If your hands ache after a long practice session, the cause might be higher up than you’d expect. The muscles that move your fingers actually live in your forearms.
That’s why a sore wrist so often comes with an achy forearm, and why a “hand problem” isn’t always just in the hand. If you play piano, guitar, drums, or strings, you’re asking those muscles to work thousands of times per session, often in sustained positions.
What the Research Says
A 2020 systematic review of 42 studies on overuse problems in musicians’ hands and wrists, published in the Journal of Hand Surgery (European Volume), found that the hand and wrist are among the most commonly affected areas, with lifetime prevalence reported as high as 89%. Pain wasn’t the only complaint, either. Musicians also described weakness, stiffness, and loss of control.
What Tends to Set It Off
The same review found a few common triggers: a sudden jump in repetitive practice (especially before an audition or concert), a change in teacher or conductor, stress, holding a heavy instrument, technique problems, and joint laxity.
It also varies a lot from player to player. A 2006 systematic review of pianists in Occupational Medicine found prevalence anywhere from 26% to 93%, with no agreement on which risk factors matter most. Two musicians can have the same pain for very different reasons, which is why I don’t believe in one-size-fits-all advice.
What You Can Do About It
- Start with load. Ask yourself what changed. More hours, new repertoire, a new instrument, a performance coming up? Then build back up gradually.
- Build capacity. Train your forearm, wrist, grip, shoulder blade, and trunk so your hands aren’t doing all the work alone.
- Check your technique and setup. Excess tension, wrist position, and instrument setup all count.
- Warm up and rest well. A five-minute warm-up and regular breaks go a long way.
If your neck and shoulders ache too, I cover that in Why Your Neck and Shoulders Hurt When You Play Music.
Three Exercises to Build Endurance in the Forearm, Wrist, and Hand
Building capacity with strength training doesn’t have to be complicated. In the video below, I walk through three exercises that are a great place to start.
1. Wrist curls with finger uncurl
This targets the muscles that bend and straighten your fingers and wrist. Focus on the slow lowering phase. It builds the endurance and control that help you stay smooth and relaxed through long practice sessions.
2. Long lever radial deviation
This strengthens the thumb side of your wrist, which supports a steady hand position for reaches, shifts, and fast passages. The longer lever makes it harder than it looks, so start light.
3. Long lever pronation and supination
This trains the muscles that rotate your forearm, which matter for piano, guitar, strings, and drums. It also supports smoother bowing, strumming, and stick work.
How to use them: Go slow, increase resistance gradually, and only move through a range where you feel in control.
Don’t Wait on These
If you notice any of the following, get evaluated by a physical therapist:
- Tingling or numbness in your fingers or hand, especially at night
- Weakness or dropping things
- Loss of control, speed, or coordination while playing
- Swelling, or pain that wakes you up or won’t settle
Numbness or tingling in the fingers can also come from nerve compression at the wrist, as in carpal tunnel syndrome. We cover how physical therapy approaches it in Can Carpal Tunnel Syndrome Be Treated with Physical Therapy for Rock Climbers?, and our elbow and wrist archive collects the rest of our hand and wrist content.
Frequently Asked Questions
The muscles that move your fingers live in your forearms, so a sore wrist or achy forearm often comes with hand pain. Playing asks those muscles to work thousands of times per session, often in sustained positions.
The hand and wrist are among the most commonly affected areas, with lifetime prevalence reported as high as 89% in a 2020 systematic review of 42 studies. Rates vary by instrument and study. A review of pianists reported anywhere from 26% to 93%.
Common triggers include a sudden jump in repetitive practice (especially before an audition or concert), a change in teacher or conductor, stress, holding a heavy instrument, technique problems, and joint laxity. Two musicians can have the same pain for very different reasons.
Three good starting points are wrist curls with finger uncurl, long lever radial deviation, and long lever pronation and supination. Go slow, increase resistance gradually, and only move through a range where you feel in control.
Get evaluated if you notice tingling or numbness in your fingers or hand (especially at night), weakness or dropping things, loss of control, speed, or coordination while playing, or swelling or pain that wakes you up or won’t settle.
Physical Therapy for Musicians in Boulder, CO
Hand pain doesn’t have to mean time away from your instrument. At Mend Colorado, I look at how you move, how you play, and how your practice load has changed, then we build a plan around what your instrument demands of you. You can read more about how we work with musicians and browse our orthopedic care library.
If hand or forearm pain is showing up in your playing, book an evaluation with Mary Pezzella at Mend Colorado.
References
Betzl, J., Kraneburg, U., & Megerle, K. (2020). Overuse syndrome of the hand and wrist in musicians: A systematic review. Journal of Hand Surgery (European Volume), 45(6), 636–642. https://doi.org/10.1177/1753193420912644
Bragge, P., Bialocerkowski, A., & McMeeken, J. (2006). A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists. Occupational Medicine, 56(1), 28–38. https://academic.oup.com/occmed/article/56/1/28/1374563
