Playing-related problems in guitarists: Systematic review and meta-analysis

Background Playing-related disorders (PRP) are among the most common occupational health problems affecting musicians; however, no prior meta-analysis has focused exclusively on guitarists. Existing reviews often group plucked-string players with bowed-string or other instrumentalists, overlooking the unique biomechanical demands of guitar performance. In addition, the widely used term PRMD (playing-related musculoskeletal disorders) frequently conflates clinically diagnosed conditions with self-reported symptoms, limiting clinical clarity. We propose a classification under the umbrella term playing-related problems (PRP) comprising: (1) PRMS—self-reported playing-related musculoskeletal symptoms; (2) PRMD—clinically diagnosed playing-related musculoskeletal disorders; and (3) PRND—clinically diagnosed playing-related neurological disorders. All are secondary to instrument playing and defined by the presence of a symptom (PRMS) or disorder (PRMD or PRND) that interferes with the musician’s ability to perform at their usual level.

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of PRP prevalence in guitarists. Studies were classified by PRP subtype. Random-effects meta-analyses of proportions were performed, with subgroup analyses and mixed-effects meta-regressions to explore heterogeneity. Funnel plots and Egger’s test were used to assess potential publication bias.

Twenty-two cross-sectional studies were included (n = 2,119). Pooled prevalence was 51.8% for any PRP, 64.5% for PRMS, 42.2% for PRMD, and 14.5% for PRND. In analyses restricted to musculoskeletal outcomes (PRMS + PRMD), specifying guitar type substantially reduced heterogeneity, with classical, bass, and flamenco guitarists showing the highest prevalences. Meta-regression identified PRP subtype, guitar type, and prevalence recall period as significant moderators; residual heterogeneity (I²) decreased from 90.7% to 0% in the most restricted model. No evidence of funnel-plot asymmetry was found for PRP. Qualitative synthesis suggested possible associations with daily practice time, warm-up habits, sex, and multi-instrumentalism, although findings were inconsistent.

PRP are highly prevalent among guitarists. Adopting the PRP– PRMS–PRMD–PRND framework may improve consistency in case definitions, facilitate valid prevalence comparisons, and support the development of instrument-specific preventive and rehabilitative strategies. Evidence from secondary outcomes suggests that incorporating warm-up routines and practice breaks may offer additional protection against these disorders. Competing Interest Statement The authors have declared no competing interest. Clinical Protocols https://www.crd.york.ac.uk/PROSPERO/view/CRD420251069560 Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study is a systematic review and meta-analysis based entirely on previously published data. No new data were collected from human participants or animals, and therefore approval by an institutional review board (IRB) or ethics committee was not required. The research was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All relevant data are within the manuscript and its Supporting Information files.