What Hurts the Guitarist?

Intro and background

Besides general health problems, many musicians also suffer from specific, playing-related musculosceletal disorders (PRMD). These are most often connected to the muscles of the back, neck, limbs and face, and have been documented since the end of the 19th century. The highest risk group of PRMD are the female musicians and string players (Zaza, Farewell, 1997; Kenny, Ackermann, 2013).

Playing a musical instrument means a lot of repeating movements and often the player has to stretch her hands and fingers to extreme positions, which can cause one form of the PRMD – overuse syndrome. A Spanish study has found that 75% of the guitarists from their sample were suffering from the overuse syndrome, thereof 62.5% of the classical guitarist and 87.5% of the flamenco guitarists, who also were reported to practice more (Marques et al., 2003)

David Johnson (2009) analyzed 13 articles on guitarists’ PRMD and found that using a foot stool instead of a guitar support raises the risk. He also brings out the the medicine related to the performing arts is comparatively young and basically starts with the birth of the magazine Medical Problems of Performing Artists loomisega in 1986.

In addition to PRMD and the overuse syndrome, the health problems of musicians are also caused by extreme doses of loud sounds (McBride et al., 1992) and working stress (Parasuraman, Purohit, 2000). These problems are more common amongs the professional musicians while current study focuses on the problems that also hobbyist have – feeling pain while playing. I have investigated the relations between the pain and practicing habits.



Translation: Pillitüübid=types of guitar, akustiline kitarr = acoustic guitar, klassikaline kitarr=classical guitar, elektrikitarr=electric guitar, basskitarr=bass guitar, keskmine=average, mehed=male, naised=female

Participants. 387 hobby-guitarists with mean age of 30.82 years and 5.98 years of playing history submitted the questionnaire. 66% were male, 34% female.


Translation: Mänguasend=playing position, istudes abivahendita=sitting without any additional devices, istudes rihmaga=sitting with the strap, püsti rihmaga=standing with the stratp, istudes jalatoega=sitting with a foot stool, istudes pillitoega=sitting with a guitar support.

Measuring. The participants estimated on a 5-point Likert scale how often they have experienced pain in back, shoulders, wrists, fingers, and feet while playing. They also had a chance for free comments. The Spearman correlation was used to detect the relations between variables and t-test to compare the means.


What hurts?

Most often the pain was experienced in fingers (85% juhtudest), followed by wrists (58,4%), shoulders (38,2%), back (35,8%) and feet (14,2%). The rank was the same regardless to the playing experience, playing position, and type of guitar with one exception: for those who use a guitar support instead of a footstool (n=16) pain in the back was the most frequent. Some mentioned pain in neck (2%), head, bottom, elbow. 4% said they never feel pain while playing (3% females, 4.7% males).

Translation: Kui paljudel..= How many people said that their … hurts while playing, sõrmed=fingers, randmed=wrists, õlad=shoulders, selg=back, jalad=feet

Male vs Female

Statistically significant differences between male and female participants were the playing experience (4.37 average years for females, 6.82 for males), feeling the pain in fingers (female 88.7%, male 83.1%), and wrists (female 62.9%, male 55.9%)


The longer the playing history the more pain in back (rho= –.173**), feet (rho= –142**) and shoulders (rho= –.186**). And less pain in fingers (rho=.261**). If the back hurts, then often do the feet (rho= .235**) or shoulders (rho= .356**).

Relations between age and the frequency of feeling pain while playing the guitar were insignificant. The more breaks between practice sessions the less pain in the back (rho= –.178**) and shoulders (rho= –.189**). The longer the practice sessions, the more pain in the back  (rho=–.256**) and shoulders (rho=–.247**). The longer the practice session the less breaks (obvious!) (rho= .289**).

What do people do with the pain?

On average, the participants practise 51 min per day and have breaks after every 49 minutes. By far the most frequent answer to the question “What have you done with your pains?” is “Nothing”. Others named playing less and some people have visited a doctor. A few participants said they have changed their repertoire, playing position or playing techniques, also adjusting the guitar (height and tension of strings, length of strap), exercising, longer playing breaks.


Only 4% said they never experienced pain during playing the guitar. Nevertheless most of the participants plan to do nothing to solve the problem. The ratio of playing sessions and the frequency of taking breaks indicates that most of the players never have breaks. More than the frequency of breaks, having pains was predicted by the overall length of the time dedicated to practicing. It is in line with previous research on overuse syndrome. Reducing the overall practicing time is possible via using more effective practice methods.

It is remarkable that having pains is related with playing experience but not with the age of the player. Moreover, physically more active people do not have less pains which is in line with Kenny and Ackermann (2013): people practicing yoga, jogging, swimming, exercising, going to gym etc do not have less PRMD.

midateedTranslation: Kas oled oma valudega midagi…=Have you done anything with your pains?;
Ei, tuleb kannatada=no, gotta suffer 🙂
Jah, olen vähem..=yes, I play less
Ei, aga on..=no, but I will, jah, olen pöördunud..=yes, I have visited doctor or other specialist, Muud…=other

Players with guitar support (instead of foot stool) experienced more pain in back than others. Probably we should not conclude that their pains are caused by the guitar support. Rather it is likely that they have started to use guitar supports because they wanted to reduce the pain they already had. This is also what one participant said.

Although there are interesting relations between different guitar types and practicing habits, it was out of the scope of current study. The most important result is that the participants of this study felt pain in exactly in same body areas regardless to their instrument type or playing position. A case study would be appropriate to move on with investigating the possible solutions.


Johanson, D. 2009. Classical guitar and playing-related musculoskeletal problems. A systematic review. University of Lund.

Kenny, D., Ackermann, B. 2013. Performance-related musculoskeletal pain, depression and music performance anxiety in professional orchestral musicians: A population study. Psychology of Music, avaldatud elektrooniliselt 2. sept. 2013. DOI: 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, 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, 1019–25.


** p<.01, * p<.05


Author: Kristo Käo, MA, guitar pedagogy lecturer at the Estonian Academy of Music and Theatre, PhD student of educational technology at the University of Tartu, partner of MatchMySound.com
Originally published in Estonian, Sept. 2013 (guitar magazine KITARR). Rough and shortened translation.

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