{"id":3969,"date":"2018-04-04T12:18:16","date_gmt":"2018-04-04T16:18:16","guid":{"rendered":"http:\/\/sites.music.mcgill.ca\/mpbs\/?page_id=3969"},"modified":"2018-04-13T10:58:27","modified_gmt":"2018-04-13T14:58:27","slug":"musculoskeletal-problems-among-orchestral-musicians-exercise-and-recovery","status":"publish","type":"page","link":"https:\/\/sites.music.mcgill.ca\/mpbs\/no-pain-no-gain\/musculoskeletal-problems-among-orchestral-musicians-exercise-and-recovery\/","title":{"rendered":"Musculoskeletal problems among orchestral musicians, exercise, and recovery"},"content":{"rendered":"

Suffering from musculoskeletal problems? You\u2019re not alone.<\/b><\/p>\n

Musculoskeletal problems are very common among orchestral musicians. There is still significant disagreement on the exact prevalence of these problems. Some studies, like the one conducted by\u00a0Fotiadis and colleagues (2013),<\/span> report 81.3% of the musicians they studied were affected, while others, like\u00a0Ackermann and colleagues (2012)<\/a><\/span>,<\/strong> come back with 84%. The largest survey ever taken on orchestral musicians was conducted by the\u00a0International Conference of Symphony Orchestra Musicians (ICSOM)<\/a><\/span>\u00a0in 1988. It revealed that 76% of the 2212 orchestral musicians surveyed had a medical problem that was severe enough to affect their playing. The neck and back were the most common sites for pain. (Fishbein, Middlestadt, Otatti, Straus, & Ellis, 1988<\/a><\/span>). How does this happen? There are many potential causes, but commonly reported risk factors include personal factors like individual technique and posture, gender (women reportedly had higher rates of problems than men), age, type of instrument played (instrumentalists in strings, piano, harp, and percussion were found to be more vulnerable than the rest of the group), as well as occupational factors like number of hours played daily, perceived exertion of playing, and difficulties recovering after an episode of musculoskeletal pain related to training and playing load (Fotiadis et al., 2013<\/a>;\u00a0Kaakkola, Liira, Savolainen, Viljamaa, 2017<\/a><\/span>).<\/p>\n

What are some solutions to these problems?<\/b><\/p>\n

Ackermann, Adams, & Marshall (2002) compared strength-training and endurance training in undergraduate music students with performance-related musculoskeletal disorders over a six week period. They conclude that while both groups showed positive results at the end of the six weeks, the endurance group had significant drops in perceived exertion of playing, suggesting that endurance training should be favored over strength training (Ackermann, Adams, & Marshall, 2002<\/a><\/span>). From these results, Brandfonbrener (2003) concludes that \u201cmusicians need light resistance work with many repetitions rather than weight training\u201d (Brandfonbrener, 2003<\/span>,<\/a>\u00a0p. 237). She recommends swimming, calling it \u201can ideal and safe form of exercise for musicians\u201d (p. 237). After the exertion is over, recovery begins. Because of orchestra musicians\u2019 often-tight schedules as well as the differing demands of programs, Kaakkola and colleagues (2017) mention that recovery can be difficult. Thus, more research is needed into the post-concert recovery period. Before we can talk about recovery, we first need to know about some basic muscle structure and function.<\/p>\n

Basic muscle structure and function<\/b><\/p>\n

There are three different kinds of muscle tissue in the body: cardiac muscle – which is only found in the heart and that is involuntary, smooth muscle – which is found in the stomach, bladder, and intestines (among other places) and that is also involuntary, and skeletal muscle – which is voluntary (Marieb & Hoehn, 2013).<\/span><\/p>\n

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Figure 1.<\/strong>\u00a0Structure of skeletal muscle<\/a> <\/span>with epimysium highlighted.<\/figcaption><\/figure>\n

Each skeletal muscle is made up of multiple parts. Connective tissue sheaths cover and reinforce the different organizational units, stopping the muscle from bursting during very strong contractions. The first layer of dense connective tissue, found on the outside of the muscle, is called the epimysium (Figure 1<\/strong>)<\/span>.\u00a0Within the muscle, bundles of muscle fibers are grouped into fascicles, which are surrounded by the perimysium, another layer of connective tissue. Finally, around each muscle fiber is a thin sheet of connective tissue called the endomysium. A single muscle fiber is made up of hundreds to thousands of myofibrils, or rod-like structures that contain the contractile elements of skeletal muscle, called sarcomeres. Sarcomeres are made up of alternating thick and thin filaments called myofilaments. The thick filaments are called myosin filaments, while the thin filaments are called actin filaments.<\/span><\/p>\n

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Figure 2.<\/strong>\u00a0Myosin cross bridge<\/span><\/a> showing calcium ions<\/p>\n

To execute a contraction, the nervous system must stimulate the muscle fiber.\u00a0When a nerve impulse reaches the sarcoplasmic reticulum (SR) (Figure 3<\/strong>), the SR allows calcium ions to be released into the cytosol\u00a0(the fluid inside of the cell), thus allowing the heads of the myosin filaments to bond to binding sites on the actin filaments.\u00a0This binding forms a cross bridge (the link between the myosin head and actin) which allows the myosin heads to pull the actin filaments along, contracting the muscle (Figure 2<\/strong>) (Marieb & Hoehn, 2013).<\/p>\n

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What causes muscle fatigue?<\/b><\/p>\n

According to Marieb and Hoehn (2013), muscle fatigue is a physiological inability of the muscle to contract even though it may still be receiving stimuli. Adenosine triphosphate (ATP) supplies the energy to form and detach the cross bridges. Although ATP availability declines during muscle contraction, it is very rare that muscles completely run out of ATP, thus Marieb and Hoehn conclude that it is not a factor in fatigue. When the nerve stimulates the muscle cell, potassium is lost from the cell and accumulates in the T tubules (the structure that allows the nerve impulse to reach the SR), which stops the release of calcium ions, interfering with contraction and leading to muscle fatigue.<\/p>\n

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Figure 3.<\/strong>\u00a0Skeletal muscle fiber<\/a> <\/span>with sarcoplasmic reticulum highlighted<\/figcaption><\/figure>\n

But wait, I\u2019ve always been taught that lactic acid causes muscle fatigue!<\/b><\/p>\n

Although lactic acid was maligned for years as being a cause of muscle fatigue because it raises hydrogen ion concentration (which lowers the pH, making things more acidic) and alters contractile proteins, lactic acid actually counteracts high potassium levels, which <\/span>do<\/span><\/i> lead to muscle fatigue.\u00a0<\/span>Unless you are absolutely maximally exerting yourself, pH will be kept within normal limits (Marieb & Hoehn, 2013). Additionally, according to Westerblad and colleagues (2002)<\/span><\/a>, the concentration of inorganic phosphate determines the amount of muscle fatigue. The more inorganic phosphate that is present, the harder it is for the myosin heads to pull the actin strands along.<\/p>\n

What are the differences between aerobic and anaerobic exercise? <\/b><\/p>\n

Before we can talk about recovery, we have to talk about the difference between aerobic and anaerobic exercise. Adenosine triphosphate (ATP) is the most useful molecule in the body because it is used to power all functional processes, including muscle contraction. ATP is stored in the muscles for later use and has to be regenerated as fast as its broken down. This regeneration is carried out by three different methods (ordered from fastest to slowest): direct phosphorylation, the anaerobic pathway, and the aerobic pathway.[tabs]
\n[tab title=”Direct phosphorylation”]<\/span><\/p>\n