Three Tension Patterns in Guitarists Over 40 (And Why Each Needs a Different Approach)

Let me tell you about three different guitarists I worked with last year.

Player A: Wakes up with stiff fingers. Takes fifteen minutes of playing before things loosen up. No sharp pain, just this persistent resistance in the joints. Morning's the worst.

Player B: Hands feel fine in the morning. But twenty minutes into playing, the base of the thumb starts aching. Rest for a few minutes and it settles. Push through and it gets worse.

Player C: Weird burning sensation down the forearm when playing certain passages. Sometimes the ring and pinky finger go a bit numb. Shaking the hand helps temporarily.

All three came in saying the same thing: "My hands are getting old. I think I have arthritis."

But when they got properly assessed by their doctors and physios, turned out they had three completely different things going on.

Player A's symptoms were consistent with early osteoarthritis in the finger joints.

Player B had tendinopathy in the thumb, an overuse injury from years of gripping too hard.

Player C had nerve irritation, likely from postural issues creating compression somewhere between the neck and hand.

Different problems. Different mechanisms. Different solutions.

And here's what I see constantly: guitarists over 40 lump everything under "my hands are getting old" or "it's probably just arthritis."

They treat it all the same way: ice, rest, maybe some supplements and wonder why nothing works consistently.

The reason it doesn't always work is because different tension patterns have different underlying mechanisms. And those mechanisms require different approaches.

I'm not here to diagnose you. But I can help you understand the different patterns I see in my work with musicians, why they matter, and why getting proper professional assessment is so important.

Because once you understand that not all hand pain is the same, you'll stop wasting time on approaches that don't match your actual problem.

Let's break down the three most common patterns I see.

Why "Just Arthritis" Isn't a Helpful Self-Diagnosis

Before we get into the patterns, I need to say this:

Most guitarists I work with have self-diagnosed "arthritis" without ever getting it properly assessed. They just assume that hand pain over 40 = arthritis = inevitable decline.

But in my years working with musicians as a manual osteopath, movement and rehabilitation specialist, I've seen that assumption lead people down the wrong path more often than not.

Here's what actually happens:

Someone's thumb hurts. They google "thumb pain guitar." Everything says "probably arthritis." So they rest it, ice it, maybe take some anti-inflammatories. It helps a bit, then comes back.

What they don't realize is that their pain might not be arthritis at all. It might be a tendon problem, which gets worse with too much rest. Or it might be nerve-related, which needs postural changes, not ice.

So they keep treating the wrong thing. The pain persists or gets worse. And they conclude that their body's just giving up on them.

That's why understanding these different patterns matters.

Not so you can diagnose yourself (you can't, and you shouldn't.) But so you can recognize that your hand pain might need a different approach than what you've been trying.

And so you can have an informed conversation with a healthcare professional who can actually assess what's going on.

Pattern 1: Morning Stiffness That Improves With Movement

What It Looks Like

Common descriptions I hear:

• "My fingers feel like rusty hinges when I wake up"
• "It takes 10-15 minutes of playing before things loosen up"
• "Mornings are the worst, evenings are usually better"
• "Cold weather makes it significantly worse"
• "Multiple joints feel stiff, not just one spot"

Key characteristic: Stiffness that improves with gentle movement and warmth.

What This Pattern Often Indicates

This pattern is commonly associated with osteoarthritis: the "wear and tear" kind of joint degeneration that becomes more common as we age.

With osteoarthritis, the cartilage that cushions joints breaks down over time. The joint gets inflamed, fluid builds up overnight, and you wake up stiff. Movement pumps fresh fluid through the joint and reduces stiffness.

But here's the important part: 

If your pain follows this pattern and it turns out to be arthritis, the common advice of "just rest it" is actually counterproductive.

Arthritic joints need movement. Gentle, regular movement. Rest makes them stiffer.

That's why understanding the pattern matters and it changes what you do about it.

Pattern 2: Pain During Activity That Worsens With Continuation

What It Looks Like

Common descriptions I hear:

• "My hands feel fine until I start playing"
• "About 20 minutes in, this specific spot starts aching"
• "If I push through, it gets worse and worse"
• "Rest for a few minutes and it settles down"
• "It's localized to one specific spot—usually thumb, wrist, or forearm"

Key characteristic: Pain that starts during use and intensifies the more you continue.

What This Pattern Often Indicates

This pattern is commonly seen with tendinopathy (what people usually call tendonitis): irritation and micro-damage to a tendon from overload or repetitive stress.

Tendons connect muscle to bone. When you overload them, whether from poor technique, sudden increases in playing volume, or just years of accumulated strain they get irritated and painful during use.

The pain during activity that worsens with continuation is classic tendon behavior. The tendon's telling you it's being asked to do more than it can currently handle.

If this pattern matches what you're experiencing, a physiotherapist or sports medicine doctor can assess whether it's a tendon issue.

Why the Approach Matters

If it is a tendon problem, the approach is completely different from arthritis.

Tendons need relative rest (reduce load, don't eliminate it), followed by progressive loading to rebuild their capacity. They don't respond well to being pushed through pain, but they also don't heal with complete rest.

That's why the pattern matters it points toward a different recovery strategy.

Pattern 3: Burning, Tingling, or Numbness

What It Looks Like

Common descriptions I hear:

• "It's not really pain, it's more like burning or tingling"
• "Certain fingers go numb—usually ring and pinky, or thumb and index"
• "Sometimes it shoots down my arm"
• "Changing my position or shaking my hand helps temporarily"
• "It's worse when my posture's bad or when my neck is in certain positions"

Key characteristic: Nerve-type sensations (burning, tingling, numbness) that are position-dependent.

What This Pattern Often Indicates

This pattern often suggests nerve irritation or compression somewhere along the path from your neck to your hand.

Could be at the neck (cervical nerve roots), the shoulder, the elbow (cubital tunnel), the wrist (carpal tunnel), or anywhere in between.

Nerves run through a lot of structures, and if they get compressed or irritated, they create these characteristic burning/tingling/numbness symptoms.

If you're experiencing these symptoms, they're worth mentioning to a doctor or physiotherapist who can do proper nerve testing to figure out where exaclty the irritation is coming from. And its important to know that because:

Nerve issues respond to completely different interventions than joint or tendon problems.

Improving posture, releasing tight muscles that might be compressing the nerve, nerve mobility exercises these are the approaches that help. Ice and anti-inflammatories usually don't do much for nerve problems.

Again that's why recognizing the pattern first matters.

Why These Patterns Often Overlap (And Why That's Okay)

Here's the messy truth: most guitarists over 40 don't have just one of these patterns. They often have combinations.

You might have early arthritis and a tendon problem. You might have nerve irritation that developed because your posture compensated for joint stiffness. You might have multiple things contributing to your pain.

That's normal. Bodies are complex. Problems layer on top of each other. This is exactly why the first step is always professional assessment.

I can teach you to recognize patterns. I can explain why different mechanisms need different approaches. But I can't tell you which one you have, or how to treat it.

What I can do is give you the framework for understanding your body better, so when you do see a professional, you can describe what's happening accurately. And so you understand why they're recommending what they're recommending.

The Approach: Why Different Patterns Need Different Responses

No matter what the specific diagnosis ends up being, the overall framework I use with musicians follows the same pattern: Release → Reset → Rebuild™. See my post here for more detail.

But the emphasis changes depending on the mechanism.

For Pattern 1 (Stiffness That Improves With Movement)

Release: Gentle movement and heat to reduce stiffness. Anti-inflammatory strategies under medical guidance. Fascial release around joints.

Reset: Improve movement quality to reduce unnecessary joint stress. Address compensations that have developed.

Rebuild: Strengthen surrounding muscles to support and protect joints. Build endurance for longer playing sessions.

Key principle: Keep moving, but move intelligently. Don't rest completely.

For Pattern 2 (Pain During Activity)

Release: Relative rest to allow tendon to calm down. Address overworked muscles creating excessive load.

Reset: Fix the technique or postural issues causing overload. Restore proper movement patterns so load is distributed.

Rebuild: Progressive loading to rebuild tendon capacity gradually. Strengthen supporting structures.

Key principle: Reduce load temporarily, then rebuild capacity systematically.

For Pattern 3 (Nerve Symptoms)

Release: Release tight muscles that might be compressing the nerve. Improve posture to reduce compression.

Reset: Restore normal nerve mobility. Address postural and movement patterns creating irritation.

Rebuild: Strengthen postural muscles to maintain good alignment. Build nervous system resilience.

Key principle: Create space for the nerve, then maintain that space.

Important: These are general frameworks. Your healthcare provider will guide the specific protocol based on proper assessment of your situation.

What to Do With This Information

I'm not asking you to diagnose yourself. I'm asking you to pay attention. I wrote a whole post on the importance of awareness of your body and how it can have a huge impact on your music.

Notice your pain pattern:

• When does it hurt? (Morning? During playing? All the time?)
• What makes it better? (Movement? Rest? Position changes?)
• What makes it worse? (Activity? Cold? Certain postures?)
• Where exactly does it hurt? (Joints? Specific tendons? Radiating?)
• What does it feel like? (Stiff? Sharp? Burning? Tingling?)

Then take that information to a professional who can assess you properly:

• Your doctor
• A physiotherapist
• A sports medicine specialist
• An occupational therapist
• A hand specialist

Tell them: "I'm a guitarist. Here's my pain pattern. Here's when it's worst and what makes it better or worse."

That information helps them assess you more accurately. And it helps them understand that your hands aren't just tools for daily life: they're your instruments, and losing their function means losing something you care about.

They'll do proper assessment. Physical examination, maybe imaging, specific tests. That's how you figure out what's actually going on.

Then they'll guide treatment. Which might include the Release → Reset → Rebuild™ framework I use, or it might include medical interventions, or both.

The Most Important Thing to Understand

Your pain is trying to tell you something about what's happening mechanically.

Different patterns suggest different mechanisms. Different mechanisms need different approaches.

You can't figure this out alone. 

But understanding these patterns helps you:

• Stop treating everything the same way
• Know when to seek help
• Communicate effectively with healthcare providers
• Understand why certain approaches are recommended
• Recognize when something's not working because it's the wrong approach for your pattern

Your Next Step

If you're dealing with persistent hand or wrist pain that's affecting your playing, get it properly assessed.

Book an appointment with someone who understands bodies: a doctor, physio, sports medicine specialist, or an osteopath.

Bring this information about pain patterns with you. Tell them which pattern sounds most like what you're experiencing.

Don't assume all hand pain is the same. Pay attention to the pattern. Get proper assessment. Then address the actual mechanism.

If you want support implementing a treatment plan, the Keep Playing guide provides the Release → Reset → Rebuild™ framework for common guitarist issues.

F.P. O’Connor

F.P. O'Connor is a Musician and Movement Specialist whose work is informed by extensive training in Manual Osteopathy, Psychology, and Strength Coaching.

He is the founder of Gentle Octaves, helping adult players develop practical, science-based systems for ease, control, and long-term playing confidence.

➜ Visit www.gentleoctaves.com

Understanding pain patterns is the first step in the Release → Reset → Rebuild™ framework.

For more on working with your body as a guitarist: Keep Playing: A Guitarist's Body Blueprint