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I've been playing guitar (both electric and acoustic) pretty seriously for about a year, 2-3 hours a day most days. I couple months ago I developed tendonitis in my fretting arm, which my doctor diagnosed as lateral epicondylitis, i.e. tennis elbow. My doctor predictably recommended laying off guitar for a while, using a compression bandage, icing it, taking ibuprofen, that sort of thing. I didn't see a specialist or physical therapist so the advice was sort of general.

I did more research on my own and found this article which describes a simple exercise that does eccentric loading of the tendon and is supposed to be great for this sort of injury, and it's been helping over the past few weeks. I do that plus daily icing of the tendons, which is also good. After a few weeks of abstinence I've worked up to playing a total of maybe 20 minutes every other day in short sessions (it's really bumming me out and I want to play a little). If anyone has more helpful advice on how I can treat it, I'm open, but I think it's just one of those things where you have to give it a few months to sort itself out.

My main question is this: assume I do all these things and in a few more weeks or a couple months, the pain is gone. How I prevent it from coming back? Do I need to make changes in my warmup/practice or my technique? I've read other questions from guitarists who have had fretting finger or hand pain; mine is related but in a different place.

My teacher, who's been teaching for 30+ years, didn't have anything at all to say about it; he's hardly heard of anyone having this sort of problem. I've talked to others and haven't learned a lot, other than that if you let it heal, you're not doomed to have it come back once you start playing again. I should definitely learn to develop a lighter touch when fretting notes and chords, which is something I've been working on, but other than that while I've heard of other guitarists who have had my condition, I haven't read a lot about what got them there and how they could avoid it.

Symptoms

Here's some additional information on my exact symptoms in case folks find this question because they're looking for info.

The pain is in my forearm, on the top/outside, a few inches below my elbow. When I first started getting it, I thought I might have had pain in the inside of my elbow too, but that wasn't the case -- I just wasn't locating the pain precisely. The pain isn't in the muscle, but the tendons that attach the muscles to the elbow. The pain isn't constant, but only comes on when I move my elbow to the extremes of its range, either bending or straightening, and also if I rotate my forearm outward. I have noticeable pain and greatly decreased grip strength if I extend my arm all the way and grasp something by pinching it between my thumb and other fingers. From what I've read these are all classic symptoms of tennis elbow.

Ironically, I have very little pain while playing, and I don't notice a particular pattern of more or less pain after I play or don't play, even into the next day. The pain isn't that intense; I wouldn't describe it as sharp, but any sort of chronic pain is something to be concerned about and correct; I don't want permanent damage.

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5 Answers 5

Sounds like you need to address several issues. You're probably squeezing the guitar neck way too tightly using your thumb more as a vice than a guide. Not necessary at all. You may need to change the angle you hold the guitar at- it could be pulled into your body.Let it out so that your fretting arm has fresh air all around it : too many players have the arm resting on or touching their leg. You may need to consider the height you have your guitar at - if it's low, there's too much bending of the wrist. You may need to think about the angle of the guitar compared to the floor. If it's pointing upwards, it'll relieve the strain.

Apart from all the stuff above - play little and often. Your teacher should have picked up on any/ many of these points, and suggested alternatives. I'm guessing that in the long periods of playing, you're sitting down. Try different seat heights.You may even find that a change to lighter strings, or setting the guitar up properly, so you don't have to press so hard will make a big difference. Cure the cause rather than the symptom !!

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I've definitely been squeezing too hard with the thumb, and I've also been pressing too hard when fretting notes, which puts even more stress on the thumb... I've been paying more attention to that since I started having pain. It hasn't made the pain go away, but I think I may need to let it heal completely and then better technique will hopefully keep it from recurring. Do you know more about problems with these specific tendons? They're involved with extending the fingers, not contracting them, which always I thought counterintuitive in a guitar RSI. –  Scott Barta Dec 16 '13 at 1:53
    
@Scott - it's not a problem I've come across in guitarists. The muscles/tendons of the thumb/wrist are more commonly affected, again, through gripping the neck too hard. I've posted on this site that one actually doesn't need to squeeze the neck to produce clear notes/chords.Tennis elbow is a misnomer - any overuse of a joint will produce some problems. Overuse in your case may well be physical positioning combined with prolonged playing. However, I'm not a doctor - never had the patients... –  Tim Dec 16 '13 at 15:59

After a mononucleosis I had tendonitis twice in my right forearm. The things you can do:

  • RELAX WHILE YOU PLAY!!!! That's the most f***ing important. Period. Ridiculously small amount of force you need when you play guitar. The approach of most people (including me, before I get to know methods of Jamie Andreas) is to use a lot of force, to ensure the string is pushed down, the strings are picked, etc. This is entirely wrong. You have to start from lightly touching the fingers and the neck of the guitar, and then figuring out the minimal required force to achieve your goals. First it will be very odd, as you will be losing the control. Then you understand that you can very much control the guitar with minimal energy as well. Later on, you will use force wisely, when needed.
  • My experience with the inflammation is that if you pay attention to your muscles, they will be telling you that you've worked too much. You had tendonitis, you KNOW that burning pain. You will start to feel that burning sensation again when you play too much; that's the limit your body can endure - injuries occur when people ignoring their limits. If you stop there, it will heal and strengthen for tomorrow. Take your time. Work on different talents: rhythm, train your ears, etc.
  • As Tim said, you better be playing daily less then having one-day marathons. Especially in the healing period. It's like if you are a runner who has inflammation, it's much better to walk daily a small amount, then sitting on your ass whole weeks. Also, muscles used for guitar playing are the same muscles then the rest. They performance is better with frequent small practice.

With the above methods I didn't have tendonitis for (about 7-8) years. I listened to my body and acknowledged my limits.

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The interesting thing with my injury is that I don't have any discomfort at all while playing, maybe only slightly if I'm stretching for a barre chord. I also didn't notice a particular pattern of having more or less pain the next day after practicing a lot or not at all. –  Scott Barta Dec 20 '13 at 15:44
    
And what about the days after the next day? If there's no pain on those, you can increase the amount of practice. Also, please note that I had a serious viral infection that I wasn't aware of (after the visible syndroms I would have to be train lightly for a year!), so probably you can have a hidden inflammation in your body or an infection which wasn't completely healed. –  atoth Dec 20 '13 at 15:52
    
The pain seems to follow overuse by maybe 2-3 days, though with a response that slow it's hard to tell if it's a real pattern or not. –  Scott Barta Dec 20 '13 at 16:00
    
To be honest, I'm not familiar with that pattern. My common sense would say you got to practice small amount every day (20 mins seems OK, to me). Seek out someone with a similar sport injury pattern, who has dealt with it. Also if a professional hasn't adjusted the neck of your guitar for you, it can be a huge a difference in terms of force needed to play the guitar. –  atoth Dec 20 '13 at 16:19
    
Since the problem was in your right arm, I'm hoping you play left-handed. Otherwise you've been holding your pick too tightly. –  Tim Jan 1 at 13:01

I haven't heard of this in any of my colleagues (guitarists) either, but I would say that you're right when you say that time will heal it. You'll probably have to put your gat aside for a couple of weeks for the sake of letting it heal, do some semi-regular stretches and light, easy strength exercises.

As for preventing it in future, my experience with this sort of injury is that once you've had it once, it's a whole lot more likely to come back again. You could try some physio on it while you're recovering (acupuncture, radiology, massage etc) - but keep doing light stretches and exercises on it and take it easy!

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i play guitar a lot, and new years eve the pain in my left arm was so constant and intense i had to call the emergency services. apart from the worry of nerve damage from the doctor that night my own doctor has diagnosed carpal tunnel and is booking me in for an op. it is very difficult to stop playing, been two weeks now and i can eel that my arm is still bad, or at least isnt gonna let me play too much. i havent tried any of the above treatments like cold compress or heat pads but am going to try them as i am getting to the point where i have to try everything to help. i think mine is a combination of tennis elbow and carpal tunnel problems. in the mean time i found this and boy, straight away i could feel it helped. check it out http://www.tennisarm.ch/ i am going to go easy with the exercises but his advice is to not stop what your doing, that there isnt a real trigger rather it is been a barrel filling up for years and you've just tipped obver the edge. the whole site makes a lot of sense and i felt the tension/pain ease almost immediatly. not to the point that it was healed but it has been the only thing that felt good and that was helping! hopefully it will help you.

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If the injury really is more of a muscle cramp as that website says, it would explain why heat worked so well on it -- heat is great for cramped muscles. Be careful you have no inflammation if you try heat though, because inflammation needs ice, not heat. Also, check out that exercise equipment I linked to -- it does the same thing as the stretches the website talks about, but it does a fantastic job really targeting the muscles and tendons to be stretched. Also, if you have carpal tunnel at the same time, be careful you don't aggravate that while treating the elbow. –  Scott Barta Jan 18 at 16:24

I'm answering my own question to document what I've been doing in case others find this question looking for help.

As of right now, I can only talk about what I've done to try to treat the injury; time will tell if changes I make to my technique (the other answers which suggest relaxing and not squeezing so hard seem right-on) prevent it from coming back.

Researching my symptoms more carefully, it seems like I may have tendonosis more than tendonitis. -itis is inflammation of the tendon, and I haven't seen other symptoms of inflammation -- no swelling, no redness, the pain isn't constant, and it didn't respond well to ibuprofen or basically not playing at all for about three weeks. -osis is degeneration of the tendon, from micro-tears that build up scar tissue.

I continued playing for maybe a couple months after first noticing the onset of symptoms (the pain was never so great that it was a dire concern, and I reached a good stopping place). Then I stopped playing and started trying to treat it.

In my question, I linked to an article about an exercise for tennis elbow. That describes an inexpensive piece of exercise equipment, a Thera-Band FlexBar, which is a rubber bar about a foot long that comes in varying diameters which correspond to resistance; I started with the red (10 lb) one and have worked up to the green (15 lb) one. You do an exercise where you grasp it in both hands, twisting it to force the hand of your bad elbow to try to curl inward, and do reps of straightening and slowly releasing your hand at the wrist; you can find pictures and videos of the exercise. This builds muscle and tendon strength by loading the tissues while they're stretching, which is supposed to be good for this type of injury (there's a similar type of thing you can do for -osis of the Achilles tendon in runners).

That exercise has helped somewhat. I've been icing the joint a couple times a day (always after doing that exercise to knock down any inflammation it may cause), and the icing has helped somewhat. I haven't been taking ibuprofen. I used an elbow brace for some number of weeks but stopped when it didn't really seem to be helping me. I stopped playing altogether for about three weeks, and after that would play a total of maybe 20 minutes every other day in short sessions, and only doing easy stuff.

All of these measures helped to a small degree, but after maybe six weeks of that I was at the point where the pain had lessened by maybe a third to half on a good day, but it was far from gone, and I still had decreased grip strength. The nature of the pain had changed a little, becoming slightly less localized and more diffuse, maybe due to the exercises, but I was starting to get a little discouraged even though I know these injuries can take a very long time to heal.

Within the past few days I've started heat treatment as well (a heating pad wrapped around my forearm), usually alternating with icing the joint, and that has made a huge improvement almost immediately. Within a couple days my pain is down by about 75%, even though I've been playing more (I got a new guitar, can't help myself). We'll see if this takes me to complete recovery, but I'm hopeful. If you're reading this because you have similar symptoms, you might want to evaluate your injury carefully to see if it's inflammation or not, because heat may not be the best treatment for inflammation, but if you're like me and ice alone isn't doing it, give it a shot.

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