Introduction

Posture, defined as the body’s alignment and positioning relative to gravity [1, 2], is fundamental to physical health, particularly for individuals engaged in prolonged or repetitive activities. Within this context, music students represent a vulnerable subgroup. Musical training requires extended practice in constrained, static, or asymmetrical positions, which increases the risk of postural imbalances and musculoskeletal disorders (MSDs) [3]. In recent years, growing empirical attention has been directed toward the relationship between musical performance and musculoskeletal health, highlighting not only biomechanical risks but also the impact on performance quality, psychological well-being, and long-term career sustainability [4].

Musicians, particularly students enrolled in intensive university training programs, often begin their musical education in adolescence or even childhood. This period overlaps with critical stages of physical development, rendering them more vulnerable to the long-term consequences of poor posture, including postural imbalances and chronic pain [2, 5]. Research indicates that more than 60% of conservatory students demonstrate postural imbalances, a prevalence significantly higher (p < 0.01) than that observed in general student populations [6]. The risk of inadequate posture is further elevated when playing asymmetrical instruments such as the violin or guitar [7]. These compounding effects underscore the urgent need for early preventive interventions in music students [2].

Biomechanically, posture is not a static concept but rather a dynamic equilibrium sustained by complex neuromuscular systems. Instrumental practice, which frequently requires fine motor control within fixed positions, can disrupt this balance [2, 8]. Even outside performance contexts, instrumentalists exhibit altered postural control compared with non-musicians, reflecting long-term neuromuscular adaptations to their training [8, 9]. Such dysfunction is evident in the weight-bearing asymmetries, increased postural sway, and compensatory strategies that place additional strain on specific musculo-skeletal regions.

The consequences of inadequate postural habits extend beyond musculoskeletal pain, affecting performance quality, musical expressivity, and even respiratory function [10]. Specific postural behaviours, particularly those involving head and torso alignment, have been shown to influence tone quality and dynamic control in cellists, illustrating the close relationship between physical alignment and acoustic outcomes [11]. Excessive tension or misalignment can provoke compensatory movements that restrict expressive nuance and compromise technical precision.

A significant proportion of performing arts students, particularly those studying music, experience playing-related musculoskeletal disorders (PRMDs) (p < 0.01) [12]. More than 86% of professional musicians report such disorders during their careers, with many music students already exhibiting early symptoms [13]. PRMDs most commonly affect the neck, shoulders, upper limbs, and back, with the severity often increasing as students advance through intensive training programs. Short-term e-learning interventions focused on posture have been shown to significantly reduce musculo-skeletal pain and improve postural habits among adolescent music students (p < 0.01) [14].

There is growing evidence supporting the integration of posture education into the early stages of music training [2]. Conservatory students who received instruction in posture, warm-up techniques, and injury prevention demonstrated significantly improved body awareness (p < 0.01) and reported a 78% reduction in injury rates over the course of one academic year [15]. Nevertheless, formal training in physical health, including posture, remains largely absent from music curriculums. Posture is still too often regarded as peripheral to performance technique rather than as an integral component of it.

Environmental and behavioural factors also play a critical role in shaping posture among performing arts students. Prolonged sedentary behaviour, excessive mobile device use, and high academic demands contribute to the development of spinal deformities such as scoliosis, kyphosis, and lordosis [2, 16]. Gender and instrument type further influence these risks; for instance, violinists and pianists display distinct postural asymmetries that require targeted ergonomic interventions [11]. Behavioural strategies, such as heightened awareness and regular stretching, have been shown to significantly reduce these risks (p < 0.01) [17]. Novel training approaches like mini-trampoline interventions have demonstrated promising results in reducing lower-limb asymmetries and enhancing neuromuscular coordination, which are critical for musicians who perform repetitive, asymmetric movements [18, 19].

Emerging technologies provide promising tools for assessing and enhancing posture. Postural monitoring systems such as force plates and three-dimensional motion capture are increasingly used to detect asymmetries and guide ergo-nomic adjustments [12]. These technologies generate objective data that supports personalised feedback and tailored training protocols. For example, the Posturo-Acoustic System integrates acoustic and proprioceptive cues to facilitate feed-forward posture control during training sessions [20].

Despite these advances, significant challenges remain. The absence of standardised protocols and validated measurement tools in musculoskeletal research on performing arts students continues to hinder cross-study comparisons and clinical translation [2, 13, 20]. Furthermore, the lack of long-term follow-up restricts the evaluation of sustained intervention effectiveness. Meaningful progress in this field will require interdisciplinary collaboration, drawing on expertise from physiotherapy, occupational health, and music pedagogy.

Recent developments in holistic preventive programs, such as the PRESTO trial, which combines biopsychosocial education with postural training, mark an important step toward evidence-based intervention strategies [21]. Embedding postural health within the core curriculum of music training, supported by validated interventions and tailored to the individual needs of students, remains essential [2, 14, 22]. As music institutions increasingly acknowledge the importance of musculoskeletal health, the integration of structured intervention programs of at least six weeks in duration has the potential to significantly enhance artistic performance (p < 0.01) and support long-term career sustainability. Building on this rationale, this study aimed at evaluating the effectiveness of a 6-week postural intervention program designed for undergraduate music students.

Subjects and methods

Results

The results of this study demonstrated statistically significant improvements in postural alignment among participants in the experimental group following the 6-week intervention program. Within-group comparisons using the Wilcoxon test revealed significant reductions in postural deviations across 4 of the 5 anatomical parameters. Specifically, head/neck alignment improved from pre-intervention means of 2.60 ± 0.84 to post-intervention means of 1.50 ± 0.52 [Z = 2.82, p < 0.01, r = 0.62, 95% CI (0.39, 1.81)]. Abdomen/pelvis alignment also showed significant improvement, decreasing from 2.80 ± 0.42 to 1.70 ± 0.68 [Z = 2.80, p < 0.01, r = 0.60, 95% CI (0.53, 1.67)]. The curvature of the spine exhibited the greatest change, improving from 2.30 ± 0.48 to 1.30 ± 0.48 (Z = 3.16, p < 0.01, r = 0.70, 95% CI [0.51, 1.49]). Shoulders/scapulae also showed significant decreases in postural deviation, with scores dropping from 2.00 ± 0.66 to 1.20 ± 0.42 [Z = 2.84, p < 0.01, r = 0.64, 95% CI (0.24, 1.36)] (Table 3, Figure 1).

Figure 1

Intragroup (within) and intergroup (between) comparisons

In contrast, no significant changes were observed in the shape of the chest, which decreased slightly from 1.90 ± 0.74 to 1.60 ± 0.70, but this was not statistically significant [Z = 1.74, p > 0.05, r = 0.38, 95% CI (−0.43, 1.03)]. Overall, the postural score in the experimental group improved markedly from means of 11.60 ± 1.72 pre-intervention to 7.30 ± 1.42 post-intervention [Z = 2.84, p < 0.01, r = 0.64, 95% CI (2.71, 5.89)], indicating shifts from ‘bad’ to ‘good’ posture according to the Klein and Thomas/Mayer tool.

No changes were detected within the control group, where all pre- and post-intervention scores remained identical across all 5 anatomical segments and in the overall postural score. For instance, head/neck alignment remained at 2.82 ± 0.40, and the overall postural score stayed constant at 11.66 ± 1.64, with no statistically significant differences (p > 0.05) observed in any domain.

Between-group comparisons using the Mann–Whitney U-test confirmed that there were no significant differences between the experimental and control groups at baseline (week 1) across any of the anatomical parameters, with p values all greater than 0.05 and effect sizes ranging from r = −0.02 to −0.30. For example, the baseline postural scores were 11.60 ± 1.72 for the experimental group and 11.66 ± 1.64 for the control group [Z = −0.12, p > 0.05, r = −0.02, 95% CI [−1.62, 1.50]) (Table 4, Figure 1).

However, significant between-group differences emerged at post-intervention (week 6) across all parameters except for the shape of the chest. Head/neck alignment differed significantly, with post-intervention scores of 1.50 ± 0.52 in the experimental group versus 2.82 ± 0.40 in the control group [Z = −3.16, p < 0.01, r = −0.80, 95% CI [−1.76, −0.88)]. Abdomen/pelvis alignment was significantly better in the experimental group (1.70 ± 0.68) than in the control group (2.50 ± 0.54) [Z = −2.12, p < 0.05, r = −0.54, 95% CI (−1.39, −0.21)]. Similarly, the curvature of the spine showed marked improvement in the intervention group compared to the control [1.30 ± 0.48 vs. 2.32 ± 0.52; Z = −2.86, p < 0.01, r = −0.72, 95% CI (−1.50, −0.54)], and the shoulders/scapulae were significantly better aligned [1.20 ± 0.42 vs. 2.16 ± 0.76; Z = −2.56, p < 0.05, r = −0.64, 95% CI (−1.57, −0.35)].

The total postural score at post-intervention further confirmed the efficacy of the intervention, with the experimental group showing significantly lower (i.e., better) scores (7.30 ± 1.42) than the control group (11.66 ± 1.64) [Z = −3.14, p < 0.01, r = −0.78, 95% CI (−5.92, −2.80)]. The only parameter where no between-group difference was observed post-intervention was the shape of the chest [1.60 ± 0.70 vs. 1.82 ± 0.84; Z = −0.66, p > 0.05, r = −0.20, 95% CI (−0.98, 0.54)].

Discussion

This study evaluated the effects of a 6-week postural intervention program on posture in music students. The results demonstrated that the participants in the experimental group (n = 10, 62.50%) experienced significant improvements (p < 0.01; p < 0.05) across 4 of 5 anatomical parameters: head/neck, abdomen/pelvis, curvature of the spine, and shoulders/scapulae. In contrast, the control group (n = 6, 37.50%) showed no meaningful changes. Beyond statistical significance, these findings also carry clinical relevance, indicating that the improvements were not only measurable but also practically meaningful. The reduction in overall postural scores from 11.60 to 7.30 reflects shifts from ‘bad’ to ‘good’ posture, an outcome highly relevant for music students at risk of musculoskeletal disorders. Improvements in the curvature of the spine and shoulder alignment, 2 of the most common areas of strain in musicians, are particularly important. The effect sizes (r = 0.60–0.70) confirm the magnitude of these benefits. Taken together, the intervention appears not only statistically robust but also clinically impactful, offering feasible and replicable approaches for enhancing postural health in music education contexts.

These results reinforce the importance of targeted, short-term interventions for music students, who are particularly susceptible to musculoskeletal disorders due to the demands of prolonged, asymmetrical instrumental practice [14, 22]. Curvature of the spine showed the most pronounced improvements (2.30 ± 0.48 to 1.30 ± 0.48; Z = 3.16, p < 0.01, r = 0.70), followed by the shoulders/scapulae (2.00 ± 0.66 to 1.20 ± 0.42; Z = 2.84, p < 0.01, r = 0.64). These outcomes suggest that the intervention enhanced not only static posture but also addressed dynamic musculoskeletal imbalances linked to compensatory strategies in instrumental performance. This aligns with earlier research highlighting the benefits of core-s trengthening and alignment training for musicians [2, 17, 42], as well as research showing acute improvements in leg stiffness and reactive power through mini-trampoline-based training, which could represent an adjunct or future extension to postural rehabilitation in musicians [19].

The absence of significant improvements in the control group strengthens the causal link between the intervention and the observed benefits. Without structured guidance, music students seldom adopt compensatory strategies that mitigate musculoskeletal strain [2, 5–7, 43].

The only anatomical parameter without significant change was the chest (p > 0.05). This may indicate that 6 weeks is insufficient to achieve measurable improvements in thoracic alignment, or that the program lacked sufficient thorax-specific exercises. This finding is consistent with the literature [2, 42, 44], which highlights the inherent difficulty of thoracic realignment due to structural rigidity and the slower adaptability of ribcage musculature [7]. The thoracic region, anchored by the ribcage, is inherently less responsive to short-term interventions compared to more mobile segments such as the cervical spine or shoulders. Improvements in chest posture often require longer interventions, typically exceeding eight weeks, particularly in populations like musicians who have long-established postural habits. While this program effectively addressed global alignment, it did not include dedicated thoracic components such as extension drills, intercostal flexibility exercises, or diaphragmatic breathing techniques. These elements are essential for meaningful thoracic change. Interventions that incorporate such components, including yoga-based breathing or the Alexander Technique, have been shown to improve thoracic alignment but usually require 8–12 weeks to yield significant results [45].

The structure of the intervention, 3×/week, combining awareness, mobility, and integrative corrective exercises, was a key factor in producing significant improvements within a short period (p < 0.01; p < 0.05). Warm-ups centred on diaphragmatic breathing improved kinaesthetic awareness and prepared the neuromuscular system for corrective drills. Exercises such as wall slides and chin tucks mirrored established rehabilitation protocols that have proven effective in both clinical and performing arts contexts [1, 11, 14, 15, 45].

The brief yet structured format of each 20-minute session supports growing evidence that micro-interventions are both feasible and impactful, especially in time-constrained academic environments [46]. Delivering the program in a group-based format likely provided additional benefits, including peer reinforcement, increased motivation, and higher adherence, factors reported in similar educational and rehabilitative interventions [9, 47].

The postural improvements observed here align with research showing that posture is not merely a matter of musculoskeletal health but also significantly influences technical and artistic performance. Head and neck alignment directly affect tonal quality and expressivity in string players [10,12], indicating that improved physical alignment can enhance both functional health and musical quality, which is a compelling implication for educators [11].

A notable feature of this study was the reliance on the Klein and Thomas/Mayer tool, which rates posture across 5 anatomical segments. While this tool provided a stand-ardised and replicable framework, it is limited to static assessment. Future research should integrate more nuanced approaches, including dynamic methods such as 3-dimensional motion capture or pressure sensors, which are increasingly used in posture research involving musicians [4, 11, 13, 22, 47]. Such methods would enable a more comprehensive understanding of the relationship between posture and performance-related movement.

Despite its contributions, this study has several limitations. The small sample size (n = 16), though reflective of the specific inclusion criteria, limits the generalisability and fell short of the 34 participants estimated by the a priori power analysis. Randomisation was not feasible due to academic scheduling, and while the groups were matched for age and study year, potential selection bias cannot be excluded. Another limitation is the absence of long-term follow-up. Although the immediate improvements observed after 6 weeks are promising, the sustainability of these gains remains unknown. Prior research suggests that postural habits, especially in populations with ingrained movement patterns such as musicians, often regress without long-term reinforcement strategies. E-learning platforms have been found effective in improving postural education outcomes in music students, demonstrating feasibility for scalable, remote interventions [48]. Longitudinal tracking (e.g., 3- or 6-month follow-up) would be needed to confirm durability. The homogeneity of the sample, all male undergraduate students aged 18–23, controlled for certain variables but restricted insight into gender- or age-specific responses. The exclusive use of male participants notably limits the generalisability of the findings, particularly as musculoskeletal disorder prevalence, postural compensations, and responsiveness to interventions may differ significantly by gender. The literature indicates gender differences in musculoskeletal disorders and postural compensation strategies in music students [47–50], underscoring the need for more diverse samples in future investigations. A more inclusive sample that incorporates female and non- binary participants would allow for broader applicability of the results across music education populations and could reveal gender-specific responses to postural interventions. Furthermore, the study did not include any functional performance outcomes, such as playing-related measures (e.g., tone quality, technical accuracy, or endurance). While postural improvements were objectively measured, the absence of performance-linked metrics limits the applied relevance of the findings for music educators and performers. Future research should incorporate both musculoskeletal and performance- based indicators to better evaluate the practical impact of such interventions.

Conclusions

This study found that a 6-week postural intervention program significantly improved postural health in music students (p < 0.01; p < 0.05). The participants in the experimental group (n = 10, 62.50%) who completed 20-minute sessions 3×/week showed marked improvements across 4 of 5 anatomical parameters, head/neck, abdomen/pelvis, curvature of the spine, and shoulders/scapulae, shifting from ‘bad’ to ‘good’ posture as measured by the Klein and Thomas/Mayer tool. The control group (n = 6, 37.50%) showed no change, confirming the effectiveness of the intervention.

These findings support the integration of posture-focused education into music curricula through brief, evidence-based sessions that fit within academic schedules. Preventive training should begin early, be tailored to instrument-specific demands, and may be enhanced by wearable or digital feedback technologies.

Limitations include the small, homogeneous sample, lack of randomisation, and absence of long-term follow-up. Future studies with larger, more diverse cohorts and longitudinal tracking are needed to test the sustainability of the effects.

Embedding structured posture programs into conservatory and university training could help prevent musculoskeletal disorders, improve body awareness, and support both performance quality and career longevity in musicians.