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Carpal Tunnel – or a pinched hose?

Physiotherapy Case Study

Carpal Tunnel

A 28 year old individual came into the clinic with right sided dull forearm pain, tingling with pins and needles into the hand. The pain started without any cause and has just gotten worse over the last two months. It also seems that the hand is worse at night and in the morning.

They have started having difficulty holding heavy pots and pans, and opening tight jars – which they don’t recall having difficulty with before.

 

Although there are many reasons why someone may have pain in the forearm, wrist, and hand, let’s go through some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

 

What causes carpal tunnel?
To have a true Carpal Tunnel Syndrome, the issue is specifically coming from the wrist – the tunnel in which one of the nerves (the median nerve – see above) of the arm goes through and into the hand. More often than not, there will be other contributing factors to wrist and hand pain!

The median nerve is the culprit in Carpal Tunnel Syndrome, and although there can be issues in only one spot causing problems, the nerve is kind of like a garden hose… the hose starts at the tap (the neck), and then runs to the end (the hand). You can lose pressure at the end of the hose by pinching it right at the end (hand symptoms), but you can also lose pressure by pinching it just a little bit on other points through the hose, ending up with the same reduced pressure (hand symptoms!)

So how can we determine what the contributing factors are? Some people will find that if they are looking one direction that their hand symptoms will get better or worse. Others will find that the chair that they are sitting in will seem to impact their symptoms.

If you have hand and forearm symptoms like pain, tingling, or numbness, a physical therapy assessment could benefit you!
What you may expect from this assessment is a postural assessment to look at your alignment, flexibility of the upper body muscles, mobility of the spine and neck, shoulders, elbows, and wrist, with an evaluation of how you move.

In many instances by the end of the assessment there is a clear driving factor to the pain and symptoms that can begin being addressed by home programming. This will put you in charge of feeling better, and not relying solely on having to come to the clinic to improve. Your therapist may provide you with a variety of homework items including stretching of muscles that are providing too much tension, strengthening of muscles that aren’t providing enough support, give exercises that will help the nerves slide and glide, and to help the joints move with more symmetry to restore balance.

A common question we are asked is how long until I’m better?

The recovery period will vary from client to client, depending on the severity and frequency of signs and symptoms, the duration of symptoms, the activity level the client is needing to maintain, and the commitment to their program. Typically, with a straightforward case we tend to see client’s 1x every 1 to 2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy to help restore joint, neural, and muscle mobility as well as progressing exercises for your home program to help you help yourself.

 

Treatment Results for our Case Study

This individual having experienced pain for a relatively short period of ended up having stiffness in the neck and the position of the head changed their symptoms quite a bit. Getting started with some stretches and movements to help the neck, shoulder, and forearm move better, was the first step along with some manual therapy in clinic. The client at the next appointment the following week had a significant improvement in symptoms and found the stretches very helpful with managing their pain. Treatment continued to progress and included range of motion, stretching, and strengthening. When the client came in for their last appointment (a short 5 weeks later!) they were pain free, and able to manage their symptoms quickly themselves if things started to get sore.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic. At Warman Physio clients are encouraged to bring their infants and children to treatment. Warman Physio has been nominated as a finalist for the 2018, 2017, & 2016 WMBEXA, is a WMBEXA award recipient of 2017 New Business Award, and a finalist in the ABEX 2018, 2017 & 2016, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, and has been nominated for the 2019 SABEX and WMBEXA Awards.
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Endo and Pelvic Floor Physio

March was Endometriosis Awareness month, and we have provided some information related to endo for everyone on our social media (Facebook and Instagram). If you are wondering what endometriosis looks like for someone living with it, you can check out the story we posted earlier in the month. As promised here are some of the things that Pelvic Floor Physiotherapy can do for you…

Pain Science

Physiotherapists that work with pelvic pain conditions, such as endometriosis, have additional training specific to the actual science behind pain. Having this knowledge to give to our clients allows us to de-mystify pain, help us understand pain perception, and why the symptoms are occurring. Globally with pain science, one of the most important things to understand are there are no pain signals to the brain. The brain receives information from the body, and depending on what all those signals are saying, will determine if something is painful or not. Have you ever stubbed your toe when you are having a great day? It hurts SO MUCH. But, if you stub your toe while you are in the middle of an argument with someone, it doesn’t hurt the same; that’s pain science!

Everyone has heard a story of someone being in an accident of some kind and being able to get to a hospital (or civilization) before feeling pain.

How does this apply to endo? Endometriosis is the presence of uterine-like tissue outside of the uterus, within the pelvic bowl and abdomen (generally). Endometrial tissue contracts during menses to shed the lining of the uterine wall. If this tissue is outside of the uterus… it still contracts on the tissue it is adhered to.

Which brings us to….

Assist muscle tension

If you have a muscle that is contracting and creating more tension over time, and you aren’t stretching it, eventually it becomes tighter. Have you tried stretching tight muscles? How about making them contract more?

Here is where we talk about what happens in a painful body – when we have abdominal and pelvic pain, we try and protect the area. This protection leads us to adopt a fetal position. Tightness develops in the abdominals, hip flexors, pelvic floor, and diaphragm, which plays into the pain cycle. Pelvic floor physiotherapists will work with each woman to obtain appropriate length, strength, and coordination of the muscles in the abdomen and pelvic bowl.

Tight muscles are often painful muscles.

Provide self-assistance tools

We are here to help you, help yourself. Giving you tools to reduce pain for between episodes, things to try during painful episodes, and ultimately manage your pain.

Some things that could be helpful include: stretching your hip flexors, deep breathing, yoga, meditation, using a wheat bag, and releasing muscles using an acupressure ball (or tennis ball).

 

Endometriosis can’t be cured by physiotherapy, but the symptoms can be managed. Contact us today to see how we can help you, or use the Book Now section to schedule your assessment today, and take control.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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What YOU want to know about the Pelvic Floor: Part 1

Q: How do I know if I should see someone?

A: There are many different signs or symptoms that children, women and men can watch for to know if they should be seeing a pelvic floor therapist. Some of the big things to think about include:

  • leaking (urine or feces)
  • urgency and frequency (many trips to the bathroom, or getting to the bathroom and voiding small amounts)
  • pain with intercourse
  • pressure in the pelvic floor
  • feeling like things are falling down or falling out
  • needing to ‘lift’ the pelvic floor or ‘help down there’ to void the bladder or evacuate the bowel
  • inability to increase activity due to any symptoms
  • low back, pubic symphysis, hip or SIJ pain
  • recurring tightness of the hips and pelvis
  • you have been pregnant
  • you have delivered a baby (vaginally or via c-section)

… and this isn’t necessarily an exhaustive list, just the first things that come to mind for clientele that frequent the clinic. Essentially if you feel there is something that is ‘off’ or ‘wrong’ within the pelvic floor, abdomen or pelvis, seeing a pelvic floor therapist may be of benefit.

 

Q: Do you recommend that all women see a pelvic floor physio? Or just if they are “leaking”?

A: There are a great many symptoms that can be indicating factors for pelvic floor dysfunction that doesn’t have anything to do with leaking in particular. To answer this question in short: yes. In long, I would say that many women would benefit from a pelvic floor assessment regardless of their “leaking” status, especially for women who have had children, or anyone who experiences pain with intercourse.

A big reason for the general answer of “yes” is the fact that what we know about pelvic floor is not necessarily functional working knowledge. Rather, most women ‘know’ they are supposed to do ‘kegels’, and yet no one has taken the time to explain or ensure that they are being done correctly. What we know about kegels is that they are meant to strengthen the pelvic floor, and most women describe that they imagine SQUEEZING the pelvic floor. As my clients know, the pelvic floor to work functionally needs to LIFT UP and IN, not squeeze, as well as RELAX down and out.

Just because you aren’t leaking, doesn’t necessarily mean that the pelvic floor is functioning well. Just the same as even though many people do not have knee pain, they often have weakness or tightness that could be addressed to prevent issues arising in the future.

 

Q: When do you recommend women be seen? During pregnancy? Post-partum?

A: Women can and should be seen whenever they are having issues. Issues are bound to arise during pregnancy and post-partum. So long as there aren’t any contraindications to a pelvic floor exam by the treating physician or OB, assessment during pregnancy is possible as well (after the first trimester). During pregnancy some women will choose to attend an assessment for labor and delivery preparation after 32 weeks gestation to help get a better handle on relaxing the pelvic floor; we do want a baby to come down and out after all!

Post-partum we are able to see women that are painful as soon as they feel up for leaving the house, and specific for pelvic floor assessment approximately 6-8 weeks post-partum. Pelvic Floor Therapy is able to address c-section healing and recovery, as well as perineal healing and recovery. Tearing, surgical incisions, other birth traumas can all be addressed in the post-partum phase.

Q: What if I haven’t had children in a few years but am experiencing problems? Can physio still help?

A: YES YES YES! The absolute best thing about the body is it’s propensity to change. It is never too late to see a pelvic floor physio, 8 weeks, 8 months, 8 years or longer we can always see what changes can be made to help resolve any complaint

Q: What are some signs of a weak pelvic floor?

A: The simple answer for this one is leaking or incontinence. The long answer is – it depends on whether it is loose and weak (not very common) or tight and weak (much more common). Often we equate something being tight or taught with being strong, but this is definitely not the case with the pelvic floor. A tight but weak pelvic floor often progresses through one or a combination of: discomfort or pain with intercourse, constipation or difficulty completely emptying the bowels, discomfort or bruised feeling through the perineum or tail bone, hip tightness and restricted movement, low back pain… and more. One client had neck pain (right by the shoulders) that she had had since her second was born (5 years previous) and nothing seemed to help. Ultimately this client had pelvic floor weakness that was driving her neck pain!

Do you know someone having issues with this area? Maybe they have some of the complaints listed above – share with them! Are YOU someone suffering with these symptoms? Contact us today to get started your path to resolution!

Do you have some BURNING questions you want answered that wasn’t covered? Send them our way and we will get them going in Part 2!

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.
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Is your NECK causing your arm or shoulder Pain?

Case Study: A client HD came to the clinic after several weeks of shoulder, shoulder blade and arm pain. This pain started in the shoulder and moved down the arm. The client would describe the pain as ‘sharp’, ‘burning’, ‘shooting’, ‘deep achy’, and ‘pins and needles’ depending on what they did. Initially their pain would come and go, but over time the pain would stay for longer periods of time. This client found that sometimes anti-inflammatory medication and massage helped, but it always came back. Since their pain started in their shoulder it was believed that it was a shoulder injury (rotator cuff). After assessment by a physiotherapist it was identified that HD had issues from the neck resulting in shoulder and arm pain. With treatment including home exercises, stretches and programming, the client was able to return to full function and a pain-free state of being!

neck-pain

The story of HD is not uncommon. Often people are not sure where to go for a variety of issues and complaints. Your local Warman Physio is able to provide assessment and treatment of any ache or pain occurring within the body, whether it was caused by an injury or ‘just showed up’ one day.

Physiotherapists are trained to provide assessment and treatment of all the body systems including the muscles, tendons, ligaments, and nervous system to identify what is causing any pain or issue.

Following is a list of conditions that Physiotherapists can help with in the neck and arm:

  • Disc bulges in the neck
    • often causes pain as is outlined in the image above with the red highlighted areas depending on the level the bulge is present
  • Nerve compression or irritation of nerves of the neck
    • pain down the arm with moving the head a particular direction like in shoulder checking
  • Carpal Tunnel syndrome
    • pain and tingling in the hand often upon waking from a night’s sleep to start
  • Rotator cuff injuries
    • pain in the shoulder often with reaching over head or behind the body
  • Tennis/Golfer’s elbow
    • pain on the outside/inside of the elbow often with lifting/carrying

 

How does the neck cause pain in the shoulder and arm?

The body is a complicated group of systems that work together to allow us to complete our everyday tasks. Our neck has 7 vertebra (C1-C7) that go from the base of the head to the base of the neck. Within your neck there are 2 joints at the top and bottom of each vertebra, and most of them are separated by small discs. Our spinal cord is enclosed inside a tunnel within the vertebra. The nerves that go down into the shoulder and arm come out from between the vertebra, through the muscles and down the arm. These nerves then control the muscles (creating movement) as well as sensation (touch, temperature, etc). If something happens to the nerve throughout it’s path down into the arm it can create issues in the movement, sensation, or both!Sometimes it is hard to figure out where pain is coming from – the muscles, joints, nerves, tendons (attach muscle to bone) or ligaments (attach bone to bone). Leave the guess work out of your pain and have it assessed by your local Warman Physio!

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