Theses and dissertations (Health Sciences)
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Item An epidemiological investigation into musculoskeletal pain in KwaZulu-Natal orchestral musicians(2024) Muhondo, Linley; Thandar, Yasmeen; Kell, ColetteBackground Non-communicable diseases pose a significant health threat worldwide. Of those diseases, musculoskeletal diseases are most responsible for a significant portion of occupational injuries in all job-sectors, including the musical sector. Musicians are prone to suffering from musculoskeletal injuries, more so than other populations. These injuries are termed playing-related musculoskeletal diseases (PRMDs). There are several risk factors associated with acquiring PRMDs including being of the female gender, age, and the type of instrument played. While most literature on musicians’ has been documented in countries abroad, there is a paucity of literature looking at the risk factors and attributes of African, and specifically South African, musicians. This is notable, as African musicians may have different characteristics to their international counterparts. The aim of this research was to examine orchestral musicians in Kwa Zulu-Natal from all sections of the orchestra to determine the prevalence of musculoskeletal injuries and the potential risk factors for these injuries, as well as their musculoskeletal injury profile. Methodology This study was a quantitative, cross-sectional descriptive study based on a self administered questionnaire. The questionnaire was piloted electronically and the necessary alterations were made. The final questionnaire was administered to members of 2 orchestras in Kwa Zulu-Natal, namely the Pietermaritzburg City Orchestra (25 members) and the Durban City Orchestra (30 members), making the targeted sample 55 musicians in total. All musicians who met the inclusion criteria were invited to participate in the study. The anonymously completed questionnaires were placed into marked boxes after completion to ensure musician anonymity. The data was analysed using IBM SPSS version 28. Association between specific risk factors and 12-month prevalence of MSK was assessed using Fisher’s exact 2-sided tests for categorical risk factors, and t-tests for continuous risk factors. A p-value of <0.05 was taken as statistical significance. Results Of the 55 musicians targeted, 30 of them participated, resulting in a response rate of 54.5%. Majority of the respondents were female (n=20). The data showed that the annual prevalence of PRMDs in the two orchestras was 46.7%. The point and one month prevalence were both 40%. The most injured section of the orchestra were the strings, followed by the woodwind section. The string section also reported the highest number of average affected areas in the orchestra (n=4). The most frequently injured anatomical sites of the body were the shoulders and wrists. There was no statistical significance found between the risk factors and injuries acquired. However, the results showed that females were injured more than the males (55%). Most of the respondents that reported musculoskeletal injury fell within the 18-24 age range and majority of the injured musicians fell in the overweight BMI body category. Most of the music teachers and the single career musicians in the study reported suffering from PRMDs and playing instruments for more than 16 hours a week on average. Conclusion The prevalence of playing-related musculoskeletal disorders among musicians was relatively high among the orchestral musicians in Kwa Zulu-Natal. Though not statistically significant, factors such as instrument played, age, and female gender were the factors that had the greatest influence on injury rates. The pain experienced was mild in nature and felt worse after playing their instruments. While the pain did not affect their activities of daily living, it did cause a few to change their way of playing or stop playing entirely for a period of time due to their pain. Majority of the players were aware of musician’s playing related health problems, and acknowledged that they are a problem, but none of them had received formal methods of education regarding them. The COVID-19 pandemic was a phenomenon that also affected the musicians in various ways.Item An analysis of the combined effects of swimming and overhead throwing on the shoulder complexes of male first division waterpolo players(2021-05-10) Gibb, Conor Beckett; Matkovich, GrantBackground Abstract Waterpolo is often compared to other sports, mainly swimming and overhead throwing sports. Swimming favours a posture of glenohumeral internal rotation and horizontal adduction. Overhead throwing sports can characteristically cause posterior shoulder immobility with a loss in glenohumeral internal rotation and horizontal adduction. Based on the fact that waterpolo players combine both swimming and overhead throwing whilst playing and training, it is the purpose of this study to investigate the sport-specific characteristics of the shoulder complexes of waterpolo players in an effort to determine how these unique characteristics may relate to the development of overuse injuries. Aim The aim of this study is to compare the dominant and non-dominant shoulder complexes of male water polo players in terms of posture, range of motion and sport- specific overuse injuries in order to develop an understanding of the combined effects of swimming and overhead throwing on the shoulders of water polo players. Methods The study used an observational based research design and consisted of 33 male waterpolo players currently competing in the Kwa-Zulu Natal mens 1st division waterpolo league. Participants underwent a shoulder digital posture examination as well as a shoulder-complex physical examination consisting of range of motion and orthopaedic testing which was then compared between the dominant and non- dominant shoulders. Participants were assessed for the presence of rotator cuff injury, glenoid labrum and LHBT injury, and anterior glenohumeral instability using the following physical tests: Empty can test, painful arc test, external rotation resistance, Hawkins-Kennedy test, Neer test, Yergassons test, Biceps Load test II, and the apprehension-relocation-surprise test. Glenohumeral range of motion was assessed using manual goniometry to measure passive internal and external rotation and horizontal adduction. Statistical analysis was performed using IBM SPSS version 27 statistical analysis software. Paired tests were used to compare outcomes from the dominant and non-dominant shoulders of the participants. To compare the posture measurements, as well as injuries present between the dominant and non-dominant shoulders, McNemar’s chi square tests were used. To compare the Range of motion measurements between the dominant and non-dominant shoulders, paired t-tests were used. A p value < 0.05 was considered statistically significant. Results Forward head posture with rounded shoulders was extremely common, with 73% of the participants in this study displaying a bilateral forward shoulder position ranging from moderate to severe, and 45% of participants displaying a bilateral forward head posture ranging from mild to severe. Glenohumeral internal and external rotation ROM measurements showed no difference between sides. There was a borderline significant difference (p=0.05) in the horizontal adduction measurements, with the non- dominant side showing greater values. The only injury test that yielded significant results was the empty can test for supraspinatus injury that had a higher prevalence for being positive on the dominant side. Conclusion The results of this study suggest that water polo players are prone to the development of a bilaterally equal forward head posture with rounded shoulders and are susceptible to similar mechanisms of bilateral overuse injury as swimmers. In addition, the dominant shoulders of these athletes are susceptible to damage caused by the repetitive, traumatic forces experienced by the posterior cuff musculature and posterior glenohumeral joint capsuloligamentous structures during the follow-through and deceleration phases of overhead throwing, resulting in an increased risk of supraspinatus-specific rotator cuff injury and a loss of glenohumeral horizontal adduction that potentially increases the risk of glenoid labrum and LHBT injury.