Sensory and Sensorimotor Features in Violinists and Violists With Neck Pain

  • Anke Steinmetz
    Corresponding author Anke Steinmetz, MD, Department of Orthopaedics, Traumatology, and Physical Medicine, Martin-Luther-University of Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
    Department of Orthopaedics, Traumatology, and Physical Medicine, Martin-Luther-University of Halle, Halle (Saale), Germany

    Department of Manual Medicine and Pain Medicine, Institute of Musicians' Medicine, Kremmen/OT Sommerfeld, Germany
    Search for articles by this author
  • Gwendolen A. Jull
    National Health and Medical Research Council Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
    Search for articles by this author



      To investigate sensory and sensorimotor function in violin and viola players with and without neck pain.


      Prospective, cross-sectional study.


      University laboratory.


      Convenience sample of violin players with playing-related neck pain (n=22), violinists without neck pain (n=21), and healthy nonmusician comparison subjects (n=21).


      Not applicable.

      Main Outcome Measures

      Measures include thermal pain thresholds (cold and heat) and pressure pain thresholds (PPTs) over the cervical spine and over a remote region (tibialis anterior muscle). Motor performance tests including reaction times, speed of movement, accuracy, coordination, and tapping speed assessed with a special upper-limb test battery.


      Musicians with neck pain had significantly lower heat and elevated cold pain thresholds as well as lower PPTs over C5-6 (P<.01) and over the tibialis anterior (P<.05). Motor performance tests revealed no differences between the symptomatic and asymptomatic musicians and nonmusician comparison groups (P>.05).


      Violin players with neck pain demonstrated signs of sensory impairment, suggesting that playing-related neck pain may be associated with augmented central pain processing consistent with findings in other neck pain groups. No differences were evident in the motor performance tests. Fine motor skills of violin players may be better assessed in the context of playing their musical instruments before definitive conclusions can be drawn about the presence or not of sensorimotor impairments in this group of musicians with playing-related neck pain.


      List of abbreviations:

      HPM/BEP (Human Performance Measurement/Basic Elements of Performance), ICC (intraclass correlation coefficient), NDI (Neck Disability Index), PPT (pressure pain threshold), SEM (standard error of measurement), VAS (visual analog scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Leaver R.
        • Harris E.
        • Palmer K.
        Musculoskeletal pain in elite professional musicians from British symphony orchestras.
        Occup Med. 2011; 61: 549-555
        • Zaza C.
        • Farewell V.T.
        Musicians' playing-related musculoskeletal disorders: an examination of risk factors.
        Am J Ind Med. 1997; 32: 292-300
        • Bragge P.
        • Bialocerkowski A.
        • McMeeken J.
        A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists.
        Occup Med (Lond). 2006; 56: 28-38
        • Middlestadt S.E.
        • Fishbein M.
        The prevalence of severe musculoskeletal problems among male and female symphony orchestra string players.
        Med Probl Perf Art. 1989; 4: 41-48
        • Daenen L.
        • Roussel N.
        • Cras P.
        • Nijs J.
        Sensorimotor incongruence triggers sensory disturbances in professional violinists: an experimental study.
        Rheumatology (Oxford). 2010; 49: 1281-1289
        • Ervilha U.F.
        • Farina D.
        • Arendt-Nielsen L.
        • Graven-Nielsen T.
        Experimental muscle pain changes motor control strategies in dynamic contractions.
        Exp Brain Res. 2005; 164: 215-224
        • Falla D.
        • Farina D.
        • Graven-Nielsen T.
        Experimental muscle pain results in reorganization of coordination among trapezius muscle subdivisions during repetitive shoulder flexion.
        Exp Brain Res. 2007; 178: 385-393
        • Fry H.J.
        • Hallett M.
        • Mastroianni T.
        • Dang N.
        • Dambrosia J.
        Incoordination in pianists with overuse syndrome.
        Neurology. 1998; 51: 512-519
        • Huysmans M.A.
        • Hoozemans M.J.
        • van der Beek A.J.
        • de Looze M.P.
        • van Dieen J.H.
        Fatigue effects on tracking performance and muscle activity.
        J Electromyogr Kinesiol. 2008; 18: 410-419
        • Kasch H.
        • Qerama E.
        • Bach F.W.
        • Jensen T.S.
        Reduced cold pressor pain tolerance in non-recovered whiplash patients: a 1-year prospective study.
        Eur J Pain. 2005; 9: 561-569
        • Scott D.
        • Jull G.
        • Sterling M.
        Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain.
        Clin J Pain. 2005; 21: 175-181
        • Sterling M.
        • Jull G.
        • Vicenzino B.
        • Kenardy J.
        Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery.
        Pain. 2003; 104: 509-517
        • Bovim G.
        Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements.
        Pain. 1992; 51: 169-173
        • Hagg G.M.
        • Astrom A.
        Load pattern and pressure pain threshold in the upper trapezius muscle and psychosocial factors in medical secretaries with and without shoulder/neck disorders.
        Int Arch Occup Environ Health. 1997; 69: 423-432
        • Johnston V.
        • Jimmieson N.L.
        • Jull G.
        • Souvlis T.
        Quantitative sensory measures distinguish office workers with varying levels of neck pain and disability.
        Pain. 2008; 137: 257-265
        • Koelbaek Johansen M.
        • Graven-Nielsen T.
        • Schou Olesen A.
        • Arendt-Nielsen L.
        Generalised muscular hyperalgesia in chronic whiplash syndrome.
        Pain. 1999; 83: 229-234
        • Treede R.D.
        • Rolke R.
        • Andrews K.
        • Magerl W.
        Pain elicited by blunt pressure: neurobiological basis and clinical relevance.
        Pain. 2002; 98: 235-240
        • Linari-Melfi M.
        • Cantarero-Villanueva I.
        • Fernandez-Lao C.
        • Fernandez-de-Las-Penas C.
        • Guisado-Barrilao R.
        • Arroyo-Morales M.
        Analysis of deep tissue hypersensitivity to pressure pain in professional pianists with insidious mechanical neck pain.
        BMC Musculoskelet Disord. 2011; 12: 268
        • Goldsmith R.
        • Wright C.
        • Bell S.F.
        • Rushton A.
        Cold hyperalgesia as a prognostic factor in whiplash associated disorders: a systematic review.
        Man Ther. 2012; 17: 402-410
        • Falla D.
        • Farina D.
        • Dahl M.K.
        • Graven-Nielsen T.
        Muscle pain induces task-dependent changes in cervical agonist/antagonist activity.
        J Appl Physiol. 2007; 102: 601-609
        • Ervilha U.F.
        • Arendt-Nielsen L.
        • Duarte M.
        • Graven-Nielsen T.
        The effect of muscle pain on elbow flexion and coactivation tasks.
        Exp Brain Res. 2004; 156: 174-182
        • Schulte E.
        • Ciubotariu A.
        • Arendt-Nielsen L.
        • Disselhorst-Klug C.
        • Rau G.
        • Graven-Nielsen T.
        Experimental muscle pain increases trapezius muscle activity during sustained isometric contractions of arm muscles.
        Clin Neurophysiol. 2004; 115: 1767-1778
        • McCabe C.S.
        • Haigh R.C.
        • Halligan P.W.
        • Blake D.R.
        Simulating sensory-motor incongruence in healthy volunteers: implications for a cortical model of pain.
        Rheumatology (Oxford). 2005; 44: 509-516
        • Vernon H.
        The Neck Disability Index.
        J Musculoskel Pain. 1996; 4: 95-104
        • Vernon H.
        • Mior S.
        The Neck Disability Index: a study of reliability and validity.
        J Manipulative Physiol Ther. 1991; 14: 409-415
        • Vernon H.
        The Neck Disability Index: state-of-the-art, 1991-2008.
        J Manipulative Physiol Ther. 2008; 31: 491-502
        • Von Korff M.
        • Jensen M.P.
        • Karoly P.
        Assessing global pain severity by self-report in clinical and health services research.
        Spine (Phila Pa 1976). 2000; 25: 3140-3151
        • Moloney N.A.
        • Hall T.M.
        • Doody C.M.
        Reliability of thermal quantitative sensory testing: a systematic review.
        J Rehabil Res Dev. 2012; 49: 191-207
        • Jones D.H.
        • Kilgour R.D.
        • Comtois A.S.
        Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women.
        J Pain. 2007; 8: 650-656
        • Pienimaki T.T.
        • Kauranen K.
        • Vanharanta H.
        Bilaterally decreased motor performance of arms in patients with chronic tennis elbow.
        Arch Phys Med Rehabil. 1997; 78: 1092-1095
        • Bisset L.M.
        • Coppieters M.W.
        • Vicenzino B.
        Sensorimotor deficits remain despite resolution of symptoms using conservative treatment in patients with tennis elbow: a randomized controlled trial.
        Arch Phys Med Rehabil. 2009; 90: 1-8
        • Fitts P.M.
        The information capacity of the human motor system in controlling the amplitude of movement.
        J Exp Psychol. 1954; 47: 381-391
        • Kondraske G.V.
        • Potvin A.R.
        • Tourtellotte W.W.
        • Syndulko K.
        A computer-based system for automated quantitation of neurologic function.
        IEEE Trans Biomed Eng. 1984; 31: 401-414
        • Kondraske G.V.
        An elemental resource for the human-task interface.
        Int J Technol Assess Health Care. 1995; 11: 153-173
        • Kauranen K.
        • Vuotikka P.
        • Hakala M.
        Motor performance of the hand in patients with rheumatoid arthritis.
        Ann Rheum Dis. 2000; 59: 812-816
        • Sheather-Reid R.B.
        • Cohen M.L.
        Psychophysical evidence for a neuropathic component of chronic neck pain.
        Pain. 1998; 75: 341-347
        • Sterling M.
        • Jull G.
        • Vicenzino B.
        • Kenardy J.
        Characterization of acute whiplash-associated disorders.
        Spine. 2004; 29: 182-188
        • Madeleine P.
        • Lundager B.
        • Voigt M.
        • Arendt-Nielsen L.
        Sensory manifestations in experimental and work-related chronic neck-shoulder pain.
        Eur J Pain. 1998; 2: 251-260
        • Chien A.
        • Eliav E.
        • Sterling M.
        Hypoaesthesia occurs with sensory hypersensitivity in chronic whiplash–further evidence of a neuropathic condition.
        Man Ther. 2009; 14: 138-146
        • Jull G.
        • Sterling M.
        • Kenardy J.
        • Beller E.
        Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash?–A preliminary RCT.
        Pain. 2007; 129: 28-34
        • Tsao H.
        • Galea M.P.
        • Hodges P.W.
        Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain.
        Brain. 2008; 131: 2161-2171
        • Boudreau S.
        • Romaniello A.
        • Wang K.
        • Svensson P.
        • Sessle B.J.
        • Arendt-Nielsen L.
        The effects of intra-oral pain on motor cortex neuroplasticity associated with short-term novel tongue-protrusion training in humans.
        Pain. 2007; 132: 169-178
        • Svensson P.
        • Romaniello A.
        • Arendt-Nielsen L.
        • Sessle B.J.
        Plasticity in corticomotor control of the human tongue musculature induced by tongue-task training.
        Exp Brain Res. 2003; 152: 42-51
        • Huysmans M.A.
        • Hoozemans M.J.
        • van der Beek A.J.
        • de Looze M.P.
        • van Dieen J.H.
        Position sense acuity of the upper extremity and tracking performance in subjects with non-specific neck and upper extremity pain and healthy controls.
        J Rehabil Med. 2010; 42: 876-883
        • Jabusch H.C.
        • Vauth H.
        • Altenmuller E.
        Quantification of focal dystonia in pianists using scale analysis.
        Mov Disord. 2004; 19: 171-180