The player holds a small spoon-shaped mallet hammer in each hand to strike the strings.

[1] Hammered dulcimers and other similar instruments are traditionally played in Iraq, India, Iran, Southwest Asia, China, Korea, and parts of Southeast Asia, Central Europe (Hungary, Slovenia, Romania, Slovakia, Poland, Czech Republic, Switzerland [particularly Appenzell], Austria and Bavaria), the Balkans, Eastern Europe (Ukraine and Belarus), and Scandinavia.

The earliest evidence comes from Assyrian and Babylonian stone carvings dated to 669 BC, showing the instrument being played while hanging from the player's neck.

Musicians modified the original design over the centuries, yielding a wide array of musical scales and tunings.

The Babylonian santur was the ancestor of the harp, yangqin, harpsichord, qanun, cimbalom and hammered dulcimers.

[3] In Western Europe, a hammered dulcimer first appears in textual and iconographic sources from the early 15th century.

[4] The hammered dulcimer was extensively used during the Middle Ages in England, France, Italy, Germany, the Netherlands, and Spain.

The tetrachord markers found on the bridges of most hammered dulcimers in the English-speaking world were introduced by the American player and maker Sam Rizzetta in the 1960s.

This chromatic Salzburger hackbrett was developed in the mid 1930s from the diatonic hammered dulcimer by Tobi Reizer and his son along with Franz Peyer and Heinrich Bandzauner.

[citation needed] Several traditional players have used hammers that differ substantially from those in common use today.

Paul Van Arsdale (1920–2018), a player from upstate New York, used flexible hammers made from hacksaw blades, with leather-covered wooden blocks attached to the ends (these were modeled after the hammers used by his grandfather, Jesse Martin).

Billy Bennington (1900–1986), a player from Norfolk, England, used cane hammers bound with wool.