Effects of playing strumming and finger plucking

songs and the influence of four hours of rehearsal

on the activation patterning of the extensor carpi
radialis.
Master thesis part 1: protocol

Vanhaelen Hans
Van Roy Nand
2019-2020

Proff. Dr. Jean-Pierre Baeyens

Dr. Ben Serien
Physical education & Physiotherapy
TITLE OF PROJECT

Effects of playing strumming and finger plucking songs and the influence of four hours of
rehearsal on the activation patterning of the extensor carpi radialis.

OBJECTIVE OF THE STUDY

The main hypothesis of this observational study is to find a relationship between different
guitar playing styles and the effect this has on the muscle activity of the M. extensor
radialis.

INVESTIGATORS

Proff. Dr. Jean-Pierre Baeyens

Dr. Ben Serien

Vanhaelen Hans (student)

Van Roy Nand (student)

SPONSOR(S)

No sponsors.

DEPARTMENTS/LABORATORIES INVOLVED IN THE STUDY

Laboratory Biomechanics , Faculty Physical Education and Physiotherapy, Vrije

Universiteit Brussel

INTRODUCTION

Concerning the top football-, soccer-, golf-player, triathlete … We all know that they put
loads of work into their jobs/hobbies. Yet we often forget that similarly to these players,
musicians strain their body likewise during long practise time. Musicians can practise up
to 9h a day doing repetitive movements, strumming, plucking. High tension and force is
often found during playing time. (1)

Wilke et al. assessed that physical performance is more important than commonly
thought and it plays a decisive role for string players. Furthermore strength, endurance,
and flexibility in particular, have a vast influence on the musician's performance. To play
an instrument requires both physical and mental skills which lead all too often to
excessive demands. For a lot of string players muscle tenseness and fatigue play an
important role for the development of PRMD. Thus muscle training should focus on the
muscles needed for playing the instrument. It are most likely the high pressure, long
rehearsals, and the listeners’ high expectations that may lead to excessive demands on
the musician. Yet, it occurs that musicians suffering from musculoskeletal disorders
usually do not consult a doctor until they are already suffering from symptoms such as
muscular tension and physical overexertion. However, intervention should be used as a
form of prevention than as medical rehabilitation. (3)
Only several studies have tackled the influence of psychosocial factors on for
musculoskeletal problems among musicians. The results showed that some psychosocial
aspects of work, e.g. work content, high job demands, long hours at work, low
control/influence, lack of social support, were related to musculoskeletal pain,
nevertheless, the methods and results were inconsistent. (4) Hence, a lot of musicians
have musculoskeletal disorders and report a large amount of physical and psychological
complaints. And while music making can give some health protective effects as well as
positive effects on well-being, it’s necessary to have more health awareness and
promotion among advanced music students. So a better understanding of the processes
underpinning musicians’ wellbeing and QoL are needed, both at a physical and a
psychological level. (5)

The studies of Wiklund et al and woldendop et al (11;12;13) showed us that guitar

players have different activation patterns depending on numerous factors like playing
time, posture, technique. However, there’s a debate on the actual consequences of an
increase or decrease of muscle activity because of the conflicting outcomes. Studies
concerning other instruments like the piano also found changes in muscle activity during
playing. An important factor of the increase in muscle activity was a change of tempo
when eliciting louder tones. Moreover, the increases in both mean activity and co-
activation of the forearm muscles in proportion to loudness and tempo were the highest.
(6) This result may explain why the finger and wrist muscles have shown the largest
incidences of playing-related musculoskeletal disorders (PRMD’s) among pianists. (7,8).

In this protocol we will discuss the important characteristics we need to address to

construct our study. Thereby we will talk about the steps we have to take in detail,
followed by a chronological setup of the plans.

PROCEDURE

STUDY POPULATION

The study population consists of guitar players. Guitarists playing experience can range
from amateur to professional. Main language is Dutch, French or English. Both male and
female are allowed.

SELECTION CRITERIA

Table 1. consists of a description of the inclusion- and exclusion criteria.

table 1 – selection criteria for study participation

Inclusion exclusion

Guitarist (professional, Other musicians

amateur, male, female,
electric, acoustic, bass,
flamenco)

Guitarists must be fit and Pain or discomfort while

not having some sort of playing guitar
PRMD’s at the moment of
testing.

English, Dutch or French Other language

SUBJECT RECUITEMENT

Luca school of arts - Campus Lemmens - Muziek & Drama will ask their students to
participate in our study next year. Additionally, will we ask friends/connections to join as
well. A few questions will be asked to screen for inclusion and exclusion criteria prior to
meeting. A mail will be sent to the participant a month and a week before the testing to
remind them where and when they need to be. An informed consent will be signed by the
participants and the researchers on the day information is given.

INTERVENTIONS

GENERAL STUDY DESIGN

An observational study design will be used to assess the muscle activity of the guitarists.

TESTING PROCEDURE

Participants will undergo a onetime examination. During this day every participant will
play 1 fingerstyle song and 1 rhythmic song. EMG results will be collected during these 2
repertoires. We expect to have +- 5 participants one day and +-5 the next day. This so
we can give our participants the opportunity to pick the best date available for them.

On arrival participants will get the exact information with the informed consent form to
sign. The required social distance between the participants will be granted. Prior to the
examination a short warm up will be requested to the participants. After connecting the
electrodes the participant shall play the 2 songs selected from his individual repertoire to
start with (time point 0). The requirements for these songs are that they consist of one
rhythmic (strumming) and one finger plucking song, both must also be at least 3 minutes
long. The finger plucking song can be an etude or an arrangement from other songs as
long as the only technique used is the plucking of the strings by the fingers. After 2 hours
of continuous guitar practice (time point T1) the participants will be requested to undergo
the measurements (sEMG capturing the MVC) again and thus play the strumming and
finger plucking song again. (time point T2)

In appendix 1 can an overview of the two testing days be found.

OUTCOME

The primary outcome of our study are the EMG-results. These results give us an idea
about the amount electrical activity in the muscles which indicates how much muscle
activity there’s present. During this procedure we will be testing muscles of the forearm,
in particular the extensor carpi radialis.
Using the EMG-results we will assess if there is a difference in muscle activation between
the finger plucking and strumming song and we will also examine the difference between
no practise time, 2 hours and 4 hours of practise time.

EMG

A semi-wireless surface electromyography (sEMG) device (Biosignalplux, Lisbon,

Portugal) will be used to measure the activation pattern of the ECR. Considering that
guitarists are playing guitar in a new environment whilst being connected to a device,
they will be hindered as little as possible by the device's wires. The sEMG will have a
sampling rate of 1000Hz (gain: 1000; range: ±1.5mV; bandwidth: 25-500Hz; input
impedance: >100Gohm; CMRR: 100dB) to measure the activation. The exact location of
the electrodes will be placed as recommended from Barbero, Merletti & Rainoldi (2012).
We will be following this guideline to have the maximal voluntary contraction reference
(MVC).

The %MVC will be used to express the amplitude of the sEMG. For the analysis of the
amplitude there will be smoothened data following a 2nd- order Savitzky Golay filter
(frame length 15) used. Furthermore, the analysis of the frequency component of the
sEMG signal will be completed with a non-orthogonal wavelets scalogram encompassing
10 frequency bands following von Tscharner (table 2 (von Tscharner, 2009), because of
the non-stationary character of the sEMG data whilst playing music. All these procedured
will be programmed in a GUI Matlab interface in advance.

The setting where 6 electrodes are placed on the forearm showed the highest correlation
between external loads and the EMG activity. This was tested in a study from 2013 from
Takala et al. (9)
Another study concluded that features of neuromuscular control differ between
individuals with LE (lateral epicondylitis) and pain-free controls. This implies potential
central nervous system involvement and indicates that rehabilitation may be enhanced
by consideration of neuromuscular control in addition to other treatments. (10) However,
if this can be detected also prior to the pain the individuals experience from the LE is not
sure.

SELECTION COURSE

In order to select the participants, we will administer a survey to the recruits from
August till November. The questions in the survey will by any means be linked with the
inclusion and exclusion criteria. If the recruit answers the questions according to the
inclusion criteria he or she will be allowed to participate in the study.

STUDY ANALYSIS

STATISTICAL ANALYSIS

For the statistical analysis will IBM SPSS Statistics be used. With the aid of Shapiro Wilk
testing and Q-Q plotting will the normal distribution of the data sets checked by means.
A two-way repeated measurements ANOVA (2-way RM-ANOVA) with a factor ‘TYPE’ (with
‘Strumming’ and ‘fingerplucking’ dividing the songs) is going to be used as statistical
analysis. A factor for the 3 measurement moments will be set for time point 0, time point
1 and time point 2.

SAMPLE SIZE CALCULATION

G*power was used for conducting the sample size. No information was given in our
related articles about the effect size, power- and, α-level. Since we had no relevant
information was an effect size 0,5 (this value corresponds to a medium effect in
g*power) and α-level 0,05 selected. The power level of 0.80 is chosen because we accept
that chance of 20% that there is no effect in the sample size (Type II error).
This was all implemented in g*force whilst the statistical test was selected on: Anova:
repeated measures, within-between interaction.
The output parameters of G*power had given us a total sample size of 8 subjects to
include in our study to have an actual power of 97.6%.
With the possibility of dropouts in our mind (10-15%) will 9 subjects be used for this
study. (1)

PLANNING

Task Period

Recruitment of participants August- September - Oktober - November

Gathering data November - December - January - February -

March - April

Process data March - April

Write out results April - May

DELIVERABLES

Since forearm activity is linked to lateral epicondylitis, is having an idea about which
factors increase these muscle activities like: finger plucking, high rhythmic songs,
loudness, tempo, duration et cetera useful for creating the ideal prevention program.
Guitarists can be more mindfully about when taking a break after a high load session on
the muscles. Thus, the chance of having playing related musculoskeletal disorders could
diminish which would have a positive effect on the lives of amateur guitar players as well
as professional guitar players.
 REFERENCES

1. Laura M. Kok. Haitjema S, Groenewegen K.A. Rietveld A.

TheInfluenceofaSuddenIncreasein PlayingTimeonPlaying-Related
MusculoskeletalComplaintsinHigh-Level AmateurMusiciansinaLongitudinalCohort Study.
PloS ONE. September 2016
2. Patrick Mullie. 2019.Masterproef 1, module: Les samples size.
3. Wilke C, Priebus J, Biallas B, Froböse I.‘Motor activity as a way of preventing
musculoskeletal problems in string musicians’. Med Probl Perform Art. 2011 Mar.
4. Jacukowicz A. ‘Psychosocial work aspects, stress and musculoskeletal pain among
musicians. A systematic review in search of correlates and predictors of playing-related
pain’. Work. 2016 Jun 16.
5. Antonini Philippe R, Kosirnik C, Vuichoud N, Williamon A, von Roten FC. ‘Understanding
Wellbeing Among College Music Students and Amateur Musicians in Western
Switzerland’. Front Psychol. 2019 May 3.
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effect of loudness and tempo on upper-limb movements during repetitive piano
keystrokes’. Human Movement Science. February 2012.
7. Bragge, P., Bialocerkowski, A., & McMeeken, J. ‘A systematic review of prevalence and
risk factors associated with playing-related musculoskeletal disorders in pianists.
Occupational Medicine’. Jan 2006.
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of playing-related musculoskeletal disorders of the upper extremity and trunk among
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Musculoskeletal Disorders Among Icelandic Music Students Differences Between Students
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APPENDIX

APPENDIX 1. SCHEMATIC OVERVIEW OF THE PROTOCOL

Hour Activity

7h30 Preparing everything

8h First participant comes in:

-warming up
-T0 (first measurements are done)

8h20 2nd participant

9h40 3rd participant

10h 4th participant

10h 1st “” T1 (second measurements, after 2h

of rehearsal time)

10h20 2nd T1

10h40 3rd T1

11h 4th T1

12h 1st T2 (third time measurements after 4h

of rehearsal time)

12h20 2nd “” T2

12h40 3rd “” T2

13h 4th “” T2

13h30 Gathering all the data and preparing for

tomorrow

This will be done on 2 separate days. Times can fluctuate so that every participant has
4hours the time the help us with the study.