These are some posts made by Sharon Butler to the SOREHAND mailing list: (Sorehand FAQ: http://www.ucsf.edu/sorehand/ ) ========================================================================= Date: Thu, 6 Jan 2000 10:48:47 EST From: Sharon Butler Subject: Sharon Butler on Sharon Butler stretches Wonderful New Years Greetings to all fellow Sorehanders, I see that there has been some new discussion about my stretches in the last day or so. I appreciate seeing the number of people whose lives I have been able to affect through my work. Here are some of my thoughts about doing the stretches that might help Sorehand newbies understand the concept behind them. The stretches are meant to restore damaged tissue to a more normal state. As a result, you have to think differently about doing them compared to stretching routines you might have followed in the past. In order to get the best possible results from my stretches, you must try to become aware of the sensations you feel that are part of your injury. Use the book to find an exercise that addresses the part of the body that you feel is injured and try the stretch. If the stretch duplicates the symptom, or amplifies it, then you are doing the right stretch. You have also chosen correctly if the stretch makes you feel like you are stretching something that is tight. Now comes the challenge. You have to imagine that the sensation you feel from the stretch is a volume you can control. You control it by the amount you have a joint bent, how firmly you are pressing into the stretch, how open your fingers might be, etc. With my stretches, you always want to have the sensations in the low to mild range. What this actually accomplishes is that by using the stretch you have accessed some part of the damaged tissue that leads to your symptoms. By stretching it lightly so that sensations remain in the light to mild range, you are gently encouraging that tissue to change. The stretch is completed when you feel the sensation disappear. In a message dated 1/5/0 1:05:03 AM, Nancy wrote: <> Nancy brings up a common misconception about doing the stretches. In her post, it is clear that she is used to doing exercises of any kind in sets with reps, etc. I see that as a way to exercise using a formula or routine. That is not the correct way to do my stretches. My stretches are meant to provide feedback from your body that tells you how far to stretch so that the tissue is not overwhelmed, how long to hold the stretch so that a release of the adhesion is accomplished, and, if you pay attention carefully to what your body is telling you, you will be able to figure out how long you should do each group of exercises so you are getting the best possible results. In this way, you do only the stretches that you body needs, and for only as long as it needs them on any particular day. This is a real challenge to shift to this new perspective of paying attention to body-feedback, but it is one well worth pursuing. It will lead to a lifetime of being aware of when a problem is brewing so you can take corrective action early and never be overwhelmed with an injury again. In my treatment practice, I recommend that clients do no more than 4 or 5 different exercises at a time. Since more tissue is injured at the beginning of a treatment regimine, you will have to plan on spending more time at stretching in the beginning and less as time passes and more and more tissue is restored to normal. Since RSI's of all types are the result of strained patterns of use, it is best if you can figure out how to break up your daily patterns of strain by injecting a few minutes of stretch here and there throughout your day. This gives the tissue the rest it craves and will result in great improvements in your symptoms. Here's an additional tip: If you have any form of tendonitis, thoracic outlet syndrome, or elbow injury, I would suggest that you stick with exercises only from the "Upper Body" section of my book for a week or two, until they no longer create much sensation for you. Then progress on to more specific exercises for the areas of your body that are injured. This helps create some "slack" in the tissue that leads to your hands and fingers which then helps them to release their adhesions. I hope this long-winded answer is helpful to you all. Many blessings for a healthy and happy New Year. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Sat, 8 Jan 2000 13:40:03 EST From: Sharon Butler Subject: Re: Sharon Butler on Sharon Butler stretches <> Dear Janet, I hope I can explain this so it is understandable. It is a complex issue and, obviously, there are certainly valid questions out there about it. In my recent post I recommended doing a stretch that reproduces a pain sensation. What I mean by that is that the area of pain is the area that needs help. It is usually one of many injured areas in a case of RSI. So to use positioning by way of a stretching exercise is a good way of locating those areas that have damaged tissue. Once a person has found this injured area, there is no benefit in continuing to stimulate the tissue to the point that it feels pain. What I recommend is that you back off on the pressure of the stretch until the sensation you feel is low to mild. This means that you still feel something in the area where you experienced pain, but it is no longer true pain, just a very mild version of what used to be pain. I believe that it is in this "therapeutic range" that tissue change can occur. I know that for some people, this explanation can seem counter-intuitive. But, it works. Because most people do anything they can to avoid their pain, it can seem scary to hear someone say that you have to pursue your pain to find out what is truly damaged and where. The trick is knowing how to treat this painful area, once you have found it, in a way that does not promote further aggravation of the injury. I suggest that you try the technique I have outlined and see for yourself how it works for you. Best of luck in your recovery, Sharon Butler ========================================================================= Date: Tue, 11 Jan 2000 09:50:03 EST From: Sharon Butler Subject: Using Butler stretches on various injuries In a message dated 1/8/0 8:16:42 PM, Nancy wrote: <> Yes, Nancy, the stretches will help all of the above injuries. In order to understand how, you have to look at what part of your body is actually injured. The one element that is constant in all of the above injuries is the connective tissue of the body, or, more specifically, the fascia. This stuff wraps and permeates through muscle, tendon is made exclusively from a form of fascia, and so are ligaments. The synovial fluid sacks you are having problems with are wrapped with fascia, so you have cords of fascia (tendons) running through fluid filled sacks covered with fascia. The nerves and blood vessels are wrapped with fascia. It's literally everywhere. What I have found happens in RSI's of all types is that the fascia is subjected to strain in some form (previous injury, poor posture, repetitive movement, chronic body stress, etc.) and tries to protect the stuff that it's wrapping by undergoing a chemical change. Here's how: Research by others shows that the fibers that make up fascia line up in the direction of strain (not unlike when you pull a bit of cotton that comes in a pill bottle - the fibers line up in the direction of your pull). Once this happens with any regularity, the fascia forms hydrogen bonds between the fibers, essentially locking them in their newly-aligned state. The problem is, these fibers have tremendous tensile strength. So, when they become locked together, they are very resistant to aggressive pulling. They also interfere with or prevent the normal sliding of tissue across one another or they can "glue" one piece of tissue to another. I often find muscles that are right next to the ulnar bone stick to that bone, usually a result of a pattern of ulnar deviation (tilting the hand towards the little finger, as is often done when using a computer keyboard). So, now, over a period of time, we have an ever-growing accumulation of more and more stuck tissues running through the arms, shoulders, wrists and hands. Once this becomes bad enough, symptoms will be produced and you are off and running with an RSI. Trouble is, it is often difficult to locate just exactly where these tissue changes have occurred and which ones are the most major source of your symptoms. That is why I suggest stretching broad areas of the body so you are more likely to catch more of the stuck areas. Remember, everything is attached to everything when we are talking about connective tissue. So, for someone like Nancy to stretch only her wrists because that is where the diagnosis says the problem is, is far less than should be done to correct her symptoms. I'd suggest that she begin stretching her shoulders and armpits to create more "slack" in the tissues that come down into her hands and wrists. This is also why I suggest stretching slowly and softly. Fascia that has formed these hydrogen bonds between the fibers is extremely strong and very resistant to change. If you pull it hard, it will pull hard back. You have to "trick" it into letting go by stretching it so softly that it doesn't fight back, easing it into a new state. By stretching it gently, you are helping to break those hydrogen bonds that are locking this stuff into such a tight and restrictive bunch of problems. It's not unlike peeling a sticky label off of a bottle so carefully that you don't tear the label. You've got to go slowly and carefully, constantly changing the parts of the stickyness that you are addressing. A little bit here, a little bit there, and finally, you're done. Works the same way with RSI's. I've seen it hundreds of times. I hope this is helpful to you all who are using stretching as a means of self-care. I am in serious development of a new web site that will cover a lot of this stuff all in one place. I'll announce its completion when it is ready. In the meantime, stretch away!!! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Thu, 13 Jan 2000 09:22:06 EST From: Sharon Butler Subject: Re: Sharon Butler's book In a message dated 1/13/0 3:09:00 AM, Ann wrote: <> The new edition of "Conquering Carpal Tunnel Syndrome" by Sharon Butler will not be out for at least one year or more. It takes forever to get a new book out. I will be working first on a fairly complex web site before I even begin on the book. Don't hold your breath waiting for the new edition of my book. I'd suggest buying a copy of the current edition now if you feel it would be of use to you. Sharon Butler ========================================================================= Date: Wed, 16 Feb 2000 08:38:41 EST From: Sharon Butler Subject: Re: Exercising with mild Tendonitist In a message dated 2/16/00 9:34:54 AM, xxxxx writes: << I'm assuming that the pain is being caused by gripping the bars while I'm doing upper body exercises (I'm not doing any type of hand exercises). >> I would suggest beginning your exercise routine with some general stretches for your upper body, neck, shoulder and arms. This might help relieve your symptoms. You should also end your exercise regimen with stretches to decompress the tissue that worked hard during your workout. I don't agree with your MD's explanation of building up the strength in your hands over time. Chances are, your hands are plenty strong already but they are functioning as if they are weakened due to adhesions in the soft connective tissues (fascia) through your shoulders and arms. Gentle, thorough stretching will help relieve your adhesions and your strength should return to normal. If your symptoms persist despite the stretching, then this may not be the time to begin this new exercise regimen in the gym. I would conclude that your tissues are more involved with adhesions than you realized and it would be more prudent to address those adhesions first, then return to the gym workouts later. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Sun, 9 Apr 2000 00:29:17 EDT From: Sharon Butler Subject: Re: Exercises for raising clavicle for TOS? In a message dated 4/8/00 8:02:46 AM, xxxxxxx writes: << Wanted to pick your collective brains for ideas on exercises to help raise the clavicles (i.e. strengthen upper trapezius, levatator scapulae, and SCM muscles). In particular, do you do anything in particular to strengthen the upper traps in PT or on your own? Of course, for TOS, this has to be done without strengthening the scalenes or other "closers" of the thoracic outlet... >> I personally would never choose to strengthen the upper traps, levator scapulae and SCM muscles to help relieve TOS symptoms. Doing so encourages a forward head position and further compression of the thoracic outlet. It also encourages a rounded shoulder abberation of the posture. I would think, over the long run, that this would lead to a whole host of other, nasty symptoms and never really provide the relief you are looking for. I encourage you to think another way about the compression of the thoracic outlet that is taking place. The lowered, "flat" clavicle might be brought about due to excessive shortness in the latissimus dorsi, which creates a downward drag on the entire shoulder girdle when it is tight. I would suggest that you try various sorts of lat-lengthening stretches to bring relief. In my work with TOS patients, we always get positive results never by tightening anything, but rather by lengthening the lats and releasing tension in all the tissue that passes through the armpits. I hope this info helps! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Tue, 11 Apr 2000 14:20:56 EDT From: Sharon Butler Subject: Good Lat Stretch Ramona, A good lat stretch goes as follows: Clasp hands together in front of you. Bring both forearms together, similar to the illustration in my book for Upper Body Exercise #5, Step A. Instead of continuing to follow the exercise in the book, do this instead...Place clasped hands and forearms down on a desk or table in front of you. You will be bending forward at the hips. Take one step backward so your feet are slightly behind your hips. While leaving the hands and forearms on the desktop, not allowing them to slide, lean back into your hips. You should feel a stretching thru the arms and sides of the body. Remain in the stretch for 10-15 seconds, then stand and put the arms at your sides until the residual sensations have disappeared. Then, try the exercise again. You can repeat this process up to 3 times at a setting. One question for you...How do the MD's explain the change in the constriction of the blood flow from normal to its current state of disarray? I don't believe that the first rib magically rises over time, so why would they consider cutting it out? I think there have been other influences such as gradual changes to the connective tissue that permeates through the shoulder area that lead to congestion in the area. MD's generally don't think of this as a possibility since they never study connective tissue and its abberational states. I would highly recommend that you work with a really good structural bodyworker who has experience working with shoulder injuries before considering surgery. Normal deep tissue bodywork, trigger point therapy, or other myofascial release techniques don't count here. You need someone who is really skilled in restoring natural balance to the tissues in the shoulder. Choose a Rolfer or Hellerworker for your best results. be sure to ask how much experience they have working with shoulder injuries. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ======================================================================== Date: Thu, 18 May 2000 23:40:53 EDT From: Sharon Butler Subject: Sharon Butler on Fascial Function Hello Everyone! It has been awhile since I have participated in the list discussions. It was quite by accident that I read one of the recent posts about fascia in which a portion of my book's explanation of how fascia works during an injury was included in the post. I gather there is quite abit of confusion about the origin of these statements. Maybe I can help... The first thing you need to understand about fascia is that it is one big piece of tissue throughout the body, from toes to the top of the head. It changes and adapts its elements according to where it is located and how that area functions. For instance, fascia that permeates muscle is very loose and fluid. The fibers are very random which allows for the stretch and flex that occurs in muscle tissue. Fascia of this kind has lots of elastic fibers in it, in addition to the collagen fibers and ground substance that are elements of all fascia. As this muscular fascia continues down the length of the muscle, the muscle fibers end and the fascia continues in the form of tendons. Tendon tissue has the same collagen fibers and ground substance, but most of the elastic fibers disappear and are replaced by white or yellow fibers which are inelastic. This leads to the incredible tensile strength that is found in tendon tissue. And so, on and on throughout the body, fascia changes and adapts according to the function of the area in which it is found. Fascia and muscle are so intimately related in the body that fascia is often not talked about in medical school training. I don't know why this is, but MD's and PT's are just beginning to wake up to the impact that fascia has in all musculoskeletal injuries. Each microscopic muscle fiber is encased in a sheath of fascia, sort of like a sausage in its casing. When the muscle fiber contracts, the fascial sheath changes along with it. When the whole muscle contracts, many layers of fascia throughout the muscle move along with the contraction. When this is done repeatedly, as often happens with repetitive strain, a potential for trouble begins. The loose, areolar kind of fascia that is found throughout, around and between muscle tissue has fibers that have no regular arrangement. It's very loose and floculant. In the classes I teach, I use fake cobweb to illustrate this property. If you've ever put this stuff around your porch or bushes at Halloween, you can relate to how it responds to pulling and stress. You pull in one spot and a wide area of the cobweb moves. If you look closely at the fibers of the cobweb, the fibers align in parallel when they are pulled in one direction. Fascia does the same thing. As muscles contract with repeated movement, the fibers that make up the fascia in that area line up in parallel with each other. When they come in close proximity with each other, they form hydrogen bonds between the collagen fibers that make up the fascia and become glued together. This causes this area of fascia to not be able to spring back to its normal loose and fluid state. Its motion will be somewhat inhibited and the muscle will have to adapt slightly in its motion because the casing around that muscle will now be changed. With more repetition, more areas undergo this change. In most cases, this is a slow process. Anyone with repetitive strain injury that has developed and changed over a period of time has experienced this process first-hand. The kind of rapid, supportive change in the fascia that I mentioned in my book is the kind of change that happens with quick trauma, as in a whiplash injury or other rapid, traumatic motion of the muscle and connective tissue. Those of you who have suffered whiplash have experienced the muscular contraction that comes with whiplash injury. But, after a period of recovery, the brain stops sending the "contract" message to the injured muscle, and, technically, the muscle should let go and function normally. But, those of you who have been injured know that this doesn't happen. The area remains tight and constricted and painful for a much longer period of time. This happens because the collagen in the fascial sheath that surrounds the muscle fibers has responded to the strain by gluing its fibers together with hydrogen bonds. Now, the area functions in a much more restrictive way, sort of like the "neck brace" I mentioned in my book. I first learned about this phenomenon while studying cranio-sacral therapy through the Upledger Institute (based in Palm Beach Gardens, Florida). They work with this phenomenon all the time at their brain and spinal cord injury center. Therapists who perform trigger point therapy are also working with this phenomenon by stimulating areas of fascial congestion to promote release. Their pressure helps to break up the hydrogen bonds that have stuck all the collagen in the area together. In the myofascial release work I do, I work more broadly, looking for the effects of fascial change as they affect larger areas of the body. I use pressure and slow motion to break up fascial congestion and adhesions that inhibit normal motion of the fascia, muscle and bone. This ability to break up the hydrogen bonds that create this gluing effect is called "thixotropy" and you can read more about it in a book called "Job's Body" by Deane Juhan. There are volumes more that can be written about fascia and how it functions and responds to stress and injury. This is not the appropriate place to present this information, however. It would simply take too much time to produce. If you are sincerely interested in learning more about fascia and its function in the body, I suggest you read "Job's Body" and "Rolfing" by Dr. Ida Rolf. And, if you are really interested, take a class in myofascial release or a class in cranio-sacral therapy. Your eyes will seriously be opened! I hope this has been helpful! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Sun, 21 May 2000 17:12:55 EDT From: Sharon Butler Subject: Re: Sharon Butler on Fascial Function << In a message dated 5/20/00 12:59:58 AM, xxxxx writes: << To cut to the chase about the way I had those tight bundles in muscles explained, they result from muscle fiber contraction that interdigitates the myosin and actin fibers of the muscle so deeply that they "have difficulty" disengaging. >> When you come to understand that each and every muscle fiber is encased in fascia, you will begin to understand that this action intimately affects the fascia as well. It is the fascia that remains stuck. Muscle fibers can only contract when they get a "contract" command from the brain. When the need to contract is over, it is the fascia that tightens and creates those knotty bundles that you are working out with your massage techniques. <> This is incorrect in my understanding. Muscle tissue contains none of the elements that can turn into tendon tissue. It is all the microscopic fascial sheaths surrounding individual muscle fibers that come together at the end of the muscle to form the tendon. << Hydrogen bonds can act quickly, too, and can make things sort of "stick together," but I've never read or heard of them being involved in the spasmodic muscle problems that we're discussing. So, I need to read those books, check them out, and see what insights are inferred.>> Begin by reading Job's Body. It is a handbook for bodyworkers and, although it is pretty technical, it is fascinating reading and well worth the time it takes to digest it all. Thanks for the comments, Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ======================================================================== Date: Mon, 22 May 2000 23:32:10 EDT From: Sharon Butler Subject: More On Fascia Here's another interesting tidbit mentioned in "Job's Body" that might provoke some interesting discussion amongst Sorehanders, especially those with medical, massage or bodywork training. Apparently, for many years, fascia was known to contain ground substance, collagen fibers, elastic fibers (in loose fascia, which is intermuscular), yellow or white fibers (for tensile strength in tendons and ligaments). Well, someone decided to look more closely at the collagen fibers and discovered that they are actually tubules. What was found to be in the tubules? CEREBRO-SPINAL FLUID!!! So, what some might argue is that facsia is an extension of the neurological system and helps to increase the flow of cerebro-spinal fluid throughout the body. Perhaps this is a partial explanation as to why the fascia responds as I believe it does, and as taught in cranio-sacral training, when it is subjected to trauma? It might have an ability to interpret the messages coming from the brain that lead to tissue response that occurs during an injury. BTW, there is a reference in "Job's Body" about where this information comes from. Didn't have time to look it up, however. What do you all think? Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Thu, 25 May 2000 21:52:57 EDT From: Sharon Butler Subject: Re: RSI education In a message dated 5/24/00 9:10:58 AM, xxxxxx writes: << Before you felt the first tinge of discomfort, what message would have kept you from being injured? I know we cannot fixed the lousy bosses and the poor business management practices, but on a personal level, how can we reach those that need to hear what many of us have learned the hard way? >> In my experience, people cannot "relate" to the pain and inconvenience of injury until they are actually experiencing it themselves, or the statistics that they will personally be affected by the injury is too overwhelming to ignore. I feel that the best way to have a permanent effect on people is to reach them at their earliest developmental stages. To teach children thoroughly about ergonomics and make sure they practice what they learn might be the best shot at making a difference in the development of adult injuries. Sadly, more and more children will begin experiencing the effects of injuries as they get more and more into using a computer for everything, in addition to their video games, etc. Reach 'em and teach 'em young, I say! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Tue, 30 May 2000 15:10:49 EDT From: Sharon Butler Subject: Re: Fw: carpal tunnel In a message dated 5/30/00 7:33:50 PM, xxxxxx writes: << >>>Anyway: Here's a question for you and others: In October I started having a lot of clicking in my left wrist. Then it started in the elbow, then on the other arm. I've told the doctors but they just make notes and say it's probably muscle weakness. Does this sound right or could it be something else?<<< >> My understanding is that clicking is created when tight tissue slips over an edge of bone. I often get this sort of thing in my neck. Some gentle, thorough stretches almost always takes care of it completely. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Sat, 9 Sep 2000 17:27:28 EDT From: Sharon Butler Subject: Re: Sharon Butler's Book - The Strech Point In a message dated 9/8/00 8:15:59 AM, xxxxxxx writes: << I'm trying to apply Ms. Butler's book, but it seems that it takes a long time for the "strech point" to relax. Is this normal, or am I doing something wrong? >> Brad, You are stretching just a bit too hard if it takes more than 30 seconds for the stretch point to release. Just lighten up a bit and you should get better results. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ================================================================ Date: Thu, 14 Sep 2000 00:40:08 EDT From: Sharon Butler Subject: Re: stretching Greg writes: << Also, since connective tissue and muscle do not really > "stretch" it begs the question as to how it is all realy working and what > exactly is being stretched. Of most concern to this list is the > involvement of the neural structures in stretching. Is it possible that > the stretch you feel at the end of the range is actually the nerve coming > under tension? Who knows at this point? >> Based on my extensive experience in healing from my own (multiple) cases of RSI, as well as the hundreds of patients I have successfully coached and treated through to complete recovery, I would like to voice some concern about the above statements. I feel they are, at the very least, misleading. In the statement above, Greg makes no distinction about the type of connective tissue he is referring to. Loose, areolar fascia, a type of connective tissue, is found surrounding and permeating through muscle tissue, supporting nerve fibers, blood vessels, etc. This type of connective tissue does indeed consist of elastic fibers, along with ground substance (fluid) and collagen fibers. (See Gray's Anatomy, section on Conective Tissue) Therefore, this type of connective tissue is designed for stretching and its health appears to be maintained by stretching and extending beyond its relaxed state. I have often found that in performing certain stretches, the nerves can begin to "fire". This indicates to me several possibilities. First, the connective tissue (fascia) that is being accessed through the stretch holds and supports one or more nerves. Second, the natural ability of that nerve to slide and glide along with the movement of that part of the body has become compromised, usually due to adhesions in the vicinity. Third, if the area is stretched repeatedly to the point that the nerve goes completely numb, I feel that this is far too much strain on the adhered nerve tissue and could possibly injure the nerve. Fourth, I have found that if the intensity of the stretch is reduced to the point that the nerve only tingles slightly during the stretch, and then completely disappears when the stretch is stopped, the adhesions slowly begin to disappear and the fascia returns to a more normal state that can be maintained for an extended period of time. The nerve also regains its normal ability to slide and glide inside the supportive connective tissue matrix, eliminating all symptoms of dysfunction. Real recovery from an RSI occurs when the sufferer successfully identifies as many of these adhered areas of the body as possible (through how they feel and how they have affected the range of motion, etc.) and effectively stretches to release them all. This is not always easy, and can take a significant amount of time and patience. So, many people decide to seek the services of someone like myself, trained and experienced in myofascial release, who can help speed up the process through direct manual stretching of affected tissue. I want to remind everyone, however, that it is quite possible for any sufferer to create a significant amount of recovery on their own through careful stretching. I hear from people who have achieved this kind of personal recovery all the time, in response to using my book. (Not intended to be an advertisement!) So, in my opinion, stretch on - CAREFULLY! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Thu, 14 Sep 2000 16:23:32 EDT From: Sharon Butler Subject: Sharon's Response: More on stretching Hello Margaret and other Sorehanders, My comments follow this excerpt... Sharon Butler In a message dated 9/14/00 10:00:52 PM, xxxxxx writes: << I have had some success with a style of stretching I learned from Aaron Mattes. It goes something like this: 1) Take the muscle to be stretched, up to where you first feel the slightest pull. I am guess this is similar to what Sharon Butler refers to as a stretch point (please correct me if I am wrong). To do this you contract the antagonist muscle. So to stretch extensors contract flexors. To stretch the muscles on the top of my forearm (while my hand is palm down position) I hold my arm out straight in front of me, elbow straight and bring my hand towards me, palm down. 2) Hold for approx. 2 seconds or one inhale exhale. 3) Release and let the muscle return to "normal", I even shake it out gently between stretches. You want to let blood flow into the area before the next stretch. 4) Repeat 8-10 times. Some times giving a gentle assist with the stretch is helpful, but gentle is the key idea. This way of stretching seems easier to teach to my clients and they seem less likely to overstretch and cause more damage.Of course, I use it myself as well. The muscle is warmed as it is stretched, so people can do this without walking in place for five minutes first (or whatever), which we are all supposed to do but no one ever really does.. Mr Mattes has a web site which I find is not very helpful. The best application I have found of his work is from his students Jim and Phil Wharton. I like their book , The Whartons' Stretch Book : Featuring the Breakthrough Method of Active-Isolated Stretching. Its on Amazon, etc. If any of the other list experts and worthies know of some problem with the above, please let me know. Thanks. >> Sharon's response: I have tried this type of stretching and have discovered several problems with it that keep me from recomending it to my clients, or using it myself. Here goes: First, when you activate or contract a group of muscles in order to stretch the opposing muscles, it makes it very hard to concentrate on the sensation of release because your brain is much more aware of the sensation created by the contracting muscles. This concerns me because I have found that extreme care must be present when stretching injured tissues and if you cannot feel the response from those tissues because something else is creating a stronger sensation, then overstretching is entirely possible. Second, I have found that brief "sets" of stretches seem to affect only the most superficial layers of tissue. In RSI's the injured tissue is often at a very deep level. To release this tissue, you must take a gentle stretch and hold it for an extended period of time, sometimes for minutes, all the while feeling the sensations that this stretch is creating in your tissues. When the sensation increases beyond the mild level, you need to release the stretch to a slight degree, still continuing the exercise. When the sensation fades into nothing, you need to gently increase the stretch until you find the appropriate sensation once again. The idea is to keep a constant, and very light degree of tension on the tight and restricted tissue, through all its layers, until it releases completely. If you follow this method all the way through to the end (where no more stretching sensations can be found), you will discover that the tissue is significantly improved, sometimes to the point of recovery. I had a personal experience with this when I was trying to figure out what stretches would restore the strength to my forearms and eliminate the tingling in my hands when I was healing from my first case of carpal tunnel syndrome (bilateral). This is how I came up with Exercise #3 in the Forearms section of my book. By just fooling around, I discovered that if I laid flat on my bed (no pillow) and stuck my arm, palm up, off the side of the bed, that I immediately felt a rather strong pulling all the way down my arm and in to my fingers. I discovered that if I moved more onto the bed so my arm was more fully supported by the bed, that this reduced the pulling significantly and made it feel more comfortable, and safe. That first time trying that stretch, I remember that it took about 45 minutes of constant, and very light, tension on those muscles before they released completely, through all the layers. While this time was passing, I felt sensations in the superficial tissue, then in deeper tissue, then superficial tissue again, and on and on. When the sensation completely disappeared, I discovered that if I opened my fingers very slightly, the tension on the muscles returned. So, I continued the stretch in this new position. Mind you, this was all an experiment, even though I had years and years of experience already in working with connective tissue, as a Hellerwork Practitioner. I guess I had the courage to try this extended experiment because I had learned over the years that fascia is pretty resilient stuff and if you treat it right, it usually will let go (and this usually meant lightening up rather than beating it up!) After a full 45 minutes of tension and release, tension and release, I got up, not knowing what to expect. To my surprise and delight, I discovered that at least 75% of my strength had returned and all of the tingling had disappeared completely. It never returned again. So much for my personal story. I hope you have found it helpful. As I have stated many, many times before, after this initial experience of healing and discovering what appeared to work, I went on to restore a more normal condition to all the tight and restricted tissue that seemed to be associated with that first case of carpal tunnel syndrome. I just kept noodling around until I found more restricted tissue, then used the same stretching technique to restore that tissue as well. Soon, all remnants of carpal tunnel syndrome were gone. To learn more about other RSI's and if the same technique would work for them as well, I began to create additional RSI's in my body. Over the years I have misused a computer mouse, sat at an ergonomically impossible workstation for months, crocheted for hours and hours daily for four months, etc. etc, to create new injuries. I know this sounds insane, but I was confident that I could heal them all through stretching alone. Over the years I have had bilateral carpal tunnel syndrome, tendonitis, deQuervain's syndrome, thoracic outlet syndrome, cervical strain, medial epicondylitis, lateral epicondylitis, and trigger finger. Using the non-invasive and gentle techniques I have described here and elsewhere, I have successfully healed from all these injuries and have absolutely no lasting effects from any of them. I can sit at a computer as long as I wish, and do whatever else I want. The only concession I have to make is that I now recognize that these activities can and do change the condition of the fascia and that if I want to remain symptom-free, I have to spend a minimum amount of time (perhaps 15 minutes per week) stretching appropriately. ANYONE else can duplicate the results I have gotten, I am sure of it. This is what I have taught to my hundreds of clients. Those who have stuck with their recovery programs and continued to learn what their bodies are telling them, and then have stretched appropriately in accordance with this information, have maintained their symptom-free status as well. To anyone who is reading this: PLEASE do not let yourself get discouraged along the road to your recovery, especially if you are trying stretching as your method of choice for the reversal of your symptoms. Remember how many times you fell as an infant as you were trying to learn to walk. You will make mistakes along the way, but fascia is pretty forgiving stuff and you can always pick yourself up, dust yourself off, and try again. IT IS POSSIBLE! DON'T GIVE UP! Sincerely, Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitiver Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Fri, 15 Sep 2000 22:43:34 EDT From: Sharon Butler Subject: Re: Sharon's Response: More on stretching Dear Sorehanders, In response to my post about stretching, Kevin asks some interesting questions. I thought I'd share my responses with the list. In a message dated 9/16/00 4:12:24 AM, xxxxxxx writes: << I was curiou about your response. You said that you used a mouse improperly...what is the proper way of using it?>> I have found that the safest way to use a mouse comes primarily from how it is positioned on your desk and in relation to your body. First, you should pull your chair up to your desk and let your arms hang straight down at your sides. Next, bend your elbows, bringing your forearms level with the desk. Your upper arms should still be hanging along your sides. Your mouse should be positioned directly in front of the hand that will be using it and your hand should be able to reach it without extending your arm at all. For most people, this means moving the mouse closer to the edge of the desk. It might also involve shifting the keyboard slightly to one side so the mouse is direct ly in front of the hand that will use it. I developed the biggest problems when I placed my mouse on a surface higher than my keyboard, when I had to reach forward to reach the mouse, or when the mouse was far to one side, causing me to lift my elbow away from my side, or making me pivot my forearm to the side, so it was no longer straight out in front of my elbow. These postures caused severe problems within a two week period. The primary injuries developed in my elbows (medial epiconylitis) and biceps (tendonitis) and the front of my shoulders (thoracic outlet syndrome). Painful... <> I had a medical director (MD) at my company at that time and he diagnosed and confirmed my injuries. I had no diagnostic tests to confirm the injuries, other than the traditional phalen's test and tinel's sign for my case of carpal tunnel syndrome, primarily because I think they are pretty much a waste of time and money. They are far too limited in their view of the body and are pretty inconsistent in their results. I began my stretching techniques immediately. <> I had complete relief from my carpal tunnel symptoms within two months. Remember, I was just trying to figure out what to do to get rid of the symptoms at that time. I didn't really have an organized plan in place. That came with practice on lots of volunteers and other clients over a two year period. It was during that time that I developed alot of the stretches that appear in my book. Many of them were developed to reach the adhesions of those early RSI clients. We sometimes had to experiment a bit before we hit the nail on the head. The injuries that were caused by improper use of the mouse took varying amounts of time to heal. The tendonitis in my biceps took only a matter of days to heal (2 or 3). The thoracic outlet syndrome was more complex and involved all of the muscles of my armpit areas, in addition to the tissues that suspend and move the shoulder blades. I also had problems with my neck with that injury. Recovery from the TOS took about 2 weeks to be completely gone. The worst of all the "mouse" injuries was the medial epicondylitis. It is really hard to design stretches that effectively reach the elbow tissues affected with this injury. After lots of trial and error, I developed a single stretch that proved most effective for those symptoms. The epicondylitis took about a month to be fully resolved. Everyone who reads this will, I'm sure, have a hard time believing how fast I was able to reverse my symptoms. It is all true and I routinely recreate these results with my clients (I usually only see people for 5 sessions for any RSI.) You must remember, however, that I have years and years of experience working with connective tissue through my Hellerwork practice (16 years), and I've received over 300 bodywork sessions, so I'm thoroughly familiar with how the tissue responds and heals from injury. These results would have been difficult for anyone else to duplicate. I feel that the stretches were so effective in relieving symptoms over a long period that I'm not sure how to answer your question about whether the condition was eradicated or the symptoms alone were eliminated. I have learned that RSI's develop in a true "cause and effect" relationship. So, even after symptoms are completely eliminated, they can recur since RSI's are "repetitive" "strain" "injuries". If you do repetitive things with your body, and add strain to any aspect of those motions, you will eventually develop an injury. In order to return to their livelihoods, I recommend my clients continue with a very short, very focused program of preventive stretches once they have "recovered". If they keep this up, they remain injury-free for years. I hope this further clarifies my response on stretching. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Fri, 15 Sep 2000 22:53:02 EDT From: Sharon Butler Subject: Re: Needle work and RSIs? In a message dated 9/16/00 9:20:11 AM, xxxxxxx writes: << It seems reasonable that if one works hard all day in a repetitive job and then goes home and "rests" by engaging in hobbies using repetitive hand activities, that there could be increased risk of developing RSIs. Hobbies like this include (obviously) computer use, knitting, peeling fruit for canning, etc. There isn't much data to back that up and I would like to request comment from listserv members regarding hobbies causing or contributing to problems, or not. What has been your experience? >> Dear Marilyn, I feel the answer to your questions comes from analyzing which muscles are being used for the various activities. Any grasping motion requires use of the same muscles that curl the fingers over a keyboard. Therefore, anyone who does a hand-intensive hobby on the same day they spend lots of time at a computer is asking for trouble, IMHO. I recommend that my clients decide which is more important to them, their work or their hobby. They should choose one or the other during their recovery. Once recovery is complete, they can slowly phase in the second activity, possibly increasing their stretching program to relieve strain patterns that are being added through that activity. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews at Amazon.com!!! ========================================================================= Date: Sat, 16 Sep 2000 15:03:13 EDT From: Sharon Butler Subject: Re: Sharon's Response: More on stretching In a message dated 9/17/00 1:51:58 AM, larsenkc writes: << so then, if u use both mouse & kbd, u need to move them back & forth so arm doesn't have to pivot? ugh.>> Yup. I think this has become necessary due to the width of the IBM compatible keyboard. There is an extra set of command keys in between the letters and numeric keypad. This is a problem. The Apple keyboard has always been more narrow, without the extra keys, but I am now saddened that their newest keyboard is the expanded type. Where are these guys heads when they design this stuff? <> My office is located in Paoli, PA, near Philadelphia. I have trained over 100 experienced bodyworkers from around the world in my treatment techniques, but, unfortunately, none in the Minnesota area. The closest are in Indiana and Michigan. Sorry I can't help you there. (There is a certified Hellerwork Practitioner in Minnesota who might be able to help you. Check www.hellerwork. com to find a therapist near you.) My website is currently in design and I hope to be able to offer folks like you lots of free self-help advice on the site. It will take awhile to get it up and running, though. I'll be sure to put a notice on the Sorehand list when it is functional. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ======================================================================== Date: Tue, 19 Sep 2000 00:25:46 EDT From: Sharon Butler Subject: Stretches for epicondylitis In a message dated 9/18/00 10:41:20 PM, AHiss writes: << Sharon, in a recent post, you mentioned you had found a stretch to address the elbow tissues affected by epicondylitis. This is the "snip" from that post.. I would love to know what that stretch is as my elbows hurt quite a bit (surprise, more on my mouse side). Thanks for all your advice on stretching - it has helped me tremendously. Amy Amy and others, Here are two stretches that work well for epicondylitis: 1. Put your hand on your hip. Your wrist should be bent at a 90 degree angle and your elbow straight out to the side. (If your wrist cannot bend to a 90 degree angle, or if you cannot get your elbow straight out to the side, then you have to work on that before this stretch will work for you.) Now, imagine moving your shoulder blade down, as if you are trying to tuck it into your hip pocket. In doing this, you should begin to feel a deep ache in your elbow. That is the stretch. I recommend holding this position until the ache gets on your nerves, or you feel like stopping. I have not found any problems with holding this position for a long time, just the annoying ache. Relief comes from frequent repetitions. 2. Hang your affected arm straight down at your side. Twist your arm so your palm is facing out, thumb to the rear. If this creates a stretching sensation anywhere in your arm or elbow, then hold this position for 30 seconds. Return your arm to its untwisted position and wait until remnants of the stretching sensation are completely gone. Repeat. When you do this stretch and you no longer get stretching sensations anywhere in your arm, then go to the twisted arm position and bend your wrist about 1 inch. (Your palm will be bending toward the ceiling, fingers away from your body.) This will create new, hopefully light, stretching sensations. Hold until the stretching sensations begin to fade. Return to the untwisted position and wait until all traces of the stretch have disappeared. Repeat. Continue repeating until you no longer get stretching sensations in this position. You are now ready to try the next position, which is the same as the others, only your wrist is now bent 2 inches. Follow the same procedure as before. NEVER try to go to a new position unless ALL traces of stretching sensation have completely disappeared in the old position. This will probably take a week or two of daily repetitions, so don't rush it! As you continue practicing the stretch, you will progress through several more stages of bending your wrist farther. When you get to the position where your wrist cannot bend any farther, and this position does not generate any stretching sensations whatsoever, then begin wiggling your fingers in this bent-wrist, twisted arm position. This is the final step of the stretch. Expect this stretch to take several weeks to get you all the way through to the final position. During this time, it is preferable not to participate in activities that flare up your elbow symptoms, if possible. While the stretch takes an extended amount of time to get the results you are looking for, it is worth its weight in gold. It really works. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Tue, 19 Sep 2000 13:51:10 EDT From: Sharon Butler Subject: Re: Stretches for epicondylitis In a message dated 9/19/00 9:30:01 PM, xxxxxxx writes: << I was trying the second stretch and I got tingling down my ring finger and pinky...which leads me to think something is happening to my ulnar nerve. Is this bad? Or is this what is supposed to happen? Thanks! Kevin >> Dear kevin, Tingling is OK, complete numbness is not. If all you are feeling is tingling, then it means that you are stretching the tissue that is affecting the nerve. If you stretch gently enough, you will release the adhesions that are tugging on the nerve (that is what gives you the tingling sensations) and your symptoms will improve. Just be gentle and expect this to take a bit of time. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Tue, 19 Sep 2000 13:56:42 EDT From: Sharon Butler Subject: Re: STRETCHING WITH WRIST INSTABILITY In a message dated 9/20/00 12:32:34 AM, xxxxxx writes: << Have been reading the stretching comments and have been stretching for many years. However, I have now become concerned that the stretching may be making my wrist instability problem worse. Could this be possible? I have a distal radial ulnar joint instability. Recently, I have almost stopped stretching and find the pain has decreased in the unstable area. I don't know if this is just a coincidence. What are your thoughts of stretching with an instability problem? >> I have only run into this a few times in my work. Unstable joints do not seem to respond as well to stretching in my experience, unless they are unstable because some of the muscles supporting the joint are overly tight and some are overly loose. This will always lead to instability that can be corrected by releasing the overly tight muscles only. But this would be extremely difficult for a non-professional to assess correctly. If you feel that some of your muscles are too tight and some are too loose, then I suggest you seek the guidance of a good physical therapist (possibly someone who works with a professional sports team, as they may have more experience with this sort of imbalance.) Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ======================================================================== Date: Wed, 20 Sep 2000 23:17:56 EDT From: Sharon Butler Subject: Nerve response while stretching In a message dated 9/21/00 8:46:10 AM, hartg writes: << It is NOT OK. Neuromobility requires backing off from this point of symptoms and gently working the motion short of any symptoms. Tingling is an indication that the normal integrity of the nerve has been violated and it may continue to flare-up symptoms. >> Greg, I have not found this to be true. I have experimented in my own body with several diferent kinds of nerve impingement and have carefully coached others through these symptoms. My assessment of what is happening when light tingling is felt is that the tissue that surrounds and supports the nerve is being put under some tension (it is being stretched) and becasue the nerve is entrapped in that matrix, the nerve is firing. This does not mean that the nerve itself is being pulled. Under those circumstances, I would expect a much stronger nerve response, since the nerve is so irritated from its impingement. In practicing stretches that elicit a mild tingling response, I have experienc ed the tingling gradually lessening and disappearing completely. Once this is accomplished, the nerve response cannot be elicited again, no matter what motion or stress on the nerve is created. Nerve tissue has resolved this way in hundreds of cases, plus in my own body in the wrists, elbows and thoracic outlet. To me, that feels like, and acts like, a resolving of the nerve impingement. What do you think? Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Tue, 2 Jan 2001 12:58:31 EST From: Sharon Butler Subject: Re: Stretches that aggravate In a message dated 1/1/01 9:45:36 AM, flibbet writes: Does anybody know of stretches which may aggravate epicondilytis (tennis elbow) ? I do a range of stretches from Sharon Butlers book and I suspect that some of them may actually be making things worse. My original RSI symptoms were and still are sore wrists, but since applying various exercises from the book my elbows are becoming excruciating, even though my computer activity has been dramatically reduced. Of course I realise that the new symptoms may merely be a reflection of the migratory characteristics of RSI. You appear to be experiencing a phenomenon that many others have experienced relating to stretching programs. Unfortunately, my book was written 6.5 years ago, well before I figured out the solution to this problem. I am putting all of the following new information on my upcoming website for RSI sufferers (I will put a notice on Sorehand when the site is operational.) Here's what I have found to be the problem in this case: People usually have symptoms in more than one area. Typically, they choose exercises or stretches that affect the area with the most pronounced symptoms. Sounds reasonable, eh? In your case, my guess is that you have chosen stretches that affect your forearms and wrists. Well, in actuality, the stretches are not just stretching specific areas, they are also affecting the connective tissue matrix that goes throughout the entire upper body, feeding down into the limbs. I have discovered that if someone has an adhesion in the shoulder or armpit area, they may not feel symptoms there. They will probably feel their symptoms in the area of their body that gets the most use. In the case of computer users, this would show up in the hands and forearms. Still, the actual problem is in the shoulders and armpits. So, the solution is to first stretch the shoulders and armpits. I am still amazed at the huge majority of RSI sufferers who have major adhesions in these areas and never feel them until we start to use stretches that affect these areas. For you, I'd recommend that you choose stretches from the "upper Body" section of my book, and try to make up your own stretches that help you open up your armpits and move all the components of your shoulders. Example: Lay on your back on the floor. Extend both arms out to the side, palm up. This simple position often brings about stretch points and you should wait in this position until they are all gone. Next, bend your elbows at a 90 degree angle so your arms on the floor now look like goalposts. Wait in this position until all stretching sensations disappear. Now, in one smooth, slow movement, keeping your arms in full contact with the floor, straighten your arms into a "Stick 'em up!" position, then slowly return to the goalpost position. Keep repeating, very slowly, for 5 repetitions. Now, put your hands on your belly and wait in this neutral position until all traces of the stretching you just did are completely, and I MEAN COMPLETELY, gone. (This recovery portion of the exercise is extremely important and may take a few minutes to accomplish the first few times you do this stretch.) You are done! This exercise is effective for moving all the componenets of the shoulder and armpit, while leaving the weight of these areas fully supported by the floor. And, as I have stressed so many times before, NEVER stretch to the point of pain, or anything even remotely like pain. This is counter-productive to damaged tissue. I would recommend that everyone who is experiencing this type of confusing feedback from their body stop doing any stretches for the hands, wrists and forearms, and start doing exercises such as this one that affect the tissue higher up on the chain (nearer the neck, shoulders and armpits). You will begin to have more improved results very quickly. Resume stretches for the forearm, wrist and hand once you feel you have gotten at least 50% improvement in the shoulder and armpit areas. Good luck in your continued recovery! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ========================================================================= Date: Mon, 19 Feb 2001 18:31:39 -0700 From: kome Subject: Re: After carpal ligament "roof" is cut,consequences for your hand? Complete loss of grip control,for example? Etc.? Hi Don; If the results were catastrophic, then doctors would not rely on the surgery pioneered by Dr George Phalen in the 1950s. Although, as I said, it's my impression that Phalen advocated a "snip" and more doctors these days use a "slice". Some Sorehanders have reported loss of grip strength, or that they have to brace one wrist with the other hand in order to pick up, say, a jug of milk. Long-term studies after CTR are hard to find. Most patients do report relief, at least initially. Sharon Butler, Hellerworker and author of "Conquering Carpal Tunnel Syndrome", has a theory that carpal bones start to drift some time after the ligament is cut. Paul once reposted her comments in a post that I then saved (below). cheers, Penney "Sharon J. Butler" Re: Thumb pain revisited >Status: RO > >David writes: > >>Recently there have been quite a few letters re. painful thumbs. I >too have a problem with my thumb. Before surgery I had a triggering >of the thumb due to a nodule on the tendon. (polar flexus?). This was >corrected by surgery to remove some of the tendon sheath near the >nodule so that "the snake didn't have to swallow the golf-ball" as my >surgeon put it. I also had a release of the transverse ligament at >the same time (open surgery). Now two years after surgery I have >been experiencing a great deal of pain at the base of the thumb. >Xrays show a narrowing of the cartilage at one side of the joint and >spurs begining to show at the other side. My doctor (new doctor) said >there was sclerosis of the bone present also. When I compare my hands >to each other the one with the thumb problem looks as though the >thumb is shifted in position toward the arm. Also one of the small >bones of the wrist near the thumb seems to protrude more on the palm >side of the hand when the wrist is bent backwards to it's extreme. >< I have a few theories about what is happening in your thumbs and wrists, David. It may not be terribly good news for you. First, go to a library and look at an anatomical drawing of the wrist. Find the transverse ligament, also known as the flexor retinaculum. It is located under the palmar portion of the extensor retinaculum. You should be able to see from the drawings that the flexor retinaculum attaches to the tissues at the base of the little finger and also to the trapezium bone (part of the wrist) which shares the joint with the first thumb bone. Also attaching to the flexor retinaculum are many of the fibers that form the fleshy pad at the base of the thumb. I believe that the role of the flexor retinaculum is to stabilize the bones of the wrist. Basically, the wrist bones form an arc that is closed by the flexor retinaculum. When this tissue is cut during carpal tunnel surgery, I believe that it leaves the opportunity for the wrist bones to start migrating. To test this theory, I checked with several of my Hellerwork clients who are medical doctors (anesthesiologists). They said that there are more and more cases of unstable wrists showing up and there is not much that can be done to help restabilize them. I think that the migration of the wrist bones that is happening in David's hand is due to this phenomenon. Also, if the flexor retinaculum is cut, it would make sense that the portions of the thumb muscle that attach to this tissue will now be unattached to anything (other than the free-floating portion of the cut tissue). With this situation, these tissues cannot be expected to work and I would suspect that they just become non-functional and atrophied over time. The remaining muscle tissue at the base of the thumb looks as if its function is to pull the thumb toward the palm because the fibers go straight down the thumb and into the wrist. If these are the only functional tissues left in the thumb, it would follow that the thumb would begin migrating toward the wrist, narrowing the joint space there. These occurances in the wrist post-CTS surgery might account for the 57% of carpal tunnel surgery patients considering their surgeries to have been unsuccessful after five years. This statistic is from the Journal of the American Medical Assoc., January, 1992 issue. Like I said at the beginning, these are my theories alone. I just remember my shock and dismay when I went to my first medical meeting on carpal tunnel surgery and saw what they actually cut. At the time, I couldn't imagine how it could ever have long-lasting results so I am very happy for those who have had the surgery and feel that they have benefited. The last point I'd like to make is that if you have had surgery, then it is even more important that you practice some form of consistent stretching to keep the joint spaces and wrist tissues as loose and fluid as you can. Restriction in these tissues over time may start pulling the bones out of alignment or limiting the range of motion of the wrist. Sharon Butler, Author: "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" "Book of the Month" at: http://web-star.com/alternative/books.html ====================================================================== Date: Thu, 12 Apr 2001 23:46:01 EDT From: Sharon Butler Subject: Re: What are the best ulnar nerve glides??? Dear Steve and others with ulnar nerve problems, In a huge majority of my clients with ulnar nerve adhesions I have discovered that the nerve seems to get stuck to the base of the triceps, just above the elbow (tip of the bone). The triceps in that area is a broad, flat tendon made up of dense, non-stretchy fascia. The ulnar nerve passes right along side of this tendon. When stress is present in the area (from muscle contraction, static positions with the elbow bent, constant carrying of objects with the elbow bent, etc.), the nerve seems to have more opportunity to get stuck to this structure. This means that if your ulnar nerve is stuck in this fashion, every time you bend your elbow the nerve gets more and more irritated because it is being tugged but it can't slide along its pathway. Here is one suggestion that you might find helpful: Let's assume that your nerve is affected in your right arm. Place your bent right arm across the front of your body. Place your left hand over your elbow area and wrap your fingers around your arm to the back of your arm, in the area just above the tip of your elbow. Press your fingertips firmly into this area and while pressing, slowly straighten and bend your arm. This places pressure on the tendonous area that may be the site of the nerve adhesions and the motion of your arm encourages the tissues to become less stuck. This little technique may not solve all of your nerve symptoms, but it often does make a considerable difference for the people I am treating for this problem. It might be necessary for you to repeat this process 2 or 3 times a day until the symptoms diminish. Note that pressing into the tendon may be uncomfortable if the tendon is adhered. Remember to never do anything to your soft tissues that cause real pain. If you find you overdo this process, stop doing it for several days until the tissue calms down. Then try again, only more gently. Remember, it does you absolutely no good whatsoever if you do something to the point where it creates lingering pain. I hope this helps! Let me know! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ====================================================================== Date: Wed, 23 May 2001 00:10:11 EDT From: Sharon Butler Subject: Re: Forearm strength In a message dated 5/21/01 1:49:12 AM, xxxxxxx writes: << When my forearm gets tired, I cramp up, specifically the muscles on the pinky side of my forearm. My forearms and arms in general are not as strong as they used to be. >> Dear Craig, I have found that many people who complain of this type of cramping and pain have a habit of tilting their hands toward their little fingers. People who use computers alot get into this habit because the keyboard encourages this sideways flex in the wrist. In my bodywork and RSI treatment practice I find that the muscles that travel along the ulna bone (leads from the elbow to the outside of the wrist) develop adhesions all along the bone. This inhibits proper function of the muscles in the area and they then feel as if they are weak. In fact, they are just stuck. You might be able to palpate this effect in your own forearms. Feel the bone and try to assess if the bone feels like bone-only or if the bone feels like it is covered with a thick layer of tissue over it. If so, your muscles are probably stuck to the ulna. To remedy this, grasp over the top of your forearm with your other hand so your fingertips cross the ulna bone and your thumb is on the underside of your forearm. Squeeze firmly. Now twist the affected forearm so the ulna with the stuck muscles slides and rolls under your squeezing fingertips. This is sort of like pulling the soft tissues away from the places where they are stuck and adhered. The next best thing to do is to break the habit of tilting your wrist toward your little finger. A good exercise is to tilt your wrist toward your thumb and while consciously maintaining the tilt, bend your wrist up and down slowly. It takes some concentration to keep your wrist tilted toward the thumb, but this has proven to be a great exercise for correcting this condition. I wouldn't recommend weights until you are certain there are no more adhesions present as this can complicate your recovery by adding extra strain to the area. Best to be gentle, conscious, and slow about restoring this tissue to its former strength and function. It will happen quicker than you think if you just take it one step at a time. All the best! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ====================================================================== Date: Sat, 9 Jun 2001 23:27:30 EDT From: Sharon Butler Subject: Re: time off to cure CTS ? In a message dated 6/7/01 11:14:27 PM, xxxxxxxx writes: << I am wondering if the carpal's tunnel heals itself when you completely avoid the cause of the problem for an extended period of time? >> In my experience, NO! I have found it is most important to be more proactive in your healing regimen. Long-time readers of this list know that I strongly encourage sufferers to get involved in gentle stretching. For carpal tunnel I have found that stretching the shoulders and armpits first can lead to faster healing. After they are looser, then start to stretch the forearms and hands. This could take several weeks to accomplish, so don't get discouraged. Therre are lots of great books on the market that have many helpful stretches for the shoulders, armpits, arms, wrists and hands. I suggest you start looking into purchasing one or more of them and start stretching right away. Just remember, the tissue you are stretching is DAMAGED. Treat it very gently and you will continue to see improvement. If you get too aggressive with it, you could experience a set-back. Best of luck in your recovery! Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ====================================================================== Date: Tue, 14 Aug 2001 00:14:22 EDT From: Sharon Butler Subject: Re: Can a nerve injury heal? In a message dated 8/13/01 11:13:06 PM, xxxxxxx writes: << But I'm still wondering: Once there is injury or compression done to a nerve, if the person changes his/her repetitive movements , can the damage done to the nerve ever heal? Will the person ever be able to return to a pain free existence? Will I always have to wear an elbow brace at night? >> I work on people all the time with nerve pain/involvement/impingement. I have even suffered those injuries myself. While treating nerve problems that occur specifically at the elbow can be tricky since it's so hard to work on the bumpy terrain of the elbow, I have not failed yet in providing virtually complete relief for these people (and myself!), provided they followed through with the program I developed for them. Changing movement patterns is not nearly enough, however. You are experiencing your symptoms because the nerves are adhered to the bone or other surrounding tissues in the elbow region. Only by releasing those adhesions can you find lasting relief from your symptoms. Release of the adhesions occurs through direct manipulation of the adhesions, provided your therapist is talented enough to be able to feel them (It took me years of searching to find the source of the problem. Adhesions at the elbow often feel just like the bone they are stuck to...And I am a soft tissue specialist with 15 years experience!). Release of the adhesions can also occur through a very slow and careful set of stretches that need to be customized to your personal case history, movement patterns and based on physical examination of the affected tissues (from your neck to your waist, from your shoulder to your fingertips). What is a good beginner's stretch for one person may turn out to be a more advanced stretch for another person, not to be used at the beginning of a recovery program. Each and every person's case is different. I know finding a talented and qualified therapist is difficult, but keep at it. Elbow surgery is virtually never a good option, in my humble opinion. Best of luck in your recovery, Sharon J. Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ====================================================================== Date: Fri, 21 Sep 2001 00:33:59 EDT From: Sharon Butler Subject: Re: what is myofacial release? In a message dated 9/20/01 2:56:20 AM, kevin m writes: << The person who coined the term, though who didn't copywrite it was Dr. Janet Travell. She was the author of a two volume set called Myofascial pain and dysfunction: The Trigger Point manual. >> Actually, I believe the first person to recognize and study the effects that restriction in the myofascial network has on the body was Dr. Ida Rolf, the originator of Rolfing. Her work with myofascia began in 1958. Dr. Rolf recognized the effect of restriction on the body's alignment within the field of gravity and began the whole field of structural integration out of that initial research. As I understand it, all work related to myofascial tissue came after she made her first discoveries. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! ====================================================================== Date: Tue, 4 Dec 2001 17:37:54 EST From: Sharon Butler Subject: Re: mouth rolfing? In a message dated 12/4/01 9:20:20 AM, xxxxxxx writes: << Internal Mouth rolfing? Why would any rolfer do that? Is it painful? No need to answer this if it's too personal. >> I just had to respond to this question. Hellerworkers (which is the training I have) and Rolfers are trained in working the soft tissues inside the mouth and nose. These are areas where incredible amounts of stress are held and the resulting changes this creates in the soft tissues of the head and neck are substantial. Every dental procedure you have ever had resulted in some changes to the soft tissues in the gums and muscles that support the function of the mouth and jaw. Our faces become wrinkled over time due to the chronic tension we hold in our facial muscles. Releasing these tissues helps create a more youthful, relaxed appearance and function. Sinus headaches are increasingly prevalent in our world today and this creates internal tension in the sinus cavities. The soft tissue structures inside the nose are continuous with tissues that extend into the head and divide the hemispheres of the brain, affect the soft palate that then connects to the deepest structures of the neck, etc., etc. I know it sounds really weird to think of someone working inside your mouth and nose. Let me just share, as a recipient of many, many of these sessions, that they can bring incredible relief, a sense of freedom, actual changes in wrinkling, release of tension in the jaw, neck, sinuses, relief from tooth grinding, the list is endless. I actually do this work on myself occasionally if someone is not available to perform it on me. If you get the chance to receive this work, I suggest you try it, no matter how weird it seems. At the very least, you will experience change in your body in a way that no other work could accomplish. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! Coming soon: www.selfcaresuccess.com to assist you with your self-care needs. ====================================================================== Date: Sat, 15 Dec 2001 15:47:25 EST From: Sharon Butler Subject: Re: Reiki and/or muscular therapy In a message dated 12/13/01 8:02:41 PM, perkins writes: << Are Reiki and Muscular Therapy helpful when it comes to RSI? If y'all had to choose among the following: a. Rolfing b. Reiki c. Muscular Therapy Which would y'all find the most effective when it comes to RSI? I really need to know.....please... >> In my opinion, Rolfing, or Hellerwork, are the best choices. I also have training in massage therapy and Reiki and can make a few comments about them here. Massage therapy (muscle therapy) works to push stale, poorly oxygenated blood out of the tissues, allowing newer, more oxygenated blood to take its place. The extra oxygen in the blood helps muscle fibers relax. So, this can have some value, but I do not believe that it will do anything other than assist in helping relieve sysmptoms. It will not help to eliminate the cause of the pain. Of course, there are all sorts of muscle therapy and some therapists may work on the tissue in a way that helps release the adhesions which are more likely the cause of the pain and dysfunction. But this is the exception, not the rule in muscle therapy. Reiki is a technique which helps balance the energy of an injured site. Reiki recognizes that pain and dysfunction usually go hand-in-hand with a disruption in the energy flow through the affected area. Reiki helps to restore that energy flow. This is also a good thing, but will give temporary, or less significant relief, and also does not address the cause of the pain and dysfunction. Most people, by the time they reach adulthood, have developed some rather significant structural shifts in their bodies. You can recognize this in a person who has one shoulder higher than the other, chronic neck and/or shoulder pain, feet that point out rather than straight ahead, improperly balanced knees, stiff hips, low back pain, etc., etc. While all of these conditions come with troubling symptoms, the underlying thing that is happening in all these bodies is that the connective tissue support system, primarily the fascia, undergoes shifts and chemical changes in response to the chronic patterns of imbalance that have been adopted by the body. Because fascia and other forms of connective tissue are one big continuous system throughout the body, a shift in one area will affect everything else. You can get a sense of what this feels like by imagining how it might feel to put a knee-high sock on backwards, with the heel on top of your foot and the leg portion twisting around so that the leg portion is in its proper place. For most people it would feel like the leg wants to twist in the direction that the sock is twisting. The same thing happens in a human body when the fascia becomes twisted, adhered, thickened, or imbalanced in some other way. Now, when you take a body that is experiencing this sort of fascial compromise and give it a job where the affected body part has to move in a repetitive way, then that body will most likely form a repetitive strain injury at some point in the future. How fast the RSI develops is a function of how repetitive the work is, how affected the tissue is, if nerves or blood vessels are stuck in the adhesions, etc. etc. Rolfers and Hellerworkers (and graduates of some other Structural Integration schools) are the only kinds of therapists who have received extensive training (850+ hours for Rolfers, 1250+ hours for Hellerworkers) in how to eliminate adhesions, restore optimum muscle function, retrain the body to move properly, while eliminating the source of the pain and dysfunction that has taken years to develop. They accomplish this by restoring the fascia to its optimum state, so it functions like a body that has never had an injury. I hope this explanation helps you to make a more informed choice in your RSI treatment. Sharon Butler, Certified Hellerwork Practitioner Author, "Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program" Check out the reviews on Amazon.com!!! Coming soon: SelfCareSuccess.com A site to help you achieve recovery through your own self care! ======================================================================