Posture, movement and Biomechanics 2– Example: Carpal Tunnel Syndrome

So, you work a lot of hours at a desk, or you travel a lot by car, plane or other vehicle. You sit. You’ve had some occasional pain in your back or neck and, well, maybe you’re not a kid anymore. Or maybe you’re a carpenter, an assembly line worker or a roofer. And now, you’re getting this numbness and tingling in your hand and fingers. You go to the doctor and she tells you it’s Carpal Tunnel Syndrome (CTS). And you need surgery.

Well, maybe.

(First of all, for you to be properly diagnosed you pretty much need either some imaging or to perform two small physical tests, called Tinel’s test and Phalen’s test. Ask the doc.)

To be concise, CTS results from irritation or inflammation of the median nerve as it passes through the tunnel in the wrist partially formed by the carpal bone. It’s a relatively small space, so if the nerve becomes inflamed and swollen, it is subject to pressure and the resulting neorogenic pain, possibly accompanied by numbness and tingling in the hand.

The surgical option enlarges the tunnel (relieving pressure on the median nerve) by cutting the ligament that forms the top of the tunnel and possibly removing other “excess” tissue such as scar tissue or a tumor.

Now, I am not going to tell you that no one ever needs this surgery or that no one ever needs surgery for anything. OK?
But, the fact is that the causes of CTS are usually preventable and the syndrome often curable without surgery. (I can’t tell you when it is or isn’t, but you usually have little to lose by trying the non-surgical methods first.)

The median nerve, of course emanates from your spinal cord. It comes out in your cervical spine with roots coming through several cervical vertebrae. It runs down your arm to a few of your fingers.

The hook is that the inflammation that is associated with CTS can result from numerous factors including compression of that nerve anywhere along its course, from your neck to your finger tips.
In fact, statistically, incidence of CTS is also associated with the incidence of Thoracic Outlet Syndrome (TOS—variable nerve compression or pain in the shoulder girdle)(Kisner), inflammation of the pronator teres muscle in the forearm (Kendall), and “excessive activity” of the neck muscles like sternocleidomastoid (SCM) and paraspinals (Chaitow.)

These all can happen from simple poor posture and or faulty movement patterns.
Now, if you swing a hammer for a living you may not have too much choice in trying to avoid a repetitive movement that may inflame your median nerve.
But pretty much everyone can do the following—

Correct your posture—sitting up straight, keeping your shoulders neutral (not rounded forward), keeping your chin in and head straight and, as much as possible, keeping your wrists in neutral position (which means not bent back.) This can prevent much of the muscle shortening and tightening as well as positions that can compress the median (or numerous other) nerve(s.)

Stretch— (If you have no medical limitations preventing you.)
To offset time spent with the typical poor posture connected to CTS, you should probably stretch your upper shoulders and neck (upper trapezius, levators, SCM, scalenes), your upper chest/shoulders (pectoralis major and minor, serratus anterior) and forearm (numerous muscles, including pronator teres.)
How—Reaching your right hand down at your side towards the floor, let your head tip to the left. Slightly vary the angle of your head to feel different versions of the stretch. Hold this to each side for 15-30 seconds and repeat 2 or three times per side.
–Standing up straight, tightening your belly, reach your straight arms to your sides at shoulder height and then move them straight back as far as they’ll go without arching your back. You can do this with an assist from a doorway or similar structure too to help your hands move back. Hold 10-30 seconds, without pain. Repeat 2-3 times.
–With your right arm held out in front of you, use your left hand to stretch the wrist down (flexion) and hold. Then do the same but stretching the hand up (extension.). Hold each for 15-30 seconds, 2-3 times. Repeat on other side.

Massage—while better if done by a trained professional, you may also be able to do this safely yourself focusing on the areas mentioned above. The idea is to find and relax contracted muscles in the abovementioned areas. As we will discuss more on this blog, simple muscle contraction can cause all kinds of pain and damage, including carpal tunnel syndrome. And it is usually at least partially correctable with massage and stretching.

In sum, we talked about carpal tunnel syndrome here, but the real message is that poor posture and incorrect biomechanical function can cause real medical problems. Further, most of your doctors are just not going to help you correct these problems at their root causes, for example, short, tight muscles. But we will.
Again, I’m not telling you not to go to you doctor. Or even not to have surgery. I’m trying to help you see the big picture and figure out how it applies to you.

Keep reading for more tips!
Be well.

Works Cited: Kisner and Colby, Therapeutic Exercise, 5th Edition, 2007;
Kendall et. al, Muscles Testing and Function 5th Edition, 2005;
Chaitow, Muscle Energy Techniques, 2007;
Mayo Clinic Website: http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326/DSECTION=prevention;
WebMD website: http://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome-surgery