results Thirty-one studies met the inclusion criteria with 21 rated as having ‘good’ methodological quality. The studies investigated a total of 25 warm-up modes and 43 outcome factors that could be grouped into eight mode and performance outcome categories. No studies of upper body warm-up effects on injury prevention were discovered. Conclusions Strong research-based evidence was found for the following: high-load dynamic warm-ups enhance power and strength performance; warm-up swings with a standard weight baseball bat are most effective for enhancing bat speed; short-duration static stretching warm-up has no effect on power outcomes; and passive heating/cooling is a largely ineffective warm-up mode. A clear knowledge gap in upper body warm-up literature is the lack of investigation of injury prevention outcomes.

Predictors of music performance anxiety during skilled performance in tertiary flute players

This study predicted music performance anxiety in skilled flute players. Participants played two orchestral excerpts under audition conditions. Prior to the performance, participants completed the State (STAI-S) and Trait (STAI-T) Anxiety questionnaires from the State–Trait Anxiety Inventory (STAI), the Kenny Music Performance Anxiety Inventory (K-MPAI) and the Fear of Negative Evaluation (FNE). They also had electromyography (EMG) and electrocardiography (ECG) measures taken before and during their performances and provided information on their musical achievements and how much time they had spent practicing the test pieces. Specially developed rating scales assessed prior level of musical achievement. Hierarchical regression analysis assessed relationships between each group of variables entered and music performance anxiety assessed with K-MPAI. The final model included the anxiety measures (STAI-T, STAI-S, FNE), a rating of the highest level of achievement as a soloist, number of minutes they practiced the test piece, and the physiological measures (EMG and heart rate [HR]). This model accounted for 70.4% of the variance in music performance anxiety (MPA) but only STAI-S and FNE contributed significant unique variance to the prediction of it. A number of methodological issues were identified in studies on music performance anxiety, and suggestions made for the conduct of future research into music performance anxiety.

Effect of a musicians' exercise intervention on performance-related musculoskeletal disorders

PURPOSE To evaluate the effect of a purpose-designed exercise program on performance-related musculoskeletal disorders (PRMDs) and associated risk factors in a sample of professional orchestral musicians. METHODS A 10-week exercise program was made available to full-time musicians employed by the eight premier symphony orchestras of Australia. Questionnaires were administered before, immediately after (T1), and 6 months after interventions (T2) containing questions relating to change in frequency and severity of PRMDs, ratings of perceived exertion (RPE) during rehearsal, private practice, and performance, as well as nine performance-related factors. Participants were also asked to rate whether these performance-related factors affected their overall playing capacity during different playing situations. A comparative control group of musicians had no intervention and completed a modified questionnaire at the same time points. RESULTS Exercise participants (n=30) reported a reduction in frequency (p<0.05) and severity (p<0.05) of PRMDs at T1 but not at T2 compared to controls (n=23). The exercise group reported a significant improvement in RPE during private practice at T1 (p<0.01) and T2 (p<0.01), but not during rehearsal and performance. At T1, the intervention was rated to be moderately to highly effective for three performance-related factors: strengthening muscles that support playing, learning techniques that support playing, and posture. Further, participants reported an intervention effect on overall playing capacity during rehearsal at T1 and T2. CONCLUSIONS A tailored exercise program for musicians was effective at managing PRMDs, especially in reducing the frequency and severity of PRMDs. Physical therapy exercises should be considered in modifying performance-related factors that have been reported to be predictors of PRMDs.

Exercise DVD effect on musculoskeletal disorders in professional orchestral musicians

BACKGROUND Professional musicians report a high prevalence of performance-related musculoskeletal disorders (PRMDs). Excessive muscle tension and fatigue have been reported as important factors contributing to PRMDs. AIMS To evaluate feasibility and effectiveness of a specific exercise programme delivered via a digital video disc (DVD) targeting PRMDs and associated risk factors. METHODS Volunteers from eight Australian symphony orchestras undertook two or more sessions per week over 12 weeks. Questionnaires were administered pre- and post-intervention with items including the frequency and severity of PRMDs, perceived exertion during different playing situations, per formance effects of the DVD and satisfaction rates. Musicians who had also participated in an equivalent face-to-face programme prior to this DVD trial compared the two interventions. RESULTS One hundred and forty-four out of 576 musicians volunteered (25% uptake), and 50 participants completed a mean 2.1 (SD 0.42) sessions over the 12 week period (41% compliance). PRMD frequency and severity were significantly reduced post-intervention (P < 0.01). Participants reported benefits of the DVD on strengthening muscles, increasing ease of movement and improving flexibility related to playing. Despite this, perceived exertion levels during private practice, rehearsal and performance remained the same (not significant). Seventy-eight per cent of participants scored their overall experience of the use of the DVD as good or excellent. Owing to its convenience and detailed exercise demonstrations, the DVD was rated as better or much better overall than the face-to-face classes by 55% of participants who had experienced both. CONCLUSIONS An exercise DVD was well received and appeared to be effective, convenient and safe in managing occupational-specific musculoskeletal disorders in musicians.

Sound exposure of professional orchestral musicians during solitary practice

It is broadly acknowledged that professional orchestral musicians risk noise-induced hearing pathologies due to sound exposure in rehearsal and performance. While much has been published regarding orchestral sound levels, little is known of the sound exposure these musicians experience during solitary practice, despite the many hours they spend engaged in this activity. This study aimed to determine sound exposure during solitary practice of 35 professional orchestral musicians, representing players of most orchestral instruments. To allow cross-comparison, participants were assessed playing similar repertoire in a controlled environment, recording simultaneously at each ear to determine sound exposure levels. Sound levels were recorded between 60 and 107 dB L(Aeq), with peak levels between 101 and 130 dB L(C,peak). For average reported practice durations (2.1 h per day, five days a week) 53% would exceed accepted permissible daily noise exposure in solitary practice, in addition to sound exposure during orchestral rehearsals and performances. Significant inter-aural differences were noted in violin, viola, flute/piccolo, horn, trombone, and tuba. Only 40% used hearing protection at any time while practicing. These findings indicate orchestral musicians at risk of noise-induced hearing loss in ensemble face significant additional risks during solitary practice. Data presented will enable more effective and targeted management strategies for this population.

Hearing and hearing conservation practices among Australia's professional orchestral musicians

Orchestral musicians are an at-risk population for noise-induced hearing loss. Following strategic approaches to mitigate exposure, many must use earplugs to safeguard their hearing, although reported usage rates are poor. Australia has progressive hearing conservation programs within many of its orchestras, yet little is known of earplug usage rates, abilities with earplugs or self-perceived hearing loss in this population. To help direct and inform future approaches to hearing conservation in Australias orchestras a questionnaire assessing hearing conservation behaviors and the prevalence of self-perceived hearing loss was distributed. A total of 580 musicians across eight professional orchestras were surveyed, with 367 completed surveys (63%) returned. Eighty percent of respondents reported a risk of hearing damage in the orchestra, 64% used earplugs of some type at least some of the time and 83% found this use difficult/impossible. Forty-three percent reported a hearing loss, including 54% in pit orchestras and 46% of those ≤50 years of age. Brass players were least likely to use earplugs, most likely to report usage difficulties and most likely of those ≤50 years of age to report a hearing loss. While earplug usage rates in Australia are encouraging and may be linked to hearing conservation measures in the orchestras, the widespread difficulty reported with the use of these earplugs, the prevalence of self-reported hearing loss and the continued vulnerability of those most at-risk indicate improvements in both earplug design and further education for musicians are required to progress hearing conservation options for this population.

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.