Prevention of Musculoskeletal Injuries in Musicians

Study Overview
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Brief Summary
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Musicians are a group with a high prevalence of musculoskeletal injuries. In particular, wind musicians, due to their playing requirements, are prone to suffer from cervical and mandibular alterations. For this reason, a specific exercise programme has been designed with the aim of analysing its effectiveness in improving these regions.

Detailed Description
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This study is a clinical trial with a control group whose participants are university music students specialising in wind instrument performance. The intervention of the participants in the Experimental Group consists of the individual performance of a specific programme of warm-up exercises prior to instrumental practice aimed at improving the mobility and strength of the cervical and mandibular regions, as well as a series of cool-down exercises after instrumental practice based on stretching the main muscles of both regions. Participants in the Control Group will continue their normal life without performing any specific exercise previously taught by the researchers. For the evaluation of the programme, an initial evaluation and a re-evaluation after 12 weeks will be carried out. In both, cervical and jaw mobility as well as body posture will be assessed. In addition, at the muscular level, the activity of the upper trapezius and masseter muscles will be assessed, and the pain threshold at trigger points will also be measured. The hypotheses are that by carrying out the exercise programme designed for wind musicians, an improvement in body posture, in the range of cervical and jaw mobility and in muscle activation will be achieved, as well as a decrease in the pain threshold. For the study of the results, an inferential statistical analysis of the data will be carried out using the Wilcoxon test for paired data or Student's t-test for repeated measures according to the sample characteristics in order to determine the effect of the exercise programme on the different variables of the experimental process. Correlation statistics will be used to establish the association between certain quantitative explanatory variables and ANOVA for categorical variables. The level of significance will be kept at p<.05 and all calculations will be carried out using the SPSS 22.0 statistical programme.

Official Title
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Prevention Programme for Cervicomandibular Musculoskeletal Injuries in Wind Musicians

Conditions
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Cervical and Mandibular Pain and Disorders in Wind Players

Intervention / Treatment
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* Other: Exercise programme


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Woodwind or metal musicians University students of music performance Exclusion Criteria: Any surgical intervention in cervical spine, orofacial region or temporomandibular joint. Analgesics or physiotherapeutic treatment in the last 24h. Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The study consists of an experimental group, which will receive an intervention, and a control group, which will neither receive nor receive any intervention.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental Group<br>Performance of a warm-up and cool-down exercise programme for the cervical and mandibular region before and after instrumental practice. | Other: Exercise programme<br>* Performing a programme of warm-up and stretching exercises for the cervico-mandibular region aimed at improving mobility and muscle condition.<br>* Other names: Warm-up and cool-down exercise programme;|
| No Intervention: Control Group<br>Participants in the control group will not make any changes in their instrumental practice habit. At the end of the study, participants in the control group will be asked to perform the exercises tested in the experimental group. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cervical range of movement | Evaluation of cervical range of motion (flexion-extension, tilts and rotations) with Kinovea software. The Kinovea software is a validated tool to measure the movements of the cervical spine. | Change from baseline at 3 months | 
| Temporomandibular range of movement | Evaluation of the maximum jaw opening with a vernier caliper. A vernier caliper is a validated tool to measure the MMO (maximum mouth opening). | Change from baseline at 3 months | 
| Head position | Assessment of head position by calculation of the craniovertebral angle, sagittal head angle and shoulder angle using SAPO software. SAPO is a validated tool for head posture analysis. | Change from baseline at 3 months | 
| Head alignment | Horizontal alignment of the head and shoulders using SAPO software. SAPO is a validated tool for head posture analysis. | Change from baseline at 3 months | 
| Cervical and orofacial pain | Visual Analogic Scale. The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations. The VAS is a straight horizontal line of fixed length, usually 100 mm. The ends are defined as the extreme limits of the parameter to be measured from 0 (no pain) to 10 (maximum pain). All the subjects will showed their pain level. | Change from baseline at 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Trapezius muscle activation | EMG assessment of resting and maximal contraction activation of the trapezius muscle. Surface EMG is a validated tool for measuring muscle activation. | Change from baseline at 3 months | 
| Masseter muscle activation | EMG assessment of resting and maximal contraction activation of the masseter muscle. Surface EMG is a validated tool for measuring muscle activation. | Change from baseline at 3 months | 
| Trapezius muscle pain threshold | Pain threshold assessment at the trigger point of the upper trapezius muscle with a digital algometer. The digital algometer is a validated tool for assessing muscle pain threshold. | Change from baseline at 3 months | 
| Masseter muscle pain threshold | Pain threshold assessment at the trigger point of the masseter muscle with a digital algometer. The digital algometer is a validated tool for assessing muscle pain threshold. | Change from baseline at 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Musculoskeletal pain, Neck pain, Temporomandibular disorders, Posture, Musician