Carpal Tunnel ~ ugh

[Carlie]

I am a 7 year Massage Therapist, and I am pretty sure that I now have CTS. I need some insight from other therapists who have this dreaded syndrome and how to continue working. I am so bummed about the possibility of loosing one of things I love dearly. I pray your replys are good! :

 

[bluePumpkin]

Essential_Balance,
Welcome to MassagePlanetL, we're glad to have you join us here. Though sorry to hear that you're in pain.
There are some posts here @ MassagePlanetL about carpal tunnel and I'm sure that if you had a definitive diagnosis it would be easier for members of the board to suggest a few options for you.
First of all, though you have been in the business 7 years, you don't mention your current situation... has your work load increased recently? Try to cut back the number of hours or days and you may need to wear a brace/splint when not in session to help rest your wrists. Is it bilateral?
How often are you scheduling massage for yourself? Have you considered chiropractic or acupuncture to help deal with pain issues? How are your body mechanics? Might be time for a "refersher."
There are so many factors that could be contributing.

Here are a few links to other threads on CTS that might give you a few ideas of what to try or how to proceed:

Carpal Tunnel? Tendonitis? Help!!
http://www.massageplanet.com/forum/viewtopic.php?t=7716

Your experiences with injury in your bodywork practice:
http://www.massageplanet.com/forum/viewtopic.php?t=8383

CTS:
http://www.massageplanet.com/forum/viewtopic.php?t=7550

Carpal Tunnel Techniques:
http://www.massageplanet.com/forum/viewtopic.php?t=5764

carpal tunnel:
http://www.massageplanet.com/forum/viewtopic.php?t=3589

carpal tunnel:
http://www.massageplanet.com/forum/viewtopic.php?t=303

carpal tunnel:
http://www.massageplanet.com/forum/viewtopic.php?t=2334

 

[Toxic Witch]

Thank you for the warm welcome and reply. Actually my work load has not increased, I have been off work for 3 weeks for a little r&r over the holidays and to do a mental catch-up after a long family illness. Previous to this, I had been experiencing numbness and burning sensations in my right hand at night while sleeping off and on for a couple of years. Recently we had a tremendous ice storm here in Oklahoma that was pretty work intensive. I was feeding horses in some rather COLD conditions and carrying hay bales that were appx. 60-75 lbs. I knew better. My right hand is now waking me almost every night around 3 am with numbness, radiating up my arm. This pain is lasting 3-4 hours. It has never been bilateral until about a week ago, shortly after the "hay" incident. I purchased splints tonight. They feel pretty good. Im on a healthy supplement regime, including flax oil, cod-liver, ginger and glucosamine chondrotin (ms) for inflamation. I have been using my Chi machine in order to maintain good circulation and self Reiki as I am also a Reiki practitioner.

I am considering acupuncture first, chiro second. I would be interested to hear of the results others have received from these two areas.

Thank you for the threads, I will definitely check them out!

Blessings

 

[Quizzard]

Hope this helps - Nerve Glides

Hi everyone,
I have wanted to post something along this line regarding - "General Care for the Therapist". Something that will outline daily stretches, etc., that will keep our hands and UEs in good health.
All therapists - MT's, OT's, PT's, etc; who use massage and perform "manual" type tx on a daily basis will benifit from these ex's listed below.
I am an MA/OTRL (hand therapist) and do these myself everyday. The idea is to do these in order to prevent injury from occuring. These ex's, along with other tx techs, will also help relieve min to mod symptoms.
This is just a start. There will be more to come: (please read and try this cut and paste)
Other things to watch out for: CMC joint of the thumbs; always warm them up 1st; use MC joints as alternative or other parts of your hand, etc to reduce stress to joint tissues; do regular stretching (elongation) to joint spaces to allow S fluids to "repack" and lubricate J spaces.



Tendon Gliding Exercises

Nine tendons pass through the carpal tunnel. Four of the nine tendons bend the tips of the fingers; another four of the nine tendons bend the middle joints of the finger, and the ninth tendon bends the thumb tip. The purpose of these exercises is to glide the tendons gently through the carpal tunnel to minimize microscopic adhesions, reduce congestion, and improve lubrication in the tendons. These are not strength exercises. Perform the exercises gently or they may cause a pain flare-up.

hook fist - touch your fingers to the top of your palm. The large knuckles should be pulled back as much as possible.
full fist- touch your fingers to the middle of your palm. All three finger joints should be bent.
straight fist - touch your fingers to the bottom of your palm. The tips of the fingers should be straight.
thumb flexion - Start with your thumb pulled back from your palm as if you are hitch-hiking, then move your thumb across your palm and try to touch the tip of the thumb to the bottom of the small finger.


Nerve Gliding Exercises

The three nerves that supply power and sensation to the hand begin at the spinal cord in the neck. They have some elasticity, like a rubber-band, and lengthen and shorten as we move our arms. With repetitive trauma, microscopic adhesions can bind the nerve. Then, when the nerve over-stretches, we experience sensations such as pain, numbness, tingling, or coldness in the fingers.

If you are experiencing nerve symptoms, these exercises to glide (or slide, or pump) the nerves are critical. In fact, in one study, the chances of avoiding surgery improved dramatically when nerve glides were added to the therapy program.

It is very important not to over-stretch the nerve while exercising or you will create symptoms. Perform these exercises at a quiet time when you can pay close attention to the signals from your body. Feeling some tension is good but do not stretch to the point that you feel pain or numbness. You may feel tension anywhere along the nerve pathway, sometimes at quite a distance from the site of pain. I've had clients feel tension in their arms, shoulders, neck, even chest and back!

I teach clients to gently "pump" the nerve so that it is carefully teased out of adhesions. Some therapists instruct their clients in a sustained hold of 10 seconds. Try it both ways and see which feels better for you.


Median Nerve Glide (the carpal tunnel nerve)

Sweep your arm out to the side until it is slightly behind you, palm facing forward, elbow gently straight
Pull your wrist back until you feel a gently tension somewhere in the arm
Relax the wrist forward until tension is relieved
Repeat 10 times


Ease the tension on the wrist to about half
Holding this position, gently raise your arm until you feel tension (stay below shoulder height)
Lower the arm until tension is relieved
Repeat 10 times


Ease the tension on the arm to about half
Tilt your head (bring opposite ear towards opposite shoulder) until you feel tension
Straighten the neck until tension is relieved
Repeat 10 times


Ulnar Nerve Glide (the funny bone nerve)

Place your arm out to your side with the wrist pulled back as if you are saying "stop"
Bring your fingers toward your ear as if to cup the ear with the palm, fingers pointing to the shoulder. Stop when you feel a gentle tension.
Bring your hand back out to the side until tension is relieved
Repeat 10 times.


As an alternative:

Hold your arm out to the side, elbow straight, fingers gently curved but not in a fist
Rotate your arm fully until the palm is up.
Gently tilt your head (bring opposite ear towards opposite shoulder) until you feel tension
Straighten the neck until tension is relieved
Repeat 10 times


Radial Nerve Glide (the back of the hand nerve)

Place your hand at your side with the back of the hand facing forward
Push your shoulder down towards the floor (the movement comes from the shoulder, do not lean)
Bend your wrist toward the palm until you are in the "waiter's tip" position (as if you are a waiter unobtrusively taking a tip)
Move your arm back behind you and up at a slight angle to the side until you feel tension
If you feel as if you need more stretch, gently tilt your head (bring oppositie ear towards opposite shoulder) until you feel tension
Straight the head or move the arm back down until tension is relieved
Repeat 10 times


These nerve glides deserve a repeat of the previous cautions. Stretch only until you feel a gentle tension. Avoid pain. Perform in a quiet environment and listen carefully to your body's feedback while performing.



Finger & Thumb Stretches

Finger abduction and adduction (Spread the fingers apart widely then bring them back together)- This is an exercise that just feels good and can help reduce swelling in the fingers. It also stretches the hand out of the position it is held in for most of the day.



Thumb stretch - Using your other hand, pull the thumb back into the hitch-hike position. You should feel a nice stretch in the muscles at the base of the thumb. Push from the base of the thumb where it meets the palm. Do not pull from the thumb tip. This can hyper-extend the tip or the middle thumb joint. This is an important stretch to perform if you use a blackberry or text-message frequently.



Wrist stretches & Forearm Muscle Stretches

These are great stretches for elbow pain or forearm tightness. Make sure to keep your shoulders relaxed. The muscles of the arm being stretched should be relaxed - do not activate the muscles. The other hand is doing all the work to provide the stretch. If necessary, start the stretch with the elbow tucked in to your side and then gradually straighten the elbow while you maintain the stretch with the other hand until you feel a good stretch. Do not hyperextend your elbow. If performing these stretches with your arm held at shoulder height is uncomfortable, you can relax the shoulder and arm so that it is half-way between the shoulder and the side of your body. These stretches should not hurt; however, it is okay to feel a gentle "good pain". Hold for 30-40 seconds. Perform 2-3 stretches before and after strenuous activity and every 1-2 hours or so during non-strenuous activity.



Forearm Extensor Stretch: Place your hand in front of your body with the elbow straight and the palm down. Let gravity bend the wrist forward. With your other hand, gently push the wrist further until you feel a good stretch. Hold for 30-40 seconds. Close your fingers gently to increase the stretching sensation.


Forearm Stretch-Fingers Relaxed Forearm Stretch-Fingers Bent Forearm Stretch-Arm Relaxed



Forearm Extensor Stretch with Full Pronation: Same as above but rotate the palm outwards as if you are swinging the small finger up towards the ceiling. Hold for another 30-40 seconds. Close your fingers gently to increase the stretching sensation.


Forearm Flexor Stretch with Pronation: Place your hand in front of your body with the elbow straight as if you are saying "stop". Support the hand being stretched with the other hand. Relax the muscles of the arm being stretched so they are not activated. Gently push the wrist further with the other hand until you feel a good stretch. Hold for 30-40 seconds.


Forearm Flexor Stretch with Supination: Begin from the "stop" position with the fingers pointing up towards the ceiling. Swing your fingers out and rotate your arm until the fingers are now pointing to the floor. Make sure the muscles are relaxed and not pulling the wrist back actively. Gently push the wrist further with the other hand until you feel a good stretch. Hold for 30-40 seconds. This forearm stretch is often the most uncomfortable for people to perform. If necessary, bend the elbow to make this stretch more comfortable.

OK I know this is a lot. Please take your time with this and try them one at a time so this is not an overload. You will notice a diffrence!

Take care,
LG

 

[corvette!!]

Hi EB,
Your description raises some ?s from me. Without seeing you infront of me, etc, it is an educated guess at the moment; but your problem sounds like it may be coming from your neck. PM me if you like and we can talk it out. I also have some tx/dx suggestions for you to help rule out other possibilities.
Take care,
LG

 

[RaZzor]

Awesome!

Amazing! I love the instruction! It feels wonderful, thank you!
I have been having some symptoms of Thorasic Outlet Syndrome latley, or well I think that's what it is. Loss of sensation from the medial side of the elbow down to the last 3 fingers, and some tenderness in the lateral pec, and tightness in the anterior neck.
I have been using my elbows a lot more in treatments latley, and I think this has contributed to the problem.
These Nerve Glides seem like they would be very benificial in this issue. Do you have any other suggestions for Thorasic Outlet?
Thanks for the great imput!

 

[Carrie]

CTS

Could this also be a multiple (double) crush syndrome? The problem may be from your neck.
Rubmyster
The info from the OT is great, I'm going to print that . 8) [/code]

 

[Lord_Darkclaw]

Not sure I don't think I have heard that term previously.... Can you elaborate? My neck has been acting up also.

 

[Sasuke U]

Thanks for the info, livgreen! I've cut and pasted and am printing it out now!

 

[...Just Me :)]

Fantastic info! Thanks for sharing.

To the OP - are you reciving any care yourself? If I were experiencing those symptoms I would get myself to a chiropractor ASAP.

Angela

 

[lovy<3]

"double crush" usually refers to two distinct areas of nerve compression. Addressing only one (ie: only in the arm,) will only partially relieve symptoms at best.

Double crush is very common, which is why we try to release everything that feeds the problem, as well as the symptomatic area itself.

 

[nextGREAT1]

Angela,
Yes I do see a chrio pretty regularly. And I do get massage, though not as regularly as I could, and should be. I am going to call them (I trade with 2 therapists and am overdue!) to schedule some appointments for the coming weeks. Maybe do some shorter concentrated sessions on that area.
Thanks for the definition Staci! I thought that was what it meant, just wasn't sure.
Ok Going to call them now...

 

[xSoni]

LG
Thank you so much for the exercise info. I did the first one while reading them and it felt great. Will definitely copy and complete them, plus share them with fellow MTs. I will PM you regarding my situation, thank you for the offer.

 

[Suzuki]

You are very welcome! I hope these ex's help (they really will if you do them as part of your daily warm up).
Yes, "double crush" speaks to a nerve impingment injury with 2 or more isolated areas of compression.
TOS - brachial plex nerve glide and all the above glides work wonders. Just remember to not push it. Have someone work your scalenes (located deep to your claviacal) Offen the scalenes become tight and press on the plexus and 1st rib below. Very hard to get to and can be uncomfortable...go at it slowly.
Don't forget to use "ice" (cold therapy/cryo) and heat. Generaly speaking, heat is indicated for increased blood flow (speed healing) and tissue laxity and ice to reduce inflamation and pain. Contrast or alternating heat and cold several times can really improve an "acute" injury by creating a "pumping" action to your vascular/lymph system - reducing inflamation, pain, etc. Use your judgment and always take care in doing any of these tx techs...
LG

 

[Julie loves Hoochieboy!]

we appreciate your posts!

Thank-you THank-you Thank-you LG!!!
I have been doing more research about my pain symptoms and I am still learning more and more.
I had one of the MT's I trade with work on me yesterday for about 1/2 hour I had him concentrate on the Rhomboids, Traps, Levator Scap, Sub Scap, Supra Spin, Scaleenes, SCM, Platisma, and Pecs. I had many TrPs in the anterior neck, and Pecs (as suspected) And I am most certianly going to have him do much work there thursday when I see him again.
After the session I felt like my shoulders dropped about 2 inches from my ears. It felt amazing.
Any other recomendations would be much apreciated!

 

[CheerxGirl]

more ex

Hi again,
Whoops; sorry about the typos above – a good lesson in slowing down and proof reading entries before shooting them off. lol
Anyway, here are more ex’s which will address TOS and brachial plex injuries. Of coures, it goes without saying (but I will anyway) to watch your postural dynamics and adjust while working and while you sleep. Yes, while you sleep. Many compression type injuries are developed and pushed forward into to serious injuries due to poor sleeping postures. During my intake evaluations, I always ask patients about sleeping posture or sleeping position. So, ask your self this question and adjust as nesessary.

*(pictures did not post? - oh well)*

Brachial Plexus Injury (Stinger/Burner)

Rehabilitation Exercises
You can begin these exercises when moving your neck in all directions (up, down, right, left) does not cause numbness or tingling down your arm or into your hand.

• Neck isometric exercises

A. Neck flexion: Sit tall, eyes straight ahead, and chin level. Place your palm against your forehead and gently push your forehead into your palm. Hold for 5 seconds and release. Do 3 sets of 5.

B. Neck extension: Clasp your hands together and place them behind your head. Press the back of your head into your palm. Hold 5 seconds and release. Do 3 sets of 5.

C. Neck side bend: Place the palm of your hand at the side of your temple and press your temple into the palm of your hand. Hold 5 seconds and release. Do 3 sets of 5 on each side.

• Head lifts

A. Neck curl: Lie on your back with your knees bent and your feet flat on the floor. Tuck your chin and lift your head toward your chest, keeping your shoulders on the floor. Hold for 5 seconds. Repeat 10 times.

B. Neck side bend: Lie on your right side with your right arm laying straight out. Rest your head on your arm, then lift your head slowly toward your left shoulder. Hold for 5 seconds. Repeat 10 times. Switch to your left side and repeat the exercise lifting your head toward your right shoulder.

C. Hands and knees neck extension: Get on your hands and knees and look down at the floor. Keep your back straight and let your head slowly drop toward your chest. Then tuck your chin and lift your head up until your neck is level with your back. Hold this position for 5 seconds. Repeat 10 times.

• Shoulder shrugs: Stand with your head directly over your shoulders, with your spine straight. Shrug your shoulders up and then relax. Do 3 sets of 10.

• Shoulder abduction and adduction: Stand with your arms at your sides. Bring your arms up, out to the side, and toward the ceiling. Hold for 5 seconds. Return to the starting position. Repeat 10 times.

Hope this helps.
Take care,
LG

 

[Pompal 09.]

Hi LGreen!
Oh thanx for posting these exersises!! Yes, this is much easier than having you try an explain them all. I will print them and give em try.
It was great meeting up with you the other day! My shoulder is def getting better. I'm doing my exersises...I swear!! ha :roll:
Thanks again, you are awesome!!
S.

 

[cool_is_sexy]

Hi S!
Thanks, you are very kind. I'm glad you are on-the-mend and you are doing your ex's??!! Talk soon,
LG

 

[cloumbgog]

ouhhh you got to meet LG? I am jealous!!!
Thanks LG, I will make sure to make theese simple steps part of my daily routine!