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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.

\"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 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.

BackgroundShoulder problems are highly prevalent among elite handball players. Reduced glenohumeral rotation, external rotation weakness and scapula dyskinesis have been identified as risk factors.AimEvaluate the effect of an exercise programme designed to reduce the prevalence of shoulder problems in elite handball.Methods45 elite handball teams (22 female teams, 23 male teams, 660 players) were cluster randomised (22 teams, 331 players in the intervention group, 23 teams, 329 players in the control group) and followed for 1 competitive season (7 months). The Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Programme, an exercise programme to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility, was delivered by coaches and captains 3 times per week as a part of the handball warm-up. The main outcome measures, prevalence of shoulder problems and substantial shoulder problems, were measured monthly.ResultsThe average prevalence of shoulder problems during the season was 17% (95% CI 16% to 19%) in the intervention group and 23% (95% CI 21% to 26%) in the control group (mean difference 6%). The average prevalence of substantial shoulder problems was 5% (95% CI 4% to 6%) in the intervention group and 8% (95% CI 7% to 9%) in the control group (mean difference 3%). Using generalised estimating equation models, a 28% lower risk of shoulder problems (OR 0.72, 95% CI 0.52 to 0.98, p=0.038) and 22% lower risk of substantial shoulder problems (OR 0.78, 95% CI 0.53 to 1.16, p=0.23) were observed in the intervention group compared with the control group.ConclusionsThe OSTRC Shoulder Injury Prevention Programme reduced the prevalence of shoulder problems in elite handball and should be included as a part of the warm-up.Trial registration numberISRCTN96217107.

ObjectivesRhythmic gymnastics is an Olympic sport that demands high training volume from early age. We investigated the extent of, and risk factors for, injuries among competitive Norwegian rhythmic gymnasts.MethodsOne hundred and seven of 133 (80.5%) female rhythmic gymnasts (mean age: 14.5 years (SD 1.6), mean body mass index: 18.9 (SD 2.2)) participated. All gymnasts completed a baseline questionnaire and the ‘Triad-Specific Self-Report Questionnaire’. Injuries, illnesses and training hours were recorded prospectively for 15 weeks during preseason using the ‘Oslo Sports Trauma Research Center Questionnaire on Health Problems’ (OSTRC-H2).ResultsResponse rate to OSTRC-H2 was 97%. Mean overuse and acute injury prevalence were 37% (95% CI: 36% to 39%) and 5% (95% CI: 4% to 6%), respectively. Incidence was 4.2 overuse injuries (95% CI: 3.6 to 4.9) and 1.0 acute injuries (95% CI: 0.5 to 1.6) per gymnast per year. Overuse injuries in knees, lower back and hip/groin represented the greatest burdens. Previous injury increased the odds of injury (OR 30.38, (95% CI: 5.04 to 183.25)), while increased age (OR 0.61 per year, (95% CI: 0.39 to 0.97)) and presence of menarche (OR: 0.20, (95% CI: 0.06 to 0.71)) reduced the odds of all injuries and substantial injuries, respectively.ConclusionsOveruse injuries were common among Norwegian rhythmic gymnasts. Younger gymnasts had higher all-injury risk. Gymnasts who were not menstruating had higher substantial injury risk. Injury prevention interventions should start at an early age and focus on preventing knee, lower back and hip/groin injuries.

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.

ObjectivesTo evaluate the effectiveness of prefabricated foot orthoses for the prevention of lower limb overuse injuries in naval recruits.MethodsThis study was a participant-blinded and assessor-blinded, parallel-group randomised controlled trial. Three-hundred and six participants aged 17–50 years who undertook 11 weeks of initial defence training at the Royal Australian Navy Recruit School (Cerberus, Australia) were randomised to a control group (flat insoles, n=153) or an intervention group (contoured, prefabricated foot orthoses, n=153). The combined incidence of medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain during the 11-week training period were compared using incidence rate ratios (IRR). Data were analysed using the intention-to-treat principle.ResultsSixty-seven injuries (21.9%) were recorded. The control and intervention group sustained 40 (26.1%) and 27 (17.6%) injuries, respectively (IRR 0.66, 95% CI 0.39 to 1.11, p=0.098). This corresponds to a 34% reduction in risk of developing medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy or plantar fasciitis/plantar heel for the intervention group compared with the control group. Participants in the prefabricated orthoses group were more likely to report at least one adverse event (20.3% vs 12.4%; relative risk (RR) 1.63, 95% CI 0.96 to 2.76; p=0.068; number needed to harm 13, 95% CI 6 to 253). The most common adverse events were foot blisters (n=20, 6.6%), arch pain (n=10, 3.3%) and shin pain (n=8, 2.6%).ConclusionPrefabricated foot orthoses may be beneficial for reducing the incidence of lower limb injury in naval recruits undertaking defence training.Trial registration numberAustralian New Zealand Clinical Trials Registry: ACTRN12615000024549.

Running is associated with a higher risk of overuse injury than other forms of aerobic exercise such as walking, swimming and cycling. An accurate description of the proportion of running injuries per anatomical location and where possible, per specific pathology, for both genders is required. The aim of this review was to determine the proportion of lower limb running injuries by anatomical location and by specific pathology in male and female runners (≥800m - ≤ marathon). The preferred reporting items for systematic reviews and meta-analyses guidelines were followed for this review. A literature search was performed with no restriction on publication year in Web of Science, Scopus, Sport-Discus, PubMed, and CINAHL up to July 2017. Retrospective, cross-sectional, prospective and randomised-controlled studies which surveyed injury data in runners were included. 36 studies were included to report the overall proportion of injury per anatomical location. The overall proportion of injury by specific pathology was reported from 11 studies. The knee (28%), ankle-foot (26%) and shank (16%) accounted for the highest proportion of injury in male and female runners, although the proportion of knee injury was greater in women (40% 31%). Relative to women, men had a greater proportion of ankle-foot (26% 19%) and shank (21% 16%) injuries. Patellofemoral pain syndrome (PFPS; 17%), Achilles tendinopathy (AT; 10%) and medial tibial stress syndrome (MTS; 8%) accounted for the highest proportion of specific pathologies recorded overall. There was insufficient data to sub-divide specific pathology between genders. The predominate injury in female runners is to the knee. Male runners have a more even distribution of injury between the knee, shank and ankle-foot complex. There are several methodological issues, which limit the interpretation of epidemiological data in running injury.

Correspondence to Professor Tim J Gabbett, Gabbett Performance Solutions, Brisbane, QLD, Australia and University of Southern Queensland, Institute for Resilient Regions, Ipswich, QLD, Australia; tim@gabbettperformance.com.au Introduction A substantial amount of research has tested the relationship between training load and injury.1 Given that sports injuries compromise team success,2 3 team administrators, players and coaches are now interested in this field. In a study of novice runners, a standard 8-week training programme (control group) was compared against an adapted, graded, 13-week training programme (intervention group) on the risk of sustaining a running-related injury.40 Although training load increases were limited to 10% per week in the intervention group, there were no differences in injury prevalence between the graded training programme (21%) and standard training programme (20%) groups.40 In team sport athletes, we have previously observed large increases in injury risk when changes in training load increased from ≤10% per week (≤7.5% injury likelihood) to ≥15% per week (~21% injury likelihood).39 The likelihood of injury was as high as 38% when the weekly increase in training load was 50%. Myth 3: avoid ‘spikes’ and ‘troughs’ at all costs The size of the current week’s training load (termed acute training load) in relation to longer term training load (termed chronic training load) determines the ‘acute:chronic workload ratio’ (ACWR, also referred to as ‘training-stress balance’).39 42 Across a wide range of sports (eg, cricket, rugby league, rugby union, Australian football, European football, Gaelic football, hurling, American football, basketball, handball and multisport athletes), rapid increases (ie, ‘spikes’) in workload have been associated with increased injury risk (table 1).43–69 When the ACWR was within the range of 0.8–1.3 (ie, the acute training load was approximately equal to the chronic training load), the risk of injury was relatively low. [...]when the ACWR was ≥1.5 (ie, the acute training load was much greater than chronic training load), the risk of injury increased markedly (figure 3A).43 70 Table 1 Summary of studies published since 2014 that have documented the loading profiles which contribute to increased injury risk in athletes Reference Loading profile contributing to increased injury risk Rapid increases in workload* High and low ACWR High CWL Low CWL Bowen et al 57 + + Caparrós et al 94 + Carey et al 56 + Colby et al 48 + Colby et al 71 + Colby et al 93 + Cross et al 58 + + + Delecroix et al 66 + + Duhig et al 69 + Ehrmann et al 59 + Fanchini et al 63 + Harrison and Johnston50 + + Hulin et al 43 + + Hulin et al 61 + + Hulin et al 62 + + Jaspers et al 67 + Malisoux et al 92 + Malone et al 47 + + Malone et al 54 + + Malone et al 55 + Malone et al 84 + + + Malone et al 86 + McCall et al 64 + McCall et al 65 + + Møller et al 51 + Murray et al 44 + + Murray et al 45 + + Murray et al 52 + Murray et al 89 + Sampson et al 68 + + Stares et al 46 + Stares et al 88 + + Veugelers et al 91 + von Rosen et al 35 + Warren et al 60 + + Watson et al 53 + Windt et al 90 + Weiss et al. 49 + *Includes rapid increases in acute load, large week to week changes in load and high acute:chronic workload ratios.