Overuse Injuries, Overtraining, and Burnout in Young Athletes.

Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.

[Stress injuries of bone in children and adolescents]. / Stressverletzungen des Knochens bei Kindern und Jugendlichen.

Stress injuries of bone in childhood and adolescence are the result of an imbalance between physical stress on the growing musculoskeletal system and its intrinsic resilience. Children who are very active in sports are particularly affected. The classical stress injuries mainly occur in the area of the lower leg, the metatarsus and the lower lumbar spine due to the disproportionate load on healthy bone; however, overuse syndromes can also occur in the area of the growth plates and possibly lead to growth plate disorders. The anamnesis usually shows stress-related pain that has existed for a long time without trauma. As part of the differential diagnosis, a stress injury must first be included in the considerations due to it being a rare entity. An X­ray examination can show the first signs of a stress reaction. In the event of a conspicuous periosteal reaction, a malignant event must also be considered. As a rule, the MRI examination is then groundbreaking and in some rare cases biopsies have to be considered. The treatment of stress injuries is usually conservative. Recurrences should be counteracted by exercise control.

Constructing a Diagnosis Model and Visualizing the Risk Relationship between Biomarkers and Overuse Injuries in Well-trained Wrestlers.

This study aimed to investigate the association between biomarkers and overuse injuries in well-trained wrestlers. Seventy-six well-trained wrestlers on a national team completed two blood sample collections, two clinical overuse injuries diagnoses, and a questionnaire survey at a 2-week interval. Multivariate logistic regression analysis and receiver operating characteristic curve were used to screen for related factors and construct the prediction probability model of overuse injuries. Using a restricted cubic spline further clarifies the relationship between biomarker levels and the risk of overuse injuries. Creatine kinase (CK), cortisol, rheumatoid factor, testosterone in men, and C-reactive protein (CRP) levels in the overuse injuries group were significantly different compared to those in the non-overuse injuries group. The diagnostic efficiency of the prediction probability model was more valuable than any single variable (area under the curve=0.96, Specificity=0.91, Sensitivity=0.89, high accuracy). A J-shaped relationship was noted between biomarkers (cortisol, CRP, and CK) and the risk of overuse injuries (cutoff point: 17.95 µg·dL-1, 4.72 mg·L-1, and 344 U·L-1; p for nonlinearity:<0.001, 0.025, and 0.043, respectively). In conclusion, a predictive model based on biomarkers (cortisol, CRP, and CK) predicted the overuse injuries risk of well-trained wrestlers. High levels of these three biomarkers were associated with a higher risk of overuse injuries, and a J-shaped relationship was observed between them.

Childhood and Adolescent Sports-Related Overuse Injuries.

Childhood and adolescent sports participation is encouraged because of health and wellness benefits. However, the increasing number of young athletes means there is the potential for more sports-related overuse injuries. Most youth sports injuries occur at the bone's relatively weaker growth centers: the epiphyses and apophyses. Little league shoulder and elbow are common overuse injuries in baseball and other single-arm dominant sports. Little league shoulder is a Salter-Harris fracture of the proximal humerus, and little league elbow is an apophysitis of the medial epicondyle. In both injuries, the athlete often reports decreased throwing velocity or accuracy. The physician should emphasize the Major League Baseball Pitch Smart guidelines when counseling on rehabilitation and prevention. Gymnast's wrist is a distal radial epiphysis injury in which the patient reports chronic wrist pain. Gymnast's wrist should be managed conservatively with immobilization. Spondylolysis is an important cause of overuse back pain in young athletes and can progress to spondylolisthesis. Patellofemoral pain syndrome presents with anterior knee pain, often made worse with running or descending stairs and improved with physical therapy. Osgood-Schlatter disease and Sinding-Larsen-Johansson disease are forms of knee apophysitis. Calcaneal apophysitis is a common cause of heel pain in young athletes and can be diagnosed clinically with the calcaneal squeeze test. Calcaneal apophysitis is treated conservatively, with good evidence for the use of heel cups and physical therapy.

Impact of Gender and Feature Set on Machine-Learning-Based Prediction of Lower-Limb Overuse Injuries Using a Single Trunk-Mounted Accelerometer.

Even though practicing sports has great health benefits, it also entails a risk of developing overuse injuries, which can elicit a negative impact on physical, mental, and financial health. Being able to predict the risk of an overuse injury arising is of widespread interest because this may play a vital role in preventing its occurrence. In this paper, we present a machine learning model trained to predict the occurrence of a lower-limb overuse injury (LLOI). This model was trained and evaluated using data from a three-dimensional accelerometer on the lower back, collected during a Cooper test performed by 161 first-year undergraduate students of a movement science program. In this study, gender-specific models performed better than mixed-gender models. The estimated area under the receiving operating characteristic curve of the best-performing male- and female-specific models, trained according to the presented approach, was, respectively, 0.615 and 0.645. In addition, the best-performing models were achieved by combining statistical and sports-specific features. Overall, the results demonstrated that a machine learning injury prediction model is a promising, yet challenging approach.

[Treatment and diagnosis of overuse injury in the Achilles tendon]. / ABC om Kronisk hälsene­smärta ­ diagnos och behandling.

Achilles tendinopathy is a common overuse injury, especially among runners. It should be divided into midportion Achilles tendinopathy and insertional Achilles tendinopathy, as the treatments are different. Achilles tendinopathy is a clinical diagnosis, which includes a combination of pain, swelling and stiffness. If pain is located 2-6 cm above the insertion to the calcaneus, it is considered a midportion tendinopathy. Pain located more distally, close to the insertion, is defined as insertional tendinopathy. Both midportion and insertional Achilles tendinopathies are primarily treated with physiotherapy during three to six months. Exercise has the highest level of evidence and is more successful in midportion Achilles tendinopathy. Insertional tendinopathy more often requires surgical treatment, with removal of bony exostosis and chronically inflamed bursa.

A Practical Approach to the Evaluation of a Cyclist with Overuse Injury.

Cycling has grown in popularity over the past 20 to 30 years, serving as transportation, fitness, and sport. Cycling is unique for several reasons: it is a non-weight-bearing sport, nearly all of the motion is in the sagittal plane, and it is one of the only sports where an individual remains attached to a machine for a long duration. As such, the cycling athlete has unique needs compared with other endurance-based athletes. The complex biomechanical interaction of bicycle and rider requires a systematic process for assessment, which provides the framework for understanding, evaluating, and treating overuse injury in cyclists.

Cervical Spine, Upper Extremity Neuropathies, and Overuse Injuries in Cyclists.

Upper extremity nerve injuries in cyclists include carpal tunnel syndrome and ulnar neuropathy at the wrist. Electromyography and nerve conduction studies aid in the diagnosis of neuropathies. Diagnostic ultrasonography or MRI can also be helpful for evaluation. Overuse injuries in the upper extremity includes biker's elbow, or a tendinopathy of the common flexor or extensor tendons, which is more common in mountain biking. Neck pain is also a common issue for cyclists. Treatment of these conditions varies from conservative management to surgical options, but a bicycle fit assessment is recommended for any ongoing symptoms.

Previous and current injury and not training and competition factors were associated with future injury prevalence across a season in adolescent elite athletes.

Introduction: Understanding the factors associated with different injury prevalence profiles in young athletes is needed for the design of tailored injury prevention programs.Objectives: To explore the factors associated with different levels of injury prevalence in adolescent elite athletes.Methods: A total of 389 adolescent elite athletes (age range 15-19 years), participating in 16 different sports, were monitored repeatedly over 52 weeks using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. The athletes were grouped in three injury categories: (1) "Low injury"; (2) "Medium injury"; and (3) "High injury," based on the proportion of times the athletes reported substantial injury over the season.Results: Logistic and multinomial regression identified substantial injury the first week (odds ratio (OR) 53.9, 95% confidence interval (CI) 7.1-407.7), and an interaction between sex and previous injury (OR 3.9, 95% CI 1.1-12.4) as significant factors that increased the odds of belonging in the High injury compared to the Low injury group. A female athlete with a previous injury the last 12 months had a higher probability of belonging in the High injury group compared to a male athlete.No significant (p > .05) difference in training, sleep, or competition exposure was found across the injury category.Conclusion: Current substantial injury and previous injury were strongly associated with the most injured athletes. Coaches and medical team should consider limiting the injured athlete competition exposure.

The Use of a Single Trunk-Mounted Accelerometer to Detect Changes in Center of Mass Motion Linked to Lower-Leg Overuse Injuries: A Prospective Study.

Movement dynamics during running was previously characterized using a trunk-mounted accelerometer, and were associated with a history of overuse injuries. However, it remains unknown if these measures are also linked to the development of overuse injuries. The aim of this study was therefore to determine how movement dynamics alter in response to fatigue, and the possible link with developing lower-leg overuse injuries during a six-month follow-up period. Two hundred and eight movement science university students completed a 12-min all-out run while wearing a trunk-mounted accelerometer. Dynamic stability, dynamic loading and spatiotemporal measures were extracted from the accelerometer. Participants sustaining an injury within the 6-month period demonstrated significantly higher RMS ratio values in the vertical direction and lower RMS ratio values in the anteroposterior direction, and lower impact acceleration values in the anteroposterior direction in an unfatigued state compared to the uninjured group. They also demonstrated an increase in dynamic loading in the horizontal plane during the run. In addition, with running fatigue both groups exhibited changes in dynamic stability and loading measures. These results show the potential of using a single trunk-mounted accelerometer to detect changes in movement dynamics that are linked to lower-leg overuse injuries.

Relationship of footwear comfort, selected size, and lower leg overuse injuries among infantry soldiers.

BACKGROUND: High rates of musculoskeletal injuries such as plantar fasciitis and stress fractures have been observed among physically active military personnel. During service time, infantry soldiers use issued boots daily that should fit well and provide comfort to prevent injuries and decrease lower extremity pain effectively. The association of military boot comfort with overuse injuries remains unclear. This study investigates the relationship between the chosen military boot size, perceived boot comfort and lower leg overuse injury. METHODS: During the cross-sectional study, 227 (males, n = 213; females, n = 14) active-duty infantry soldiers at a mean age of 29.5 years old, and with an average service time of 7.2 years were assessed for a history of overuse injury, footprint length, appropriate shoe size, and footwear comfort. Males with a history of overuse injury (n = 32) and non-injured age-matched controls (n = 34) were selected for detailed testing and establishing the possible relationship between footwear comfort and lower leg overuse injury. RESULTS: No relationship was found between footwear comfort and a history of lower leg overuse injury. N = 38 (57.6%) of study subjects were wearing an inappropriate shoe size daily. Inappropriate shoe size usage affected footwear comfort ratings significantly. CONCLUSIONS: Study results showed that improper boot size was significantly related to comfort ratings but was not associated with a history of lower leg overuse injury.

Lesiones deportivas por sobreuso en niños y adolescentes / Sports injuries due to overuse in children and adolescents

La actividad deportiva en niños y adolescentes ha presentado un aumento sostenido en nuestro país en los últimos años; esto ha generado un aumento de las lesiones deportivas por sobreuso. Éstas pueden tener múltiples orígenes, dependiendo de la edad y la actividad del paciente. La mayoría son de manejo conservador, sin embargo, algunas requieren manejo quirúrgico. Lo más importante es la prevención de estas lesiones mediante el uso de equipo apropiado, regulando la intensidad y tipo de entrenamiento y tratando precozmente las lesiones.

Sports activity in children and adolescents has presented a sustained increase in our country in recent years, generating an increase in sports-related overuse injuries. These injuries vary in nature, depending on the patient ́s age and level of training. Most are conservatively managed; although, some will require surgical treatment. It is important, however, to try to prevent these injuries by using appropriate equipment, regulating the intensity and type of training and treating injuries early

Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques.

Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.

A Neurophysiological Pattern as a Precursor of Work-Related Musculoskeletal Disorders Using EEG Combined with EMG.

We aimed to determine the neurophysiological pattern that is associated with the development of musculoskeletal pain that is induced by biomechanical constraints. Twelve (12) young healthy volunteers (two females) performed two experimental realistic manual tasks for 30 min each: (1) with the high risk of musculoskeletal pain development and (2) with low risk for pain development. During the tasks, synchronized electroencephalographic (EEG) and electromyography (EMG) signals data were collected, as well as pain scores. Subsequently, two main variables were computed from neurophysiological signals: (1) cortical inhibition as Task-Related Power Increase (TRPI) in beta EEG frequency band (ß.TRPI) and (2) muscle variability as Coefficient of Variation (CoV) from EMG signals. A strong effect size was observed for pain measurement under the high risk condition during the last 5 min of the task execution; with muscle fatigue, because the CoV has decreased below 18%. An increase in cortical inhibition (ß.TRPI >50%) was observed after the 5th min of the task in both experimental conditions. These results suggest the following neurophysiological pattern-ß.TRPI ≥ 50% and CoV ≤ 18%-as a possible indicator to monitor the development of musculoskeletal pain in the shoulder in the context of repeated and prolonged exposure to manual tasks.

Distúrbios osteomusculares e dor em profissionais de enfermagem que atuam em centro de material e esterilização / Musculoskeletal disorders and pain in nursing professionals working in a material and sterilization center

Introdução: O estudo teve como objeto os Distúrbios Osteomusculares (DOM) e dor em profissionais de enfermagem que atuavam em Centro de Material e Esterilização (CME). Objetivo geral: Analisar as implicações do trabalho do CME na ocorrência de distúrbios osteomusculares e dor nos profissionais de enfermagem que atuavam neste setor. Objetivos específicos: Identificar a presença de distúrbios osteomusculares em profissionais de enfermagem que atuavam em CME; Identificar a presença, localização e intensidade da dor em profissionais de enfermagem que atuavam em CME; Analisar a associação das características sociodemográficas, laborais e de saúde com a presença de distúrbios osteomusculares; Analisar a presença de dor com distúrbios osteomusculares nos profissionais de enfermagem que atuavam em CME; e Discutir os distúrbios osteomusculares no profissional de enfermagem na perspectiva dos DORT no trabalho em CME. Metodologia: Tratou-se de um estudo transversal, do tipo descritivo exploratório, com abordagem quantitativa. Os locais de estudo foram os Centros de Material e Esterilização de um Centro de Alta complexidade em Oncologia (CACON) da cidade do Rio de Janeiro. A população do estudo foi composta por 36 profissionais de enfermagem. Foi aplicado um questionário para obtenção do perfil sociodemográfico, laboral, de hábitos de vida, saúde e ambiente de trabalho e o diagrama de áreas dolorosas de Corlett e Manenica (1980). Foi realizada análise estatística com auxílio dos softwares Statistical Package for the Social Sciences (SPSS) versão 21.0, Programa R versão 2.7.1, Microsoft Excel ® e o nível de significância utilizado foi de 5%. Resultados: observou-se predomínio do sexo feminino (87,5%), da raça não branca (54,2%), que vivia sem companheiro (62,5%), com nível de escolaridade do ensino médio (41,7%), com filhos (70,8%). A prevalência de DOM foi em 66,7% dos participantes. Quando associada às características do trabalho com os distúrbios osteomusculares, observou-se que 91,7% dos profissionais eram auxiliares/técnicos de enfermagem, que trabalhavam no turno diurno (70,8%), plantonistas de 12 horas (62,5%), utilizavam transporte público até o trabalho (77,3%), gastavam em média 69,6 minutos para chegarem ao trabalho e com tempo de atuação no CME entre 1 e 5 anos (62,5%). Destacou-se que 79,2% dos participantes relataram que ficavam "sempre" na posição de pé para realizar as atividades no CME. Os que pegavam peso representaram 54,2% dos participantes, os que consideraram o trabalho "repetitivo" foram 87,5% dos participantes e os que referiram que o trabalho realizado era "cansativo" representaram 95,8% dos participantes. Os participantes que disseram que "não consideravam o ambiente de trabalho com condições ergonômicas adequadas para a realização das atividades" representaram 91,7%. Com relação à queixa dolorosa, 75,0% referiram como "presente" na avaliação inicial e, na avaliação final, foram 95,8%. Quanto à intensidade, 50,0% relataram dor leve na avaliação inicial e 35,3%, de dor aguda/muito aguda na avaliação final. Quanto à localização da dor, a região da coluna lombar correspondeu a 50% dos participantes que referiram dor nesta região na avaliação inicial. Na avaliação final, houve presença de dor nas regiões da coluna, juntamente com região da perna/pé, e corresponderam igualmente a 83,3% dos participantes, seguida pela região do pescoço, com 70,8%. Conclusão: Concluiu-se que existia forte relação entre o trabalho realizado no CME, acometimento por DOM e presença de dor em várias regiões do corpo, sendo necessário um olhar voltado à prevenção de exposição ocupacional de ordem osteomuscular. Ações educativas e a ginástica laboral podem ser adotadas, assim como ações de controle gerenciais para minimizar a sobrecarga física causada pelo retrabalho e, assim, prevenir o acometimento por DORT a longo prazo, pela especificidade do trabalho realizado neste setor.

Introduction: The study had as its object the Musculoskeletal Disorders (MSDs) in nursing professionals who worked in the Central Sterile Supply Departments (CSSD) and as a research question, whether there is an association between sociodemographic, occupational, health, and lifestyle variables and the presence of MSDs in professionals working in CSSD? Objectives: To analyze the implications of CSSD work on the occurrence of MSDs and pain in nursing professionals working in CSSD; and the specific objectives: Identify the presence of MSDs in nursing professionals working in CSSD; Identify the presence, location and intensity of pain in nursing professionals working in CSSD; To analyze the association of sociodemographic, work and health characteristics with the presence of MSDs. To analyze the the presence of pain with MSDs, in nursing professionals working in CSSD; Discuss MSDs in nursing professionals from the perspective of Work-related musculoskeletal disorders (WMSDs) at work in CSSD. Methodology: This was a cross-sectional, descriptive exploratory study with a quantitative approach. The study site was the Central Sterile Supply Departments of a High Complexity Oncology Center (HCOC), in the city of Rio de Janeiro. The study population consisted of 36 nursing professionals. A questionnaire was applied to obtain the sociodemographic, work, lifestyle, health and work environment profiles and the diagram of painful areas by corlett and manenica (1980). Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21.0, Program R version 2.7.1, Microsoft Excel ® and the significance level used was 5%. Results: there was a predominance of females (87.5%), non-white (54.2%), living without a partner (62.5%), with high school education level (41.7%), with children (70.8%). The prevalence of MSDs was 66.7% of the participants. When the characteristics of work were associated MSDs, it was observed that 91.7% of the professionals were nursing assistants/technicians, working the day shift (70.8%), 12-hour on-duty (62.5%), used public transport to work (77.3%), spent an average of 69.6 minutes to get to work and had worked at the CSSD between 1 and 5 years (62.5%). It was highlighted that 79.2% of the participants reported that they were "always" in the standing position to carry out activities at the CSSD; Those who picked up weight represented 54.2% of the participants, those who considered the work "repetitive" were 87.5% of the participants and those who reported that the work performed was "tiring" represented 95.8% of the participants; Participants who said that "they did not consider the work environment to be ergonomically suitable for carrying out activities" accounted for 91.7%. Regarding the pain complaint, 75.0% would refer as "present" in the initial assessment and in the final assessment, 95.8%. As for intensity, 50.0% reported mild pain in the initial assessment and 35.3% acute/very acute pain in the final assessment. As for the location of pain, the lumbar spine region corresponded to 50% of the participants who reported pain in this region in the initial assessment. In the final evaluation, there was the presence of pain in the regions of the lumbar spine again, together with the leg/foot region and they corresponded equally to 83.3% of the participants, followed by the neck region with 70.8%. Conclusion: It was concluded that there is a strong relationship between the work carried out at the CSSD, involvement by MSDs and the presence of pain in various regions of the body, requiring a look towards the prevention of occupational exposure of a musculoskeletal order. Educational actions and labor gymnastics can be adopted, as well as management control actions to minimize the physical overload caused by rework and thus prevent the onset of MSDs in the long term, due to the specificity of the work carried out in this sector.

Overuse Knee Pain in the Pediatric and Adolescent Athlete.

Overuse knee pain is common in young athletes. There are many potential overuse injuries which present with insidious onset of pain that can challenge sports medicine providers, including Osgood-Schlatter's disease, patellofemoral syndrome, osteochondritis dissecans, and stress fractures. The differential diagnosis of insidious onset knee pain also includes malignancies, infections, and rheumatologic issues. A thorough history and physical examination can guide the treating provider in making a diagnosis and appropriate treatment plan. Although not always necessary, imaging is often helpful in overuse knee pain, and laboratory workup may be necessary. Conservative treatment is often the first recommendation in the management of overuse knee pain in young athletes, and this may include activity modification, ice, anti-inflammatory medications, bracing, and physical therapy. This review summarizes common overuse knee injuries seen in pediatric and adolescent athletes.

Training Load and Its Role in Injury Prevention, Part 2: Conceptual and Methodologic Pitfalls.

In part 2 of this clinical commentary, we highlight the conceptual and methodologic pitfalls evident in current training-load-injury research. These limitations make these studies unsuitable for determining how to use new metrics such as acute workload, chronic workload, and their ratio for reducing injury risk. The main overarching concerns are the lack of a conceptual framework and reference models that do not allow for appropriate interpretation of the results to define a causal structure. The lack of any conceptual framework also gives investigators too many degrees of freedom, which can dramatically increase the risk of false discoveries and confirmation bias by forcing the interpretation of results toward common beliefs and accepted training principles. Specifically, we underline methodologic concerns relating to (1) measure of exposures, (2) pitfalls of using ratios, (3) training-load measures, (4) time windows, (5) discretization and reference category, (6) injury definitions, (7) unclear analyses, (8) sample size and generalizability, (9) missing data, and (10) standards and quality of reporting. Given the pitfalls of previous studies, we need to return to our practices before this research influx began, when practitioners relied on traditional training principles (eg, overload progression) and adjusted training loads based on athletes' responses. Training-load measures cannot tell us whether the variations are increasing or decreasing the injury risk; we recommend that practitioners still rely on their expert knowledge and experience.

Overuse syndrome of the hand and wrist in musicians: a systematic review.

We systematically searched medical publication databases for articles in English on upper extremity overuse syndrome in musicians. We focused on non-specific pain disorders, including diagnostic definitions, epidemiology, pathophysiology, risk factors, symptoms, treatment, and prevention. We included 42 out of 156 identified articles. The point prevalence of playing-related musculoskeletal disorders ranges from 37% to 47% in musicians with the hand and wrist among the most commonly affected areas, and the lifetime prevalence is reported as high as 89%. Leading symptoms are pain, weakness, stiffness, and loss of control. Intense repetitive use during practice, or before an audition or concert, recent changes in conductors or teachers, psychological stress, the effort of holding a weighty instrument, wrong technique, and joint laxity have all been identified as risk factors. The need for prevention is highlighted. Today's therapy is mostly based on individual rehabilitation programmes rather than on long-term rest. However, treatment remains predominantly based on beliefs rather than on evidence. The entire subject needs intensive future research.