Right arm pain

[gvurrdon]

Over the past few weeks an annoying issue has been building up, specifically pain in my right (picking arm) elbow and bicep. The pain increases such that by 30 minutes I've usually had enough, and straightening my elbow out again hurts even more. This pain affects guitar and bass guitar playing, but not double bass.
I took some instruments to a local physiotherapist and asked them if they could spot anything relevant as I played. One thing they found is that whilst playing the guitar, which is pretty much always seated, I was drawing back my right shoulder; this might be behind the bicep pain (not entirely sure about the elbow).
Playing standing up is less painful but the pain doesn't completely disappear, and I have to keep concentrating on keeping my shoulder in a reasonably stable position. My strap is adjusted so that the guitar is at roughly the same height sitting or standing.
Of course, a more detailed medical investigation could be useful. I'm waiting for an appointment but I have no idea when it might be.
Meanwhile, I wonder if anyone has any thoughts. I took a look at this thread: Posture when seated with guitar, what works for you?
...but I don't find the classical posture shown to be very comfortable and would rather keep the guitar on my right leg.
The guitars I'm using are a Telecaster, Les Paul and a Gretsch G2420. I've not noticed any great difference on my shoulder between them.

[John A.]

Over the past few weeks an annoying issue has been building up, specifically pain in my right (picking arm) elbow and bicep. The pain increases such that by 30 minutes I've usually had enough, and straightening my elbow out again hurts even more. This pain affects guitar and bass guitar playing, but not double bass.
I took some instruments to a local physiotherapist and asked them if they could spot anything relevant as I played. One thing they found is that whilst playing the guitar, which is pretty much always seated, I was drawing back my right shoulder; this might be behind the bicep pain (not entirely sure about the elbow).
Playing standing up is less painful but the pain doesn't completely disappear, and I have to keep concentrating on keeping my shoulder in a reasonably stable position. My strap is adjusted so that the guitar is at roughly the same height sitting or standing.
Of course, a more detailed medical investigation could be useful. I'm waiting for an appointment but I have no idea when it might be.
Meanwhile, I wonder if anyone has any thoughts. I took a look at this thread: Posture when seated with guitar, what works for you?
...but I don't find the classical posture shown to be very comfortable and would rather keep the guitar on my right leg.
The guitars I'm using are a Telecaster, Les Paul and a Gretsch G2420. I've not noticed any great difference on my shoulder between them.

I've had issues with pain in shoulders and elbows (both arms) at various times (not biceps, though). The cause of the pain has always turned out to be tendinitis (plus some arthritis in my right shoulder). Some of it is from repetitive-stress/over-use, some is chronic effects of a specific (tennis) injury. Left elbow pain was probably guitar-related (I was doing some things that stressed the elbow). The sources of the other cases were sports-related (tennis, weight lifting, cycling).

Once chronic pain emerged (or recurred), even though pain might be triggered and/or compounded by guitar playing, I have never found that adjusting my position or technique solved the pain. In all cases, what has done the trick is treating the injury underlying the pain by seeing an orthopedist who specializes in arms, getting a precise diagnosis, and then going through one or more courses of PT (I also had a cortisone shot once, but I it didn't do much). Probably not relevant to you, but getting the handlebars up much higher on my bike made a difference on both shoulders. Now that my elbow is OK, I don't do the thing that caused the problem, and the pain hasn't come back, but that change did not make it go away. PT did.

TL; DR: Don't self-diagnose or ask other guitar players. Go to an arm specialist for diagnosis, imaging, and treatment.

[gvurrdon]

TL; DR: Don't self-diagnose or ask other guitar players. Go to an arm specialist for diagnosis, imaging, and treatment.

Thanks for the reply.
I'm on the waiting list for an appointment but it's hard to tell when one might become available.
Unfortunately, there are various other possibilities for things which could cause RSI, though guitar playing is the activity which causes the most obvious pain.

[John A.]

Thanks for the reply.
I'm on the waiting list for an appointment but it's hard to tell when one might become available.
Unfortunately, there are various other possibilities for things which could cause RSI, though guitar playing is the activity which causes the most obvious pain.

Fortunately, I have a good health insurance plan (at least by US standards), and don't have to wait to see specialists. Good luck to you with that.

[wolflen]

The one avenue to at least help will be to exercise on a regular schedule before playing. Not only your arm/shoulder but entire upper body workout.

Of course consult with a doctor before doing such as it may not be the correct course of action.

The list of "causes" are many and varied. Nuro/muscular pain can be alleviated. I have had chronic right hand pain and it affected my playing..which caused
fear of not being able to play etc..The first thing I was told was "..try not to traumatize it.." and slowly..with exercise and doing some
positive thinking I was able to restore full function to my hand.

Hope you recover soon.

[Cunamara]

The odds are good that this is due to how you are using your body- not only when playing but in general. Most of us have poor motor/functional habits that we develop over the course of our lives that become chronic and entrenched: how we hold our heads, how we hold our shoulders, etc. It can cause transient or chronic neck pain, shoulder and arm pain, low back pain, etc.

I went to a master class with Mark Whitfield who talked about being wrongly diagnosed with ALS because of weakness in his hands affecting his ability to play guitar. For the most part, ALS results in disability and death within a year or two of diagnosis in the majority of cases. This was a pretty significant blow, as you can imagine. A little while later, he got a call rescinding the diagnosis and identifying that his problem was spinal stenosis in his neck. This was due to his lifelong habit of hoisting his left shoulder much higher than his right shoulder, lifting the guitar on its strap, which eventually caused irreversible problems in his spine. He had spinal fusion surgery and is functioning much better.

I would suggest consider looking into the Alexander Technique. This is taught in many music schools as a preventive strategy for repetitive strain injury. I have found it very helpful with my own neck and low back pain, even within just a couple of months study. It really takes a teacher to learn the technique properly, but there are books and videos available to provide more information and some things to try- there are several books aimed specifically at musicians. Adrian Farrell has a book written expressly for guitarists called Effortless Guitar.

[starjasmine]

Think very carefully to see if you can identify anything new in your routine - musical or otherwise. When you do get an appointment, bring this info up. In the meantime, ice works wonders. As does exercise in general, as long as you don't re-injure.

My most recent visit to the PT was due to sudden and intense interest in playing authentic Chicago blues, with a LOT more string bending than I ever do, every day, along with humoring my cat's newfound (but ultimately injurious) desire to sleep curled up in the crook of my armpit. After a few weeks of lots of extreme string bending, along with sleeping with my left shoulder raised WAAAY higher than it should be (hello Mr. Whitfield), I couldn't raise my arm to shoulder height. It hurt to try to drive or to shampoo. Doc diagnosed a torn rotator cuff.

Years ago, I used to have lower back problems till I started walking daily. I had a sit-behind-the-screen-all-day day gig and then I'd go home and sit some more while I practiced. Ice to reduce the inflammation, weekly massages to keep the muscles from locking up again, and just moving around more in general worked wonders.

Then there was the time I got tendinitis in my right shoulder from an ergonomically-incorrect desk setup at that day gig. There's no way I would have diagnosed this on my own. My whole arm hurt as if I had broken something. Doctor prescribed NSAIDs, ultrasound, icepacks, PT and correcting the ergonomics. I recovered but for a long time I still had to be careful not to overdo it in that shoulder.

These days, I have very few RSI issues; when I do notice something popping up, I can almost always trace it back to some adjustment I made in my picking technique or overdoing some fretting hand activity. If something hurts, I take it as a sign that I need to change.

Hope this wasn't a useless ramble ... good luck & do get to that appointment as soon as you can.

SJ

[gvurrdon]

Thanks for the suggestions.
The Alexander Technique might be worth a look. I'd not thought of it, though I happen to know a drummer whose job is teaching it. Perhaps I ought to get in touch with him...

[Kapn.K]

Best of luck. I'm almost 55, had one major rotator cuff injury 2 years ago. I have all kinds of pains that come and go. Some annoying and some you can't keep playing with. I almost always play standing up, now. Focus on posture and not looking at the instrument(helps your neck and shoulders). I do all my physical therapy routines on both arms. I think some is nerve path related. Just getting a little snug as they run through your shoulder down to your fingers. A good stretch that I feel in my armpits, helps. You may try adjusting the angle of your guitar as it slightly changes how and where you're resting your picking elbow. The body of the guitar may be putting pressure on a spot that your body just doesn't care for. Maybe take on more of a classical stance if you must sit. I even saw esteemed jazz guy Randy Rhoads, do it. lol. I know someday the pains will win but I'll fight to keep playing as long as I can.

[Cunamara]

Certainly worth having a talk with your friend. AT really does need the hands-on guidance of a teacher rather than watching videos or reading a book. Videos and books are helpful for supplementing what the teacher can show you, but so much of the learning is nonverbal. I had a weeklong workshop and I'm now taking a semester class at the university music department nearby (senior citizen education program, no tuition charge).

starjasmine's advice is spot-on: if it hurts, there's a reason. Don't treat the symptom, identify the root cause and treat that.

[pauln]

Good luck in your search for a solution.
Not a specialist, but here're my thoughts...

Left shoulder
Most put the strap between their neck and the outer edge of their shoulder. The muscle under the strap is suspended between the neck and outer end of the shoulder. The force of the strap presses down on the muscle and the increased tension tries to draw the neck to the left. The raising of the left shoulder is an attempt to relieve that.
Some use a wider strap with padding, but the force is the same (the guitar doesn't get lighter), just the distribution of the force is over a greater length of the muscle. This only relieves the "digging in thin strap" discomfort, but does not change the total down force or tension in the muscle.
Worse, if you like to position yourself so that looking down your finger board and looking at the rest of the band are both in the same direction; you might spend a whole set with your head held turned to your left - the muscle under the strap further tightened and the pull on the neck while it's turned from neutral orientation. A solution to just this aspect is to move to the other side of the stage and alternate looking at the finger board and the band, turning the head both ways.
The solution for the strap itself is to move it to the outer edge of your shoulder. The old style straps that tied to the head stock ran up the back and off the outer edge of the shoulder. You can get the same comfort using a thin strap run out over the "corner" of your shoulder (a rough underside like leather helps to learn how to keep it in place).
I have used mandolin straps for decades - perfect length, no metal buckles, just a nice 3/4 inch strip of leather.

Right shoulder
Those that offset the guitar to their right (right leg when sitting, "John Cash style" when standing) are holding their right arm back with considerable continuous force using back right shoulder muscles, superimposing the action of playing on already tensed geometry, also off neutral center. The solution is the bring the guitar to center and let your right arm fall naturally forward to the guitar (using the strap out over the edge of your shoulder promotes positioning the guitar to center, good left arm form). That is, your picking hand is over your navel rather than your right belt loop.
Depending on your picking technique, this may also help unload the down force against the guitar body that some players apply with their forearm in order to stabilize their picking hand.