Impact of Manual Therapy on Instrumentalist Musicians With Playing-Related Musculoskeletal Disorders: A Systematic Review

Objective: To investigate the effects of manual therapy on playing-related musculoskeletal disorders (PRMDs) in instrumentalist musicians. Data Sources: PubMed, MEDLINE, CINAHL, Scopus, Web of Science, and EMBASE were searched from inception until December 17, 2024. Study Selection: Randomized controlled trials (RCTs), noncontrolled trials, case reports evaluating the effects of any manual therapy on PRMDs of instrumentalists were selected. Data Extraction: Two independent authors extracted data and assessed quality using different risk of bias assessment tools, depending on study design. Data Synthesis: Of the 529 retrieved titles, 9 were included: 3 articles on 2 RCTs (one with 69 string/wind/percussion players and the other with 30 wind players, aged 18-30y), 1 case series (689 instrumentalists), 1 pre-post trial (32 string/wind/keyboard/percussion/other instrumentalists, aged 18-30y), and 4 case reports (4 string/wind/keyboard players, aged 25-64y). The first RCT showed significantly reduced pain and disability after soft tissue and mobilization techniques along with postural exercises versus postural exercises alone in temporomandibular dysfunction of wind instrument students. The other RCT reported immediate and medium-term significant pain reduction after Tuina versus sham Tuina in PRMDs in professional musicians. The case series, pre-post study, and 1 case report were of low-very low quality, while 3 case reports were of good quality. However, it should be noted that support for treatment was very limited; both RCTs were underpowered and had a high risk of bias, whereas the evidence from the other studies was limited by low quality and/or design. Heterogeneity did not allow for meta-analysis. Conclusions: The evidence supporting manual therapy for PMRDs in instrumentalists is scarce and of low quality. High-quality RCTs are needed to investigate the risks and benefits of these interventions.