Conservative Treatment of Repetitive-Stress Injuries: Exercise Is the Key

By Adam Silk, DC

Chiropractic has now reached its 115^th year. During that time, many things have changed, of course, but the mission to get sick people well without drugs has been the course that remains unchanged.

Gone are the days when chiropractors were sent to jail for practicing medicine without a license and scope of practice was limited to cricks in the neck or back pain. The modern-day chiropractor is a primary health care provider, a portal of entry to the health care system, with a plethora of techniques and modalities at their disposal. Today's chiropractor uses a whole-body approach and effectively helps patients with a myriad of health conditions ranging from headaches and nutritional issues to arthritis, musculoskeletal problems and even systemic health issues.

Repetitive-Stress Injuries: A Significant Health Problem

Advancements in technology have brought about an increase in repetitive stress injuriessuch as carpal tunnel syndrome (CTS), lateral and medial epicondylitis of the elbow, and general complaints involving the thumb and hand. Chiropractors have very successfully risen to the challenge of treating these common problems without the use of drugs or surgery; and with the growing lack of confidence patients have taking medications, overuse of anti inflammatory drugs to control painful symptoms, and long recovery times involved with surgery and rehabilitation, patients are increasingly open to other treatments.

Chiropractors are not immune to these health issues, either; the constant pounding our hands and wrists take, along with the repetitive nature of our work, can create CTS-like symptoms at times. Treating these overuse injuries of the hand, wrist and elbow in our patients and ourselves without drugs or surgery should always be the first option.

Resistance and Flexibility Exercises

Directed exercise is the missing link; all conventional exercises force flexion of the hands to grip the weight or machine. In chiropractic college we were told to use rubber bands and do finger extension exercises. Three to five minutes of appropriate exercise helps to strengthen the muscles associated with extension of the fingers and help protect the associated structures of the hand by increasing their ability to handle repetitive stress regularly placed on them. Although it not always possible to correct through exercise alone, this is an effective strategy to help avoid surgery and reliance on OTC medications.

Millions of people suffer each year with tennis elbow and carpal tunnel symptoms. Computer / data entry personnel, dentists and hygienists, auto technicians, machinists, assembly workers, massage therapists, musicians, tennis players, golfers, and yes, chiropractors are all at risk. The common risk factor is the necessity to repetitively grip, squeeze and apply force to closing of the hands in order to accomplish their daily tasks. This repetitive action (hand/finger flexion) required by people in all of the above activities (along with numerous others) perpetuates an imbalance in the relationship between the finger flexor muscles that close the hand and the finger extensor muscles that open the hand. The tendons that affect movement of the hand are long, passing over several joints. The muscle bellies located far away further complicate the relationship.

It is necessary and actually very healthy when there are naturally occurring muscle imbalances among the opposing muscle groups; however as with most things, too much of any one thing can be a problem. In the case of the wrists and elbows, the extrinsic location of the opposing muscles of the hands and wrist are naturally very imbalanced in favor of hand flexion. This imbalance forces the hand to close and squeeze; this hand and wrist flexion puts a near-constant strain on the extensor muscles. Directed resistance exercise and flexibility exercises for the palms help stimulate blood flow and increase the distribution of blood to the distal portion of the tendons involved in movement of the hand, fingers and wrist.

The Chiropractic Opportunity

This is probably not the chief complaint or primary issue that brings patients to your office. However, consider that 60 percent of people over age 55 suffer from some type of hand stiffness, wrist or elbow pain. The problem begins with some muscle cramping or feeling of fatigue in the extensor region, many times going ignored. The more these repetitive activities continue, the risk of injury increases, as the finger extensor muscles rarely - if ever - receive any opportunity for conditioning. (If you think about it, this is one of the few areas of the body faced with this problem.)

You can equate this with the effect gravity has on the spine over time. The constant pushing of gravity, if left unattended, contributes to postural issues over time. The solution, as you know, is as simple as preventative measures such as stretching the front and back of the legs and the pectoral region, inversion traction of the spine, chiropractic spinal adjustments and strengthening the muscles of the upper and lower extremities and back.

When dealing with hand and wrist pain, we must take into consideration that the flexor muscles that close the hands are the workhorses of the upper extremity. This constantly overstimulated muscle group creates an unhealthy dynamic and a major imbalance in the hand. The decreased flexibility in the finger flexors and the reducing power in the finger extensors create instability in the structures of the wrist and elbows. As repetitive forces are applied to these structures, pain and limitations can develop.

As chiropractors, we are well-suited to handle these cases with our innate understanding of balance and openness to comprehensive treatment programs that do not place potentially dangerous pain-relieving medication at the forefront of the treatment program. The real answer is to increase blood flow; this helps to bring increased nutrition to the damaged tissues and optimize the healing process. It can take less than 10 minutes a day.

Certainly there will be patients who will require surgical intervention and anti-inflammatory medication; but in many of these cases it may be as simple as tailoring a strategy that includes rest from the activity causing the problem, applying ice to reduce inflammation, and rebalancing the relationship between the finger flexors and finger extensors, specifically addressing the muscles involved with extension of the digits. Corrective chiropractic care plans including exercise techniques applied to all involved areas of the body while increasing flexibility in the muscles that close the hands will allow the patient to handle greater levels of repetitive motion in the wrist and elbows.

There are a multitude of devices on the market that aid in strengthening the finger flexor muscles; in many cases, the exercises are not particularly unique, as everything we do in life - holding a phone, eating with utensils, carrying packages, driving a car, riding a bike, holding a tennis racket or golf club - provides similar muscle stimulation to make our grip strong.

With about five minutes a day of directed exercises, my hands and wrists and fingers feel almost perfect. The exercises are the perfect balance and work great for me and my patients. I recommend finger extension exercises to anyone with elbow, wrist or hand pain and stiffness. Give it a try; all you have to lose is the pain. Your patients will thank you.