Investigating Professional Classical Guitarists' Performance-Related Musculoskeletal Disorders: Exploring Lived Experience & Evaluating a New Guitar Support

Specialist musical training frequently does not prepare guitarists for the high physical demands of professional careers, leaving them at higher risk of developing playing-related musculoskeletal disorders (PRMDs). Among professional musicians, injuries remain 'hidden' as musicians are reluctant to discuss them for fear it would jeopardise their career. The over-arching aim of this thesis is to gain further insight into professional classical guitarists' lived experiences of PRMDs, an area of research that is currently under-explored. Quantitative studies carried out in Australia, Great Britain, Europe, and the United States show the prevalence of overuse injuries among classical orchestral musicians. However, far fewer studies focus on classical guitarists, and extant research literature contains inconsistencies in epidemiology, definition, and assessment of injury type, location, severity, and duration, that hamper understanding. Given the guitar's popularity there has been surprisingly little work carried out to understand and mitigate PRMDs among this population, and the experiences of musicians themselves (a valuable source of potential insight) remain under-researched. This thesis offers a critical examination of the societal and physiological risk factors that contribute to PRMDs and the ways they are currently addressed by music education, together with an empirical study of the lived experiences of overuse injuries among professional classical guitarists. To highlight professional performing guitarists' perspectives on PRMDs, semi-structured interviews were carried out with eight participants and the resulting data subjected to Interpretative Phenomenological Analysis (IPA). A second empirical enquiry centred on ways to reduce and/or prevent overuse injuries via the introduction of a bespoke intervention; an innovative guitar support, functioning as an integrative 'prosthesis', rather than external attachment. The lived experience of its use was examined through accounts of guitarists who tested it for two weeks. Data generated by the first study was split into two data subsets: musicians' focal hand dystonia (mFHD), and posture-related pain. Findings from this first study confirm that there is a culture of silence amongst professional classical musicians living with injuries, which hinders the dissemination of helpful information. It also shows that this is commonly accompanied by a distrust of medical professionals. A musician's identity is strongly intertwined with their instrument, so being unable to play is psychologically devastating. Musicians do not appear to learn what the body needs for healthy and optimal function until they are injured, but crucially, both psychophysical and psychosocial factors can contribute to the development of mFHD. This neurological impairment of mFHD can terminate a career by robbing the musician of control of a finger or whole hand. Onset patterns, symptoms, and treatment needs of mFHD vary. Regarding the second data subset, although the role of posture in low back pain is controversial, this thesis shows that 'improved' posture can drastically reduce back pain in classical guitarists. Findings from the second study indicate that guitarists are open to trying different guitar supports that do not require changes to the guitar itself, with limited data supporting the idea mentioned above - that 'improved' posture can reduce back pain. In conclusion, this thesis informs and enhances theoretical understanding of some of the risk factors for developing PRMDs by drawing on sports rehabilitation literature and health research, alongside phenomenological insight into guitarists' first-hand experience of over-use injuries. These insights could be used to inform the design of music performance education curricula that focus on the health and longevity of not just classical guitarists, but musicians in general.