Quantitative Postural Evaluation in Orchestral Musicians (the OPErA Project): Protocol for a Cross-Sectional Study

Musicians are at high risk for playing-related musculoskeletal disorders due to prolonged static postures and asymmetrical movements. Despite the prevalence of these disorders, objective ergonomic assessments in orchestral settings are limited.

The primary aim of this study (the Orchestral Posture Ergonomic Assessment [OPErA] project) is to quantify postural deviations in professional orchestral musicians, with and without their instruments, and to investigate their association with pain and pain leading to performance limitation. Secondary aims include exploring demographic, clinical, and occupational factors associated with these outcomes.

This cross-sectional study will enroll 250 professional musicians from Italian orchestras, excluding pianists. Postural assessments will be conducted in 2 phases-without and with the instrument-using the Physical Analyzer Portable, a device for calibrated photo acquisition. Anatomical landmarks will be marked with electrocardiogram electrodes to measure inclination, rotation, and asymmetries in the frontal and sagittal planes. Pain and disability will be evaluated using validated questionnaires (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]; Modified Oswestry Disability Index; and Neck Disability Index). Statistical analysis will include descriptive statistics, 2-tailed t tests, chi-square tests, and regression models to explore associations between posture and pain.

The protocol was approved in November 2022 and funded in 2025. Data collection was conducted from May 2023 to April 2026. By the time of manuscript submission (February 2026), 240 of the target 250 participants had been enrolled. Data analysis is ongoing, and the results are expected to be published in July 2026.

This study will provide quantitative insights into postural deviations and their relationships with pain and pain leading to performance limitation. The findings are expected to identify instrument-specific associated factors and compensatory behaviors, supporting the development of targeted ergonomic interventions and preventive strategies for musicians' health.