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Posts for tag: stretching

These days, it seems like you can't turn around without bumping into someone who has Carpal Tunnel Syndrome or is on their way in for carpal tunnel surgery. If you are like me, you may, at times, have wondered if you have or have had Carpal tunnel syndrome yourself! In today's blog post, we are going to review what Carpal Tunnel Syndrome (CTS for short) is, some practical ways to treat it and when you might want to consider surgical intervention.

The Carpal tunnel is composed of the bones on the back side of the wrist (carpal bones) and the transverse carpal ligament on the inside. The median nerve and nine flexor tendons (tendons from muscles that cause your fingers and wrist to curl) run through the middle. When the fingers and wrist are used in a neutral (non-bent) fashion, the flexor tendons glide along the tunnel walls, lubricated by their own fluid. However, using the wrist and fingers repetitively in a flexed (bent-forward inclination) posture can set off a cascade of events that creates CTS. Therein lies the rub... LITERALLY!

Continuous use of the wrist and fingers in a flexed posture does the following:

  • Creates an over-development of the flexor tendons (making them larger)

  • Creates a relative weakness of the extensor tendons (the opposing muscle group that would normally keep the wrist and fingers in a neutral inclination)

  • Increases fluid retention and inflammation in and about the Carpal tunnel

  • Causes fluid pressure on the median nerve, which produces the classic presentation of CTS

The Median nerve is the nerve that is impacted by compression of the Carpal tunnel. Though you can have wrist and forearm pain from a number of different sources, if it originates from CTS, you will have some pretty characteristic symptoms:

  1. Numbness along the thumb, index, middle and half of the ring finger

  2. Tapping over the wrist (palm side) will often give a shooting sensation into the same area, as described in number one above

  3. Placing the back of the hands together with the wrists bent at ninety degrees can also increase the numbness

  4. Shaking the hands can often relieve the symptoms for a short time

  5. In long standing conditions, a weakness in the muscles of the thumb and index finger can develop leading to an inability to grasp or hold onto items

What To Do?

First the bad news: Personally, I have had the privilege of working on a number of patients over the years who either had or were on their way to getting CTS. Typically, the ones who had constant numbness and or weakness were beyond conservative measures, and ended up with surgery.

But there is good news:  More often than not, those that did go in for CTS surgery did well, as long as it was not too far along (mostly aggressive muscle weakness). In addition, those patients who were not too advanced in the syndrome were often able to put surgery off, sometimes indefinitely!

The keys to keeping CTS from progressing, and possibly reversing its effects, revolve around balancing the relationship between the flexor muscles (those that close the hand and flex the wrist) and the extensor muscles (those that open the hand and extend the wrist) by focusing on the following:
  1. Stretch the flexor muscles of the wrist and fingers.

  2. Strengthen the extensor muscles of the wrist and fingers.

This can be done fairly easily with an exercise band or even a rubber band. The key to this approach is repetition - just as CTS doesn't "show up" overnight, neither will it go away instantly. You are really reforming the connective tissue in your wrist and forearm - it is a very specific workout program designed to reverse the cumulative effects of years of abnormal movement.

Typically, we encourage people to stretch and do their exercises three times per day, everyday for three months, before deciding this approach will not work for them. In addition to stretching and strengthening, two other things can be useful: a nighttime splint that keeps the wrist neutral, and vitamin B6. Both of these can reduce inflammation and help the nerve tissue heal itself.
 

 

Over the last month, we have posted multiple blog posts about conditions that impact the head, neck and wrist. We are completing a short video that will include demonstrations on neck and shoulder stretches, home trigger point therapy for problem muscles, and CTS stretches and exercises. Watch your email over the next week for the link!

Until then,
Eat well, think right and move a lot!


Dr. Doug Williams
Care Chiropractic
Lafayette, Indiana

By Dr. Doug Williams
April 27, 2016
Tags: exercise   ergonomics   stretching  
If you are cruising the Internet looking for good stretches, you will find no shortage of options. But, are they all good? Is there an optimum stretch? Is there a best way to stretch? These are all good questions and I hope to answer them for you by the end of this post.

Is all stretching good for you? The answer to this question is no, not all stretching is good. Not all tissue needs to be stretched and not all tissue needs to be stretched all of the time. With that said, most stretches won't hurt you, but they may not be the best thing for you either. The science behind flexibility (the outcome of stretching) is varied and has conflicting data. However, there are some generally accepted axioms regarding stretching that I've listed below:
  • Focus on stretching after exercise as opposed to before. Generally, a slow warm-up is more beneficial for preparing your muscles for exercise, as stretching may place a joint at risk for injury.
  • Stretches held for longer than 10-12 minutes have the potential to permanently change the length of ligaments and muscles. In fact, this type of stretching has its own term called traction. We use traction in the office to alter posture - it is a valuable tool, but really needs professional oversight.
  • Because of the way our bodies are built to maximize certain movements and actions, there are fairly predictable patterns of muscles that tend towards tightness and others that tend towards weakness.
  • Much of the developed world has similar patterns of muscle shortening, which are usually secondary to the amount of sitting we do and the amount of moving we don't do.
Here at the office, I am always on the lookout for the biggest bang for the buck. For something to reach "Big Buck" status, it has to meet these three criteria:
  1. Cover issues that most people have.
  2. Be easily understood and reproduced.
  3. Be simple enough to do in two minutes or less.
The two stretches outlined below meet this criteria and we recommend them often. They will stretch a large number of the muscle groups that tend to become short because of our unique human frames, the amount of time we spend sitting in cars and soft furniture, and generally not moving enough throughout the day.

A few things to remember before you get started:
  1. If you are currently in a lot of pain ( 7+ on a scale of 0-10) or dealing with a new injury, then you need to talk to your chiropractor before engaging stretching as it may aggravate your condition.
  2. Stretching is not about how much you can get out of your body, but how much your body will give you. Stretching should feel like a pleasant pull and you should feel relaxed and more pliable afterwards. If performing the stretches is painful, then you are either pulling too hard or something else is wrong. Try dialing back the intensity - if that doesn't help, then contact us before continuing.
  3. You are not going to undo years of poor posture, injury or chronic pain with stretching once for 2 minutes. Stretching is like putting a little money in the bank with each paycheck; it may not look like much at first, but, over time, your investment grows! Add that to a good exercise, nutrition and supportive chiropractic program, and then you'll see progress!
Go ahead and give the following stretches a try. During the day, work on them once an hour, as long as you keep the above three points in mind. A really good time to stretch is in the shower under hot water - just don't slip on the soap! If you are trying to stretch right as you get out of bed, go slowly as our bodies are naturally stiff in the morning. These stretches would be great to incorporate after exercise as a cool down and after you have been sitting for awhile, like at a computer or while talking on a cell phone.


Remember: Eat Right, Move Right, and Think Right!

Doug Williams, D,C,
Care Chiropractic 
Lafayetette, Indiana