Analysis of deep tissue hypersensitivity to pressure pain in professional pianists with insidious mechanical neck pain

Twenty-three active expert pianists, 6 males and 17 females (age: 36 ± 12 years) with insidious neck pain and 23 pianists, 9 males and 14 females (age: 38 ± 10 years) without neck pain the previous year were recruited. A numerical pain rate scale, Neck Disability Index, hand size and pressure pain thresholds (PPT) were assessed bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, the second metacarpal and the tibialis anterior muscle in a blinded design.The results showed that PPT levels were significantly decreased bilaterally over the second metacarpal and tibialis anterior muscles (P < 0.05), but not over C5-C6 zygapophyseal joint and deltoid muscle (P > 0.10), in pianists with neck pain as compared to healthy pianists. Pianists with neck pain had a smaller (P < 0.05) hand size (mean: 181.8 ± 11.8) as compared to pianists without neck pain (mean: 188. 6 ± 13.1). PPT over the tibialis anterior muscles was negatively correlated with the intensity of neck pain.Our findings revealed pressure pain hypersensitivity over distant non-symptomatic distant points but not over the symptomatic areas in pianists suffering from neck pain. In addition, pianists with neck pain also had smaller hand size than those without neck pain. Future studies are needed to further determine the relevance of these findings in the clinical course of neck pain as playing-related musculoskeletal disorder in professional pianists.Work-related musculoskeletal disorders (WMSD) cause pain, disability, and loss if employment for workers enrolled in several occupations [1] As playing of an instrument is an example of work, [2] playing-related musculoskeletal disorder (PRMD) is the proper term related to music-specific work-related musculoskeletal disorder. In fact, PRMD is defined as "...pain, weakness, lack of control, numbness, tingling, or other symptom that interfere with musicians' ability to play the instrument at the level he/she is accustomed to..." [3]PRMDs area a recognized proble