Three-dimensional motion analysis of upper limb movement in the bowing arm of string-playing musicians

To explore the role of three-dimensional movement analysis in defining patterns of joint movement while bowing on different stringed instruments, and its potential for future use by the clinician in the study of musculoskeletal problems in musicians.

A protocol was developed for analysis of bowing arm movements using the MacReflex 3-D analysis system- including definition of marker sites, positioning of the musician within the calibrated area and standardised bowing sequences. This protocol was then used to determine whether the system was sensitive to differences between instrument types and to variation in bowing style and technique between individual players. The ranges of movement in the shoulder, elbow and wrist were compared between instrument groups in a cohort of 39 asymptomatic string players.

The system gave reproducible results on repeated testing, and demonstrated clear differences between instruments, as well as stylistic differences between players. Range of shoulder movement increased progressively towards the upper register of the cello, while decreasing on the violin. Maximum elevation of the shoulder was significantly greater on the cello (P<0.001), while elbow flexion, and therefore range, was consistently greater on the violin.

Clear and reproducible differences in style and technique were demonstrated between individuals. The increased range of shoulder movement in the upper register of the 'cello may contribute to the greater prevalence of neck and shoulder symptoms among 'cellists. Further study is required to establish whether different musculoskeletal symptoms produce characteristic patterns which could help in diagnosis and development is required to make the system feasible for routine use.

Musculoskeletal problems are common among musicians. Different instruments and playing positions make different demands on joints and may contribute to the variance in reported incidence of musculoskeletal symptoms among violinists and cellists. Three-dimensional analysis may prove helpful in the future for the diagnosis of different musculoskeletal syndromes in string players, or for identifying movement patterns which could exacerbate repetitive strain injuries. However, as this is the first application of the technique in this complex area, preliminary work was required to establish feasibility and to obtain data on normal players.