Patterns of Over-Use Seen in 658 Affected Instrumental Musicians

The term ’over-use ’ is generally used to denote changes in tissues which have been taken beyond their biological tolerance. The painful musculo-ligamentous over-use from excessive practice or playing (over-use syndrome) is probably more common in musicians than all their other occupational maladies put together. The upper limb is generally affected by pain derived from the over-used muscles and ligaments which may be tender to examination in the more advanced examples. In such advanced examples, a type of muscular failure may occur where there is loss of strength, loss of response (speed, agility) and loss of control (accuracy) (Fry, 1986a, 1986b, 1986c, 1987a, 1987b, 1987c; Owen, 1985; Lederman & Calabrese, 1986). This type of muscular failure may occasionally be present without pain and is also associated with excessive playing (Hochberg, Leffert, Heller & Merriman, 1983; Hallett, Lederman & Calne, 1987). The muscles remain under voluntary control but with reduced performance. Muscular over-use may affect the muscles of the embouchure (painful or painless), of the soft palate and around the eustachian tubes (usually painless) seen in high