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Doug Rich is an orthopedic certified specialist and a certified hand therapist. He has been a practicing physical therapist for over 20 years, and was voted one of the best orthopedic physical therapists in the state of Arizona. Doug currently runs our Civic Center Scottsdale physical therapy clinic. He is here today to explain how your posture can actually effect carpal tunnel syndrome, and how physical therapy can help you can change it.
Carpal tunnel syndrome is the compression of the median nerve (which travels through the arm), caused by swelling as it passes through the carpal tunnel, a tight area in the wrist. This leads to symptoms such as numbness, pain, or tingling in the thumb, first finger, middle finger, and half of the ring finger. It also causes slower and altered signals to the hand from the brain, which can lead to weakness of the hand. Often, someone with carpal tunnel syndrome will complain of having difficulty hanging on to objects such as coffee cups. Another hallmark sign of the syndrome is increased pain or tingling while trying to sleep.
The cause of carpal tunnel syndrome is generally considered to be the product of excessive pinching with the thumb and fingers, combined with a repetitive bending of the wrist. This causes a thickening of the tissue around the carpal tunnel as the body strengthens to deal with these stresses. The smaller carpal tunnel then compresses the median nerve more. However, a recent model explaining the syndrome, called double crush syndrome, sheds new light on the condition. In this model, the medial nerve is already a little swollen before it even reaches the carpal tunnel. This means it is already being squeezed in another area, so a very small amount of pressure at the wrist would be enough to inflame the nerve. It turns out, these other crushing areas are the result of our 21st century posture, caused by sitting for long durations. Nine times out of ten, someone with carpal tunnel syndrome has the posture of a forward head and shoulders and a bent upper back.
A forward head leads to compression of the nerves that exit the neck and pass through the muscles that are tightened from trying to hold the head in this position. The forward shoulders also cause a tightening of the chest muscles, and again compress the same nerves as they continue through the body. A hunched-back posture (kyphosis) is the result of the body trying to give our head, which weighs as much as a bowling ball, some support by moving the lower spine back under the head. Therefore, to properly address double crush symptom, we find it necessary to also address posture problems. Here are a few of the simple techniques that may help.
Just telling someone to sit up straight is a great idea in theory, but the muscles and ligaments won’t physically be able to straighten because they have already tightened up and adapted to a poor posture. Therefore, we must first stretch out these tissues before we can straighten our posture. To achieve a forward head, therapists implement a chin tuck. Patients lie on their backs and tuck their chin down, making a double chin, while keeping their head in contact with the bed or floor. To remedy the forward shoulder and hunched back, patients start with a pectoral (chest) stretch. They stand in a corner, place their forearms against the wall, and lean their chest forward until they feel a stretch. Therapists also utilize foam rollers, and patients can lay on them to slowly straighten their upper backs.
There are many different techniques to achieve better posture, but knowing why we are doing certain exercises can be a motivation in itself. As the neck and shoulder areas loosen up, we can tell patients to “straighten up,” just like mom used to. Except this time, it will have an effect on the entire body and even decrease some problems down in the arms.
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