Injury
This page details physical injuries related to guitar playing. Most are related to muscles, the skeleton, and nerve compression, which can be avoided with care to warming up and good posture.
Disclaimer: I am not a medical doctor, nor was one consulted in writing this page. This page should not be considered expert medical advice.
Here is an extensive set of resources from University of Nebraska-Lincoln on this subject.
Contents
- 1 Guidelines to Avoid and Recover from Injuries
- 2 Repetitive Stress Disorder (RSD) or Repetitive Strain Injury (RSI)
- 3 Carpal Tunnel Syndrome (CTS)
- 4 Tendinitis and Tendinosis
- 5 Arthritis
- 6 Strained/Pulled Muscles
- 7 Saturday Night Wrist (Radial Nerve Compression)
- 8 Hearing Loss and Tinnitus
- 9 Bulging/Herniated Disks
Guidelines to Avoid and Recover from Injuries
- Always warm up!!!
- Stretch before and after playing, and during breaks.
- Warm-up with cardio and full-range motions of the fingers, wrists, elbows, and shoulders.
- Slowly play warm-up exercises that use all the muscle groups of the hands.
- Hold or sling your guitar properly to prevent unnecessary strain on the wrists, shoulders, or elbows.
- Use good technique and find comfort in holding the pick and gripping the neck, with the wrists as straight as possible.
- Try setting up your instrument for easier playing - lower action, thinner strings.
- Don't play beyond your ability - work up to difficulty over time.
- If you start to feel pain, do not try to "push through" it. Stop and stretch and do full range motions.
- The best thing for an injury is rest - don't mask the pain with medication and make the injury worse.
- Always use good form when lifting and carrying heavy equipment, avoiding rounding the lower back and over-exerting smaller muscle groups.
- Exercise to strengthen your muscles, both in terms of weight-lifting and practicing technique exercises.
- Take regular breaks from playing.
- Keep good posture when sitting and standing.
- Don't over-strain the wrists and hands - use only as much force as is needed. Feeling like you need to tighten up is a sign you are trying to play beyond your ability.
- See a doctor if pain is extreme and persists several days. Do not continue playing guitar if it is painful.
- Pay attention to other activities and ensure they follow the same guidelines in breaks and ergonomics. Computer use, playing video games, using certain hand tools, cooking, using a smartphone, and even smoking can all present additional stress on the hands.
Repetitive Stress Disorder (RSD) or Repetitive Strain Injury (RSI)
Repetitive Stress Disorder or Repetitive Strain Injury is an umbrella term vaguely related to a variety of conditions that seem to resolve around repetitive motions and/or vibrations. Most of these revolve around pain in the muscles and joints of the hands, wrists, elbows, shoulders, and neck. Unfortunately, there is not a lot of solid information in this field, other than saying to avoid lots of small, repetitive motions and prolonged exposure to vibrating machinery. Most seem to revolve around holding a joint outside of its resting position for enough time to cause a nerve compression, or otherwise irritating a sensitive nerve.
For guitar players, nearly all of guitar playing revolves around playing small, repetitive motions. The best advice is to warm-up, including stretches and improving blood flow. That will reduce the build-up of toxic byproducts in the muscles that can injure them and surrounding tissue, as well as reducing pressure on nerves. Listen to your body. If your joints start to ache, stop playing. Don't try to "push through" the pain. Do more stretches. As long as there is no associated pain, perform large, forceful, non-repetitive exercises on the affected muscles/joints - this will force blood into the muscles and clear out lingering toxins as well as stretching muscles and tendons. I'm talking about getting into a push-up position and lifting yourself by your finger-tips, as well as lifting weights - a few reps that really work the muscles and change the pace from the small, repetitive movements involved in playing guitar.
Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome is caused by compression of the median nerve in the wrist. There are numerous ways this can happen, but it is commonly associated with repetitive, low impact movements of the wrist and fingers, such as working on computers or playing guitar. It is also associated with holding one's wrist in a prolonged bent position.
The best way to combat CTS is by stretching the muscles and tendons surrounding the wrist as described in the warm-up page. You should also be sure to hold the guitar in a comfortable position where the wrists are straight as possible.
For more information, see Wikipedia.
Tendinitis and Tendinosis
Tendinitis is the inflammation of tendons, causing pain and joint stiffness. It is often caused by harsh exercise of the connected muscles, such as prolonged activities without rest. For guitarists, the main risk is playing for long periods without taking breaks, using poor technique which forces more stress on certain muscles, over-straining the hands/wrists/elbows rather than using as relaxed grip/movement as possible, and holding the guitar in a position that makes playing more difficult (like slinging the guitar too low).
Another suggestion is to build the muscles of the hands and arms (which typically requires building up the entire body's muscles). This makes the relative effort needed to pick the strings and fret the notes that much easier and less likely to injure one's tendons.
Tendinitis is typically treated with anti-inflammatory drugs, rest, and rehabilitating exercise. Repeated injury to the area, particularly while it is healing may lead to tendinosis. While the injury may feel better after several days, a full recovery can take months and activity that caused the initial injury should be avoided.
Tendinosis is not simply inflammation of tendon tissue but its breakdown at the cellular level, with the typical inflammation absent. As there is no inflammation as in tendinitis, anti-inflammatories are not effective treatment. It takes a long time for the body to repair tendon tissue - recovery requires lots of rest and very gradual rehabilitation.
Arthritis
Arthritis is the wearing down of the cartilage separating the bones in joints. This can be due to a variety of sources, mainly high-stress activities on joints, inflammation, and lack of nutrition/exercise. While not strongly caused by guitar playing (unless holding the guitar terribly incorrectly), it can make playing unbearable. The best way to combat this is to practice good ergonomics in all areas of life and avoiding activities that involve high joint stress. If you do find yourself with joint inflammation, be sure to combat it with anti-inflammatory drugs. And be sure to get enough fatty acids (fish oil) in your diet, or use supplements.
Strained/Pulled Muscles
A muscular strain (often called a pulled muscle) is a tear in the muscle tissue due to overstretching or extreme overuse. It is a relatively rare condition for guitar players; however, it can happen. If playing for long periods of time, doing technically-difficult types of playing, like large stretches, holding exotic chord shapes or large barre chords, playing long fast passages, and extreme picking. As always, you should work your way up to performing technically-difficult techniques or passages. Trying to jump right into things can over-exert your hands and injure them, especially if you fail to warm-up. Cardio to get blood flow to the muscles and stretching will reduce the likelihood that a difficult movement will result in a strain.
You should also watch out for your neck and shoulder muscles. If you play for long periods of time with bad posture and/or constantly holding your neck/shoulder muscles stiff in a certain position (usually for the picking hand), will weaken the muscles if held in place too long. Then even a slight jerk can cause an injury. Be sure to use good posture and hold your guitar in a place where you are as relaxed as possible, and take breaks when possible. Also, try to slowly use the muscle to force blood flow into it.
You should also watch out for strained muscles when carrying gear. Trying to lift something with your bicep that should really be done by your thighs and buttocks is a bad idea. Use the big muscles for the heaviest gear, using the smaller muscles only to stabilize them. Don't jerk your neck. Try to hold your shoulders back, not forwards.
Saturday Night Wrist (Radial Nerve Compression)
Dave Mustaine suffered this injury and basically had to relearn how to play guitar for several weeks before regaining his former technical ability. It is caused by a nerve compression in the armpit/inner upper arm, which basically causes paralysis of the wrist and finger muscles. The "Saturday Night" portion of the name is due to it being associated with getting drunk/wasted and passing out in a chair, with one's arm draped over the backrest.
Hearing Loss and Tinnitus
Exposure to loud sound will injure and kill sensitive hearing cells, leading to hearing loss. This can be gradual due to moderately loud sound over many years or immediate due to extremely loud sound. Once the cells are dead, they do not grow back - there is no treatment or recovery. Tinnitus is the perception of sound although none is present, and it often accompanies hearing loss.
Obviously these are serious maladies that all musicians should be very concerned about. The important thing is prevention. Whether practicing or gigging, or even just listening to music, you should use earplugs to protect your ears. This also goes for non-music related activities such as industrial jobs and shooting guns. If you do experience ringing after exposure to loud sound, be sure to let your ears rest before exposing them again - there is a chance the cells are injured and can recover.
Bulging/Herniated Disks
A bulging or herniated disk is a condition where the lining that surrounds a spinal disk (ring of cartilage that keeps the vertebrae from touching each other) is torn, allowing some of the disk's internal tissue to press against the spinal cord, causing debilitating pain. Often a severe injury cannot heal and requires surgery.
Guitarists face this injury mostly in the form of lifting heavy equipment with poor technique. Never round your lower back when performing heavy lifts - try to stick your butt out like a girl in a rap video. Bend your knees, and use your legs and butt muscles, not your lower back. While you are carrying heavy equipment, try to keep your back straight - don't hunch to one side. Try to hold things in front of you with both hands, not off to one hip or hanging by one arm.
This risk is increased by maintaining poor posture while playing or doing studio work. Set up your studio with ergonomic chairs and well-arranged equipment. You don't want the piece of gear you most constantly tweak or view on or just off the floor. Put it on your desk - get it at elbow height or higher. Be aware that sitting puts considerable pressure on the back, and be sure to get up and move around every hour or so.