This study examined how standing violinists regulate postural balance when several conditions are varied, including playing posture, weight of the instrument, technical and physical difficulty of the musical piece, and presence or absence of a musical score. It also examined whether imagining playing an easy or difficult piece affects their postural control. This observational study included 16 violin students from a music university (age 21 yrs, SD 4). Postural control was assessed using two stabilometric platforms (frequency 100 Hz). Nine conditions were tested: standard standing; violin posture without/with instrument; motor imagery of an easy and a difficult piece without/with instrument; playing of an easy and a difficult piece, with/without a music stand. Center of pressure (CoP) parameters were extracted, and weight distribution asymmetry was calculated. Depending on data characteristics, either parametric or non-parametric statistical tests were conducted to compare conditions. Compared with the standard standing position, the violin posture without the instrument and the posture with violin and bow showed a significant decrease in CoP sway area (p ≤ 0.010). All violin playing conditions induced a significant increase in CoP parameters (sway area, total, anteroposterior, and mediolateral displacements) compared with the other conditions (p ≤ 0.036). Postural demand was greater for the difficult piece than for the easy one. Motor imagery of violin playing did not increase postural control demands compared with non-playing conditions. Playing the violin, whether performing an easy or a difficult piece, places substantial demands on postural control. Preventive standing balance exercises for violinists may help reduce the risk of early fatigue and playing-related pain. In the presence of injury, motor imagery can be safely employed to maintain violin training, as it does not impose high demands on postural control.

Psychological stress concerns many musicians and poses a risk for their mental and physical health. However, there are thus far no instruments that measure psychological stress of musicians in particular. We aimed to fill this gap by developing a questionnaire designed specifically to detect components that increase psychological strain in musicians. The Lübecker Inventar für psychischen Stress bei Musizierenden (Lübeck Inventory on Musicians' Psychological Stress, LIMIT) was developed through consultation with experts from the field. Subsequently, the factorial structure was examined on a sample of N = 602 musicians. Multiple factor extraction methods were compared using model fit criteria to determine an adequate/representative number of factors and items. Reliability and validity of the questionnaire were tested. The Kaiser-Meyer-Olkin criterion revealed an excellent sampling adequacy (0.945). Excluding non-fitting items, the final LIMIT is composed of 34 items loading on four factors: "self-efficacy," "depression," "time-management," and "pressure." The scale reached an excellent reliability (Cronbach's a = 0.938) and fulfilled validation criteria. The LIMIT can be a useful screening tool for assessing musician-specific psychological strain, enabling musicians and practitioners to identify stress at an early stage and to seek out support in good time. An English validation is in progress.

Approximately 27,000 college marching band (MB) artists in the United States could benefit from access to healthcare services and patient-centered care (PCC). The purpose of this study was to explore healthcare providers (HCPs) who MB artists have access to and the artists' perceptions of PCC. We used a cross-sectional, web-based survey to explore which providers MB artists had access to. In total, 751 MB artists (age 20±8 yrs) completed the survey. Respondents who reported no access or were unsure were prompted to complete an open-ended response describing what they would do if an injury or illness occurred. Participants who had access to an athletic trainer (AT) completed the Global Perceptions of Athletic Trainer Patient-Centered Care Tool (GPATPCC; a=0.90; 15 items [1 reverse-scored]; 4-point Likert scale [1=strongly disagree, 4=strongly agree, 0=unsure]; score=average). Participants with access to other HCPs completed the Consultation and Relational Empathy tool (CARE; a=0.97; 10 items; 5-point Likert scale [1=poor, 5=excellent]; score=sum). Scores for the tools were standardized (z-score), and a Mann-Whitney U test determined PCC differences between those with access to ATs and those with access to other HCPs. Overall, 42.5% of MB artists had access to a HCP. The MB artists with access to ATs expressed satisfaction (mean 3.05±0.67) on the GPATPCC tool. Participants who completed the CARE tool expressed they were satisfied (mean 39.59±8.78). However, 57.5% of MB artists reported having no access or being unsure, who commonly relied upon communicated with MB leadership (33.8%) when injured. No significant differences were identified between ATs and other HCP ratings of PCC (U=4615, z=-0.36 p=0.719). Over half of MB artists reported a lack of access or a lack of familiarity with what HCPs are available. Those with access to HCPs were satisfied with the care they received. Continued efforts should be focused on improving MB artists' access to HCPs.

Musicians are labelled 'fine motor athletes' due to the significant demands of practice and performance. In response, sports medical concepts and expertise have been adapted and mobilized to address musicians' health considerations. However, understanding distinct differences between the sports and performing arts medical contexts is critical. Mismanagement of fatigue and acute fatigability are identified as key risk factors for deleterious symptoms and injuries in musicians. Acute fatigability in athletes and musicians have been assumed to occur similarly, although this has yet to be empirically demonstrated. This study aimed to evaluate acute muscular performance fatigability during piano performance of varied intensities. Fourteen university pianists attended a single experimental session and performed three pieces of randomly ordered repertoire for 10 minutes each. Repertoire were self-selected to be physically easy (rating of perceived exertion [RPE] 9/20), somewhat hard (RPE 13/20), or hard (RPE 17/20). At baseline, after each repertoire performance, and following a concluding 10-minute silent sitting period, participants completed maximum voluntary contraction (MVC) grip and shoulder strength tests. Surface electromyographic (EMG) data were obtained from bilateral upper trapezius and forearm flexor and extensor muscles. Data were analyzed using uni- and multivariate repeated measures analyses of variance (ANOVAs). No evidence of muscular performance fatigability was found in study pianists at any intensity. Mean EMG amplitude and average median EMG frequency did not significantly vary during any repertoire performances or MVC tests (F≤1.72; p>0.09). Additionally, no changes in force or EMG parameters were found during any MVC tests (F≤1.19; p>0.31). The absence of muscular performance fatigability during even the most intense piano performances suggests substantially differing mechanisms of fatigability and perceived exertion in pianists versus those commonly seen in sport athletes. Further research is needed to understand the mechanisms of acute fatigability in musicians and develop musician-specific management strategies.

Prolonged sitting and performance hours in musicians may lead to an increased risk of musculoskeletal pain around the spine and pelvis. This situation may lead to an asymmetry of spinal segments, which in turn may correlate with muscle contractions around the lumbopelvic area and can lead to musculoskeletal pelvic girdle pain. The aim of this study was to investigate the segmental mobility of the vertebral column in two groups of musicians, those with and without pelvic girdle pain. This study included 45 musicians who played their instrument for at least 10 years. Musicians were divided into two groups depending on if they had pelvic girdle pain or not. Spinal mobility was evaluated by a hand-held computer-assisted device called the Spinal Mouse system, and pelvic girdle pain assessments were evaluated using orthopedic tests including the active straight leg raise (ASLR), flexion abduction external rotation (FABER), pelvic pain provocation (P4), and long dorsal ligament palpation (LDL). The current study found no significant differences in the thoracic, lumbar, and sacral curves in the trunk flexion tests between musicians with and without pelvic girdle pain (p=0.28, 0.54, and 0.63). However, analysis of spinal mobility revealed that musicians with pelvic pain had significant limitations of spinal flexion mobility, mainly in the thoracolumbar region in the sagittal plane (p=0.02 and 0.01). This study revealed a significant correlation between pelvic girdle pain and limitations of segmental spinal flexion mainly in the thoracolumbar region of the sagittal plane in musicians. A lack of spinal mobility appears to be prevalent among musicians with pelvic girdle pain.

The aim of this study was to develop a contemporary dance technique-specific, high-intensity dance fitness test and carry out preliminary testing into measuring the physiological intensity and reliability. The choreography of the Dance Fitness Indicator© (DFI©) is based upon Humphrey/Limón, Graham, and Cunningham techniques and includes dance elements that relate to fitness elements, that increase in intensity over four levels designed to observe changes in heart rate (HR) and rate of perceived exertion (RPE) as the DFI© progresses. Each level lasts for 4 minutes, 16 seconds, with a 1-minute rest between each level; the full DFI lasts for 20 minutes, 12 seconds. Twelve contemporary dancers (9 females, age 24±6.86 yrs; 3 males, age 20±0.58 yrs) were taught the DFI© in a familiarization session before undertaking two test trials, within a 1-week period. Dependent variables to measure intensity were heart rate (HR), rate of perceived exertion (RPE), and blood lactate (BLa). Data for level 4 during test 1 and test 2, respectively, were: HR 184±16.79 bpm vs 187±16.18 bpm; RPE 17 ±2.43 vs 17 ±2.12; and BLa 8.9 ±2.71 mmol/L vs 9.1±2.41 mmol/L. Reliability was calculated by determining the coefficient of variation from paired samples t-tests between test 1 and test 2, which demonstrated consistency/good reliability (<5%) for end BLa (3.2%), HR (1.7%), and RPE (0.9%). These preliminary results suggest that the DFI© requires a high physiological intensity demand, through movement-specific contemporary dance technique, relating to dance performance intensity, and is a reliable testing mode within a dance studio environment. It could also be used to assess dancers' physiological abilities to cope with high-intensity intermittent cardiovascular and technical demands of dance performance; however, further testing with greater numbers of subjects is recommended.

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. 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. 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). 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.

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. 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. 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. 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.

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. 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. 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. 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.

To translate, culturally adapt, and validate the psychometric characteristics of the Italian version of the Dance Functional Outcome Survey (DFOS-IT) in adult dancers. Clinical measurement study. The DFOS-IT was forward translated, reconciled, backward translated, and reviewed by an expert committee to establish optimal correspondence with the original English DFOS. We examined test-retest reliability in 58 dancers within a 10-day period, using intraclass correlation coefficients (ICC2,1). In a sample of 265 healthy and injured dancers, the following were examined: 1) construct validity, comparing the DFOS-IT to SF-36 using Pearson correlations; 2) exploratory factor analysis and internal consistency; and 3) sensitivity, by generating receiver operating characteristic curves and determining area under the curve (AUC). In a subgroup of 44 dancers, we determined internal responsiveness across three time-points using repeated measures ANOVA (p<0.05). Injured dancers' scores were analyzed for floor and ceiling effects. The DFOS-IT demonstrated very high test-retest reliability (ICC≥0.98). Single-factor loading in exploratory factor analysis supported unidimensionality of the scale, with high internal consistency (a=0.93). DFOS-IT total, activities of daily living (ADL), and Dance Technique scores had strong construct validity compared with scores on the SF-36 PCS (r≥0.71). There was excellent sensitivity, with high AUC values (AUC≥0.80). There were significant differences across time for DFOS-IT scores (p<0.001), demonstrating responsiveness to change, and no floor or ceiling effects. The DFOS-IT is a valid, reliable, and responsive tool that can be used as an outcome and screening measure for Italian adult ballet and modern dancers following lower extremity or low back injury.