Harmonizing musculoskeletal health: transformative effects of 8-week intervention program on posture in music students

Background and Study Aim Musculoskeletal complaints are common among music students, irrespective of gender. They develop due to intense practice over an instrument; spending long hours of practice may cause muscular imbalance, tension, and awkward posture. The repetitive nature of practice in music students may cause overuse and fatigue. This increases the risk of acute pain and can affect both quality of life and performance. Therefore, the present study aimed at evaluating the transformative effects of an 8-week intervention program on posture in music students. Material and Methods The 8-week intervention program with transformative effects was conducted over 8 weeks (from September 18 to November 12) on Mondays and Thursdays, for 45 minutes each session. The program aimed to benefit 25 music students, of whom (i) 15 were in the experimental group (with an average age of 24.20 years, average weight of 82.40 kg, and average height of 178.60 cm), and (ii) 10 were in the control group (with an average age of 24.60 years, average weight of 78.40 kg, and average height of 182.20 cm). All participants were enrolled in the second year of a master’s degree program in Performing Arts. Standardized measures for evaluating posture (utilizing Klein and Thomas’s method, as refined by Mayer) were conducted both before (Week 1, September 18) and after (Week 8, November 12) the intervention. The impact of the 8-week intervention program was assessed using the Wilcoxon Rank-Sum Test, Wilcoxon Signed-Rank Test, and Pearson’s r. Results Significant differences (p < 0.05, < 0.01) between 25 music students (M); in particular experimental group (n = 15) and control group (n = 10), were in 4 (80%) segments of body in post-test: (i) Head and neck; (ii) Abdomen and pelvis; (iii) Curvature of spine; (iiii) Shoulders and scapulas. Insignificant differences (p < 0.05) between 25 music students (M) were in pre-test. Conclusions Significant differences (p < 0.05, < 0.01) indicated the transformative effects in the experimental group’s (n = 15) posture. This emphasizes the potential of the 8-week intervention program in promoting musculoskeletal health of music students. Therefore, additional research is necessary to investigate the lasting resilience (sustainability) of advantages and enhance the intervention plan in music education.


Introduction
Maintaining the posture (correct) is of upmost importance in promoting the well-being of music students, allowing to engage in music-making with comfort (ease); however, prevention of posture in not common in music students.Despite its importance, playing-related musculoskeletal disorders (PRMDs) persist in music students, leading to discomfort, pain, and career-limiting injury [1,2,3].Recognizing the challenge, educators (researchers) turn attention to interventions (target) aimed at improving the posture in music students [1,4,5,6].
Music-making (practice) is demanding because of intense practice over an instrument, i.e., spending long hours of practicing may cause muscular imbalance, tension, and awkward posture [7].Maintaining the posture is important because of preventing the playing-related musculoskeletal disorders, maximizing the playing technique (routine), and understanding the importance of ergonomics [8,9]; however, incorrect posture (awkward) may cause muscle tension, joint strain, and (even) chronic pain [9,10,11].Incorrect posture in music students is common (± 58%), more in females [12].± 85% of first-year (freshman) music students enrolled in higher education (university, college) experience acute pain; ± 34% of them experience playing-related musculoskeletal disorders, either in advance of enrollment in bachelor's degree [13,14,15].Prevalence of playing-related musculoskeletal disorders in music students may differ, depending on diverse factors; in particular, instruments played, intensity of practice, level of awareness, and preventive measures taken [1].Responsibility 02 02 79 for health (musculoskeletal) in music students is low; therefore, raising awareness and offering the instructions (target) in preventing the playingrelated musculoskeletal disorders while studying may influence the careers of music students [11].
Despite its importance (maintaining the posture), correcting the incorrect posture is challenging; in particular, in music students who develop maladaptive postural habits over years of practice [6,16].Demands of music-making (practice) prioritize mastering over an instrument and artistic expression over well-being of music students, leading to overlook and/or dismiss the signs of discomfort.Learning environment (itself) may worsen the playing-related musculoskeletal disorders because intense practice over an instrument happens in settings with inadequate support (ergonomics).Educators (may) lack the training and/or awareness in addressing posture effectively, focusing on musical instructions over principles of biomechanics [17].Differences in disciplines (e.g., anatomy, ergonomics) necessitate tailored approaches in correcting the posture, making it challenging to devise universal interventions [1].Despite the challenges, the imperative in promoting the posture (correct) and preventing the playingrelated musculoskeletal disorders compels the educators (researchers) to explore the innovative interventions tailored to needs of music students [4,5,18,19,20].
Interventions aimed at improving posture in music students; in particular, enrolled in higher education, represent important areas of research (science) in music education; however, research in Slovakia about this topic is not as advanced as it is in other countries [21].Because many gaps remain in literature, in terms of Slovak scale (the best of authors' knowledge), the present study was aimed at evaluating the transformative effects (impact) of 8-week intervention program on posture in music students.
Evaluating the impact (transofrmative effects) of 8-week intervention program on pusture in music students was carried out in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.All subjects provided written informed consent [22].
15 music students (60%) of experimental group underwent 8-week intervention program [1] under the guidance of lecturer -M.Marko; who informed the experimental group (60%, n = 15) of principles of 8-week intervention program.8-week intervention program was chosen because of supporting the musculature (muscular system) of spine, neck, abdomen, and shoulders [4], allowing the experimental group (60%, n = 15) to exercise (low-load; early stage), advancing to patterns of resistance [5].8-week intervention program consisted of 5-minute warm-up, 35-minute intervention, itself (3 sets of 12 reps and/ or 3 sets of 6 reps -1 min), and 5-minute cool down.15 music students (60%) of experimental group documented the progress of 8-week intervention program, recording details; in particular, number of sets/ reps and possible problems.Experimental group (60%, n = 15) informed the lecturer in case of musculoskeletal discomfort and/ or pain and he (lecturer), in turn, monitored the signs of fatigue; in particular, shaking, loss of control [6].Social (group) setting as method of delivery was choosen because of its cost effectiveness.8-week intervention program (transformative effects) was aimed at alterations in neuromuscular patterns and improvements in strength, in consequence of physiological adaptations.
Standardized measure (Klein and Thomas/ Mayer) [23] to evaluate the posture (static) was carried out; in particular pre-(September, 18

Statistical Analysis
Evaluating the impact (transformative effects) of 8-week intervention program on posture in music students was by Wilcoxon Rank-Sum Test (2 independent samples, non-parametric), Wilcoxon Signed-Rank Test (2 dependent samples, nonparametric), Pearson's r, and descriptive statistics (Ibm Spss Modeler).Significant differences (p < 0.05, < 0.01) between 2 independent samples (experimental vs. control group) were evaluated by Wilcoxon Rank-Sum Test, of which the significance level (α) was 0.01 and 0.05.Significant differences (p < 0.05, < 0.01) between 2 dependent samples (Week 1, Week 8) were evaluated by Wilcoxon Signed-Rank Test, of which the significance level (α) was 0.01 and 0.05 [25].Measuring of linear correlation between 2 sets of data (variable) was evaluated by Pearson's r [26].Descriptive statistics (arithmetic mean, percentage) described the features (basic) of 25 music students.

Discussion
Regarding the impact (transformative effects) of 8-week intervention program on posture in music students (100%, n = 25), the incidence rate of research (available) is low [27]; and because many gaps remain in literature, in terms of Slovak scale [21] (the best of authors' knowledge), the present study was aimed at evaluating the transformative effects of 8-week intervention program on posture in music students.
Research carried out by authors [13][14][15] underlines the prevalence of playing-related musculoskeletal disorders in music students and harmful effects of incorrect posture (see Introduction). ± 84% of music students surveyed the playing-related musculoskeletal disorders, with the spine, neck, and arms emerging as the most affected areas [28].
Recognizing the challenges, authors pay attention (more) to interventions (target) aimed at improving the posture in music students [4][5][6][18][19][20].Repeated measure analysis (after 8 weeks) of changes in quality of posture at week 8 (post-) between 2 dependent samples was significant (p < 0.01); in particular, difference of 6.40 in postural score (index) was significant (Z = -3.84,p < 0.01, r = -0.84)and in favor of experimental group (60%, n = 15).Similar study [29] involved 10 participants (n = 10); clarinetists experiencing the playing-related musculoskeletal disorders during the intense practice over an instrument.6-week (3x/ week) intervention program consisted of autonomous exercises aimed at enhancing the mobility of joints, strengthening the posture; in particular, focusing on scapular region and limbs (upper).Standardized Educational institutions (music schools, higher education) are in charge of teaching music students; in particular, professional subjects; however, how to take care of musculoskeletal health (posture, in our case) is absent [21,30]; therefore, education institutions must take measures (active) in addressing the absence in education [1].Addressing the absence, education institutions may incorporate the education of musculoskeletal health into curriculum.By educating (instrument-specific ergonomics, autonomous exercises), it may address the demands placed on music students [31].Music students who receive tailored assessments and/or guidance by health professionals improve awareness of posture [9,32].Integration of musculoskeletal health education into curriculum is not just important, but necessary too.
Using evidence (available) of interventions in cooperation with medical experience and current best practice [33], 8-week intervention program was effective at improving posture in experimental group (60%, n = 15).According to results of 8-week intervention program (see Results), we may recommend it for practical use of static load in music students; however, it must be kept in mind that types of instruments are important in terms of designing of interventions because demands are not always equal [29].

Conclusions
Transformative effects of 8-week intervention program on posture in music students (100%, n = 25; M) emphasize the important role of interventions (target) in terms of promoting the musculoskeletal health.Effectiveness of 8-week intervention program in promoting the posture (correct) suggests that interventions may result in significant benefits (p < 0.05, < 0.01) in musculoskeletal health.8-week intervention program incorporates the combinations of target exercises, ergonomic alterations, and educational aspects aimed at enhancing the posture awareness.Such interventions are important because of minimizing the danger of musculoskeletal disorders (MSDs) and optimizing the performance and wellbeing in music students.
Significant differences (p < 0.05, < 0.01) underscore the importance of prevention (early) and active measures in addressing the musculoskeletal issues in music students (100%, n = 25).Given the demanding nature of practice over an instrument, music students are susceptible (particularly) to developing the playing-related musculoskeletal problems (PRMDs).Implementing of 8-week intervention program (early) in music students' practice may help in terms of preventing the musculoskeletal issues; however, additional research is necessary in terms of investigating the lasting resilience (sustainability) of advantages and enhancing the intervention plan in music education.