Elaine - Guitarist Neck

Do you play the guitar a lot? Have you experienced any of the following symptoms below?

A very stiff neck
Aching shoulders
Pins and needles in your fingers
Swollen / stiff fingers / hands
Headaches from an achy neck
The feeling that your upper back is twisted

Beware, you are re-shaping your musculo-skeletal system by your repetitive guitar playing! This reshaping leads to the development of “guitarists hump” and potentially a prolapsed neck disc (which is VERY painful). Correction of this problem, once it has been allowed to develop is a difficult and VERY long term job and playing the guitar (as well as functioning normally generally) becomes very difficult and depressing!

Don't Dispair!
So long as your pins and needles symptoms are not present all the time - there is hope - you can get back to normal! In fact, I have met musicians who have. I am also convinced that I am improving and I am still able to gig (though this has been depressing at times and I have had difficult moments with numb fingers coming and going). Don't expect the cure to be easy, however, you can expect months and months of painful hands / neck / back, not being able to rest for very long before needing to try doing some physio exercises to get rid of swollen/painful/pins and needles hands / fingers. I haven't had a proper, solid sleep since it started (at the time of writing this nine months ago). Anyway, read on and I hope this is helpful for you.

My own experience
I have been playing the guitar and singing intensively (3 gigs per week on average) for about 20 years now. I have experienced all of the above symptoms ,my first being just over 10 years ago, where I developed a neck so stiff that I had great difficulty turning it at all to either side. I visited an ostiopath friend who kindly treated me for free, on and off, for a couple of years. We looked at increasing the strap area over my left shoulder to spread the weight of the strap and I had massage and ice pack treatments. I continued to self massage and to daily stretches to try and keep this problem at bay. Then about 4 years ago I was feeling very twisted and wanting to reduce the weight of the guitar on my shoulder and I discovered a double strap on the internet, which I thought should spread the weight of the guitar and help to prevent the twisting feeling. Sadly, following the use of this strap combined with my altered musculature (and probably exacerbated by the onset of the menopause) brought on a prolapse of one of the discs in my neck in December 2011. Since then I saw the BAPAM specialist musician physio, who advised me to see my Dr and have lots of tests done as well as giving me physio exercises to do, which I began. My Dr sent me for a neck X-ray, which showed a prolapsed disc and he referred me for physio on the NHS, back in February, which I still haven’t had (and it is nearly September now!) plus very strong anti-inflammatory drugs to help to dry up the fluid from the prolapse and combat the terrible stabbing pains in my swollen hands and fingers, which came on especially whenever I tried to lie down to sleep! Since seeing my Dr I have felt pretty abandoned medically and in a very dark and lonely place, wondering whether I’d ever really be able to continue my guitar playing and singing career. My family have funded some physio sessions with a place I can recommend called “Scorpio” and I am now doing some exercises which seem to be starting to make a difference. The stabbing pains have gone now but my fingers are still swollen and get pins and needles easily. At the beginning of September I began to be able to play the guitar and not lose the sensation, after a while, in my plectrum holding finger and thumb (helped by wearing a thumb pick instead of using a plectrum) or in some of the fingers trying to press down the strings on the fretboard! I still have trouble sleeping for more than a couple of hours at a stretch at night before my hands start to hurt enough to wake me up and need me to massage them and do a few physio stretches to ease the swelling and pins and needles. I haven’t had a good night’s sleep since it all started in December 2011! Towards the end of September I started noticing an occasional feeling of cool liquid running down my legs and into my toes (like a wakening up of some kind - not unpleasant). On October 5th I had my first gig and night's sleep with no pins and needles, though this has come back a bit since gigging again. The general trend is definitely towards an improvement in my condition but I have good and not so good days as it gets better. On October 18th I had my third (private) physio appointment (still waiting for an NHS physio appointment!) and the physio did some deep muscle needling (ouch)! I was told that I was heading in the right direction - my "hump" reducing but that a series of sports massage sessions might help to repair /straighten out the muscle fallout going on in the neck/shoulder/upper back. I have had six sessions over December '12 / January '13 at the excellent West Thames Physiotherapy centre, which has definitely helped. I asked again about my NHS physio referral on February 22nd 2013 and received my first (excellent) NHS physio session on May 3rd 2013 - over a year since I was referred. The NHS physio says the Dr should have asked for an "urgent" referral - as my symptoms were still bad after 6 weeks! I'm still gradually improving all the time and the NHS physio says I should be able to return my neck shape and function to normal with effort doing the exercises!

What is Guitarist Neck?
Its actually guitarist shoulders, upper back and neck. All body movements have opposing muscle groups to allow the skeleton to move in both directions. By hunching forwards around the guitar, both the neck and shoulder muscles become stronger on the side which does the hunching and weaker on the side doing the opposing motion. I was also stretching my neck forwards a bit to sing into a microphone and bending it to look down at music on a stand set up lower than my eye level. All of this repeated movement (gigs usually consisting of 2 hours performance) over the years served to re-shape my shoulders and neck and began to develop a hump on my spine at the top of my shoulders too! I believe (though I can’t prove it) that the use of a double strap was very detrimental and could have contributed to the prolapse of the disc (combined with the stretching forwards of the neck to sing into a microphone). For a right handed guitar player, like myself, the guitar strap normally sits on the left shoulder, which is relatively static compared to the right shoulder, which helps to control the strumming arm. It seems so obvious to me now that strapping down a shoulder which was trying to move about for me couldn’t be a good idea!

Reversing the damage
I believe that I am now (slowly) reversing the damage I have caused myself by:-

1. taking the weight largely off my shoulders by resting my guitar on a rest which clips to a spare (broken) mic stand. I made this myself from a "clip on" drinks holder. (I initially tried to clip it to the mic stand I was using to sing from but the action of strumming jogged the stand too much and made singing into the mic very difficult)! If you look very carefully in the photo below I am using my guitar rest at this Jubilee gig. I still have the single strap over my left shoulder (with an extra spongy pad at the point of shoulder contact which I made from memory foam) but I'm not really putting much weight on the strap at all - its more for a safety fall back mode.

2. I try not to stick my neck forward while singing by positioning the microphone closer to me.

3. I strum the guitar strings with a thumb pick instead of a plectrum – so that if my fingers and thumbs go a bit numb I have more confidence that I’ll still be in control of the strumming.

4. I am working on strengthening the weaker opposing neck and shoulder muscles (I would advise seeing a physio about this to help you specifically). For myself, I currently have 4 specific types of exercises to strengthen these muscles. First is to lie face down and raise just the shoulders towards the sky for 10 reps at a time. Second is to lie face down and make the neck pull the head back (away from the floor) keeping the chin in (just a small movement). The next two involve the use of a rubber webbing strap. Standing evenly with head facing forward, hold the two ends of the strapping and pull out and backwards slowly for ten reps at a time. You should feel the shoulder (back) muscles working. Lastly is a variation of this but the strapping is hooked over a fixed point such as a coat hook on a wall, which is about the level of your head, and similarly the two ends of the strapping are pulled out/down and backwards slowly for ten reps at a time.

5. I also do a daily stretching work out based around the movements given to me from the BAPAM physio.

6. I use a back brace when I’m rehearsing and working at the computer, which I got from Essential Aids.

7. I make sure my neck is supported when I try to lie back to sleep.