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Overuse injuries are generally defined as a repetitive micro-trauma to tissue. Many researchers have associated particular biomechanical parameters as an indicator of such injuries. However, while these parameters have been reported in single studies, in many instances, it has been difficult to verify these parameters as causative to the injury. We have investigated overuse injuries, such as patella-femoral pain syndrome, using a dynamical systems approach. Using such methods, the importance of the structure of coordinative variability (i.e. the variability of the interaction between segments or joints) becomes apparent. We view coordinative variability as functionally important to the movement and different from end-point or goal variability. Using concepts derived from the work of Bernstein, we conducted studies using a continuous relative phase and/or modified vector coding approaches to investigate the coordinative variability of overuse injuries. Consistently, we have found that the higher variability state of a coordinative structure is the healthy state while the lower variability state is the unhealthy or pathological state. It is clear that very high coordinative variability could also result in injury and that there must be a window of 'higher variability' in which non-injured athletes function. While this finding that coordinative variability is functional has been shown in several studies, it is still not clear if reduced variability contributes to or results from the injury. Studies are currently underway to determine the potential reasons for the reduced variability in injured athletes. Nevertheless, our laboratory believes that this understanding of how joints interact can be important in understanding overuse injuries. Keywords: Variability, Coordination, Dynamical systems, Overuse injury

\"The Feldenkrais Method is a self-discovery process using movement that aims for performance with minimum effort and maximum efficiency-it can help musicians hone their bodies to perfect a balance of strength, skills, and agility. This guide to the Method for instrumentalists includes many beneficial exercises, activities, and case studies\"-- Provided by publisher.

This easibility cohort study follows a prior randomized control pilot trial that examined the feasibility and impact of a formal Musculoskeletal Health for Musicians (MHM) program. In this follow-up study, an expanded program was designed to target hand and arm pain by adding exercises for the wrist, elbow, forearm, and hand intrinsic muscles. The MHM program combines education with exercise instruction to prevent pain and injury in musicians. The aim of this study was to design and implement an expanded MHM program targeted at arm and hand pain and formally assess feasibility and overall adherence and changes in performance-related pain scores. The hypothesis was that the program would be feasible and high adherence to the expanded MHM program would lead to improvements in patient-reported hand and arm pain. Feasiblity Cohort Study Musicians were administered a questionnaire prior to and after implementation of the expanded MHM program. The questionnaire collected data on practice habits, type of instrument, number of years of playing, and instrument playing level. The validated, Musculoskeletal Pain Interference and Impact Questionnaire for Musicians (MPIIQM) was used to collect data at baseline and ≥1 month after implementation of the MHM. It included categories related to frequency, intensity, duration and location of pain, and impact of pain on playing habits. A customized survey (rated 1–5) captured adherence across five categories. The two-part expanded MHM program included a 30-minute lecture on overuse injuries, musculoskeletal pain conditions, and anatomy related to performance mechanics, with extra focus on the hand and arm anatomy. The second, 70-minute component included a workshop covering five domains: warm up exercises, pacing/breaks, posture/playing positions, “smart” practice habits, and specific pre-performance and exercises plus the hand specific program. The exercise section contained an additional 10-minute module focused on hand exercises. All 48 subjects recruited for the study participated in the expanded 100-minute MHM program suggesting that attending such a program is feasible. Of these patients only 17 responded to the follow-up survey and were included in the final analysis. The mean age was 24 ± 7 years 71% female, and 29% male. Participants played their instrument for an average of 16 ± 7 years and practiced an average of 14 ± 9.5 h/wk. At baseline, the pain level was 4.5/10 and did not change at follow up (4.5/10). Our preliminary results demonstrated low adherence to the MHM in 3/5 domains (smart practice, posture, pacing) and high adherence in physical warm-up and exercises. An expanded MHM program targeting the hand and arm is feasible to implement and yielded high participation at multiple higher education music programs. Compared to our pilot study, we had a lower response rate for follow-up and overall adherence, likely due to less follow-up time points, and absence of weekly reminders. High adherence to pacing guidelines, posture recommendations, and smart practice habits were related to pain reduction in our previous study. The low adherence numbers here may reflect the weak outcome. •MHM program focuses on arm and hand pain, teaches specific exercises.•35% of musicians completed surveys; low adherence to practice and posture.•No significant pain reduction observed, indicating adherence challenges.•Need for tailored, long-term interventions to reduce musician pain highlighted.

Even though practicing sports has great health benefits, it also entails a risk of developing overuse injuries, which can elicit a negative impact on physical, mental, and financial health. Being able to predict the risk of an overuse injury arising is of widespread interest because this may play a vital role in preventing its occurrence. In this paper, we present a machine learning model trained to predict the occurrence of a lower-limb overuse injury (LLOI). This model was trained and evaluated using data from a three-dimensional accelerometer on the lower back, collected during a Cooper test performed by 161 first-year undergraduate students of a movement science program. In this study, gender-specific models performed better than mixed-gender models. The estimated area under the receiving operating characteristic curve of the best-performing male- and female-specific models, trained according to the presented approach, was, respectively, 0.615 and 0.645. In addition, the best-performing models were achieved by combining statistical and sports-specific features. Overall, the results demonstrated that a machine learning injury prediction model is a promising, yet challenging approach.

•Different instruments have specific demands and injuries from unique ergonomics.•Treatment plans for of overuse injuries should be musician-centered.•A framework helps customize patient-centered approaches to prevention and treatment. Invited Clinical Commentary Performance related musculoskeletal disorders (PRMD) are common in instrumental musicians and often affect the upper extremities. These overuse injuries typically result from inadequate attention to the musculoskeletal demands required for the high-level performance of musician-students and experienced instrumentalists.1 PRMDs often interfere with career trajectory, and in extreme cases, can be career ending. Many clinicians and healthcare practitioners treating upper extremity injuries are not familiar with the specific demands faced by instrumental musicians and how to tailor treatment and prevention strategies to the specific risks and occupational needs of each instrumental group. This paper describes an evidenced-based framework for the assessment, prevention, and treatment of musculoskeletal musician injuries to provide clinicians with an instrument-specific, and musician-centered guide for practice. We synthesized available literature on instrumental ergonomics, biomechanical demands, and upper extremity injuries to highlight the risks and common upper-extremity pathologies, focusing on the specific demands of instrumental groups: piano, high strings (violin and viola), low strings (cello and bass), percussion, woodwinds, and brass. Targeted assessment, prevention, and treatment strategies are reviewed in this context to provide healthcare providers with an evidence-based framework to approach the treatment of PRMD to mitigate incidence of injury during practice and performance. A comprehensive search of electronic databases was conducted including all study designs. This review describes risk factors for PRMD in instrumental musicians, strategies to prevent misuse and performance injury, and musician-centered interventions to allow playing while reducing risk of misuse. The suggested assessment and treatment framework can assist clinicians with a customized patient-centered approach to prevention and treatment by addressing the gap in clinical knowledge with the goal of ultimately reducing the incidence and severity of PRMD in musicians.

Objectives To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. Methods A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Results A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences ( p  = 0.052–0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). Conclusion The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Background: Excessive foot pronation may be attributed to an increasing burden on leg muscles during running, which might be a factor in medial tibial stress syndrome. We developed an elastic foot orthosis (EFO) that can decrease foot pronation and aimed to identify whether this orthosis could limit the increase in lower leg muscle hardness after running. Methods: Twenty-one healthy volunteers participated in this randomized crossover trial with an elastic or sham foot orthosis (SFO). All volunteers ran on a treadmill for 60 min while wearing either orthosis. Muscle hardness of the posterior lower leg was assessed using shear wave elastography before and after running. The Wilcoxon signed rank test was used to compare muscle hardness between the two orthotic conditions. Results: No significant differences were observed between the two orthotic conditions before running (p > 0.05). After running, the flexor digitorum longus (FDL) hardness in the EFO group was significantly lower than that in the SFO group (p < 0.01). No significant changes were observed in the other muscles. Conclusion: The results suggest that the EFO can restrict the increase in FDL hardness with running. The EFO may be an effective orthotic treatment for medial tibial stress syndrome.

Music performance requires a high degree of physical skill, yet until recently, musical training has paid little attention to the considerable demands made on the mind and body. The Biology of Musical Performance and Performance-Related Injury presents singers and instrumentalists with accurate information on the physical processes that underlie their craft. The book provides a concise overview of the biological principles associated with performance technique while assuming no prior scientific knowledge, making it accessible to both musicians and to health professionals who treat performance-related medical conditions. Author Alan H. D. Watson explains the concepts and techniques of music performance, discussing themes such as posture and the back; movements of the arm and hand and associated problems; breathing in singers and wind players; the embouchure and respiratory tract in wind playing; the larynx and vocal tract in singers; the brain and its role in skill acquisition and aural processing; and stress and its management. Watson offers performers and teachers the tools they need to create a rational approach to the development and communication of technique. He also provides insight into the origins of performance-related injury, helping to reduce the risk of such problems by encouraging a technique that is sustainable in the long term. Each chapter includes several illustrations and an extensive bibliography for further reading. To support the text, a CD-Rom is included, featuring original diagrams that clearly illustrate the relevant aspects of body structure and function, explaining and illuminating key concepts through an extensive set of animations, sound files, and videos.

This book equips music educators with everything they need to know to prevent common injuries. Using principles of ergonomics and body mechanics, it approaches teaching music from the standpoint of wellness, giving music educators practical advice on how to intervene before pain interferes with performance.