Prevention and therapy of orchestra musicians’ playing-related musculoskeletal disorders with transcranial direct current stimulation: a pilot study

Background: Orchestra musicians and music students complain about painful playing-related musculoskeletal disorders (PRMDs) without receiving appropriate therapeutical support. The aim of this pilot study was to provide a proof of concept of a new treatment regimen for PRMDs based on a comprehensive assessment. This regimen consisted of transcranial direct current stimulation (tDCS) in addition to physiotherapeutic exercises and psychological coaching. As a part of the assessment, we tried to demonstrate the feasibility of multiple new diagnostic tools that could potentially investigate the efficacy of the treatment regimen and elucidate pathophysiological mechanisms of PRMDs. Methods: Musicians from the Orchestra Academy of the Vienna Philharmonic Orchestra were asked for their voluntary participation. Seven participated in their choice of self-administered tDCS sessions with concurrent physiotherapeutic exercises, physiotherapeutic and psychological assessments, the pain questionnaire, and medical imaging or 3D motion capture acquisitions. The feasibility of these methods was determined through observation of the investigators and participant feedback, as well as a safety questionnaire and a checklist. Results: All pilot trials (n = 10) were completed successfully without any major issues. Some minor problems, such as lack of electrode connectivity or tingling/burning sensations of the scalp, were encountered by the participants during the tDCS sessions (n = 2/2 participants), the physiotherapeutic assessments (n = 1/3) and exercises (n = 1/2), the psychological assessments (n = 1/2) and the medical imaging (n = 1/2). Conclusions: The trials showed very promising results for all investigated study parts, therefore demonstrating the feasibility and safety of studying this new treatment regimen in a randomized clinical trial with a larger sample of musicians. Also, the medical imaging and 3D motion capture acquisitions encourage further investigation to evaluate their potential diagnostic applicability for musicians’ PRMDs.