Category Archives: upper limb

work out your workout

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If like most people you do not have a huge amount of spare time on your hands making the most of the time you do have is important, this applies to working out too. All the exercises you do should have a clear purpose and part of that purpose should be about minimising harm.

We are all a bit different, the work we do, new and old injuries, joint conditions, congenital deformities and the way stress affects us can make exercises that are easy for others hard for you to do. Sharp pain is a definite warning to back off any particular exercise.

The look you want to achieve and what we specifically need or want to do well is an important consideration, as is your muscle type. Some people get bigger muscles than others using the same exercises and this applies to stretching and cardio too. 

Squats for instance can give you increased thigh strength, if you lift or are naturally a bit week in your thighs squats become more important to your needs. Squats generally help you lift things better, even if is just your own backside getting on or off  chairs which becomes increasingly harder for many as they age or put on weight. Squatting down too far (past 90 degree knee flexion), can damage your knees, the greatest value of squats is supporting postural strength. Squatting with your knees bent more acutely than 90 degrees is a common exercise hazard many fall into.

The pressure inside your knees increases greatly when you fully flex your knees under your own body weight and much more so under extra load (pushing against a weight). Squats are safer if your knees are good.

If you have had a knee replacement full squats simply are not possible. It is fine to do full knee bends when you are not weight bearing as with leg stretches but under load it is a different story.

Another exercise that has a high risk factor is the shoulder press, if you are a footballer needing to reinforce your collarbones for front on tackling, shoulder press (and other exercises with similar actions) can help protect your upper body.

The trouble with shoulder press type exercises is that a)- any history of neck trauma like from a whiplash injury from a road accident can create a weakspot that might give way under stress. b) shoulders do not work efficiently when your hands are supporting weight above the height of your shoulders or behind the centre line of your body and c) Some of the muscles in shoulder press such as your upper trapezius and supraspinatus are always working against gravity anyway and are more likely to need stretching.

It is ok to workout hard but workout smart too.

The Elbow

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Our hands are as useful as they are partly because of the design of the elbow, not only does the elbow bend like a hinge but it can also rotate 180 degrees from the bent position, the screw driver would be quite a useless invention if the elbow was unable to do this!

Two  common conditions of the elbow are Tennis Elbow (lateral epicondylitis) and Golfers Elbow (medial epicondylitis). Tennis Elbow (TE) is mainly a problem brought on by the over use of the muscles on the top side of your forearm (the wrist extensors), tennis is not the only activity that can give you TE but it is a very common cause of it due to the playing backhand strokes repeatedly. This can overuse and inflame the wrist extensor muscles, the main muscles used with this stroke.

Golfers Elbow (GE) on the other hand is chiefly brought on by overuse of the muscles on the underside of your forearm (the wrist flexors). Like tennis causing TE, GE has causes other than playing golf too much, but is commonly caused by playing golf because of how the wrists are cocked forward alot particularly with executing approach shots.

Both of these conditions can be very painful and debilitating and can take some time to recover from. Anti inflammatories and pain killers can mask the symptoms but rest, soft tissue treatment (ie massage) and rehabilatative exercise are usually the most effective ways of remedying the problem, therapies such as acupuncture, massage and osteopathy have given relief to many with these conditions. Improving one’s technique at playing these games can be a good way of avoiding these injuries too.

Any activity that emphasises the repeated use of your wrist muscles can give you TE or GE, playing musical instruments, typing, using hand tools, riding motorbikes and jet skis, gardening and massaging can cause elbow stiffness. You can also develop other wrist conditions such as Carpel Tunnel Syndrome through the repeated strenuous use of forearm muscles.

As the old saying goes “An ounce of  prevention is worth a pound of cure”, Regular stretching and  massage can help you avoid avoid getting TE and GE, it is worth a try.  Consulting an occupational therapist can help you find ways of modifying the way you do things at work to lessen stressful  impacts on your elbow joints. The longer muscular problems are ignored the more likely they will eventually lead to cartilage, tendon or ligament problems which are much harder to fix.

Exercising with free weights, whether they are specifically arm exercises or not can really tighten your elbows, which are not only constantly bending under load but also supinating (palm up) and pronating (palm down) under load too which can strain the ligament sheet between the bones of your forearm. If you like using free weights you should become very diligent about Self Massaging the muscles of your forearm and your triceps.

Arthritis

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There are many forms of arthritis ( the word means joint inflammation), by far the most common form is osteo-arthritis (OA) characterised by cartilage thinning at the ends of the bones where they meet other bones to form joints. All the joints are lined with cartilege, the smooth, slippery-when-wet nature of cartilege allows the bones the slide easily against one another and they can absorb shock. Considered to be a normal process of aging if you live long enough, OA can interfere with smooth joint movement.

If your genes have been passed on by OA sufferers it can predispose you to it, contact sport will greatly increase your chances of getting it as will being chronically overweight and unfit.

OA is the number one cause of needing hip and knee replacement surgery, you can sometimes actually hear and feel the bones grinding against one another in OA sufferers- when it gets to that stage it can get quite debilitating and very uncomfortable.

The good news is you can help yourself by following some sensible strategies. Walking and running on grass is easier on knees than the pavement. Wear good joggers check your running posture. Getting regular massage is useful, it helps free up muscle and joint action. Sometimes muscles tighten and increase the pressure inside your joints reducing your comfort and performance. Physio, osteopathy, chiropractic, massage and acupuncture are useful in combatting the effects of OA. Alkaline diets can reduce joint inflammation too.

There are other less common forms of arthritis such as rheumatoid and psoriatic arthritis and unfortunately some people can suffer from more than one type at the same time.

Climate can play a part in the severity of arthritis, OA for instance usually feels worse during cold weather where rheumatiod arthritis (RA) will be more acute when the weather is hot.

Arthritis can also be compounded by other problems such as weight gain, tendonitis and shin splints, causing pain to radiate further from the joint itself along your legs, a common location for OA. Arthritis often effects people’s spines and hands too which can be extremely debilitating, basically where ever you have cartilege you can get arthritis.

Some arthritis sufferers find pharmaceutical medications quite satisfactory in controlling their symptoms but for others the side effects just aren’t worth it, if your stomach lining is a little on the sensitive side for instance you may be one of those people.

If you do get aching joints don’t just fob it off as getting older, be open to the possibilities and try them enough times to show some results.

Please remember to massage your “good side” too, when you are limping it adds to the wear and tear of the good side. It is common for knee and hip replacement patients to have a second joint replaced in fairly quick successuion so make a point of looking after both sides.

Frozen Shoulder

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In medical literature Frozen Shoulder’s proper name is Adhesive Capsulitis, as the name suggests the shoulder joint develops adhesions inside it that interferes with the smooth sliding motion that we  normally take for granted. Frozen Shoulder (FS) is also sometimes referred to as Fifties Shoulder because it’s onset is most commonly experienced by people in the 45-55 age group.

The common wisdom in medicine is that  FS resolves itself after 2 years, which is ok if you are prepared to wait that long. Leaving FS untreated tends to be further complicated by the fact that it usually occurs on the side of the body that you tend to use most. Once FS sufferers start to reach things off high shelves by bending sideways rather than use their other hand, mid back pain and stiffness starts to develop on your “good side” (this is a type of compensatory effect). This gives you an extra problem.

People who regularly stretch their shoulder muscles each day will rarely be taken by surprise with FS, once they feel it start to tighten and lose mobility they know it is time to see their favourite body worker. When treated early FS is usually quickly rectified. If you let it take hold because you choose to ignore the early signs or you just don’t notice it come on because you never stretch your shoulder muscles  FS is a lot harder to get rid of.

Basically if you find it difficult to reach upwards and backwards with either hand you are possibly on the way to getting FS. it is time to get some therapeutic massage, acupuncture or some other form of soft tissue work. Even though FS is a middle aged problem younger people can get it too.

FS is more likely to happen if you have had shoulder injuries in the past, like getting rotator cuff damage from a shoulder dislocation or repetative strain injuries through poor exercise practises (ie- too many push-ups) or chronic cramped work posture.

For many FS sufferers the first time they notice their condition is when they suddenly reach for things they were formerly able to grasp like an umbrella on their car’s back seat, a hand rail descending stairs or putting coats and pullovers on.

Basically if you notice your shoulders start to tighten do something about it sooner rather than later, it may save you much expense and annoyance later on.

Sometimes your FS occurs as an isolated problem, other times it can happen as a part of something bigger, like PMR (polymyalgia rheumatica) which can effect all your joints.  Stretch regularly and act early. 

Carpal Tunnel Syndrome (weak and tingling hands)

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Carpal Tunnel Syndrome (CTS) is a common health complaint, it’s symptoms include hand weakness, tingling, numbness and pain.

CTS manifests most commonly in pregnant women and people who work in  manual occupations such as brick layers, chefs, musicians,carpenters and plumbers. In the case of pregnancy women’s bodies contain extra blood (for the foetus) and this extra blood volume marginally dilates the veins and arteries thus increasing the pressure through the carpal tunnel which is the inner passage way in your wrists that contains the nerves and blood vessels that enervate and provide blood to your hands.

In the case of those who have highly manual occupations and passtimes it is the sheer repetition and effort with which they use their hands that causes a prolonged fluid build up in their wrists that does not fully subside even hours (or days) after “downing tools for the day”. Whether your CTS is because you are busy or pregnant you may wake in the middle of the night with an intense pulsating throb in your hands that vigorous shaking can relieve and the treatment of CTS is identical in both groups, that is surgery if you see a doctor and massage and acupuncture if you elect to have this problem addressed by someone such as myself.

CTS is not always a clear cut thing to diagnose and treat because  muscular stiffness and “pinched nerves” in your upper spine and arms can contribute to it, sometimes in a minor way and sometimes substantially. In the case of taking the surgical option this then becomes a job for a neuro or spinal surgeon rather than a hand surgeon (and occassionally both!).

The good news is if you are pregnant with CTS it will probably go away immediately after you have your baby,  for all you workers who get it, unless you change jobs or have a long holiday the symptoms probably won”t go away and if left untreated will probably worsen.

Over the years I have successfully treated CTS on numerous ocassions working those muscles from the neck to the hand, as the muscle stiffness subsides so too do the symptoms of the CTS, stretching exercises between treatments further enhances results and help to prevent a return of the symptoms once it has been brought under control.

If your CTS gets really bad and you want a rapid result surgery may be a tempting option (so long as you can fully rest several weeks while your stitches heal), at a comparable (or cheaper) total cost you might like to try the acupuncture and massage option that will not impel you to take several weaks off work.

If you suspect that you have CTS and you have the time and patience for it, using Self Massage can reduce it’s symptoms. You also need to review your work practises, maybe there are easier and less manual ways of going about things in your daily life.

Occasionally (or in conjunction with the more usual causes listed above), you may be a “fist-clencher”, if others complain that you turn your taps off too hard  in your home or at work, your problem may be that you do not process stress so well, this is something you may need to give further thought to.