[Discussion] Guitar, back pain, and why you get it

After some comments on another thread about guitars causing back pain, and it being an inevitability as we get older, I have written a new article on the topic. I first published this on my Substack where I share lessons and write about guitar, and I hope it helps some of you to avoid the pain in the first place or be able to reduce what you already experience.

Are you doomed to a life of back pain if you play the guitar?

Do you need to avoid heavier guitars like Les Pauls?

Are solid body guitars only for the young?

No, no, and no.

It is true that playing the guitar can cause back pain. But that doesn’t mean you have to just live with it, nor limit what models you play.

In this article, we’re going to look at why guitar players get bad backs and how to address it.

Before we go any further I want to make it clear that I’m only talking about healthy individuals — if you suffer with a physical condition that’s causing the aches and pains, I’m not claiming to know how to fix it. Nor am I going to suggest that the fixes will happen overnight.

Why do guitar players get back pain?

To address this problem properly, we need to start at the beginning and get on the same page:

  • Back pain is not limited to guitar players

  • Back pain is not limited to older people

  • Back pain is not necessarily caused by problems in the back

  • Guitars are generally not heavy enough to be a cause of pain

The last point is what I want to address first. We talk about “light” and “heavy” guitars but it’s important to remember these are relative terms. Les Pauls are notoriously heavy, but the reality is they generally weigh around 9lbs. A 10lb example would be considered especially heavy.

So they weigh around 4kg to 4.5kg, on average. If you went to a gym and picked up a 5kg weight plate, you would not call it heavy. This is a weight that you could comfortably do bicep curls with — and the bicep is a relatively small muscle that is limited to lighter weights than your back.

Likewise, you could lift that 5kg plate over head and do shoulder presses comfortably. You could hold it in your hand and run to the other side of the gym. If you attempted to deadlift it, it’s so light that you would barely know you were using a weight.

The bottom line is it’s a small amount of weight. And guitarists then put a strap on that weight and assign it to some of the biggest muscles in the body — the back.

There’s a relevant argument to be made that a weight plate is small, so the weight is in a compact package versus a guitar which is physically bigger. This is true. And the guitar being held lower down adds some additional force (especially if you hold it really low, which is going to put unnecessary strain on your back and possibly pull your shoulders forward, so it’s advised not to do this).

But absurdly-low-slung guitars aside, none of this turns it into a significant amount of weight that should cause healthy adults pain.

So why are guitarists complaining about back pain?

Back pain is not necessarily caused by problems in the back

If we develop a pain somewhere, we naturally assume that the problem is in that spot. In actuality, pain can develop because of a problem somewhere else — it’s not uncommon to have ankle pain because a problem with the knee or hip is causing an issue with alignment, for example.

So just because you have pain in your back, it doesn’t automatically mean that the back is the problem.

In healthy individuals, back pain is often caused by lifestyle and posture.

Consider this, from University of California, Irvine (bold emphasis is mine):

How you hold your body, often called body language, can tell more about you than your words. One’s posture can be a representation of this, as it shows the configuration of overactive and underactive muscle groups in the body. … In modern life, individuals spend countless hours sitting. Whether it be typing away on the computer at the table, wearing uncomfortable shoes, or watching TV at home, all contribute to poor posture. This creates body stress, which strains your muscles over time [1]. Alignment of the body refers to how the head, shoulders, spine, hips, knees, ankles should all relate to each other. Proper alignment can help prevent joint pain, muscle strain, and prevent long-term consequences such as misalignment of the spine.

Many people in this digital age are unaware of the severe effects that poor posture can cause. Poor posture has many short-term effects on the body, ranging from soreness to decreased flexibility [2].

Low back pain often occurs because those muscles are being forced to carry a load that they’re not designed for. When we stand, our core and glutes support us. With bad posture, the core and glutes are weakened and the low back takes up the slack — leading to pain.

You can test this for yourself: while standing, make an effort to squeeze your glutes (your butt cheeks) together firmly. You should notice that it forces you to stand a little straighter, and you may also notice it takes some pressure off your low back.

How much do you sit?

It’s not a secret that modern life is a sedentary one. But the impact of this on the body is often overlooked.

Worse, when the problems start to appear, we ignore them.

For example: if a young adult experiences back ache, they might think that it doesn’t matter because they’re young. In reality, the body is giving early signs that bigger problems will occur in the future.

Instead of ignoring those signs, address the root cause now.

Or, we play a guitar, it hurts, so we blame the guitar. When the body gives us a warning, instead of blaming the guitar and avoiding it, we should take the opportunity to ask ourselves if it’s something we need to address.

Consider your typical day. How much do you sit? If you’re like many people, the answer is “a lot”:

  • Sit down for work

  • Sit down while driving

  • Sit down to watch TV

Our muscles aren’t being used while we’re sitting down. Actually it’s worse than that: sitting down for long periods of time will cause tightness in the hip flexors (at the front of the hip), which then puts stress on the low back. Combine that with weakened muscles in the same area and you’ve got a recipe for low back pain — guitar or no guitar!

How to tell if your lower back is working too hard

As we force our body into these positions, over time it begins to change physically — and visibly.

One of the most common results is anterior pelvic tilt (APT), which you will be able to see when you stand sideways to a mirror. APT is when your hip flexors are tight and pull down on your pelvis. Ordinarily, the abdominal muscles and glutes are strong enough to keep alignment, but the sedentary lifestyle is the perfect storm because these muscles are weakened. The result is a pelvic tilt that sticks your butt and stomach out, so you resemble Donald Duck:

Here’s an image of how APT looks, and which muscles are affected

As you can see, the hip flexors and low back are both red and “Short and tight.”

Because the other muscles are weakened, they’re not doing their required jobs when needed. In other words, when you stand up, your posture is wrong. Then, you pick up a guitar and it puts additional strain on the low back, causing pain.

But the guitar is not the problem! The ache/pain is alerting you to a problem that you need to fix. (If you do have APT, here is a good article to learn more and correct it.)

Stretches for guitar players to ease back pain

If you’re an otherwise healthy person not suffering from a medical condition that causes pain, you probably need to work on stretching a few things and strengthening a few things.

Here’s a short video by ShedMasterScott, a guitar player and teacher sharing his favourite stretches. He credits these with literally saving his back after enduring long-term pain:

Instagram video of stretches for guitarists

You can also supplement this with strength exercises for your core and glutes (if you have APT, you definitely need to do this). You don’t need to spend all day in the gym, one or two minutes of glute bridges a day and a couple of sets of core exercises will make a big difference.

I also suggest trying to minimise some of the causes of your pain in the first place. I invested in a sit/stand desk to reduce the amount of time I spend sitting, and I make time to walk every day. If you can’t do that, try to take some extra breaks to stand and stretch.

One important thing to note here is that everyone will have a different journey. If you’re young, most of this will be preventative action. If you’re undoing decades of poor posture, it may take you a while for your body to respond to the new exercises and before you find it comfortable to play certain guitars again. To be clear, I’m certainly not suggesting that if a Les Paul is uncomfortable today, you’ll be fine with it tomorrow. This is a process, and you can’t expect to fix overnight what took months or years to occur in the first place.

But for most people, back pain isn’t inevitable or something you have to just accept. It also shouldn’t stop you from playing your favourite type of guitar — more often than not, the guitar-induced ache is a symptom, not a cause.

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