This page is a collection of notes and tips on the subject of pain while playing guitar, pain and injury issues related to playing, RSI, etc. 

These notes are phrased for the more intermediate or advanced level guitarist, as it's common for more serious guitarists to run into issues with pain. If you are just playing casually (for example, less than 1 hour per day) you will likely not run into any significant pain issues just from playing guitar.

I get asked about these subjects so often that I thought it would be useful to just have one link to send to people that contains the general advice I would give to anybody without knowing the details about their particular situation.


Unfortunately, I have had a lot of experience dealing with pain issues related to guitar playing. I often get asked about these subjects as they are, sadly, very common issues for guitarists that are putting in a lot of hours on the instrument.

While I still experience a fair amount of discomfort, and some pain, over the twelve years since the onset of my symptoms I have learned how to manage myself and my symptoms enough so that they do not significantly interfere with my life and my guitar playing. There have been several periods of time when I was unable to play guitar without experiencing a lot of pain. In those times I was very anxious that I would not be able to play normally again. Even though I still have issues, I'm very grateful to have recovered as much as I have!

I have worked with several different doctors, physical therapists, and did year or so of weekly sessions with an Alexander Technique instructor. Additionally, I did a lot of independent research on the issue of pain related to playing an instrument.

I absolutely do not have all the answers (and no medical degree! full disclosure!) so here I am just sharing a collection of notes/strategies that I picked up that I found useful.

I want to clarify first that I'm not saying every guitarist is going to run into these issues as obviously many great guitarists do not have these problems. I have just seen and heard of these types of problems often enough ( especially from guitarists who are older, say in their 40s, 50s, and later) that I feel it's worth being cautious and educated.

General Notes and Considerations

Anything tough/new get into it gradually - new gauge of strings, some new physically challenging technique (like new chords or fast lines with pinky stretching,) or lots of bending  - don’t go all in, start with something like that in small doses to let your body acclimate.

I think the first time I started experiencing pain was when I just went from a period of not playing all that much to practicing difficult material all day on an acoustic with thick strings and high action. There are a lot of factors that led to my personal pain issues, but I’m sure this ‘diving in’ approach didn’t help.

Similarly, if you say, take a week or two off from playing because you’re on vacation, get back into it gradually.

Keep practice material varied, do not repeat the same things over and over again.

Be mindful of what material is more likely to cause pain, like chords with big stretches and faster or louder playing. If you're starting to feel some discomfort, mix up your practice routine so that you don't have consistent focus on the things that are causing physical pain. For me, my issues are worse with a lot of use of the pinky, especially stretching the pinky and ring finger apart, or rapid alternation of ring and pinky, so I'm mindful about these things.

Something that was stressed from several sources was to never play for more than 25 minutes at once - play 25, break 5 and let your arms and hands truly rest, then play again. Keep in mind with this strategy you can still play for as many hours per day as you like, you're just taking short breaks for your hands.

If you're concerned about lost time when doing this, note that the breaks do not even have to be breaks from practicing, as not all practicing has to involve use of the hands.

Ideas for the 5 minute rest periods: 

  • First of all, no use of the hands! No typing, carrying, etc.

  • Solfege singing practice, ear training with apps, programs, recordings, etc.

  • If working with sheet music of any kind, you can take a moment to study the music on paper without actually playing it, trying to visualize and audiate any of the issues that are coming up for you in your practice.

  • Listen to inspiring music.

  • Or -  you could just do nothing and take a true rest. Focus on your breathe. Clearing your mind can be useful, or take a moment to think about how you want to spend the next 25 minute session, or reflect on how the last 25 minute session went. Were you focused? Did you work on what you intended to work on? etc.

Technique Specific

Technique is one of the most important things for preventing injury. Sadly, most non-classical guitarists have no idea what they are doing when it comes to positioning, posture, etc.

I think there's big potential for injury in jazz and rock guitar because so many jazz and rock guitarists start out playing 'easier' music like rock and folk, music that you can play pretty well with less formal technique and sloppy posture, but then they take that same approach towards music that is more physically demanding. That may mean music with big left hand reaches, more challenging fingerings. Applying the casual rock/folk playing technique to this kind of music can be a disaster. That was my experience at least; I was a sloppy rock guitarist and didn't have any problems when I was playing simpler music, but things got a lot worse as I was pushing myself without knowing a lot of what I know now.

Maintain a neutral wrist for your fretting hand - not tensed to be straight, but avoid significant pronation, supination, or deviation. Try to avoid bending your neck a lot to stare at the fretboard.

Here is a video I made for fretting hand technique considerations.

And here is a 'brief' video I made for students covering some basics of what I teach for sitting position. It's dry I know, no attempt was made to make the video particularly entertaining. At 14 minutes it might seem excessive but honestly this is just scratching the surface of the things I have to say about sitting position.

Last thing on technique: Beware of excess 'tension,' which I know is much easier said than done. Tension in your neck, shoulder, elbow or forearm can lead to an injury in your hand. Also note that it's easy to get physically tense when we are mentally tense, for example being frustrated at not progressing as fast as we'd like, nervous about a gig, stressed about personal issues, etc.

General Awareness

Listen to warning signs. If something starts to feel a little funky and it lasts for more than a few days, don't let it progress to something worse. Simplest thing - take a break.

Be mindful of how you use your hands in other activities, typing, sports etc. Intensity, frequency, etc. It's smart to use good 'technique' in every activity you do, especially more strenuous things like weight training. (I'm not saying don't lift weights, just be educated about good form and technique!)

Self massage/rolling techniques can be great. Possibly painful but in the process (if you're doing it right) but they do loosen you up. Look up ‘rolling’ or lacrosse ball rolling, for forearms or shoulders, neck

My Impression of the Alexander Technique

The Alexander Technique perspective is that a huge component of injury prevention is maintaining good use of the head and spine, which on the surface isn't that difference than the typical recommendation: "maintain good posture," but there are some very significant distinctions with Alexander Technique:

In theory, "good posture" is good, but one can also have misconceptions about what good posture is and actually be tensing and flexing different muscles to contort oneself into what he or she perceives as an upright and proper position. So Alexander Technique focuses more on the most easy and safe use of the body for any activity, rather than just simply sitting with good posture. 

What's tricky about the Alexander Technique is that it's not part of a regulated medical industry, so it's not easy to find a 'good teacher,' and it is also taught in different ways. I had a very good experience working with Ruth Kilroy who (at least at the time) had a practice in Newton, MA. I was taught a lot of strategies that I found helpful. My experience with Alexander Technique seemed to make a difference not only in the amount of pain I was experiencing but also in how much easier certain physical activities felt, both on the guitar and elsewhere.

To my knowledge there have not been that many scientific studies exploring the effectiveness of the Alexander Technique, so if sticking with scientific, medically proven principles is important to you, you could of course do some research before getting involved.

Conclusion

If you haven't been experiencing any pain related to playing, great! Use reasonable caution and consider the tips and notes here as a general guide through your guitar playing life.

If you've already been experiencing some pain that doesn't go away after a few days, definitely see a doctor and if the issues continue be prepared to see multiple doctors and get different opinions. it is possible that you won't get a definitive diagnosis from one or even multiple sources, but get started on getting a medical perspective. Physical therapy and occupational therapy, can, at minimum give you a lot of things to consider for symptom relief. You may have to see many different people before finding the right treatment. For example, I saw one OT and two PTs before I wound up connecting with a PT that was the most helpful.

You can reach out to me if you have more questions, however, if you're starting to get some significant pain while playing, get a professional medical opinion (or two or three!) before asking me, as I have no medical credentials!

Jake Estner