Surface Electromyography in the world of music
Author: Eng. Martina Palmieri
Introduction to the clinical issue
Music and sport have a fundamental element in common: the dependence of performance on the development of appropriate motor skills. Specifically, an athlete is trained in the control of motor qualities such as strength and balance (the so-called gross motor skills), while a professional musician is required to move with finer nuances associated with biofeedback responses, so here we are talking about fine motor skills. The profession of the musician therefore requires highly precise and repetitive movements of the upper limbs, comparable to those of a professional athlete. Not surprisingly, musical performance is considered one of the most difficult learned behaviors . However, it was only in the 1980s that a clinical interest in a professional musician’s disorders began to develop. In fact, the level of knowledge relating to this topic is still at a primordial stage compared to how much information can be found, instead, for the world of sport .
An orchestral musician generally concentrates on his main instrument for the entire duration of his career, dedicating time and energy to it, with a highly disciplined method . It is estimated, in fact, that an orchestral musician plays for about 1300 hours per year . Such a large amount of activity makes this category of professionals exposed to the risk of developing musculoskeletal disorders, so much that it was necessary to coined an ad hoc term: playing-related musculoskeletal disorder (PRMD) , .
Behind this nomenclature there are three main problems that afflict professional musicians :
– overuse or misuse syndrome, which manifests as persistent pain in the muscle bellies;
– musculoskeletal diseases due to repeated movements or prolonged maintenance of incongruous postures;
– focal dystonia, better known as the musician’s occupational cramp.
Among the various instrumentalists analyzed, violinists have the highest prevalence of PRMD, with incidence rates ranging from 65% to 85% , so a particular interest has developed in them.
Playing the violin is, in fact, an extremely complex motor task. The bow strokes produced by the right arm expose him to dynamic patterns, which are added to the static force of the hand for a firm grip of the bow. The left forearm and hand, on the other hand, move quickly on the keyboard through rapid and well-controlled movements. At the same time, the upper part of the limb is kept in a static position that favors the stabilization of the violin between the shoulder and the chin .
The main objective in playing an instrument has always revolved around the creation of a kind of perfect sound; teaching as well, for centuries, has been based on methods that want to achieve the same goal. Again, the design of musical instruments is aimed at optimizing the performance, thus forcing the musician to adapt to the instrument with a consequent anthropometric variation. Where there is room for non-physiological but induced variation, there is also the possibility of incurring potentially debilitating changes, even in the long term. Many of these injuries, moreover, due to their tendency to become chronic, cause the end of the career of various professionals.
Importance of evaluation in the clinical issue
So it becomes essential to have a deep understanding of the patterns of muscle use and the energy activity produced during the common activities performed. Having this information available, thanks to the progressive monitoring of the health of the muscle groups involved and appropriately structured strengthening (or maintenance) exercises, it is possible to reduce the occurrence of problems but also to optimize the relationship between energy expenditure and quality of performance.
Importance of objective technological evaluation
In this, surface electromyography is a strong ally, due to its ability to obtain quantitative information on the muscle recruitment strategy and on energy expenditure for each muscle analyzed, without introducing particular obstruction in carrying out the task, thus simulating a daily gesture and by obtaining reliable information.
For example, through the use of this technology, a study  was recently conducted on a group of 18 professional violinists, by analyzing the muscular use both in static conditions, i.e. by asking the subjects to hold the violin in position for 20 seconds, and during the performance of an extract from the second movement of the Mozart Violin Concerto No. 5 in A major, 2nd movement (K 219 “Turkish”).
This investigation showed the presence of a greater use of the muscles of the left forearm compared to the contralateral counterparts. It was also possible to understand that this type of gesture requires a constant effort but of limited intensity, which however produces a strong fatigue of the motor units involved.
In conclusion, thanks to the use of precise technologies that can be used in scenarios as similar to everyday life, such as surface electromyography, it is possible to proceed – parallel to the commitment to refine the quality of performance in terms of theoretical and practical study of the instrument – also with a prevention strategy. It is based on reliable and quantitative biometric data of the problems to which professional musicians are exposed due to the size and type of muscular work they bring into play.
 Mann , S., Panduro, M., Paarup, H., Brandt, L., & Sogaard, K. (2021). Surface electromyography of forearm and shoulder muscles during violing playing. Journal of Electromyography and Kinesiology, 1-8.  Visentin, P., Li, S., Tardif, G., & Shan, G. (2015). Unraveling mysteries of personal performance style; biomechanics of left-hand position changes (shifting) in violin performance. PeerJ, 1-20.  Nyman, T., Wiktorin, C., Mulder, M., & Johansson, Y. (2007). Work postures and neck-shoulder pain among orchestra musicians. American journal of industrial medicine, 370-376.  Paarup, H., Baelum, J., Holm, J., Manniche , C., & Wedderkopp, N. (2011). Prevalence and consequences of musculoskeletal symptoms in symphonyorchestra musicians vary by gender: a cross-sectional study. BMC Musculoskeletal Disorders, 1-14.  Zaza, C. (1997). Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. «Health and the Musician» conference, 23-27.  Kok, L., Huisstede, B., Voorn, V., Schoones, J., & Nelissen, R. (2016). The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Environ Health, 373-396.  Moraes, G., & Papini, A. (2012). Musculoskeletal disorders in professional violinists and violists. Systematic review. Acta Ortop Bras, 43-47.  Rensing, N., Schemmann, H., & Zalpour, C. (2018). Musculoskeletal demands in violin and viola playing: a literature review. Med Probl Perform Art., 265-274.