musicians often experience musculoskeletal pain as a result of lengthy and long - term 
 instrument performance . more students enrolled in music schools note upper limb pain 
 compared with students enrolled in ordinary schools1 . it has also been reported that the incidence of upper limb pain is 
 higher in those who have longer practice times . therefore , it can be said that upper limb 
 pain in musicians is a symptom of overuse , with lengthy and long - term instrument performance 
 being contributing factors . musculoskeletal pain in musicians is common not only in the 
 upper limbs but also in the lumbar and cervical regions , as well as in the shoulder 
 girdle2 . for example , it is conceivable that when playing a heavy instrument 
 such as the tuba , a large load is applied to the trunk to maintain the performance posture . furthermore , as instruments in a marching band are played while marching , a large load is 
 probably also applied to the lower limbs . however , the performance postures 
 of various types of instruments have not been sufficiently investigated . thus , the present 
 study clarified the characteristics of the standing performance posture for the trumpet and 
 the marching euphonium and investigated the effect of the performance postures of these 
 instruments on the lower limb musculoskeletal system . the subjects were 10 female university students in japan . their ( mean  sd ) age was 20.5  
 1.3  years , their height was 159.6  6.2  cm , and their weight was 55.1  7.2  kg . because the subjects were not 
 professional trumpet or marching euphonium performers , they all received sufficient 
 instruction from the instructor regarding the trumpet and marching euphonium performance 
 posture prior to measurements . the purpose and contents of the study were sufficiently 
 explained to the subjects , whose consent to participate in the study was obtained . additionally , approval was obtained from the shijonawate gakuen university ethics committee 
 ( approval number 23 - 2 ) . the subjects adopted a closed - leg resting standing position , a trumpet performance posture , 
 and a marching euphonium performance posture . all instrumental performance postures were 
 adopted in the standing , and the subjects focused directly ahead on a mark positioned at eye 
 level . subjects maintained performance posture without actually playing the instrument . the 
 angle and muscle activity of the trunk and lower limbs were measured while the postures were 
 maintained . the measurement was performed in the sequence of the resting standing position , 
 the trumpet performance posture , and the marching euphonium performance posture . the trunk 
 and lower limb angles were measured using a three - dimensional motion analysis device 
 ( cms - hs , zebris medical gmbh , isny , germany ) . markers were attached to the lateral 
 malleolus , lateral epicondyle of the femur , greater trochanter , and acromion on the left 
 side of the subjects . the sampling frequency was 100  hz , and the measurement time was 10 s. 
 measurements were performed as soon as the subjects could maintain a stable performance 
 posture . the collected data were processed by image analysis software ( win - date , zebris 
 medical gmbh ) , and the angles of knee flexion , hip flexion , and anterior tilt of the trunk 
 were calculated . the angle of knee flexion was considered as the angle formed between the 
 line linking the lateral malleolus and the lateral epicondyle of the femur and the line 
 linking the lateral epicondyle of the femur and the greater trochanter . the angle of hip 
 flexion was considered as the angle formed between the line linking the lateral epicondyle 
 of the femur and the greater trochanter and a vertical line . the anterior tilt angle of the 
 trunk was considered as the angle formed between the line linking the acromion and the 
 greater trochanter and a vertical line . a surface myograph ( myosystem 1200 , noraxon inc . , the muscle activities measured 
 were those of the cervical paraspinal muscles , upper fibers of the trapezius , lumbar 
 paraspinal muscles , gluteus maximus , rectus femoris , biceps femoris , and lateral head of the 
 gastrocnemius on the left side . after treating the skin sufficiently to create a skin 
 resistance of no greater than 10  , electrodes ( blue sensor p-00-s , ambu a / s , ballerup , 
 denmark ) were attached parallel to the muscle fibers at the center of each muscle . spacing between the electrodes was 25  mm , the 
 sampling frequency was 1,000  hz , and the sampling time was 10 s. measurements were performed 
 as soon as subjects could maintain a stable performance posture . the collected data were 
 subjected to full - wave rectification using electromyogram analysis software ( myoresearch , 
 noraxon inc . ) , and the average amplitude of the central three seconds was determined . the 
 average amplitude of each muscle was normalized as 100% according to the average amplitude 
 of the 3-s maximum voluntary contraction . statistical analysis entailed a one - way analysis of variance and multiple comparison using 
 tukey 's method . mean  sd . a : significant difference between the standing position and the trumpet 
 performance posture ( p<0.01 ) . b : significant difference between the standing position 
 and the marching euphonium performance posture ( p<0.01 ) . c : significant difference 
 between the trumpet performance posture and the marching euphonium performance posture 
 ( p<0.05 ) mean  sd . a : significant difference between the standing position and the marching 
 euphonium performance posture ( p<0.01 ) . b : significant difference between the 
 standing position and the marching euphonium performance posture ( p<0.05 ) . c : 
 significant difference between the trumpet performance posture and the marching 
 euphonium performance posture ( p<0.01 ) the anterior tilt angle of the trunk decreased significantly in the trumpet and marching 
 euphonium performance postures compared with the resting standing position , as well as in 
 the marching euphonium performance posture compared with the trumpet performance posture 
 ( table 1 ) . the muscle activity of the cervical 
 paraspinal muscles , upper fibers of the trapezius , and lumbar paraspinal muscles increased 
 significantly in the marching euphonium performance posture compared with the resting 
 standing position , as well as in the marching euphonium performance posture compared with 
 the trumpet performance posture ( table 2 ) . however , there were no significant differences in other measurement items between the 
 postures . the anterior tilt angle of the trunk can be rephrased as an increase in the posterior tilt 
 angle of the trunk . this is likely a means for maintaining the combined center of gravity of the 
 instrument and the body in the most stable position possible . an increase in the posterior 
 tilt angle of the trunk increases the lumbar lordosis angle . this increase results in 
 tension being applied to the anterior tissues of the lumbar spine , such as the anterior 
 longitudinal ligament , and compressive force being applied to the zygapophyseal joints4 . christie et al . reported that an increase 
 in the lumbar lordosis angle while standing is associated with chronic low back pain5 . consequently , maintaining the performance 
 posture for the trumpet and the marching euphonium for a long period can contribute to low 
 back pain . no significant difference was found in the muscle activities of the lumbar paraspinal 
 muscles between the resting standing position and the trumpet performance posture , but a 
 significant increase was noted in the marching euphonium performance posture compared with 
 the resting standing position . the lumbar paraspinal muscles are antigravity muscles which 
 are contracted continuously while standing , thus easily incurring mechanical stress . it is 
 conceivable that , since the muscle activity of the lumbar paraspinal muscles increases 
 during the marching euphonium performance posture , holding the performance posture for a 
 long time increases the load on the lumbar paraspinal muscles and is therefore a factor 
 leading to lumbar fatigue and low back pain . the muscle activity of the upper fibers of the 
 trapezius increases in line with instrument weight in the trumpet to marching euphonium 
 postures . when holding these instruments , the shoulder joint flexes and abducts , while the 
 scapula rotates up and elevates . the muscle activity of the upper fibers of the trapezius is 
 likely to increase to maintain such a posture . we also found that muscle activity of the 
 cervical paraspinal muscles increased significantly in the euphonium performance posture 
 compared with the resting standing position . since the posterior tilt angle of the trunk 
 increases in the marching euphonium performance posture , it is necessary to tuck in the chin 
 to face forward chin - in posture  and is 
 considered a posture in which the muscle activity in the cervical area including the 
 cervical paraspinal muscles increases6 . 
 sustained contraction of these muscles is a likely factor of muscle fatigue . furthermore , 
 obstruction of blood flow by sustained muscle contraction will result in myalgia7 . therefore , holding the trumpet and marching 
 euphonium performance postures for a long time would be factors of myalgia . the present findings suggest that the trumpet and marching euphonium performance postures 
 increase the load on the cervical and trunk musculoskeletal system . moreover , the load on 
 the musculoskeletal system increases in line with increased instrument weight . however , the 
 trumpet and marching euphonium performance postures do not affect the musculoskeletal system 
 of the lower limbs . therefore , we consider it important to evaluate the cervical and trunk 
 musculoskeletal systems and to conduct conditioning coaching appropriate for trumpet and 
 marching euphonium performers . because these instruments are supported by the left hand and 
 played with the right hand , the trunk and lower limb musculoskeletal system on the left 
 side , that is , the supporting side , was measured in the present study . we plan to measure 
 the trunk and lower limb musculoskeletal system on the right side to elucidate the effect of 
 performance postures on the whole body . in addition , it is possible that the trunk and lower 
 limb musculoskeletal system is affected differently by the technique used to hold the 
 instrument with the left hand during trumpet and the marching euphonium performance . because 
 the angles and muscle activities of the upper arm were not measured in the present study , we 
 plan to perform these measurements in a future study to elucidate the influence of different 
 instrument holding techniques on the trunk and lower limb musculoskeletal systems .
[ purpose ] the purpose of the present study was to investigate the effect of trumpet and 
 marching euphonium performance posture on the trunk and lower limb musculoskeletal system . 
 [ subjects ] the subjects were 10 female university students . [ methods ] subjects maintained 
 a resting position , a trumpet performance posture , and a marching euphonium performance 
 posture . the angles and muscle activities of the trunk and 
 lower limbs were then measured . 
 [ results ] the anterior tilt angle of the trunk decreased significantly in the trumpet and 
 marching euphonium performance postures compared with the resting standing position , as 
 well as in the marching euphonium performance posture compared with the trumpet 
 performance posture . 
 the muscle activity of the cervical paraspinal muscles , upper fibers 
 of the trapezius , and lumbar paraspinal muscles increased significantly in the marching 
 euphonium performance posture compared with the resting standing position , as well as in 
 the marching euphonium performance posture compared with the trumpet performance posture . 
 [ conclusion ] the results suggest that the performance position for trumpet and the 
 marching euphonium performance increases the load on the cervical and thoracic 
 musculoskeletal system , which increases with greater instrument weight . 
 however , the same 
 instrument performance postures had no affect on the musculoskeletal system of the lower 
 limbs .