Tools for Injury Prevention
The top 5 goals for most musicians are to play well mechanically, expressively, and (most of the time) from memory. Unfortunately, many musicians develop mild to severe injuries in attempts to reach these goals.
A survey “of roughly 400 Berklee-trained musicians revealed that 78 percent of respondents experienced pain, numbness, or discomfort while practicing or performing…though guitarists and pianists are among the most often injured." But injuries aren’t limited to professional musicians; they’re also a common occurrence in amateurs according to a study published in PLoS One. Anecdotally, I've never met a musician who hasn’t had some kind of repetitive stress injury (RSI) at some point in their musical path.
Tendinitis (inflammation of the tendons).
Carpal Tunnel Syndrome (median nerve compression & inflammation).
Acute & Chronic Pain (hands, wrists, arms, shoulders, back, hips, knees, legs, & neck)
Chronic Muscle Fatigue
Focal Dystonia (not common, but very serious).
Spinal Disk Herniations (not common, but very serious).
Fortunately, most injuries tend to be relatively minor and temporary but others, like focal dystonia & spinal disk herniations, can be very serious and potentially permanent. In both cases, the causes are basically the same.
TOO MUCH PRACTICE
Naturally, there isn’t one simple answer. It depends on multiple factors including your age, practice time availability, general health, how much you exercise, your sleep schedule, and individual differences based on genetics.
The younger you are, the more resilient the body is, which means you can generally practice longer than many adults. Also, if you have a regular exercise routine, are in generally good health, and get about 7-9 hours of sleep regularly, then you might be able to engage in longer practice sessions without significantly increasing your risk of developing an RSI.
That said, the general recommendation (e.g., 6) is that a practice of 2-4 hours per day is enough and that after 2 hours, we risk experiencing diminishing returns if we don't have our practice well-planned. Each practice session should never exceed 60 minutes which includes a 5 to 20-minute warm-up, a 40-55 minute strategic practice and/or performance practice session, followed by light stretching and plenty of movement. At a professional level, you may engage in a maximum of three to four 60-minute practice sessions per day with at least 1 hour of rest between sessions.
Personally, my limit is two 60-minute sessions during the day, every day, and one 20-30 minute session at night for 3 days/wk. This works very well for my body and my musical goals. Keep in mind that I have been a professional musician for 21 years and have worked my way up to this amount of practice over time.
Regardless of whether you are an amateur musician or professional, I always recommend starting with a small amount of practice time and working your way up gradually. Start with one 15-minute session per day for 2 weeks, then try 30 minutes/day for the next 2 weeks, and so on, until you reach 60 minutes.
Too much practice also means repeating something too many times in a row (esp. in one sitting). And, of course, excessive repetitions basically guarantee RSIs.
Our intuitive approach for a challenge-spot (CS), for example, might be to repeat a correction 15 times before moving forward. But it's significantly better for both memory and injury prevention to do 5 repetitions of one CS in 3 sets, interleaved with a few more CSs. For example, a better and safer repetition schedule might look like this:
Set 1 = CS1 (x5) --> CS2 (x5) --> CS3 (x5)
Set 2 = CS1 (x5) --> CS2 (x5) --> CS3 (x5)
Set 3 = CS1 (x5) --> CS2 (x5) --> CS3 (x5)
Unfortunately, starting later in life increases our risk of developing injuries (7). Our bodies are much more resilient when we are younger and can handle more physical stress. As kids and young adults, we also heal faster, so if we do get a minor injury, we can usually get over it pretty quickly.
If you’re starting later in life (like I did), think of music practice as a new sport and ease into it. As you get more comfortable and develop more endurance, you can increase your practice time gradually.
POSTURE & TENSION
Playing with poor posture and too much body tension is a very common cause of RSIs for musicians (1, 2, 4) For the body, good posture includes having a comfortably straight back & no hunching over at the neck or upper back. For the arms and hands, good posture is a little more complex, but it ultimately should feel and look, as close as possible, to your natural arm and hand movements when you are not playing guitar. Too much bending at the wrist, shoulders at the ears, fingers that bend in exceedingly unnatural ways, and hunching over at the neck are all signs of bad posture that can significantly increase your risk of developing an injury.
Excess tension, especially in the left hand (i.e., pressing too hard on the fretboard) is the leading cause of tendinitis and carpal tunnel syndrome for guitarists. Always make sure to play with minimum pressure in the left hand and minimum effort in both hands. If a passage is difficult for your left hand, first practice the passage with muted notes where you place your fingers on the strings, but do not press down on them. Once you memorize your positions and can move your fingers freely, begin adding pressure gradually.
Research also shows that not taking enough breaks to relax and stretch can make us more prone to developing RSIs (e.g., 8). I recommend taking three kinds of breaks during your practice:
Micro-Breaks: 2-10 seconds long. I prefer taking these after every 1-2 repetitions.
Movement Breaks: 2-3 minutes to stand up, stretch, walk around, or do some quick cardio (e.g., jumping jacks).
Long breaks: at least 60 minutes between each practice session with a Maximum of 3 practice sessions per day.
Coincidentally, I made a video on the importance and benefits of taking breaks where I show you exactly how to implement each kind of break into your own practice.
STRESS & ANXIETY
It should come as no surprise that practicing with high amounts of stress or anxiety can cause us to become tense which can lead to a mountain of injuries including one very serious injury called focal dystonia (FD). FD is a neuromuscular disorder that seems to result from years of long-term stress, anxiety, and tension while playing (1, 2, 3, 4). In this kind of injury, the muscles used for playing stop responding in the way that we want them to respond -- as if they had minds of their own. This injury tends to be pain-free but also extremely persistent and pretty debilitating in terms of music performance. Imagine trying to curl your fingers and seeing one of them extend instead! That's focal dystonia.
Stress and anxiety in music can come from many different sources including life stress (unrelated to music), stress from performing in public (i.e., performance anxiety), and anxiety from having a perfectionist mindset (i.e., worrying about, and avoiding errors like the plague). The most common source for many musicians who start later in life is anxiety from having a potentially unhealthy perfectionist (i.e., error-free) mindset. So what can we do about this?
Here are some ideas that work well for me before and during a practice session:
Take a few deep breaths and consciously relax, your mind and body.
Have a cup of caffeine-free tea (chamomile).
Engage in 5-15 minutes of interoceptive meditation where you sit still, close your eyes, and focus on both your breathing and how your body feels.
Remind yourself that mistakes are a necessary part of the learning process. Do your best not to get upset or anxious about them. Getting anxious about mistakes increases the probability of making them more often! When you do make a mistake, think of it as a significant improvement opportunity (SIO) for you to improve your playing.
Never avoid mistakes! Instead, allow them to occur and then stop immediately to problem-solve, and correct them. Practice changing your mindset from error prevention to error correction.
There is no neuroscience showing that drugs and alcohol are beneficial for learning even though they may help you relax in the short term. So, personally, I don’t recommend them for stress and anxiety relief.
The amount of research out there on how proper sleep is essential for efficient learning and how insufficient sleep negatively affects learning and memory is more than I can count at this point (e.g., 2, 8, 9). There's also research showing how less than 7 hours of sleep per night, on average, for most people, can increase our risk of developing injuries (e.g., 11).
As often as possible, make sure that you are getting between 7 to 9 hours of solid sleep every night. Not only will this help you learn better, but you will have much more energy, a much higher ability to focus, and a lower chance of developing an RSI.
When I first started learning guitar, my practice routine was basically nonexistent. I would just play whatever I had in my head and hoped that by doing so often I would get better. This turned out not to be the best strategy and my progress was very slow as a result.
Unsurprisingly, I also got injured a lot because I would engage in way too many repetitions and practice for too long. So make sure that you have an efficient practice routine that is written down. In this practice routine, you should clearly state your specific goals, challenges, and the solutions for each challenge for each piece, exercise, falseta, etude, or excerpt you want to work on.
I also recommend writing down a limit for how many repetitions you do as well as a time limit for each challenge-spot you are working on. For example, I give myself a maximum of seven repetitions -- 3 correct reps. in a row -- and a maximum of five minutes for any trouble spot. Once I have gone through 3 to 5 troublespots, I repeat them for 1-2 more sets.
A NOTE ON PAIN
A few neurological studies (e.g., 3, 10) have shown that musicians tend to be more sensitive to pain than non-musicians (esp. resulting from pressure and heat). For example, a safe but hot 100°F cup of coffee might feel like burning hot 150°F to a musician even though it’s not really burning them. According to this same research, this is “probably due to use-dependent plastic changes elicited in somatosensory pathways” that make us perceive pain as stronger than it actually is.
The implication is that a tiny bit of pain might not necessarily be a sign of trouble and might not necessarily mean that we have to take a long break from playing until the pain goes away.
But…please take this with a grain of salt. I’ve only found 2 studies on this so we should judge our pain on an individual and situational basis. In my opinion, if it hurts to play, take a quick break to analyze why this might be the case and make adjustments to your posture, hand pressure, tension level, and playing intensity. If the pain disappears, continue playing. If not, take a longer break. And if the pain persists after the long break, talk to your doctor.
Injury prevention should be at the top of our list with regard to music practice. Please take the information above very seriously. Injuries, whether they are acute or chronic, or mild to severe, slow our progress and are, of course, painful and exceedingly annoying.
If you find yourself getting injured often and cannot find a solution, please contact me to see if I can help!
For guitar lessons, lectures, workshops, and educational performances please contact me below as well or at firstname.lastname@example.org.