Neuro-mechanical aspects of playing-related mobility disorders in orchestra violinists and upper strings players: a review

Submitted: 8 May 2020
Accepted: 14 June 2020
Published: 4 August 2020
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Orchestra musicians are at high risk of neuro-mechanical disorders due to the intense stresses their body withstand, leading to pain and injury. This review presents a comprehensive account of the works on the circumstances and types of playing related mobility disorders of upper strings players, as well as on the relevant neuro-mechanical factors and perspectives to those disorders. The following aspects are considered: asymmetry and imbalance in the musculo-skeletal system, muscle-bone-joint interactions, repetitive overloading and fatigue. An additional factor relates to neuro-muscular redundancy in the motor system, whereby more muscles and tendons than strictly necessary are engaged in performing a motor task, thus making the system indeterminate, with no unique solution. This same task can be performed with different muscle combinations. It is thus of interest to verify whether playing disorders may be alleviated by considering alternative techniques of performance.

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Caldron PH, Calabrese LH, Clough, JD, Lederman RJ, Williams G, Leatherman J. A survey of musculoskeletal problems encountered in high level musicians. Medical Problems of Performing Artists 1986;1:136--9.
Lockwood AH. Medical problems in secondary school-aged musicians. Medical Problems of Performing Artists, 1988;3:129-32.
Manchester RA. The incidence of hand problems in music students. Medical Problems of Performing Artists 1988;3:15-8.
Larsson LG, Baum J, Mudholkar GS, Kollia, GD. Benefits and disadvantages of joint hypermobility among musicians. New England Journal of Medicine 1993;329:1079-82. DOI: https://doi.org/10.1056/NEJM199310073291504
Fishbein M, Middlestadt SE, Ottati V, Straus S, Ellis A. Medical problems among ICOSM musicians: overview of a national survey. Medical Problems of Performing Artists 1988;3:1-8.
Hohls QR. An investigation into performance related musculoskeletal disorders of professional orchestral string musicians in South Africa. Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology at the Durban University of Technology, January 2010.
Lee HS, Park HY, Yoon JO, Kim JS, Chun JM, Aminata IW, Cho WJ, Jeon IH. Musicians’ medicine: musculoskeletal problems in string players. Clinics in Orthopedic Surgery 2013;5:155-60, doi: 10.4055/cios.2013.5.3.155 DOI: https://doi.org/10.4055/cios.2013.5.3.155
Gembris H. Heye A, Seifert A. Health problems of orchestral musicians from a life-span perspective: Results of a large-scale study. Music & Science 2018;1:1-20.
Kelleher LK, Campbell KR, Dickey JP. Biomechanical Research on Bowed String Musicians. A Scoping Study. Performing Arts Medicine Association Symposium, Snowmass, CO, July 19–23, 2013. pp 212-8. DOI: https://doi.org/10.21091/mppa.2013.4042
Handal C. Documenting postural changes and repetition among violin players and their influence in the development of musculoskeletal disorders. LSU Master's Theses, Louisiana State University and Agricultural and Mechanical College; 2013. p 62.
Brown S. Shoulder pain and the instrumental musician. Journal of Back and Musculoskeletal Rehabilitation 1992;2:16–27. DOI: https://doi.org/10.3233/BMR-1992-2204
Wales J. 3D Movement and Muscle Activity Patterns in a Violin Bowing Task, M.Sc. Applied Health Sciences, Brock University; 2007.
Shan G, Visentin P, Schultz A. Multidimensional signal analysis as a means of better understanding factors associated with repetitive use in violin performance. Med Prob Perf Art 2004;19:129-39. DOI: https://doi.org/10.21091/mppa.2004.3022
Reynolds JF. Shoulder Joint and Muscle Exposure in Violin Musicians: A Three-Dimensional Kinematic and Electromyographic Exposure Variation Analysis. A dissertation submitted to the faculty of the Graduate School and of the University of Minnesota, May 2009.
Afsharipour B, Petracca F, Gasparini M, Merletti R. Spatial distribution of surface EMG on trapezius and lumbar muscles of violin and cello players in single note playing. Journal of Electromyography and Kinesiology 2016;31:144–53. DOI: https://doi.org/10.1016/j.jelekin.2016.10.003
Fjellman-Wiklund A, Grip H, Karlsson JS, Sundelin, G. EMG trapezius muscle activity pattern in string players: Part I—Is there variability in the playing technique? Int J Ind Ergon 2004;33:347–56. DOI: https://doi.org/10.1016/j.ergon.2003.10.007
Vesamäki E. Surviving Over-practice Injury, The quest to find freedom in violin technique, Thesis for the degree of Master, Royal College of Music in Stockholm, Department of Classical Music, 2015, p.38.
Mizrahi J. Muscle/Bone Interactions in the Musculo-Skeletal System. Published by the Center of Excellence for Applied Biomedical Modelling and Diagnostics, Warsaw (ISSN 1733-0874); 2004
Martin RB, Burr DB. Structure, Function and Adaptation of Compact Bone. New York; Raven Press; 1989.
Nordin M, Frankel V. (1989). Biomechanics of Bone. In: Nordin M, Frankel V eds. Basic Biomechanics of the Musculoskeletal System. Philadelphia (PA): Lea and Febiger, pp 3-29.
Brook N, Mizrahi J, Shoham M, Dayan J. A biomechanical model of index finger dynamics. Med Eng Phys 1995;17:54-63. DOI: https://doi.org/10.1016/1350-4533(95)90378-O
Janda V. Proximal crossed syndrome. In: Hutson M, Ellis R, eds. Textbook of musculoskeletal medicine. 1st ed. New York: Oxford University Press; 2006. pp 48-9.
Page P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance, The Janda Approach; Human Kinetic Publishers; 1988. ISBN 9781450408288.
Steinmetz A, Seidel W, Muche B. Impairment of postural stabilization systems in musicians with playing-related musculoskeletal disorders. J. Manipulative Physiol Ther 2010;33:603-11. DOI: https://doi.org/10.1016/j.jmpt.2010.08.006
O'Shea C, Bettany-Saltikov JA, Warren JG. Effect of same-sided and cross-body load carriage on 3D backshape in young adults. Stud Health Technol Inform 2006;123:159-63.
Jager M, Luttmann A. The load on the lumbar spine during asymmetrical bi-manual materials handling. Ergonomics 1992;35:783-805. DOI: https://doi.org/10.1080/00140139208967363
Kjelland JM. Application of electromyography and electromyographic biofeedback in music performance research: a review of the literature since 1985. Med Probl Perform Art 2000;15:115-8. DOI: https://doi.org/10.21091/mppa.2000.3023
Kok LM, Vliet Vlieland TPM, Fiocco M, Nelissen RGHH. A comparative study on the prevalence of musculoskeletal complaints among musicians and non-musicians. BMC Musculoskeletal Disorders 2013;14:1-7. http://www.biomedcentral.com/1471-2474/14/9 DOI: https://doi.org/10.1186/1471-2474-14-9
Philipson L, Sorbye R, Larsson P, Kaladjev S. Muscular load levels in performing musicians as monitored by quantitative electromyography. Med Probl Perform Art 1990;5:79-82.
Levy CE, Lee WA, Brandfonbrener AG, Press J, Levy AE. Electromyographic analysis of muscular activity in the upper extremity generated by supporting a violin with and without a shoulder rest. Med Probl Perform Artists 1992;7:103-9.
Payne LZ, Deng XH, Craig EV, Torzilli PA, Warren RF. The combined dynamic and static contributions to subacromial impingement, a biomechanical analysis. The American Journal of Sports Medicine 1997;25:801-8. DOI: https://doi.org/10.1177/036354659702500612
Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics 2003;18:369–379. DOI: https://doi.org/10.1016/S0268-0033(03)00047-0
Page, P. (2011). Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. The International Journal of Sports Physical Therapy, 6(1), 51-58.
Potau JM, Bardina X, Ciurana N, Camprubí D, Pastor JF, de Paz F, Barbosa M. Quantitative analysis of the deltoid and rotator cuff muscles in humans and great apes. Int J Primatol 2009;30:697–708. DOI: https://doi.org/10.1007/s10764-009-9368-8
Juhan D. Job's Body : A Handbook for Bodywork. Barrytown: Station Hill Press. 2003.
Benedetti E. Cello, bow and you: putting it all Together. Oxford: Oxford University Press; 2017.
Mizrahi J, Susak Z. Bilateral reactive force patterns in postural sway activity of normal subjects. Biological Cybernetics 1989;60:297-305. DOI: https://doi.org/10.1007/BF00204127
Bechtol CO. Normal Human Gait. In: Bowker JH, Hall CB, eds. Atlas of Orthotics. St. Louis; Mosby; 1975. pp 133-43.
Fry HJH. Incidence of overuse syndrome in the symphony orchestra. Medical Problems of Performing Artists 1986;1:51-5.
Szende O, Nemessuri M. The physiology of violin playing. Budapest: Collet's Ltd, Akademiai Kiado; 1971.
Bejjani FJ, Ferrara L, Pavlidis L. A comparative electromyographic and acoustic analysis of violin vibrato in healthy professional violinists. Medical Problems of Performing Artists 1989;4:168-75.
Bejjani FJ, Kaye GM, Benham M. Musculoskeletal and neuromuscular conditions of instrumental musicians. Arch Phys Med Rehabil 1996;77:406-13. DOI: https://doi.org/10.1016/S0003-9993(96)90093-3
Bernstein N. The coordination and regulation of movement. London; Pergamon Press; 1967.
Shumway-Cook A, Woollacott M. Motor Control: Theory and Practical Applications, Baltimore, MD; Williams & Wilkins; 1995.
Mizrahi J. Mechanical impedance and its relations to motor control, limb dynamics, and motion biomechanics, J Med Biol Eng 2015;35:1-20, DOI 10.1007/s40846-015-0016-9. DOI: https://doi.org/10.1007/s40846-015-0016-9
Mizrahi J, Daily D. Modeling the foot-strike event in running fatigue via mechanical impedances. In: Tarum Goswani T ed. Injury and Skeletal Biomechanics. InTech, (ISBN 978-953-51-0690-6); 2012. pp 153-170.
Katz A, Tirosh E, Marmur R, Mizrahi J. Enhancement of muscle activity by electrical stimulation in cerebral palsy – a case control study. J Child Neurology 2008;23:259-67. DOI: https://doi.org/10.1177/0883073807308695
Moore M, DeHaan L, Ehrenberg T, Gross L, Magembe C. Clinical assessment of shoulder impingement factors in violin and viola players. Medical Problems of Performing Artists 2008;23:155-63. DOI: https://doi.org/10.21091/mppa.2008.4032
Berque P. Gray H. The influence of neck-shoulder pain on trapezius muscle activity among professional violin and viola players: an electromyographic study. Med Prob Perf Art 2002;17:68-75. DOI: https://doi.org/10.21091/mppa.2002.2011
Tulchinsky E, Riolo L. A biomechanical motion analysis of the violinist’s bow arm. Medical Problems of Performing Artists 1994;9:125–30.
Loram A. A Scientific investigation into violin and viola playing. MSc in Performing Arts Medicine, University College London, Division of Surgery and Interventional Science. 2013.
Hoppmann RA.. Musculoskeletal problems of instrumental musicians. In: Sataloff R T, Brandfonbrenner AG, Lederman RJ. eds. Performing Arts Medicine, 3rd ed. Narberth, PA: Science and Medicine Art Publishers; 2010. p 207.
Wynn Parry CB. The interface. In: Wynn Parry, CB, Winspur I, eds. The musician's hand. London, Martin Dunitz Ltd; 1998.
Tubiana R. Movements of the fingers. Medical Problems of Performing Artists 1988;3:123-8.
Patriarco AG, Mann RW, Simon SR, Mansour JM. An evaluation of the approaches of optimization models in the prediction of muscle forces during human gait. J Biomech 1981;14:513-25. DOI: https://doi.org/10.1016/0021-9290(81)90001-4
Suponitsky Y, Verbitsky O, Peled E, Mizrahi J. Effect of selective fatiguing of the shank muscles on single-leg standing sway. J. Electromyography and Kinesiology 2008;18:682-9. DOI: https://doi.org/10.1016/j.jelekin.2007.01.009
Vaughan CL, Davis BL, O'Connor JC. Dynamics of Human Gait. Champaign; Human Kinetic Publishers; 1992.
Dommerholt J. Performing arts medicine – Instrumentalist musicians, Part II – Examination. Journal of Bodywork & Movement Therapies 2010;14:65-72. DOI: https://doi.org/10.1016/j.jbmt.2009.02.004
Kok LM, Groenewegen KA, Huisstede BMA, Nelissen RGHH, Rietveld, ABM, Haitjema S. The high prevalence of playing-related musculoskeletal disorders (PRMDs) and its associated factors in amateur musicians playing in student orchestras: A crosssectional study. PLoS ONE 2018;13: e0191772. https://doi.org/10.1371/ journal.pone.0191772 DOI: https://doi.org/10.1371/journal.pone.0191772
Burkholder KR, Brandfonbrener AG. Performance-Related Injuries among Student Musicians at a Specialty Clinic. Medical Problems of Performing Artists 2004:19:116-22. DOI: https://doi.org/10.21091/mppa.2004.3020
Miller G, Peck F, Watson JS. Pain disorders and variations in upper limb morphology in music students. Medical Problems of Performing Artists 2002;17:169-72. DOI: https://doi.org/10.21091/mppa.2002.4016
Feuerstein M, Hickey PF. Handbook of pain assessment, Ergonomic approaches in the clinical assessment of occupational musculoskeletal disorders, ‏ New York; Guilford Press; 1992.
Kuorinka I, Forcier L. Work-Related Musculoskeletal Disorders: A Reference Book for Prevention. London: Taylor & Francis; 1995. ISBN 0-7484-0132-6
Lederman RJ. Neuromuscular and musculoskeletal problems in instrumental musicians. Muscle Nerve 2003;27:549-61. DOI: https://doi.org/10.1002/mus.10380
Colley E. Injury in the Orchestra: The Ergonomic Nightmare. In: Robertson SA ed. Contemporary ergonomics 1994. Proceedings of the Ergonomics Society’s Annual Conference, University of Warwick 19-22 April 1994, University College, London; Taylor and Francis; 1994. pp 22-6.
Moraes GFS, Antunes AP. Musculoskeletal disorders in professional violinists and violists. Systematic review. Acta Ortop Bras 2012;20:43–7.
Chong J, Lynden M, Harvey D, Peebles M. Occupational Health Problems of Musicians. Canadian Family Physician 1989;35:2341-8.
Moore A, Wells R, Ranney D. Quantifying exposure in occupational manual tasks with cumulative trauma disorder potential. Ergonomics 1991;34:1433-53. DOI: https://doi.org/10.1080/00140139108964888
Turner-Stokes L, Reid K. Three-dimensional motion analysis of upper limb movement in the bowing arm of string-playing musicians. Clinical Biomechanics 1999;14:426-33. DOI: https://doi.org/10.1016/S0268-0033(98)00110-7
Kinoshita H, Obata S. Left hand finger force in violin playing: Tempo, loudness, and finger differences. J Acoust Soc Am 2009;126:388–395. DOI: https://doi.org/10.1121/1.3139908
Grosshauser T, Troster G. Finger position and pressure sensing techniques for strings and keyboard instruments, 13th International Conference on New Interfaces for Musical Expression (NIME’13), May 27 – 30, KAIST, Daejeon, Korea;2013.
Zajac F, Winters JM. Modeling musculoskeletal movement systems: joint and body-segment dynamics, musculotendinous actuation, and neuromuscular control. In: Winters JM, Woo SL-Y, eds. Multiple Muscle Systems-Biomechanics and Movement Organization. New York; Springer-Verlag; 1990 DOI: https://doi.org/10.1007/978-1-4613-9030-5_8
Buchner HJ, Hines MJ, Hemami H. A dynamic model for interphalangeal coordination. J Biomech 1988;21:459-69. DOI: https://doi.org/10.1016/0021-9290(88)90238-2
Long C, Conrad PW, Hall EA, Furler, SL (). Intrinsic-extrinsic muscle control of the hand in power grip and precision handling. J Bone and Joint Surgery 1970;52A:853-67. DOI: https://doi.org/10.2106/00004623-197052050-00001
Butz KD, Merrell G, Nauman EA. A biomechanical analysis of finger joint forces and stresses developed during common daily activities. Computer Methods in Biomechanics and Biomedical Engineering 2012;15:131–40. DOI: https://doi.org/10.1080/10255842.2010.517525
Moran JM, Hemann JH, Greenwald AS. Finger joint contact areas and pressures. Journal of Orthopaedic Research 1985;3:49-55. DOI: https://doi.org/10.1002/jor.1100030106
Mizrahi J, Solomon L, Kaufman B, Duggan TO'D. An experimental method for investigation of the distribution of loading forces in the human cadaver hip joint. Journal of Bone and Joint Surgery 1981;63B:610-3. DOI: https://doi.org/10.1302/0301-620X.63B4.7298695
Schwartz DA, Peimer CA. Distal interphalangeal joint implant arthroplasty in a musician. J Hand Ther 1998;11:49-52. DOI: https://doi.org/10.1016/S0894-1130(98)80061-6
Mizrahi J, Verbitsky O, Isakov E. Fatigue-related loading imbalance on the shank in running: a possible factor in stress fractures. Annals Biomed Eng 2000;28:463-9. DOI: https://doi.org/10.1114/1.284
Beck BR. Tibial stress injuries. An aetiological review for the purposes of guiding management. Sports Med 1998;26:265–79.
Burr DB, Martin RB, Schaffler MB, Radin EL. Bone remodeling in response to in vivo fatigue microdamage. J Biomech. 1985;18:189–200. DOI: https://doi.org/10.1016/0021-9290(85)90204-0
Milgrom C. The Israeli elite infantry recruit: a model for understanding the biomechanics of stress fractures. J. R. Coll. Surg. Edinburgh 1989;34:S18–S21.
Schaffler MB, Radin EL, Burr DB. Long-term fatigue behavior of compact bone at low strain magnitude and rate. Bone (N.Y.) 1990;11:321–6.
Radin EL. Role of muscles in protecting athletes from injury. Acta Med Scand Suppl 1986;711:143-7. DOI: https://doi.org/10.1111/j.0954-6820.1986.tb08943.x
Burr DB. Bone, exercise and stress fracture. In: Holloszy JO, ed. Exercise and sport sciences review. Baltimore, MD; Williams and Wilkins; 1997. pp. 171–94. DOI: https://doi.org/10.1249/00003677-199700250-00009
Quarrier N. Performing arts medicine: The musical athlete. Journal of Orthopaedic and Sports Physical Therapy 1993;17:90–5. DOI: https://doi.org/10.2519/jospt.1993.17.2.90
Radin EL, Parker HG, Pugh GV, Steinberg RS, Paul IL, Rose RM. Response of joints to impact loading. J Biomech 1973;6:51-7. DOI: https://doi.org/10.1016/0021-9290(73)90037-7
Dawson WJ. Intrinsic muscle strain in the Instrumentalist. Medical Problems of Performing Artists 2005;20:66 - 9. DOI: https://doi.org/10.21091/mppa.2005.2013
Manchester RA, Flieder D. Further observations on the epidemiology of hand injuries in music students. Medical Problems of Performing Artists 1991;6:11-4.
Dawson WJ. Upper-extremity problems caused by playing specific instruments. Medical Problems of Performing Artists 2002;17:135. DOI: https://doi.org/10.21091/mppa.2002.3022
Feinberg J, Brandt KD, Steichen JB. Tenodesis of the digital extensors in a violist: The unmasking of a congenital anomaly by technical proficiency. Medical Problems of Performing Artists 1988;3:109-12.
Patrone NA, Hoppman RA, Whaley Y, Schmidt R. Digital nerve compression in a violinist with benign hypermobility: a case study. Medical Problems of Performing Artists 1989;4:91-4.
Radin EL, Paul IL, Rose RM. Mechanical factors in etiology of osteoarthrosis. Annals of Rheumatic Diseases 1975;34:132-3.
Wosk J, Voloshin AS. Wave attenuation in the skeletons of young healthy persons. J Biomech 1981;14:261-8. DOI: https://doi.org/10.1016/0021-9290(81)90071-3
Barczyk-Pawelec K, Sipko T, Demczuk-Włodarczyk E, Boczar A. Anteroposterior spinal curvatures and magnitude of asymmetry in the trunk in musicians playing the violin compared with nonmusicians. Journal of Manipulative and Physiological Therapeutics 2012;35:319-26. DOI: https://doi.org/10.1016/j.jmpt.2012.04.013
Ackermann B, Adams R. Physical characteristics and pain patterns of skilled violinists. Med Probl Perform Artists 2003;18:65-71. DOI: https://doi.org/10.21091/mppa.2003.2013
Kaufman-Cohen Y, Ratzon NZ. Correlation between risk factors and musculoskeletal disorders among classical musicians. Occupational Medicine, 2011;61:90–95. DOI: https://doi.org/10.1093/occmed/kqq196
Ackermann B, & Driscoll, T. Assessing performance-related shoulder pain in the musical athlete – Are typical shoulder examinations enough? Medicine and Science in Sports and Exercise 2013;45:65.
Moran C. Using myofascial techniques to treat musicians. Journal of Hand Therapy 1992;5:97–101. DOI: https://doi.org/10.1016/S0894-1130(12)80264-X
Schaefer P, Speier J. Common medical problems of instrumental athletes. Current Sports Medicine Reports 2012;11:316–22. DOI: https://doi.org/10.1249/JSR.0b013e318272c8ae
Stanhope J. Physical performance and musculoskeletal disorders: Are musicians and sportspeople on a level playing field? Performance Enhancement & Health 2016;4:18–26. DOI: https://doi.org/10.1016/j.peh.2015.11.004
Dick R, Berning J, Dawson W, Ginsburg R, Miller C, Shybut G. Athletes and the arts – The role of sports medicine in the performing arts. Current Sports Medicine Reports 2013;12:397–403. DOI: https://doi.org/10.1249/JSR.0000000000000009
Ackermann B, Kenny D. Fortune J. Incidence of injury and attitudes to injury management in skilled flute players. Work, 2011;40:255–9. DOI: https://doi.org/10.3233/WOR-2011-1227
Ioannou C, Altenmüller E. Approaches to and treatment strategies for playing-related pain problems among Czech instrumental music students. An epidemiological study. Medical Problems of Performing Artists 2015;30:135–142. DOI: https://doi.org/10.21091/mppa.2015.3027
Kreutz G, Ginsborg J, Williamon, A. Health-promoting behaviours in conservatoire students. Psychology of Music 2009;37:47–60. DOI: https://doi.org/10.1177/0305735607086047
Stanhope J, Milanese S, Grimmer K. University woodwind students’ experiences with playing-related injuries and their management: A pilot study. Journal of Pain Research 2014;7:133–48. DOI: https://doi.org/10.2147/JPR.S49620
Wood G. Prevalence, risk factors, and effects of performance-related medical disorders (PRMD) among tertiary-trained jazz pianists in Australia and the United States. Medical Problems of Performing Artists 2014;29:37–45. DOI: https://doi.org/10.21091/mppa.2014.1009
Niederbracht Y, Shim AL, Sloniger MA, Paternostro-Bayles M, Short TH. Effect of a shoulder injury prevention strength training program on eccentric external rotator muscle strength and glenohumeral joint imbalance in female overhead activity athletes. Journal of Strength and Conditioning Research 2008;22:140-5. DOI: https://doi.org/10.1519/JSC.0b013e31815f5634
Mihata T, Gates J, McGarry MH, Lee J, Kinoshita M, Lee TQ. Effect of rotator cuff muscle imbalance on forceful internal impingement and peel-back of the superior labrum. A Cadaveric Study. The American Journal of Sports Medicine 2009;37:2222–7. DOI: https://doi.org/10.1177/0363546509337450
Meister K, Andrews JR. Classification and treatment of rotator cuff injuries in the overhead athlete. JOSPT 1993;18:413-421. DOI: https://doi.org/10.2519/jospt.1993.18.2.413
Wickham J, Pizzari T, Balster S, Ganderton C, Watson L. The variable roles of the upper and lower subscapularis during shoulder motion. Clinical Biomechanics, 2014;29:885–91. DOI: https://doi.org/10.1016/j.clinbiomech.2014.07.003
Kibler WB. The role of the scapula in athletic shoulder function. The American Journal of Sports Medicine 1998;26:325-37. DOI: https://doi.org/10.1177/03635465980260022801
Voight ML, Thomson BC. The Role of the Scapula in the Rehabilitation of Shoulder Injuries, Journal of Athletic Training 2000;35:364-72.
Tsai N-T, McClure PW, Karduna AR. Effects of muscle fatigue on 3-dimensional scapular kinematics. Arch Phys Med Rehabil 2003;84:1000-5.
Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther, 2000;80:276-91. DOI: https://doi.org/10.1093/ptj/80.3.276
Newmark J, Hochberg FH. "Doctor, it hurts when I play": painful disorders among instrumental musicians. Medical Problems of Performing Artists 1987;2:93-7.
Kivi P. Rheumatic disorders of the upper limbs associated with repetitive occupational tasks in Finland in 1975-1979. Scand J Rheumatol 1984;13:101-7. DOI: https://doi.org/10.3109/03009748409100371
Hadler NM, Gillings DB, Imbus HR, Levitin PM, Makuc D, Utsinger PD, Yount WJ, Slusser D, Moskovitz N. Hand structure and function in an industrial setting: influence of three patterns of stereotyped, repetitive usage. Arthritis Rheum 1978;21:210-20. DOI: https://doi.org/10.1002/art.1780210206
Luopajarvi T, Kuorinka I, Virolainen M, Holmberg M. Prevalence of tenosynovitis and other injuries of the upper extremities in repetitive work. Scand J Work Environ Health 1979;5(Suppl):48-55. DOI: https://doi.org/10.5271/sjweh.2675
Miller MH, Topliss DJ. Chronic upper limb pain syndrome (repetitive strain injury) in the Australian workforce: a systematic cross sectional rheumatological study of 229 patients. J Rheumatol 1988;15:1705-12.
Roto P, Kivi P. Prevalence of epicondylitis and tenosynovitis among meatcutters. Scand J Work Environ Health 1984;10:203-5. DOI: https://doi.org/10.5271/sjweh.2344
Liu S, Hayden GF. Maladies in Musicians. Southern Medical Journal 2002;95:727-34. DOI: https://doi.org/10.1097/00007611-200295070-00013
Toledo SD, Nadler SF, Norris RN, Akuthota V, Drake DF, Chou LH. Sports and performing arts Medicine. 5. Issues relating to musicians. Arch Phys Med Rehabil Suppl1 2004;85:S72-4.
Abreu-Ramos AM, Micheo M. Lifetime prevalence of upper-body musculoskeletal problems in a professional-level symphony orchestra: age, gender, and instrument-specific results. Medical Problems of Performing Artists 2007;22:97-104. DOI: https://doi.org/10.21091/mppa.2007.3022

How to Cite

Mizrahi, J. (2020). Neuro-mechanical aspects of playing-related mobility disorders in orchestra violinists and upper strings players: a review. European Journal of Translational Myology, 30(3). https://doi.org/10.4081/ejtm.2020.9095