A Study of Musculoskeletal Discomforts and Associated Risks among Indian Percussion (Tabla) Players

Musculoskeletal disorders at work are often the prime topic of discussion and research (Yeung et al, 1999). They are widespread in many countries, incurring substantial cost and affecting quality of life. The major contributory risk factors are non-optimal body posture, forceful and repetitive movements, whole body vibration and psychological stress. The risk factors are prevalent in almost all occupations (Punnett and Wegman, 2004). Unlike other professionals, the work of instrumentalist involves playing musical instruments hence work-related musculoskeletal disorders are called playing-related musculoskeletal disorders (PRMDs), which are often disabling (Zaza et al 1998; Bragg 2006). The prevalence of PRMDs in musicians has been found to range from 32% to 87% (Zaza et al, 1998; Storm, 2006).

The Tabla is the most popular percussion instrument used in Indian classical music. Ragothman (2004) reported that Tabla players also suffer from PRMDs. Tabla playing involves repetitive striking movements, force, contact stress and constrained posture for longer period of time which may be the predisposing factors for PRMDs. A study from The University of Pittsburg reported that Indian Tabla players suffer from musculoskeletal discomforts. Among harmonium, sarod and Tabla, Tabla players suffered from the greatest discomfort (http://www.umc.pitt.edu/india3/studv.htmr).

The authors conducted the study to find the most affected areas of discomfort and to identify the major risk factors contributing to playing related musculoskeletal discomforts among Indian Tabla players. Eighty-four professional Tabla players voluntarily participated in the study. The Nordic musculoskeletal questionnaire (NMQ) was administered to identify the susceptible/affected anatomical areas. A questionnaire consisting of eight items on a 10 point likert scale based was administered to identify the risk factors contributing to PRMDs. Results of the NMQ showed that the most commonly affected areas were the lower back (74.15%), right shoulder (67.06%) and neck (67.06%). The internal consistency of the questionnaire was determined by Cronbach's alpha which was found to be acceptable. From the factor analysis results, two factors emerged. Factor one was identified as posture related risk factors while factor two was identified as occupation related risk factors. The risk factors identified in the study were similar when compared to other instrumentalists.


Mishra, W., De, A., Gangopadhyay, S., & Chandra, A. M. (2013). A study of musculoskeletal discomforts and associated risks among indian percussion (tabla) players. Ergonomics SA, 25(2), 2-11. 

Employee health linked to performance of businesses

Employers believe there is a clear link between employee health and organisational performance, a study has suggested - yet nearly twothirds also believe the rising cost of providing healthcare benefits means that current levels of provision will be unsustainable in the future.

A poll by Jelf Employee Benefits found that 93% of employers believe positive health interventions and prevention can influence personal and organisational performance. Yet worryingly, nearly two-thirds (62%) did not believe current healthcare benefits were sustainable over the long term, primarily because of concerns over increasing cost. One of the biggest worries for employers was the cost of managing and providing benefits for an ageing and ailing workforce, rated as a concern by 57% of employers.

"It is important that employers get the right strategy in place to support the structure of their employee benefits by addressing the shortterm costs of premiums and the longer-term healthcare strategies to support both the business and the employee."

Employee health linked to performance of businesses. (2014). Occupational Health, 66(1), 5. 

Ultrasonography in myofascial neck pain

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The authors' aim with this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain.  The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography.  There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up.

The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.

Stecco A, Meneghini A, Stern R, Stecco C, Imamura M. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surgical and Radiologic Anatomy 2014 04;36(3):243-53. 

Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius

The authors' aim with this study was to investigate whether eutectic mixture of local anesthetics (EMLA) cream phonophoresis superior to conventional US over the trigger points (TPs) in terms of improvements of pain, range of motion and disability in myofascial pain syndrome (MPS).  Fifty patients (42 female, 8 male) diagnosed with MPS were included in the study. Patients were randomly assigned into two treatment groups including phonophoresis (PH) group (n = 25) and ultrasound (US) group (n = 25). PH group received EMLA cream phonophoresis (2.5 % lidocaine, 2.5 % prilocaine); US group received conventional ultrasound therapy over the all active TPs on trapezius muscle for 10 min a day for 15 sessions.

Outcome measures were performed before the treatment course and at the end of a 15-session course of treatment. Student T, Mann-Whitney U, chi-square and Wilcoxon tests were used for statistical analysis.  At the end of the therapy, there was statistically significant decrease in both PH group and US group in terms of number of trigger point (NTP) (p = 0.001, p = 0.029), pain intensity on movement (p = 0.001 vs. 0.002) and right/left cervical lateral ROMs (p = 0.001/p = 0.001, p = 0.009/p = 0.020) relative to baseline. The NTP decrease in PH group was significantly higher than that in US group (1.84 ± 1.46 vs. 0.72 ± 1.45; p = 0.01). Pain intensity at rest (p = 0.001) and NPDI scores (p = 0.001) were statistically improvement in only PH group.

EMLA cream phonophoresis is more effective than conventional ultrasound therapy in terms of pain and associated neck disability, and it seems the complementary treatment option for MPS.

Ustun N, Arslan F, Mansuroglu A, Inanoglu D, Yagiz AE, Guler H, et al. Efficacy of EMLA cream phonophoresis comparison with ultrasound therapy on myofascial pain syndrome of the trapezius: a single-blind, randomized clinical study. Rheumatol Int 2014 04;34(4):453-7.

CHELT therapy in the treatment of chronic insertional Achilles tendinopathy

The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy.  The authors' aim of this study was to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal Shock Waves Therapy (ESWT) in the treatment of Achilles tendinopathy.

In this prospective, clinical trial, 60 subjects affected by insertional Achilles tendinopathy were enrolled and randomized to CHELT (30 subjects) or to ESWT (30 subjects). In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy (wavelength of 1,084, 810 and 980 nm) added to a flow of cold air at -30 °C.

Both groups of participants performed stretching and eccentric exercises over a 2-month period. The visual analogue scale (VAS), the Ankle-Hindfoot Scale, and the Roles and Maudsley Score were measured before treatment (T0), and at end of the treatment session (T1) and 2 (T2) and 6 months (T3) after treatment during the follow-up examinations.

In both groups, the authors found a statistically significant improvement of the VAS at T1, T2 and T3. It also gave the patient a full functional recovery and greater satisfaction.

Notarnicola A, Maccagnano G, Tafuri S, Forcignanò MI, Panella A, Moretti B. CHELT therapy in the treatment of chronic insertional Achilles tendinopathy. Lasers in Medical Science 2014 05;29(3):1217-25.

Application of ultrasound-guided trigger point injection for myofascial trigger points in the subscapularis and pectoralis muscles to post-mastectomy patients

The authors objective was to investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients.This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. The authors performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method.Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline. In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.


Stecco A, Meneghini A, Stern R, Stecco C, Imamura M. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surgical and Radiologic Anatomy 2014 04;36(3):243-53. 

You scream I scream for Icecream

Its hot!!!
Round the clock.
Thermoregulation pushed to its limits now!

Let me share a fact - Our body have  physiological mechanisms more effective for combating the cold than the heat.