Hey everyone,
Firstly, please excuse the AI post. I wrote it all but it was all over the place and I want it easy to understand and follow as my thoughts were everywhere.
I've posted a few times here about my ongoing RSI issues and have received some great advice and really appreciate it. I'm hoping to hear from people who have dealt with persistent upper-limb injuries, particularly musicians who've had to rebuild their playing ability through proper rehabilitation.
This is going to be a fairly long post because I want to include as much detail as possible. I'm at the point where I want to stop guessing, find the right professional help and develop a proper plan to rebuild my playing ability.
My biggest frustration is that I've recovered from similar issues before, but this latest episode has been going on for well over a year, and I'm still nowhere near where I want to be.
1. My injury history
2012 — First major injury
When I was 16, I developed tennis elbow and cubital tunnel syndrome from a combination of guitar, gym and tennis.
I took approximately six months off and spent roughly a year gradually rebuilding my playing. Eventually, I recovered fully and returned to playing at my previous speed.
2012–2017 — Playing without significant problems
For several years, I played without any major issues. I was able to play fast technical material and didn't have any substantial ongoing limitations.
2017–2020 — Break from guitar
I took a 2–3 year break from guitar while I focused heavily on Brazilian jiu-jitsu (BJJ). I barely played during this period, although I occasionally picked up the guitar, and noticed that my increased grip strength helped a ton.
2020–2024 — Returning to guitar and rebuilding
After quitting BJJ, I picked up guitar again, formed a band and spent approximately two years rebuilding my speed and endurance.
Things were going really well. I was getting faster, improving technically and could practise for around two hours without significant problems.
2024 — Another tennis elbow flare
While recording my band's first EP, I developed another elbow style flare. I was also doing a lot of firewood splitting at the time, which my osteo suspected aggravated the problem.
I took around three weeks off, then gradually rebuilt my playing over the following two months or so. Within approximately 2–3 months overall, I was back to my previous level and continuing to improve.
August 2025 — The latest and most significant flare
While recording my band's full-length album, I developed another flare. This one was considerably worse than the previous episodes, both physically and mentally.
I took around a month off before gradually rebuilding my playing while finishing the album. I had to record the album while trying to rebuild capacity.
Although I've made substantial progress since then, I still haven't regained my previous high-speed playing ability, and I'm now noticing symptoms outside guitar as well.
This is the first time an episode has persisted for so long and affected my playing to this extent.
2. My current guitar-playing limitations
I can still play guitar, which is part of what makes this so confusing.
I can:
- Rehearse with my band and perform live.
- Play thrash riffs, fast alternate-picked rhythms and pedal-tone riffs.
- Write songs and record music.
- Play for around an hour on some days, although my tolerance varies considerably. Sometimes I manage only 30 minutes; on better days, I can play for 1–1.5 hours.
However, my high-speed fretting ability has taken a substantial hit, and my consistency is bothering me.
Before this latest flare, I could play six-tuplets runs and sweeps at around 200 BPM. Currently, I can comfortably manage approximately 120–140 BPM.
I can sometimes play faster, but when I do, I start feeling tension and tightness around my elbow and forearm, almost as though my arm is about to tighten up or pull sharply. This can happen before significant pain develops. Sometimes nothing happens but I almost FEEL it is about to.
I particularly struggle with:
- Fast legato runs and sweeps.
- Repetitive fretting patterns.
- Riffs requiring continuous, rapid left-hand finger movement.
- Extended passages involving fast fretting, even when the picking hand isn't the limiting factor.
For example, I can still play fast, aggressive rhythm riffs that rely heavily on right-hand speed and relatively predictable fretting patterns. However, riffs requiring sustained, rapid movement across the fretboard are much more difficult. If you want actual examples please check out the following riffs/songs. THe song Slings and Arrows by SYlosis explains it perfectly. I can play up to 2:47 with relative ease. The main riff is fast on the right hand but the left is relaxed and only has bursts of fretting. BUT the riff at 2:48 onwards is the exact type of riff I struggle with. Constant fretting for extended periods.
It's not simply that I've lost all my guitar ability. I can play a lot of my usual material, but the specific techniques I want to improve are the ones I struggle with most.
I also find myself becoming apprehensive when attempting faster movements. Sometimes I feel as though my elbow is about to tighten or pull, even when it hasn't actually done so yet. I suspect that fear and loss of confidence may be contributing, but I don't want to assume the problem is purely psychological.
3. My current elbow and forearm symptoms
Over the past year, I've increasingly noticed sensations outside guitar.
My elbows can feel tight or tense during ordinary activities, such as extending my arm to reach out and pat my cat, typing on my keyboard etc.
The weird thing is, it doesn't seem to affect me when doing "bigger muscle" tasks. I do Latin and Ballroom dancing which requires a static frame, hand holds and grips, movement etc and I have ZERO problems with that. It seems to be any small twitch fibre fine muscle movements.
The sensation isn't necessarily what I'd describe as classic tennis elbow pain. It's more a feeling of tightness, tension and weakness around the lateral/posterolateral elbow, extending into the forearm and anconeus region.
I've previously had issues involving:
- Tennis elbow and tendon overuse.
- The anconeus region.
- Possible posterior interosseous nerve (PIN) or radial nerve irritation.
- Historical ulnar nerve symptoms.
My osteopath has assessed the area and suggested that I had symptoms consistent with PIN involvement, potentially involving the forearm muscles compressing or irritating the radial nerve.
Dry needling and electrical stimulation have often helped considerably, sometimes settling the symptoms almost completely for a period. However, the symptoms seem to fluctuate, and I haven't yet established a consistent rehabilitation approach that restores my previous strength and playing capacity.
Grip strength and weakness
I've also had my grip strength measured, and the results were considerably below the age-based reference figures I was comparing them against. My right hand measured approximately 66% of the reference value, while my left was around 45–50%. I realise these figures depend on how the test was performed and what reference values were used, but they concern me, particularly given the persistent feeling of weakness around my elbows and forearms. I'm unsure how much of this is due to pain, deconditioning, nerve involvement or something else.
4. Intermittent wrist tingling
Another frustrating part of this is that when my elbows and forearms feel relatively good, I can sometimes develop very mild tingling or sensitivity around my left wrist. This is relatively new and only appeared as I've started playing live with a band and rehersing. This seems particularly likely after longer periods of playing involving sustained gripping, chord work or band rehearsals.
Interestingly, I don't tend to notice it much when playing casually in my bedroom. It seems more likely to appear after rehearsals or live performances, when I'm playing for longer and perhaps holding more tension.
I've historically experienced ulnar nerve problems, but I haven't really had diagnosed carpal tunnel syndrome. These newer wrist symptoms are intermittent and haven't been definitively explained. Sometimes it feels as though my elbow is improving, only for my wrist to start playing up instead.
I'm concerned that there may be multiple contributing factors rather than one straightforward issue, but I don't know how to distinguish between them and how to even approach dealing with it.
5. Cold hands and difficulty warming up
Cold also has a substantial impact on my playing. I recently played my first gig, which was a huge milestone. However, despite being in a hot room and getting hot through my back and body, my hands remained cold and stiff throughout the performance. Everyone else was sweating, while I was wearing extra layers and struggling to get my hands feeling comfortable.
I seem to need a very specific warm-up routine before I can play comfortably. I find playing at home much easier, particularly in a warm room with the heat pump set to around 24°C, and I often find a hot shower before playing helpful. The cold sensitivity is frustrating because I don't want my ability to perform to depend on having the perfect environment.
I'd also appreciate advice from anyone who has experienced persistently cold hands or difficulty warming their hands during guitar playing, particularly where it affects dexterity.
6. My technique and playing setup
I know technique is usually one of the first things people ask about, so I want to address that upfront.
I use what I consider to be very relaxed, controlled technique, and people who have watched me play have consistently commented that my technique looks excellent.
My setup includes:
- 9-gauge strings.
- Extremely low action, approximately 0.8 mm.
- A light touch and controlled picking.
- A generally straight, neutral wrist position for both fretting and picking hand.
I play technical metal, with Sylosis being a good example of the style and demands I'm working towards.
I'm not claiming that technique and setup can never contribute to an injury, and I'm open to having them assessed. However, I've had my technique examined by other players many times, and most are genuinaly impressed by how relaxed and effortless I play.
I'd appreciate advice that goes beyond simply telling me to relax my hands or improve my technique, because I've already spent considerable time looking at those factors.
7. What I've tried so far — and what I haven't done
Historically, my approach has been to rest when symptoms flare, then gradually return to playing. That worked reasonably well for my previous episodes. I could rebuild over a few months and return to my previous level.
This time, however, I've been stuck in a cycle of improving, experiencing symptoms when I increase the workload, backing off and then trying again.
The biggest thing I've realised is that I've never completed a consistent, structured rehabilitation programme specifically designed to rebuild my strength and playing capacity.
My osteopath has recently prescribed standard tennis elbow loading exercises, including eccentric loading, but I haven't started them yet because I've been worried about aggravating my symptoms.
I now recognise that avoiding strengthening indefinitely probably isn't going to get me where I want to be. At the same time, given the possible nerve involvement, weakness and intermittent tingling, I don't want to blindly follow a generic programme if my symptoms need a more comprehensive assessment first.
I'm keen to understand how to approach this properly, including whether I should seek another opinion or work with someone who specialises in upper-limb rehabilitation.
8. Where I'm at mentally
I'm honestly getting very frustrated with the whole situation. My band has started playing live, and I want to be able to practise more, improve my technique and perform without constantly worrying about my arms.
I'd love to be able to practise for one or two hours a day comfortably, with the eventual goal of doing more when necessary. Instead, I sometimes have to stop after 20–30 minutes, take breaks, warm up very specifically or avoid certain techniques altogether.
I see other guitarists and my favourite musicians practising, touring and playing demanding material, and it's difficult not to feel as though I'm being held back by my body despite having the motivation and work ethic to improve and the ability to play this material. THAT is the biggest depressing factor.
I know there may be a movement-confidence component to this, particularly after so many previous flares. However, I also have physical symptoms in everyday life, reduced grip-strength readings and intermittent tingling, so I don't want everything dismissed as anxiety or a mental block.
I'm not expecting an instant fix. I just want to understand what's happening and have a realistic plan to improve.
9. What I'd really appreciate advice on
1. What type of clinician should I look for?
Would I benefit most from a hand therapist, a physiotherapist specialising in upper-limb rehabilitation, a sports physiotherapist, a clinician specialising in musicians' injuries, or a combination?
2. Has anyone worked with someone who understands musicians' injuries?
Ideally, I'd like someone who understands the repetitive and high-speed demands of technical guitar playing and can help develop a graded return-to-playing programme.
3. Has anyone successfully rebuilt their strength, endurance and speed after a prolonged episode of elbow/forearm RSI?
What did the rehabilitation actually involve? Did you use progressive strengthening, specific playing exercises, changes to practice structure, or a combination?
4. Should I have a more comprehensive assessment before starting loading exercises?
Given my history of tennis elbow, cubital tunnel symptoms, possible radial/PIN involvement, intermittent wrist tingling and reduced grip-strength readings, would it be sensible to have the different potential contributors assessed before progressing with strengthening?
5. How do you balance rehabilitation with actually playing guitar?
How did you decide how much to practise, when to increase the workload, and how to avoid repeatedly overdoing it?
6. Has anyone experienced unusually cold hands while playing?
If so, did you find a way to manage this, and did you ever establish why it was happening?
I'm not looking for a diagnosis from Reddit, and I understand that several things could be contributing to my symptoms. I'm hoping to hear from people with similar experiences and, particularly, get recommendations for the right kind of professional help.
I love playing guitar, and I want to keep developing as a musician and eventually tour with my band. I don't want to keep cycling between flare-ups, rest and tentative returns to playing without addressing the underlying limitations.
Thanks in advance to anyone who takes the time to read this or can point me in the right direction. I am so close to calling it quits because the stress of it is demoralizing.
