Using Exercise to Prevent Pain

One of the most promising exercise systems for treating wrist pain appears to be yoga. In 1998, a group of researchers at Hahnemann University in Philadelphia published a study that tracked forty-two people with CTS. The patients in the experimental group received a yoga-based intervention two times per week that consisted of eleven yoga postures designed for strength-ening, stretching, and balancing each joint in the upper body.⁷

4. The frequency of carpal tunnel syndrome in computer users at a medical facility [SWSW01]

5. Carpal tunnel syndrome and keyboard use at work: a population-based study [Atr07]

6. A systematic review of conservative treatment of carpal tunnel syndrome [PAF07]

7. Yoga-based intervention for carpal tunnel syndrome: A randomized trial [GSKA98]

Chapter 7. Preventing Wrist Pain

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Figure 29—The median nerve

After eight weeks, the researchers found that the yoga group had significant improvement in grip strength and pain reduction while the control group saw no significant change. The yoga group also showed more improvement on Phalen’s Test than the control group. However, neither group showed signifi-cant differences on Tinel’s Sign. The Hahnemann study was seminal in its use of yoga as a CTS treatment, but more research is starting to back it up.⁸ Yoga is not without dangers. A number of publications in the last few years have warned of the injuries suffered from the improper practice of certain poses.⁹ The injuries run the gamut from sore shoulders to paralysis. For that reason, it’s best if you learn yoga under proper instruction and supervision.

See Goal 10, Take a yoga class, on page 113.

8. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome [OMM08]

9. http://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html

In the meantime, there are many other ways to achieve the benefits of yoga without incurring the dangers. In fact, some studies have shown that general exercise and physical fitness are just as effective at treating wrist pain (we’ll discuss this more in Chapter 10, Refactoring Your Fitness, on page 147).¹⁰ For the purpose of this chapter, we’ll practice some simple exercises that you can do in just a few minutes from the comfort of your desk.

Nerve-Gliding Exercises

If you read a lot of tech blogs then you may have seen videos of people demonstrating unusual stretches that are supposed to help relieve wrist pain.

There is some science to show that this kind of static stretching helps, but in some cases applying too much pressure to the stretch (often by putting your bodyweight into it) can cause further damage.

Instead, a system of exercises called nerve-gliding has shown the most improvement in patients with wrist pain or CTS.^11,12 These exercises are a form of dynamic stretching, which moves a muscle, nerve, or tendon through a range of motion. This puts less stress on the joint, and appears to also increase strength.

Let’s try a few nerve-gliding exercises for your wrists. You can do all of these right at your desk.

Jazz Hands Hold your left arm up and to your side with your elbow bent, as if you are about to wave “hello” to someone. With your left hand, make a loose fist. Your thumb should wrap over the top of your fingers. Then gently open the hand and stretch the fingers as far as your can. In partic-ular, your thumb should be perpendicular to your forearm.

10. http://health.nytimes.com/health/guides/disease/carpal-tunnel-syndrome/print.html

11. Can we use nerve gliding exercises in women with carpal tunnel syndrome? [Pin05]

12. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review [MTSB04]

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Slowly close your fist again, and repeat the exercise five to ten times for each hand. You can do both hands at the same time if you would like (but only for this exercise, not the others).

Shadow Puppets Hold your left arm up and to your side with your elbow bent, as you did in the previous exercise. Make a loose fist again, but this time extend your middle and ring fingers. Then rotate your wrist as if you are drawing circles in the air with those two fingers.

Make two or three circles going clockwise, and two or three circles going counterclockwise. Then repeat the exercise with the other hand.

The Egyptian Extend your right arm to the side, with the palm of your hand facing the ceiling. Then bend your hand backward, as if you are trying to point your fingers toward the ground. This is the starting position. To perform the exercise, bend your elbow to a ninety-degree angle.

Straighten your elbow again, and then repeat the exercise three to five times for each arm.

Shoulder Shrug Extend your right arm to the side at a forty-five-degree angle. Then bend your hand backward so that your fingers are pointing behind you. This is the starting position. To perform the exercise, gently shrug your shoulder upward.

Drop your shoulder slowly, and then repeat the exercise three to five times for each arm.

Head Tilt Extend your right arm to the side at a forty-five degree angle and bend your hand backward as you did in the previous exercise. Then gently lean your head to the left, bring it back to center, and then lean it to the right.

Perform the exercise three to five times for each arm.

In these exercises, you’re gliding your median nerve through its range of motion, which classifies them as mobility exercises. The median nerve is very long (traveling from the neck to the fingers), which is why the exercises use all of the joints in your arm. The exercises can be done individually or they can all be done as a group up to four times per day. At the end of the chapter we’ll add them to your daily checklist.

Research suggests that nerve-gliding increases the lubrication of the tendons and nerves in your arm, but exercise alone is not sufficient to keep these tissues pain-free. You’ll also need to ensure that you’re not putting unneces-sary strain on them. To do this, you need to work on your posture. That’s where our musician friends can help.

Chapter 7. Preventing Wrist Pain

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Ethan Kind eventually relieved his pain by employing a method called the Alexander Technique. Now he teaches this method to students who suffer symptoms similar to his. But the technique can be applied to more than just musicians; it’s an excellent tool for programmers, as well. After we discuss your next goal, we’ll dive into the Alexander Technique.

Goal 10