Wrist pain and TMS

If you'd like to hear more about the treatments described in the previous post, there are a number of good sites out there devoted to John Sarno's theories about Tension Myositis Syndrome. Here are just a few of my favorites:

tms wiki
tmsrecovery.com
tarpityoga
Rachel's RSI homage
Dr. Sarno's website

In the meantime, keep in mind that a large part of the treatment he recommends lies in truly believing that you are fundamentally o.k. - and that there is nothing "structurally" or physically wrong with you. If you feel pain, try not to focus on it. Think instead of the emotional anger or frustration that may be contributing to it, and try to own that frustration. It may be a stretch for some, but a lot of people with carpal tunnel syndrome or other RSI's have experienced partial or complete relief by doing this. Rachel's RSI homage has some great testimonials.

There's also a fair amount of independent evidence that the brain can in fact be trained to increase or decrease the amount of pain you experience. This study by Sean Mackey, a Stanford University pain expert, used MRI brain scans to show that focusing on pain increased it, whereas focusing the attention elsewhere could decrease or even eliminate the sensation of pain.

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Carpal Tunnel Syndrome and Dr. John Sarno's Mindbody Medicine

Whether you have Carpal Tunnel Syndrome, tendonitis or repetitive strain injury, there are a million people out there who will give you advice about how to deal with your pain. But before you continue to treat your wrist pain, I highly recommend you check out Dr. John Sarno's book The Divided Mind: The Epidemic of Mindbody Disorders. Dr. Sarno argues that many of the conditions often associated with fibromyalgia, carpal tunnel syndrome or back pain are actually caused by various forms of emotional repression. I know it may sound Freudian at first, but there's a lot of evidence to back up his claims. Here's his theory.

Scientists and doctors are starting to come around to the fact that the mind and body are not separate entities but part of the same system. And when you think about it, this mind/body connection makes a lot of sense. If your brain can process cues from your body - registering pain, fatigue, and temperature changes - why can't your body be affected by your mind? For example, you've probably noticed that your muscles tense up when you're feeling nervous. When you're embarrassed, you might blush. Both of these situations are widely accepted examples of purely emotional reactions being displayed as physical (bodily) phenomena.

Dr. Sarno spent years treating patients with chronic back pain. After a while he began to notice common personality types among his patients. Many of them were perfectionists and chronic do-gooders. They tried hard to please others, and when they failed they often blamed themselves harshly. To make a long story short, Sarno hypothesized that many of these people were repressing feelings of anger and frustration that were harmful to their good self-image. When he made them aware of these feelings, many of his patients experienced immediate relief from their painful symptoms.

This does not mean that their symptoms were imaginary. In all of his writings, Sarno adamantly makes a distinction between real physical pain which is caused by emotions, and "psychosomatic" pain that is merely imagined, or "all in your head." Studies of most of the patients he diagnosed with this condition, which he called "Tension Myositis Syndrome" or TMS, showed one common physical characteristic: decreased blood flow to the areas where they experienced pain. His theory is that this decrease was the mind's attempt to distract the patient from emotions that they did not want to recognize. He also noticed that the decrease occurred in areas of the body where the patient might reasonably expect to feel pain, generally in an area there had been a lot of buzz about in the media. For a long time it was back pain. Then, when Carpal Tunnel Syndrome became a widespread source of attention, more and more people started showing up with pain in their wrists. Coincidence?

Again, this does not mean that these people's pain was "all in their heads." It was very, very real, and was caused by decreased blood flow to their wrists. Other independent studies have shown that decreased blood flow can cause both pain and temporary structural damage to muscle fibers. This study on "Overuse Syndrome," which was cited in the Google blog's entry on carpal tunnel syndrome, is one such example. In keeping with this, Sarno noticed that most of his patients found relief from treatments that increased circulation, such as heat and massage, and none had lasting structural damage once the source of their problem was addressed.

Now I'm not a sucker for self-help books, but I really think there may be some truth to this. What finally sold me was that a group of high achieving Harvard students managed to heal their carpal tunnel syndrome just by following the suggestions in his book. They started a website to document this amazing event, called Harvard RSI Action. It's very worth a read.

I'll be posting more on this later, but for now I highly suggest you keep an open mind to these theories, especially if you've experienced other symptoms associated with TMS, such as back pain, leg pain or stomach problems. Here's an interview with Sarno, just to give you a quick idea of where he's coming from.

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Carpal Tunnel Syndrome and Neck Pain

One of my biggest problems with the standard medical treatments for Carpal Tunnel Syndrome is that, like most western remedies, they treat the symptoms rather than the cause. Let's say you're having pain in your wrists. You go to the doctor and they suggest that your problem is compression of the Median Nerve, the primary "cause" of CTS. But your median nerve doesn't just appear in your wrist and disappear when it hits your elbow. No, it travels all the way past your elbow, up to your shoulders, your neck and (surprise!) your SPINE.

Everyone knows that poor sitting posture contributes CTS, but doctors - especially wrist and hand specialists - rarely ask you how your back and neck is feeling when you tell them your wrists hurt. This is a big mistake on their part. Throwing ibuprofen at the problem won't help you if the muscle tension and poor posture that are causing your pain continue to go untreated.

There's a great post on this issue at Dr. Davis' Back and Neck Blog, which recommends seeing someone with chiropractic experience in the upper spinal regions. My recommendation? Stretch your neck! I'm no doctor, but I know from experience that this can help immensely.

My Favorite Neck Stretches for Wrist Pain

Performing regular neck stretches has been a lifesaver for me. Here is my #1 all time favorite carpal tunnel relieving exercise, which I can reel working all the way down to my fingertips. I highly recommend it.

1. Hold your right arm behind your back, pulling down gently with your left hand. Tilt your head to the left from the crown up, keeping your face and gaze forward, until you feel a stretch in the side of your neck. Hold for 30 seconds.







2. Hold your right arm behind your back, pulling down gently with your left hand.This time, turn your head and face sideways, so that you are looking off to your left. Hold for 30 seconds, switch arms, repeat.

3. Below is another favorite stretch of mine, which is pretty much self explanatory. I especially like the second triceps stretch, since for me the pain often travels all the way up my arms.

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Alleviate wrist pain with Voice Recognition Software

There are a lot of voice recognition programs out there, but Dragon NaturallySpeaking 10 is by far the best. The Mac version is MacSpeech Dictate, and is basically the same program. It's good too, in fact I'm using it right now! Don't bother with any older or cheeper programs - they don't work. If you want to type without using your hands, get one of these two programs and a decent microphone, and you'll be good to go.


Read reviews of these programs here.

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Self-Test for Carpal Tunnel Syndrome

Before you begin to treat the pain in your wrists, you should know the answer to the following question: Do you have carpal tunnel syndrome, or a different repetitive strain injury? The following is an excerpt from "3 Minutes to a Pain-Free Life," By Dr Joseph Weisberg & Heidi Shink, which you can read online here.












This is the test the doctor gave me, and it seems to be pretty well accepted. REMEMBER: IF YOU DON'T HAVE CARPAL TUNNEL SYNDROME, your pain is still real! Don't let doctors or friends dismiss it. Other RSI's (Repetetive Strain Injuries) can be just as debilitating. Read more about RSI's here.

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Wrist Exercises for Carpal Tunnel and Tendonitis

This video, of lifehacker fame, demonstrates some excellent and highly effective wrist exercises for carpal tunnel and tendonitis. I do them every day now, and I've definitely had some relief. Check it out!



Note: do these several times a day, especially before you type!

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My Life with Carpal Tunnel Syndrome and RSI: A Brief History

The Symptoms

Several years ago I was working full time as a freelance writer and administrative assistant at a small nonprofit organization. I was on the computer from 9-5 every day, and often got back on it in the evenings. I wasn't typing all the time. Sometimes I was just surfing the internet, using a mouse, or editing things I'd already written. But over time these activities started to take their toll.

It started in my right hand. I'd notice a slight tingling sensation in the back of my wrist, which gradually spread to my hand and fingers. Foolishly, I ignored it.

Several months later, I was firmly convinced that I had carpal tunnel syndrome. My wrists hurt all the time, sometimes when I wasn't even typing. When I did have to type or use a mouse, the pain was unbearable. I tried to push through it, but this only led to my fingers going numb. My grip strength decreased. My elbows and shoulders started to hurt. I started to feel pain just thinking about typing. I was afraid I'd have to quit my job.

Dorsal wrist syndrome and the nebulous RSI

Going to the doctor was not at all helpful. The first person I saw said I'd have to get expensive nerve imaging tests before she could recommend me for physical therapy. On top of that, she said there was no treatment for carpal tunnel syndrome except ibuprofen and surgery (this is not true). A second doctor decided that I did not have carpal tunnel syndrome but rather something he called "dorsal wrist syndrome." When I asked him what this meant, he said "dorsal means back. It means you have pain on the back of your wrists." A lot of people think it's comforting to name the problem, and they're probably right. But as names go, this one left me pretty hopeless. All I knew was that I had a repetitive strain injury, or RSI, which is caused by performing the same small muscle movements day after day. RSI is a broad category that covers a variety of problems, including tendinitis and carpal tunnel syndrome.

Wrist RSI's and cortisone shots

Clearly, this doctor had no real ideas about what was wrong with me, and my insurance wouldn't cover any of the tests he recommended. Still, despite his lack of knowledge about my condition, he went ahead and suggested cortisone shots. Cortisone is a steroid that reduces inflammation and, if applied correctly, can diminish the pain associated with RSIs. Frustrated and in pain, I agreed to try it. After several weeks and several hundred dollars, there was no improvement in my wrists.

Doctors and the over-medication of America

Looking back on the situation, I'm shocked that this doctor even offered me the cortisone injections. He had no idea what exactly was wrong with me, and didn't know where the pain was originating. Cortisone only works if it's injected into the exact area that is inflamed. Since all he knew was that the dorsal side of my wrists hurt, there was very little chance of success.

Unfortunately, doctors get paid and not by the hour, but by the treatment. This is a huge problem in our health care system. Basically, if a doctor recommends you for surgery or some other expensive treatment, he or she makes more money. With this kind of dollar incentive, it's not surprising that doctors recommend surgery for conditions that often heal on their own.

If you have carpal tunnel syndrome or another wrist RSI, I would not put too much faith in doctors or specialists, at least not unless you have a long-standing relationship with them or some seriously good health insurance. The fact is, there's very little they can do for you. Cortisone injections have mild success, but only if the problem is inflammation. With most RSIs, there's a lot more going on than that. Physical therapy can be helpful, but most of the techniques, stretches and exercises you learn there can easily be learned on your own.

Surgery for carpal tunnel syndrome

Don't do it! Full recovery from this procedure takes months, and the surgery itself can result in nerve or muscle damage. also, there is some debate as to whether it is more effective than just waiting it out. Our bodies to have the capacity to heal themselves It, and slicing through ligaments to give your nerves more room (that's what most surgery entails) is a lot like trading one problem for another.

Carpal Tunnel vs. RSI

I do not have carpal tunnel syndrome, but whenever I have is a lot alike it. I still can't type for long periods of time. When I do I have to use a special keyboard, an ergonomic mouse, and sit in the best possible position at all times. Mostly I just use voice recognition software. I'll tell you more about these methods in subsequent posts, but for now, I simply want to point out that even if you don't have carpal tunnel syndrome, your symptoms can be very real. Carpal tunnel has become the buzzword of the condition, but the majority of wrist RSIs are not actually carpel syndrome. this is very important to remember. A doctor may tell you, after a series of tests, that you do not have carpal tunnel syndrome, and send you on your way. I know from experience that this can be very frustrating. However, whether or not you have it is not the issue. The issue is what it does to you and how you can treat it, and with the exception of surgery, the same treatments apply.

Best treatments for wrist RSI and carpal tunnel syndrome

This is essentially the subject of this blog, so at the moment I'm going to be as general as possible. Details will follow.

1. Ergonomics

2. Rest

3. Heat and Ice

4. Stretching

5. Good attitude

6. Exercise

7. Massage

8. Acupuncture

9. Ibuprofen

10. Vitamins and supplements

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