HEALTH & WELLNESS Dr. Lou Jacobs: He Treats Guitar & Bass Pain

May 12, 2023

As seen in Guitar Girl Magazine Issue 18 Winter 2021 – Women in the Music Industry

Getting injuries from playing is every musician’s nightmare. It often takes getting hurt to make us more aware of our bodies and how we heal, but it doesn’t need to be that way.

Dr. Lou Jacobs is a chiropractor and acupuncturist in Portland, Maine, who’s specialized in musician injuries for the last 20 years. After offering his services to Gogol Bordello during a tour stop, word got out. Now, Grammy-nominated singer-songwriter Katie Herzig; guitarists Steve Vai, Trey Anastasio, and Tommy Emmanuel; and bands like Eagles of Death Metal and The Pixies have become his clients. In our interview, Dr. Jacobs shares his best prevention and recovery tips.

What are some common guitarist and bassist injuries that you see, and what causes them?

The most common ones involve the shoulders, arms, and hands: frozen shoulder, carpal tunnel syndrome, ‘tennis elbow, trigger finger, impingement syndrome of the shoulder, numbness, tingling, weakness, and pain. Much like athletes who practice repetitive movements over and over to perfect their sport, musicians put a lot of repetitive strain on the muscles, ligaments, tendons, nerves, and joints of their arms. Working up and down the neck of the guitar, even fast repetitive strumming, may lead to what I call playing-related musculoskeletal disorders (PRMD). Practicing, playing, performing without adequate breaks, and self-care lead to these types of injuries. Athletes don’t practice or compete without warming up and cooling down, and you, the ‘musical athlete,’ shouldn’t either.

One of the biggest fears that musicians have is not being able to play their instrument again (due to an injury or a surgery). How do you approach that?

In order to get a handle on what is a reasonable or unreasonable fear, a pretty extensive review of one’s history is necessary. Not just playing history, but life history. I approach this through listening with patience, not rushing, and reading a musician’s ‘autobiography’ regarding all factors that may contribute to injury or perpetuation of a problem. I have patients write down not only their playing history up to the present, but also their accidents, injuries, and daily activities related to work, family, and the like.

All life factors play a role in the likelihood of permanent disability or a future that is uncomplicated. For example, if someone fell off their bike at seven years old and broke their wrist, that would certainly have an impact on the degree to which strumming a guitar stresses the wrist. That particular wrist may be much more prone to a risk for permanent disability in the future when compared to the wrist that plays guitar without a childhood injury. If you sit at a desk all day mousing on your computer, a strained elbow from practicing scales will be more likely to arise, remain strained, and become chronic. We can’t always change our daily lives, or history, so we have to work around the life of the musician outside of music as well. Oftentimes, the music isn’t the biggest factor in risk assessment.

In the case of a previous surgery, it’s typically an issue of identifying whether the surgery had permanent negative side effects, what they are, and whether or not there is any chance of positive change. Even procedures considered ‘successful’ sometimes leave chronic scar tissue issues, nerve damage, and other aches and pains. These need to be addressed whenever possible.

I have found that even serious musicians sometimes cut their post-surgery recovery efforts short because they ‘feel better.’ Feeling better is just the tip of the iceberg. Imagine trying to ‘get out of the woods’ with an injury. All you have to do is get to the outer edge of the woods to cross out of the painful forest. To be less vulnerable, you should position yourself a mile or two away from the edge of the woods. That requires post-surgical follow-through, plus some.

What’s the fastest way to recovery for these types of playing-related injuries?

Therapeutic exercise, treating inflammation with heat, ice, massage, and a handful of other drug-free, non-invasive measures will help at home. I often utilize acupuncture, therapeutic ultrasound, cupping, and other soft tissue modalities to alleviate symptoms of soft tissue injuries. But it’s not enough to feel better; one has to function better, reduce risk factors, and create stability in the injured area(s), so that their normal routine that caused the problems doesn’t cause them to return again. Unless absolutely necessary, I don’t suggest changing any playing-related activities. No time off. Getting better without playing is like getting skinny without eating. At some point, you’ll have to eat or play again, and then what? You will have recovered in a ‘time off’ bubble, and when you return to playing, you’ll be more likely to experience a resurrection of the issues you had prior to your partial healing. Add more good to your life, arms, shoulders, and hands. Don’t eliminate your passion; that’s bad.

Are there any self-destructive habits that we string instrumentalists should become more aware of?

Posture during playing leads to a lot of problems. Thin straps on guitars lead to shoulder and neck issues. Sleep positions, day jobs, stress, driving, and a number of other seemingly harmless activities are huge contributors to problems. These and other daily activities become unconscious, self-destructive habits that lead to issues for guitarists and bassists. Recognition of the fact that all physically, mentally, and chemically stressful activities may contribute to musical injury vulnerability is huge. Not assessing your whole life, but rather just the musical one, is a big mistake. Not treating yourself like the musical athlete that you are, also falls into that category. If you want to go pro, you have to train like one.

Dr. Lou’s Self-care Tips for Musicians

Here are the best things musicians can do for self-care to prevent injuries and enjoy touring and a lifetime of playing:

Reduce mental stress. It leads to tension and inflammation, which are contributing factors to more common PRMD’s (playing-related musculoskeletal disorders).
Exercise and maintain tone in the muscles of your upper back, posterior shoulders, and core.
Sleep on your back. See Dr. Lou’s YouTube video on this topic: https://www.youtube.com/watch?v=RK8yqLBcNos&t=34s
Stretch.
Take breaks while practicing. One break per hour would be fine for most.
Don’t slump over your instrument.
Watch your wrists, especially when playing bass.
If things feel out of control, they probably are. Seek professional advice before you are forced to quit your passion.