We report the major findings from the psychosocial questionnaire component of a cross-sectional population survey of the musicians in Australia's eight full-time professional symphonic and pit orchestras. The response rate was 70% (n = 377). Female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians (<30 years) were significantly more anxious compared with the oldest musicians (51+). The youngest female musicians were most affected by music performance anxiety. Music performance anxiety was lowest for the older musicians (51+ years). Thirty-three per cent of musicians may meet criteria for a diagnosis of social phobia. Twenty-two per cent answered in the affirmative to a question screening for post-traumatic stress disorder. Thirtytwo per cent returned a positive depression screen; this subgroup had higher scores on the anxiety measures. Linear regression analysis identified the State-Trait Anxiety Inventory (STAI-T), the Social Phobia Inventory (SPIN), the Anxiety and Depression Detector (ADD) and age as independent predictors of music performance anxiety severity. Significant numbers of musicians drank alcohol in a manner outside the National Health and Medical Research Council (NHMRC) alcohol guidelines (2009); only 6% were current smokers. This study has identified a significant pattern of anxiety, depression and health behaviours that require attention in occupational health and safety policies and programmes for this workforce.

We examined self-reported frequency and severity of performance-related musculoskeletal pain disorder (PRMD), trigger point pain (TPP) and depression, social phobia (SPIN) and music performance anxiety (MPA) using the Kenny Music Performance Anxiety Inventory (K-MPAI) in a cross-sectional survey of 377 professional orchestral musicians. Most (84%) musicians had experienced performanceimpairing pain; 50% reported current pain. Females reported more performance-impairing pain and more current pain than males. Cluster analysis indicated a complex relationship between depression and PRMD severity. Three clusters showed the hypothesized relationship (i.e., more depression, more pain). Musicians in the fourth cluster denied depression but reported the most severe pain, suggesting a group who somatize their psychological distress. Cluster analysis also revealed a strong relationship between PRMD severity and MPA. Clusters with higher scores on K-MPAI reported higher scores on PRMD severity. TPP was not associated with self-reported PRMD frequency or severity. There was a significant linear relationship between TPP and MPA for females, but males scoring the highest MPA reported lower TPP than those with milder MPA. Neither SPIN nor beta blocker use was associated with PRMD frequency or severity. The complex relationships identified between PRMD, TPP, depression and MPA may have important implications for PRMD management in professional musicians.

This paper reports on the major findings from the questionnaire component of a cross-sectional survey of the musicians in Australia’s eight fulltime professional symphonic and pit orchestras, focusing on performance-related musculoskeletal disorders (PRMDs). METHODS: All musician members of the orchestras participating in this project were invited to complete a self-report survey. The overall response rate was about 70% (n = 377). In addition to general health and experience questions, respondents who reported a current or previous PRMD were asked to report on a range of associated factors. RESULTS: Of the participants, 84% had experienced pain or injuries that had interfered either with playing their instrument or participating in normal orchestral rehearsals and performances. Fifty percent reported having such pain or injury at the time of the survey, mostly with disorders perceived by the musicians to be work-related. Twenty-eight percent had taken at least 1 day off from work for such pain in the previous 18 months. The most common broad sites affected were the trunk (primarily the back), the right upper limb and neck, the left upper limb and neck, and the neck alone, but the relative proportions varied by instrument. Of those musicians who reported at least one episode of pain or injury in the past, less than 50% reported that they had completely recovered. The most commonly cited performance-related factors that had contributed to injury or pain all related to training and playing load (including practice and performance). CONCLUSION: This study provides strong evidence that PRMDs are a common complaint in professional orchestral musicians and identifies a range of factors suggested as contributing to the occurrence or persistence of these disorders.

The Sound Practice Project is a 5-year study involving baseline evaluation, development, and implementation of musician-specific work health and safety initiatives. A cross-sectional population physical and psychological survey and physical assessment were conducted at the same time, with an auditory health assessment conducted later. The results were used to guide the development of a series of targeted interventions, encompassing physical, psychological, and auditory health components. This paper provides an overview of the project but focuses on the health findings arising from the cross-sectional survey. Three hundred and seventy-seven musicians from the eight professional symphony orchestras in Australia took part in the cross-sectional study (about 70% of eligible musicians). Eighty-four percent (84%) of musicians reported past performance-related musculoskeletal disorder (PRMD) episodes; 50% were suffering a current PRMD. Of the 63% who returned hearing surveys, 43% believed they had hearing loss, and 64% used earplugs at least intermittently. Noise exposure was found to be high in private practice, although awareness of risk and earplug use in this environment was lower than in orchestral settings. Improved strategic approaches, acoustic screens and recently developed active earplugs were found to provide effective new options for hearing protection. With respect to psychosocial screening, female musicians reported significantly more trait anxiety, music performance anxiety, social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians were significantly more anxious compared with the oldest musicians. Thirty-three percent (33%) of musicians may meet criteria for a diagnosis of social phobia; 32% returned a positive depression screen and 22% for post-traumatic stress disorder (PTSD). PRMDs and trigger point discomfort levels were strongly associated with increasing severity of psychological issues such as depression and music performance anxiety.

Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper-functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.