by Christina Abbott on December 10, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
Life throws a lot of curve balls at us. After all, life is a school, not a beach. In the process of learning positive things from these events, we are also challenged emotionally. Those stressful times cause muscle tension, commonly resulting in arm and hand pain. We also have physiological stress reactions to challenges, hormonal and chemical events that need to be dissipated with exercise and stress reduction.
Toxins in our environment and diet add to the mix. The more we take in through our lungs and mouth and skin that our bodies need to get rid of, the more physical stress our organs of elimination endure. When toxins build up and hang around in a gang, they become reactive and cause trouble. The reactions are called oxidative stress. It’s like rusting iron. The accumulated waste decomposes and becomes acidic. Acids break down our cells, causing the tissues that form them to become unhealthy. Acids also cause pain. If you put an acid on your skin, it can “burn” it. The same thing can happen on the inside.
The second part of this discussion is about what happens to our bodies after age 45. It has been found that at about this age, our digestive tract begins to manufacture fewer bicarbonates to neutralize the acids in our blood. Because a small change in blood acidity can be life-threatening, our bodies carefully guard those levels and get rid of the excess. Where does the excess go? From my research, they go to two places. The first is our organs of elimination, like the kidneys. Over time they become stressed with the extra load they are required to process. The other place the acids seem to go is out into the interstitial fluids, meaning the fluids between the tissues. So it seems that these very fluids that bathe and nourish the nerves can also irritate them. How long can vulnerable tissues stay healthy in a toxic medium?
When life events and the effects of aging cause a buildup of tension and waste, there will be muscle and joint pain.
by Christina Abbott on December 9, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
There is no event that initiates arm and hand pain from accumulated tension. It’s just the sum total of all the tensions to which the upper extremity is subjected over time. People come into my Neuromuscular Therapy center near Boston saying, “I’ve been doing this all my life and I’ve never had pain before. Why now?”
There is a threshold of nervous system activity that can actually be measured in Hertz, a unit of frequency defined by cycles per second. There’s a huge volume of signals coming through our nerves monitoring everything that’s going on in our bodies. Our brain doesn’t need to know all of that, so the spinal cord mediates and automatically responds to the input. That’s called reflexive action. When the sum total of the input exceeds that threshold, the signals can no longer be handled reflexively and the information goes up the spinal cord to the brain. That’s when we feel pain. So we pay attention to it. We rest, ice, stretch, take pills or do something to make the pain go away. Now with that under control, we go about living our life until the pain recurs. We’ve just stepped over that threshold again. The signals had never gone away, they had just been spinning in a reflex arc below the level where the brain needed to get involved.
To keep the pain from coming back, reduce the accumulation of tension. That means some preventative measures: regular exercise and stretching, stress reduction, massage and bodywork, a healthy diet, supplements and herbs, drinking enough water, detoxification measures, postural correction, avoiding repetitive motions, a warm bath maybe with epsom salts (or aromatherapy, a candle and a glass of wine!). You’ve heard it all before. The fact is that the older we get and the more tension we accumulate, the more time we need to take care of ourselves. Maybe that’s why there’s retirement!
by Christina Abbott on December 8, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist. Damage cause by unaccustomed overuse is effectively treated with Neuromuscular Therapy in my Boston area treatment center.
A typical scenario for a person who suddenly has arm and hand pain is that a deadline comes due at work and you’re not ready! To meet the target date and keep your job, you work long hours under stress for a couple of weeks (unaccustomed overuse). Without warning, you are in pain! How did this happen!? You didn’t feel it coming and now you’re in so much pain that you have to get help typing to finish in time. This is about an energy crisis and about aging.
Until about age 15 a person can do a lot physically without consequence because the “mother cells” or stem cells that can differentiate into any kind of cell needed for healing are still in active mode. At about that age, the number of stem cells available to create healing reduces because the body is coming toward the end of it’s cycle of growth. Rapid healing slows down as the body ages starting at about age 15. The next change comes around age 45 when the production of bicarbonates produced in the digestive tract to neutralize acids in the blood slows down. The effect is that there are more acids in the system that begin to cause oxidative stress (like rusting iron). Again, as the cells begin to be less efficient due to this process, the capacity of the body to heal quickly slows down.
So, the sad fact is, that as we get older, we can’t overload muscles with unaccustomed tasks without preparing the muscles for that work. They just can’t recover as quickly as they did when we were young. “Personal Training” is a field that addresses this fact. The muscles need to be trained and conditioned to do what we require of them. Even with conditioning, unaccustomed overload will very likely cause spasm and pain.
An energy crisis in the muscles is caused by using up the nutrients and oxygen needed to perform work faster than the body can provide them. The cells need fuel to burn to provide the energy needed to contract and relax the muscles as they move. The arm and hand muscles aren’t very big so they can’t store as much fuel as the large working muscles. Unaccustomed overuse can easily deplete the reserves and cause an energy crisis that basically shuts the muscles down until they get more fuel. If you’ve been running on empty for days, the damage can be serious like the engine on a car seizing up when it runs out of oil.
Refueling and repairing the damage means a program of stretching, icing and muscle treatments, increasing blood flow and providing the nutrients necessary for muscle health.
by Christina Abbott on November 27, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
Nerve irritation and compression are a focus of medical diagnoses and treatments for the relief of pain. What to do with muscles that become chronically painful as a result is another story. In my Neuromuscular Therapy practice in Metro-West Boston, I often treat this problem of continued muscle pain when conditions like herniated discs have healed.
When nerves are irritated or compressed they send distress signals to the muscles along their nerve pathways. If the stimulus continues, the muscles become sensitive. Think of what happens when you rub someone’s arm. At first it feels good, but if you rub in the same place for too long, it begins to get sensitive. If that can happen within a few minutes, think what happens over weeks of irritation. Inflammation results and all the complications that occur when it becomes chronic.
Hypersensitivity happens with nerve irritation and chronic inflammation, but also when the fluids that bathe the nerves becomes toxic. If waste products and irritating substances from food and the environment are allowed to build up in these interstitial fluids, the nerves are forced to live in a toxic environment. If the toxins aren’t drained efficiently by the blood and lymph systems, hypersensitivity results.
Active Trigger Points emit chemicals that are damaging to soft tissue and send pain signals outward to specific referral zones. Tight muscles put pressure on blood vessels in the upper body that trap toxins in the arms and hands and prevent delivery of healing cells. Irritation of nerves rubbing against bones in the elbow cause inflammation. Overworked muscles produce waste products from burning metabolic fuels. All of these circumstances cause inflammation that produces toxins in the arms and hands that must be removed to prevent nerve irritation and hypersensitivity.
by Christina Abbott on November 23, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
“Use it or lose it,” the saying goes, and with muscles, there’s a lot of truth to that. If you’ve ever seen the before and after view of someone who has had a cast for a broken limb, you’ve probably seen how much the muscles can shrink. It only takes two weeks to lose immobilized muscle tissue and much longer than that to build it back up.
The tendency is to rest a muscle when it is painful to use it. That’s logical if using it is causing harm. It isn’t always clear that movement is doing that, however, which is why Physical Therapists and doctors prescribe strengthening exercises to improve these conditions. Understanding why arm and hand muscles are in pain is key to deciding whether to rest it or use it.
Trigger Points are a major concern in this regard, and often not considered in the diagnosis and treatment of acute and chronic muscle and joint pain. Trigger Points cause the muscle in which they occur to contract constantly. Giving such a muscle extra work to do only makes it worse. The reason is that a working muscle is burning metabolic fuel. Every time fuel is burned, a waste product is produced. In the case of muscles, metabolic waste products are acidic, like lactic acid. Acids can damage soft tissue and cause degeneration if they aren’t cleared away. Degenerated tissue becomes chronically irritated and weak, eventually bcoming atrophied.
Another cause of pain and damage to soft tissue is caused by chronic irritation to tendons by microtears caused by overuse. These tiny tears at the attachments of the muscles cause a “non-specific inflammatory response” that promotes healing unless the tendon is continuously damaged. The condition is called tendonitis when the damage is chronic. Tendonitis can become enthesopathy (according to Travel and Simons, a disease process at the attachments of tendons or ligaments to bones or joints). Enthesopathy can turn into enthesitis, a chronic condition that can cause fibrosis and calcification at these attachment sites.
So this is a little like arthritis where chronic inflammation causes changes in the bone. Once that happens, it’s hard to stop the process and harder to cure the condition. Paying attention to keeping the soft tissue healthy in the beginning stages is very important. Getting appropriate and effective treatment and doing your home care is crucial to bringing your muscles back to health. Rest has it’s place when movement causes friction and inflammation, but releasing the tension that causes irritation is the key to recovery. This is the work I do in my Neuromuscular Therapy center near Boston.
by Christina Abbott on November 19, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist. Treating arm and hand pain is an important part of my Neuromuscular Therapy practice near Boston.
Our culture loves the relaxed look! Back rounded, head forward, slouched and cool. Standing up straight, chest proud, chin up feels too straight forward and out in view.
Posture may be the most common initiating and perpetuating factor in creating arm and hand pain. That cool slouch weakens the back and shortens the front muscles until it becomes hard to sit up straight without tiring immediately. When the shoulder and chest muscles become shortened and tight, they block the flow of blood and nerve signals to and from the arms that they need to be healthy and do the work you give them to do. Reduced blood flow creates an undernourished and toxic condition in the arms and hands which eventually turns into pain. Muscles become weak from lack of neural communication and eventually become injured.
To correct this, the chest and shoulders need to open up and the back muscles tighten up. When the chest is tight, it’s like a heavy spring which is hard to pull against. The back muscles do the pulling, so when the work load becomes to great, it weakens. As the back gets weaker the chest and shoulders get tighter and the cycle goes on.
Start by watching the position of your low back, especially when sitting. Your butt should be at the back of the chair and the small of the back slightly arched. In that position your head and shoulders will automatically come back into alignment with no effort from your muscles.
Stretch your chest and shoulder girdle as you strengthen your back muscles by doing the doorway stretch. As you continue to do this exercise daily, you’ll find how effortless good posture becomes. You’re on your way to reducing pain in your arms and hands.
Doorway stretch: Stand in a doorway with one foot straddling the threshold and your hands on the door jamb, elbows at your side. Lower your shoulders and tuck them in against your ribs as if you were trying to slip your shoulder blades into your back pockets. Shift your weight onto the forward foot until you feel a pull in your shoulders and chest. Exhale and actively stretch for two seconds using the door jamb as your assistant. Release the pressure, then repeat 10 times. Stretch in these three positions 1) elbows at your waist, 2) upper arms parallel to the floor, 3) reaching as high as you can. If your range is restricted by joint tension or pain, go as high as you can, increasing your range as you are able.
by Christina Abbott on November 18, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
Neurovascular entrapment is what happens when nerves and blood vessels become trapped by tight muscles and the taut bands of Trigger Points. Entrapment is not the same as compression. Nerve compression occurs between bones or other hard tissues. Vascular entrapment happens in soft tissue when pressure from contracted muscles squeezes the blood vessels, preventing a normal flow of nutrients and oxygen from reaching the tissues further along, causing pain and ill health. The same thing happens with nerve entrapment. Signals from the brain and spinal cord don’t reach the muscles as quickly, causing numbness (dysesthesia), abnormal sensations (paresthesias) and loss of function.
A Trigger Point in the muscles can form a hyperactive nodule that pulls on the muscle fibers attaching to it, forming a taut band which can act like a cord, cutting off the supply of blood and nerve signals. Like a cord around your neck, it can be very effective.
Going the other way back to the center, it causes problems too. If blood, traveling to the heart through the veins, is blocked and prevented from passing efficiently, waste products build up behind the blockage, becoming acidic and toxic to the tissues. Nerve signals traveling back to the spinal cord and brain are prevented from reaching the command centers quickly, bringing information about sensations (like tension and pain) that need to be delivered as a warning of danger to the tissues.
The results can be serious. Tension and Trigger Points need to be relieved to restore normal functions and health to all of the tissues that depend on blood and nerve signals for life.
by Christina Abbott on November 17, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
Local overuse for prolonged periods of time is what is known as Repetitive Stress or Repetitive Strain. Muscles that are given more work to do than they have energy or nutrient reserves to accomplish, will become sore, or worse, injured and painful. These conditions concern me greatly. I treat them weekly in my Neuromuscular Therapy center near Boston.
In our computer generation, local overuse of the muscles of the arm and hand is like an epidemic. Work deadlines that require many hours of overtime or working under stress are common in this competitive environment. Social networking that encourages texting is another source. How many people do you know who use their thumbs for hours on end this way. Computer games are a common source of overuse. When people get caught up in a game they can get lost so absorbed that they’re not aware of their bodies. Same for those who get lost in the cloud, spending hours in their heads with their hands on the computer keyboard without regard or care for how their bodies feel. Musicians practicing for hours on end to excel are candidates for injury. There’s even a branch of medicine know as “Performing Arts Medicine” that addresses these issues.
The muscles of the arm and hand are not meant to do heavy work. They aren’t large, like the thighs or the upper arms. Because they don’t have bulk to push through extra work, the existing fibers get overworked. When they get injured, there isn’t any more muscle to take over the load, so injured muscles must continue to work under duress without reserves. Like running out of gas in the tank, the muscles run out of fuel, or like running out of oil in the engine, they get “hot” and seize up.
To prevent injury, muscles need frequent breaks to recruit “food” molecules, change in the way they are used to get a little rest and cool down, stretching to reduce tension and open space for nourishing and lubricating fluids to flow, cardio exercise to increase general blood flow and get the “feel-good” chemicals pumping. All of these measures give muscles enough energy, nutrients and oxygen to do the work you give them, and time and space to clear away the waste products they produce that can damage the tissue and cause pain.
by Christina Abbott on November 11, 2009
This is a series on arm and hand pain causes. If you missed the beginning, go back to the Checklist.
Many years ago now, I attended a talk by Dr. Emil Pascarelli to the RSI/Mass COSH group in Boston and was cheering to myself in the back of the hall when I heard him say that most Repetitive Stress/Strain Injuries start in the upper body. That had been just my experience in treating lots of RSI patients in my NMT Center near Boston. After months of treatment, the forearms would become less sensitive and stronger, but there would still be pain in the muscles of the upper body. Resolving those issues was a key that opened the door for me to be more successful in treating RSI and then of many other painful complaints in the arms and hands.
What is important to understand is that when the upper body muscles are tight they can block the flow of blood and nerve signals to the arms. If there is reduced blood flow to the working muscles, they can’t stay healthy, especially if they are overworked by hours on a computer or by one-sided vigorous exercise. They run out of energy, nutrients and oxygen and get strained and injured.
When the nerves are trapped, signals can’t get back and forth to the spinal cord and brain that control movement, systemic balance and all communication to and from the muscles.
When blood flow is reduced, not only do the muscles get starved, but waste products produced in the arms by the work the muscles are doing can’t be removed efficiently. They build up and cause a toxic condition which causes pain and breaks down the cells that make up the soft tissue. The lymphatic system, working with the circulatory system and essential to life also becomes blocked, adding to the toxicity and ill health.
The most important muscles that cause this condition are the scalene muscles in the neck, the pectoralis minor in the chest, the subclavius under the collarbone and the subscapularis in the armpit (axilla). The thoracic outlet pertains to the triangular space between two scalene muscles and the first rib. The nerves from the neck that go down the arm can be trapped in this triangle when the muscles are tight. The major artery from the heart joins the nerves, forming a neurovascular bundle that goes over the first rib and under the collar bone (clavicle) and pecoralis minor muscle before splitting in the axilla and going down the arm. Tension in the thoracic outlet space can cause “thoracic outlet entrapment” or the more serious “thoracic outlet syndrome.” Entrapment can block blood and nerve flow to the arms causing pain, tingling, numbness (dysesthesia) and unusual sensations (parasthesias).
Entrapment also commonly occurs under the pectoralis minor’s very strong tendon and can be felt as numbness when the arms are overhead.
In the axilla, the brachial plexus of nerves split into the various branches that send messages to different parts of our arms. Tension in the axilla, primarily in the subscapularis muscle can impact those nerves.
To reduce symptoms and improve soft tissue health, the tension and Trigger Points in all of these muscles must be relieved so that the blood, lymph and nerves can do their jobs. Then the muscles can begin to rebuild.
by Christina Abbott on November 10, 2009
This is the beginning of a series on arm and hand pain which will include thumb pain, hand pain, finger pain, wrist pain, forearm pain and elbow pain. General physiological considerations will be reviewed that affect all of these conditions and syndromes. As a Neuromuscular Therapist practicing in the Metro West Boston area, I have treated many patients successfully with a variety of arm and hand pain complaints paying attention to these considerations. Specific muscular causes, syndromes and conditions that cause pain will be addressed as well as information about which muscles most commonly cause symptoms. Self treatment tips and stretches will be included as well as ideas about what you can do to feel better and heal faster.
General considerations beyond medical conditions:
1) Upper body and shoulder girdle/chest tension
2) Neurovascular entrapment
3) Local overuse for prolonged periods of time
4) Posture, muscle imbalances, back weakness
5) Tissue deterioration and atrophy (incl. enthesopathy and active Trigger Point physiology)
6) Nerve irritation, hypersensitivity and nerve compression
7) Trigger Points
Muscular causes of arm and hand pain:
1) Unaccustomed overuse
2) Accumulated tension
3) Life and the affects of aging for those over age 45
4) Structural asymmetry like a leg length discrepancy
5) Old injuries or surgeries
6) Repetitive stress
7) Posture and positional stress
8) Emotional stress
Muscles most commonly causing arm and hand pain:
1) Extensors of the fingers, esp. middle finger and index finger
2) Flexors of wrist and fingers esp. the common tendon at inner elbow (medial epicondyle)
3) Thumb muscles, both intrinsic and extrinsic
4) Shoulder muscles, esp. those that move the arm
5) Scalene muscles in the neck
6) Supinator and pronators
7) Minor causes: Pinkie abductor, two opponens muscles
Conditions and syndromes that can be treated:
1) Carpal tunnel syndrome
2) Cubital tunnel syndrome
3) DeQuervain’s syndrome
4) Repetitive stress/strain injury (RSI)
5) Tennis elbow (lateral epicondylitis)
6) Golf elbow (medial epicondylitis)
7) Blackberry thumb
8) Trigger thumb and finger
Conditions that can be helped:
1) Dupuytrens contracture
2) Reflex sympathetic dystrophy
3) Reynauds disease
