Physiotherapy and performing arts health

Well-known problems

Playing-related musculoskeletal complaints are common: a systematic review of 21 studies with 5,424 professional musicians reports point prevalences between 9 % and 68 % (Kok et al., 2016). In violinists, the neck and shoulders are a frequent focus; players with neck pain show altered activity of neck and shoulder muscles (Berque & Gray, 2002; Steinmetz et al., 2016). Violinists’ problems reach many medical specialties (Zinn-Kirchner et al., 2023).

Searching for causes

The causes are multifactorial. Orchestral musicians name high or sudden increases in playing load as major contributors (Chan & Ackermann, 2014); muscle activity and fatigue are discussed as further factors (Möller et al., 2018). Posture itself is defined in very different ways, and a link between “poor” posture and pain has not been clearly established (Rousseau et al., 2026). Exercise approaches are promising but still thinly supported: four intervention studies on motor control exist for bowed string players (Adamik et al., 2026), and purpose-designed shoulder-blade exercises activate the target muscles with little immediate change while playing (Rousseau et al., 2026, Part II).

Functional asymmetry or demanding pattern?

The violin requires asymmetry: a raised left arm, a rotated head, a moving bow arm. Not every deviation from symmetry is a problem. The question is which positions and movements are functional for a player and a task, and which sustained or repeated patterns may increase physical strain over time. A shoulder that lifts briefly during a string crossing is not the same as a shoulder held high throughout a piece.

Structured video assessment

Physiotherapists, physicians and body-work experts assess short video clips of seated violinists, recorded from two standard camera angles. They give an overall impression from healthy to risky and mark the body regions that catch their eye, with illustrated reference positions for each region. These ratings are expert judgements, not measured injury risk: how they relate to movement data and to reported complaints is itself a research question.

We are preparing pretests with external experts. Physiotherapists and performing arts health specialists who would like to take part are welcome to contact us: Healthy-Strings@matthias-bertsch.at. Invited raters log in to the rating area.

What the tools can – and cannot – say

• Visualisation: “Here is the original video and a model-based movement trace.” – not yet: “this shoulder position is harmful”.
• Technical validation: a parameter agrees sufficiently with reference systems for a given task and setting.
• Rating validation: trained experts recognise a defined observation reliably.
• Association: a feature is related to an outcome in a defined cohort – which is still not causality.

Muscle activity (EMG), contact forces on the instrument and the player’s own reports complete the picture where cameras cannot see.

AI analysis: combining data and knowledge

Healthy Strings brings together movement data from ordinary video, sound analysis and – in sub-studies – EMG and sensors with the knowledge of physiotherapists and violin teachers. Machine learning can find patterns in such multimodal data; expert assessments define what these patterns mean and serve as the human reference against which automated analyses are checked. Physio experts are therefore part of the analysis from the start, not only at the end.

For musicians, teachers and therapists: Health & Support – research summary, healthy practice and professional societies.

Partners in this field

• Centre for Music Physiology, mdw – University of Music and Performing Arts Vienna – Motion-Emotion-Lab
• Osnabrück University of Applied Sciences, with INAP/O – Institute of Applied Physiotherapy and Osteopathy: 3D kinematics and EMG in upper string players, a cohort study of music students, a clinic for musicians
• The University of Sydney: performing arts health, physiotherapy and musculoskeletal health of musicians
• ENPPA – European Network of Physiotherapy for Performing Arts, founded in 2026 in Osnabrück with several Healthy Strings members among its founders