Novel Ultrasonographic Thickness and Strength Assessments of the Flexor Digitorum: A Reliability Analysis

OBJECTIVES: Clinical conditions such as focal dystonia often require the assessment of atrophy and weakness of the finger muscles. However, due to a lack of well-established protocols, the current investigation focused on assessing the reliability of thickness and strength assessments of the flexor digitorum (FD) muscle, including both the superficialis and profundus components. As a secondary assessment, the reliability of the strength measurement of the extensor digitorum muscle was examined as well. METHODS: Different thickness measurements of the FD were taken via ultrasonography and averaged to estimate the mean thickness of the FD. Likewise, individual finger strength measurements taken by a custom-made finger pressure device were averaged to compute the mean strength of the flexor and extensor digitorum muscles. Test-retest reliability of the above measurements performed at two different time points (about 6 months apart) were examined on the right and left hands of 10 participants. RESULTS: Findings indicated excellent test-retest reliability (ICC > 0.92) for the mean thickness assessment of the FD and mean strength of the flexor and extensor digitorum for both dominant and non-dominant hands. The standard error of measurement was ≤4.3% for all three mean assessments, indicating high sensitivity. Likewise, the smallest detectable change was also sufficiently small for the mean thickness and mean strength of the flexor digitorum (≤5.1%) and moderately small (≤12%) for the strength of the extensor digitorum. CONCLUSIONS: Results indicated an excellent relative and absolute reliability, for both hands, for the mean thickness and strength assessments of the flexor digitorum muscle and for the mean strength of the extensor digitorum (measured for both hands). These measurements can be used for future investigations and can contribute to the establishment of more precise methods for assessing the muscles in the forearms which serve the hand.

Dancers’ Perceptions of Accessibility and Quality of the Relationship with Healthcare Professionals in Quebec

OBJECTIVE: To understand dancers’ perception of accessibility to care and quality of the relationship with healthcare practitioners in Quebec; to identify the key elements of an optimal dancer–physician relationship; and to propose recommendations for improvement. METHODS: An online questionnaire consisting of multiple choice, “yes/no,” and short answer questions was sent to professional dance organizations, companies, agencies, and schools in Quebec, Canada. Information regarding the dance artists’ sociodemographics, dance background, dance-related injuries, and access to a primary care physician were collected. Experiences and expectations regarding the dancer–physician relationship were surveyed. One-way ANOVA analyses and Pearson correlations were performed to assess differences of perception between dancers’ demographic characteristics and associations between the variables. RESULTS: Out of 161 participants, 144 met inclusion criteria, consisting of largely French-speaking females, North American or European decent, self-employed contemporary dancers with an average age of 33.13 ± 10.81 yrs. Dance artists sought medical care from osteopaths (47.9%) and physiotherapists (36.1%) more frequently than from physicians (8.3%). Fully employed dancers had more favorable perceptions of the dancer–physician relationship compared to self-employed dancers and those who had mixed streams of income. The perception of most participants was that physicians do not comprehend the unique dance-associated impacts on health (81.8%). The most important aspect affecting perception of the relationship with the physician was diagnostic acumen (41.3%). Most participants (79.0%) selected “works with other health professionals [...] and gives expert advice” as an important expectation from physicians. CONCLUSION: This research is the first investigation of the dancer–physician relationship in Quebec. It reveals a desire amongst the dance artist community to improve the dancer–physician relationship and the overall quality of their unique healthcare requirements.

Musculoskeletal Pain and Musical Performance in First and Second Violinists of Professional Youth Chamber Orchestras: A Comparative Study

OBJECTIVE: First and second violinists in orchestras use identical instruments, but the motor patterns used to execute the different notes may vary between the two groups and the biomechanical gestures may influence musculoskeletal complaints. The primary objective of this study was to compare the pain intensity and interference in musical performance of first and second violinists of professional youth chamber orchestras. Second, to investigate the correlation between pain and the musical practice profile in this population. METHODS: This cross-sectional study enrolled 74 violinists, aged 12 to 17 years, from three professional youth chamber orchestras in Brazil. Participants completed a validated self-administered questionnaire, the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians–Brazilian version (MPIIQM-Br). Variables related to musical practice profiles were also recorded. Data analysis applied t-tests for independent samples and Pearson’s correlation coefficient. RESULTS: The sample of first violinists (n=39) presented 23 males and 16 females, and the second violinists (n=35) included 23 females and 12 males. The mean age was 13.9 yrs (SD 1.1) and 14.1 yrs (1.0) for the first and second violinist groups, respectively. Most participants (n=66, 89%) reported pain in at least one moment of their career, and 54 (76%) reported pain at the time of data collection. A higher pain prevalence was identified in the right shoulder (37.7%), in 28.2% of the second violinists and 9.4% of the first. The second violinists presented higher scores for most variables related to pain intensity and pain interference in performance (p < 0.05). A correlation was observed between time working at a professional level and the number of affected areas on the body pain map (r=0.30; 95% CI 0.23–0.42) and between the hours of daily practice and the number of affected areas on the body pain map (r=0.39; 95% CI 0.29–0.45). CONCLUSION: Second violinists had more complaints of pain and difficulty in playing their instrument compared to the first violinists. The study also found a correlation between the number of body areas with pain complaints and variables linked to the violinists’ practice profile.

Prevalence of Playing-Related Musculoskeletal Problems Among Professional Orchestra Musicians in South Africa: A Study Using the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM)

BACKGROUND: The prevalence of playing-related musculoskeletal problems (PRMPs) in professional musicians is well documented in the literature, but few studies have been done on South African professional musicians. OBJECTIVE: The present study aimed to evaluate the prevalence of PRMPs, pain intensity, and pain interference among full-time and part-time orchestral musicians, using a validated self-report instrument specifically designed for musicians. METHODS: Seventy-nine full-time and part-time professional orchestral musicians took part in the study and completed the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM). RESULTS: A lifetime prevalence of PRMPs was 76% and point prevalence 30%. Of the PRMP group, 30% experienced current pain that interfered with their ability to play. Upper strings players reported the most PRMPs. The most commonly reported pain locations were right and left upper limb, neck, forearm, and elbow. The mean pain intensity score for the PRMP group was 16.3 (SD 6.62) (out of 40) and the mean pain interference score was 21.2 (9.98) (out of 50). Female musicians reported experiencing pain more frequently and intensely and also reported more pain sites than males. CONCLUSIONS: This study, the first to make use of a validated self-report instrument, shows that musculoskeletal problems are common among full-time and part-time professional orchestral musicians in South Africa.

Psychological Wellbeing and Grit Among Freelancers in the UK Dance Industry

The UK dance industry is composed largely of freelance workers, yet freelancers are an under-researched population within the dance science literature. The aim of this study was to investigate psychological wellbeing and grit (a combination of passion and persistence) among freelancers working in various roles in the UK dance sector. A total of 282 freelancers completed validated questionnaires tapping psychological wellbeing and grit (the 18-item Psychological Wellbeing Scale and Short Grit Scale). Analyses revealed relatively high levels of wellbeing, with participants scoring particularly high on personal growth and purpose in life (15.73 and 14.11, respectively, out of a maximum of 18). They also had high levels of grit (3.90 ± 0.33 out of a maximum of 5). Freelancers who identified as being early career reported significantly higher levels of grit than the mid and late career groups. Significant positive correlations were found between grit and the wellbeing domains of personal growth, purpose in life, and positive relations. Overall, the results of this study support previous qualitative research suggesting that a freelance dance career may provide elements of psychological wellbeing, and that passion and persistence towards long-term goals could be essential in the pursuit of a freelance career.

Impact of a Neck Strap Intervention on Perceived Effort, Thumb Force, and Muscle Activity of Clarinetists

OBJECTIVE: Clarinetists often report discomfort of the right wrist and thumb and note that it is likely the result of the constant force applied to the area from the instrument’s weight and the musician’s technique. One preventative measure to reduce this discomfort is the use of a neck strap. The objective of the current study was to document the biomechanical impacts of this intervention. METHODS: Eight experienced clarinetists played a series of three etude pieces while playing both with and without a neck strap. For each condition, the force between the right thumb and clarinet was measured, electromyographic (EMG) data were collected from seven muscle groups, and subjective assessment of perceived effort was obtained. RESULTS: The results showed that when the neck strap was used, there was a significant decrease in the average force between the thumb and clarinet (p<0.05) and a decrease in the average perceived effort required for the right shoulder and thumb of the participants (p<0.05). Importantly, there were no statistically significant increases in the muscle activity of any of the neck and shoulder muscles with the introduction of the neck strap intervention. CONCLUSION: A neck strap intervention had positive effects on the right thumb while not causing any known adverse effects to other areas such as the neck, upper back, and shoulders.

Risk Factors for Musculoskeletal Complaints in Female Musicians: A Systematic Review and Exploration for Future Studies

BACKGROUND: Female musicians are prone to the development of musculoskeletal complaints (MSC). The etiology of this increased risk is poorly understood. As the number of professional female musicians increases, so does the importance of understanding female-specific risk factors for MSC in musicians. OBJECTIVE: To provide an overview of current literature of proven and possible risk factors/etiology of MSC in female musicians, and to identify topics for future studies. METHODS: Systematic review performed according to international guidelines. A database search was performed in MEDLINE (PubMed), Embase, CINAHL, Cochrane, PsycINFO, clinicaltrials.gov, and gray literature. Studies were independently selected and rated by two reviewers. QUIPS and STROBE guidelines were used for assessing quality and risk of bias. Risk factors were categorized by means of the theoretical framework of the International Classification of Functioning (ICF) and evaluated using the Bradford Hill criteria for causality. RESULTS: Out of 1,924 records, 10 eligible studies were included. A low to moderate level of methodological quality was present in the studies. Fifteen risk factors could be identified from the included studies, which were positioned in the ICF model. The two most frequently mentioned female-specific risk factors were hand size and joint laxity. None of the risk factors fulfilled Bradford Hill’s criteria for causality. Many other risk factors were suggested, while a number of expected causes were not encountered. CONCLUSION: At this moment, no evidence-based deductions can be made about female-specific risk factors for MSC in musicians. There is a lack of high-quality studies in this field and a need for studies with a different focus and a prospective study design.

Survey of Musculoskeletal Injuries among Female Bharatanatyam Dancers in the Udupi District of India

BACKGROUND: Bharatanatyam is an Indian classical dance form that is practiced globally. There is limited information about the prevalence of injuries in Bharatanatyam dancers. OBJECTIVES: To investigate the prevalence of musculoskeletal injuries and specifics of dance training in female Bharatanatyam dancers in the Udupi district of India. METHODS: We developed and tested a survey for Bharatanatyam dancers regarding injury history in the prior year, including location, time loss, cause, and need for medical help. We also obtained demographic and training information. RESULTS: 101 dancers completed the survey. 10.8% of dancers reported musculoskeletal injuries because of participation in dance. They sustained 0.65 injuries/1,000 hours of dancing. The most frequently injured areas were ankle (27.2%) and knee (27.2%) followed by lower back (13.6%) and hip (9%). Despite being injured, 36.4% of the dancers continued to dance. 54.5% of the injured dancers sought the help of a medical professional for their dance-related injuries. The most common surface for dance was concrete followed by other hard surfaces such as marble and tile. CONCLUSION: Female Bharatanatyam dancers are prone to injuries of the lower extremity and back. Most dancers in our study practice the Pandanalluru style on hard surfaces. There is a need to investigate the impact of training factors on the injury occurrence.

Experiences of Student Circus Arts Performers Undertaking a Shoulder Rehabilitation Program Via Telehealth Consultation During the COVID-19 Pandemic

OBJECTIVE: To explore the subjective experiences of student circus arts performers with atraumatic shoulder instability undertaking a 12-week shoulder rehabilitation program during the COVID-19 pandemic lockdown, in Melbourne, Australia. METHODS: Using a qualitative design, 14 circus arts students from the National Institute of Circus Arts (Australia) were individually interviewed via teleconsultation. All interviews were recorded, transcribed, and analysed using inductive thematic analysis. RESULTS: Five overarching themes were identified: (i) impact (physical and mental), (ii) opportunity, (iii) developing routine, (iv) client-therapist relationship, and (v) transformation. All participants reported positive physical changes to their shoulder including increases in strength, stability, range of motion, less pain, “clicking” and “clunking,” improved posture, muscle memory, as well as carry-over to functional circus activities. The pandemic’s mental impact varied across the cohort, with positive and negative experiences described in relation to cognitive, social, and affective factors. Most performers felt the pandemic provided an opportunity to focus on rehabilitation of their shoulder. The program effects were also underpinned by positive client-therapist relationships and a progressive transformation of learning where students gained knowledge of their condition, developed tools to manage their current shoulder impairment, and learned how to apply this new knowledge to future management of their condition. CONCLUSION: A shoulder exercise intervention delivered via teleconsultation during the COVID-19 pandemic resulted in subjective reports of positive physical changes to the participants’ shoulder health complaint. This was facilitated through client-physiotherapist relationships, providing structure during uncertain times, and by providing education to help in understanding their condition and its future management.

Perceptions of Motivational Climate and Association with Musculoskeletal Injuries in Ballet Dancers

OBJECTIVE: Sports science has identified the trainer–athlete relationship in the etiology of injuries. We aimed to investigate: 1) the association between empowering (EMC) and disempowering (DMC) motivational-climate and musculoskeletal injuries in ballet, and 2) if EMC moderates the association between DMC and injuries. METHODS: A cross-sectional cohort survey-study was conducted online among ballet dancers (>18 yrs old) reporting acute and overuse injuries of the previous 2 years. Motivational climate was assessed with the Empowering-and-Disempowering Motivational Climate Questionnaire (5-point Likert scale). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire assessed severity of overuse injuries. Linear regression was performed adjusted for the confounders age, sex, expertise, experience, and initiation-age with an interaction term between EMC and DMC to assess effect modification. RESULTS: An international sample of 189 dancers (26.7±7.9 yrs; 130 professionals) reported 197 acute and 465 overuse injuries (in the previous 2 years). Mean EMC was 3.1±1.07, DMC 3.3±1.08. EMC was associated with less acute (b=–0.22; 95%CI –0.40 to –0.04) and overuse injuries (b=–0.74; 95%CI –0.99 to –0.50), while DMC was associated with more injuries (acute: b=0.30; 95%CI 0.13 to 0.47; overuse: b=0.74; 95%CI 0.50 to 0.98). When tested together and adjusted for confounders, EMC lost its protective effect (acute: b=–0.15; 95%CI –0.19 to 0.49; overuse: b=–0.34; 95%CI –0.81 to 0.13). DMC was positively associated with injuries throughout all settings (acute: b=0.43; 95%CI 0.10 to 0.76; overuse: b=0.46; 95%CI 0.00 to 0.91). EMC showed no moderating effects on DMC in the adjusted models. CONCLUSION: To avoid injuries, it is not enough to create an EMC, because any disempowering nuances may negatively affect empowering climates. Teachers should avoid DMC altogether to prevent injuries in dancers.