Thoracic Outlet Syndrome

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Your thoracic outlet is located at the junction of your shoulder and torso, it is the internal opening where the nerves and blood vessels enter your arm from your body. Thoracic Outlet Syndrome (TOS) is a condition where the thoracic outlet becomes constricted which creates pressure on the nerves and blood vessels that pass through it. This pressure creates localised pain in your neck, shoulder and upper back accompanied by pain, numbness, weakness and tingling in your arm and hand.

When TOS occurs 95% of the time it is the result of pressure on the nerves in the thoracic outlet rather than on the veins and arteries. The most common causes of TOS are trauma to the shoulder and neck, from poor postural habits and from sport and other activities that  strain the neck.

In the case of trauma a broken collar bone might bend downwards at the fracture line creating pressure on the thoracic outlet. A whip-lashed neck, particularly from a side on impact can create inflammation and swelling that likewise pressurises the nerves, veins and arteries in your shoulder.

When TOS is caused by poor posture and repetitive strain the scalenes (muscles at the side of your neck)  stiffen to the point where they start to occlude the thoracic outlet  thus creating symptoms in your arm and hand.

Less commonly a minor deformity of the vertebrae (bone) in your neck might create TOS taking the form of a false short rib.

The symptoms and causes of TOS are similar in many ways to that of carpel tunnel syndrome (CTS), with the important distinction that CTS can be exclusively a problem of repetitive strain to the muscles of the forearm.  CTS also affects the whole hand whereas TOS affects only the little finger side of your hand.

Sport and other physical activity that requires repetitive raising of your arms above your head can cause TOS, these activities include weight lifting, swimming, volleyball and working above your head as often experienced by plumbers and electricians. Avoidance of these activities lessen the likelihood of getting TOS.

Sitting for long periods infront of your computer screen can give you TOS, always remember that your body is made to move, that is why we have muscles and joints. Doing regular neck stretching exercises can go a long way to protect you from getting TOS.

TOS is described as being positional or static. If your symptoms only occur when you arm is held in a particular position your TOS is positional. If your TOS is constant it is static.

The most effective therapies for treating TOS include osteopathy, chiropractic, physiotherapy, acupuncture, massage and stretching. Avoiding activities that have caused the symptoms are obviously helpful too but if you cannot do this because it is part of your job you are best advised to get regular preventive treatment and exercise.

If your TOS is the result of a deformed vertebrae or depressed fracture of the collar bone you may require surgery.

Rheumatoid Arthritis

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Rheumatoid Arthritis (RA) afflicts approximately 1 in every 100 people, it is 3 times more prevalent in women than it is in men and usually has an onset of symptoms between 40 and 50 years of age though sufferers as young as 15 have been recorded. RA is usually diagnosable through blood tests and like other forms of arthritic disease will not manifest exactly the same in all people who have it.

RA mainly affects the small joints in the body, in our hands, feet and neck but can  affect the larger joints too. RA causes painful swelling in the lining  (synovium) of the joints, often (but not always) producing painful nodules under the skin that can vary in size from a few millimeters to a few centimetres over the bony protruberances of the joints.

RA is an auto immune disease with no definate and definable cause but medical science has establiushed that sufferers tend to have relatives who also suffer from RA. RA is three times more common in smokers, it may be triggered by an immune response to another illness and recent studies suggest that vitamin D deficiency may cause people to be more susceptible to it.

Physical activity is greatly curtailed by a flare up of symptoms which tend to be more intense first thing in the morning for an hour or more. Many sufferers find hot weather particularly distressing and find cooler climates more agreeable. RA increases the risk of cardio vascular disease, anaemia and lung fibrosis.

Part of the difficulty of treating RA is that the drugs used to controll it’s symptoms often have undesirable and confusing side effects. Prednisone for instance can lessen the severity of RA symptoms but prolonged use can cause osteoporosis which can in itself be a consequence of lowered physical activity because exercise is difficult and painful.

In recent times fish oil and krill oil containing omega 3 fatty acids have been found effective in lessening RA symptoms. I have met several people over the years who have claimed that alkaline diets have been helpful in treating their own RA, a therapy that most medical authorities do not recommend whether because they do not think it works or that most people do not have the necessary discipline to strictly follow it.

Gentle massage and joint mobilisation can be helpful in treating the symptoms of RA but. An increasing number of RA sufferers find medical marajuana helpful in making their lives more comfortable which is clearly not a legal option in most countries, for a health practitioner to even suggest it’s use in such places may be a crime in itself.

Meditation can help RA sufferers cope with their disease, it costs nothing and will not make the symptoms worse if it doesn’t work for you.

In more severe cases joint replacement surgery is used when disablement and pain becomes intolerable.

Hip and calf muscles

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The muscles located at the top and front of your hips are your hip flexors (because they raise your thigh when flexed) and work cooperatively together with the  muscles at the back of your calves (gastrocnemius, soleus, tibialis posterior). For this reason when there is a problem with your hip flexors it effects the calves and vice versa.

When you get a hip or calf muscle injury it will usually effect  one leg more to begin with and will restrict how long a stride you can take. This happens because when your hip flexors (muscles at the front and top of your thigh) are stiff they are unable to stretch fully when you move your thigh backwards when you are walking. In the case of stiff or injured calf muscles it becomes more difficult to move your leg backwards and make proper contact with your heel on the ground and they will shorten your stride to.

There is an easy way to check and see if this is happening with you if you are unsure. The next time you walk on a straight path with evenly sized and spaced squares of pavement (see postural tips in book) see if your feet land in equal postions on each pavement square as you walk on, a bit like the games kids play when they are trying not to step on the lines.

If you find (as most will to some extent) that it is difficult to keep stepping in an identical place on each paver with your right and left feet, the chances are that the hip and calf muscles are stiffer on one leg than the other. To begin with there maybe no discomfort in your short-stepping leg atall and if you are lucky you may be able to eventually equalize the relative tensions in your right and left legs through daily stretching exercises alone.

If you ignore your uneven stride and do not use corrective stretching exercises each day you will progressively stiffen further until you do start to notice pain when walking in your hip/groin area and your calf (or maybe even injure them). If you are a regular  runner or stretcher you are more likely to notice a developing problem early on but if you are not you might not know how stiff your leg muscles are getting until you go to sprint across a busy road during break in the traffic.

I have torn my own calf muscles on 2 occassions doing just this and I have known plenty of others who have done this too. It is painful and inconvenient but preventable.

You can do alot to safe guard your own leg muscles from tearing with regular massage and stretching. Your lower back will benefit from these strategies too because your hip muscles join and move the bones in your thigh, pelvis and lower back, infact you may notice lower back pain before your hip or calf feels stiff.

Give it a go today and see if you can easily land your feet in even positions on pavement squares walking at a normal pace, if you cannot it is time to do something now.

Tai Qi

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Tai Qi has been receiving much attention by the American College of Sports Medicine since 2011 because it’s health effects are becoming much better understood. ACSM classifies Tai Qi as a neuro motor exercise, meaning that it improves your balance, agility, proprioception and posture through the Tai Qi method of movement. Previously it was a little hard to categorise, it has elements of strength training and stretching and cardio too so it really didn’t fit snuggly into any one of these categories.

Take a close look at someone who is really good at Tai Qi and try to copy what they are doing. It is very, very difficult to move with muscle control that precise. That is why the same movements are practiced over and over again, just like polishing a rough rock smooth.

The important thing to understand with Tai Qi is that it works best when its postures and semi-circular movements are applied to everyday tasks. Just learning to move with a Tai Qi widened gait really improves stability and balance, learning this way of moving when you are young will make you a better balanced and confident walker as you age. Watch how people change direction as they practice Tai Qi, you will never trip yourself over moving that way.

Tai Qi is much harder than it looks, it strengthens your thighs and improves your posture. Tai Qi can also leave you with a really peaceful feeling after you have done it.

When I was in Guangzhou I saw elderly women on many occasions out with their swords at dawn in elegant “Crouching Tiger Hidden Dragon” like postures. There was no way I could imagine my similarly aged mother doing the same thing and I would love to be that lithe and coordinated now. yet alone when I am their age.

The curved motion of Tai Qi is the strongest way to move for the least amount of effort, it is about moving perfectly. Tai Qi’s lesser known cousin Qi Gong looks less martial arts like but it is very bit as effective an exercise as Tai Qi is.

Many elderly people become risk averse to exercising after a fall, particularly if they get injured which can cause muscle wastage and worsen osteoporosis. Playing it safe sitting rather than walking will eventually weaken your legs and your pelvic floor, causing incontinence as well immobility. Tai Qi can be practiced at home when your not at class, practice it every day for best results.

The young can benefit greatly from Tai Qi too but it is the middle aged and elderly who need it most. The more upright and sure footed we are the less likely we are to fall. When we start to lose  balance and movement control life becomes a much more fearful and restricted place.

Yoga

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Yoga has been around for a long time and there are many different styles, Ashtanga yoga for instance is quite strenuous and alot of it is done standing up whereas Sachananda yoga is more meditative and passive. Within each yoga style individual teachers will go about teaching their classes differently to one another so rather than being fixated on a particular style it is generally more useful to find a teacher who you feel comfortable with. Someone perhaps close to your own age and who is familiar with the type of health and fitness issues that you are subject to.

Where ever you learn yoga it is important that the teacher gives you useful one on one advice and feedback, if you are a nervous beginner all forgotten about at the back of a packed ashram, you will not progress as fast as you will in a smaller beginner-friendly class. It is even better still if you get one-on-one tuition in your own home, it will be more expensive but you will learn much faster. Home tuition is particularly useful if you cannot make it to class or are shy about learning infront of a class full of strangers, it is also good if you have the necessary discipline and motivation to do it by yourself.

If you need to learn yoga as a part of a large group to keep motivated and perhaps to make new friends,  home tuition may be less attractive but whether you go solo or not, practising between lessons will get you the results you are looking for much faster. If you have had a yoga teacher highly recommended to you by someone whose judgement you trust it is a good starting point to find the right teacher. If such guidance is not available to you google where ever is closest and ask about attending casually until you are ready to make a longer term commitment.

The best stretching exercises in the world will not work if your body is too stiff to do them, getting a course of massages, acupuncture, osteopathy or chiropractic will give you a good head start to a more flexible, energised and calmer mind and body.

If you at first do not find a teacher you are comfortable with try another one, there may be a Pilates teacher with a strong background in yoga who may be worth trying. Not all yoga postures (asanas) are suitable for all people, if you have had neck problems for instance or you have a large body headstands might not be a good idea, if you have doubts about doing particular exercises discuss it with the teacher, there are usually several different ways to achieve better flexability using yoga.

Please be patient for results, years of neglect cannot be fixed in a few months. Once you start to get into the right stretching positions and learn to relax into them you will really start feeling the benefits. Compare how a stiff old body moves to a supple young body, it is flexibility that produced fluid motion.

I was once told by an older more experienced nurse that she found that people who had stiff bodies often lacked mental flexibility too…..refusing to do stretching exercise is a good example 🙂