Principles of Good Practice Hygiene - Guitar Injury: Cause, Prevention, and Treatment
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Why does my wrist hurt? Do I need to stop playing guitar? What can I do?
As a serious guitarist, sooner or later you will likely experience pain or injury in your shoulders, back, neck, arms, wrists, or fingers. Pain is your body’s signal to you that something is amiss and needs to be addressed. Fortunately, most guitarists’ injuries can be prevented using the principles of good practice hygiene. Minor overuse injuries can be treated early with the conservative measures discussed here. If these measures do not help you and your pain persists, then it is essential to see your physician and get your problem diagnosed so it can be treated properly. The goal of this article is to impart to you the benefit of the valuable information we have learned from our battles with pain and injury.
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In no event is the information presented here a substitute for the care and judgment of your doctor. A pinch of prevention is worth a pound of cure. The care of your body as the primary instrument of your self-expression is of incalculable importance to you as a musician. Minor stresses and strains can be easily be taken care of or entirely prevented if you pay attention to your body, know when to stop or take time off from playing, and apply preventative and conservative self-care.
In the past, I experienced a severe case of tendonitis in my left wrist, and mild carpal tunnel pain in my right wrist. At one point my guitar progress had come to a screeching halt, as I had to let my body heal and deal with strong recurring pain in my wrists. This carried on for years and was very frustrating not only for guitar, but everyday things such as driving, opening doors, lifting things, etc....and to think...I could've prevented this.
I have lived with fibromyalgia since I was 16 years old and swam headlong into a pool wall during a swimming competition. Life since then has been a series of physical challenges because of chronic pain, fatigue, spinal disc herniations, nerve impingements, carpal tunnel pain, and tendonitis. Learning how to cope with these chronic pain issues has enabled me to do the things that I have wanted to do despite my body’s sensitivity and tendency to sustain injury even with the simplest of tasks and stressors. By using the practice principles we will discuss in this article, I was able to train my body to gradually accept the activity of playing guitar as a normal and painless part of my life in the space of two years. In fact, these principles have made guitar playing a source of physical conditioning that has helped me cope with chronic pain symptoms in all areas of my life.
We will help you understand how to prevent and deal with injuries caused by bad practice hygiene: poor posture, unnecessary tension, incorrect techniques, and unhealthful habits. The first half of this article will cover injury prevention, and the second half will cover coping with the early stages of injury and pain. Keep in mind that many of the recommendations here can be applied to playing other musical instruments besides the guitar and even non-musical activities such as sports, using a computer, and other activities of daily living.
Why am I experiencing this pain?
At this point let’s address some possible reasons that you may experience pain from playing guitar and how it may be prevented or eliminated:
1) Improper posture
Common places to feel pain are the shoulders, back, neck, arms, and wrists. Improper posture can create unnecessary tension in the musculoskeletal system and contribute to microscopic injuries to the soft tissues of muscles, ligaments and tendons called “microtears.” Excessive microtearing can lead to inflammation and swelling, the tingling and numbness of nerve impingement, and severe pain and disability. These injuries can happen in a short period of time during a single practice session or can accumulate over many sessions. Cumulative injury from poor body mechanics can result in carpal tunnel syndrome, tendonitis, bursitis, or other repetitive stress injuries. The main offender you want to eliminate is excess tension.
Maintaining good positioning and posture in the shoulders, back, arms, elbows, and wrists.
Shoulders - Keep your shoulders in a relaxed natural position. Make sure not to raise your shoulders up while playing. For example, some players make it a habit to raise their shoulders while playing on the lower frets and then bring them back down on the higher frets (or vice-versa). Use a wide, comfortable guitar strap that allows ideal height placement for your guitar so that you are not hunching up your shoulders to reach your guitar.
Back - If you are slouching when you play, you will eventually experience neck or back pain. Make sure to keep your back straight while playing. If you play seated, make sure you have a comfortable height-adjustable chair that promotes good posture and use a foot stool so that you are not straining to hold the guitar in position.
Arms/ Elbows - Many times people play with their arms/elbows raised up almost horizontal. This creates a lot of tension, and can cause pain in your forearm or elbow. Your fretting-side elbow should stay close to your body, but not directly up against it, raising slightly on occasion. Your picking-side arm should come around the front of the guitar and find a natural and relaxed position from which to pick and strum the strings.
Wrists - Wrists are a very common area of pain for guitarists. Many times this is due to static tension and excessive bending of the wrist. While fretting notes on the guitar, your fretting-side wrist should only bend moderately as you curve your fingers to reach for strings. Raise the height of your guitar to reduce bending, if necessary. Keep your thumb behind the middle part of the neck or lower. Your picking side wrist should only slightly bend while picking, if at all. Make sure to notice and release any excess tension in your forearms, wrists, and hands while playing.
The principle of good body mechanics, relaxed positioning, good posture, the right chair, comfortable strap, and so on, is called “ergonomics.” Good ergonomics will prevent injuries associated with poor positioning and reduce the wear and tear on your body. Checking often for any tension and releasing it by consciously relaxing will begin your training to play without tension.
2) Applying too much pressure with your hands.
Many players press down too hard on the guitar strings, and this creates a lot of excess tension. After developing the initial calluses on your finger tips, you should not be experiencing pain or tenderness when you play. This is especially true for electric guitar. Don’t strangle your guitar to try to make it sing--you should not have to clamp down hard on the strings in order to get a good tone. For the most part, you should use just enough pressure to push the string against the fretboard and obtain a good tone, and no more. Static, unreleased tension in the hands is unnecessary and can lead to injury. Learn to relax the fingers that are not being used to hold down a string. In addition, make sure that your guitar is properly set up and intonated, and that the action is not too high.
3) Not warming up properly, or at all.
Failure to warm up will make you more susceptible to injury. As a guitar player, you are just like any athlete training your muscles to make specific and complex movements. And, just like athletes, your muscles must be warmed up in order to greatly reduce the chance of injury. Cold muscles are more susceptible to developing microtears. This is particularly a problem during the winter months. You can try warming up your arms and hands with a warm water soak or shower. Dry thoroughly and dress warmly. Try various exercises to gently stretch your fingers, wrists, arms, back and shoulders. Start playing with a warm up plan of guitar exercises and stick to it. Use it faithfully before each and every time you play or practice. If you don’t notice a difference in your flexibility, speed, and precision in playing, then you aren’t doing it right. Make it a habit so that you don’t even have to think about it.
4) Playing or practicing for lengthy periods of time without sufficient breaks.
This is a very common way to become injured. Many players will play for hours on end without taking a break, and slowly over time they will start to feel aching in their wrists, arms, or elsewhere. If you play 45 minutes straight, you should take at least a 10-minute break to give your body a rest. In addition, you must pace the intensity of your play or practice sessions. Do not make radical changes to your routine. This is a quick route to severe injury. Do not suddenly increase the frequency or intensity of your play or practice. Work up to it. Remember, you are an athlete—a small muscle athlete. Approach each new activity or concept with a graduated approach just as if you were training for a peak performance—because you are!
5) You have experienced prior injury to a body part, and the movements made to play guitar have aggravated this area.
This principle is critical and cannot be emphasized enough: Do not ever play through pain!!! If you are feeling pain when you are playing guitar, stop and rest. This may require taking anywhere from 1-3 days to a week or two off from playing guitar. If that's how long it takes for your body to heal, then so be it.
At first, the pain of an injury may be very subtle, and you may think to yourself that it's no big deal. Do not ignore an injury or you WILL regret it. By playing through the pain you are taking a big risk of making it a much worse, long-term injury. You may not notice that the pain is getting worse until it is too late for preventative measures to be effective. Before you know it, your arms, wrists, etc., will be throbbing or numb and you'll have to seek medical attention.
6) You are not getting enough sleep.
Sleep is the Great Restorer. This is when the body is supposed to rest and devote its energies to repairing the wear and tear sustained in intense activity during the day. Sleep deprivation is also deprivation of the body’s healing time. Sustained sleep deprivation increases the chances of developing an injury that will take longer to heal.
Good “sleep hygiene” is essential to getting a good night’s rest and staying healthy. It is worth the effort to implement these practices.
What can I do to cope with the pain I am feeling?
For any severe or persistent problem, of course, you should immediately consult your doctor. The following measures are commonly recommended by health care professionals and you can easily try them to see if they help or even completely eliminate the symptoms of your injury:
As we just stated, rest is very important. If you are playing and you notice pain, stop playing your guitar and rest until you no longer feel the pain. This will be the first thing you can do to stop pain associated with overuse and could be the very first thing your doctor will recommend to you. It is vitally important to rest in order to allow your body to heal. Allow for sufficient time for healing to take place. This may take days to several weeks.
2) Ice and Medicine
If you are experiencing pain after you have stopped playing, it may be a sign that there is inflammation in and around the area where you are hurting. Ice is very good to reduce swelling and inflammation. The most safe and effective type of icepack is crushed ice topped off with water in a self-sealing type plastic bag. You want the pack to be cold enough to anesthetize the injury, and reduce swelling, but not so cold that you will “freeze-burn” the skin. This is a fine distinction, because if you do not get the area cold enough, you will not reap the benefit of icing. On the other hand, you do not want to cause yourself additional injury from a pack that is too cold. Most commercial ice packs are too cold and require a cloth barrier. Unfortunately, a cloth barrier can easily be too thick for adequate therapeutic benefit, even when used with these ultra-cold commercial packs. You will not need to use a towel or cloth to prevent injury with this type of pack. It will be cold enough to drive out inflammation and swelling, but will not freeze-burn your skin. Use for 7-10 minutes at a time. You may repeat this treatment 2 or 3 times with 15 minute breaks. Getting through the first few seconds of contact discomfort with the cold will be the most difficult part of this treatment. Never run warm water or use a heating pad over inflamed areas. This will make the inflammation worse.
You may also want to try taking an over-the-counter non-steroidal anti-inflammatory drug (NSAID) such as aspirin, naproxen, or ibuprofen to help decrease pain and inflammation. You can get this type of medicine at nearly any grocery store, convenience store, or drug store. If you go to your doctor, he or she will most likely prescribe an NSAID drug for you as a first line of treatment. Do not use NSAIDs if you are allergic or sensitive to NSAIDs, or if you are taking other medications that have interactions with NSAIDs, or if you have any medical conditions for which the use of NSAIDs are contraindicated. Your doctor or pharmacist can help you determine if NSAIDS are right for you. The advantage of calling your local pharmacist is that the pharmaceutical advice given is of the highest possible quality, you do not have to make an appointment, and a courtesy consultation is generally 100% free of charge. Never take NSAIDs on an empty stomach and be sure to drink plenty of water. No medication is without risk or potential adverse effects, so make sure you are aware of side effects, adverse reactions, and your tolerance for this kind of treatment.
3) Splints and Braces
If you have wrist or forearm pain, wearing a brace or splint could greatly reduce the pain you feel. These over-the-counter products are designed to compress, support, or minimize movement in a painful area. Most splints and braces are designed to be worn at night while you are sleeping.
Ysrafel found that wearing a brace/splint was helpful, but would sometimes irritate his skin after extended use by rubbing against his palm and in the webbing of his thumb. He personally recommends and uses musicians’ wrist straps found at www.newgrip.com/guitar.html. This site also contains practical user information. This product is recommended by numerous musicians as well.
Another product that Char found helpful is called “The Carpal Solution.” These soft, disposable FDA-approved devices are a proven, unique therapy from First Hand Medical that provides lasting relief in 80% of carpal tunnel syndrome sufferers within one week. These devices do not cause the muscle atrophy associated with the compression and immobilization of ordinary splints and braces and promote rapid return to activity. They can be ordered online at www.mycarpaltunnel.com.
Splints and braces should not be used near open wounds or over bone fractures or deformities, nor should they be used to relieve symptoms of chronic diseases. If your injury is severe enough to require bracing, then it is best to consult your physician and get a definitive diagnosis and treatment plan for your problem.
Should I see a physician?
If the pain persists after trying the above suggestions, you absolutely must consult your physician. Make sure to let him or her know what you have already tried and what worked for you and what did not work for you. It should not come as a surprise to you that your doctor may want to recommend these exact same conservative measures to you again to document your complaint and the recommendations for your treatment plan, and your response to these recommendations. It is well known in the medical profession that, “If it isn’t documented, then it never happened.” Your doctor may instead take your treatment to the next level and order x-rays, other medications, cortisone injections, physical therapy, surgery, or even make a completely different finding or diagnosis.
Surgery should always be considered a last resort. If it is recommended to you, it behooves you to always get a second opinion from another doctor or specialist before submitting to such an expensive and ultimately invasive procedure. It is your body and you only get one in this life, so take good care of it.
Use the techniques and preventative measures we have presented to you to enable yourself to play hard and stay healthy. In summary, these are the core principles of Good Practice Hygiene:
If you are experiencing pain that is keeping you from playing guitar, don't let despair or frustration make you give up or lose hope! Follow the advice of your doctor, give yourself time to heal, and stay positive. Staying positive will not only help reduce stress and speed the healing process, but it will keep you open to other activities that could help you develop and grow as a musician when you are back to normal and playing guitar again. For instance, you could practice your ear training, music theory, songwriting, and many other music-related activities. The strong foundation that developing these alternative skills will provide to you during your period of convalescence has the potential of taking your playing as a musician to completely new heights of ability and expression that you might never have otherwise achieved. It is up to you what you will make of the challenges that life throws your way.
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