Introduction and Background

Beyond general health issues, many musicians suffer from playing-related musculoskeletal disorders (PRMD), which primarily affect the support and movement systems of the body. These disorders, commonly associated with the back, neck, hands, and facial muscles, have been documented since the late 19th century. Studies have primarily focused on professional musicians, identifying female musicians and string players as the most at-risk groups (Zaza & Farewell, 1997; Kenny & Ackermann, 2013).

Guitar playing involves repetitive movements, often stretching fingers and hands into extreme anatomical positions, which can lead to one form of PRMD—overuse syndrome. A study conducted by Spanish researchers found that 75% of the guitarists they surveyed experienced overuse syndrome, with flamenco guitarists (87.5%) affected more frequently than classical guitarists (62.5%). In addition to differences in playing posture, flamenco guitarists also had longer practice sessions on average (Marques et al., 2003).

David Johnson (2009) reviewed 13 studies on PRMD in classical guitarists and identified one key risk factor: the use of a traditional footstool instead of a modern support device. He also pointed out that performing arts medicine is still a relatively young field, its development coinciding roughly with the launch of the journal Medical Problems of Performing Artists in 1986.

In addition to PRMD and overuse syndrome, musicians face other occupational hazards such as excessive noise exposure (McBride et al., 1992) and work-related stress (Parasuraman & Purohit, 2000). These concerns primarily affect professional musicians, but my study focused on an issue that also affects amateur players: experiencing pain while playing the guitar. The research aimed to map out the areas of pain, their frequency, and possible correlations with playing habits. Additionally, participants were asked what, if anything, they had done to alleviate their pain.

Methodology

Participants

A total of 387 guitarists completed an electronic survey. The average participant was 30.82 years old (men: 32.6 years, women: 27.5 years) and had been playing for an average of 5.98 years. This suggests that the typical respondent was an amateur guitarist who had taken up the instrument as an adult. The majority of respondents were male (66%), with females making up 34% of the sample.

Data Collection

Participants rated their pain frequency on a five-point Likert scale, covering back, shoulders, wrists, fingers, and legs. They could also provide free-form comments. To analyze relationships between different variables, I used Spearman’s rank correlation, while mean differences were compared using a t-test.

Results

Where Does It Hurt?

The most common pain area was the fingers (85% of respondents), followed by wrists (58.4%), shoulders (38.2%), back (35.8%), and legs (14.2%). This ranking remained the same regardless of playing experience, posture, or guitar type, with one exception: among players using a support device (n=16), back pain was the most frequently reported issue. Less common complaints included neck pain (2%) and, in isolated cases, headaches, hip pain, and elbow pain. Notably, 4% of respondents (3% of women and 4.7% of men) reported never experiencing pain while playing.

Gender Differences

Significant differences were found between male and female guitarists. On average, women had less playing experience (4.37 years) than men (6.82 years). Women also reported finger pain more frequently (88.7% vs. 83.1%) and wrist pain more often than men (62.9% vs. 55.9%).

Correlations

• The longer a guitarist had been playing, the more frequently they experienced back (rho = –.173**), leg (rho = –.142**), and shoulder pain (rho = –.186**).
• However, finger pain decreased with more years of playing (rho = .261**).
• Back pain was often accompanied by leg pain (rho = .235**) and shoulder pain (rho = .356**).
• Age did not correlate with pain frequency, but older participants reported spending less time on physical activity per day (rho = –.273**).
• The more frequently a guitarist took breaks, the less they experienced back pain (rho = –.178**) and shoulder pain (rho = –.189**).
• However, the overall daily practice time had a stronger correlation with pain than break frequency: longer practice sessions were associated with higher pain levels in the back (rho = –.256**) and shoulders (rho = –.247**).
• Guitarists who practiced for longer periods tended to take fewer breaks (rho = .289**).

What Do Guitarists Do About Pain?

On average, respondents practiced for 51 minutes per day and took breaks every 49 minutes. The most common response to pain was doing nothing. Among those who took action, the most frequently mentioned solution was reducing playing time. Fewer participants sought professional help, and only a small number mentioned adjusting their repertoire, playing posture, or technique. Some modified their instrument setup (string height and tension, strap length), did stretching exercises, massaged the affected area, or took extended breaks from playing.

Discussion and Future Research

Only 4% of respondents had never experienced pain while playing the guitar, yet most had no plans to address it. The ratio of practice time to break frequency suggests that many guitarists practice in long, uninterrupted sessions, and a simple way to reduce pain could be to take more frequent breaks. More than break frequency, total daily playing time was the strongest predictor of pain, aligning with previous research on overuse syndrome. Reducing daily playing time by adopting more efficient practice methods could be a practical solution.

Interestingly, pain frequency increased with years of playing and practice time but not with age. Additionally, there were no significant correlations between physical activity levels and pain while playing the guitar. This finding is consistent with Kenny and Ackermann’s (2013) study, which found that musicians who engaged in activities like yoga, swimming, running, gymnastics, or strength training did not experience PRMDs less frequently than those who did not exercise.

Among guitarists using a support device, back pain was the most common complaint—unlike other players, for whom back pain ranked fourth. This does not necessarily mean that the support device caused back pain; rather, it is possible that these players adopted a support device because of pre-existing back pain, as one respondent noted in the comments.

While the data reveal several interesting differences in practice habits, playing postures, and instrument types, those topics go beyond the scope of this article. The most important conclusion is that the hierarchy of pain locations is remarkably consistent across different types of guitarists. Future research could focus on case studies that not only map out pain locations but also investigate effective solutions for reducing pain.

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References

• Johnson, D. (2009). Classical guitar and playing-related musculoskeletal problems: A systematic review. Master’s Thesis, Lund University.
• Kenny, D., & Ackermann, B. (2013). Performance-related musculoskeletal pain, depression, and music performance anxiety in professional orchestral musicians: A population study. Psychology of Music. https://doi.org/10.1177/0305735613493953
• Marques, D.N., Rosset–Llobet, J., Fonseca Marques, M.F., Gurgel, I.G.D., & Augusto, L.G.S. (2003). Flamenco guitar as a risk factor for overuse syndrome. Medical Problems of Performing Arts, 18(1), 11–14.
• McBride, D., Gill, F., Proops, D., Harrington, M., Gardiner, K., & Attwell, C. (1992). Noise and the classical musician. British Medical Journal, 305, 1561–1563.
• Parasuraman, S., & Purohit, Y.S. (2000). Distress and boredom among orchestra musicians: The two faces of stress. Journal of Occupational Health Psychology, 5(1), 74–83.
• Zaza, C., & Farewell, V.T. (1997). Musicians’ playing-related musculoskeletal disorders: An examination of risk factors. American Journal of Industrial Medicine, 32, 292–300.
• Zaza, C. (1998). Playing-related musculoskeletal disorders in musicians: A systematic review of incidence and prevalence. Canadian Medical Association Journal, 158, 1019–1025.

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Publication Note

This article is a translation of an original research piece originally published in November 2013 in the magazine KITARR. The study remains relevant today, as many guitarists continue to experience playing-related pain. While the data reflects responses from that time, the findings provide valuable insights into the ongoing challenges of guitarist health and ergonomics.

Here’s how to read the Figure labels:

Istudes abivahendita → Sitting without support
Istudes jalatoega → Sitting with a footstool
Istudes pillitoega → Sitting with a guitar support
Istudes rihmaga → Sitting with a strap
Jah, aga on plaanis → Yes, but it is planned
Jah, olen vähem mänginud → Yes, I have played less
Jah, olen pöördunud arsti või muu spetsialisti poole → Yes, I have consulted a doctor or specialist
Jalad → Legs
Kas oled midagi oma valudega ette võtnud? → Have you done anything about your pain?
Keskmine → Average
Kui paljudel vastanutest on kitarrimängu ajal valutanud… → How many respondents have experienced pain while playing the guitar…
Klassikaline kitarr → Classical guitar
Mehed (n=254) → Men (n=254)
Muud vastused → Other responses
Mänguasend → Playing posture
Osalejate kasutatavad mänguasendid. → Playing postures used by participants.
Osalejate kasutatavad pillitüübid. → Instrument types used by participants.
Pillitüübid → Instrument types
Püsti rihmaga → Standing with a strap
Randmed → Wrists
Selg → Back
Sõrmed → Fingers
Õlad → Shoulders
Ei, aga on plaanis → No, but it is planned
Ei, tuleb ära kannatada → No, I just endure it
Elektrikitarr → Electric guitar
Basskitarr → Bass guitar
Naised (n=133) → Women (n=133)