Impact of Manual Therapy on Instrumentalist Musicians With Playing-Related Musculoskeletal Disorders: A Systematic Review.

The randomized trials were small, at high risk of bias, and not suitable for pooling. In one trial, participants were randomized before eligibility was checked, so the final analysed group was smaller than the number randomized. In another trial, the group receiving manual therapy also received extra therapist contact, and the mouth-opening assessor was not blinded. Nonrandomized studies and case reports delivered manual therapy together with other treatments, so no single component can be credited. The case series provided almost no methodological detail or numerical results. The review only included instrumentalists, not singers or conductors. Heterogeneity of instruments and manual therapy approaches prevented separate analysis.

The investigators reported no financial or nonfinancial disclosures.

Do not read the reported pain reductions as proof that manual therapy works. The randomized trials were small and at high risk of bias, and several studies gave manual therapy together with exercises, ergonomic changes, splints, or other treatments.