Musicians, Neck Pain, and PRMD: Chiropractic Care, Management, and Prevention

Musicians pour countless hours into perfecting their craft, often repeating the same postures and movements for extended periods. This dedication often leads to a specific category of injuries known as Playing-Related Musculoskeletal Disorders (PRMDs). Among these, neck pain is particularly common—especially for those who play string instruments, piano, or wind instruments that involve prolonged static postures and repetitive use of the upper body.

What Are PRMDs?

PRMDs are injuries or pain that interfere with a musician’s ability to play or perform or execute daily activities unrelated to music at their usual level. These can signal muscle strains, nerve compression, inflammation, or even chronic musculoskeletal dysfunction affecting performance and quality of life. While injuries can strike almost any area, the neck, shoulders, and upper back are especially vulnerable due to the physical demands of playing an instrument.

Why Musicians Suffer With Neck Pain

Sustained Forward Head Posture: Reading sheet music or looking at their hands or strings encourages hunched shoulders and a jutting chin.

Instrument Position: Violinists and violists hold their instruments under the chin, risking asymmetrical strain. Cellists, pianists, and guitarists may lean forward for hours and often with an asymmetrically tipped head and chin.

Repetitive Movements: Fast passages, vibrato, or certain strumming techniques stress the same muscle groups repeatedly.

“Focus”: Many musicians find themselves clenching their jaw while playing or practicing, particularly when they are learning. The tension caused in the neck by clenching the jaw may become significant enough to heavily impact neck function on top of the jaw dysfunction that clenching often causes.

How Chiropractic Care Can Help

Chiropractic care has long been recognized as a viable, non-pharmacological approach for treating musculoskeletal pain among musicians and then creating a neurological, structural and biomechanical environment that becomes supportive and resilient while playing in the future. Most of the many musicians that I work with search for chiropractors with extensive experience in working with musicians, because an understanding of musicianship is a huge part of putting together the healing pieces of a care plan. Chiropractors focus on the spine and musculoskeletal system, employing manual therapies to address pain, misalignment, or mobility issues.

For neck pain related to PRMDs:

Spinal Manipulation: Gentle adjustments to the cervical (neck) spine can improve mobility and decrease pain.

Soft Tissue Therapy: Myofascial release, trigger point therapy, and stretching target tight muscles and fascia contributing to stiffness and discomfort.

Postural Assessment: Chiropractors can identify faulty posture or technique that might be perpetuating symptoms and work with musicians on better ergonomic strategies. As a musician health specialist, our office has a specialized room with many instruments that can be used to demonstrate playing posture. Musicians are encouraged to bring their “go to” instruments though.

Exercise Prescription: Musicians learn stretches and strengthening exercises appropriate for their specific needs and instrument.

Management Strategies

Calculated Rest and Gradual Return: Temporarily reducing playing time may allow inflamed tissues to recover. Gradually increasing practice length and intensity is key. Our efforts and action steps are designed to try to minimize downtime though. Being told to not play, when you work as a professional musician, is not advice that is typically well received or even possible. Whenever possible, a specialists care is combined with continuing to play, so that results and playability are working together.

Ergonomic Adjustments: Adjusting music stands, seating, or instrument supports to encourage neutral spine alignment lessens chronic neck strain.

Heat and Cold Therapy: Alternating hot and cold packs can reduce inflammation and ease sore muscles. While these have limited long term therapeutic value, the do provide temporary relief to some right after an injury.

Physiotherapy: Chiropractors are highly trained in physiotherapy and are trained to implement a multidisciplinary plan including manual therapy, instrument technique modification, and progressive exercises.

Mindfulness and Body Awareness: Our patients are educated, as they should be, on how the body works, how to interpret what our bodies are telling us, and how to use that information to heal and remain healed and strong.

Prevention Tips for Musicians

Incorporate Breaks: Pause every 30–45 minutes for stretching and to reset posture.
Daily Stretching: Gentle neck, back, and shoulder stretches decrease risk of overuse.
Strength Training: Building core and upper back strength supports good playing posture.
Warm Up: Just like athletes, musicians should warm up muscles before intense practice.
Instrument-Specific Adjustments: Use chin rests, shoulder pads, or ergonomically designed seating as needed.
Monitor Posture: Consider mirrors, video recordings, or app-based feedback to spot and correct poor playing habits.

When to Seek Professional Help

If neck pain persists for several days, interferes with performance, or is accompanied by symptoms such as numbness, tingling, or weakness, it’s time to seek professional care. Chiropractic care—especially when integrated with other health providers—can provide both relief and long-term strategies for prevention.
Musicians thrive when their bodies, as well as their instruments, are in tune. Attention to neck health, smart practice habits, and professional support like chiropractic care can help you play longer, stronger, and healthier.

Dr. Lou Jacobs has been working with musicians and performing artists for over 23 years. While he sees families and is board certified in perinatal and pediatric chiropractic care, music and musicians are one of his true loves. Dr. Lou is one, if not the most called on chiropractor for musicians in the northeast. Most recently he has worked with Cypress Hill, Mt. Joy, Trombone Shorty, The Drive By Truckers, Jack’s Mannequin and Darkstar Orchestra. He has worked with Steve Vai, Trey Anastasio, Mumford & Sons, Ziggy Marley and the melody makers, Gary Clark Jr. and many others. Dr. Lou is accepting new patients with availability varying. Calling early is encouraged. Dr. Lou also consults with musicians online. To reach Dr. Lou, please email Sandra Escobar at Sandra@drloujacobs.com or call (207) 774-6251. Dr. Lou was interviewed for the following article in Guitar Player Magazine in 2023: https://www.guitarplayer.com/lessons/how-to-play-guitar-forever