Best physiotherapy exercises for Carpal Tunnel Syndrome

If you’re experiencing a tingling, numbness or pain in one or both hands you may have a condition called Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome is quite common during pregnancy but it can affect anyone, at any age. It’s caused by compression of one of the nerves in your wrist and one of the key features is that your symptoms will have a clear ‘edge and aspect’. This means that symptoms will be located in a very specific part of your hand. So specific, in fact, that you could draw an imaginary line around it like this:

Pain and numbness felt in the hand with Carpal Tunnel Syndrome

It’s also likely that your symptoms are worse at night. You may wake up with a dead sensation in your hand or intense pins and needles and often hanging your arm over the edge of your bed and shaking it brings back the normal feeling. Activities that involve gripping may also trigger your symptoms and as time progresses you may find that your hand feels a bit weaker or clumsier during intricate tasks.

Self-test for Carpal Tunnel Syndrome

Bend your wrists and stay in this position for 3 minutes.

Physiotherapist demonstrating the test for Carpal Tunnel Syndrome

If this test brings on your symptoms within 1-2 minutes, then it’s likely that you have Carpal Tunnel Syndrome.

How to relieve Carpal Tunnel Syndrome

Here are our four top tips for relieving the symptoms of Carpal Tunnel Syndrome:

1. Stretch out your wrist muscles: 

Wrist stretch for Carpal Tunnel SyndromeWith your elbow straight, bend your wrist back and use your other hand to gently help stretch. Hold for 15 – 30 seconds and repeat 3 times.

2. Stretch your thumb muscles:

Thumb stretch for carpal tunnel syndrome

With your elbow straight, take hold of your thumb and gently draw it back to increase the stretch. Hold for 15 – 30 seconds and repeat 3 times.

3. Glide the nerve as it travels from your neck to your wrist:

Nerve flossing for carpal tunnel syndrome

Make a fist and bend your wrist towards your shoulder on your bad side, side bend your head away. Then press your palm away and bend your head towards the bad side. Move within a comfort zone and repeat 15 times.

Tips: you might want to start with a slightly smaller range of movement and build up.

4. Wear a wrist splint at night:

hand splint for carpal tunnel syndrome

Put your splint on before you go to bed and wear it through the night for 2 weeks.  It can also be worn during the day for short periods if you are unable to avoid doing an activity that normally brings on your symptoms. Look for a splint which contains a shaped metal bar sitting along the palm side of your hand and forearm.

Other treatment options for Carpal Tunnel Syndrome

Your GP might recommend a steroid injection to reduce swelling and relieve compression on the nerve. It can give good short term relief of your symptoms but it’s vital that any underlying causes are addressed to prevent the condition from coming back.

If treatment hasn’t been effective, your GP can refer you for tests to see how fast your nerves are able to send electricals signal from one part to another (nerve conduction testing). If these tests show that your nerves are not working quickly enough you may be offered surgery to release the pressure at your wrist.

Although it is possible to have carpal tunnel in both hands at the same time it’s unusual. If you are experiencing your symptoms in both hands the problem may actually be coming from your neck. Either way we’d recommend a physical assessment with your GP or a physiotherapist.

If you think you might be suffering from Carpal Tunnel Syndrome and you’d like to speak to someone about your symptoms, please don’t hesitate to give us a call.

The Physiofit Team!


Best advice for neck pain

Patient with neck pain stretching at work.

Neck pain is really common and most people will experience at least one episode at some point in their life.

It’s often something really simple that triggers the pain like carrying something heavy, sleeping awkwardly or spending your day driving or hunched over a computer.

Your neck muscles are also frequently affected by the way you are feeling. Periods of stress and anxiety cause muscle tension, which in turn can lead to pain.

Most of the time, neck pain is not a sign of any serious injury and it generally gets better in a matter of weeks.

First aid for neck pain

Keep your neck on the move - gentle movement helps your body heal and prevents other joints and muscles around the painful part of your neck from becoming weak, stiff and painful too. Stay within a comfort zone and move your neck in all directions, little and often. If you work at a desk, get up and move around frequently during the day. Don’t wait until your neck feels uncomfortable before stretching, it’s far less effective this way.

Heat pack– placing a wheat bag or hot water bottle around your neck for 10- 15 minutes wil relax tight, sore muscles. This usually gives some temporary relief from pain, so afterwards it’s the ideal time to work on your neck movements.

Painkillers and anti-inflammatories – taking regular medication will allow you to move your neck more normally. This will help to speed up your recovery and prevent other areas of your body from compensating. Have a chat with your GP or pharmacist if you have any questions about which medication would work best for you.

Shaped pillow – If your sleep is affected by your neck pain, try rolling up a hand towel lengthways and place it in a pair of tights to hold the shape. Slide the roll into your pillow case along the bottom edge so that when you place your head on the pillow the rolled towel supports your neck.

Breathing exercises – if stress or anxiety are triggers for your neck pain then breathing exercises are a great way to relieve neck symptoms:

  • Lie down somewhere comfortable and quiet.
  • Place one hand on your abdomen and one hand on your breastbone.
  • Inhale and imagine your abdomen filling with air like a balloon. Your lower hand should rise while your top hand remains still.
  • Make a smooth transition to the next breath without pausing.
  • Allow the breath to exit your body without effort - imagine your lower hand sinking through your body towards the floor. This will help you exhale fully.
  • Count to keep to each breathe long and even – 5 seconds in and 5 seconds out.

Tips: If you can breathe in through your nose as this adds greater resistance and slows the breath down. Practice twice a day for 5 mins.

Better posture – draw your shoulders back gently and imagine an invisible cord pulling you up from the crown of your skull, so the back of your neck lengthens and your chin drops in slightly towards your throat. An ergonomic assessment might be helpful to support better posture at work.

Gentle massage – gently working into the muscles around your neck and upper shoulders can also help to warm up and relax your muscles before trying to get your neck moving.

We offer a range of treatments for neck pain and send out all our exercise programmes with video links so you can be confident you’re doing them correctly.

If you think we might be able to help, don’t hesitate to get in touch.

The Physiofit Team!


Exercises for relieving sciatic pain from piriformis syndrome

Sciatica - piriformis syndrome treatment

Sciatica or piriformis syndrome?

So you think you’ve got sciatica (trapped nerves)? If you’ve got pain in one of your buttocks, down back of your thigh and maybe even symptoms into your calf or foot then this might well be the case.

The sciatic nerve is formed by lots of smaller nerves coming together from your spine and travelling in a bundle down the back of your leg.

Sciatica’ is the term given to pain caused by compression or irritation of this nerve. In most cases this is due to a problem with one of the discs in your lower back but there also are two small muscles in your pelvis called the piriformis muscles and if one of them is tight, strained or goes into spasm then this can also compress the sciatic nerve. The symptoms of this ‘piriformis syndrome’ are so similar to a trapped nerve in your back that it’s actually called a false sciatica.

The Piriformis muscles help to control the hip joint during movement of the legs and sometimes they can become overworked when other muscles (such as the gluteals) are weak. Sitting, walking upstairs or an incline or stretching the buttock (pulling your knee into your chest) might become gradually more painful if you have piriformis syndrome. While these activities can also be problematic if you have ‘true’ sciatica, there are a couple of distinguishing features. If your pain increases when you cough, sneeze or strain then it is likely the problem is coming from your lower back; but if coughing doesn’t affect you, then it could be piriformis syndrome. You could try these two tests which are usually painful with this specific condition:

Test 1: Lie on your side and bend your hip to just below 90 degrees. Let your knee drop down and press gently with your hand.

Test for piriformis syndrome

Test 2: Sit in a chair with a band tied around your knees and press your knees outwards into the band.

Test for piriformis syndrome - sciatic pain

If either of these tests are painful, you might have Piriformis Syndrome.

Self help for piriformis pain

  1. Avoid sitting on hard surfaces or with your legs crossed and get up to move every 20 minutes.
  2. Heat can be helpful - try lying on your front with a hot water bottle on your buttock.
  3. Release your piriformis muscles with a massage ball:

 

Piriformis treatment with a spiked ball

Roll for up to 1 minute and if you find a sore spot, hold for 10 seconds until you feel it relax. Start with light pressure and build up as it feels more and more comfortable. It’s not pain-free but shouldn’t be an endurance test either.

  1. Stretch your hips:

 

Stretch your hips to relieve sciatic pain - piriformis syndrome

Start on all fours and move your knee towards your hands. Slide your heel across until it’s under the opposite thigh. Finally slide your other leg back along the floor and lean over the top to stretch your hips. Hold for 30 seconds and repeat 3 times

  1. Check the position of your pelvis and lower back in a mirror. If you have a deep inward curve of your lower back this means that your buttock muscles can’t work properly and your piriformis muscles are also overstretched.

 

Correct your posture to relieve sciatica - piriformis pain

Correct your posture by pulling your tailbone right underneath (tilting your pelvis backwards to flatten your lower back), then press it out behind you (tilting your pelvis forwards to arch your lower back). Find the halfway point and hold this ‘neutral’ position. It might feel a bit odd to begin with as your muscles and joints aren’t used to this new position but keep practising and your body will soon develop its muscle memory!

  1. Strengthen your buttock muscles. While you still have symptoms in your buttock you’ll need to increase the number of repetitions gradually – try 5 repetitions of each and build up to 15:

 

Squats

Correct squat technique. Strengthen glutes to relieve sciatic pain.

  • Hinge through your hips - start the movement by moving your tailbone behind you.
  • Keep your trunk upright and your shoulder blades drawing down and backwards.
  • Hold your knees in line with your toes and keep your weight in your heels.
  • Your gaze should remain forward but lower slightly as you squat so you keep the length through the back of your neck.
  • Lower and rise at a constant pace.

Bridge

Strengthen your glutes ot relieve sciatic pain - piriformis syndrome

  • Breathe out and scoop your tailbone upwards, flattening your lower back into the floor. Continue to lift your hips, peeling your spine, bone by bone, up off the mat.
  • Breathe in to hold the bridge and breathe out to lower your spine again like a string of pearls.

Swimming

Strengthen your glutes to relieve sciatic pain - piriformis syndrome

  • Start on all fours. Press the floor away with your hands and tuck your tailbone in slightly.
  • Breathe out and slide one leg out behind you and reach away through your toe.
  • Breathe in to lower again and repeat on the opposite side

Tips: keep your abdominals gently drawn in and your back as still as you can throughout.

A few precautions …

If you’ve had a heavy fall onto your side or bottom in the last month since your symptoms started then it’s worth arranging a checkup with your GP or a physiotherapist as this type of accident can cause an injury to one of the pelvic joints (sacroiliac).

If you have tingling or numbness down one leg it’s important to see your GP to rule out a trapped nerve in your back before starting any treatment plan.

If you’ve had any recent changes in your normal bladder or bowel habits, tingling or numbness in both legs or around your groin or a feeling that your legs aren’t under ‘normal control’ then urgent medical attention is required. Call for an ambulance or go straight to your local A&E department.

Prevention is definitely better than cure and no-one likes to be overworked, so strengthen your buttock muscles and make sure they’re taking their fair share of the load!

And as always, give us a call if you want to talk things through.

The Physiofit Team!


Best treatment for tennis elbow

Tennis elbow pain - blog treatment and exercises

It may be called ‘tennis elbow’ but playing tennis isn’t the most common cause of this painful condition affecting the tendon on the outside of your elbow. Repetitive activities, such as gripping or typing, are actually far more likely to cause the kind of accumulative tendon strain that becomes painful over time.

Tennis elbow is sometimes misdiagnosed when the pain is actually referred from your neck or caused by a trapped nerve at your elbow. These conditions, however, are far less frequent and if your elbow pain is largely related to movements of your hands and wrist, rather than persistent pain exacerbated by changes in your posture, then it’s likely you have tennis elbow.

Tennis elbow first aid

Pain control – apply an ice pack for up to 10 minutes, twice a day and take painkillers or anti-inflammatories as advised by your GP or a pharmacist. This will help you continue to use your arm for light activities and to keep your elbow moving, encouraging blood flow and preventing weakness from developing while your tendon heals

Rest – the most important thing you can do is to modify or stop doing activities that strain the tendon.

Try to identify a cause – have you started a new job or taken up a new sport? Has there been a sudden increase in your workload or working hours? New computer set-up? Consider how you can modify your activity and home or work to reduce stress on the tendon in a sustainable way for at least 3 to 6 months.

Start gentle stretching – straighten your elbow, palm down and bend your wrist. Use your other hand to press gently on the back of your hand to increase the stretch. Hold for 30 seconds, three times and repeat this regularly during the day.

wrist stretch for tennis elbow

Strengthen up – you can start strengthening exercises as soon as pain allows. Stay within your comfort zone, the exercises shouldn’t stir up your pain significantly at the time or affect your ability to use your hand for other general activity. Start by holding a 0.5kg weight, palm downwards with your forearm and hand on a table. Lift the weight 10 times, rest for 30 seconds and repeat. Increase the number of repetitions to 15 (as pain allows) and complete 3 sets with rest breaks. You can make this exercise a bit harder by putting your hand over the edge of the table to lift and lower the weight. Allow the pain to guide you … doing too much too soon may delay healing.

Move your arms and neck and upper back – often if the elbow hurts we don't use the hand and shoulder as normal on that side either. This can lead to tightness down the arm of either soft tissues or neural tissues. Try these two stretches to keep everything moving normally:

upper back stretch for tennis elbow

Mid back mobiliser: slowly relax backwards over the back of your chair as far as you can move comfortably. Keep your elbows together and try not to arch your lower back. Repeat 5 times.

Stretch in sitting to improve tennis elbow at work

Spinal rotation: turn your upper body to one side and use the back of your chair to gently increase the stretch. Repeat 3 times each side.

Should I use a tennis elbow clasp?

A clasp can be helpful to change the amount of stress that falls on the tendon at the elbow. When you are wearing it you’ll know straight away whether it’s going to be helpful or not as the tendon pain should immediately reduce when using your hand. I tend to recommend using a clasp only for specific activities that can’t be avoided or modified in your work or home life.

My GP has suggested that I could have a steroid injection?

Opinions vary but it’s thought that an injection might work best within 2-3 months of the pain starting. However having a steroid injection on its own has been shown to be less effective than having physiotherapy treatment.

If your symptoms don’t settle or they improve but you have difficulty returning to your usual activities, it might be time to consider an assessment with a health professional who specialises in ergonomics and overuse injuries.

Please get in touch if you think we can help,

The Physiofit Team


Rowing - how to prevent back pain

How to prevent back pain in rowers

With only a month to go until the 2016 Oxford Cambridge boat race, here are our training tips to keep your back strong and flexible, to prevent injury and to keep you out on the water!

The risk factors for back pain in rowers

  • Insufficient hamstring flexibility, core strength and general fitness
  • Sudden increases in training time on an ergometer with high load and low stroke rate
  • Inadequate warm up
  • Ignoring niggling aches and pains and continuing to train
  • Poor technique/rigging
  • Inexperience
  • Previous history of back injury

How to prevent back pain

  • Hamstring flexibility - The leading cause of low back pain in rowers is due to tight hamstrings. If your hamstrings are tight the amount of flexibility in your hip joints is reduced and your lower back compensates by bending more than it should … causing back pain. You need to hold your hamstring stretches for at least 30 seconds, 5 times each side, with a short rest in between, several times per day to be effective.
  • Core strength - You may be aware that the muscles in our body work in pairs. Each has a buddy and as one muscle tightens the other relaxes to produce a synchronized and controlled movement. The abdominals and lower back muscles work together like this but if you have weak abdominals (strength or endurance) then you may find your lower back muscles working a bit harder than they should be while you’re rowing. This may be noticed at first as a bit of lower back tightness in the morning – don’t wait for it to develop into a back problem … speak to your coach about some core exercises or try a pilates class.
  • General Fitness - Try to combine your rowing training with other aerobic exercise, such as cycling or running. Variety in activity is the best way to prevent overuse injuries, while allowing you to train frequently enough to build fitness. Even twice a week for 20-30 mins and you will notice a big change. Feeling fitter while you row will reduce fatigue during training and thus reduce your risk of injury.
  • Gradual build up – it’s vital that you build up the miles gradually and rest days are important. Over training is a huge cause of low back pain, as well as many overuse injuries. If a muscle is fatigued the risk of injury is much greater. Ask a more experienced rower for a programme, or get advice from a coach if you’re just starting out.
  • Warm up - Before getting on the ergometer or into the boat, get moving to warm up your muscles. Even 10 minutes will significantly reduce the risk of injury. Try a fast walk, into a light jog, then some drills like high knees and butt kicks. This gets your heart rate up, pumping fresh nutrients into all the muscles, ready for the training ahead.
  • Early assessment - If you feel a niggle in your back, stop training until you’ve spoken to your coach, an experienced rower or a physiotherapist. You may need to change your training programme (load size, intervals, frequency) or your set-up in the boat but if you keep training through low back pain your symptoms could get worse and this could increase the rest time you need to recover. You can call for some advice from one of our physiotherapists, without charge: 07721 085511.

Good luck Cambridge!

Hope to see the rest of you out on the water – the Physiofit team!


An exercise to improve knee pain

featured image knee

If a client has pain in their knees, hips or lower back (even their feet) then I routinely examine the buttock muscles to check the strength and how they function in general and sporting activities.

I'm  particularly interested in the strength of the Gluteus Medius muscles (the buttock muscle found on the outer part of your hips). These muscles support your pelvis and stop your knee from rolling inwards when you walk and run. They are frequently weak or underactive (lazy) resulting in poor movement patterns and pain over time.

One of the best exercises to strengthen the Gluteus Medius is to practice squatting on one leg:

A good tip is to practice this exercise in front of a mirror to begin with, so you can see what your hip and knees are doing. Start with a 1/4 squat like I am demonstrating in this video, being really precise with your technique, up to 30 repetitions on each side once or twice a day.

For more ideas about strength and conditioning exercises to prevent knee pain, take a look at this article:

Runners Knee


How to use a foam roller properly!

How to use a foam roller properly

Would you believe me if I told you that for less then £20 you could significantly increase your flexibility, reduce muscle soreness, improve joint mobility and posture? 

These are all benefits of regular foam rolling!

How does it work?

All of the parts of your body (muscles, organs, joints, bones, nerves  etc) are encased in a web of soft tissue called ‘fascia’.

Fascia wraps in layers and folds around each structure binding everything together compactly and spreads continuously throughout the whole body joining it all up.

As I may have mentioned in several of my previous blog posts … sustained positions or activities that we repeat often through the day (e.g. sitting) encourage our soft tissues to remodel themselves. In time these changes can change our posture causing altered movement patterns and areas of accumulative strain, uneven pressure in joints and overuse of muscles. All of which can result in pain!

Changes in the fascia such as tightness and areas of localized restriction can be ‘released’ by foam rolling exercises. Foam rolling is also often used prior to a workout to increase flexibility and afterwards to reduce muscle soreness.

Tips for foam rolling:

  • Apply a moderate amount of pressure using your body weight (it’s shouldn’t be a test of your endurance!).
  • Roll slowly and if you find a tight or sore spot hold it for a few seconds until it relaxes. If it’s too sore, work around the area to help loosen it.
  • Avoid rolling your back- use a spiked massage ball or tennis ball instead.

How to improve your hamstring flexibility

Improve hamstring flexibility

You might have thought that if you stretch out your tight hamstrings regularly they will eventually get longer, suppler and you might be able to touch your toes again … but this isn’t really how it works, so here’s my over-simplified explanation:

Your nervous system plays a large role in determining your “hamstring” flexibility! 

What I mean is that when you bend forwards and you meet resistance or tightness in your “hamstrings”…. it’s really your brain deciding how far it is willing to let you move in this direction.

For example, if your core is weak then your hamstrings will be told by your brain to ‘kick in’ early to compensate for the lack of stability and act as a brake to activity that might overload and injure your back.

By working on core strength and alignment during movements such as bending you reduce the need for the ‘emergency brake’ action of the hamstrings and your brain is more likely to allow you to move further into range.

That’s not all …

Muscles are made up of little units, like links in a chain, called ‘sarcomeres’ which slide into and away from each other.

When the links slide together the muscle gets shorter and when they slide apart the muscle gets longer. Each link has a set ‘sliding’ distance and this won’t increase by stretching.

When you frequent one position habitually (e.g. sitting) your body tries to be helpful by making adaptations in the length of your muscles to make this position more comfortable for you.

Essentially if your daily routine involves sitting at work, driving home and then collapsing on the sofa exhausted… then your hamstrings are in a shortened position for most of the day and your body will efficiently break down the hamstring muscle links that are not in use when you are sitting.

Ergo over time there will be fewer muscle links ... your hamstrings become shorter … and you can no longer touch your toes!

So what’s the answer?

Simply stretching your hamstrings once or even twice a day is not enough of a stimulus and within one hour the effect of this kind of stretching is negligible. It would be far more effective simply to stand up and change position for a couple of minutes every hour in addition to stretching intermittently.

It takes a lot of determination to change the length of a shortened muscle, so as always, prevention is much better than cure ... change position and move frequently during the day, stretch intermittently with good alignment and strengthen your core muscles!


Hypermobility and exercise

Safe exercises for hypermobility

Help for those with hypermobile joints

I’ve noticed recently that there’s been a rise in the number of my clients looking for help with the physical issues associated with hypermobility- an excessive flexibility meaning that the joints of the body have greater range of motion (laxity).

They do tend to be women - but not always - and although being hypermobile isn’t always a problem (for dancers it can be an advantage) for some having hypermobility means that they frequently sprain their joints just doing simple everyday activities.

Repeated re-injury of weak joints can lead to persistent (chronic) pain that can be widespread throughout the body. It’s an ‘invisible’ condition and as such there’s not always much sympathy or understanding and most of my clients have been dealing with these challenges since their childhood.

Getting back in control

There are lots of small elements - like workplace ergonomics, lifestyle modifications, pain relief treatments and pacing- that can make up a strategy for managing your condition and put you back in control.

I highly recommend Clinical Pilates with it’s focus on strengthening postural muscles, improving body awareness and maintaining normal joint positioning during movements to move the spine evenly, avoiding ‘hinging’ at the points of most natural flexibility.

Scissors

A great exercise for people with hypermobility is ‘scissors’. I’m teaching a lower level version of this exercise for beginners:


Pedal Power … how to set up your bike correctly

Setting up your bike correctly to avoid inuries

You know you’re in Cambridge when cyclists seem to outnumber the pedestrians! Cycling is a great way to get fit, stay fit and avoid the traffic … so here are my tops tips for setting up your bike correctly and avoiding bad habits that can lead to painful niggles:

1. Seat height:
Avoid knee pain by adjusting that the height of your seat so that you can straighten your knee fully with your foot flat on the pedal, when the pedal is down in the 6 ‘o’ clock position.

2. Stretching:
The more you cycle, the stronger your thigh muscles (quadriceps) become and over time these muscles will get shorter unless you stretch them out regularly … and by regularly I mean at least twice a day. Try lying on your side or your front and taking hold of your ankle and pull your foot towards your bottom. You’ll need to hold for at 30 seconds and repeat a few times on each side to see the benefit.

3. Knee alignment:
Are your knees rolling in as you peddle? Knee pain can still occur even if you have good flexibility and the correct seat height if your knees roll in when you’re on your bike. Weakness of the buttock muscles means that it can be difficult to maintain good alignment of your knees as you push down on the pedal and exercises to strengthen these muscles such as squats or lunges might be worth adding to your training.

4. Handle bars too far forward … too low … or if the bike is simply too big for you:
All of these will cause you to lean forward too much and overstretch your back muscles, which can cause low back pain. It’s really worth taking your bike to a good fitter who can take a good look at you on the bike and make the proper adjustments to suit you.

5. Core strength
Being able to keep your lower back and pelvis still while cycling means that you can put power down through the pedals. A stronger core is key to this and will help prevent overuse injuries, improve balance and stability and improve your performance by making you leaner and more efficient.