Beyond overload: A biofeedback-based assessment linking postural awareness and sensorimotor control to musculoskeletal health in orchestral musicians

Professional musicians often develop playing-related musculoskeletal disorders (PRMDs) from prolonged static postures, repetitive movements, and chronic biomechanical overload. However, the link between instrumental practice, postural awareness, and sensorimotor control lacks objective, multidimensional investigation. This preliminary study explored these relationships in 28 professional orchestral musicians divided into wind, bowed, and string instrument groups. Participants completed a structured questionnaire investigating musical practice habits, musculoskeletal symptoms, and postural awareness through the validated Postural Awareness Scale (PAS). Functional assessment included flexibility and core endurance tests, while sensorimotor control was quantitatively assessed, for the first time in this target, using the Libra biofeedback-based proprioceptive system. Musculoskeletal pain and discomfort were found to be highly prevalent across all groups, mainly involving the shoulder and spinal anatomical districts. Bowed instrument players showed significantly lower PAS scores than the other groups, suggesting reduced postural awareness associated with sustained asymmetric playing positions. Libra assessments revealed generally poor postural stability, particularly during eyes-closed conditions, indicating increased reliance on visual input for balance regulation and possible proprioceptive deficits. Functional tests also highlighted suboptimal core endurance and flexibility throughout the sample. Overall, findings support the hypothesis that PRMDs result from a complex interaction between cumulative biomechanical overload, reduced postural awareness, and altered sensorimotor control. In this context, specialized kinesiologists might play a pivotal role in prevention and management through tailored proprioceptive training, postural re-education, and adapted conditioning programs integrated into routine musical practice, thereby promoting long-term health, functional efficiency, and performance sustainability in this target population.