When practice hurts: Associations among music activity, musculoskeletal pain, and music performance anxiety

Music performance anxiety (MPA) has traditionally been conceptualized as a predominantly psychological phenomenon, with limited attention paid to musicians' embodied physical experiences. The present study examined whether musculoskeletal pain is robustly associated with MPA and whether performance-related variables are statistically indirectly associated with MPA through musculoskeletal pain. Using cross-sectional survey data from a large sample of musicians (N = 343), we assessed associations between recent musculoskeletal pain, MPA, musical activity time, and performance-related stress, while controlling for demographic and musical background variables. Regression analyses indicated that musculoskeletal pain was consistently and positively associated with MPA, even after adjusting for multiple covariates. Mediation analyses further indicated a significant statistical indirect association between musical activity time and MPA via musculoskeletal pain, whereas no significant indirect association was observed for recent performance participation. Moderation analyses indicated that professional status moderated the association between musculoskeletal pain and MPA, while exploratory stratified mediation analyses showed numerical differences in indirect-effect estimates across professional-status groups. Together, these findings highlight musculoskeletal pain as a psychologically salient bodily factor associated with MPA and suggest that pain may be relevant to the association between sustained music activity and anxiety experiences. The results underscore the importance of integrating bodily and psychological perspectives in models of MPA and in interventions targeting musicians' performance-related well-being.