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The Guitarists Guide To Overcoming RSI And Other Arm Injuries – Part 1

If you play guitar long enough you’re bound to have a day when you over do it and suffer a minor guitar related injury. Most of the time the pain associated with guitar playing is finger tenderness, which goes away within a couple of weeks of playing as your hands adjust and callous up. Unfortunately from time to time a more serious injury can result from overpricing and can be very disruptive to your guitar playing progress and health in general.

Not many people know but I struggled with various Repetitive Strain Injuries (RSI) a decade ago and even had to stop playing for a period of 18 months as I went through therapy after therapy before eventually having surgery to decompress a nerve in my left elbow. This period was extremely disruptive and frustrating for me but gave me a whole new perspective on playing guitar and how fortunate I am to have a second shot at learning how to play.

In this article I will outline some of the most common guitar related injuries as well as my experience overcoming RSI which plagued me for almost 3 years. I hope that by sharing my story I can help at least one person avoid developing an RSI related guitar injury like tendonitis, tenosynovitis, carpal tunnel or cubital tunnel, or can help other players,who like me have been in pain for months or even years with no hope or end in sight, start playing pain free.

If you’ve been diagnosed with, or believe you have Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Tendonitis, Tenosynovitis or any other from of RSI then I hope that this article is a first step-in the direction of one day playing guitar 100% pain free.

sign, caution, warning

Quick Disclaimer

I am not a doctor nor am I qualified to give medical advice. In the event that you have developed a guitar related injury should immediately stop playing and seek advice from a professional.

The advice I share here is based on my experience working with dozens of medical professionals, specialists and physical therapists over a period of 3 years and is a summary of what worked for me in my situation.

An Overview Of Common Guitar Related Injuries

Finger Tenderness
 
This is a sensation of pain that you feel in your fingertips when first starting guitar and generally goes away after a few weeks of learning to play. It’s normally nothing to worry about as long as it doesn’t feel like a muscle pain. More experienced players may experience this when learning how to bend or apply vibrato which is more physically demanding than other techniques. 
 
Hand Fatigue
 
It’s perfectly normal to feel muscle fatigue after playing a sport or completing an intense workout. The same is true of your guitar playing. If you’re doing intense techniques like bending or vibrato you may feel fatigue and should rest for a few hours before your next session. Use your own judgment and commons sense as to what feels right and normal and don’t push through pain, instead use it as an indication that you are playing with too much tension and that your practice session is done for now.
 
Repetitive Strain Injury (RSI) 
 
RSI is an umbrella term for a series of injuries that result from overuse and are normally directly associated to a specific activity that involves repetitive movements. They are thought to have both physical and psychological causes and manifest themselves as pain, throbbing, numbness, tingling and fatigue sensations. RSI’s are often long term inures and can plague people for many months or even years. All of the following injuries can be grouped as RSI’s
 
Tendonitis 
 
Tendonitis is an inflammation of the tendons caused by repetitive movement with excess tension or poor technique. It can be felt as a tired feeling or a dull ache and in guitar players generally occurs in the forearm or wrist. It is colloquially called golfers wrist or tennis elbow among other names depending on the sport that caused it.
 
Tenosynovitis 
 
Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. It is often called ’Trigger-Finger’ due to one or more fingers getting stuck in a particular position as if you were pulling a trigger.
 
Carpal Tunnel Syndrome
 
This condition manifests as a throbbing pain or intense pins and needles sensation in the wrist caused by compression of the medial nerve. The pain can be so intense that it can wake people in the middle of the night. It is my belief that the fatigue from overuse may result in inflammation which presses on the nerve and causes of the the sensations. CTS is a common diagnoses for people who use their hands reptioiblu such as bank tellers, supermarket cashiers and office staff who spend hours on a computer over a period of years. Because people use their hands for almost everything, recovering from carpal tunnel is very difficult because people cannot actually rest effectively.
 
 
Cubital Tunnel Sundrome
 
This condition is similar carpel tunnel syndrome in symptoms however effects the elbow and is caused by compression of the ulnar nerve (the scientific name for your funny bone) It is characterised as effecting the elbow and last two fingers and can spread pain and tingling from the elbow to the rest of the arms, hands and shoulders. Like Carpal Tunnel it is a compression caused by overuse with sufferers of Cubital Tunnel waking in the night to intense pins and needles.
bullying, stress, head

My Battle With RSI

I started playing guitar when I was 15 and would fanatically play anywhere between 3-6 hours per day in my quest to become the greatest guitar player of all time. During the whole high school period I never once had any issues with my hands other than playing so much that I wore through the skin on my fingers or had general fatigue after a few hours of shredding which was back to normal the next day.
 
Post high school I studied a Bachelor Degree in Music Performance. My course had about 24 contact hours per week. I was doing about 3-4 hours per day of practical classes and then coming home to practice for another 3 hours. I really struggled in my first year having gone from the highschool approach of learn a piece and play it note for note to pass an exam to having to improvise and know my instrument really well. I just scrapped through  it through first year, so my solution to do better in second year… practice more.
 
In my second year of study I was clocking up around 5 hours of guitar a day. On top of this I was doing several shifts each week working a checkout at the supermarket, or on the free days, lifting heavy weights at the gym. Compound all of this together with driving a manual car for two hours a day and typing on a computer or a smartphone for a few more hours more it quickly ads up to almost every waking minute spent doing something with my hands.
 
It was also round about this time that self checkouts were introduced at the supermarket I was working at and I was also promoted to a service desk manager position. I went from happily serving customers and enjoying my time at work to dealing with disgruntled people’s problems or fixing the same self inflicted self checkout error that occurred from people not taking 10 seconds to read the instructions on the screens before they started mashing buttons and causing errors. I stopped enjoying work and went into every shift ready to do battle with a limitless swarm of people who I thought were idiot customers out to get me with never-ending problems. Eventually the stress and frustration at having to smile through the abuse of unhappy customers or angry technophobes (I could only watch people press the button that said “I don’t want to bag my item” and then put their item in the bagging area which triggered the unexpected item warning and caused then turn to me and tell me the machine is broken so many times) got to me and I became very cynical wound up which of course effected a lot of other areas of life.
 
To top it all off I also bought a new guitar (a Gibson Gary Moore signature BFG Les Paul) and fell in love with it. The action (string height) was really high but I couldn’t bear to part with it for the 3 days it would take to get the service done so I just kept practicing, all the while the high action was causing me to grip harder than normal.
 
The Perfect Storm
 
Playing an instrument with a really high action caused me to have to squeeze the strings harder than normal in order to fret the notes cleanly, and because I was overly tense and stressed out from work, I was already over squeezing without even realising it. Compound this with 5 hours of daily guitar practice and either a gym session of a few hours packing groceries before typing assignments or socialising on Facebook or via SMS and you can see how I was overworking every muscle and tendon in my arms. Eventually something had to give.
 
One day I was practicing for my lesson and I felt a tickle in my forearms. A few minutes later the tickle was a sharp stabbing pain, then an irregular dull ache. I did my lesson and the pain only got worse and became a constant ache. I should have stopped but I pushed through. My arm was aching by the end of it, and I stopped after my lesson, but by then the damage was done. I woke up the next day in intense pain all throughout my arm. I couldn’t even make a fist without sharp pains shooting through my arm and hand. I saw the doctor and he diagnosed me with tenosynovitis,  an inflammation or wearing away of the sheaths that house the tendons that when inflamed, rub against each other and cause pain. I was told no guitar for 3 days and that it would calm down.
 
After 3 days I picked up my guitar and began to play, I probably got about 20 minutes in before I felt the familiar ache once again. I put the guitar down and booked in another session with the doctor. 3 days became one week, became two weeks, became a month, which became three months. Each time I would stop playing guitar for days, weeks or months at a time and within a few minutes of playing that familiar sense of pain would come surging back. (it’s also worth mentioning that I would feel pain when typing on the computer, messaging on my phone, lifting baskets and scanning groceries and any fine motor skills that required my fingers.)
 
My doctor told me that the tendosynovitis had developed into Repetitive Strain Injury (RSI), an ongoing condition where repetitive actions cause different forms of pain. Mine had manifested itself in both my wrists, forearms and elbows and often extended to my shoulders, neck  jaw and lower back.
 
At Uni, assessments were cancelled and I ended up dropping out of the practical subjects which I couldn’t play or do any preparation for.
 
During this time I was not only resting, but receiving physiotherapy, osteotheracpy, acupuncture and trying everything I could to avoid RSI. Nothing I did seemed to help at all. In fact my pain seemed to change and move around and develop. I definitely began with tendonitis and tenosinovitus which would eventually develop in Cubital Tunnel Syndrome. I stopped using my left arm as much to help it recover and that only resulted in developing Carpal Tunnel Syndrome in my right hand and eventually left hand. I was in pain in every waking hour and it sucked.
 
After a year of trying every remedy and therapy under the sun I finally elected to have the surgery to decompress my left elbow. I had the surgery, and pretty much had to learn how to use my left hand again Everything from making a fist to tying my shoe laces to using a fork and eventually playing guitar had to be relearned. The recovery process took about 6 months but I was finally back to playing 3 hours a day.
 
Was my cubital tunnel syndrome cured?
 
yes…
 
Was I pain free?
 
no…
 
I still hand carpal tunnel in both wrists and 24/7 tendonitis. 
 
Despite all this I was still cheery and optimistic during the whole time, and very happy that I was back to playing guitar, but the ongoing pain was something I was getting prepared to live with for the rest of my life. That is until I had two major breakthroughs moments.
 
The first a good friend of mine got a jet ski for Christmas and we went out or a spin. He tore it up while I held on a passenger before he invited me to try it. I hesitated at first because I didn’t want to hurt my arm, but then thought “what the heck, my arm always hurts anyway so I may aswell have fun” so I jumped on the drivers spot and took control. We spent the next 3 hours riding that jetski and not once did I feel any pain in my hands or wrists. I couldn’t believe it. When I got home that night I raced to my guitar to try it out and within 5 minutes I was in excruciating pain. I couldn’t understand why, but something curious had happened.
 
The next breakthrough was when my Grandpa had his hip replaced. He went in for surgery and three days later was walking again. I couldn’t figure out how a 70 year old man could be walking three days after major surgery and me at age 21 couldn’t recover from a hand injury that occurred 18 months earlier. In frustration I googled ‘how to cure RSI’ and chanced upon a page where a lady detailed her life with 5 years of RSI which vanished after reading a particular book. Her story sounded very similar to mine, and when I visited the website of author I read dozens of similar stories and it felt as If they were describing me and my situation.
 
I bought the book on Audible and listened to it that afternoon and immediately started implementing the exercises. 3 Days later I was 90% pain free and aware of all the extra tension I was holding in my body.
 
The book was called ’The Mind Body Prescription’ by Dr John Sarno. In his book he details his experience with psychosomatic pain which is pain that is imagined in the mind and manifests itself as real symptoms. Long story short, I had a genuine arm injury 18 months earlier which was likely caused by a combination of overuse and excess tension. When I took on additional stressful roles at work I would come home in a bad mood, extra tense and would need some way of blowing off steam. A routine of playing guitar in a heightened state of stress (and the physical result of actually gripping harder as a result of the stress) became a viscous cycle of perpetuation where I exacerbated the problem and conditioned myself to feel pain when I played (just like Pavlov conditioning dogs to salivate at the sound of a bell). I just got more and more wound up and it got worse and worse over time.
 
After reading the book I was able to do a short mental routine to put myself in a separated place mentally which stopped the conditioned pain from occuring immediately. From there I was able to figure out how tense I actually was and work on relaxing and removing the excess tension that I had as I played. As I practiced in this relaxed I stopped overworking and damaging my muscles and tendons and could actually give them the time to recover. I changed my mindset towards work so that I was in a much better place mentally and wasn’t coming home stressed and practicing as an escape. Cutting off the stress choked out the cause of my tension and when the tension wasn’t there my hands could recover. Then all the same therapies like massage stretching which had been mildly effective previously started to help out tenfold now that the cause of tension had been eliminated and the recovery could take place.
 
To some of you this might sound crazy or like some new age mind over matter nonsense, but Dr Sarno’s book (and his original book Healing Back Pain which I read shortly after and believe to be a much more concise and better volume if you read it and substitute the words ‘back pain’ for RSI, Carpal Tunnel or whichever injury you have been diagnosed with) helped me immediately to the point where I believe If I had of had his book earlier I would not have required surgery. This book was an important breakthrough on the mental side of things, but there were many important steps I took on the physical side of things aid in my recovery too.

The 3 Things That Helped Me Overcome My RSI Problems

Three things that helped me the most in overcoming RSI, Carpel Tunnel & Cubital Tunnel were:
 
  1. Stretching
  2. Good Posture
  3. Awareness and Reduction of Excess Tension
1) Stretching
 
Having a routine of back, shoulder, neck and arm stretches to loosen up my muscles and tendons was very important. A lot of people also go straight to massaging the areas in pain (hands, arms and wrists) when often the pain is being triggered by an imbalance or tension somewhere else in the body.
 
A particularly helpful physiotherapist told me that for every hour you spent bent forward over a guitar/computer/desk etc you should spend 5 minutes stretching yourself the opposite way. Creating a routine of stretches for morning, night, and immediately before practice was very helpful and an important step for recovery.
 
I will include my stretching routine and some video demonstrations in Part 2 of this article next week.
 
2) Posture
 
Having good posture and a workspace that helped me maintain was the next important step. Previously I mentioned that pain in the arms and hands is often a result of tension somewhere else. Something as simple as having your desk height too high may cause you to hold your arms in an unnatural extended position for periods longer than nature ever intended. As a result our shoulders tense up or use other muscles to assist and as these muscles wear out more and more connected muscles are pulled out of alignment. Start compounding this with hours spent playing guitar daily across a period of several weeks, month for years and it’s easy to build up a lot of tension resulting in pain and RSI.
 
Often people go out and spend hundreds of dollars on massages and therapy when all they had to do was fix their posture or adjust the height of their desk chair.
 
My recommendations for solving posture related problems include:
 
  • Getting yourself a good quality padded guitar strap that is wide and spreads the weight out across your shoulder.
  • Adjusting your guitar strap so that your guitar is the same height regardless of if you are standing or sitting.
  • Adopting the classical guitar posture so that your shoulders maintain an even T shape.
  • Practicing with a mirror (or recoding yourself practicing) so that you are aware of your posture and can adjust towards the T shape.
  • Having a comfortable chair that can be adjusted to any height you need.
  • Adjusting the height of your desk and chair so that your arms sit at a 90 degree angle when typing on a computer or writing.
  • Having a footstool or other item that you can use to support your leg and maintain good posture.
  • Having your guitar setup and serviced regularly so that it is in good condition and facilitates ease of playing.
  • Have an appropriate gauge of strings to suits your playing style.
 
I also recommend
  • Never sitting on the end of your bed to play
  • Sitting in a position that causes you to hunch over your guitar
  • Practicing 3 times throughout the day rather than doing one long practice session
     
3) Awareness and Reduction of Excess Tension
 
Out of all the factors contributing to my particular case of RSI this is the hardest one to fix, but the one that had the biggest impact on my recovery.
 
Becoming aware of how tense I was all of the time and how stresses from work and other areas of life were contributing to my RSI injury allowed me to finally overcome the problem. The stress was the fuel and the tension it caused was the engine that was grinding away at my muscles and tendons.
 
Stress became tension, and tension caused my to over squeezing and doing all sorts of damage. Imagine it like trying to drive your car with one foot on the accelerator and the other foot on the break. The engine revs and the wheels try to spin, but the breaks hold them in place causing the motor to wear out or the break pads to grind away.  You could also imagine the damage to your tendons like walking on hot coals and burning your feet, but before they have time to recover you’re walking on them again and adding a whole layer of new damage and scar tissue to your already damaged feet.
 
 
Other things I found helpful
 
  • Wearing a brace when sleeping – I bought a postage cylinder from the post shop and put a sheet of foam inside it which kept my arm straight when I slept. I also had a wrist brace for this same purpose when I had carpal tunnel.
  • Massage Therapy
  • Reading the books The Mind Body Prescription and Healing Back Pain by Dr John E Sarno
  • Icing my hands and elbows before bed
guitar, man, music

Your Mindset Towards Recovery

No matter how long your pain has been going on, or how serious it is, you will recover, and having a mindset that is conducive to your recovery is of the upmost importance. 
 
Humans have evolved over thousands of years to recover from injuries and adapt. The idea that you might play guitar too much once and cause yourself a permanent injury is total rubbish and any doctor who recommends you give up playing guitar is being lazy or is inexperienced in the areas of RSI. These doctors equate playing guitar as the cause of the pain and believe if you eliminate guitar then its problem solved instead of helping you identify and solve the underlying causes of the pain.
 
You can recover, and having a positive mindset about recovery is the most important element of getting your hands and arms back to 100%. 
 
Make a decision that you will recover and make a plan to make your goal of recovery a reality. Stay positive by thinking about the day that you will pick up your guitar and play pain free and how good that will make you feel. Reflect upon all the awesome experiences you had in the past playing pain free and what opportunities the future holds. I used to start every day by imagining the day I was going to pick up the guitar and just play, as well as all the epic gigs that the future was holding for me.
 
If you want to recover, here is the process you need to follow:
 
  1. Make a decision that you are going to recover
  2. See a medical professional for a proper diagnosis and a recovery plan
  3. Rest for the recommended period of time so that you stop damaging your muscles and tendons and can begin recovering.
  4. Start identifying all the stresses in your life and any possible contributors to your overuse injury. 
  5. Systematically eliminate as many of the stresses and causes of your pain as you can
  6. Learn to manage the ones that you can’t eliminate entirely
  7. Increase your awareness of tension, posture and bad technique as you gradually increase your play time.
  8. Gradually increase the amount of time that you play each week, and be disciplined to avoid re-injuring yourself.
 
For example
 
  • Week 1 – play for 5 minutes, 3 times a day
  • Week 2 – play for 10 minutes, 3 times a day
  • Week 3 – play for 15 minutes, 3 times a day
  • Week 4 – play for 20 minutes, 3 times a day
 
Keep on increasing by 5 minute intervals each day until you are doing 3 blocks of 60 minutes. This should more than cover the playing and practice needs of both hobby and professional players. Be disciplined not to go over you allowed time and should you feel any pain, stop immediately and take a break from playing.

In Summary

Every person recovers at a difference rate. You might feel better within days of adjusting your guitar strap or buying a better chair, Or may take weeks or months of reducing environmental stressors and eliminating tension form your playing. Take things one day at a time and stay positive. Avoid the temptation to overplay and stop if you start to feel pain. The first couple of months may be more about management but eventually you will be able to live a pain free life.
 
It’s worth mentioning that from time to time I do have overuse injuries and the occasional flare up (usually from typing on a computer rather than guitar playing) which I generally attribute to being caused by my posture or holding myself too tensely. Adjusting my posture and taking a few short breaks is the usual fix and I’m back to normal the next day.
 
This article has been much longer and more comprehensive than I initially set out to write and I still have much to share on the matter including my stretching routine nd a guided video on all the stretches that I have found particularly helpful and relevant to guitar players.
 
Stay tuned for part 2 coming next week.

About The Author

GuitarLessonsMelbourne

Michael Gumley is a Guitarist and Musical Educator based in Melbourne Australia. He is the founder of Melbourne Guitar Academy, Guitar Ninjas and the Guitar Dojo Online and is on a mission to raise the standard of contemporary guitar education worldwide. 

Michael suffered from several guitar induced RSI injuries in his early twenties and would happily take time to help any guitarist suffering fro similar injuries on their own path to recovery. You can reach out to Michael to social media @MichaelGumley or email him via  (info)@melbourneguitaracademy.com 

A proper practice plan can be very beneficial for those seeking to recover from or manage a hand injury. If you’re looking for guitar lessons in Melbourne or need assistance in overcoming your RSI Injuries visit Melbourne Guitar Academy to book a free initial consultation (in person or via zoom) so that we can help assist your recovery.

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