Guitarist tendonitis – Shoulder, wrist, and finger pain – How to avoid them

Tendinitis: What Is It Really?

Tendinitis is a term commonly used to describe pain and other symptoms occurring in various tendons of the body.

Especially in (Abat 2017):

• Knees: Patellar tendonitis, pes anserinus tendinitis.
• Achilles Tendon.
• Shoulder: Rotator cuff tendinitis, supraspinatus tendinitis (for more specific information on this topic, see the article: Shoulder Tendinitis: Healing Time).
• Elbow: Lateral epicondylitis (Tennis elbow) or medial epicondylitis (Golfer’s elbow).

In medical terminology, the terms used are:

• Tendinopathy: Refers to tendinous pain without specifying the exact pathology.
• Tendinitis: An inflammatory reaction accompanying tendon injury, which is actually rare.
• Tendinosis: Tendon pain with damaged tendons (degenerative state) with few or no inflammatory cells.

However, This Doesn’t Change Much in Everyday Life. Therefore, I will use the term “tendinitis” for the rest of this article, as it is more familiar to most people.

Source: Charnoff 2022

Common Causes of Tendinitis

Despite decades of research on the subject, it remains challenging to fully understand why some people develop tendinitis while others do not, even in similar situations.

It is believed that:

• There is damage to the tendon.
• This damage triggers an acute inflammation.
• This inflammation initiates a process that leads to the deterioration of the tendon.

What causes this initial damage? Likely factors include:

• Mechanical stress: The strain on the tendon during movement.
• Repetitive overloads: Especially during professional or sports activities.
• Toxic chemicals.

Additionally:

• Age,
• Genetic predisposition,
• Comorbidities (other diseases),
• Lifestyle habits

all increase the risk of healing failure, which leads to tendinitis.

Source: Charnoff 2022

Usual Treatment for Tendinitis

The initial treatment for tendinitis, similar to that for musculoskeletal disorders in general, is primarily conservative:

• Relative Rest: Decrease the strain on the tendon without completely stopping all activity.
• Possible Application of Cold: To relieve symptoms (although this is debated).
• Physical Therapy: The role of the physical therapist is to help you identify the appropriate level of strain for your tendon in your specific case:
  • What daily activities, at what frequency and intensity?
  • Are specific exercises necessary?

❓ Regarding Anti-Inflammatories (NSAIDs): The usefulness of anti-inflammatories, whether taken as medication or applied topically, is debated. Recommendations are not unanimous.

❌ Corticosteroid Injections: Previously a common treatment, corticosteroid injections are no longer the first-line treatment. While short-term pain relief has been observed with steroid injections, long-term follow-up has linked them to less favorable clinical outcomes.

❌ Mesotherapy.

Most patients with overuse tendinopathies fully recover within 3 to 6 months.

For patients seeking more than conservative treatment, other options are available but should be carefully weighed for their benefit-risk ratio.

Source: Charnoff 2022

I will now hand over to Xavier (or rather, the writing!) so he can explain the specifics of tendinitis/tendinopathies in guitarists.

The Most Common Painful Areas for Guitarists

Studies on this issue are still relatively scarce, particularly when focusing specifically on guitarists rather than all instrumentalists. However, recent publications reveal some trends.

For musicians in general, the most common pain areas are primarily in the:

1. Cervical spine
2. Shoulders
3. Lumbar spine

For guitarists, there is a notable distinction with a predominance of pain in the:

1. Wrist
2. Fingers
3. Shoulder

In addition to studies on the subject, my personal observations of the most common consultation reasons in my practice also support this trend.

Note from Nelly: Keywords entered into search engines by users confirm this! The body parts most frequently associated with “guitar pain” or “guitarist tendinitis” are the fingers, wrist, and shoulder.

Directly Related to the Wrist and Fingers, the forearm and elbow are also very frequently sites of pain and tension during guitar learning due to their crucial roles in the instrumental gesture.

Of course, we are discussing musculoskeletal pain here, excluding more superficial skin issues, particularly at the fingertips.

What to Do if You Think You Have Tendinitis While Playing Guitar?

Here are some tips from Xavier on how to handle “guitarist tendinitis.”

Guitarist Tendinitis: Does It Really Exist?

First and foremost, to be more comprehensive (and in line with current terminology), we should talk about tendinopathy rather than tendinitis.

Does it really exist? Yes, absolutely!

However, such injuries are much less common than one might imagine.

It has become almost customary—especially in music—to label a large portion of musculoskeletal and tendinous pain as “tendinitis.”

Yet, true tendinopathies would constitute only about 10% of physical issues faced by musicians.

Guitarist Tendinitis vs. Overuse Syndrome

Conversely, more than 50% of physical issues are thought to originate from so-called “nonspecific” musculoskeletal-tendinous disorders, such as muscle overuse syndrome.

What is a “nonspecific” disorder?

It is a musculoskeletal-tendinous disorder that causes pain but does not meet the diagnostic criteria for a “specific” disorder (such as tendinopathy).

However, many guitarists (and more broadly, musicians) experience confusion between these two issues, which are closely related yet relatively distinct in many aspects.

This confusion can lead to not knowing how to address a physical problem that is poorly understood or misdiagnosed, resulting in inadequate or incorrect treatment.

How to Diagnose Tendinitis or Overuse Syndrome?

The diagnosis of an overuse syndrome is often made by exclusion.

In contrast to tendinopathy, it is not possible to clearly identify clinical signs and diagnostic elements for an overuse syndrome.

Ultimately, the absence of findings on various imaging techniques (ultrasound, MRI, etc.) and negative results from specific tendinopathy tests will reveal the presence of an overuse syndrome.

The symptoms of an overuse syndrome can be quite variable, but most commonly include:

• Pain during playing (specifically during play),
• Stiffness,
• Increased fatigue,
• Absence of pain that is purely analytical (targeting a specific muscle/tendon) and pain at rest or nocturnal pain (typical of inflammation or tendinitis).

How to Treat an Overuse Syndrome in Guitarists?

There are numerous therapeutic approaches for treating overuse syndrome, each with varying degrees of effectiveness as evidenced by the limited studies on this delicate subject.

However, it seems clear that certain practices are effective in addressing the needs of guitarists suffering from overuse syndrome.

Reconditioning the playing technique, in particular, helps eliminate the source of tension by analyzing and correcting any problematic movements that may have developed due to an inefficient playing technique. Improving physical condition and overall muscle strength is another practical approach that gradually alleviates overuse syndrome by enhancing muscular capacities.

Muscle care, including stretching and general lifestyle adjustments such as hydration, diet, and sleep, are also important factors to address.

Additionally, adapting equipment (such as straps and support accessories) and reorganizing work practices can play a significant role in managing overuse syndrome.

Other tools, such as strict rest, splints, yoga, and gentle exercise methods, can also be used, but they tend to be secondary in the approach to treating overuse syndrome.

Reconditioning the playing technique, improving physical condition, muscle care, lifestyle adjustments, and adapting equipment and work organization are the main strategies for treating what is often referred to as “guitarist’s tendinitis” (though it is more frequently an overuse syndrome).

How to Avoid Pain in Your Fingers, Hands, Wrists, and Shoulders When Playing Guitar

The main key to avoiding pain is to focus not just on the instrument, but on your entire body.

Especially during intense learning phases, it’s almost automatic to concentrate on the tips of your fingers, the part of your body in direct contact with the instrument, and responsible for the sound produced. Yet, how you position the rest of your body will impact your playing.

Neglecting the functional placement of your shoulders, back, and head is directly related to pain, as it can cause tension and strain.

Structuring your practice time is also crucial.

• Be progressive,
• Allow yourself breaks, ideally every hour,
• Change positions, standing/sitting,
• Switch guitars, amplification equipment (amp/simulator), repertoire, and technical work…

Variations are numerous and can help you progress much faster (and more safely!) compared to relentless sessions focused solely on a single musical motif you want to master at all costs.

Finally, maintaining a healthy lifestyle, as mentioned earlier, plays a significant role in preventing pain.

Your muscles and tendons need water and other nutrients; depriving them of these can also lead to pain.