Curing Carpal Tunnel Syndrome (Median Nerve Entrapment) and Tendonitis

By Malcolm Kogut

Symptoms: NumbnessAcheTinglingSharp pain

What is a Symptom?

A symptom is not what is wrong but a sign that something is wrong.

If you are barefoot and step on a nail, pain is the symptom, the nail is what is wrong. You wouldn’t just take an aspirin to solve your problem, you would take out the nail.

If a car’s tires wear out unevenly and faster than normal, that is a symptom that the alignment is bad. Getting new tires will not solve the problem.

If your wrist and arms hurt, that is a symptom that your alignment is bad.

If a tennis player loses a match and smashes his racquet on the court, the broken racquet is a symptom that his sportsmanship is bad.

In all of these cases, you wouldn’t treat the symptom, but the problem.

Traditional Treatment

RestIf you have the time and mental fortitude to rest long enough to heal, when you go back to doing the same activity with the same bad habits that created the problem in the first place, your problem and pain will probably reassert itself because nothing has changed.

Anti Inflammatory DrugsThese simply mask the pain. The problem with drugs is that if you can’t feel the pain, you may continue moving incorrectly causing more damage and be unaware of this continued problem until it gets so bad that the drugs have no more effect. Drugs can easily contribute to a downward spiral. Pain tells us that something is wrong. Don’t eliminate the pain.

Brace/SplintThese are the beginning tools of a downward spiral. The body is designed to move. If you hinder natural movement by isolating a specific part, your body will have to compensate for the lack of movement and overuse other parts. Splints treat the symptom and not the problem while at the same time they create new problems. Braces are good for broken bones but not necessarily soft tissue. Pain is good. It tells us that something is wrong and needs correction.

The body is designed to move sympathetically. For instance, when you walk, as your left foot and hip move forward, your right shoulder will go backward. If you walk with your right hip and right shoulder locked together, you will develop knee pain. The problem is the shoulder but your doctor will treat your knee because that is where the pain or symptom is. Take heed of the childhood song “The toe bone is connected to the foot bone . . .”

SurgeryBefore you consider surgery, read my slide about what CTS is.

Physical TherapyWhen considering PT, read my slide about stretching.

Treating A symptom

Think of the pain your foot would be in if you had a nail in your shoe. If you take off the shoe for a week (rest) your heel will heal. If you then put the shoe back on, the nail will just re-puncture your foot. Nothing has changed.

You can take medicine to mask the pain, you can even splint your foot (brace) and do leg lifts (PT) to strengthen the leg. None of these will help after you put the shoe back on. You have to treat the problem, not the symptom. Blood and pain is the symptom, the nail is the problem.

In the case of MNE, CTS or tendonitis, pain and numbness are the symptoms. Improper movement is the problem.

Causes of Median Nerve Entrapment (or Carpal Tunnel Syndrome)

Improper movementWe are taught when lifting heavy objects how not to bend our backs but lift with our knees. How come nobody ever teaches us how to use our arms and hands properly?

Dual Muscular PullOur bodies are capable of many movements and just because we can, doesn’t mean we should. See “Dual Muscular Pull.”

Over Stretching (warm ups)There is a myth that stretching "warms up" the body. What it actually does is create micro tears in the muscles and tendons so the body's response is to rush blood to the site in an effort to heal and immobilize the area of damage caused by stretching. That rush of body temperate blood gives us the sensation of "warming up." In actuality we are setting the stage for tendonitis. Stretching to the extreme range of motion is not healthy. It would be better to warm the body than its isolated parts. Olympic athletes sit in saunas or hot tubs to achieve this.

Sympathetic Movement

Don't do this, but from a sitting position, turn your head as far back around as you can. Make note of how far you can actually go. You can mark your spot by picking an object to look at. You probably only turned your head approximately 90 degrees. If you moved to your extreme range of motion, because you isolated your neck, you probably felt discomfort, pain, strain or gave yourself whiplash.

Now, working with your shoulders, stomach muscles and hips; turn from your hips, then add the shoulders, then the neck and you should be able to see about 180 degrees or, almost directly behind you. Keep in mind that every motion has an equal and opposite motion. While turning, if you were turning to your left, as your right shoulder moves forward, your left shoulder must also pivot backward. Don't anchor it. That sympathetic movement should be natural for most people but it isn't always. Whenever you isolate any part of the body, you run the risk of injuring a sympathetic part. If your right and left shoulders don't work together in the turn, you will not be able to turn as far, or, you run the risk of straining something. This is how many people incredulously get whiplash while simply turning their head to see if there is any oncoming traffic.

Now, stand up and add the knees and ankles to that mix. If you were looking to the left, keep your left foot anchored flat to the floor and pivot on your right toe. You can probably see at a 270 degree angle by turning and using all your body parts (of course, you could just turn your head to the right).

All those movements as I dictated probably have you moving at your extreme ranges of motion. You should only turn you neck about 40 degrees, then your hips aiding you to about 90, then your shoulders about 130, and your ankles and knees to about 170. Your eyes can do the rest.

Herbs and Nutrition as a Cure

I don’t know. If the gasket lining your car’s engine has wear and tear, upgrading the oil quality and octane of the gasoline you burn may help but won’t solve the problem of the worn gaskets. YMMV. Try dietary supplements. I hear pectin works. It is still treating the symptom. Even if the additional nutrition helps to rebuild damaged tissue, you may still be damaging tissue by moving incorrectly.

What is a Dual Muscular Pull?

Hold your hand out in front of you and while keeping your fingers together, like a little child wave “bye bye.” Now abduct your fingers, that is, spread them out as far as they will go, now try waving bye bye. Feels awful, doesn’t it. Those are dual muscular pulls. You are using your muscles to do two things at the same time: spread out and flex.

When many people play the piano or type, they spread their fingers out and although momentarily and often imperceptibly, they are doing these pulls to their fingers. The same thing happens when you do the pop gun gesture. Pianists create dual muscular pulls with their thumbs when they cross it under their palm. It happens in the forearm when you extend or curl a pinky or thumb while moving other fingers. It happens when you raise a single finger high in the air as instructed to do in the ubiquitous Hanon exercises. Those movements are all bad.

Fingers are not designed to do the work we subject them to. Our arms are designed to do much of the work and the fingers are designed to attend to the finer details but in unison. Although they are very flexible, your hand and fingers should only do one thing at a time. The fingers are part of the hand. The hand can only move in one direction at a time so all the fingers should only work in that same direction. They can isolate but it isn’t efficient. That is the difference between a child prodigy and a life long amateur. The prodigy has learned to move all five fingers in one direction at a time. More on that later.

What is Tendonitis?Within your wrist your long flexor tendons run from the forearm to the finger tips and on top of your wrist are your extensors. Hold your forearm with your other hand and move ALL YOUR FINGERS at the same time (never ever isolate a finger). Feel the muscles work? Those are the muscles which move your fingers. Those muscles become tendons which then attach to your finger bones. They move the bones much like a pulley. Now lay ALL your fingers across your opposite wrist like you are taking your pulse but DON'T squeeze with your thumb. Feel the tendons glide within? Many people mistakenly think their tiny and weak finger muscles move their fingers but it is the strong and powerful forearm muscles.

As the tendons move, they are in a sheath lubricated with synovium fluid which helps them to glide within. If you overstretch that tendon, you can tear it and scar tissue can form. Those scars can adhere to the sheath making it painful to move since each movement will tear at more tissue. If your doctor prescribed rest and braces, you will not be able to move properly and this gives the body a chance to make the scar tissue more permanent. Think of it like a room you never use and soon, cobwebs will form in the corners and spread from there. Not moving also dries out the synovium fluid because your body will think it doesn’t need it. Much like the engine oil in an unused vehicle will settle to the oil pan below, the lubricant within your tendon sheath will dry up. This is a perfect example of why PROPER MOVEMENT PROMOTES HEALING and rest and splints don’t.

What is Carpal Tunnel Syndrome (Median Nerve Entrapment)?

Your wrist is made up of bones on the top, then tendons, then your median nerve, and it is all capped off by a sheath called the traverse tunnel ligament. It is a tightly packed structure with no room for anything else. When you move your fingers, the tendons glide back and forth like a pulley system. If you bend your wrist and move your fingers, the tendons are now grinding down on the nerve. Using wrist rests for keyboards and letting your arm rest on a desk when using your mouse are bad movements for your median nerve since they are putting added pressure on the tunnel and tissues within. What idiot came up with the idea of wrist rests?

As a “cure” for your symptom, a surgeon will cut the traverse sheath so that there is more room for the inflammation. This is a great cure for the symptom but not the problem. Inflammation is the symptom, the problem is you are probably moving wrong and causing inflammation. Your surgeon just created more room for your inflamed tendons. While this extra room will alleviate the pain and symptom, it also made it so you can inflame the tendons even more because you think you can now move with impunity. But don’t worry, if you continue to move improperly you can have secondary surgery in a few years. Or, you can just fix the movement problem and not have surgery at all.

Bending the Wrist

If you were playing tug of war with a friend and the rope was taut, it would just go back and forth effortlessly through the air with no friction. Now imagine your friend on one side of a shed and you on the other and the rope is dangling over the roof and you play tug of war, you are now sawing, grinding and chewing into the roof.

If you move your fingers and bend your wrist up, down, left or right, you are sawing through the median nerve, much the same as the rope through the roof. This causes tendonitis and the dreaded “carpal tunnel syndrome.”

It is okay to bend the wrists but only in the mid range of motion. Never to the extreme. Read up on Dorsiflexion, Palmar Flexion, Radial Deviation and Ulnar Deviation. They are noble capabilities which have a place in our repertoire of movement but, just because you can, doesn’t mean you should.

Avoiding Dual Muscular Pulls

First let me warn you not to try any of this without the guidance of an Argus eyed, experienced and knowledgeable teacher. In the case of piano playing or typing, there are several simultaneous movements which need to coalesce into one. If you are devoid of one of these movements or even executing one of them incorrectly, you could hurt yourself further as they all need to work together. I will cover a few of them here.

Go write on a chalkboard. Notice that you use your shoulder and whole arm as you write. You don't bend or twist the wrist but you write and use the arm as one unit. That is how you need to learn to type, play an instrument or use the mouse. Never bending or twisting the wrist, not resting it on the table or some stupid wrist guard. Never isolating a finger but using arm weight, forearm rotation, forward shifting and shaping to depress the keys—much like you did writing on the chalkboard. Once you learn all of those movements and apply them to your instrument or workstation, every movement you make will become effortless and pain free. You will also heal.

If you have tendonitis, ringing a doorbell can be painful. Keeping your hand relaxed and all your fingers together, not extended but with a nice and natural slight curve. Use the longest finger to depress the button only, push from your elbow. You will not engage the long flexor tendons at all. Your bone structure will ring the bell.

If you have tendonitis, depressing the left click button of the mouse can be painful. That is because the finger is flat and that weak position places tremendous strain on the tendon in order to depress the button in that prostrate position. While in the flat position, the tendon is at its weakest and can easily be injured. The tendon’s main purpose is to align the bones so that they are stacked for optimum strength utility. The tendons are there to make the bones do the work. Consider hovering over the mouse and forward shifting onto the button rather than flatly pressing it.

Look at an x-ray of a finger. There are three bones and then the knuckle. They are all held together by soft tissue. Each joint is very powerful when properly aligned. If you hyperextend the first joint, you lose power. If you fully extend the second joint, you could hurt yourself. The power of the finger is in the curve of properly aligned bone joints.

If you were to lay a two by four on the ground and try to poke something, it would strain both you and the board, and would not be very efficient. If you were to pick up the board and poke your object while holding the two by four in the air, you would achieve maximum strength and stress would be minimized.

Consider the domed ceiling of a Cathedral Apse. They are often curved with five or so support columns holding up the ceiling or roof. This is architectural genius. Now place all five fingers on a table with the palm arched, like your hand is a spider on the table. Feel the strength and power of the position and alignment? Just like the dome of a ceiling. With both hands on the table you could support a lot of weight but just because you can, don’t.

It is important that none of these fulcrum be broken. Consider casting a fishing pole. Its flexibility gives it power. If it were broken and you taped it back together, it would lose a lot of power and most of its flexibility. Never break a finger fulcrum. Many pianists and typists break the first one. This is called the distal phalange.

Playing the piano is more complicated. When playing the piano, consider the see-saw. If a light person is sitting on the seat of one end of the see-saw, and a person three times their weight is sitting opposite but closer to the center fulcrum, the light person will be “heavier” and have the advantage. Try it. The key on a piano is lightest on the end and heaviest in the black area. The dilemma in trying to play on the end of the keys is that the fingers are different lengths so this requires an in/out motion with the whole arm while forward shifting into the keys with a straight wrist. The arm places the fingers where they need to be, rather than the fingers dragging the whole arm where it wants to go or contorting to fit some position. Some pianists and typists will equalize all their fingers so that they are all touching the keys at the same time. This adds tension to the muscles which may not be readily noticeable but can cause fatigue, aches and will definitely hamper technique. If your hands or arms are sore or ache after playing, there is something wrong.

Think of equalizing the fingers this way: If five people of differing heights were standing in a room and you lowered the ceiling so that two or three of them had to bend their necks and backs, that is what happens when you try to equalize your fingers. Something will have to be strained.

Bone alignmentAll five fingers are equally strong. Many people regard the fourth and fifth fingers as being weak. They are not. Look at your hand with your fingers abducted (spread out). Notice that the forefinger or middle finger is probably in a straight line with your forearm. That is why those finger are considered strong, because they are naturally aligned. Now radial deviate just a bit (bend your wrist toward the thumb). Notice that the pinky is now in a straight line with the forearm. It now has the power of the forefinger because all the bones are aligned (provided, you maintain the fulcrum at the knuckle when you play or type).

There is another movement which must come into play here: Rotation

Every action has an equal and opposite action. If I were to swing a tennis racquet, I would back swing then forward swing to hit the ball (not taking into account the dozens of other body parts which allow me to do that). To swing a baseball bat, you stand there packed with coiled energy, then back swing, then forward swing to hit the ball. Golf, slapping someone’s face, swatting a fly—they all have equal and opposite movements.

When playing the piano or typing, our fingers can acquire tremendous power, effortlessness and speed when rotation is employed. The pinky, when aligned and rotation is applied and the knuckle fulcrum is maintained, can set up the rest of the fingers for their execution when following through from the rotation. An up movement of the arm is needed too, as the keys are located down. Applying rotation, up and down, in and out and constantly adjusting alignment so that the hand (including all the fingers) does only one thing at a time and moves in only one direction at a time, will not only promote healing but is the first step toward effortless mastery.

The thumb has special needs, too.

Many pianists are taught to pass the thumb beneath the palm then play down. This is both abducting and adducting at the same time. It is a dual muscular pull. Not only that, it is pulling on other muscles which get in the way of what they are doing or going to do next.

The thumb is very content simply rotating down from the forearm to play play a key. The arm has the speed and power to move the hand out of the way so that the next finger can depress the next key without the thumb crossing under.

Think about the thumb and pinky when you extend them or curl them up or under. If there was something just out of your reach and you were going to lean over to grab for it, and I held your other arm and pulled you in the opposite direction, you probably wouldn’t be able to grab the object. That same thing happens to the hands when you isolate fingers. A lot of pianists miss notes or have poor technique because one finger is pulling in the opposite direction the hand is trying to go. Just because you can, doesn’t mean you should. Over time this can cause fatigue, aches, injury and definitely hamper your technical efficiency. This is why some people are prodigies and other people are not.

Another reason not to cross the thumb beneath the palm is that the thumb and forefinger tendons intersect. When you cross under and move one of the fingers, you grind the two tendons against one another. Just because you can, doesn’t mean you should. Over time this can cause fatigue, aches, injury and definitely hamper your technical efficiency as it is pulling the hand in two opposing directions at the same time. Crossing the thumb under the palm also causes De Quervain's Syndrome.

Keep in mind, as I warned you earlier, don’t try this at home without the guidance of a knowledgeable teacher. The rotation must come from the elbow, with gravity and with a little bit of up motion. But even if you think your are rotating from the elbow, you also need to apply arm weight and all the fingers have to move in the direction the arm is going. Sure, the fingers can go in the opposite direction of the arm but I wouldn't advise it.

Arm Weight and Up and Down Motion

Many piano players complain about the stiff action of some pianos. Organists who play on tracker organs face the most resistance. How come musicians such as Bach were reputed to be able to play these instruments with blistering speed, fire and power? I’m sure the answer is that their bones were aligned, they didn’t isolate their fingers, they played with rotation and they employed arm weight allowing gravity to play the key instead of using their tiny muscles.

It doesn’t require an ounce of finger strength to depress a key if you let gravity depress the key with your arm weight, much like the aforementioned doorbell. The trick here is to only allow enough weight to fall on the key to depress it—and no more. We never press into a key. Once the key goes down, it rests on the bed of the board and can go no further. Pressing not only does nothing further to augment the tone but you are also moving downward and you can’t move to the next key since the arm needs to go up to get to it, and you can hurt yourself. When you stand, you are not pressing into the ground. All your weight is just there. If there was a low ceiling above you and you pushed on it to go down, you would only be straining and could hurt yourself. If you chose to do battle with the key bed of a piano, it will win. The only pressure that is needed is what is required, no more. Why press further?

Here are some tips for Healing

Proper movement. I’ve already said enough about that. Contrast Baths. Fill one side of a sink with ice cold water and the other side with hot water. Soak your arms in one side for one minute, then soak them in the other side for one minute. Go back and forth several times. You may have to add more hot water halfway through. The heat helps promote circulation which rushes tissue repairing blood to the site of injury and also flushes out toxins, damaged tissue and acids which may be causing pain, aches and fatigue. The cold helps to reduce inflammation. If your hands are sore, a contrast bath can help take away some of the ache and pain. But it is not a cure, it is only alleviating the symptoms. If this takes away your pain, don’t use this tool as a way to go back to doing something which is harming you.

Deep Tissue Myofacial Massage Therapy

This is not the same as a feel good Swedish massage. The therapist will locate the scarred tendon and massage it along its fiber and break up the scar tissue. This kind of massage can be painful and make you feel like you just got beaten up or had a grueling physical workout. This is good. Drink a lot of water after the massage in order to aid the body in flushing out the toxins the therapist just released. It can be tricky finding a massage therapist who can effectively do this. They all think they can but only someone who is trained properly and has knowledge of the muscles and tendons can promote healing.

Woe Is Me

I had tendonitis for two years before I discovered how to heal myself. During my final six months I was in constant pain. My arms ached and stabbed with sharp pain with every movement. I sought relief from several doctors and none of them were able to help. After only one hour of moving properly, I was pain free—which is not the same as healed, but I was on my way. After a few weeks of moving properly, I was experiencing painless snapping sensations in my arms and wrists as the proper movement was helping to release my tendons of their tethered scar tissue.

Not everyone has the mental capacity or patience to heal themselves. You must be in tune with your body, willing to re-learn how to move, you need the discipline to never perform those activities with improper movement again, and you need to possess a basic and visual understanding of physics and geometry. Without any one of those components, I'm sorry but you won’t heal.

The alternative is that there are surgeries, splints, drugs and a copious assortment of quack nostrums for you to try.

Once you do, you will be able to transpose this skill to everything you do: Walking, running, hiking, skiing, hammering, sawing and swimming–if you feel tension you will be able to analyze your movement and immediately realign your body for optimal efficiency and correct whatever was causing the fatigue.

As I said, not everybody has the capacity to heal themselves. Either they don't have the patience to break old habits and retrain the body to move differently, or they just don't comprehend the mechanics of their body. It is very much like a machine with levers, pulleys and rubber bands designed to move efficiently–and capable of moving inefficiently.

I posted a recording of me exaggerating a few of the aforementioned movements. Take note of the forearm rotation, the up and down, all the fingers going in one direction at the same time and the in/out motion. There are sections where my tone and lines are uneven. My excuse is because I was concentrating on exaggerating my movements for your benefit. The truth is that I have much more work to do.

The song is “Sweet Georgia Brown” and it is located here: http://youtu.be/ADT5vt4evfc(If the hyperlink doesn't work, go to YouTube and search for my channel: malcolmpk88 It will be among the recent uploads.