Friday, July 11, 2008

Curing and Preventing Carpal Tunnel Syndrome

Some of the ideas here are unique; I think you'll find them useful to prevent and cure Carpal Tunnel Syndrome (CTS).  They come from my own experience, from  long mentoring in the method by many patient teachers, and from my pleasant memories of many hours doing Awareness Through Movement in my Feldenkrais Training.  

Maybe I am spoiled, but I like to be comfortable, and during my Training, I did get very comfortable in my body. That was new for me. I wanted to hang on to that delicious feeling. So, many times, as a spontaneous natural event, I've found my body has prompted me to invent numerous little gestures, movements, stretches or isometrics in response to some less-than-comfortable body sensations. I've made note of these - my body has been my teacher -  you'll get all the details here - those related to CTS. I am quite sure that for me, at least, they have a subtle corrective, soothing and long-term healing or prevent-trouble effect. I think they'll speedily take you out of trouble (if you do everything I recommend in this post) and keep  you that way. You'll really enjoy them. Each of them only takes a few seconds, and can be done practically anytime, anywhere.  

First some perspective. We no longer walk on all fours. If we did, our hands would be flatter, not so curled-into-the-center from all the gripping and holding that we do with our hands, especially our dominant hand.  If you were to walk on all fours, your body weight would flatten and widen the hand.  From my Feldenkrais Training, I remember how good that felt for the hands. And one thing I have learned, for sure: if a movement or a "body-idea" is grounded in developmental movement (early childhood, toddler, etc) and if additionally it feels really good to do it, for sure there are tremendous healing benefits in exploring that approach. But who has time to spend an hour a day walking on hands and knees gardening or doing ATM lessons? So, I invented shortcut exercises for myself -  they have become habitual and feel SO good and they counterbalance what happens while using a mouse or typing at a computer keyboard, to a certain extent.

We spend lots more time gripping, typing, sitting motionless than people did 150 years ago. It goes along with increased industrialization. We need to strike a balance between flat, open hands with moveable wrists and gripping hands with tense wrists.  When our forebears built log cabins, knitted, cleared land, fought battles, carried water, did gardening, hunting, rode horses, they did many more things with their hands than just grip or type or mouse with stiff wrists.

The exercises that follow can become just like any other little habit, like licking the lips or swallowing or blinking the eyes. I don't think you'll ever have trouble again with your wrists if you take time to do this. They don't take long - except for the few minutes it takes to initially read the description, puzzle it out, and learn to do it the first time. It takes many words to describe a simple movement. 

How to to flatten/widen the hands (in lieu of crawling on the floor on all fours) - little habits to make part of your every day life:
  • Put your hands in prayer position (open palms, lengthened fingers, not clasped) between your knees. Squeeze your knees together strongly. Especially direct the pressure of the knees to the butt of both palms - that is where the opening and flattening is most needed. That can be done anytime you are sitting in a chair. It's also great exercise for the internal hip rotators. Press and release with a 2 or 3 second rhythm, or whatever is comfortable for you.
  • When lying in bed on your side, place your bottom hand between your knees. Again, direct the pressure to attempt to straight or flatten the butt of the palm - where the palm meets the wrist. You can even fall asleep this way. 
  • Widen and open your fingers to the maximum comfortable stretch (as if carrying a tray of food and you wanted to make your hand as flat and bent back and wide as possible) - hold for 3 seconds and release. Particularly emphasize pulling the thumb as far back - in the opposite direction from gripping - as you can comfortably. You'll see many piano players do their version of this little "gesture" just before playing a piece on the piano. For sure, those folks need supple and comfortable hands and wrists. Well trained piano players can teach us about avoiding CTS. They know a lot. Please notice, for starters, they sit on a hard, flat bench with minimal cushioning. That is no accident. This little stretch can be done anytime, anywhere, and if you want to be unobtrusive, do it under the table when you are sitting, say waiting for lunch. 
  • When getting up out of a chair, bend back your wrists and fingers somewhat as part of the process of coming up to sit. 
  • Sitting in a chair, place both palms face down (fingers of either hand pointing at each other) on top of your thighs so that your thumbs are about 3 inches below your belt-line. Press both your hands into the mid-line, stretching back your wrists and fingers while flattening your palms. To increase the stretch bring your hands more towards the outside of the legs as you press towards mid-line. To increase the intensity, use your legs to press outwards against the hands; this strengthens the external hip rotators while stretching back the wrists and fingers. 
  • Use one hand to press the other hand back, stretching back one or more fingers and the wrist as well. Particularly press the thumb backwards. This can be done anytime you have free hands. 
  • When standing next to a wall, lean with one hand - palm flat, fingers widened - on the wall. You can create a great stretch this way, and you have tremendous leverage, the entire weight of your body. Get used to stretching the wrist back. If you persist, every month you'll gain about 1/2 inch or more range. It is a great way to stretch those over-tight flexor muscles in the forearm.
  • Consider taking Bikram Yoga classes (the type of yoga I know best). It is very intelligent. The very first exercise - it's not only a breathing exercise because for 20 slow repetitions of 6 seconds each you are taking your clasped hands under the lowered chin, and opening the elbows up to create a tremendous stretch of the hands and wrists - such as we have been discussing. But, the Bikram way  is much more powerful and quicker than any of my methods. Really, I don't think you'd get CTS if  you did Bikram regularly. And it is never too late to start. I did have one guitar player with thumb and wrist trouble, but because he did Bikram just once a week, his situation quickly resolved.  
  • When you sit in the "thinker pose" with chin  cradled with bent hand, take that opportunity to press the chin  into the hand, bending back the wrist even more.
  • Stretch back the fingers or your right hand, one-by-one, for 3 seconds each, as you also bend back the palm. Be sure to include the thumb. Pull back on the fingers hard enough so that you feel a definite stretch  in the belly of your forearm. Repeat for the left hand.  
  • When you are lying in bed, or on the floor, face up (supine, on your back) place one or both palms face down under your buttock or sacrum. The weight of your torso will compress and flatten the hand(s). Adjust the position of the hand so that the thumb, particularly, is flattened relative to the hand, or even bent backwards somewhat. 
  • While sitting in a chair, place one or both hands under your sitting bones. This is one of my favorites. Lean left and right, a little front and back; this gives a good massage, while powerfully stretching out, the palms, thumbs and fingers. This is my current favorite. 
I don't do these things systematically; I invent ways to press the wrist and fingers back, and these are just a few examples. I do them because it just plain feels good.  At first, though, it may feel strained - so go easy, take your time. Eventually you will crave that nice open feeling in palms, fingers and wrists, and you'll seek it out like I do.   

Quick, Easy Isometrics to Prevent and Cure Carpal Tunnel Syndrome:
  • To isometrically strengthen the shoulder external rotators: While sitting in a chair place both hands between the knees, palms together as before. This time push the legs apart with your hands, as you resist with your legs. You arms are attempting to widen the distance between your knees, but you don't allow it. This isometric strengthens the external rotators of the shoulder joint. We do too much internal rotation when typing or writing and this isometric can balance the muscular development in the arms and shoulders. This will absolutely help prevent pain and trouble in the arms, hands or wrists. 
  • To isometrically strengthen the external rotators of the forearm: With your left hand grasp your right forearm, just above the wrist. Rotate your right hand so that the right thumb moves in a clockwise circle - but prevent that movement with your left hand. In other words, you are attempting to externally rotate the right forearm, but your left hand prevents it. After doing the isometric, release your left hand and "follow through" or continue with the movement of your right forearm rotating into external rotation (thumb going clockwise) to the very limit of it's range. This isometric strengthens the external rotators of the forearm. This is very important, since when we type we are continually internally rotating both our forearms. This will balance that severe imbalance. It will also feel very good, a nice feeling. Do with both arms once or twice a day, at odd moments while sitting at your desk or work station. It only takes a few seconds.
  • To isometrically strengthen the finger, thumb, palm and wrist extensors: With one hand make a gentle fist, and bend in the wrist so the fingers and wrist come closer to the inner belly of the forearm. Place your other hand on top of the soft fist, holding the fingers, thumb and wrist bent as they are. Now, attempt to straight out the clenched fingers and fist, the bent thumb and wrist - but prevent it with the other hand. Experiment until you find a comfortable gripping style with which to do this. Here,  you are strengthening the exact opposite hand and wrist muscles that you use to type and write and grip objects with.  Do both hands. This exercise may feel difficult or painful - so start off very easy. These muscles in most of us are very weak, and under-utilized. It will take time to strengthen them to normalcy (when that happens, as antagonists they will release the flexors). After 4-8 weeks your hands and wrists will have much more balanced musculature; the joints will be more aligned and not pulled only in one direction, which is an invitation for trouble. Please try this before you submit to CTS surgery! Here is a hint: You can do this same exercise by placing the "soft fist" over one knee, gripping the knee, and resist with your other hand. This actually makes the exercise easier to do. 
How to Have More Relaxed Hands, Softer Hands, to Encourage Softer Grip:

If your hands are too tense 24/7 as is the case with so many people, just getting massage or doing the things listed here won't be enough. You need to do something during the day to reprogram your nervous system to have softer hands, to use less effort, to be able to have "quiet hands" when you are not using them. They should not be always "ready to go". 

The movement is called "The Bell Hand" in the Feldenkrais work, and there are many variations and many ideas related to this. It is best learned from an ATM lesson, but you can still benefit from simply doing this:

When sitting, standing or lying down - at any time - softly open and close your right hand. The movement is very small, minimal, and effort is also minimal. Do very little, easily,  and the actual movement can be so small that you don't even see any movement. Two variations that I like: a) first do just the opening of the fist voluntarily, and let the closing (such as it is, it will be a very small movement) be involuntary and b) close the hand into a soft fist, but ever so slightly and slowly and easily - rhythmically- and then allow the opening to be passive. Do the left hand also. 

Even 5 minutes a day of this can work wonders. Like many somatic ideas, this one is so powerful that if you do nothing else than this, in time you might completely reverse your troubles.  

Rowing Machine or Exercise Tubing Exercise - the most essential exercise:

Because we all reach forward so many times a day, we need to strengthen the muscles that pull the arms back into the body. These are "rowing machine" type movements. If you have a rowing machine, use that for at least 10 minutes a day. Keep your shoulders well-down and your chest slightly lifted as you do rowing exercises - this is crucial. If you go to the gym, do all kinds of rowing movements, use the rowing machines instead of the stationary bikes, etc, and include lat pull downs, rowing with one arm, various angles (use cable machines for this), etc. Personally, I use a chin-up bar in my kitchen (very well secured to the doorway!), with 5 exercise-tubings hanging over the bar. I grab these, fall backwards as I resist and pull back with my arms. I'll rhythmically fall half-way backwards, then bounce up. I suspect the benefits are similar to a rebounder.  I'll stand at different angles and use one arm, both arms, then the other arm. I'll get on my knees to get a different angle of pull.  It is a wonderful, relaxing, rhythmical way to do the rowing movements, low tech  and low cost. Because it is so close-at-hand I can do this several times a day, at any time, and I do - whenever I start to get neck pain, that is my fix. These exercises will keep your head from being protruded forward, help you maintain erect posture, and insure that the mechanics of your head, neck and shoulders stay in the normal range. I'd say there is nothing else better for staying out of pain and trouble of any kind while working many hours at a computer keyboard and monitor. 

If you build this into your lifestyle you'll be most pleasantly surprised at the benefits. Granted this may not seem directly related to CTS, but in the Feldenkrais way of looking at things, it is. 

Here is another thing you'll want to do if you are eager to cure carpal tunnel by yourself. Michael Young is a Massage Therapist who has produced a DVD on curing carpal tunnel syndrome. As soon as you can, buy  his DVD, from mrtherapy.com, and do what he says, it only take five minutes twice a day. He claims this will prevent and cure carpal tunnel. I agree; he is a smart man (and courageous, to go public with his experience, that flies in the face of much medical dogma), and his techniques really do work. He states that he has never failed to completely cure carpal tunnel, with over 60 some cases, except once when a person failed to do the 5  minutes twice  a day homework, using the natural self-help method he describes (plus private sessions in extreme or stubborn cases). Be patient when you see that DVD, he does stutter a little bit, and the good stuff, the "how to do it" is all at the very end of the DVD.  If you are determined to go the natural route, listen only to people like Michael who have had experience curing this condition - there are numerous people out there like that (including me), you need to search them out; unfortunately you don't find them in the medical community, as far as I can see.  

Also please read what I have written about chair sitting posture, thumb pain, castor oil and shoulders and start making a few changes. At least just read those articles - it will change your perspective on the whole issue, and it will begin to become clear what changes you need to start making.  It can make a huge difference. You might want to privately see a somatic practitioner like a Feldenkrais Practitioner to get guidance as to what steps to take first.  Carpal tunnel syndrome is not only about the wrists - it has to do with our whole body organization as we sit and work at a desk or do our job.  How do you hold yourself as you work? How is your breathing? What is going on with your pelvis to help or hinder you? Are you holding your shoulders too tight? Is  your belly relaxed? Why not? What is the carriage of your head as you work? Are you mostly staring with your eyes as you work? What kind of chair do you use? How is your ergonomic set up?  What movements are available to you as you sit and work? These are some of the issues that a somatic practitioner will look at with you. While they may not seem to be directly related  to wrist or thumb pain, you might be very surprised at the results you get.  

Please see a nutritionist - or at least do research on the net, or read a book about diet and carpal tunnel -  to be sure your diet is helping and not hindering your situation. Certain B vitamins  (Vitamin B-6, 200 mg three times a day, according to Andrew Weil, MD) can help carpal tunnel, and a low-inflammatory diet can never hurt. Before you agree to surgery, at least give these harmless, alternative ideas a fair trial. There are many good books and internet resources for ways to help carpal tunnel with diet and supplements. Again, do a little research.

If  you are not able to see a Feldenkrais practitioner, at least do a weekly ATM class - if there is no local teacher, then use the free  "The Open ATM Project" for free AMT downloads you can use at home, at your convenience. Any of the ATM lessons will help you become more body smart, and help you organize yourself  at your desk so you don't create more trouble for yourself while typing and working.  If your trouble is really serious and you are determined to cure it by non-invasive means (no surgery or injections) try to see at least an experienced chiropractor, osteopath, personal trainer, and massage therapist (at least three of the four) at a minimum. Get their opinion, and ask others - friends and co-workers - if they know of anybody who is curing carpal tunnel with alternative methods. Granted, your insurance may pay for surgery, and perhaps you will get some paid time off - but if you go the natural route instead, you'll be far ahead in the long run. 

Frankly, after working some years with people who were receiving Worker's Compensation, I became a little bit discouraged. There is never a resolution. There are MDs and lawyers, and monthly checks to contend with. Often there  are heated emotions, of fear or anger or anxiety about being unable to work again. These may not be obvious, but they are under the surface. So there may be a subconscious tendency to not want to fully recover - sad, but true. That means they usually find ways to block full recovery, they are invested in staying disabled. That is not a habit you want to cultivate. 

To put it more bluntly, people on Worker's Comp or SS Disability often will take on a victim mentality, that perpetuates their trouble and blocks healing. They are nice, sincere folks, and if you tried to tell them this, they would emphatically protest - and they really believe this - that this description does not apply to them, that they are really and truly an exception, that what the Doctors have told them must certainly be true, "My Doctor is really good and special", they have a true disability, and I have an MRI  or X-rays to confirm my diagnosis, etc etc. It is only after many years of working with all types of clients, that I can see clearly the contrast between those folks and "normal" clients. 

It is quite amazing the quick healing progress and transformation that can be had if you take the opposite attitude: I do not have to accept a diagnosis. OK, maybe I have to slow down awhile to recover; It is just temporary -  I am a healthy not sick and this trouble has "come to pass".  I take responsibility for creating or allowing this injury or trouble, and what I create I can un-create. It is just an opportunity for me to be proactive, learn new things, and take back responsibility and use my own internal healing gifts."

If  you approach trouble with this attitude, trouble will run from you.  It really does all start in the mind and spirit. That's not philosophy but clinical observation, from seeing all types of clients for over 14 years. I have never seen anybody, if they are taking money for a disability, with this positive attitude. I've seen numerous people - it is fairly rare - with that upbeat attitude, and for them, their troubles were all quickly resolved, or if not, it did not rule their life.  Granted it may not always be feasable to stay out of that system, but at least minimize your time there, work on natural healing methods, and prolong surgery at all costs - even if you have to go into debt. 

I agree with Michael Young that carpal tunnel is fully reversible and curable, and there is no justification for surgery. I agree with Michael that the prime cause of CTS is knotted, extremely tight muscle fibers in the belly of the forearm (and the shoulder and neck, often)  - not so much the wrist itself or the thumb and fingers.  To release this tightness, while stretching the muscles, is very intelligent - that is the technique that Michael will teach you on his DVD. 

Really, you can't even notice or sense how tight some muscles are until you stretch them - then you know how many painful knots and tight muscles are really there.  So please, get his DVD ( and study it. I have not had the extensive experience he has had, but what I've seen confirms that view.  Personally I have found it can take many weeks or months of regular sessions and client cooperation to get that complete resolution. That's partly because I work with habits that may be slow to change, instead of with a "quick-fix" attitude. Feldenkrais work will teach you how to type and write without creating those knotted muscles in the forearm, in the first place. And Feldenkrais, alone, in time will work wonders. But when you have serious pain, and need help fast, Michael Young's DVD is a great resource in addition. 

I also recommend to clients using castor oil on their hands every night, 2 or 3 days on and 4 days off for several weeks. Before going to bed, use a cotton glove saturated in castor oil (from the health food store - no hexane or solvents) and put it over the hand in  trouble. Then put over that a larger kitchen plastic glove, and seal off the end of the glove by tying a long rag around the top of the glove where it meets your forearm. Using castor oil like this will take the pain way down (at least 60% or more, in my experience. But, it takes 2-3 days of using castor oil before you get the pain relief) , reduce inflammation, eliminate any infections, reduce swelling, detoxify drug residues, speed healing and calm the nerves as well. It is an ancient and time proven remedy. I would never be without a large bottle of castor oil in my refrigerator. 

Please see my post on Castor Oil where I describe the benefits and protocols in more detail. 

All this may seem too much to do; But actually once you learn these things just 20 minutes a day will suffice. If your alternative is surgery and the possibility of many months or years on Worker's Comp without work at half pay, 20 minutes a day is nothing, if you can avoid it. Granted, it will take you a week or two to put all these things in place, and that will take more than 20 minutes a day. If you are really serious you could be out of trouble and back to work with no pain, in an unbelievably short period of time - especially if you incorporate castor oil as a regular part of your routine. (Of course, I am assuming you have a traditional case of CTS and not some additional serious medical pathology).  



  




5 comments:

Anonymous said...

Here is a link to some castor oil packs: http://www.earthclinic.com/Remedies/castor_oil.html

from the site Earth Clinic: folk remedies and holistic cures"

Anonymous said...

Rowing machines can cause Carpal Tunnel Syndrome so if you already have CTS, it's not a good idea to be rowing.

Skythia Haven said...

Carpal tunnel syndrome is a compression on the the median nerve due to prolong typing, computer gaming and writing. You can check more information on this site and read more articles on our experts advice. http://carpaltunnelhq.com

Anonymous said...

Thanks for writing such a great post!

I tried the "widening fingers" exercise last night and my hands felt immediately better. Wow, what a difference!

I'm looking forward to trying all the other stretches to keep my hands flexible and pain-free. Thanks again.

Corinna Jones said...

You wrote:

"Certain B vitamins (Vitamin B-6, 200 mg three times a day, according to Andrew Weil, MD) can help carpal tunnel, and a low-inflammatory diet can never hurt."

And I thought 200 mg three times a day seemed very high. I spoke with my doctor and did a search and according to the Mayo Clinic:
"The recommended daily intake of vitamin B6 is as follows for adults: 1.3 milligrams in men and women ages 19-50; 1.7 milligrams in men aged 51 and older; and 1.3 milligrams in women aged 51 older.", and recommends no more than 200mg per day. Meanwhile, the National Center for Biotechnology Information posted a study stating:
"Vitamin B6 (pyridoxine) causes neuropathy at intakes of 1000 mg per day or more, which is about 800 times the daily intake from foods. There have also been occasional reports of toxicity at intakes of 100-300 mg per day."

Neurotoxicity is a very likely side effect of taking your recommended dosage of B6. You can't claim your information came from (one single, albeit well-known) doctor and believe you do not share in the responsibility of sharing reliable information on your blog. At the least, if you are recommending taking anything, you should know and mention possible dangers associated.