Carpal Tunnel therapy

[Andrej Marjan]

Peter Hiscocks wrote:

>I went through this some years ago. I thought carpal tunnel was some sort of
>new-age ailment and never gave it a thought. Then, in the middle of typing a
>large manuscript, my wrists felt like they were getting electric shocks, and
>they started to hurt like crazy. Driving the car aggravated the problem
>significantly.
>  
>

Ditto, but it's important to make sure one actually has CTS. In my case, 
I had severe tendonitis pretty much from my shoulder to the tips of my 
fingers. My arm is quite functional now, but I'll probably never regain 
100% mobility and flexibility in my right wrist (it's at about 85% of my 
left wrist).

>It was very scary, I thought I would have to give up typing altogether. My
>GP sent me off to see someone at Wellesly, and the guy immediately wanted to
>do surgery. Surgery may or may not work, but the thought of permanently
>screwing up my wrists made me look for an alternative solution. My GP
>thought the surgery was the answer, but he didn't press me on it.
>
>  
>

As with most other treatments MD's recommend (for anything, alas), 
surgery just deals with the effect and not the cause. Slicing open your 
wrists does nothing to address whatever damaged your body in the first 
place. So even if the surgery helps with the symptoms, one can expect to 
reinjure oneself.

>For the fourth visit to my GP, I asked if something like a sports medicine
>doctor would be a good idea. After all, this must be something that happens
>to athletes - albeit in a different part of their body. He then recommended
>Dr. Robert Grisdale (416-485-1344 x 432), who is a Chiropracter and sports
>medicine therapist. I must admit that I had some doubts about chiropracters
>in general, but Grisdale showed me how to fix the problem, so I'm a convert.
>He worked on my upper back and gave me a bunch of stretching exercises that
>really cured the problem. At first I did the exercises on a twice-daily
>basis. Then I dropped slowly down to once a day and then to 'as needed'. The
>total exercise routine takes about 10 minutes, involves a bunch of stretches
>and a brief workout with a stretchy band.
>  
>

I saw a chiropractor as well (Lynette Nissen at Bloor Avenue 
Chiropractic), which really helped. Exercises are key. They must be done 
religiously.

My neck and upper back were locked stiff. Her explanation (loosely, from 
memory) was that the cramped muscles bent the spine out of shape, 
impinging on nerves and constricting blood flow to the arm. Over time, 
this does Bad Things to the tissues in one's arms.

The important thing is to see someone who will do soft tissue work as 
well as skeletal adjustments. There are some bone breakers out there who 
just do spinal manipulations, which hurts like hell if your muscles are 
locked up, and seems absurd to me, since the cramped muscles are what 
pulled the spine out of alignment in the first place!

The take-away is that humans are like all other animals: we were 
designed to move. We were not designed to sit immobile in front of a 
keyboard for 12+ hours a day, so we need to work frequent, varied 
movement into our daily routines to keep healthy.

Another thing that helps (prior to/after injury) is to build up general 
arm (and body) strength. So go swimming, hit the gym, etc.

>Grisdale's comments was 'You've been building up a
>debt in your body, and now you need to start repayment.'
>  
>

This is a general point with all such injuries: it took time to cause 
the injury, and it will take time to heal it.

So in Peter's case, he can look forward to at least some time of *no* 
typing whatsoever, then a gradual re-introduction of keyboarding.

>My mother (always ask mom!) mentioned that Vitamin B6 had the effect of
>shrinking nerve bundles. The root of the Carpal Tunnel problem as I
>understand it is that the nerve connections abraid on the sides of the
>tunnel, they become inflamed, and worsens the problem. So shrinking the
>cable going through that opening can help. I started at 100mG doses and then
>when the problem got better dropped back to 25mG on a daily basis. B6 can be
>gotten from the drug store or wherever without prescription. I can't be
>absolutely positive that this works, but my impression was that it helped
>and my understanding is that B6 is pretty benign.
>  
>

Maximum daily dose of B6 is 300 mg; more than that and it's a 
neurotoxin. 100mg won't hurt, and more can help in cases of severe 
inflammation. But as with all anti-inflammatories, this is not a 
permanent fix -- this is a crutch to help heal.

The root cause of the inflammation must be addressed; if it's not, then 
using the anti-inflammatory just masks symptoms and allows the injury to 
worsen.

>- Of course, you need to take regular breaks. Binge typing is what got me
>into this mess in the first place. You *must* have a proper chair, at the
>proper height, with a proper desk. When I got this problem I was working on
>a table and sitting on a barstool. I now cringe when I think of it. Your
>forearms should be level.
>  
>

This is key. Also don't slouch in your good chair. I found tilting my 
seat forward and the back rest back helped. Basically I was imitating 
the posture of a kneeling-type chair.


>On Sun, Jan 30, 2005 at 01:02:13PM -0500, Peter King wrote:
>  
>
>>I went to my doctor, who diagnosed CTS and ordered up blood tests and
>>nerve conduction tests to be sure, but then *immediately* began to
>>talk about surgery. Everything I've read on the Net says that surgery
>>really ought to be a last resort, only after six months to a year of
>>working with "conservative" (non-interventionist) therapies. Plus the
>>fact that I don't really want my carpal ligament severed.
>>    
>>

If your MD is anything like most MD's, he's not qualified to diagnose 
CTS. Don't trust his diagnosis.

>>It struck me that this group must have a fair amount of collective
>>experience with this medical problem, and, just possibly, also have
>>some collective wisdom about how to deal with it. I don't need medical
>>information; I have all that. What I want to know is what people have
>>tried and how successful (or not) it may have been -- anecdotal reports
>>are just the ticket. I'll pay for the physiotherapy if that's the way to
>>go; I want this problem *gone*.
>>
>>What I've tried to date: wrist splinting, either all day or at night only,
>>both apparently ineffective; strong doses of ibuprofen as anti-inflammatory;
>>lightening up (but not swearing off) keyboarding; and extensive complaining.
>>    
>>

Bad news: you've been abusing your body for a long time and have caused 
yourself a significant injury.

Good news: it can be healed (so long as you avoid the butchers). But it 
will take time to undo the damage you have done, and it will require 
changes in your basic habits.

But such is the way with all real healing: there are no magic pills and 
no quick fixes. And the only effective, permanent solution for any 
ailment is to change whatever caused the ailment in the first place.

Don't get depressed over what you read on the net -- much of it is junk. 
Also don't trust MD's. <Insert rant against the Medical Establishment 
here. This message is too long already. :)>

If you need reason not to trust MD's, I've got tons of horror stories (I 
was born with an immune deficiency).

Just a brief point to ponder: when's the last time you saw a healthy, 
slim, vital-looking doctor, with a shiny, lustrous coat and bright, 
clear eyes? ;)
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