Playing an instrument is not just an art form. For our bodies, it can feel like an athletic pursuit. Specifically, research estimates that between 46% to 90% of musicians will experience at least one playing-related musculoskeletal disorder at some point in their lives.[1][2] This is because behind every performance is hours of holding precise positions, repeating intricate movements, and the strength of maintaining control at all times. And just like other athletic pursuits, musicians can often be left with pain and discomfort.
When pain or an injury develops, it’s not about pushing through or taking a short break to recover. It’s about understanding why your discomfort or symptoms have occurred and what you can do to not only recover, but to stop the problem from returning in the future. This is where working with a physiotherapy team experienced in working with musicians, like our team here at PhysioCentral, is invaluable.
Understanding the Musician’s Body
Adding to the comparison between being a musician and an athlete above, here’s one thing that must be highlighted: musicians rarely receive the stringent physical preparation and injury prevention advice that athletes do, despite their bodies potentially undergoing a range of strains:
- The neck, shoulders, and spine need to support static postures and fine control. This is why the neck is one of the most commonly reported regions of pain across various instrument types, according to research.[3][4]
- The arms, wrists, and hands need to perform precise, repetitive movements. This is particularly relevant for keyboard, string or wind instrumentalists, with studies reporting hand or wrist pain in up to 65% of musicians.[5]
- The jaw and facial muscles are needed to stabilise mouthpieces or hold instruments.
- The breathing muscles may need to adapt to support wind and brass playing.
All of these require strength, endurance, and coordination. Unfortunately, without training or awareness of these potential problems and the need for prevention strategies, these small mechanical stresses accumulate and can lead to pain or injury.
Why Musicians Are Prone to Pain and Injury
The most common causes of pain, discomfort or injuries that our physiotherapists see among our clients who are musicians include:
- Repetition and overuse: every scale, arpeggio, or bow stroke is a small, controlled movement. When you multiply that by hundreds of hours of play, you can create significant strain on muscles, tendons, and joints.
- Sustained postures: long rehearsals require holding the same position, such as sitting at a piano, standing with a violin or guitar, or supporting a heavy brass instrument. A static posture promotes stiffness, reduced circulation, and general fatigue.
- Asymmetry: instruments are often asymmetrical. Violinists tilt and rotate their heads and shoulders. Guitarists lean and twist. Pianists often favour one side subtly when reaching keys.
- Early and intensive training: here in Hong Kong, many children start lessons young and practise for long hours. Developing bodies are particularly vulnerable to overload if posture, rest breaks, and strengthening aren’t addressed.
- Performance pressure and stress: anxiety before exams, auditions, or concerts can increase muscle tension, especially in the neck, jaw, and shoulders, making the pain worse.
Common Problems We See in Musicians
While injuries will vary depending on the instrument you play, there are some common problems we see repeatedly:
1. Neck and Shoulder Pain
Violinists and violists hold their instruments between their shoulder and chin, loading the neck and trapezius muscles. Pianists can lean forward over the keys. Guitarists hunch to see the frets. Over time, this can lead to muscle fatigue, joint irritation, nerve sensitivity, and tension that spreads to the upper back and arms.
2. Upper Back Strain and Posture-Related Fatigue
Spending long periods sitting or standing can encourage a slouched or rounded shoulder posture and increased curvature through the spine over time. This posture restricts lung expansion (which is important for wind and brass players) and can lead to mid-back stiffness and aches. It can also affect shoulder blade movement and make arm use less efficient.
3. Jaw Pain and Headaches
Known as temporomandibular joint (TMJ) dysfunction, this is common in wind and brass players who hold a mouthpiece firmly and maintain prolonged jaw tension. String players with head rotation can also irritate jaw muscles. Jaw issues often cause headaches around the temples or behind the eyes.
4. Wrist, Hand, and Finger Overuse
Pianists, guitarists, and string players use high-speed, repetitive finger and wrist movements that can inflame tendons and irritate nerves (including carpal tunnel syndrome). Small joints can become stiff or painful, making fine motor control more challenging.
5. Nerve Irritation and Tingling
Positions that involve neck rotation or arm elevation can irritate nerves passing into the arm and hand. This may feel like tingling, numbness, or reduced grip strength.
How Physiotherapy Can Help
Here at PhysioCentral, we use various techniques and therapies to support our clients involved in music. These include:
Comprehensive, Music-Specific Assessments
During this assessment, where possible, we can:
- Analyse your instrument set-up and posture
- Observe your playing technique
- Assess your neck, shoulder, jaw, spine, and upper limb mobility and strength
- Screen for nerve sensitivity and muscle imbalance
- Gain a strong understanding of the specific physical demands of your instrument, which allows us to tailor a personalised rehabilitation plan
Personalised Exercise and Conditioning
Most clients we see have never had a physiotherapist or physical therapist teach them how to best support their bodies. Part of a treatment plan often involves custom-prescribed exercises to help:
- Build deep neck and shoulder stabiliser strength
- Improve upper back endurance and posture control
- Support finger, wrist, and forearm control
- Address imbalances from asymmetrical playing positions
For example, violinists might work on controlled neck flexion and scapular support, while pianists may focus on forearm and wrist control with shoulder stability.
Hands-On Therapy for Relief
As part of your care with us, we may use:
- Soft tissue release to ease tension in overworked muscles
- Joint mobilisation to restore regular neck, shoulder, and spine movement
- Dry needling or acupuncture for stubborn trigger points
- TMJ techniques for jaw pain and headaches
Instrument Set-Up and Ergonomics
Even minor adjustments can change how your body feels:
- Optimising chin and shoulder rests for string players
- Adjusting chair height, bench distance, and foot support for pianists
- Looking at strap and stand positions for guitarists and wind/brass players
- We also discuss practice habits, including warm-ups, breaks, and recovery strategies, to help protect you from overload.
Prevention: Protect Your Passion
Pain and discomfort aren’t things anyone wants as part of their music journey, and it certainly shouldn’t be seen as the price of progress. Our physiotherapists spend time teaching you how to recognise, manage and prevent problems before they stop you playing. We may discuss:
Warm-up help routines for the neck, shoulders, hands, and jaw
Micro-break strategies, pausing every 20–30 minutes to reset posture
Strength and mobility programmes to support long sessions
Awareness of early warning signs like tingling, fatigue, or jaw tension
Balanced practice schedules, combining technique work, creative play, and breaks to reduce repetitive strain.
For young musicians and parents, establishing these habits early on can help reduce the likelihood of chronic injuries that often affect adult players.
Specialist Support You Can Trust
Our physiotherapists understand the unique physical challenges musicians face. We have physiotherapists on staff, such as Jeremy, who work extensively with musicians of all ages to support them on their journey. His areas of speciality also include the neck, shoulder, jaw pain, and headaches.
Your body is an essential part of your instrument. Taking care of it is crucial for your long-term comfort and continued enjoyment of your craft. If you’re a musician at any level and are struggling with pain that you suspect may be related or that is limiting your ability to play, we’re here to help. Book an appointment online by clicking here or call us on +852 2801 4801
References:
[1] https://pubmed.ncbi.nlm.nih.gov/35678565/
[2] https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.772357/full
[3] https://www.mdpi.com/1660-4601/17/11/3991
[4] https://pubmed.ncbi.nlm.nih.gov/35678565/
[5] https://pubmed.ncbi.nlm.nih.gov/29705171/