Sorehand- Therapies

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Date:    Sat, 2 Dec 2000 09:32:25 -0800

Subject: Re: ARGH! when your SO doesn't get it

At 10:50 AM 12/2/00 -0500, you wrote:
>Your response sounded as if I had wrote it.  I had a private mediation back
>in August.  In Sept I receive my permanent impairment settlement a whole 10
>grand.  Well I finally was able to see a doctor that truly specializes in
>RSI (had tried for about 7 months to get him approved via WC).  He told me
>that I could have a full recovery and prescribed Myotherpy.  I have only had
>2 session but have had great relief.
>I wish there was some way to
>make people on the sorehand list understand that myotherapy could very well
>be their answer.  We've all become so skeptical especially after 5 years of
>dealing with doctors that didn't help.
>Linda

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Date:    Sun, 18 Feb 2001 17:51:24 -0700
Subject: alternatives to surgery

Thought this journal article might be of interest.
cheers, Penney

J Hand Ther 1998 Jul-Sep;11(3):171-9
Nerve and tendon gliding exercises and the conservative
management of carpal
                       tunnel syndrome.

Rozmaryn LM, Dovelle S, Rothman ER, Gorman K, Olvey KM,
Bartko JJ

While developments continue in the surgical management
of carpal tunnel syndrome, little emphasis
 has been placed on the evaluation of a comprehensive
non-surgical treatment. In this study, 197
patients (240 hands) presenting for treatment of carpal
tunnel syndrome were divided into two groups.
 Patients in both groups were treated by standard
conservative methods, and those in one group were
 also treated with a program of nerve and tendon
gliding exercises. Of those who did not perform the
nerve and tendon gliding exercises, 71.2% underwent
surgery compared with only 43.0% of patients
who did perform them. Patients in the experimental
group who did not undergo surgery were
interviewed at an average follow-up time of 23 months
(range, 14-38 months). Of these 53 patients,
 47 (89%) responded to this detailed interview. Of the
47 who responded, 70.2% reported good or
excellent results, 19.2% remained symptomatic, and
10.6% were non-compliant. Thus, a significant
 number of patients who would otherwise have undergone
surgery for failure of traditional conservative
 treatment were spared the surgical morbidity of a
carpal tunnel release (p = 0.0001).

 Publication Types:
 Clinical trial
Controlled clinical trial

   PMID: 9730093
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Date:    Sun, 18 Feb 2001 19:34:25 -0500
Subject: Re: unnecessary Carpal tunnel surgery?

Carol, the link between RSI and allergies was hard to figure out for me, and
took me years, until this clue: I went to the allergy clinic and got the
basic test to see what you're allergic to.  I'm allergic to everything.  So
my head swelled up and turned red.  They thought I was going to die.  I went
home and took a long bath... but for three days, had pain in my *hands*,
typical CTS/RSI pain.  The allergins which cause puffyness aggrivated the
joints and nerves in the hands.  I couldn't use them for three days.

If you think allergies are a factor for you, the most important detail is
the cleanliness of your bedding (hot water each two weeks), mattress (get a
dust mite cover), and carpet in the bedroom (steam clean, hot water).  Then
perhaps a HEPA filter.  Allergies are like filling a cup: You're alright
until the cup is full, and then you get symptoms.  Night time is your time
to re-energize, and so focus on allergin exposure there can increase your
tolerance throughout the day.

john
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Date:    Sun, 3 Dec 2000 19:44:16 -0400

Subject: Re: Next Sugery!!

Hi Anne

I agree totally with you here .. this was basically my story too ...
right hand , the dominant and *mouse* (grr) hand was gone cold and dead.

I had fought with this since 92 ... GP said no more cortosone shots in the
wrist ...
Neorosurgeon said do CTS Release to right hand first then left, (left was
not as bad mind you) .. right healed up after open CT release ... still upper
arm/shoulder problems ... was TOS of course... I did the better nutrition thing .. more
water ... yoga myofascial release therapy had trigger points in every single muscle...
stretching ...
swimming .. whirlpool bath installed ... skating .. off to the gym for more
cardio and develop some muscle tone ... I was up to comfortably doing shrugs
with 45 lb dumbells and 90 min workout three times a week.
I was feeling great and more fit at 40 then ever!!!

Summer came and no time for the gym .. was feeling great anyway right ...
muscle tone decreased ... shoulder muscles no longer holding everything
up and in it's proper place ... fall arrives and guess who is having trouble
again ... circulation down .. inflamation ... pain .. tingling in fingers
and both hands ... things were looking grim!!:<

However, (pregnant pause ..  drum roll ...) the gym had shown me
the secret!!!

PT, my MD, and vascular specialist agree ... decrease in muscle tone and
general fitness level means decrease in circulation for me. My PT tells me
my shoulder is supposed to float above the ribs on muscles ... deflate those
muscles and we have a problem!

No more forgetting about the gym ... it's either stay fit or stay in pain!

Recovering muscle tone now .. next try to build some endurance into those
muscles.

So I have a home gym setup now, new treadmill machine, blood circulating
through my arm again ... less right hand finger tingling everyday ... try to
stay clear of the computer and especially the *mouse* (that still hurts) ... and
am fast on the road to recovery and a better lifestyle ... even if it was not
by choice!

My arm is informing me I am done typing now!

hth
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Date:    Thu, 21 Dec 2000 23:04:54 -0800
Subject: my RSI update - thanks to all of you

Hi Everyone,

I had not visited this list in a long time. Some of
you might remember me. I reported RSI in mid-september
and filed for WC. I have been in treatment since -
mostly physical therapy and did not use my injured
hand to type in the last 2 1/2 mnths. There has been a
lot of improvement, but I had pretty bad flare-ups in
certain specific areas. So I went to an RSI
specialist. He is a Chiropractor, but 90% of his
patients are RSI. He did some tests and told me that I
can start using my right-hand for typing. I still have
pain but he is  monitoring me and treating me - mainly
physical therapy, but I am much, much better than I
was 3 months ago. I want to sincerely thank all of you
who helped me out with tons of valuable information
when I felt thoroughly useless and utterly helpless.

Just to give a re-cap of what helped me and what did
not help me in the course of the treatment that
atleast some of you could benefit from:

The first doctor I went to (I had to go this doctor
because my insurance required me to)was pretty much
useless. I was diagnosed with tendonitis, carpel
tunnel, wrist injury and what not (everything except
what I really had!) etc. etc. I took Celebrex for a
month and that had absolutely no effect. The good
thing was that the doctor recommended a good place for
physical therapy and I was pleased with the service I
got from them. PT did help me quite a bit - but it was
a slow, painful recovery process. The pain slowly
subsided, but I had flare-ups in specific areas vs all
over the hand. That is when I went to see a
specialist. I found the doctor to be quite
knowledgeable in RSI. He diagonised my symptom as
Myofascial syndrome.

He gave me the following advice to keep myself away
from RSI.

1. Posture, Posture, Posture (ergonomic rules)

2. Breaks, breaks, breaks (a one second break every 5
min. (shake the hands/roll shoulders); a one minute
break every half-hour (do stretches for hand and
neck); a 5 minute break every hour (get up and walk)

3.Stretches, stretches, strectches (get the
stretch-break software)

The streches and breaks will keep the blood flow going
into the muscles which otherwise due to repetitive
action get deprived of oxygen.

4. Drink 8 glasses of water a day (have a waterbottle
on your desk and finish it by end of the day)

5.Aerobic exercise (even walking would do) for 30 min.
everyday.

6. Have multi-vitamins everyday and definitely brand
names matter. He mentioned that the ingredients will
show minerals as 'chelated' and that is the form our
body is able to absorb. I got it from the natural food
store - expensive but big difference between the 2
brands.

If I do this religiously, then RSI will stay away from
me! I have been trying to do this and have been seeing
lot of relief from pain. I hope to recover completely
within the next couple of months.

I also bought Flextend - but both the physical
therapist and the doctor said that it should not be
used as a treatment, but more as a preventive. So when
I get closer to normal, I can start using it to
strengthen my muscles and maintain them.

Hope this info. is useful for atleast some of you.

And many thanks to all of you, especially Penney,
Joan, Elise, Greg, Mark and many others who took time,
effort and interest to provide valuable information.

HAVE A HAPPY AND SAFE HOLIDAY!!!

Rekha

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Date:    Thu, 21 Dec 2000 08:22:25 -0800
Subject: Re: Now what?

Hi Richard,

It sounds like you are in the beginning stages of RSI.  Now is the time to
educate yourself.  Start with RSI:  A Computer Operator's Guide by Emilio
Pascarelli, MD, then move on to the Feldenkrais Method
(www.Feldenkrais.com) as some of the practitioners are familiar with the
condition that is highly connected to musicians.  Read about the Bates
Method for improving your eyesight.  Much of this RSI stuff is related to
an overuse of the eyes.  Start paying for deep tissue massage, especially
myofascial release therapy if you can find someone in your area (?) who
does it.

In my experience, RSI is not an "it" as you refer to it (Does it eventually
"go away," or is it
always a problem?)    RSI is a process.  It starts with losing a sense of
ourselves (in front of a computer, or playing a musical instrument, or just
getting caught up in the "system") and it becomes a "problem" when we
continue to ignore the signals from our body and minds.

As for "go away", consider embracing your situation, rather than thinking
of it as a disease.  It has been my experience that when I welcome
constraints into my life that they become integrated into the whole (me).

I have taken 7 years to heal from RSI, TOS, but if I overdo it, or slack on
my health care, or don't do my exercises, or in my case, get my period, I
suffer from swelling, and irritation of soft tissues that eventually
settles down when the "stress" subsides.

Elise 
Certified Feldenkrais Practitioner
At 07:11 PM 12/20/00 -0500, you wrote:
>Hi all,
>
>I have bilateral cubital tunnel syndrome (for about 5 months).  My Doc says
>it is very mild (NCS test) and I should not consider surgery.  I have no
>pain, just a mild tingling in my ring/pinkie fingers.  I've tried
>chirporactic (hasn't done that much), but I noticed very significant
>improvement once I started Yoga, stretching, and massage the last few
>months.  However, my progress now seems to have "leveled off."  Fortunately,
>I am a psychologist and spend most of my days not using my hands at all with
>the exception of writing brief chart notes.  Mine started when writing my
>doctoral dissertation and I will never have to do that again :)  What has
>happened long term with most of you?  Does it eventually "go away," or is it
>always a problem?  My ultimate goal is to be able to get back to my hobby of
>guitar playing 1-2 hours per day, but I wonder if that is realistic.
>Fortunately, my work typing load is extremely light ---10-15 minutes a day
>tops.  Any and all comments are welcome.  I'm hoping that since mine is a
>mild case it can still get better, but I'm concerned because it has been a
>while.
>
>Thanks,
>
>Rick 

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Date:    Mon, 1 Jan 2001 12:40:16 -0500
Subject: Re: stretches that aggravate

The stretches in Sharon's book are meant to be done in a very specific way,
with careful attention to the stretch point.  The stretch point was
difficult for me to feel, and I believe I often went beyond, and made my
symptons worse.  I eventually stopped doing the stretches altogether, and
switched to full-body movements such as t'ai chi and feldenkrais, which have
made an enormous difference.  I do stretch at the gym, but I generally do
stretches for things like hips and legs more than for my upper-body.  I also
want to mention that 4 years after symptom onset, I am back to doing normal
pain-free workouts at the gym, including weight training for upper body--
something I thought I would be afraid to try again (although I still avoid
shoulder-specific weight machines). You really can get better.

This may seem like it doesn't make much sense -- to pay less attention to
the "problem areas" but I really did find that ANY stretches focusing on my
pain areas made things worse.  I highly recommend feldenkrais (which deals
with "lengthening" instead of stretching) and t'ai chi or chi kung.    (If
you don't want to give up on the stretches, I  believe that some feldenkrais
classes will help you become aware of the "stretch point" so that you could
continue with Sharon's stretches without pain.)

I do NOT agree with any advice that suggests you do stretches (or yoga,
etc.) that feel painful when you are in the midst of doing them.  Gentle
movement is best!

Laura
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Date:    Tue, 16 Jan 2001 14:05:53 -0600
Subject: Re: help (TOS)

John-
I was thinking about trying Yoga also-  haven't had any experience with it
but have heard that it does wonders for people.  I'll check into it-
thank you so much!
Tamra

Tamra,

Poor ergonomics can easily get you into this mess.  so fixing your ergonomic
situation is one step to recovery.  reducing your computer work activity
might also be a necessary part of the solution.  But this alone probably
won't fix stuff.  As soon as you go back to the computer, even with changed
habits (and these must evolve consciously over a long period), you'll
probably end up right back where you started.  I did.  Wow that sucked.

The part i want to describe is the knowledge you now get to learn about your
body, and experimentation and learning about what helps (and harms) you.
You will develop a regimen specific to you that works for you.  and it is
quite frightening, especially when you sense no improvements, when you feel
simply lost and hopeless.  it takes a long time to recover.  but consider:
it took you a long time to get so screwed up!  accept that and it's easier
to accept the recovery time.  The body is remarkably resilliant, and when we
apply knowledge of our selves and of the human body's characteristics, we
can achieve amazing results.

i had horrible symptoms, i was suicidal and in horrible pain.  I took a
class called 'Bikram's Yoga' cuz my girlfriend suggested it.  And now it's
two years later.  I could do 60+ hours computer crap if I wanted to.  (Who
would want to?)  I am in the best shape of my life.  I found little help in
doctor after doctor, shelled out thousands for massage therapy, but now have
nearly cured myself (I still feel a bothersome 'itch' and sometimes a 'burn'
in my neck, and my hands do feel kinda funny, but this is very minor stuff.)
using Bikram's method of yoga.

Bikram's Yoga is a physical yoga focused on the whole body but with emphasis
on spinal health.  It's a lot cheaper than hiring someone to do stretching
and massage for you, a lot more empowering, and two to four times more
effective.  If I'm at work now, I have at least eight ways to lengthen my
nerves, open my joints, recycle my blood, stretch my muscles, and release my
tension, using skills derived from body awareness developed over over
thousands of years.  what a deal.

John Dempsey, Student of Bikram's Yoga
check out my results at http://www.oz.net/gifs!!!
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Date:    Mon, 5 Feb 2001 09:52:33 -0800
Subject: Re: questions re:cubital tunnel and observations

I have a wonderful trigger point therapist who relieved me of my RSI
symptoms.
I went to an open-house recently where a "neuromuscular therapist" (NMT)
was giving free demos. She claimed that NMT was good for trigger point
relief so I got on her table for a demo (I was painfree when I laid down).
She worked on my trapezius muscle for about 5 minutes. About 5 minutes
later, I was in excrutiating pain. I had to go to my therapist to get
relief (and it was immediate relief).
So, BEWARE of individual therapists...they may know the lingo but may not
have the manual skills needed to really help relieve trigger points.

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Date:    Wed, 7 Feb 2001 16:09:27 -0800
Subject: Re: Osteopath & Trigger points

Tony,
  Indeed you are lucky to be located where you are. Your osteopath
did several things. He used a combination of ischemic pressure and movement on
some of your trigger points which is also referred to as Muscle release
technique or Active Release techniquetechnique and did a another form of
treatment that is
called spray and stretch on your arm. Active release Technique is enjoying
populariyty now and is a way to engage more of the proprioceptive inputs to help
interrupt the pattern of spasm and pain that is there. Spray and stretch
originated with thephysician that did the most importnat and exhaustive research
on Trigger Points, Dr. Janet Travell. She was presidential physician for Kennedy
and Johnson as well as an amazing researcher. There is a two volume 600+ page
set she and Dr. David Simons wrote called Myofascial Pain and Dysfunction: The
Trigger Point Manual.
A simplified definition of a trigger point is a fibrous area within a muscle
near the end plate of a nerve whose continuing contraction maintains a feedback
loop between the sensory afferent nerve, the spine, brain and the spinal motor
nerve that in turn maintains a hypersensitivity and contraction response both in
that muscle and in related myotacic (muscle/joint movement)areas. Basically it
is a signal post that tells the body to splint, guard and limit motion to a
specific area. Trauma, overuse, misdirection of activity, even drafts can lead
to trigger points, as described in the Travell books. She talked abouit a lot of
perpetuating factors, including lifestyle, diet and exercise( or lack of). T
Methods that are used to get rid of trigger points were :by injection of the
point with an anesthetic solutionfolloewd by a stretch of the involved area,
Spray and stretch using a vapocoolant that is sprayed along the path of muscle
and nerv to shock the tissue then stretch the are!
a, dry needling(insertion of a needle into the space without injection, ischemic
pressure( Bonnie Prudden went to Travell for a skiing injury and was so
impressed with her own recovery that she worked out a way of using sufficient
pressue for a short period over the trigger point to rob it of blood flow
the"ischemia" which produced a similar effect to the anesthesia),and Active
release technique which is using ischemic pressure over the point while actively
moving the involved tissue.
All are aimed at providing either overstimulation or distraction to the affected
area so that the feedback cycle is interrupted and the area can resume normal
activities. the stretches serve to further thae body that that area is again
capable of greater motion than before. All in all they work, but they all have
their share of discomfortboth for the patient and for the practitioner.Your
physician is working to break the pattern of pain and spasm in your arms that is
mediated by those "trigger points. I used trigger point therapy for many years
until I had a chance to learn less invasive techniques, first from osteopaths
(such as Strain-Counterstrain also called preferred positional release, and
Muscle Energy and Functional Indirect Techniques that all use indirect action to
relieve neuromuscular or musculoskeletal stresses in the body) which is why I
think so highly of the profession. You could ask your physician about his
knowledge and use of those other techniques, he amy h!
ave studied them as well. A self-care book on the market that uses an indirect
technique is Muscle Pain Relief in 90 seconds: The Fold and Hold Method by Dale
Anderson, M.D.
Hope this was helpful.
Kevin 
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Date:    Wed, 7 Feb 2001 08:13:44 -0800
Subject: Re: tried it all

Dan,

Your story sounds similar to mine.  When I wasn't able to get near a
computer without reactivation of symptoms, I persevered by taking Bates
Lessons for improved eyesight.  As soon as I was able to identify how I was
holding myself at the computer (started by "staring"), I was able to adjust
my eyes and gaze.  Since then, I have been working at the computer.

Also, as a Feldenkrais teacher, I would look further down and notice how
you use your pelvis while sitting at the keyboard.  A pattern of flexion in
the back and extension in the chest is common with people with neck and arm
problems.

Also, as a person who's been there with TOS, I can tell you that it takes a
long time for soft tissue injuries to heal, especially tendons.  In my
opinion, this is because at the root of the injury is the conditioned
patterns of holding the body stiff when doing something that caused pain in
the past.  Kind of like Pavlov's dog salivating at the sound of a bell in
anticipation of being fed.  A good book that showed me the power of my
thinking, "Frogs into Princes" by Richard Bandler and John Grinder, as well
as "Change Your Brain" by the same authors was helpful.  These researchers
are the creators of NLP, neurolinguistic programming.

Good luck,

Elise
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Date:    Wed, 7 Feb 2001 21:51:51 -0500
Subject: Spray and stretch (Travell)

Re: the spray and stretch.    For a couple of yrs I practiced this =
technique. The Travell Book is intense reading(anyone want to buy it =
from me cheap?)  The actual technique is difficult to master w/o a bit =
of training. Perhaps this was my pitfall with the technique. It is truly =
amazing to see a muscle spasm "melt" before your eyes. The problem, for =
me, was that as soon as the spasm was released and the motion was =
returned it (the spasm) returned in no time (next day). My theory (not =
really mine) is that the mm spasm is a reaction to an underlying =
problem. Attacking the spasm does not correct the problem, only the =
symptom. Whether you believe the problem is from a "deranged disk" or =
"thoracic outlet" or whatever, the spasm is a reaction to the problem. =
Personally, I feel the best approach is improving posture when sitting =
at the computer or playing the cello, improved posture when sitting on =
the sofa or driving the car, and good posture when sleeping (thin, =
feather pillow and a cervical roll).=20

Larry
------------------------------

Date:    Mon, 19 Feb 2001 09:34:31 -0600
Subject: water

Carol....I am reading a fine book called ,Your Body's Many Cries for Water,
by Dr. F. Batmanghelidj, M.D.   It addresses the role of dehydration in
cases of asthma and allergies.  It is available on Amazon.Com.  He says " It
is recognized that asthmatics have an increase in histamine content in their
lungs and that it is the histamine that regulates the bronchial muscle
contraction.  Since one of the sites for water loss through evaporation is
in the lungs, bronchial constriction produced by histamine means less water
evaporation during the act of breathing....a simple natural maneuver to
preserve the body water."  I find his theory of the body regulating the use
of water very interesting...he says that certain bodily functions get first
rights to the water that is ingested and as they are satiated then the other
organs and systems get their share.  I believe that the musculoskeletal
system is a little lower on the list for water than is the brain and some of
the other life maintenance systems so if there is dehydration, because
people are not consuming their required daily ration of water ( about 64 oz.
or an oz. for every LB of your body weight divided by 2), the liquid that
bathes the tendons in their gliding process can become too low.  This can
cause tissue irritation and difficult gliding of the tendons.  His book has
a section devoted to asthma and allergies as well as a chapter on rheumatoid
arthritis pain.  It might not be 100% true, and I do not claim it to be, but
it does illustrate the importance of water to our  systems and most of us do
not drink sufficient water (not juice, coffee, soft drinks, beer, milk....)
just WATER!!

Explanation and List of Sorehand Topics

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Revised Nov 21, 2000