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Journal of Integrative Medicine ›› 2015, Vol. 13 ›› Issue (4): 257-261.doi: 10.1016/S2095-4964(15)60181-9

Special Issue: Massages

• Research Article • Previous Articles     Next Articles

Immediate effects of Tuina techniques on working-related musculoskeletal disorder of professional orchestra musicians

Cláudia Maria Sousaa, Luis Moreirab,c, Daniela Coimbrad, Jorge Machadoa, Henry J. Gretena,e,f   

  1. a University of Porto, Institute of Biomedical Sciences Abel Salazar, 4099-030 Porto, Portugal
    b Jean Piaget Health Superior School, 4405-708 Gaia, Portugal
    c Research in Education and Community Intervention – RECI, 3515-776 Viseu, Portugal
    d Porto Polytechnic Institute, Superior School of Music and Performing Arts, i2ads, 4000-035 Porto, Portugal
    e German Society of Traditional Chinese Medicine, 69126 Heidelberg, Germany
    f Heidelberg School of Chinese Medicine, 69126 Heidelberg, Germany
  • Received:2015-01-27 Accepted:2015-03-16 Online:2015-07-10 Published:2015-07-15

Musicians are a prone group to suffer from working-related musculoskeletal disorder (WRMD). Conventional solutions to control musculoskeletal pain include pharmacological treatment and rehabilitation programs but their efficiency is sometimes disappointing.
The aim of this research is to study the immediate effects of Tuina techniques on WRMD of professional orchestra musicians from the north of Portugal.
Design, setting, participants and interventions
We performed a prospective, controlled, single-blinded, randomized study. Professional orchestra musicians with a diagnosis of WRMD were randomly distributed into the experimental group (n = 39) and the control group (= 30). During an individual interview, Chinese diagnosis took place and treatment points were chosen. Real acupoints were treated by Tuina techniques into the experimental group and non-specific skin points were treated into the control group. Pain was measured by verbal numerical scale before and immediately after intervention.
After one treatment session, pain was reduced in 91.8% of the cases for the experimental group and 7.9% for the control group.
Although results showed that Tuina techniques are effectively reducing WRMD in professional orchestra musicians of the north of Portugal, further investigations with stronger measurements, double-blinding designs and bigger simple sizes are needed.

Key words: Diagnosis (TCM), Stress, Tuina, Musicians, Musculoskeletal disorders

[1] Fragelli T, Carvalho G, Pinho D . Musician’s injuries: when pain overcomes art. Rev Neurocienc, 2008,16(4):303-309
[2] 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
[3] da Costa BR, Vieira ER . Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med, 2010,53(3):285-323
[4] 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
doi: 10.1186/1471-2474-12-223
[5] Lockwood M . Medical problems of musicians. N Engl J Med, 1989,320(4):221-227
doi: 10.1056/NEJM198901263200405
[6] Zaza C . Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ, 1998,158(8):1019-1025
[7] 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
[8] 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
[9] 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
[10] Heming MJE . Occupational injuries suffered by classical musicians through overuse. Clin Chiropr, 2004,7(2):55-66
doi: 10.1016/j.clch.2004.02.008
[11] Llobet R . Musicians health problems and in their relation to musical education.The ISME Commission for Education of the Professional Musician[M]. Preparing Musicians: Making Sound Worlds, 2004,: 195-209
[12] Zuskin E, Schachter EN, Kolcić I, Polasek O, Mustajbegović J, Arumugam U . Health problems in musicians — a review. Acta Dermatovenerol Croat, 2005,13(4):247-251
pmid: 16356400
[13] Greten HJ . Chinesische Medizin als vegetative Systembiologie: Teil I: Therapeutische Verfahren(Leitthema). HNO, 2011,59(12):1160-1164
doi: 10.1007/s00106-011-2413-x
[14] Doenitz C, Anjos A, Efferth T, Greten T, Greten HJ . Can heat and cold be parameterized? Clinical data of a preliminary study. J Chin Integr Med, 2012,10(5):532-537
doi: 10.3736/jcim20120508 pmid: 22587975
[15] Porket M . Chinese medical diagnostics — Comprehensive textbook. Dinkelscherben: Phainon Editions & Media. 2001.
[16] Karner M, Brazkiewicz F, Remppis A, Fischer J, Gerlach O, Stremmel W, Subramanian SV, Greten HJ . Objectifying specific and nonspecific effects of acupuncture: a double-blinded randomised trial in osteoarthritis of the knee. Evid Based Complement Alternat Med, 2013,2013:427265
[17] Porket H . Classical acupuncture — The standard textbook. Dinkelscherben: Phainon Editions & Media. 1995.
[18] Greten HJ . Understanding TCM II. Heidelberg: Heidelberg School Editions. 2013.
[19] Greten HJ . Understanding TCM I. Heidelberg: Heidelberg School Editions. 2013.
[20] Greten HJ . Clinical subjects. Heidelberg: Heidelberg School Editions. 2013.
[21] Kober A, Scheck T, Schubert B, Strasser H, Gustorff B, Bertalanffy P, Wang SM, Kain ZN, Hoerauf K . Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology, 2003,98(6):1328-1332
doi: 10.1097/00000542-200306000-00005 pmid: 12766639
[22] Wu YC, Zhang JF, Wang CM, Wang JX . Clinical study of tuina for stiff neck. J Acupunct Tuina Sci, 2009,7(4):225-227
doi: 10.1007/s11726-009-0225-2
[23] Hsieh LL, Kuo CH, Lee LH, Yen AM, Chien KL, Chen TH . Treatment of low back pain by acupressure and physical therapy: randomized controlled trial. BMJ, 2006,332(7543):696-700
doi: 10.1136/bmj.38744.672616.AE pmid: 16488895
[24] 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
[25] Lin X, Yuan WA, He TX . Clinical research on Tuina therapy in treating lumbar intervertebral disc protrusion. Liaoning Zhong Yi Yao Da Xue Xue Bao, 2008,10(5):129-130
[26] Diário da República . Decreto Regulamentar n.o 76/2007. 2007.
[27] Mccaffery M, Beebe A . Pain: clinical manual for nursing practice. Michigan: Mosby Company. 1993.
[28] Holdgate A, Asha S, Craig J, Thompson J . Comparison of a verbal numeric rating scale with the visual analogue scale for the measurement of acute pain. Emerg Med (Fremantle), 2003,15(5-6):441-446
doi: 10.1046/j.1442-2026.2003.00499.x
[29] Fortin M . O processo de investigação: da concepção à realização. Loures: Lusociência. 1999.Portuguese.
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