The Body is not Robot

In 1992, ergonomic disorders accounted for 56% of the illnesses reported to the Occupational Safety and Health Administration (OSHA).  This is double 1984 levels. OSHA estimates that by the year 2000, cumulative trauma disorders will account for 50 cents of each dollar employers spend on medical care. A study by the Labor Department said 3.2 million cases of repetitive motion injuries in 1989 were serious enough to take time away from jobs, adding up to 57 million lost workdays. Each worker compensation claim for repetitive stress injuries can cost up to $30,000 - $100,000. The American Academy of Orthopedic Surgeons estimates cumulative trauma disorders (CTD) cost $27 billion annually in medical treatment and lost income. One repetitive stress injury, carpal tunnel syndrome (CTS), has reached epidemic proportions, and has been call the technological disease of the '90's. If you feel you may suffer from CTS, as with any medical condition, you should consult your physician. In addition, you should have as much information from as many sources as possible. That's the reason I wrote a book specifically on this subject and why I'm writing this article.

I believe a cure to this disease need not necessarily be limited to expensive, sophisticated surgical techniques. Instead, simple massage therapy in combination with structural realignment and self-help techniques can be one answer to alleviating the pain and distress already being suffered by thousands.

Carpal tunnel treatment has become the surgery of the decade, despite all the drawbacks. The treatment is expensive, and there is no guarantee of post-surgical improvement. In fact, according to Dr. Fred Meyer, MD, orthopedic surgeon with Hand Surgery Associates in Phoenix, Arizona, "the surgical success rate for CTS in only 54-56 percent, and additional surgeries are required in about 10 percent of the cases." (Taken from the DataHand) press release, January 24, 1994) And according to some reports, at best, the procedure results in a minimum of a two-to six-month loss of use of the hand(s) involved.

Surgical procedures include the possibilities of cutting the volar carpal ligament and flexor retinaculum, (taking pressure off the median nerve at the wrist), laser surgery, cutting the supinator or pronator muscles at the elbow joint, and possible shoulder surgery if the pain keeps moving upward. The surgery is suppose to alleviate the pressure on the nerve. However, for many, these surgical techniques are only a temporary fix . The physician may be treating the symptoms of the pain, not the actual cause of the problem.

SYMPTOMS Increased occurrence of dropping objects. Loss of the sense of touch. Tingling and numbness in the fingers and hand. Loss of grip strength in the hand. Pain in the shoulder while sleeping. Pain in the elbow area. Pain in the wrist area. Burning in the wrist area. Tendinitis in the elbow joint If you have these symptoms, you may have carpal tunnel syndrome or be at risk of developing this affliction.

WHAT IS CARPAL TUNNEL SYNDROME? Carpal tunnel syndrome is an entrapment and compression of the median nerve due to structural, muscular and postural misalignment. It is brought on by the over-worked, over-strained muscles of the arms and hands, resulting in a loss of nerve conductivity and leads to a muscle-strength problem. Persons in the secretarial and clerical professions and those who work with them, who perform continuous repetitive movements, are at higher risk to develop CTS.

A median nerve entrapment can develop anywhere along the vertebral joints in the neck through the shoulder joint, descending to the elbow and ending, finally, with distortion and pain in the wrist and hand.

Techniques that can be used to evaluate you are: Applied kinesiology or muscle monitoring - the evaluation of how the nervous system controls muscle function; A dynamometer - which quantifies and measures grip strength; Tinel's test - by manually tapping the volar ligament over the median nerve to elicit a pain response; Phalen's test - which is extreme hyper-extension and hyper-flexion of the wrist joint to see if there is a pain or numb response.

I discovered that the vast majority of my clients over the past year and a half, have had tendinitis which lead them to have carpal tunnel syndrome at a later date even though many did not show any outward symptoms. This was due to the decrease in muscle strength in the arms and hands. These individuals were from varied backgrounds, represented a wide range of occupations and lifestyles, and participated in many different types of sports. What they all had in common, however, was use of their hands and the muscle weakness. CAUSES?

Any direct stress applied to the joints can eventually cause carpal tunnel syndrome. So can incorrect posture, such as habitual forward and backward neck bending that causes continual irritation of the nerve roots in the cervical vertebrae, causing pain in the neck, shoulders, arms and hands. Having the proper ergonomic equipment to support the body will help prevent carpal tunnel syndrome in most instances.

The cause of carpal tunnel syndrome is a bio-mechanical problem of structural and muscular failure that leads to a decrease in nerve transmission to the hand. As emphasized by the title of this article: the body is not a robot. Consistent repetitive movements will cause mechanical exhaustion of the body's muscles.

Following the pathway of the median nerve, correct posture helps to alleviate many of the stresses on the body. The elbow, however, is a joint that is difficult to protect and is most often ignored. The elbow joint is in constant motion and has considerable stress applied to it. Even correct posture and keeping the wrist in a neutral position compromise the elbow joint to some degree.

Constant repetition of a specific motion causes the muscles of the forearm to become tight, sore, and fatigued. Trigger points, (hyper-sensitive areas in a muscle that are tender to the touch and have a specified referral area of pain) will activate and set off a pain-spasm cycle when muscles start to tire from physical overuse. When this occurs, the tightness of the tendons and muscles put stress on the elbow joint when it is held in one position, when there is direct weight on the joints, or when constant repetitive motion is maintained for many hours, creating stress on the elbow and wrist joints.

Once the muscles of the forearm become tight, the tendons begin to pull on the elbow joint. The increased pressure on the joint creates a misalignment of the skeletal structure at the elbow and eventually the wrist. Nerve transmission decreases, causing the muscles to become weaker, less flexible and to lose mobility.

The widespread use of computers has caused carpal tunnel syndrome to spread like an epidemic, but the condition has been around for a long time. People involved in all types of occupations such as a carpenter, mechanic, glass blower, grocery clerk, baker, medical transcriptionist, dispatcher, needlepoint, cyclist, students, meat cutter, chef, secretary, homemaker, massage therapists and lastly with the increase of technology, the increased use of the computer, experience CTS. Why? Because they use their muscles.

HOW CAN YOU DETECT CARPAL TUNNEL SYNDROME?

Muscle monitoring is an immediate method for assessing what is "out of balance" in the body. Used on a regular basis, such an assessment can prevent injury and deterioration of the body.

A CTS SELF-EXAMINATION

This test is done at the lower joint where the fingers attach to the hand: Step 1. Place the pads of your thumb and little finger together, palm side up, and have a friend try to pull the thumb and little finger apart. Step 2. Place the pads of your thumb and little finger together, palm side down, and have a friend try to pull the thumb and little finger apart. If your fingers come apart easily, this may be an indication you have carpal tunnel syndrome.

PREVENTION & MAINTENANCE Even if you have CTS, do not fret. It could be eliminated by following a program which includes a program of self-corrective techniques and warm-up exercises before beginning your day and continuing throughout your day to help maintain the body. The Montgomery Method is a Twelve-Step, Self-Corrective and Maintenance Guide.

*Self-Massage for the forearms and hands.
*Press acupressure points for increased energy to the hands.
*Stimulate neurolymphatic reflex points (The Chapman Reflexes) to flush the muscles of soreness and pain.
*Stretching and range of motion exercises for the hands.
*Strengthening exercises.
*Receive a regular upper body massage and self-massage the arms daily.
*Chiropractic visits, as needed.
*Acupuncture to revitalize the body's vital energy, as needed.

Following this prevention-body maintenance program can eliminate carpal tunnel syndrome and give you a pain-free body. CTS IS NOT a Disease and does not have to be debilitating if you learn the protocol for maintaining your body. Your were not born with a manual for body maintenance, so now you must learn it.

Printed in the April 1994 issue of the Journal of Court Reporting 

References:

Carpal Tunnel Syndrome/Prevention & Treatment, third edition, Kate Montgomery, San Diego, CA, Sports Touch) Publishing, 1994. 80 Pgs. 

End Your Carpal Tunnel Pain Without Surgery, Kate Montgomery, Nashville, TN, Rutledge Hill Press, 1998. This is an updated version of the above book.

Touch For Health, John Thie, D.C., Marina del Rey, CA, DeVorss and Company, 1979.

In Touch, California Chiropractic Association, Newsletter, The Bottom Line of Ergonomics, May 1993.

Out of Hand, Wall Street Journal, Edward Felsenthal - staff writer, July 14, 1994