Why guitarists are at the highest risk of back, neck and hand pain among all musicians
If musicians suffer for their art, then guitarists may suffer the most of all.
A meta-analysis of 18 separate studies conducted over more than a decade found guitarists were commonly afflicted with more playing-related pain than other musicians.
“There was a tendency for guitar players to have the highest pain prevalence,” according to the study, which was published in the Medical Problems of Performing Artists journal. The most affected body regions were wrist, back, neck, and shoulder or arm.
A more recent 2020 study specifically looked at classical guitarists and found a stunning 88.9 per cent said they experienced playing-related pain in the past year, with pain in the left thenar (the base of the thumb) and upper right back common complaints. Surprisingly, these injuries occurred despite most guitarists using ergonomic aids such as foot stools and guitar supports.
Poor posture is a key reason.
Guitarists still tend to sit in one position for long practice periods, where one hip is raised higher than the other. Hunching over the instrument to look at the fretting hand can put extra pressure on the neck and back. Over-flexing the wrist or apply too much force when fretting the strings can also lead to nerve damage.
Adam Del Monte using a guitar support to avoid injury while playing.
Are common instrument choices causing unnecessary physical stress?
The asymmetrical design of the guitar encourages guitarists to play in a non-neutral position, which can lead to physical problems. But the choice of instrument can also make an enormous difference to injury rates.
Almost half (45 per cent) of the high-level guitarists in the classical guitar study played a larger 660mm (26 inch) scale length guitar, compared to about one-third (35 per cent) who played a standard 650mm (25.2 inch) guitar.
Yet the median player was only about the average height of 5’9” (175 cms) and a slightly heavier-than-average 177 pounds (80 kgs).
Larger classical guitars are often louder than standard guitars, which would help the average guitarist in the study who played 14 performances over the previous year. But it also places more demands on bodies and hands (unless a guitarist is physically bigger than average).
A separate study has found that pianists with smaller-sized hands are at greater risk of injuries. A similar issue is likely at work given a smaller grip span on the classical guitar’s wider neck width.
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The majority of players in the classical guitar study (39%) also preferred high tension or even extra-high tension strings (9%) compared to medium tension strings (45%). Fewer than 5% reported using light strings (which are not commonly manufactured for classical guitars). About two-thirds of guitarists (67%) described their instrument’s action (the distance between the fingerboard and string) as “medium” compared to about one-quarter (23.68%) who described their action as “low”.
High tension strings and a medium action (which still tends to be relatively high compared to a steel-string acoustic or electric guitar) also place greater strain on the hands and fingers.
The classical guitar world is extremely traditional and slow to change. The reason Tárrega and other legends didn’t use amplification is because it didn’t exist in their day. It’s now been almost a century since the first guitar amp was built and there are many ways a guitarist can boost their volume while preserving the acoustic qualities of the instrument.
Ergonomic aids: no guaranteed solution
Almost three-quarters (72.1 per cent) of guitarists in the classical guitar study used a foot stool while almost 60 per cent used a guitar support (some also used cushions or hip mats). However, neither foot stools or guitar supports made a difference to subjects who reported lower back pain (bilateral).
The study didn’t explore the reasons for this finding, which on the surface appears counterintuitive.
The obvious benefit of using a foot stool to raise the left leg (for right-handed guitarists) is less strain on the left wrist as the guitar neck is angled higher.
However, foot stools cause their own physical imbalances, according to Virginia Rueda in her book The Healthy Guitarist.
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“The more the hip is flexed by raising one leg above the horizontal, the more the pelvis and lumbar spine are pushed back,” she said.
This imbalanced height also caused the spinal column to twist, causing various back muscles to over or under compensate in response.
Other ergonomic aids that keep the feet at the same height don’t have this issue, according to University of Missouri – Kansas City guitar instructor, Bráulio Bosi, writing in a separate research paper.
“Most of the problems caused by the footstool can be corrected by the use of ergonomic guitar supports such as the different models of ErgoPlay guitar supports or cushions that raise the guitar without altering the position of the body,” his paper said.
However, even using a guitar support such as an ErgoPlay is no guarantee of being pain free. Bosi quotes another study that used a particular ErgoPlay model that didn’t lift the instrument to the proper height, causing the player to bend their back to securely hold it in playing position.
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Whatever ergonomic aids a guitarist uses, they should never hold a fully fixed position for long – slight movements while playing or getting up to stretch are important, according to Rueda.
