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Journal of Integrative Medicine ›› 2015, Vol. 13 ›› Issue (5): 314-318.doi: 10.1016/S2095-4964(15)60194-7

Special Issue: Massages

• Research Article • Previous Articles     Next Articles

Effects of self-administered exercises based on Tuina techniques on musculoskeletal disorders of professional orchestra musicians: A randomized controlled trial

 Cláudia Maria Sousaa, Daniela Coimbrab, Jorge Machadoa, Henry J. Gretena,c,d   

  1. a Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-030 Porto, Portugal
    b Porto Polytechnic Institute, Superior School of Music and Performing Arts, 4000-035 Porto, Portugal
    c German Society of Traditional Chinese Medicine, 69126 Heidelberg, Germany
    d Heidelberg School of Chinese Medicine, 69126 Heidelberg, Germany
  • Received:2015-03-30 Accepted:2015-05-28 Online:2015-09-10 Published:2015-09-15

Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing.
To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS).
Design, setting, participants and interventions
We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n = 39) and the control (n = 30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks.
Main outcome measures
Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points.
In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20.
The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

Key words: Tuina, Musculoskeletal disorders, Professional orchestra musicians, Randomized controlled trial

[1] Ostwald PF, Baron BC, Byl NM, Wilson FR . Performing arts medicine. West J Med, 1994,160(1):48-52
[2] Zaza C . Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ, 1998,158(8):1019-1025
[3] Leaver R, Harris EC, Palmer KT . Musculoskeletal pain in elite professional musicians from British symphony orchestras. Occup Med (Lond), 2011,61(8):549-555
doi: 10.1093/occmed/kqr129 pmid: 22003061
[4] Kaneko Y, Lianza S, Dawson W . Pain as an incapacitating factor in symphony orchestra musicians in S?o Paulo, Brazil. Med Probl Perform Art, 2005,20(4):168-174
[5] Oliveira C, Vezzá F . Musicians’ health: pain resulting from playing musical instruments among members of orchestras of the ABCD region, S?o Paulo, Brazil. Rev Bras Saúde Ocup, 2010,35(121):33-40
doi: 10.1590/S0303-76572010000100005
[6] Llobet R . Musicians health problems and in their relation to musical education. The ISME Commission for Education of the Professional Musician. Preparing Musicians: Making Sound Worlds. 2004; 195-209.
[7] Lederman R . Neuromuscular and musculoskeletal problems in instrumental musicians. Muscle Nerve, 2003,27(5):549-561
doi: 10.1002/mus.10380 pmid: 12707974
[8] Joubrel I, Robineau S, Pétrilli S, Gallien P . Musculoskeletal disorders in instrumental musicians: epidemiological study. Ann Readapt Med Phys, 2001,44(2):72-80
doi: 10.1016/S0168-6054(00)00063-5 pmid: 11587655
[9] Kok LM, Vlieland TP, Fiocco M, Nelissen RG . A comparative study on the prevalence of musculoskeletal complaints among musicians and non-musicians. BMC Musculoskelet Disord, 2013,14: 9
doi: 10.1186/1471-2474-14-9
[10] Dawson WJ . Upper-extremity problems caused by playing specific instruments. Med Probl Perform Art, 2002,17(3):135
doi: 10.1353/lat.2002.0016
[11] Bird HA . Overuse syndrome in musicians. Clin Rheumatol, 2013,32(4):475-479
doi: 10.1007/s10067-013-2198-2
[12] Lockwood AH . Medical problems of musicians. N Engl J Med, 1989,320(4):221-227
doi: 10.1056/NEJM198901263200405
[13] Frank A, von Mühlen CA . Playing-related musculoskeletal complaints among musicians: prevalence and risk factors. Rev Bras Reumatol, 2007,47(3):188-196
doi: 10.1590/S0482-50042007000300008
[14] Fragelli TBO, Carvalho GA, Pinho DLM . Musician’s injuries: when pain overcomes art. Rev Neurocienc, 2008,16(4):303-309
[15] Wu S . Occupational risk factors for musculoskeletal disorders in musicians: a systematic review. Med Probl Perform Art, 2007,22(2):7
doi: 10.1089/jwh.2007.DIR1
[16] Sousa C, Greten HJ, Machado J, Coimbra D . The prevalence of playing-related musculoskeletal disorders(PRMSD) among professional orchestra players. Revista Música Hodie, 2014,14(2):111-121
[17] Schnitzer TJ . Update on guidelines for the treatment of chronic musculoskeletal pain. Clin Rheumatol, 2006,25(Suppl 1):S22-S29
doi: 10.1007/s10067-006-0203-8 pmid: 16741783
[18] Curatolo M, Bogduk N . Pharmacologic pain treatment of musculoskeletal disorders: current perspectives and future prospects. Clin J Pain, 2001,17(1):25-32
doi: 10.1097/00002508-200103000-00005
[19] Paarup HM, Baelum J, Holm JW, Manniche C, Wedderkopp N.Prevalence and consequences of musculoskeletal symptoms in symphony orchestra musicians vary by gender: a cross-sectional study. BMC Musculoskelet Disord, 2011, 12(): 223
[20] Heming M . Occupational injuries suffered by classical musicians through overuse. Clin Chiropr, 2004,7(2):55-66
doi: 10.1016/j.clch.2004.02.008
[21] Heinan M . A review of the unique injuries sustained by musicians. JAAPA. 2008; 21(4): 45-46, 48, 50 passim.
doi: 10.1097/01720610-200804000-00015 pmid: 18468369
[22] Suskin E, Schachter E, Kolčić I, Polašek O, Mustajbegović J, Arumugam U . Health problems in musicians — a review. Acta Dermatovenerol Croat, 2005,13(4):247-251
pmid: 16356400
[23] Greten HJ . Chinesische Medizin als vegetative Systembiologie. HNO, 2011,59(12):1160-1164
doi: 10.1007/s00106-011-2413-x
[24] Greten, HJ . Understanding TCM I. Heidelberg: Heidelberg School Editions. 2013.
[25] Greten HJ . Clinical subjects. Heidelberg: Heidelberg School Editions. 2013.
[26] Kong LJ, Fang M, Zhan HS, Yuan WA, Pu JH, Cheng YW, Chen B . Tuina-focused integrative Chinese medical therapies for inpatients with low back pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med, 2012,2012: 578305
[27] Cen SY, Loy SF, Sletten EG, Mclaine A . The effect of traditional Chinese therapeutic massage on individuals with neck pain. Clin Acupunct Orient Med, 2003,4(2):88-93
doi: 10.1016/S1461-1449(03)00043-4
[28] Guo YM . Treatment of 157 cases of cervical spondylosis of vertebral artery type by tuina therapy. J Acupunct Tuina Sci, 2009,7: 113-115
doi: 10.1007/s11726-009-0113-9
[29] Lei L, Huang J, He Y, Duan W, Tang H, Gan W . Tuina treatment of 150 cases with lumbar intervertebral disc herniation. J Acupunct Tuina Sci, 2011,9(2):123-126
doi: 10.1007/s11726-011-0489-1
[30] Lee MK, Chang SB, Kang, DH . Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. J Altern Complement Med, 2004,10(6):959-965
doi: 10.1089/acm.2004.10 .959 pmid: 15673989
[31] Fortin M . O processo de investigação: da concepção à realização. Loures: Lusociência. 1999. Portuguese.
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