Research & References

45 Years of Experience and Extensive Research

My work is informed by 45 years of experience playing and teaching the violin, as well as by extensive research into the physical demands of violin and viola playing and the problems that can arise.

Over many years of playing and teaching, I have encountered a wide range of physical difficulties affecting violinists and violists. This practical experience has led me to examine these problems through research in areas including musculoskeletal health, movement, ergonomics, physical load, posture, instrument support, fatigue and playing-related disorders.

The research I have reviewed covers a broad range of subjects relevant to physical problems in violin and viola playing. The references presented on this page are a selection of published research and literature that I consider particularly relevant to the work described on this website. They are not intended to represent the entirety of the available research.

Academic research provides a broader evidence base for understanding physical problems, the physical demands of playing and factors that may contribute to difficulties. The findings are considered alongside my practical experience when working with individual violinists and violists.

What the Research Covers

Research into musicians’ physical problems covers a wide range of subjects. These include:

• Playing-related musculoskeletal problems
• Pain and discomfort
• Tension and muscular load
• Fatigue and physical exertion
• Restricted movement
• Movement coordination
• Neuromuscular control
• Altered sensation and nerve-related problems
• Task-specific movement difficulties
• Posture and asymmetry
• Upper-limb movement
• Neck and shoulder loading
• Hand and finger demands
• Repetitive movements
• Playing duration and workload
• Instrument-related physical demands
• Anthropometric factors — the relationship between body dimensions and physical demands
• Interaction between player and instrument
• Individual differences in movement strategies
• Biomechanics of violin and viola playing
• Limitations and quality of available evidence

Occurrence of Physical Problems

Research involving musicians has consistently found that physical problems associated with playing are common, although reported rates vary between studies because researchers have examined different populations and used different definitions and methods.^1–4

A systematic review by Kochem and Silva examined 34 studies concerning playing-related musculoskeletal disorders in string players. Only eight studies were considered to have satisfactory methodological quality, and reported prevalence ranged from 64.1% to 90%.¹

A broader systematic review by Kok and colleagues examined 21 studies involving 5,424 professional musicians. Reported 12-month prevalence of musculoskeletal complaints ranged from 41% to 93%, while lifetime prevalence ranged from 62% to 93%.²

Earlier systematic work by Zaza also demonstrated the substantial occurrence of playing-related musculoskeletal disorders among musicians.³

Research specifically involving violinists has produced similarly high figures. Kochem and Silva studied 106 Brazilian violin players and found that 86.8% reported at least one painful area during the preceding 12 months.⁴

Violin and Viola

Violin and viola playing presents particular physical demands because the instrument is supported between the head, neck, shoulder and upper body while both arms and hands perform highly coordinated tasks.

Rensing, Schemmann and Zalpour reviewed the literature concerning the musculoskeletal demands associated specifically with violin and viola playing. Their review examined the physical requirements of playing and the range of musculoskeletal problems reported among violinists and violists.⁵

Moraes and Antunes conducted a systematic review of musculoskeletal disorders in professional violinists and violists, identifying problems affecting several regions of the body rather than a single anatomical location.⁶

Mizrahi reviewed neuro-mechanical aspects of playing-related mobility disorders in orchestra violinists and upper-string players, including the interaction between movement, motor control and the demands of performance.⁷

Movement, Coordination and Biomechanics

Violin playing requires precise coordination between the two arms and hands while the body continuously adapts to changes in musical demands.

Research has examined how violinists coordinate bowing and fingering, how movement changes during shifting, and how different playing conditions affect upper-body movement.^8–12

Spahn and colleagues compared violinists’ body movements while standing and sitting and when positioned differently in relation to the music stand.⁸

Visentin and colleagues examined the biomechanics of left-hand position changes, including the movements involved in shifting.⁹

Kazennikov and Wiesendanger studied bimanual coordination between bowing and fingering, including changes associated with position and string changes.¹⁰

Sayegh and colleagues investigated coordination between bowing and fingering and the timing relationships involved in violin performance.¹¹

Michaud, Begon and Duprey examined bow-side kinematics and the variability of violinists’ movements according to bow stroke, string and tempo.¹²

Muscle Activity, Physical Load and Fatigue

Playing requires sustained and changing muscular activity rather than a single fixed physical posture. Research has therefore examined muscle activity, perceived exertion and fatigue during violin playing.^13–15

Chan and colleagues compared self-perceived exertion with objective measures of neuromuscular fatigue during a training session involving orchestral violin players.¹³

Mann and colleagues used surface electromyography (EMG) — a technique that records electrical activity produced by muscles — to examine forearm and shoulder muscle activity during violin playing.¹⁴

Kinoshita and Obata examined left-hand finger force in relation to tempo, loudness and differences between fingers.¹⁵

Posture and Physical Organisation

Posture is frequently discussed in relation to musicians’ physical problems, but research does not support a simple explanation in which one particular posture automatically causes pain or other physical difficulties.¹⁶

Rousseau and colleagues conducted a systematic review of studies assessing posture while musicians played. The review identified substantial variation in assessment methods and found that the relationship between postural impairment during playing and pain was not straightforward.¹⁶

Wolf and colleagues developed and evaluated a marker-based three-dimensional method for analysing upper-body kinematics in violinists and violists. Their work illustrates how movement during playing can be examined objectively rather than relying solely on visual impressions.¹⁷

Further work by the same group examined the reproducibility of this type of three-dimensional movement measurement in violinists.¹⁸

The Player and the Instrument

The physical demands of violin and viola playing cannot be separated completely from the way the instrument is held and supported.

Research into the ergonomics of violin and piano playing has examined the interaction between the musician, the instrument and the physical organisation required for performance.¹⁹

Other studies have examined factors such as left-hand finger force, upper-body movement and the physical requirements associated with different playing tasks.^15,17,18

Instrument dimensions, support arrangements, body proportions and individual movement characteristics can all be relevant when considering the physical demands of playing.¹⁹

Research Methods Used to Study Violin Playing

Different research methods provide different types of information about violin playing and musicians’ physical experience. Methods used in the literature include:

• Questionnaires and symptom surveys
• Clinical and physical assessments
• Visual observation
• Three-dimensional motion capture
• Electromyography (EMG), which records muscle electrical activity
• Force measurement
• Postural assessment
• Kinematic analysis, which measures movement
• Anthropometric measurements
• Performance analysis
• Fatigue measurements
• Experimental comparisons

A questionnaire may identify how frequently a problem is experienced, while movement analysis or EMG can provide information about particular physical characteristics of playing. Each method therefore provides only part of the picture.

Possible Contributing Factors

Research has examined a range of factors that may be associated with physical problems in musicians. These include:

• Playing duration
• Overall workload
• Repetitive playing
• Demanding repertoire
• Performance schedules
• Physical demands of particular movements
• Body dimensions and proportions
• Instrument dimensions
• Instrument support
• Playing position
• Muscular activity
• Fatigue
• Previous physical problems
• Individual movement characteristics

Systematic reviews have highlighted the difficulty of establishing simple causal relationships. Baadjou and colleagues found considerable heterogeneity between studies of risk factors for musculoskeletal disorders in musicians, with many studies being cross-sectional and therefore unable to establish cause and effect.²⁰

Rotter and colleagues similarly identified substantial variation in study designs, terminology, exposures and outcome measures in the literature concerning professional musicians.²¹

Research Methods and Evidence Limitations

Research into musicians’ physical problems has important limitations. Studies may involve relatively small groups of participants, use different definitions of physical problems, or rely partly on self-reported symptoms.

Observational research can identify associations but does not necessarily establish that one factor causes another. Research involving professional musicians may also not directly represent students, amateur players or musicians at other levels.^2,20,21

Findings from studies of other instruments cannot automatically be applied to violin or viola playing. Even research specifically involving violinists and violists can differ substantially in terms of repertoire, playing conditions, participant characteristics and measurement methods.

For these reasons, research findings need to be considered in context rather than treated as a single explanation for an individual physical problem.

References

The following references are selected examples of academic literature relevant to the areas discussed on this page. They provide background evidence and context for the subjects discussed here.

1. Kochem, F. B., & Silva, J. G. (2018). Prevalence of Playing-related Musculoskeletal Disorders in String Players: A Systematic Review. Journal of Manipulative & Physiological Therapeutics, 41(6), 540–549. DOI: 10.1016/j.jmpt.2018.05.001.
2. Kok, L. M., Huisstede, B. M. A., Voorn, V. M. A., Schoones, J. W., & Nelissen, R. G. H. H. (2016). The occurrence of musculoskeletal complaints among professional musicians: a systematic review. International Archives of Occupational and Environmental Health, 89(3), 373–396. DOI: 10.1007/s00420-015-1090-6.
3. Zaza, C. (1998). Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ, 158(8), 1019–1025.
4. Kochem, F. B., & Silva, J. G. (2017). Prevalence and Associated Factors of Playing-Related Musculoskeletal Disorders in Brazilian Violin Players. Medical Problems of Performing Artists, 32(1), 27–32. DOI: 10.21091/mppa.2017.1006.
5. Rensing, N., Schemmann, H., & Zalpour, C. (2018). Musculoskeletal Demands in Violin and Viola Playing: A Literature Review. Medical Problems of Performing Artists, 33(4), 265–274. DOI: 10.21091/mppa.2018.4040.
6. Moraes, G. F. S., & Antunes, A. P. (2012). Musculoskeletal disorders in professional violinists and violists: Systematic review. Acta Ortopédica Brasileira, 20(1), 43–47. DOI: 10.1590/S1413-78522012000100009.
7. Mizrahi, J. (2020). Neuro-mechanical aspects of playing-related mobility disorders in orchestra violinists and upper strings players: a review. European Journal of Translational Myology, 30(3), 9095. DOI: 10.4081/ejtm.2020.9095.
8. Spahn, C., Wasmer, C., Eickhoff, F., & Nusseck, M. (2014). Comparing violinists’ body movements while standing, sitting, and in sitting orientations to the right or left of a music stand. Medical Problems of Performing Artists, 29(2), 86–93. DOI: 10.21091/mppa.2014.2019.
9. 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, 3, e1299. DOI: 10.7717/peerj.1299.
10. Kazennikov, O., & Wiesendanger, M. (2009). Bimanual coordination of bowing and fingering in violinists—effects of position changes and string changes. Motor Control, 13(3), 297–309. DOI: 10.1123/mcj.13.3.297.
11. Sayegh, S. I., et al. (2005). Coordination of bowing and fingering in violin playing. Cognitive Brain Research, 23(2–3), 436–443. DOI: 10.1016/j.cogbrainres.2004.11.008.
12. Michaud, B., Begon, M., & Duprey, S. (2022). Bow-Side Kinematics Studies in Violinists: An Experimental Design Tracking Intra- and Inter-Musician Variability by Bow Stroke, String Played, and Tempo. Medical Problems of Performing Artists, 37(3), 135–142. DOI: 10.21091/mppa.2022.3020.
13. Chan, R. F. M., Chow, C. Y., Lee, G. P. S., To, L. K., Tsang, X. Y. S., Yeung, S. S., & Yeung, W. E. (2000). Self-perceived exertion level and objective evaluation of neuromuscular fatigue in a training session of orchestral violin players. Applied Ergonomics, 31(4), 335–341. DOI: 10.1016/S0003-6870(00)00008-9.
14. Mann, S., Panduro, M. B., Paarup, H. M., Brandt, L., & Søgaard, K. (2021). Surface electromyography of forearm and shoulder muscles during violin playing. Journal of Electromyography and Kinesiology, 56, 102491. DOI: 10.1016/j.jelekin.2020.102491.
15. Kinoshita, H., & Obata, S. (2009). Left hand finger force in violin playing: tempo, loudness, and finger differences. Journal of the Acoustical Society of America, 126(1), 388–395. DOI: 10.1121/1.3139908.
16. Rousseau, C., Taha, L., Barton, G., Garden, P., & Baltzopoulos, V. (2023). Assessing posture while playing in musicians – A systematic review. Applied Ergonomics, 106, 103883. DOI: 10.1016/j.apergo.2022.103883.
17. Wolf, E., Möller, D., Ballenberger, N., Morisse, K., & Zalpour, C. (2019). Marker-Based Method for Analyzing the Three-Dimensional Upper Body Kinematics of Violinists and Violists: Development and Clinical Feasibility. Medical Problems of Performing Artists, 34(4), 179–190. DOI: 10.21091/mppa.2019.4029.
18. Wolf, E., Möller, D., Ballenberger, N., Morisse, K., & Zalpour, C. (2022). Marker-Based Method for Analyzing the Three-Dimensional Upper Body Kinematics of Violinists: Reproducibility. Medical Problems of Performing Artists, 37(3), 176–191. DOI: 10.21091/mppa.2022.3025.
19. Chi, J.-Y., Halaki, M., & Ackermann, B. J. (2020). Ergonomics in violin and piano playing: A systematic review. Applied Ergonomics, 88, 103143. DOI: 10.1016/j.apergo.2020.103143.
20. Baadjou, V. A. E., Roussel, N. A., Verbunt, J. A. M. C. F., Smeets, R. J. E. M., & de Bie, R. A. (2016). Systematic review: risk factors for musculoskeletal disorders in musicians. Occupational Medicine, 66(8), 614–622. DOI: 10.1093/occmed/kqw052.
21. Rotter, G., Noeres, K., Fernholz, I., Willich, S. N., Schmidt, A., & Berghöfer, A. (2020). Musculoskeletal disorders and complaints in professional musicians: a systematic review of prevalence, risk factors, and clinical treatment effects. International Archives of Occupational and Environmental Health, 93(2), 149–187. DOI: 10.1007/s00420-019-01467-8.