Playing Guitar in Pain: How to Avoid and Manage Pain

guitar shoulder pain
shoulder pain is never fun

Guitar and Pain

Guitar has brought me love, joy, adventure, and hope but it also brought me chronic pain. I have chronic pain in my left shoulder and my lower back. It started to affect the people that I care about, academics, practicing/performance(I would write breaks in my rider), driving a car, going out with friends –everything.

After performing and teaching for over 15 years, I had to call it quits on my passion and love… at least for now (I teach on Saturdays). This topic is near and dear to me and I emphasize pain-free playing for all my students.  No pain, no gain is a lie — it can end your career. Get that mentality out of your skull! That’s just plain stupid. The underlying theme is you work at your art, your passion, but listen to your body.

When I would see the doctor for treatment at college, he essentially told me that musicians were like athletes! We demand a lot from our bodies and while the activity is different from football, it’s just as demanding if not more (imbalanced , static motion). When I asked him about who he treated the most, what athlete he saw the most, he told me he saw dancers  the most, then injuries from weight lifting, musicians, and then athletes. We are not wimps! Go guitar muscles!


Ok. I’m not a doctor and suggest you see one to get diagnosed and educated on helping cure the pain. This is just my experiences.

Prevention is the best thing you could do. If you never experience pain, make the investment into prevention. I’ll tell you some tips that will help. As we age, it’s easier to get injured and have nagging pain. Some people are just lucky, maybe genetically, and can have horrible form and be fine. Just being comfortable but having horrible form is bad because a decade down the line if you experience pain, you are trying to undo a decade worth of bad form.

break time
Increase your focus and let your body rest — take a break!

Breaks

Recovery? Sleep? Remember when people tell you to take breaks for better cognition and physical recovery? I never listened because I just got into the music so much! I started to set a timer for 20 minutes and would do some stretching. The problem for me is, the damage was done already but at least it wasn’t getting worse. So, if you’re a teacher, make sure your students take a break! Get up and walk away from the guitar (maybe do something totally different, stretching, water, etc). My pain is more manageable by taking breaks. This isn’t always possible but you can determine what is in your locus of control. I try to schedule 15-minutes between lessons. Sometimes teach without a guitar (I borrow theirs if I need to demonstrate).

Yoga Poses
Hip Opener Yoga poses

Yoga and Exercise

Yoga and physical exercise. I have been doing yoga for over 6-7 years. I have a membership to 24 hour fitness that I buy from Costco and use it daily. I do yoga and yoga/pilates class. It’s great for the mind, soul, and your body. For the first time since playing guitar, I felt NO PAIN after a yoga class! I was on to something here. Go do yoga but limit your range of motion if you feel pain. For example, I do not do a full back bend (wheel pose) because it hurts my back. I avoid headstands because it messes up my neck (bad form).

It’s also a great break and most yoga instructors are very good when it comes to addressing pain! Turns out when I do hip openers, my back pain decreases! I was diagnosed with degenerative disc disease, meaning that the spaces because some of my spinal discs were very close. This affects the nerves that go through there and say if you’re paying guitar and have a slight lean forward (a la all the guitar methods I read) it will stress that area. Pressure on a nerve can cause discomfort. It was pain in my case. During a recital, I had a yoga mat in the green room to lay down on to relax my back. Hip openers like pigeon pose and spinal twist helps me. Give it a try but limit your range of motion to pain free.

Physical therapy (PT). I have been doing physical therapy for over 5 years. I’ve seen a spinal specialist, a pain specialist and numerous physical therapists. Believe it or not, sometimes it takes a few physical therapists until you get one that your body really responds to their treatment. Their treatment is exercise by addressing imbalances. For my, my transversus abdominis was weak. I thought I had a strong core but sit-ups, crunches, and leg raises do not work these muscles. These muscles act like a girdle around your waist and help support your upper body.

My exercises were not difficult per ce, but it was difficult for me. Here’s a link for some exercises:

https://www.physio-pedia.com/Exercises_for_Lumbar_Instability

 

Shoulder pain. I have been doing tons of exercises to strengthen my rotator cuff, my supraspinatus muscle, stretching, icing, my back muscles, stretching my chest muscles, and working my neck. I always focused a lot on my shoulder but the true culprit was the positioning of my head. Whenever I used a computer, sat at a desk, sat in a chair to practice, my head would go forward and put tons of pressure on my neck. In turn (and time), this would stress muscles of the shoulder and traps and the underlying nerves.

I stretch my neck daily, do neck strengthening exercises, new chest and upper back stretches and keep a check where my head is. Sounds stupid but makes total sense. When I was practice at lease 5 hours a day, I often kept my music stand to my left requiring me to turn my head slightly. I saw pictures of Sor or Aguado doing it and supposedly it helped remember the music (monkey see, monkey do). Or I was always looking down at my fingers so my head was always looking down stressing my traps and shoulders.

I developed nerve pain that would shoot down my arm and into my fingers.  I would loose feeling in my fingers. After seeing the doctor and physical therapist, I started doing nerve stretch and activation movements. I also used to video record myself and play it back. I would hear musical phrases and rhythms that needed to be corrected but also bad form; my head would be looking down or my shoulder raised to my ear.

Holistic Approach

I didn’t have good health insurance and was always trying to find a cheaper and more natural alternative. At first, my physical therapist recommended deep tissue massage. A good technician helps here, especially if they have experience treating other musicians. If you are near Campbell, California, I recommend Lori at Body Therapy. Definitely do the massage but realize that they are helping you feel better and give you some of your life back but they are not fixing your problem.

Acupuncture. I tried this for a few months. They also tried cupping on my shoulder and back, as well as putting needles into my lips, head, and shoulder. I also had some electrical treatment. In the end, the effects only lasted a day for me. Your mileage may vary.

Alexander Technique. I did this while I was finishing up my master’s degree. I swear that without Dana at her Alexander Technique studio, I would never be able to graduate. I had to unlearn a lot of things about sitting and walking. We also did stuff with my guitar but mostly based around sitting and my head. It’s actually tough. You need to practice what she teaches you, otherwise, habits for 30+ years will not be broken. I think this is valuable and she did some sort of active release at the end of the session. This fixed my pain for a while. It was really amazing. I swear her hands can heal. Like eastern medicine, it takes a while.

Chiropractor. I went to a few for half a year or so. I been to ones where they have me on some table that swivels up, down and around and also where the practitioner manipulates your body and cracks your back. Usually it feels really good, but it wears after a few hours for me. It wasn’t worth it for me but if your case is acute and need a natural way of relief, that might help if you just want  short-term relief. They will still tell you to do exercises like a PT.

Feldenkrais Method. This was recommended to me by another guitarist. He said it cured his shoulder ills. This was totally new to me and I didn’t know what to expect but there was a significant reduction of my pain. Unfortunately, I wasn’t able to make appointments with my practitioner. I think it uses a lot of active/release method and noticed a lot of rhythmic motion. Definitely give it a shot. more info

Inversion Table. I’ve only tried them in stores. They felt pretty awesome for my back but there are risks. I read the fine print and they will say stuff like there is a small chance of stroke when you hang upside-down! I used Lynx portable back stretcher. It seems to help when I’m really tight and I used it daily before bed. Sometimes, I would overdo it and it would hurt when there was pressure on my discs (standing). So I crawled into bed. Don’t over do it. If you feel really tight, it might give you some relief. The stroke risk just scared me too much to consider getting an inversion table. I’m sure the risk is super small (plus it’s expensive).


Some Parting Thoughts

1.) Breaks help. 2) awareness of my head would help even more 3) having better form where my left arm was always relaxes and positioned so I wasn’t always in ‘impingement’. 4) build this into routines where it’s natural. You can use technology like the Lumo Lift or just place a small book on your head for balance. My PT even put tape on my back to remind me to keep my should blades close to each other.

Get rid of the footstool. The first thing my doctor told me was that my hips were uneven. One side was much tighter (and higher) than the other. I played a piece for him using my footstool and he asked if I can play but have both of my feet on the ground.

My guitar teacher told me about the ergo play guitar support and I switched to that. Wow! My shoulder felt so much better and more free! I now use a guitar strap and which positions the guitar to the correct position and I stand. That fixed the whole sitting down issue altogether. I now and sit or stand to play!

Playing tension-free. One of the things I always admired about some of my guitar friends was their ability to play without tension. They looked so relaxed when they played. This is key not only to avoiding pain but also to create better music. Notice if you are pushing down too hard on the strings. Since I was self-taught in the beginning, I was used a horrible guitar with high action (distance from the strings to the fretboard was large). I always pressed down hard to play. There was some other advice that I should play acoustic guitar because you had to push down harder and would be a stronger player. What horrible advice! I wish I had a teacher that taught me tension free playing and I didn’t listen to that bad advice of pushing harder was better.

Ice and sleep. I didn’t sleep that much and my mattress was horrible. Get sleep! It’s important for your body to heal itself and for cognitive functionality like learning and memory. When I came home from a day of teaching, I would ice my shoulder and back. I literally felt like a baseball player with the ice bags! I kept ice bags at the school I taught as well. I also got a Tens unit form Amazon. This would give electric stimulus via adhesive patches. It makes icing more effective.

I also carried Ibuprofen with me at all times if there was no ice. The pain was so bad, I started to take doctor prescribed opioids and muscle relaxers. This was not a good thing. At this point, I started seeing a new physical therapist that got my pain level from a 8 to a 3! Manageable with exercise and stretching but took years! That’s pretty cheap compared to medicine with horrible side affects that don’t actually fix anything.

The best thing is to avoid pain and incorporate breaks, stretching, strengthening, and proper form into your daily practice. You are an elite athlete and you need to treat your body that way. Do yoga (you can watch youtube videos, download an app, or buy a book) as many exercises in yoga are what physical therapists incorporate in their programs! If you see a physical therapist, do everything they tell you to do. Schedule breaks, even in your performances, practicing and teaching. Take notice of your daily actions. If you’re sitting too long? Is your head in front of your shoulders? Are you using a footstool? Are you playing with tension? Don’t do things that could damage your body like trying to ‘pop’ your shoulder in or hang upsidedown holding weights to stretch your back. The latter is called traction and let a PT do it for you.

More to come: videos and exercises that I used.