Table of Contents

DEC 2025, Vol 40, No 4

ARTICLES

Developing a Screening Tool for Psychological Stress in Musicians: The Lübeck Inventory on Musicians’ Psychological Stress (LIMIT) [Open Access]
 Christine Sickert, Stine Alpheis, Jonas Obleser, Daniel S. Scholz

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. [Open Access: Licensed under CC-BY-NC-SA 4.0 Int.]

Relationship Between Musculoskeletal Pain, Psychosocial Aspects, and Quality of Work Life in Violinists and Violists: A Cross-Sectional Study in Rio de Janeiro, Brazil
Aretuza Cesar Santos, Frederico Barreto Kochem, Luciana Crepaldi Lunkes

BACKGROUND: Violinists and violists are prone to mus­culoskeletal pain due to repetitive movements, sustained postures, and long hours of practice. While perform­ance-related musculoskeletal disorders are well docu­mented internationally, little is known about their preva­lence and psychosocial correlates among Brazilian professional musicians. OBJECTIVES: To (1) describe the prevalence, intensity, and interference of musculoskeletal pain across 12-month, 4-week, and 7-day time frames, together with perceived quality of working life; (2) examine correlations between pain, psychological dis­tress, and work-related quality of life; and (3) test whether pain severity was independently associated with psychological distress and work-related quality of life in multivariate regression models adjusting for demographic and professional covariates. METHODS: In this cross-sectional study, 122 musicians from 10 orches­tras completed validated questionnaires, including the Musculoskeletal Pain Intensity and Interference Ques­tionnaire for Musicians (MPIIQM-Br), the Depression Anxiety and Stress Scale (DASS-21), and the abbreviated Quality of Work Life Questionnaire (QWLQ-bref). Statis­tical analyses comprised descriptive statistics, Spearman correlations, and multivariate linear and logistic regres­sion models adjusting for age, sex, and years of profes­sional experience. RESULTS: Nearly all participants (95.1%) reported having experienced musculoskeletal pain affecting their playing, with the shoulders (44.2%), wrists (36.5%), scapulas (21.2%), and cervical region (21.2%) most affected. Although overall quality of work­ing life was rated satisfactory, 13.1% reported moderate to severe psychological distress, particularly stress symptoms. Higher pain interference was consistently associated with greater psychological distress (b = +0.30, p = 0.013) and lower work-related quality of life (b = –0.28, p = 0.015). Pain intensity alone was not a sig­nificant independent predictor when controlling for covariates. CONCLUSIONS: Musculoskeletal pain is highly prevalent among Brazilian violinists and violists and is closely linked to psychological distress and reduced work-related quality of life. These findings high­light the need for comprehensive strategies addressing both physical and psychosocial aspects of musicians’ health.

Craniocervical Characteristics of Wind Musicians: An Observational Study in Spanish Conservatory Students
Clara Rodríguez-Gude, Yaiza Taboada-Iglesias, Margarita Pino-Juste

INTRODUCTION: Playing wind instruments may promote neck, arm, or shoulder pain, as well as temporomandibu­lar pain. The cervical and orofacial regions are associated, due to their proximity and the influence they both have on body posture. In wind musicians, the mouth is respon­sible for producing the sound. Any alteration in the char­acteristics of the orofacial system can affect the embouchure when playing a wind instrument. AIM: To observe demographic and physical characteristics in the cervicomandibular region in a sample of university wind students. METHODS: An observational descriptive cross-sectional study was carried out with wind students in the two higher conservatories of the region of Galicia, Spain. We studied the posture of the head and neck, the range of cervical movement and mouth opening, the presence of trigger points in the upper trapezius and masseter, as well as their algometry and electromyographic value. RESULTS: 30 woodwind and 19 brass students were eval­uated, 51% of whom were female. A tendency towards a forward position of the head and protraction of the shoulders was observed, maintaining horizontality in the frontal plane in both the head and shoulders. Cervical movements were diminished, while the mouth opening was greater than standard. In this sample, a relatively high prevalence of trigger points in the upper trapezius was observed, while the masseters showed greater sensi­tivity to pain and greater activation during trapezius con­traction. CONCLUSIONS:Musicians in this study pre­sented an anteriorized position of the head and shoulders in the sagittal plane, with a decrease in cervical range of motion particularly in the transverse plane.

Diagnostic Ultrasound Findings and Treatments in Cellists with Performance-Related Musculoskeletal Disorders: A Retrospective Study [Open Access]
Tsung-Ko Lin, Stanley King Hei Lam, Mei-Chen Yeh, Lee-Wen Dai, Daniel Chiung-Jui Su

OBJECTIVE: Performance-related musculoskeletal disor­ders (PRMDs) are common among orchestral musicians, with string players, including cellists, at high risk due to their unique playing posture and forceful movements. Despite frequent reports of pain, especially in the upper back, shoulders, and hands, specific tissue pathologies in cellists remain underexplored. This study investigates ultrasound findings in cellists with PRMDs and their clini­cal implications. METHODS: This retrospective case series study, conducted at a musician clinic in a tertiary medical center from January 2019 to September 2023, included cellists diagnosed with PRMDs. Exclusion crite­ria included traumatic accidents and rheumatological conditions. Data collected according to the CARE guide­lines included demographics, PRMD severity, discomfort localization, ultrasound imaging findings, and treatment modalities (e.g., postural training, manual therapy, and injections). The null hypothesis was rejected at a < 0.05. Statistical analysis was performed using SPSS (ver. 27.0). RESULTS: Fifty-one cellists were included. The majority were students (70.6%), with Stage 4 PRMDs being the most common (60.7%). Common discomfort regions included the left scapulae/shoulder (33.3%), left hand (25.4%), and right scapulae/shoulder (19.6%). Ultrasound revealed the left serratus anterior superior bundle (21.5%) and left levator scapula (15.6%) as the most affected sites. 98% of participants resumed playing within 3 months after the interventions, with reported functional improvement and pain reduction. Treatment included physical therapy, instrument adjustment, ultra­sound-guided regenerative injection (hypertonic dex­trose and/or platelet-rich plasma), and a postural retraining program. CONCLUSION: This study provides the first ultrasound-based analysis of PRMDs in cellists. Key lesions were identified in the left serratus anterior superior bundle and levator scapulae. Ultrasound-guided regenerative injections and postural retraining effectively treated cellists, with 98% returning to playing within 3 months. [Open Access: Licensed under CC-BY 4.0 Int]

Ballet-Trained Individuals Demonstrate Reduced Postural Sway and Less Variation of Spinopelvic Kinematics Compared with an Age-Matched Untrained Group During Demi-Pointe Standing
Eri Fujii, Yasuyuki Yoshida, Mayumi Kuno-Mizumura, Noriaki Maeda, Junpei Sasadai, Yukio Urabe

OBJECTIVE: The aesthetic demands require adaptations in posture that serve both functional efficiency and artistic purposes, but the relationship between spinopelvic alignment and center of pressure (COP) displacement in ballet dancers is understudied. Exploring the differences in these parameters between ballet-trained and untrained individuals could help determine whether the posture of dancers, adapted to aesthetic demands, is also efficient from a kinematic perspective. In this study, we compared postural sway characteristics and segmental kinematics between ballet dancers and non-dancers during three different standing positions with progressively increasing heel elevation (normal, 1/4 pointe, and demi-pointe). Additionally, this study sought to clarify the relationship between the spinopelvic and lower limb kinematics and the oscillations in the COP of the body. METHODS: This study was designed as a comparative cross-sectional study. The study involved 11 ballet dancers and 10 nondancers. Variables such as COP path length, mean angular position, and coefficient of variance (CV) of the spinal-pelvis system (midthoracic, thoracolumbar, and lumbopelvic regions) and lower limb joints (hip, knee, and ankle) were measured. For variables with normal distribution, a two-way repeated-measures ANOVA was conducted to detect group and task effects, with post-hoc Tukey’s HSD tests for significant interactions. Additionally, the relationships among COP path length, angular position, and CV were analyzed using correlation coefficients. RESULTS: Dancers demonstrated significantly shorter COP path length in demi-pointe (701.3 vs 902.2 mm, p<0.05) and greater ankle plantar flexion in both elevated positions (1/4 pointe: –13.3° vs –7.2°, p<0.05; demi-pointe: –44.7° vs –22.5°, p<0.01) compared to nondancers. With increasing heel height, the number of segments showing a significantly higher CV compared with normal standing increased in both groups. In the demi-pointe posture, dancers exhibited a correlation between COP path length and hip and knee angles (p<0.05) and nondancers showed correlations between COP path length and CV of the midthoracic (p<0.01), thoracolumbar (p&lt;0.05), knee (p&lt;0.01), and ankle (p&lt;0.01). CONCLUSION: Dancers exhibited better balance, as indicated by a shorter COP path, particularly in the demi-pointe position, compared to nondancers. While no significant differences were found in spinopelvic kinematics between groups, these were associated with COP path length in nondancers during demi-pointe owing to within-group variations, unlike in dancers.

Japanese Performing Arts Medicine Association Has Launched  [Meetings]
Naotaka Sakai

The Japanese Performing Arts Medicine Association (JPAMA) has officially launched. This marks the realization of a vision first articulated by Dr. Naotaka Sakai in this journal in 2017. Although JPAMA was established in 2022, it initially comprised only doctors and dentists. In 2025, a third kind of academic conference was scheduled, for not only medical professionals but also basic researchers, music educators, musicians, and dancers. By structuring JPAMA as a tripartite organization—comprising the Performing Arts Medicine group, Performing Arts Therapy group, and Performing Arts Science group—it enabled medical professionals to engage in more specialized discourse. This new tripartite structure offers a potential model for the future development of performing arts medicine societies.