Pressure Pain Threshold on the Finger Digit Pads in Stringed Musicians

Introduction

Modern human civilization is permeated by music, and our ability to appreciate music is the result of our brain’s capacity to analyze a variety of complicated auditory patterns. Musicians’ brain-body interactions occur at several levels of physical and cerebral organization in time and location, as they perform the highly coordinated human action of playing music in an ensemble.^1,2

The impact of musical training on the body is an area that requires further research to understand and treat orthopaedic or neuromuscular injuries and abnormalities in musicians. The need for this arises as musicians propose several justifications for playing through pain, including the need for money, loss of a job, or the mere desire to continue performing, which can endanger their long-term career and health.³

The guitar, as we know, is a musical instrument in which a striker is used to pluck stretched strings that vibrate to produce sound. In practice, the non-dominant hand is used to fret the guitar strings,whereas the dominant hand is used to strum.^4,5 Overuse injuries arise in the fretting (non-dominant) hand as the finger pad is pressed down repeatedly on the stretched guitar strings, this micro-trauma can lead to changes in the somatosensory system’s structural and functional organization, which can change the pain threshold.⁶

The pain threshold can be interpreted as the lowest intensity of a stimulus that is regarded as painful and varies from person to person. It is crucial to examine how the pain threshold changes in musicians because pain functions as a deterrent to further injury to the body part.⁷

Despite being the second-most played instrument in the world, guitar players suffering from repetitive stress to the tissues in the wrist and hand have not been the subject of any particular study.⁸ Regarding the treatment of injuries in musicians, the impact of musical training on the body requires further research. Thus, by understanding the variation in the pressure-pain threshold in musicians, we can develop a patient-centered strategy to prevent and treat performance-related musculoskeletal disorders (PRMD).⁹

Material and Methods

This observational study aimed to determine the pressure-pain threshold in guitar players and to compare the pressure-pain threshold changes between guitar and non-guitar players using a dolorimeter. This study was conducted across various music schools in Mysore, India.

This study was conducted for a duration of three months and based on convenience sampling, 82 participants were recruited, of which 41 were guitar players and 41 were non-guitar players. Written informed consent was obtained from all participants who were willing to participate in this study. Ethical clearance from the Institutional Ethical Committee of the Medical College was obtained before the commencement of the study (reference no: JSSMCIEC/05012022/04NCT/22021-22).

Guitar players at all levels (beginners, instrumentals, amateur, professional) who met the age criteria of young adults (18-20 years) and adults (40-60 years) were included. Only participants who practiced for a minimum period of two days per week (one hour a day) for at least three months were included. The procedure was explained to the participants and consent was obtained for their participation. The recruited participants were screened for any recent trauma to the hand, history of surgery to the hand, diagnosed with any inflammatory conditions or any compression neuropathy, occasional players, and other factors that could alter the study or cause any further injury were excluded from the study.

The subject was comfortably seated on a chair and a firm surface (table) was used to support the hand. The part to be tested was exposed, cleaned, and checked for any contraindications. The therapist supported the participant with the test finger. The subjects were instructed to close their eyes to eliminate any visual feedback. Force was applied perpendicular to the skin. The test started with the contact of the device with the skin. The dolorimeter was pressed distally into the pad of the finger (index, middle, ring, and little finger) distally. The subject was asked to say ‘STOP’ once the minimal pressure pain threshold was perceived by the individual. The test was done 3 times and the data obtained were recorded. The data obtained were analyzed using SPSS Statistical software, and appropriate bar graphs were used to compare the results.

Results

For the study, 82 participants were included; two groups each of 41 healthy right-handed guitarists and 41 healthy non-guitarists. The right-handed (dextral) non-guitarists were 20 males and 21 females with a mean age of 20.3 yr (SD=1.78). The guitarists included 30 males and 11 females with a mean age of 22.9 yr (SD=6.06). Based on the results, there was a significant difference in the minimal mean pressure-pain threshold between the plucking (dominant hand) and fretting hands (non-dominant) among the guitar players. The mean pressure pain threshold data of guitarists and non-guitarists documented using the dolorimeter yielded differences in the values of the pressure-pain threshold between the two groups. The mean pain threshold among guitarists and non-guitarists is shown in Figure 1

The mean pain threshold was higher in the pads of the left middle finger and left ring finger in guitar players than in non-guitar players (Figure 2). These data reveal that there is an alteration in the pressure-pain threshold in guitarists.

Discussion

This study aimed to compare the pressure pain threshold on the finger pads of stringed musicians. A study conducted on the impact of musical training in string musicians by Gorniack SL et al., reported that string musicians should be examined and treated separately from typical healthy controls with regard to hand function since the effects of musical training in musicians reflect brain reorganization in this population.¹⁰ As evident from expert opinion, the pain and sensory threshold may be high due to repeated pressure and thickening of the skin and fascia. This is evident in the study results that the non-dominant hand, which is used to fret the strings of the guitar, applies more pressure, thus owing to the higher pain threshold. The mean pain threshold difference in the pads of the left middle finger and left ring finger in guitar players was 55% and 50%, respectively, indicating that these fingers, which are used to apply more pressure on the strings of the guitar, yielded a higher pain threshold due to repetitive microtrauma. As the dominant hand is used only to strum the guitar strings, the amount of pressure applied on the strings is low, and thus, little somatosensory changes can be observed. Thus, in clinical practice, stringed musicians should be considered a sensitive population during the treatment of orthopaedic and neuromuscular conditions. In addition, a guitarist needs to train adequately and follow proper fretting techniques to reduce overuse injuries and repetitive microtrauma to the fingers, as it may lead to other sensory problems or conditions in guitarists and thus may affect their career as a musician.

The type of guitar used was not considered in the present study. Individual comparisons of pressure-pain thresholds among the different levels of guitarists and age-gender-based comparisons were beyond the scope of this research.

Further studies can compare the pain threshold among different levels of guitar players to gain a deeper understanding of the alterations in the pain mechanisms of guitar players and can be used by clinicians to understand the pain perception and diagnose the various musculoskeletal conditions of hand-in guitar players.

Conclusions

The results of this study show that there is an alteration in the pain threshold in guitarists compared to that in non-guitarists. There was an increase in the pain threshold in the left middle and left index fingers of the guitarists. Providing adequate rest periods between practice hours and following appropriate techniques to fret the strings of the guitar can help reduce strain on the fingers. These data can aid in developing training regimes that are more skill and technique oriented.

Conflict of interest

Nil

Funding and Acknowledgements

This study was part of the main study funded by Rajiv Gandhi University of Health Sciences, Bangalore, India.