Guitarists & Muscle Imbalances


Guitar FingersAny instrument that uses a limited set of motions for extended periods of time will be prone to developing muscle strength imbalances.  Guitarists do many biomechanically imbalanced activities such as:

  • The fret hand wrapping around the neck is held in extreme wrist flexion for extended periods of time with little to no wrist extension.
  • Some chords/fingerings utilize finger flexion to a much higher degree than finger extension.
  • Using a pick involves extensive thumb and index finger opposition (holding the pick)
  • The guitar may be suspended over one shoulder
  • The weight of the guitar is in front of the body’s center of gravity, requiring long-term arching the low back
  • The head may be held in extreme flexion to look at the hands, etc.

Low back painThese examples all demonstrate how one motion at a joint may be utilized to a much greater degree than it’s opposite (or antagonistic) motion.  Even as guitarist become more experienced and learn how to use less force, there will still be more exertion in one direction for many activities.   As the imbalanced exercise continues of months, years and decades, muscle strength imbalances will result.

Why Is Balanced Muscle Strength Important?

Neck painAll the muscles around any given joint need balanced strength pulling in each direction.  For example, the muscles that pull your fingers forward need strength comparable to the muscles that pull your fingers backward, to the outside, to the inside, into opposition, etc.  If one muscle around a joint is stronger or weaker than the rest, the bones of that joint will not remain properly centered.  Each time an imbalanced joint moves, it will tug to one side, leaving you at a mechanical disadvantage.  This imbalanced motion will stretch, scrape or pinch tissues abnormally, causing some damage.  As a result, your speed, power and endurance will suffer and your chance of developing pain and injuries increases.

Health Issues Guitarists Are Prone To

Hands in pain

  • Carpal tunnel syndrome – with tingling, pain or numbness in the hand and/or fingers
  • Tenosynovitis – With imbalances, the bursas around some tendons will experience excess pressure which irritates them leading to inflammation
  • Ganglion Cysts – the inflammation in some bursas can become so pronounced that lumps will develop in the wrist or hand
  • Thoracic Outlet syndrome – Guitar straps depressing the shoulder can cause pain which radiates from the shoulder down the arm.
  • Neck Radiating Neuralgia – Pain coming from pinched nerves in the neck
  • Lumbar strain – holding the weight of the guitar can imbalance muscles and cause low back pain.

Diagnosing Guitarist Health Issues

Muscle strength imbalances may be diagnosis by a trained specialist in Performing Arts Medicine and will typically involve a history, physical exam and testing specifically designed to look for muscle imbalances in the large to very small muscles of the hand.  In more advanced situations, this may include x-rays, MRI, EMG, nerve conduction studies.  It is important to work with a doctor who is experienced working with:

  • Muscle imbalances
  • Finger and hand issues
  • Musicians and the stresses each instrument is prone to

Play Better by Balancing Muscles 

Steve Vai playing guitarCorrecting muscle imbalances can also be used to help improve your performance.  Balanced muscles around each of the key joints will improve your SPRITE profile.  This means you will be capable of having better:



  • Speed
  • Power
  • Range
  • Independence
  • Technique
  • Endurance

Contact: Dr. John M. Wallman, DC to arrange an appointment to evaluate your music related biomechanics at  His background includes: 4 years at Manhattan School of Music; undergraduate studies of music education and; plays over a dozen instruments.  In his health care practice, he has specialized in Performing Arts Medicine and written the exercise manual “Finger Exercises for Musicians”.  He is President of the Diagnosis Foundation and practicing at Long Island Integrated Medical in Ronkonkoma, NY.