Successful management of a professional viola player with a complex playing related musculoskeletal disorder

Abstract Objective: This paper presents the case of a 53-year-old female professional violist with chronic disabling neck and shoulder pain who had failed standard conservative management. A multimodal approach including Mulligan Concept manual therapy techniques resulted in a successful return to the workplace. Methods: Mobilization with Movements and Sustained Natural Apophyseal Glides as part of Mulligan Concept manual therapy approach, were the main treatment techniques utilized. Neuro-dynamic exercises, strengthening exercises, ergonomic interventions, alterations in playing load, and posture training were also implemented. Pain, range of motion and disability levels were monitored throughout treatment. Results: Significant improvements were seen in both neck and shoulder range of motion alongside considerable pain reduction in both regions. Clinically meaningful improvements were also noted in Neck Disability Index and Shoulder Pain and Disability Index scores. Discussion: Ergonomic intervention with postural correction and replacement with a lighter viola also contributed to patient recovery and return to the workplace. The Mulligan approach has proved to be effective in a wide variety of conditions. Still, it has not previously been considered in managing complex neck and upper limb disfunctions in string players. Conclusion: This paper highlights how an intensive manual therapy program had better results compared with standard conservative management. Multimodal intervention with occupational, ergonomic, and physiotherapy approaches was effective, leading to progressive re-integration into the workplace. Mulligan Concept manual therapy techniques should be considered in the management of playing related musculoskeletal disorders.