Forearm Pain in String Players

One of the most common aches and pains musicians ask about is pain in the forearms while playing, mostly commonly the left hand or fretting/fingering hand. These pains are most often related to overuse which can become a tendinitis of the forearm extensors (most common) or flexors. Overuse can be related to the musician’s practice routine, posture, inadequate warm-up, inflexibility of the forearm, or poor playing technique. 

Practice Routine

Often musicians practice for long stretches without rest breaks. In general, for every 45 minutes of practice should be accompanied by at least a 5-minute rest from playing before resuming practice. Several hours of practice can be continued if this technique is used. During practice, players will often play hard passages, such as very fast, technical passages, repeatedly. It is better to play a hard passage for about 5-8 minutes at a time and then give that passage a break and go work on some other technique that is less demanding of the left-hand forearm musculature such as a scale more focused on bow or intonation technique rather than left-hand speed/dexterity. Additionally, it may be more beneficial to split practice into smaller duration chunks throughout the day rather than one long practice sitting if scheduling allows.

Wrist and Hand Posture

If a string player has excessive wrist flexion or extension in the left hand as commonly seen in fiddle players or less experienced players, this changes the mechanics of forearm musculature over the wrist joint and can lead to pain. The violinist or violist should work to keep the wrist in a neutral position during all playing with the occasional exception of higher positions which may require a slight degree of wrist flexion to accommodate the higher register. If a cellist or bassist, faulty wrist posturing may be related to the direction the instrument is facing as it should be slightly rotated toward the right hand to accommodate playing on higher strings. Guitarists often have challenges with excess flexion in their fretting hands which is related to how high or low on the abdomen the guitar is resting. Guitarists should consider adjusting the length of their shoulder strap or the height of their foot stool (if seated) to help reduce the excess wrist flexion often seen when playing in open or lower positions.

Inadequate Warm-up

Most musicians when asked about warming up think of slow practice of scales, arpeggios, etudes, etc. as a warm-up. Though it is a warm-up of sorts, it is not the physical type of warm up the body needs to prepare for playing (before you pick up the instrument). Much like athletes, musicians need to begin to think about physically warming up the body and increasing tissue temperature and blood flow. I recommend dynamic warm-ups, which I have written about in a previous post, which you can find here. This helps actively stretch your playing muscles while also increasing blood flow, which is preferred over static stretching. 

Inflexibility of the Forearm Musculature

Tightness of the intrinsic muscles of the hand, forearm flexors, and forearm extensors can lead to increased pain while playing. Inflexibility of these muscle groups can lead to muscle imbalances between groups placing increased strain on other synergistic muscle groups and/or alter biomechanics. This can also lead to difficulty playing on lower strings, in higher registers on string instruments, or affect technical speed and agility of left hand during fast passages. Regular, frequent stretches of the wrist and forearm muscles throughout the day, even outside of playing will help to increase flexibility of these muscles, may reduce pain, and may improve playing technique. 

Playing Technique

Forearm pain in the left hand in string players often occurs because the player has excess tension in the forearm musculature due to pressing the strings too hard. It happens more commonly during faster or louder passages. Often the left-hand presses harder to accommodate desire for a more poignant, assertive musical style or if the player is anticipating a harder passage upcoming, they tend to press harder in anxious, anticipation of the difficult passage. This excess of pressure causes increased strain in the forearm extensors (most commonly) and flexors which can lead to either muscle tightness/myofascial pain or an eventual elbow tendinopathy such as lateral or medial epicondylitis. For all string players, the least possible amount of tension should be used between the string and the fingers to produce a good tone. No greater tension is ever necessary, including during louder, faster, or harder playing to help avoid overuse injuries.

In summary

Developing healthy practice habits through adequate warmups, flexibility exercises, playing posture and technique, and understanding practice pacing and structure can greatly reduce forearm pain while playing. If pain persists with after trial of these techniques, it is likely time to contact your local physical therapist to help you reduce pain and improve your ability to play your instrument.