Playing-related problems in guitarists: Systematic review and meta-analysis
Abstract
Background
Playing-related disorders (PRP) are among the most common occupational health problems affecting musicians; however, no prior meta-analysis has focused exclusively on guitarists. Existing reviews often group plucked-string players with bowed-string or other instrumentalists, overlooking the unique biomechanical demands of guitar performance. In addition, the widely used term PRMD (playing-related musculoskeletal disorders) frequently conflates clinically diagnosed conditions with self-reported symptoms, limiting clinical clarity. We propose a classification under the umbrella term playing-related problems (PRP) comprising: (1) PRMS—self-reported playing-related musculoskeletal symptoms; (2) PRMD—clinically diagnosed playing-related musculoskeletal disorders; and (3) PRND—clinically diagnosed playing-related neurological disorders. All are secondary to instrument playing and defined by the presence of a symptom (PRMS) or disorder (PRMD or PRND) that interferes with the musician’s ability to perform at their usual level.
Methods
Following PRISMA guidelines, we conducted a systematic review and meta-analysis of PRP prevalence in guitarists. Studies were classified by PRP subtype. Random-effects meta-analyses of proportions were performed, with subgroup analyses and mixed-effects meta-regressions to explore heterogeneity. Funnel plots and Egger’s test were used to assess potential publication bias.
Results
Twenty-two cross-sectional studies were included (n = 2,119). Pooled prevalence was 51.8% for any PRP, 64.5% for PRMS, 42.2% for PRMD, and 14.5% for PRND. In analyses restricted to musculoskeletal outcomes (PRMS + PRMD), specifying guitar type substantially reduced heterogeneity, with classical, bass, and flamenco guitarists showing the highest prevalences. Meta-regression identified PRP subtype, guitar type, and prevalence recall period as significant moderators; residual heterogeneity (I²) decreased from 90.7% to 0% in the most restricted model. No evidence of funnel-plot asymmetry was found for PRP. Qualitative synthesis suggested possible associations with daily practice time, warm-up habits, sex, and multi-instrumentalism, although findings were inconsistent.
Conclusions
PRP are highly prevalent among guitarists. Adopting the PRP– PRMS–PRMD–PRND framework may improve consistency in case definitions, facilitate valid prevalence comparisons, and support the development of instrument-specific preventive and rehabilitative strategies. Evidence from secondary outcomes suggests that incorporating warm-up routines and practice breaks may offer additional protection against these disorders.
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