MusicPhysio Congress 2018

Anamnesis and analysis of performance related problems

• Rationale: The subjective and objective examination including observation of the posture and playing behaviour can be an important factor to find the right treatment strategy for performance related problems or disorders. Therefore, this workshop will present a possible approach to integrate these factors into a physiotherapeutic treatment session along a clinical reasoning decision pathway including a multidimensional clinical framework.
• Educational Objectives: Case studies possibly a Demo-Patient

• At the end of the workshop, the participants will be able to…
• 1. ... to have new possibilities or ideas to structure and analyze a physical examination with and without an instrument
• 2. ... confirm your own hypothesis through clinical tests (insight, depending on your own experience) 
• 3. ... to have new possibilities or ideas to categorize a functional performance related problem and to form a treatment plan based on the gathered information
• Approach of Presentation: PPT, Videos, Pictures, possibly a Demo-Patient
• Content of Presentation:  Many musicians present neuromusculoskeletal symptoms while playing their instrument or develop them over an amount of time. In a functional demonstration of playing the instrument maladaptive movement patterns can be identified, further confirmed in the physical examination and then treated in a targeted manner. This workshop will present an analysis and treatment approach for musicians with playing related problems using examples from the clinical practice.
• Clinical Implications: The medical care of performance related problems can be improved by a specific examination and treatment

Practical physiotherapeutic "Grounding" Exercises for Musicians

• Physical and psychosocial risks in musicians career have been well documented in the past few decades. According to numerous international studies, musical performance, competitive pressure, frequent long practice (possibly without breaks), a general lack of exercise could cause physical discomfort in lives of music-students, professional musicians and all performers. In the worst-case scenario, an existing playing-related musculoskeletal symptom(s) (PRMS), disorder(s) (PMSD) or “micro”-trauma, a possible high stress could interfere with the course of the healing process and endanger musician´s career.
• Educational Objectives: As an educational interactive workshop lecture, each individual will have a possibility to adapt each exercise to an individual case and later in life to use parts of the exercise(s), as well as mix and match the philosophies of each of the physiotherapeutic methods.
• At the end of the workshop, the participants will be able to…
• 1. …demonstrate and perform few exercises as well as promote own body awareness
• 2. …describe own perceptions
• 3. …use music-physiology tools, which could positively improve musician ́s practice and performance
• Approach of Presentation: This workshop, as an educational interactive lecture is planed as “learning by doing” concept. Goals are to help develop and/or improve body awareness by doing easy practical exercises and to promote musical performance.
• Content of Presentation: Physiotherapy exercises have been proven to be valuable asset in music-physiology practice. The “functional problem of a movement" is decisive for selecting the exercises for musicians. The movement-training concept for musicians should economize the movement processes, to train the perception, coordination, self-correction and stabilization. The exercises should promote the unity of body and mind.
• Clinical Implications: The clinical and practical implications of this workshop are posture- and movement training, perception, relaxation, stress management as well as health promotion. When body learns to develop itself harmoniously, it could influence a body-mind unity positively, in sense of promoting “healthy body + healthy mind = healthy music” musical performance.

The arm is the connection between body and instrument for piano-, string-, wind instrument players as well as percussionists. To move the arm in free function, all the connecting muscles have to be able to hold and to lift, to slow down and to accelerate (Klein- Vogelbach 2011). The arm is connected with the trunk over the scapula. This connection, called the scapulothoracic joint is of major importance. It has to be both, mobile and stable. The muscles contributing to good scapula stability are the M. serratus anterior, M. trapezius, rhomboids and M. pectoralis minor.  If this anchoring of the arm onto the thorax is not sufficiently stable, the trunk-, scapula- and arm muscles along the whole chain have to compensate the instable situation (Tanno 2011). This can result in taut bands and the so called myofascial Trigger Points (Mtrps). If the overload is prolonged the fascias around the muscles can additionally produce adhesion sites. The fact, that musicians have to practice for hours increases the overload of some muscles or muscle groups which can lead to pain and dysfunction. (Dejung 2009, Gautschi 2016).

The Trigger Point- specialists IMTT are trained, to recognize taut bands and Trigger Points as well the adhesions sites in the connective tissue. They will release the painful spots with manual techniques and sometimes with dry needling. The Trigger Point- specialists also care about prevention. They will analyze the overload position and tell the patients which muscles they should stretch or relax and which muscles they should strengthen. The therapists also determine if the musician should change position of the spine, thorax, scapula or the arm while playing the instrument. The Trigger Point-specialists also make a test, to recognize if the connection between scapula and thorax is stable or unstable. The reason for the instability could also be a scoliosis, a flat spine or a hyperkyphoses of the thoracic spine.  Specific exercises will be introduced and instructed. A good cooperation between musician and therapist can optimize the situation as you can see in the pictures below.

Sensor controlled muscle function diagnosis in musicians´ health

• At the end of the workshop, the participants will be able to…

1.   understand the basic principles of electromyography in a clinical setting

2.   identify motor control strategies in complex movements

3.   get an impression of electromyography as a biofeedback tool in therapy

• Approach of Presentation: Biomechanical analyses are capable of capturing and evaluating human movements. In addition to the two major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities. Neuromuscular parameters can be assessed, e.g. inter- and intramuscular coordination, muscle fiber distribution, fatigue behavior or timing. From a physiotherapeutic point of view, it is of interest to analyse and quantify parameters such as motor control, muscular coordination or compensation strategies with different loads, etc.
• Content of Presentation: (1) Theoretical basics of EMG, (2) Clinical applications of EMG in the context of musicians´ health, (3) EMG in dynamic and postural control. 
• Clinical Implications: An effective application of EMG in a clinical setting depends on the integration into the clinical reasoning process. Without this, there is a risk that one "loses" in the collected biomechanical data and „loses“ the clinical connection to the patients´ problem. The EMG supports the clinical reasoning process and can support to confirm or disconfirm hypotheses. In the application of EMG, some factors in the clinical setting have to be considered in order to collect data. These factors are important and should be taken into account before analysis

Pelvic Pain and Posture Assessment and Management in Professional Musicians

• Rationale: The aim of this workshop is to educate physiotherapists and musicians about  relationship between the posture and pelvic pain and to teach specific exercises about pelvic pain and postural disorders.
• Educational Objectives: Refreshing about pelvic anatomy and core stability mechanism Respiratory system and pelvic floor muscles connection
• -To aware of interrelation between posture and pelvic pain
• -To learn pelvic pain assessment
• -Treatment of pelvic pain
• -To learn postural alignment
• -To design pelvic pain exercise session which includes yoga, pilates and specific exercises for pelvic pain and postural disorders

• At the end of the workshop, the participants will be able to…

1.  Use diaphragmatic breathing and pelvic pain management
2. Teach to musicians postural alignment while performing, sitting and standing
3. Teach specific relaxation and stretching exercises on pelvic floor muscles in musicians with chronic pelvic pain.

• Approach of Presentation: Practical and theoric information
• Content of Presentation:

1. Anatomy & physiology of the pelvis (the pelvic girdle & the pelvic floor)
2. Posture & the pelvis a. Musculoskeleteal changes in  musicians b. Posture
3. Musician's pelvic floor problems a. Incontinence b.Prolapse c.Pelvic pain d. DRAM
4. Pelvic girdle pain and pelvic floor pain a. Terminology / classifications b. Risk factors c. Prevalence d. Physiology of pain ,e. Pelvic pain in musicians   f. Guidelines for diagnosis and treatment of pelvic girdle pain
5. Anatomy, physiology and research in core stability
6. Subjective & Objective Assessments
7. Motor recruitment & proprioception in pelvic pain
8. Retraining stability of the pelvic girdle
9. Functional flexibility of the pelvis
10. Neural mobility of the pelvis
11. Physical activity and exercise guidelines for musicians a. Contraindicationsb. Safe and unsafe exercise c. Warning signs d. Recommendations e. Benefits of Exercise f. High risk and low risk exercise 
12. Exercise programming for pelvic pain and good posture  in musicians

An introduction to real-time sonification based on motion capture data