Playing-related problems in guitarists: Systematic review and meta-analysis

BackgroundPlaying-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 musicians ability to perform at their usual level. MethodsFollowing 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 Eggers test were used to assess potential publication bias. ResultsTwenty-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 (I{superscript 2}) 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. ConclusionsPRP 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.