Neck and shoulder pain in musicians usually comes from holding one position for a long time while the arms make small, repeated movements. The neck muscles, the muscle over the top of the shoulder (upper trapezius), the rotator cuff and the nerves running from the neck to the arm take most of that load. The common problems are muscle strain, rotator cuff irritation and nerve irritation at the neck or near the collarbone. Most ease with changes to practice time and position.
Key takeaways
- Load: most playing-related neck and shoulder pain comes from long sessions in one position or practice time added too quickly.
- Instrument patterns: violin and viola load the left side of the neck; guitar and bass load the strap shoulder and a neck bent toward the fretboard.
- Practice changes: a few minutes off every 25 to 30 minutes and slow increases in practice time are the main changes.
- Tingling in the fingers: this can come from a nerve in the neck or near the collarbone and is worth checking if it keeps returning.
Common problems by instrument
- Violin and viola: the head turns and tilts left to hold the instrument against the collarbone, and many players lift the left shoulder to grip it. Pain builds on the left side of the neck and over the top of the shoulder. A chin-rest and shoulder rest that leave a gap make you clamp harder. The bowing arm holds the right shoulder partly raised, which can irritate the rotator cuff on that side.
- Guitar and bass: a strap puts the weight on one shoulder; an electric bass often weighs 4 to 5 kg (9 to 11 lb). Looking down at the fretboard keeps the neck bent forward, so pain often sits at the base of the neck and as pain between the shoulder blades. A wider strap spreads the load, and sitting for part of a rehearsal removes it.
- Piano and keyboard: pain comes from slightly raised shoulders, a head pushed forward to read and a bench at the wrong height. As a starting point, the forearms sit roughly level with the keys and the music sits where you can see it without dropping the chin.
- Drums: reaching up and across to cymbals hundreds of times a session loads the rotator cuff. Pain at the top or outer shoulder when reaching up fits shoulder impingement. Lowering the most-used cymbals and bringing them closer cuts the reaches above shoulder height.
- Wind and brass: flute players hold both arms raised to the right with the head turned left, a position linked with neck pain and arm tingling. A saxophone neck strap pulls the head forward. Brass players often stand with the upper back rounded, and pain builds between the shoulder blades on long days.
Early warning signs
Pain from small movements repeated for hours is often called RSI (repetitive strain injury) in the neck and shoulders. It tends to build in steps:
- Pain while playing that settles within an hour: the earliest stage.
- Pain that starts earlier in each session: the tissue is tolerating less than it did.
- Pain that lasts into the next morning: load is outpacing recovery.
- Pain in everyday tasks: carrying a bag or reaching to a shelf.
Practice changes that reduce load
- Breaks: stop for 3 to 5 minutes every 25 to 30 minutes.
- Gradual increases: add practice time slowly, for example 10 to 15 minutes a day each week, rather than doubling before an audition or tour.
- Shorter sessions: two 45-minute sessions usually load the neck less than one 90-minute session. Start with 5 to 10 minutes of easy playing.
- Set-up: chin-rest fit, strap width, bench or stool height and a music stand at eye level.
- Higher-risk periods: a new instrument, new technique or a run of performances. Plan extra breaks around them.
Pain that settles within an hour of playing is the stage where small changes to practice work fastest.
Keep going or ease back
- Pain that settles within an hour: keep playing, with shorter sessions and regular breaks. Most people notice a change within 1 to 2 weeks.
- Pain that lasts after playing: cut playing time to about half for 1 to 2 weeks, in 15 to 20 minute sessions, and see a physical therapist who will watch you play. Ask which structure is irritated.
- Pain at night or with tingling: stop or sharply reduce playing until assessed.
- Rebuilding: add 5 to 10 minutes per session every few days if the next morning is no worse. Full practice often takes 4 to 8 weeks after a muscle strain and several months after nerve or tendon problems.
Where else this could be coming from
- Muscle strain: neck muscle strain and knots give tender spots at the side of the neck or top of the shoulder, without arm symptoms.
- Pinched nerve: a pinched nerve in the neck sends pain into the arm, often with tingling in particular fingers, and is often worse looking up.
- Thoracic outlet: thoracic outlet syndrome gives arm and hand symptoms that build with the arms held up or forward, the position of violin and flute, and ease when they come down.
- Rotator cuff: rotator cuff tendinopathy gives pain at the outer upper arm, worse lifting the arm out to the side.
- Forearm and hand: pain in the elbow, wrist or hand from playing is a separate problem from the neck and shoulder.
Call your local emergency number or go to the emergency department if
- Chest symptoms: chest pain or pressure with pain in the left shoulder, arm, neck or jaw, especially with breathlessness or sweating.
- Sudden weakness: sudden weakness in an arm or leg, unsteady walking, or loss of bladder or bowel control.
- Injury: severe neck pain after a fall, such as from a stage.
See a doctor today if
- Swollen, discolored arm: one arm becomes swollen, heavy and bluish, which can be a clot in an arm vein.
- Pale or cold hand: the fingers turn white or cold and do not recover when you lower the arm.
- Worsening weakness: arm weakness that grows over days, such as trouble holding up the bow.
Get it checked soon if
- Pain that outlasts playing: pain lasts into the next day for more than 2 weeks despite reduced playing.
- Recurring tingling: finger tingling keeps returning when you play.
- Painless loss of control: the fingers or mouth muscles stop responding normally while playing. This can be focal dystonia, assessed by a neurologist.
More on this area: neck and shoulder pain by job and sport.
Most playing-related neck and shoulder pain eases when practice load changes early.
Written by Louise Yow, Neck & Shoulder Physio.