When Playing Hurts: How Musicians Can Build Endurance to Reduce Pain

Professional musicians face a hidden occupational hazard that audiences rarely see: the physical toll of their craft. A groundbreaking study from St Mary’s University London reveals that targeted endurance training could offer relief to string players suffering from playing-related pain—but the results come with important nuances that every musician should understand.

The Physical Demands of Professional Music

Picture a violinist during a three-hour orchestral performance. Their left arm remains elevated, fingers dancing across strings with millimeter precision. Their right arm draws the bow in controlled, repetitive motions. Now imagine maintaining this position for up to nine hours on rehearsal days, week after week, year after year.

The numbers tell a sobering story. Research shows that up to 86% of professional orchestral musicians experience playing-related musculoskeletal disorders (PRMDs)—pain, numbness, tingling, or weakness that interferes with their ability to play. Among string players specifically, the statistics break down into a catalogue of discomfort: 59% experience lower back pain, 55% neck pain, 55% shoulder pain, 23% elbow pain, and 32% hand and wrist pain.

These aren’t just minor inconveniences. PRMDs can derail careers, forcing talented musicians into early retirement or lengthy absences from work. The psychological impact compounds the physical suffering, as musicians watch their ability to express themselves through their instrument slip away.

Understanding the Endurance Connection

The recent study investigated a specific hypothesis: could improving muscular endurance help reduce these playing-related problems? The logic is straightforward—if muscles can work longer without fatigue, they should better handle the sustained demands of instrumental performance.

Twenty-four professional string players from orchestras across the UK participated in the six-week trial. Half followed a structured exercise program three times weekly, focusing on building endurance in the shoulders, neck, and back. The other half continued their normal routines as a control group.

The exercise program wasn’t about building bulk or maximum strength. Instead, participants performed high-repetition sets with lighter weights, progressing from 12 repetitions per set in week one to 25 repetitions by week six. Three specific exercises targeted the posterior muscles most stressed during string playing: reverse flies, shoulder flexion, and shoulder hyperextension, all performed standing with free weights.

The Results: Promise with Important Caveats

The intervention group showed significant improvements. Their shoulder endurance, measured through a specialized test where participants hold their arm horizontally with weight, increased by an average of 35 seconds—a 28% improvement. More importantly, they reported meaningful reductions in both the frequency and severity of their playing-related pain.

But here’s where the story gets interesting and highlights why one-size-fits-all solutions rarely work in healthcare. The researchers discovered that not all string players benefited equally. When they analyzed the data more closely, they found that low-string players (cellists and double bassists) experienced much more pronounced improvements than high-string players (violinists and violists).

This difference makes biomechanical sense. Cellists and bassists maintain different playing positions than violinists and violists. The angle of arm elevation, the weight of the instrument, and the required movements all differ substantially between these instrument groups. What works for one may not work as effectively for another.

Even more intriguing was the role of chronic pain. Participants who already dealt with chronic pain—pain present even when not playing—showed less improvement from the endurance training. In some cases, particularly among high-string players with chronic pain, symptoms initially worsened before potentially improving.

The Science Behind the Success

Why would endurance training help with playing-related pain? The researchers propose several interconnected mechanisms that paint a picture of how our bodies adapt to sustained physical demands.

First, endurance training improves muscle efficiency. When muscles work more efficiently, they produce less metabolic waste—substances like lactate and hydrogen ions that can irritate tissues and trigger pain signals. Think of it like upgrading from an old, inefficient engine that produces lots of exhaust to a newer, cleaner-running model.

Second, this type of training increases capillarization—the development of tiny blood vessels within muscle tissue. More capillaries mean better oxygen delivery and faster removal of metabolic byproducts. It’s like adding more roads to reduce traffic congestion in a busy city.

Third, regular exercise influences our body’s natural pain management systems. Physical activity stimulates the release of endorphins and endocannabinoids—our internal pain relievers. These systems can become more responsive with regular training, potentially raising our overall pain threshold.

However, these benefits don’t apply universally. In people with chronic inflammation or persistent pain, these natural pain-relief systems may already be compromised. Exercise might temporarily increase inflammation before eventual improvement, explaining why some participants, particularly those with existing chronic pain, didn’t see immediate benefits.

Practical Implications for Musicians

What does this mean for musicians dealing with playing-related pain? The study offers both hope and caution.

For musicians, especially cellists and bassists, who experience pain primarily during playing but feel fine otherwise, a structured endurance training program could provide significant relief. The key is consistency and proper progression—starting with manageable repetitions and gradually building up over weeks.

The exercises don’t require expensive equipment or gym memberships. Simple movements with light dumbbells or resistance bands, performed regularly, can build the specific endurance needed for sustained playing. The study’s participants saw improvements with just 20-30 minute sessions, three times per week.

However, musicians dealing with chronic pain should approach endurance training more cautiously. The study suggests they might experience an initial increase in discomfort before seeing benefits. Working with a physical therapist or healthcare provider familiar with musicians’ injuries becomes especially important for this group.

Timing matters too. The study allowed 48-72 hours between training sessions for recovery. Musicians should plan their exercise schedule around performances and heavy rehearsal periods, avoiding intense training right before important concerts.

The Bigger Picture: Rethinking Musician Health

This research contributes to a growing recognition that musicians are, in many ways, athletes of the small muscles. Just as dancers train their bodies for performance, musicians may benefit from targeted physical conditioning.

But the study also highlights the complexity of musician health. The differences between instrument groups suggest that training programs should be tailored to specific instrumental demands. A violinist’s shoulder endurance needs differ from a cellist’s back strength requirements.

The chronic pain factor adds another layer of complexity. Musicians who’ve played through pain for years may have developed compensatory patterns and chronic inflammation that require more than exercise alone to address. Comprehensive care might include technique modification, ergonomic adjustments, stress management, and sometimes medical intervention alongside physical training.

Moving Forward: Integration, Not Isolation

Perhaps the most valuable insight from this research is that addressing musician pain requires an integrated approach. Endurance training shows promise, but it’s not a magic bullet. Musicians should consider it one tool among many for maintaining their physical health.

This might mean combining endurance exercises with proper warm-ups before playing, regular breaks during practice, attention to posture and technique, and stress management strategies. Some musicians might benefit from Alexander Technique or Feldenkrais Method lessons to improve body awareness and movement efficiency.

The study’s six-week timeframe also raises questions about long-term adherence. Can musicians maintain an exercise routine alongside demanding performance schedules? How do benefits persist if training stops? Future research will need to address these practical concerns.

Conclusion: A Step Toward Sustainable Careers

Playing-related pain has long been accepted as an inevitable part of a musician’s life—a price paid for artistic excellence. This study challenges that assumption, suggesting that targeted physical training can reduce pain and potentially extend careers.

The key takeaway isn’t that all musicians should immediately start high-repetition weight training. Instead, it’s that musicians can take active steps to build their physical resilience, but these steps should be tailored to their instrument, their current pain situation, and their individual needs.

For the music community, this research reinforces the importance of treating musician health holistically. Conservatories might consider incorporating physical conditioning into their curricula. Orchestras could provide access to exercise facilities or physical therapy services. Individual musicians can take ownership of their physical health, viewing exercise not as time away from practice but as an investment in their musical longevity.

The path from pain to performance isn’t always straight, as this study shows. But with careful attention to individual needs and consistent effort, many musicians may find that building physical endurance translates into sustained musical expression—allowing them to play not just through the pain, but beyond it.