Written by Gergely Olah (aka Greg) | Movement specialist & guitarist
I help musicians get rid of playing-related injuries like wrist pain, tendonitis or carpal tunnel syndrome since 2017 with my 7 years of experience in the field of movement and health.
Guitar tendonitis is probably the most frightening injury among guitarists. (It certainly affects other musicians too, like pianists or violinists, but let’s not lose our focus.)
It this article we are going to go over the symptoms and the root causes of guitar tendonitis, and then the do’s and don’ts of a successful treatment plan.
First, what is tendonitis?
Every medical term ending in -itis simply refers to inflammation, so tendonitis literally means the inflammation of tendons (although you will learn that it’s much more than that…)
And the tendons are the structures that connect muscle to bone. They are much stronger and less elastic than muscles, with weaker blood flow. This is going to be very important later!
In fact, tendonitis is an umbrella term because depending on the location of the affected tendon, the symptoms can vary a lot. Guitar tendonitis usually affects the elbow, forearm (wrist), or fingers, so that’s where the symptoms develop. Sometimes these symptoms are given a name, like “De Quervain’s” in case of thumb tendonitis.
What are the symptoms?
(Some guitarists scream tendonitis as soon as they feel something in their wrist, but it’s usually not that after all…)
- pain that is exacerbated by movement, especially with resistance, for example when you try to lift something (sharp, intense pain)
- swelling, redness, heat or even a burning sensation (this phase might only last a couple of days)
- crackling or grating sensation when moving
- stiffness, soreness especially in the morning
- in some advanced cases, a lump may appear along the tendon (this implies significant tendon damage)
The misunderstood guitar tendonitis
Now that we’ve got the fundamentals out of the way, let’s see how most people (including medical professionals) treat tendonitis.
They treat it as if it was simply an inflammatory condition, where the goal is to cover inflammation first with icing, then some OTC anti-inflammatory drugs (like NSAIDs), or topical creams.
Of course, none of these will work in the long-term, because they simply mask the symptoms without dealing with the root issues.
At this point, doctors might suggest a corticosteroid injection, which is the worst of them all. See the explanation below, in the text box.
So, with all this treatment, things might get better for a shorter period, but it’s almost 100% certain that there will be additional inflammatory episodes in the future.
Anti-inflammatory drugs: more harm than good? Studies have shown that NSAIDs (non-steroidal anti-inflammatory drugs) like Aspirin, Tylenol, Ibuprofen actually cause injured tendons, ligaments, muscles and fascia to heal up to 33% weaker and 40% less elastic. This is probably not what you want... They might also contribute to chronic illnesses. For example, Vioxx was taken off the market after being the #1 NSAID in the US for ten years, because as it turned out, it significantly increased the risk of several cardiovascular diseases.
Corticosteroid injections are even worse. Scientists have shown like 20 years ago that they eat the collagen foundation of soft tissues (including tendons!), and even bones and joints. For example, it causes the cartilage in a joint to weaken and become thinner over the years. Of course, people rarely make the connection between joint wear (e.g. osteoarthritis) and the steroid shot they had years ago... According to the Journal of Bone and Joint Surgery, if you have more than one injection in the same joint over the course of your lifetime, your chance of premature degeneration in the injected joint is 100%.
So in short, the problem with anti-inflammatory drugs is that short-term relief is traded for long-term and permanent damage.
If we want to get rid of guitar tendonitis for good, then we have to understand that inflammation is simply the tip of the iceberg. It’s a symptom, a consequence, and not the problem itself.
Inflammation is a healthy, normal response to tissue damage. And that’s exactly what the root of the problem is: tissue damage, or in other words, degeneration.
Degeneration? How is that possible?
Well, in a nutshell, the “root of all evil” is the repetitive, monotonous load inherent in guitar playing. Of course, it doesn’t have to be guitar – pianists or violinists are affected too, as well as desk workers.
This type of repetitive workload strains the soft tissues (muscles, tendons, ligaments, fascia) in one certain way over and over again. And as always, the body adapts. A healthy stimulus would bring a healthy adaptation, but this repetitive workload is not healthy, because it’s done in a narrow, restricted range of movement. So it brings an “imbalanced adaptation”, which means that, for example, some muscles will become too tense, too strong (overused), while others become too weak (underused).
These tense, shortened muscles pull on the tendons, which creates micro-injuries in them – let’s call this degeneration. In time, this whole situation leads to irritation, and finally, to inflammation.
So, the main reason for guitar tendonitis is degeneration, or in other words, tissue damage or irritation due to tense muscles (and adhesions but that’s another story).
If you have tendonitis, you can be sure that there is some level of degeneration in your affected tendon. It’s probably microscopic, but it’s there.
How to heal guitar tendonitis
Now that we know the main reason, we can easily figure out what to do.
First, we have to reduce tension in the surrounding muscles and other soft tissues.
This is a “two birds with one stone” type of solution, because:
- Tense muscles have impaired circulation because they constrict the blood vessels in and around them. Reducing the overall tension levels improves blood flow, which improves the rate of regeneration of the whole area.
- Relaxing the overused, shortened muscles will put less strain on the tendons, allowing them to rest, and heal.
Then, we have to restore proper range of motion and ease of movement in the affected joint. In other words, we have to increase mobility. Why? Because restrictions and adhesions in the tissues make normal function impossible. This is where smart stretching and mobility drills come in, that load the tissues and joints in every direction possible. Be careful not to overdo this step…and wait until your symptoms are mostly gone.
Movement is life. If you stop moving (heart included), you are dead. The body is made to move, it's the foundation of good health. The truth is, we can't expect the body to function properly and pain-free if most of our lives consist of restricted, repetitive movements and sitting around.
But there's no need to become an athlete or anything like that. Just find ways to use your body and your arms, hands as diversely as possible.
Don’t forget nutrition either. It’s hard to build something new out of nothing. The body needs good quality, natural foods that are high in nutrients. You might want to supplement with collagen, vitamin C, and Omega 3 as well to aid tissue regeneration and to reduce inflammation naturally.
Of course, there’s more to it, but with the help of this guide, you should be able to research further on this topic.
But if you want to get back to playing guitar for hours every day without issues, then you need a professional and effective solution to guitar tendonitis.
The guitarstrength course is the best self-care method for guitarists, and now it’s available online. Check it out here: