Musicians are at a significant risk of occupational diseases that can adversely affect their careers. If timely diagnosis and proper treatment are not provided, they may be forced to take a break from or even end their careers. Therefore, early diagnosis is crucial to solving problems without forcing artists to step away from their careers.

Complaints in musicians are studied in five stages:

Stage 1: Pain occurs after lessons, exercises, rehearsals, or performances. It does not affect performance.

Stage 2: Pain occurs during lessons, exercises, rehearsals, or performances but does not cause restrictions in performance.

Stage 3: Pain occurs during lessons, exercises, rehearsals, or performances and starts to affect daily life. The artist feels the need to change their technique or shorten their practice time.

Stage 4: Pain begins as soon as lessons, exercises, rehearsals, or performances start and prevents further performance. It significantly affects daily life.

Stage 5: There is pain in all daily activities. The artist cannot participate in lessons, exercises, rehearsals, or performances.

Several risk factors contribute to musculoskeletal injuries in musicians, which are classified into three groups:

Environmental Factors:

Temperature, work area, the placement of equipment, technical materials used and their arrangement, flooring, and lighting.

Physical Factors:

Poor posture, repetitive and forceful movements, long working hours, falls and impacts, vibrations.

Personal Factors:

Age and gender, physical fitness (strength, flexibility, endurance), nutrition, posture, habits (smoking, alcohol, etc.), psychological stress, and general health factors (pregnancy, diabetes, osteoporosis).

The most common scenario in musicians involves the increased presence of a single risk factor or the combination of multiple risk factors. Performance anxiety, intense work and performance schedules, and irregular or inadequate nutrition also play a role in causing injuries.

Prevention of musculoskeletal injuries in musicians occurs in two stages:

1. Control of Risk Factors: Knowing personal limits (balancing physical and psychological expectations), maintaining good general health.
2. Early Detection and Prevention: Identifying early signs of injury (when pain is at stage 1 or 2) and seeking professional medical help.

However, musicians typically seek help only when pain reaches stage 3 or 4.

Musculoskeletal Injuries in Musicians

Musculoskeletal injuries in musicians are classified into four groups:

• Tendon issues (tendinitis, tenosynovitis)
• Cramps (focal dystonia)
• Muscle strains
• Nerve compression in the face, neck, back, arms, and hands

Tendon Issues:

Tendons are cord-like structures that do not have the ability to stretch. They are surrounded by a sheath that provides lubrication. Tendon injuries result from excessive stretching or friction caused by repetitive movements. Tendinitis and tenosynovitis occur near the joints due to stretching, increased friction, and improper positioning. Over-stretching or direct trauma to the tendon leads to damage on the surface, which heals with repair tissue. Repeated trauma causes thickening and further damage to the tendon, and the sheath may also thicken, limiting movement.

Focal Dystonia:

Focal dystonia is a functional disorder where a specific muscle experiences cramping, fatigue, loss of coordination, and involuntary flexion or extension of the joint. It can be either painful or painless and interferes with playing a musical instrument. Cramps may not occur in all cases. Prolonged practice, rehearsal, or performance can cause muscle stiffness or cramps, and focal dystonia may also occur at rest. Typical locations for focal dystonia include the hands and fingers for string and keyboard instrument players.

Muscle strains:

Different muscles are at risk in musicians. The type of musical instrument, the playing technique, and the posture during performance are all important. In string and keyboard instruments, issues commonly arise in the hand muscles, shoulder muscles (rotator cuff), forearm, and neck muscles. In wind instruments, problems often involve the muscles around the mouth, the jaw joint, neck, and hand muscles. In percussionists, forearm muscle and Achilles tendon problems are more prominent.

Nerve entrapments:

Peripheral nerves, after separating from the central nervous system, follow specific anatomical spaces in the upper and lower extremities. Peripheral nerves include both motor nerves that control muscles and sensory nerves. For coordinated movements, both types of nerves must function properly. In nerve entrapments (entrapment neuropathies), the issue is that peripheral nerves become compressed in specific areas along their path.

Carpal tunnel syndrome:

It occurs due to compression of the median nerve at the wrist level. It manifests with pain and numbness in the thumb, index, and middle fingers. Repetitive and/or prolonged wrist flexion is believed to contribute to the development of carpal tunnel syndrome symptoms. The left hand of violin, viola, and guitar players is generally at risk.

Cubital tunnel syndrome:

It is caused by compression of the ulnar nerve at the elbow level. It presents with pain, numbness, and tingling extending from the elbow to the fourth and fifth fingers. A posture requiring prolonged elbow flexion and supination (palm facing upward) poses a risk for cubital tunnel syndrome. The left hand of violin, viola, and guitar players is at risk.

Thoracic outlet syndrome:

It arises from compression of the brachial plexus (the junction area of nerves going to the arm) at the shoulder level. It presents with symptoms similar to carpal tunnel or cubital tunnel syndrome. Due to clamping the instrument between the chin and shoulder, violin and viola players are at risk. Because of posture, pianists and transverse flute players also face a risk of thoracic outlet syndrome.

Sciatalgia:

It occurs as a result of compression of the sciatic nerve around the hip. Musicians who have to sit slightly leaning forward or sideways for long periods may experience sciatalgia and lower back pain. The pain spreads along the course of the sciatic nerve.