Osteopathic management of musculoskeletal disorders in musicians: prevention and treatment

Musicians, whether professional or amateur, spend hours practicing their instrument, often in demanding, repetitive postures. This passion, though rewarding, unfortunately exposes many of them to musculoskeletal disorders (MSDs). According to studies, between 60% and 90% of musicians suffer from pain related to their practice, whether tendonitis, neck pain or muscular contractures. These disorders can not only affect their performance, but also threaten their careers. 

Faced with these challenges, osteopathy presents itself as a holistic, non-invasive solution for preventing and treating RSI in musicians. This article explores the causes of these disorders, the role of osteopathy in their management, and practical advice for musicians.

Musculoskeletal disorders (MSDs) are a group of conditions affecting muscles, tendons, joints and nerves. They are caused by excessive or inappropriate demands on the musculoskeletal system, often linked to repetitive movements, prolonged postures or sustained effort.

MSDs are particularly common among musicians, due to the physical demands of their instrumental practice. Playing an instrument involves precise and often repetitive gestures, performed over long hours in sometimes awkward positions. This repetition can result in muscular and joint fatigue, leading progressively to pain and functional limitations.

Intensive practice of a musical instrument places heavy demands on the musculoskeletal system. Repetitive movements, awkward postures and prolonged exertion can lead to a variety of disorders, the most common of which are :

Tendonitis is inflammation of the tendons, often caused by repetitive movements and muscular overuse. In musicians, they mainly occur in the wrists, elbows and shoulders, depending on the instrument played.

• De Quervain's tendonitis: This inflammation of the thumb tendons is common among pianists and guitarists, due to repeated flexion-extension movements of the thumb and hand.
• Epicondylitis (tennis elbow): This tendonitis affects the extensor muscles of the wrist, and can affect violinists, violists and drummers who use their forearms intensively.
• Rotator cuff tendonitis: Common among violinists, violists and trumpeters, it results from excessive and prolonged tension of the shoulder muscles.

Nerve compression occurs when a nerve is pinched or irritated by surrounding tissues (muscles, tendons, ligaments), resulting in pain, numbness and loss of strength.

• Carpal tunnel syndrome: manifests as tingling, numbness and muscle weakness in the fingers. Common among pianists, violinists and guitarists, it is caused by compression of the median nerve at the wrist, often exacerbated by repetitive movements and poor wrist posture.
• Thoracic-brachial outlet syndrome: This condition affects blowers and violinists, in whom asymmetrical posture or pressure on the shoulders can lead to compression of nerves and blood vessels, causing pain and tingling in the arm.

Neck and back pain are very common among musicians, due to prolonged, asymmetrical postures that generate muscular tension and postural imbalances.

• Cervicalgia: Violinists and violists are particularly at risk, as they hold their instrument under the chin, resulting in prolonged contraction of the neck and trapezius muscles.
• Dorsalgia and low back pain:
  • For pianists and guitarists, prolonged sitting, sometimes with an arched back, can cause back pain.
  • Double bassists and harpists, who play asymmetrically, can develop tension in the lumbar region.

Contractures are defensive reactions of the muscle to excessive effort or poor posture. They result in a sensation of stiffness and persistent pain.

• Shoulders and trapezius: Highly solicited by violinists, violists and trumpeters, these areas are under constant tension, leading to painful contractures.
• Forearms and hands: Pianists, guitarists and drummers often develop muscle tension in these areas, due to the rapid repetition of movements.
• Bruxism and jaw tension: for clarinetists, saxophonists and singers, excessive jaw tension can lead to temporomandibular pain and headaches.

• Prolonged, asymmetrical postures: Violinists or flute players, for example, often maintain an unbalanced head and neck position.  
• Repetition of precise movements: Constant repetition of certain gestures (fingering, bow strokes, pressure on the keys) places intense demands on the same muscle groups, leading to tendonitis and inflammation.
• Performance-related stress: Anxiety and pressure can increase involuntary muscle tension, particularly in the neck, shoulders and back.
• Lack of warm-up or cool-down: As with all athletes, insufficient warm-up before playing and inadequate cool-down afterwards can lead to pain.
• Body asymmetry: many instruments require postural asymmetry (violin, guitar, clarinet, trumpet), creating an imbalance between muscle chains and increasing the risk of muscular and joint tension.

Osteopathy is based on a holistic view of the body. In the case of musicians, this means understanding how posture, repetitive movements and muscular tension interact to cause RSI. The osteopath seeks to restore the body's structural and functional balance, by acting on areas of dysfunction.

Before any intervention, the osteopath makes a complete diagnosis:  

• Anamnesis: Detailed interview to understand instrumental practice, work habits and injury history.  
• Palpatory examination: Assessment of muscle tension, joint restrictions and postural imbalances. The osteopath examines the cervical, back, shoulder and hand regions in particular.  

1. Structural techniques

These techniques aim to restore mobility to locked joints. For example, gentle spinal manipulation can relieve back and neck pain, common among violinists and guitarists.

2. Myofascial techniques

The osteopath uses myofascial release techniques to relax tense muscles, particularly in the trapezius, shoulders and forearms. These techniques improve blood circulation and reduce tension.

3. Cranial and visceral techniques

• Cranial: release stress-related cranial tension, common among musicians during performance periods.  
• Visceral: Improve breathing and posture by working on the thoracic and abdominal organs.  

4. Personalized advice and exercises

The osteopath offers advice adapted to each musician:  

• Warm-up and stretching: Specific exercises to prepare muscles and joints before practice.  
• Postural correction: Adjustments to improve ergonomics during instrumental practice. 
• Stress management: Relaxation and breathing techniques to reduce performance anxiety.  

Benefits

• Reduced pain and tension: Musicians often experience significant relief after just a few sessions.  
• Improved mobility and performance: Better posture and greater freedom of movement promote more fluid practice.  
• Injury prevention: By acting on the underlying causes, osteopathy helps prevent recurrences.  

Limits

• Need for multidisciplinary collaboration: Osteopathy must often be complemented by other approaches (physiotherapy, medicine).  
• Variable results: Effectiveness may also depend on the age and severity of the disorder. 

Musicians are particularly exposed to musculoskeletal disorders due to their demanding and repetitive practices. Osteopathy, with its comprehensive, non-invasive approach, offers an effective solution for preventing and treating these disorders. By acting on postural imbalances, muscular tensions and joint restrictions, it enables musicians to return to a healthier, more efficient practice.  

To maximize benefits, a multidisciplinary approach is essential, combining osteopathy, physiotherapy and ergonomic advice. Finally, musicians need to be made aware of the importance of warm-up, cool-down and stress management in preserving their long-term health.