PARIS — For orchestra musicians, performance is everything. So, it's no wonder that musculoskeletal disorders (MSD) — a reality for so many of these professionals — are not openly discussed. Physical pain is often pushed aside, unexpressed, until one day the suffering gets to be too much, the ability to play is impacted, and all the effort to keep things under wraps and under control culminates in burnout.

Anne Maugue was one of the speakers at the French College of General Medicine's 16th Congress of General Medicine (CMGF 2023). Maugue is a postdoctoral researcher at Côte d'Azur University in Nice. She also plays flute in the Monte-Carlo Philharmonic Orchestra. Through her presentation to the physicians, she sought to raise awareness about MSDs in professional musicians as well as the associated psychosocial risk factors. "If caught early enough, this pain can often be successfully treated."
High Prevalence

"You’re a violinist in a major symphony orchestra. It's Sunday night, 8 o'clock, and you've just come off the stage. A few minutes ago, you felt a sharp pain in your right arm — a pain that is now, already, overwhelming. The conductor accused you of not being focused, of not concentrating. You know that you have another rehearsal in just a few hours, Monday morning. So, what do you do — other than hope that the pain goes away by then? Where can you turn to get help?"

With this opening scenario, Maugue was able to immediately orient the attendees to the realities that professional musicians face.

Pain is far from anecdotal. In professional orchestras, its prevalence over 12 months is between 41% and 93%. "An elite athlete has a full training staff they can turn to. An elite musician, on the other hand, usually only has their general practitioner — and that's assuming the musician even reaches out to get treatment to begin with.

"The fact is that most of the time musicians only care about the pain when it becomes chronic, when it causes discomfort that affects their playing," said Maugue.

How, then, does one evaluate this problem? In a Danish study, musicians rated the musculoskeletal problems they had experienced in the preceding 7 days. When the researchers compared those reports with findings from a clinical examination, they found that the examiners were not able to identify which musicians had reported problems. Why? Because a diagnosis does not reflect the severity or the impact, both of which are subjective.

"When faced with pain, the musician's initial reaction is denial," said Maugue. "The pain is often attributed to something other than the physicality of playing their instrument. They then turn to self-care, to colleagues. It's only much later that they consult a medical professional."

As a result, the physician is seldom aware of the musician's psychological distress and has no sense of how long it's been since the pain first started.
Work Environment

Carrying around an instrument all the time and maintaining nonergonomic postures for extended periods are just two of the factors that put professional musicians at risk of physical pain. Not to be forgotten, Maugue added, are the work-related pressures. Musicians are not immune to issues with their work environment. They can feel like they aren't getting the resources they need, proper recognition from their leaders, or support from their colleagues. In the end, such feelings can engender a sense of unfairness — and that acts as a stressor that can give rise to MSDs.

Evidence of this phenomenon can be found in the results of a study that Maugue conducted. Out of 440 French orchestra musicians (44% women), 64% said they had experienced MSD-related pain in the preceding 12 months and 61% in the preceding 7 days.

Using industrial and organizational psychology scales of measurement, Maugue was able to show, through hierarchical regression, that "emotional exhaustion and MSD-related pain occur when the environment in which people work causes them to feel a sense of unfairness."
Early Detection

Finally, Maugue encouraged general practitioners to ask every patient whether he or she plays a musical instrument. If the answer is yes, get an idea about any pain that he or she may have been feeling in the back, neck, and upper extremities so that prompt treatment can be given.

"There are other studies underway that are looking to better characterize instrumental activity and to enable more effective management by sports medicine departments," said Maugue. "But back to patients with MSDs. It's important to understand everything about their playing. Where do they practice? How often do they practice? What's their posture like when they play? What's the tempo of the music they're working on? Because what we see in professional musicians is likely to be seen in amateur musicians as well — particularly in young people who study at a conservatory," where not much is being done to prevent MSDs.

"If professional musicians are given treatment early on, half of them can be permanently cured," she concluded. "And then, just like elite athletes, they'll be able to get right back to playing."

This article was translated from Medscape's French edition.