Epidemiology of neuromuscular injuries in guitar players living in Portugal: Associated risk factors

Abstract

BACKGROUND:

Playing guitar involves several physical demands, most inclusive of which are long hours of practice, which can make musculoskeletal symptoms common.

OBJETIVE:

To determine the epidemiology of neuromuscular injuries in guitar players residing in Portugal and risk factors.

METHODS:

The sample consisted of 105 guitar players, being 103 (98.10%) men, aged between 30–75 years (29,83±10,23). The measurement instrument used was a digital survey, shared by email, on social networks and in person.

RESULTS:

Fifty-six (53.30%) guitar players had injuries throughout their musical practice, totaling 132 injuries, 13 (12.40%) guitar players were injured at the time of assessment and 31 (29.5%) guitar players had injuries in the last 12 months, totaling 63 injuries. The value of injury proportion was 0.29 (CI 95% : 0.14–0.44) and the injury rate was 0.42 injuries per 1,000 hours of music practice. The most common types of injury were: tendinopathy (22; 34.92%) and low back pain (9; 14.29%). The most affected anatomical sites were: wrist (18; 28.57%) and lumbar spine (10; 15.87%). Repetitive movement was the injury mechanism most mentioned by guitar players (24; 35.29%) followed by maintaining postures for a prolonged period of time (15; 22.06%). Guitar players who did not warm up before practicing were 0.33 (CI: 0.13–0.79; p = 0.013) more likely to have an injury.

CONCLUSIONS:

There was a high percentage of injuries in guitar players and failure to warm up was a risk factor for the development of injuries. This type of study can help in creating injury prevention strategies in this type of population.

Keywords

Injuries guitar players musicians epidemiology cross-section study prevalence neuromuscular

1 Introduction

Musculoskeletal symptoms are common among many musicians besides guitar players. This can often lead to participation restrictions and activity limitations that has resulted in quitting playing or even changing careers [1 –3]. Playing the guitar involves skills that can be comparable to the dexterity required in professional athletes, yet without the proper emphasis on physical and mental preparation observed in the latter. These skills encompass long hours of practice and a range of physical demands such as prolonged maintenance of postures, repetitive movements of the shoulder, elbow, wrist, and fingers [1 –5].

There are many musicians of many levels around the world, this includes hobbiyists, amateurs and professionals alike. The Fender Musical Instruments Corporation (FMIC), the largest guitar manufacturer, along with YouGov^®, a global company specializing in behavioral data and consumer opinions analysis, conducted a study involving a sample of 10,644 participants aged between 14 and 64. The study revealed that in the United States alone, between 2020 and 2021, 16 million people started learning the guitar [6].

Playing the guitar requires the use of both hands. The dominant hand is used to hold the pick (or fingerpickand) and the non-dominant hand plays the chords. On the dominant side there is a flexion of the fingers and wrist to reach the strings and radial deviation of the wrist is required. Chords, on the other hand, necessitate small and repetitive movements with the wrist typically in ulnar deviation. The wrist is in its maximum flexion range most of the time, directly impacting the fingers ability to generate force and exerting maximum pressure on the median nerve through the tendons [1–3 , 7].

Several factors can be related with musculoskeletal disorders in musicians such as long hours at work [8 –10], high job demands, public exposure, repertoire, competition, job context, and previous injury [9, 10]. During musical practice guitar players engage in isotonic contractions related to dexterity movements. This includes fast and repetitive motions and isometric contractions that serve to hold the guitar for extended periods. Holding the guitar results in elevation or lateral fixation of the shoulders and neck, leading to potential muscular imbalances [2, 3].

Shan et al. [3] observed a tendency for trunk rotation towards the non-dominant side while playing the guitar. This led to the development of dysfunctions in scapular stabilizers, especially in the lower angle of the dominant side scapula. Thus, playing the guitar may be associated with the development of musculoskeletal symptoms and injuries.

In Portugal, epidemiological studies on neuromuscular injuries in guitar players are unknown. Internationally research in this population remains scarce [1 , 7]. Any injury or symptoms may significantly limit the ability to sustain the load of musical practice. Therefore, the objective of this study was to determine the epidemiology of neuromuscular injuries in guitar players residing in Portugal, describing the type, location, and mechanism of injury, as well as associated risk factors.

2 Methodology

This study was a cross-sectional investigation approved by KinesioLab –Research Unit in Human Movement, Piaget Institute (KL.2023.02). All participants were informed of the study’s objective. Their participation was voluntary, with the option to withdraw at any time without any prejudice. Confidentiality and data privacy were ensured. All procedures are done in accord with the Declaration of Helsinki of 1964.

2.1 Population

The study population included guitar players of all genders aged 18 years or older residing in Portugal. Inclusion criteria involved guitarists with a minimum of 12 months of guitar practice willing to participate voluntarily and playing at least one of the following types of guitars: acoustic/semi-acoustic guitar, electric guitar, bass, or Portuguese guitar. No data was found that estimated the population of guitarists in Portugal.

2.2 Measurement instruments

The measurement instrument used was a digital survey shared via email, social media and in person by researchers using QR codes at concert venues. The researcher was available to clarify any doubts that might arise when completing the questionnaire, either online or in person, as appropriate. The data collection period took place between May 2022 to June 2023.

The survey underwent review by a panel of experts consisting of three specialists: a Ph.D. in Epidemiology and Physiotherapy, a guitar teacher with 15 years of experience and a professional guitarist involved in various internationally recognized projects. Subsequently, a pre-test was conducted with a sample of 12 guitarists who participated in the AL METAL festival organized by Vector Sound Productions in Faro, southern Portugal.

The survey was divided into two parts. The first part focused on sociodemographic characteristics, practice habits and musical habits. The second part addressed the classification of injuries associated with musical practice.

The first part of the survey included the following questions: Age, gender, years of guitar practice, primary musical style (Blues, Classical, Fado, Heavy/Metal, Jazz, Pop/Rock, Rock), weekly practice/rehearsal frequency and duration, type of guitar played (Acoustic/Semi-acoustic, Electric, Bass, Portuguese guitar), dominant hand, band affiliation, number of concerts played annually, most frequent playing position during practice/rehearsal and concerts, use of a guitar strap during rehearsal/concert, engagement in specific movements during rehearsal/concert other than playing the guitar (e.g., headbanging), regular practice of another musical instrument, warm-up and cooldown routines before and after rehearsal/concert, engagement in another profession besides music, regular physical exercise (minimum of 2 times per week).

In the second part of the survey respondents were asked about the presence of injuries during the entire practice period. Times involved were at the survey application, in the last 6 months and in the last 12-months.

Only guitar players who reported an injury related to musical practice in the last 12 months continued to fill out the survey. They provided information on number of injuries, type of injury, location of the injury, occurrence of the injury, whether they underwent any treatment and if yes, specifying the type of treatment, mechanism of injury, downtime caused by the injury and the current status of the injury. For these questions, respondents were allowed to classify a maximum of three injuries considered more severe and/or requiring more recovery time.

Injury was defined as any condition or symptom resulting from musical practice that had at least one of the following three consequences: If the individual had to stop playing the instrument for a minimum of one day due to the condition or symptom; If there was no need to stop playing, but the guitar player had to modify their technique (reduction in the number of practice hours, decreased intensity of effort, or diminished ability to perform specific technical gestures); If the guitarist sought advice or treatment from healthcare professionals to address the condition or symptom resulting from musical practice.

2.3 Data analysis

The statistical software used for data analysis, was the Statistical Package for the Social Sciences (SPSS), version 28. The statistical approach employed included descriptive methods such as frequency distributions and measures of central tendency and dispersion.

To determine the proportion of injuries, the total number of guitar players who had at least one injury in the last 12 months was divided by the total number of participants in the sample. The injury rate was calculated as the total number of injuries divided by the total time the guitar players were exposed to risk, defined as 1,000 hours. The total risk time was calculated by multiplying the total average hours of practice/rehearsal by the frequency of this practice/rehearsal, both over one week, and then multiplying this value by 12 months (52 weeks). The average number of injuries per guitar players was obtained by dividing the total number of injuries by the total sample size. The average number of injuries per injured guitar player was calculated by dividing the total number of injuries by the total number of injured guitar players [11].

Statistical inference was applied through binary logistic regressions (Enter method) with the aim of testing the influence of the variables used in this study on the presence of injury.

The level of statistical significance was set at 0.05.

3 Results

The sample consisted of 105 guitar players, with 103 (98.10%) being male and 2 (1.90%) female, ranging in age from 30 to 75 years (29.83±10.23 years). Regarding handedness, 95 (90.50%) guitar players were right-handed, and 10 (9.50%) were left-handed. The vast majority of guitar players reported using a guitar strap (84; 80%). Sixty-five (61.91%) guitar players played only one type of guitar, while 40 (38.09%) used more than one type. The most used type of guitar was the electric guitar (74; 51.03%).

Thirty (28.6%) guitar players mentioned playing another instrument besides the guitar, being the drums the most used. Fifty-two (49.52%) musicians played only one musical style, while 53 (50.48%) played more than one. The most musical styles played by the guitar players was heavy-metal/metal (61; 29.33%) (Table 1).

Table 1
Absolute and relative frequencies of professional’s characteristics

Professional’s characteristics n; %

Guitar types Electric 74; 51.03%

Acoustic/semi-acoustic 48; 33.10%

Bass 20; 13.79%

Portuguese guitar 3; 2.08%

Another instrument Drums 13; 35.14%

Bass 7; 18.92%

Piano 6; 16.22%

Keyboard 3; 8.11%

Harmonica 2; 5.41%

Roncoco 1; 2.70%

Mandolin 1; 2.70%

Percussion 1; 2.70%

Saxophone 1; 2.70%

Viola 1; 2.70%

Ukulele 1; 2.70%

Musical styles Heavy-metal/Metal 61; 29.33%

Rock 49; 23.56%

Pop/Rock 33; 15.87%

Blues 22; 10.58%

Classical 20; 9.62%

Jazz 13; 6.25%

Fado 7; 3.37%

Death Metal 2; 0.96%

Metal/Rock 1; 0.48%

Professional’s characteristics	n; %
Guitar types	Electric	74; 51.03%
	Acoustic/semi-acoustic	48; 33.10%
	Bass	20; 13.79%
	Portuguese guitar	3; 2.08%
Another instrument	Drums	13; 35.14%
	Bass	7; 18.92%
	Piano	6; 16.22%
	Keyboard	3; 8.11%
	Harmonica	2; 5.41%
	Roncoco	1; 2.70%
	Mandolin	1; 2.70%
	Percussion	1; 2.70%
	Saxophone	1; 2.70%
	Viola	1; 2.70%
	Ukulele	1; 2.70%
Musical styles	Heavy-metal/Metal	61; 29.33%
	Rock	49; 23.56%
	Pop/Rock	33; 15.87%
	Blues	22; 10.58%
	Classical	20; 9.62%
	Jazz	13; 6.25%
	Fado	7; 3.37%
	Death Metal	2; 0.96%
	Metal/Rock	1; 0.48%

The guitar players had a range of musical practice experience between 2 and 45 years (19.98±9.86), with a practice/rehearsal frequency of 1 to 10 times per week (4.10±1.98). Thirty-seven (35.20%) guitar players practiced more than once a day, with a weekly duration ranging from 1 to 45 hours (6.75±6.17). During rehearsals, the seated position was more commonly adopted (60; 57.10%) compared to the standing position (45; 42.90%). During concerts, 74 (70.50%) guitar players mentioned adopting the standing position more frequently compared to the seated position (11; 10.50%), and 20 (19%) mentioned not performing concerts.

Sixty-nine (65.70%) guitar players reported belonging to a band. During practice/concerts, 58 (55.20%) guitar players reported engaging in other types of movements, such as headbanging. The annual frequency of concerts varied between 0 and 280 (35.88±63.66).

Fifty-one (48.60%) guitar players mentioned performing some type of warm-up before musical practice, with a duration between 1 and 90 minutes (14.69±14.22), and only 21 (20%) guitar players engaged in stretching after a rehearsal or concert, with a duration between 1 and 90 minutes (11.86±21.63). Twenty-two (21%) guitar players worked exclusively in music, and 83 (79%) (63 (84%) reported engaging in another professional activity, with 73 (69.90%) working full-time and 10 (9.5%) part-time. Forty-six (43.8%) guitar players engaged in regular physical exercise, at least twice a week, while 59 (56.2%) did not.

Fifty-six (53.30%) guitar players experienced an injury during their entire musical practice, with 14 (13.30%) having 1 injury, 20 (19.10%) having 2 injuries, 10 (9.5%) experiencing 3 injuries, and 12 (11.40%) presenting 4 or more injuries, totaling 132 injuries. At the time of questionnaire completion, 13 (12.40%) guitar players were injured. In the last 12 months, 31 (29.5%) guitar players suffered an injury, with 10 (9.50%) having 1 injury, 10 (9.50%) having 2 injuries, and 11 (10.5%) experiencing 3 injuries, totaling 63 injuries. Table 2 presents the types and locations of injuries reported in the last 12 months, considering a maximum of 3 injuries.

Table 2

Type and location of injury

Type of injury	Location of	n	%
	injury
Tendinopathy	Ankle	1	34.92
	Shoulder	4
	Elbow	8
	Wrist	9
	All	22
Muscle bruise/	Wrist	1	6.35
sprain/rupture	Hand/fingers	2
	Lumbar spine	1
	All	4
Fracture	Wrist	2	3.17
	All	2
Paresthesia	Forearm	1	4,76
	Hand/fingers	2
	All	3
Meniscal injury	Knee	1	1.59
	All	1
Cartilage damage	Knee	1	1.59
	All	1
Carpal tunnel syndrome	Wrist	4	6.35
	All	4
Ligament injury	Elbow	1	1.59
	All	1
Luxation	Shoulder	1	1.59
	All	1
Thoracic pain	Thorax	2	3.17
	All	2
Low back pain	Lumbar spine	9	14.29
	All	9
Neck pain	Cervical spine	8	12.70
	All	8
Non-specific pain	Forearm	1	7.94
	Wrist	2
	Hand/fingers	2
	All	5
TOTAL	63	100

Fig.1

Absolute and relative frequencies of injury locations.

Right away we will present the epidemiological data of the reported injuries: the injury proportion was 0.29 (95% CI: 0.14–0.44), the injury rate was 0.42 injuries per 1,000 hours of music practice, the average number of injuries per guitar player was 0.60, and the average number of injuries per injured guitar player was 2.03.

The majority of injuries occurred during practice/rehearsals (39; 61.90%). Guitar players could report more than one mechanism of injury and the repetitive motion was the most reported mechanism of injury by guitar players (24; 35.29%). Thirty-eight (60.32%) injuries underwent treatment, and 25 (39.68%) received no treatment. Guitar players could mark multiple treatments simultaneously, so the number of treatments will exceed the value of 38 injuries. The majority of injuries was treated with rest (20; 33.90%).

Regarding the downtime caused by the injury, 27 (42.86%) injuries did not lead to a cessation of musical practice but the guitarists played in a conditioned manner. Concerning the current status of guitar players in relation to the injury, in the majority of injuries (32; 50.79%), the guitar players reported having no pain or symptoms and being fully recovered. Detailed results are presented in table 3.

Table 3

Absolute and relative frequencies of injuries characteristics

Characteristics of injuries		n; %
Occurrence of injuries	During practice/rehearsals	39; 61.90%
	During concerts	14; 22.22%
	During stretching after rehearsal/concert	6; 9.52%
	During warm-up before rehearsal/concert	4; 6.35%
Mechanism of injury	Repetitive motion	24; 35.29%
	Maintaining postures for prolonged periods	15; 22.06%
	Adopting improper postures	10; 14.71%
	Falling	1; 1.47%
	Did not specify	18; 26.47%
Types of treatments performed	Rest	20; 33.90%
	Physiotherapy	13; 22.03%
	Medication	13; 22.03%
	Immobilization	5; 8.47%
	Non-conventional therapies such as reiki, shiatsu, acupuncture	5; 8.47%
	Osteopathy	2; 3.39%
	Surgery	1; 1.69%
Downtime caused by the injury	Did not lead to a cessation of musical practice but played in a conditioned manner	27; 42.86%
	Up to two days of	15; 23.81%
	Between 3 to 7 days	5; 7.94%
	Between 8 to 14 days	4; 6.35%
	Between 15 to 30 days	2; 3.17%
	Led to the interruption of musical practice for more than 30 days	10; 15.87%
Current status of the injury	No pain or symptoms and being fully recovered	32; 50.79%
	No pain, but the guitar players were still in treatment and/or with conditioned activity	8; 12.70%
	There was pain, but the guitar players were not in treatment	16; 25.40%
	There was pain, and the guitar players were in treatment	7; 11.11%

Table 4 presents the data obtained through binary logistic regression between the presence of injury in the last 12 months and the risk factors analyzed in this study. We analyzed several possible risk factors that could be associated with guitarist injuries, however only the variable performing warm ups obtained a statistically significant result. The data revealed that guitar players who did not warm up before musical practice or concerts had 0.33 (CI: 0.13–0.79) more chances of developing injuries than those who warmed up (p = 0.013).

Table 4

Relationship between the event the presence of injury and variables about non-modifiable sample factors and guitar music practice characteristics

Variables	OddsRatio_crude (CI 95%);	p-value
Sex (male^*) female	2.43 (0.15–40.18)	0.534
Age group (until 29 years old^*)≥30 years old	2.00 (0.39–10.11)	0.402
Years of practice (≥11 years^*)≤10 years	1.11 (0.38–3.24)	0.852
Weekly training (≥4 times^*) until 3 times	1.10 (0.48–2.55)	0.819
Duration of training per week (≥6 hours^*) until 5 hours	1.39 (0.59–3.23)	0.451
Rehearse more than once (no^*) yes	1.24 (0.52–2.95)	0.630
Dominant side (left^*) right	1.76 (0.35–8.79)	0.492
Belongs to a band (yes^*) no	2.21 (.84–5.79)	0.107
Position adopted in rehearsals (standing^*) seated	1.06 (0.45–2.47)	0.902
Position adopted in concerts (seated^*) standing	1.90 (0.38–9.53)	0.433
Carrying out warm-up band (yes^*) no	0.33 (0.13–0.79)	0.013
Play another musical instrument (no^*) yes	2.00 (0.73–5.52)	0.181
Practice physical exercise (yes^*) no	0.89 (0.38–2.09)	0.802
Guitar type (acoustic/semi-acoustic^*) electric	1.2 (0.38–3.76)	0.754
Guitar type (electric guitar^*) bass	2.67 (0.87–8.17)	0.086
Music style (Pop/Rock/Blues/Classic/Jazz/	1.12 (0.46–2.65)	0.820
Fado^*) Heavy-metal/Metal/Rock/Death Metal

^*Class reference.

4 Discussion

This study revealed that out of the 105 surveyed guitar players, 53.30% experienced injuries during their entire musical practice. This represents 132 injuries. In the last 12 months, this percentage was 29.5%, representing 63 injuries. Although there are various epidemiological studies on injuries in musicians [1 , 12–15], very few specifically addressed this population (guitar players), making it challenging to compare data.

Fjellman-Wiklund & Chesky (2006) assessed 520 guitar players and found 81% of them had injuries; however, they did not specify the time period of these injuries, making it difficult to compare with the data from this study. The percentage difference between this study and theirs may be related to the inclusion of a higher number of female guitar players, who, in certain injuries, showed prevalence rates two to three times higher than male players. This aspect was addressed in the systematic review by Silva et al. (2015) which concluded that pain was more prevalent in female musicians and in the study by Portnoy et al. (2022), which found that females exhibited a higher number of symptoms and longer durations.

Fjellman-Wiklund & Chesky [16] assessed 520 guitar players and found 81% of them had injuries, a value higher than that found in this study;; however, they did not specify the time period of these injuries (all entire practice or 12-months period), making it difficult to compare with the data from this study. A possible explanation for this high prevalence value in the study of Fjellman-Wiklund & Chesky [16] may be related to the inclusion of a higher number of female guitar players, who, in certain injuries, showed prevalence rates two to three times higher than male players. This factor was addressed in the systematic review by Silva et al. [17], which concluded that pain was more prevalent in female musicians, and in the study by Portnoy et al. [1], which found that females exhibited a higher number of symptoms and longer durations.

The high prevalence of injuries in the guitar players in our study sample may be related to the complexity and demands of the technique used during musical practice. This could be associated with insufficient physical preparation, lack of breaks during rehearsals/concerts, and ineffective or nonexistent treatment of previous injuries [2 , 14].

Regarding the type of injury, this study found that the highest percentage of injuries was tendinopathy, representing 34.92% of the injuries, followed by low back pain, present in 14.29%. Concerning tendon injuries, these can lead to significant disability, with various injury mechanisms such as: mechanical stress imposed on the muscular tendon unit through movements requiring strength and speed, leading to an inflammatory reaction; repetitive use of the structure or a sudden increase in the volume and intensity of practice, for example, before or during a concert, exceeding biological limits and leading to an overuse syndrome; or direct trauma [7 , 18–20]. All these mechanisms are present in guitar practice in which the guitarists remain during prolonged periods of maximum wrist flexion and elbow flexion performing repetitive movements and maintained for long periods [1–3 , 7].

Concerning low back pain, the finding of this study aligns with the study by Silva et al. [17], where they stated that low back pain was the most prevalent painful condition among musicians, with lifetime prevalence estimates ranging from 11% to 84%. The origin of this symptomatology may arise from prolonged, often incorrect postures with the trunk in flexion, exposing possible muscle imbalances in the trunk extensors, abdominal wall, and hip extensors [21].

The body region that obtained the highest percentage of injury was the wrist, representing 28.57%, followed by the lumbar spine with 15.87%. The study by Fjellman-Wiklund & Chesky [16] found that the most injured regions were the left fingers (32.9%), left wrist (29.8%), and left hand (24.7%), followed by the wrist (21.7% right wrist and 29.8% left wrist) and the lumbar spine (21.3% right and 18.4% left), with the elbow showing lower percentages (9.7% right and 8.4% left). This study divided the regions into right and left, and the percentage of all regions exceeds 100%, making it difficult to compare with the data from our study.

Sheibani-Rad et al. [22] demonstrated that the wrist and hand were the main injured locations in string instruments. One possible hypothesis for the high prevalence of wrist injuries can be explained by the positioning of the dominant hand mostly with the wrist in flexion and radial deviation, often performing complex chords, reaching extreme positions, which can lead to injury [19, 23]. In the non-dominant hand, if a small and very thin pick is used, requiring more precise gripping, along with repetitive movement it can increase muscle tension in the fingers and hand and lead to injury or symptoms [14].

Regarding lower back pain, intrinsic factors such as stature and extrinsic factors such as extreme positions of trunk rotation and flexion adopted during practice, as well as the cumulative weight of the guitar may be related to the presence of pain in this region [14, 22].

The injury mechanisms most mentioned by guitar players were repetitive movement (35.29%) and prolonged maintenance of postures (22.06%). The latter factor is of utmost importance since the injurious load originated from a postural fixation, even if initially not inappropriate; in this sense, variability and sporadic breaks are essential in this population [19].

Regarding the type of treatment the majority consisted of rest (33.90%), physiotherapy (22.03%), and medication (22.03%). In the acute phase of the injury, especially from repetitive movement mechanisms that can trigger overuse syndrome, some possible treatments may focus on rest, ice, anti-inflammatories, and reducing or modifying activity. Identifying injuries in the early stages and starting specialized rehabilitation are crucial to optimizing the prognosis for most of these injuries.

A high percentage of injuries (39.68%) were not treated and regarding the downtime caused by the injury, 42.86% of injuries did not lead to a cessation of musical practice but guitar players played in a conditioned manner. Maintaining the load on the injury can create a vicious circle of compensations, muscle tension, and inflammation [24], leading to a worse prognosis. The study by Betzl et al. [19] mentioned that many musicians live daily with pain related to musical practice and do not seek help from healthcare professionals, resorting to self-help strategies and techniques for pain reduction. These techniques include rest, topical solutions, bandages, and stretches.

Of all the variables analyzed in this study, the only risk factor for preventing injuries that achieved statistical significance in the binary logistic regression analysis was the practice of some form of warm-up before musical rehearsals or performances. Warm-up facilitates the transition from rest to exercise, promotes muscle stretching, increases blood flow, raises body temperature, reducing susceptibility to injuries by increasing connective tissue extensibility, and enhances range of motion and muscle performance [25].

The present study had some limitations, such as the inability to identify the number of guitar players in Portugal, including amateurs, making it impossible to verify if our sample was representative of this population. The sampling method was convenience-based, leading to a higher number of responses from a specific geographic area, a specific musical style, and a majority of males, thus reducing representativeness. The data collection format through self-completion of an online questionnaire may introduce biases; however, it is the best way to obtain a larger number of participants. Future studies involving a larger sample and diagnosis by healthcare professionals are necessary.

5 Conclusions

The present study revealed a high percentage of injuries among the analyzed guitar players in the sample with tendinopathy and low back pain being the most prevalent types of injuries. The anatomical sites most affected were the wrist and the lumbar spine and the main injury mechanisms included repetitive motion and prolonged posture maintenance. The only risk factor associated with the presence of injuries was the lack of warm-up before rehearsals/concerts. Studies at this level are necessary as they provide a comprehensive understanding of the mechanisms that can lead to injury, enabling healthcare professionals to act in reducing risk through preventive strategies and planning more effective interventions.

Ethical considerations

This study was approved by KinesioLab –Research Unit in Human Movement, Piaget Institute (KL.2023.02). All participants were informed of the study’s objective. Their participation was voluntary, with the option to withdraw at any time without any prejudice. Confidentiality and data privacy were ensured. All procedures are done in accord with the Declaration of Helsinki of 1964.

Informed consent

The measurement instrument used was a digital survey shared via email, social media and in person by researchers using QR codes at concert venues in which participants gave their informed consent to participate in the study.

Conflict of interest

None.

Footnotes

Acknowledgments

To all study participants, to Inês Adrião for the elaboration of the figure and to Sofia Freitas for reviewing the text in English.

Funding

No funding.

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