I write to you as a musician and massage therapist, and as a survivor of both Carpal Tunnel and Cubital Tunnel Syndromes, very painful and debilitating repetitive strain injuries affecting the wrist. The term “repetitive strain injury” (RSI) means a muscle that has been used so frequently, doing the same motion, that has become injured, often causing pain at nearby joints and regions distant from the injured muscle. This article will provide tips to both prevent and treat both conditions, as the steps for treatment are also the steps for prevention.
I successfully treated my RSI’s, and prevent future injury, by using a combination of trigger point therapy and myofascial stretching techniques after meeting Julie Donnelly, LMT, an internationally recognized authority on repetitive stress conditions. Julie Donnelly developed a self-massage system, The Julstro Self -Treatment Kit, based on trigger point therapy, a deep tissue treatment pioneered and documented by Dr. Janet G. Travell, the White House physician during both the Kennedy and Johnson administrations, and Dr. David G. Simons in their seminal medical textbooks, “Myofascial Pain and Dysfunction: The Trigger Point Manual.” According to Dr. Travell and Dr. Simons, myofascial trigger points are tiny contraction knots that develop in a muscle when it is injured or overworked.
Imagine two palm trees with a rope tied between them. That rope represents your muscle. A muscle fiber only knows how to contract or release. Through repetitive activity, your muscles develop what’s known as “muscle memory.” This is how you are able to do physical activities without your mind actively engaging. Your muscles remember how to do it. It’s how I can play scales on my guitar without thinking about them or looking at the fretboard. If you do enough repetitive activity, some of your muscle fibers in the muscle being overworked will get “stuck” in the contracted position creating a knot, or trigger point. Returning to our rope analogy, imagine taking that rope, pulling on it to create some slack, and then tying a knot. The rope won’t return to its original length and one of the trees will start to bend.
The same thing happens to our muscles. The trigger points cause the muscles to shorten, which cause tension on the tendons that attach them to bones and joints. This often will cause nerve impingement, as in the case of tight flexor and extensor muscles of the forearm causing impingement of the median nerve in the carpal tunnel. In the case of Cubital Tunnel Syndrome, it is often trigger points in the triceps or forearms that are the culprit of compression of the ulnar nerve through the cubital tunnel. (Think your funny bone.) Like the rope causing the tree to bend, you won’t be able to stretch the muscle back to health unless you remove the knot.
To treat your RSI, simply find the trigger points in the muscles that are referring the pain to the wrist, in most cases the flexors and extensors, massage them with deep, steady pressure to get the trigger points to release, and then stretch the muscle and its fascia using a slow, long, gentle stretch. Fascia is the connective tissue that surrounds muscle fibers and muscles. That clear “skin” around raw chicken breast is fascia. Its job is to protect muscle by contracting. The only way to get it to un-contract is through long, slow, gentle stretches.
To massage your left forearm muscles you can run the bony ridge of your right forearm (the ulna bone) down the skin of the left forearm from elbow to wrist, using pressure as you go. You may want to use some lotion as lubricant. Massage the hairy side of the forearm to treat the extensor muscles. Massage the other side to get the flexor muscles. Then use your left ulna to treat the right forearm.
To stretch the flexor muscles, place your hands together palm to palm pointed upwards as if you were saying a prayer. Slowly bring your wrists down towards the floor with the ultimate goal of having them be parallel with your elbows and holding that position for a minute. You may not be able to get to that point yet as your muscles may be tight. That’s ok. Do what you can. Start off doing 15 second increments four times until you can build up to a minute.
To stretch the extensor muscles, place your hands together, but this time back of palm to back of palm. The goal of this stretch is then to raise your wrists while keeping your elbows down and your hands together. For many people, their extensors will be really tight from overuse, such as typing. Again, do what you can, and do not over-exert yourself. Build up to a minute stretch. Flexibility will come in increments. Slow and gentle is the way to go!
Ideally, if you are either suffering from RSI to the wrist, or you perform an activity that is at high risk for an RSI, such as prolonged computer use, jack-hammering, or musician, then you should do this massage treatment and fascial stretch 3-5 times a day. Know that it will take a little time for your muscles to return to get back to their original shape. Do not get discouraged. Also, if you continue to put repetitive strain on your arms, then I would advise getting a massage tool and either books or DVD’s about trigger point therapy, such as The Julstro Self -Treatment Kit, to give your further tools and information about the other muscles of the arm, as they can also be the cause of wrist pain.