# Safety and feasibility of a multimodal approach for orchestra musicians with playing-related musculoskeletal disorders (PRMDs)

## TL;DR

This study explores a new treatment approach for orchestra musicians with musculoskeletal pain, combining brain stimulation, physiotherapy, and psychological support, and finds it safe and feasible.

## Contribution

The study introduces a novel multimodal treatment for PRMDs in musicians and evaluates advanced diagnostic tools like MRI and 3D motion capture.

## Key findings

- tDCS sessions with physiotherapy were completed by 2 participants across all 10 sessions, with mild side effects reported.
- MRI and 3D motion capture provided useful data on brain activation and movement patterns during simulated playing.
- A new pain questionnaire was completed quickly by participants, highlighting common pain areas like the neck and back.

## Abstract

Orchestra musicians frequently experience painful playing-related musculoskeletal disorders (PRMDs) yet often lack access to effective specialized treatment. This feasibility study aimed to establish proof-of-concept for a novel, multimodal treatment regimen and to explore potential diagnostic tools for PRMDs.

Musicians from the Orchestra Academy of the Vienna Philharmonic Orchestra participated in different interventions from a therapeutic and diagnostic protocol. The therapeutic part encompassed self-administered transcranial direct current stimulation (tDCS) sessions targeting the primary motor cortex with tailored physiotherapeutic exercises and psychological coaching. Separate diagnostic interventions included comprehensive physiotherapeutic and psychological assessments, pain questionnaires, and the acquisition of magnetic resonance imaging and 3D motion capture data. The feasibility of these methods was thoroughly evaluated through safety questionnaires, completion checklists, direct observation by the investigators, and detailed participant feedback.

The therapeutic tDCS sessions with concurrent physiotherapeutic exercises were completed by 2 participants across all 10 scheduled sessions. Mild to moderate tingling/burning sensations during tDCS sessions were reported in 3 of 10 sessions (30%), and electrode connectivity issues occurred in 3 of 10 sessions (30%), which participants could resolve independently. All seven participants engaged in various diagnostic assessments. The novel pain assessment questionnaire was completed by four participants in under 5 min, with reported pain intensities ranging from 0–5 on a 0–10 scale, most frequently in the neck, wrist/hand, and upper and lower back. Functional magnetic resonance imaging during simulated instrument playing revealed discernible activation patterns, including bilateral primary motor cortex activation, and 3D motion capture provided detailed kinematic data from a violinist.

This study provides initial evidence for the feasibility and safety of a combined treatment approach (tDCS, physiotherapy, psychological support) for musicians suffering from PRMDs. Furthermore, the results encourage further exploration of advanced imaging and motion capture techniques as potential diagnostic and monitoring tools. These findings support conducting a larger scale, randomized clinical trial to investigate the efficacy of these approaches.

The online version of this article (10.1007/s00508-025-02566-y) contains supplementary material, which is available to authorized users.