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Why WebMD's diagnosis of Carpal Tunnel is Wrong

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Every year, over three million cases of carpal tunnel syndrome (CTS) are reported in the United States (Mayo Clinic). True CTS results from irritation or inflammation of the median nerve as it passes through the tunnel in your wrist. This tunnel is a narrow passageway of ligaments and bones at the base of your hand. Pressure can build up in this tunnel, resulting in numbness or tingling in the hand. Continued strain can lead to severe pain in your wrist, making work and daily activities uncomfortable to accomplish.

However, symptoms such as numbness, tingling, and wrist pain are oftentimes resulting from musculoskeletal dysfunction (meaning: tight muscles), and not true CTS.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed.  The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally in the forearm and arm.  CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed upon.

Many cases of Carpal Tunnel Syndrome are misdiagnosed for several reasons.

  • We don’t truly understand the causes of Carpal Tunnel. It seems to be aggravated by overuse and strong evidence that by correcting daily movement you can make significant improvement.

  • While the Median Nerve is implicated in CTS, it actually begins from the spinal cord and rooting through your neck and out almost every vertebrae before running down towards your fingers.

  • Given that the Median Nerve crosses many muscles on the way to your fingers. It’s no wonder that any number of factors might cause CTS-like symptoms like a tight muscle in your neck or shoulder may cause “tingling” in the fingers. And while it’s similar it isn’t necessarily CTS.

  • It goes misdiagnosed because most doctors aren’t necessarily well versed in understanding soft tissue related dysfunction. This leads to a general diagnosis of “tendonitis” which often will call for you to rest.

    • Do seek a second and third opinion if the doctor wants to inject you or schedule you for surgery.

Fortunately, carpal tunnel-like symptoms can often be easily managed with soft tissue work performed on the scalenes, pec minor, coracobrachialis, and several other upper extremity adhesion sites at the cervical spine.

Two very common suggestions to relieve CTS are cortisone injections in your wrist, or surgery to cut the transverse carpal ligament to release pressure.

While it may seem like a quick fix, I am strongly against cortisone injections as they have been shown to speed up degeneration of damaged ligaments and cartilage.

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Do I Have Carpal Tunnel Syndrome?

Many cases of CTS are often misdiagnosed but can be resolved with soft tissue work and improving every day movement. The following tests will help gauge if you should seek help from a medical professional:

1. Phalen's Test

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  1. You can perform this seated or standing.

  2. Passively let your wrist flop into a flexed position as shown in the diagram above.

  3. Hold this position for 60 seconds or until symptoms are reproduced.
    Positive response: numbness and tingling occurs on the palmar aspect.
    Negative response: 3 minutes passing without symptoms reproduced.

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(The two hand version above is an alternative way to test, though I prefer the one hand version.)

2. Tinel's Test

Tap where circled

Tap where circled

  1. Lightly tap over the median nerve as it passes through the carpal tunnel in the wrist.

  2. Follow your index finger from the tip, then down the palm and up the forearm looking for any sensation.
    Positive response: A sensation of tingling in the distribution of the median nerve over the hand or in the thumb or first 3 digits.
    Negative response: no sensations.

If either test returns positive, I recommend seeing a doctor. If both tests return negative, great! You most likely do not have CTS and can relieve symptoms without surgery.

What to do if both tests return negative:

1. Correct Your Posture

Great little infograph from The Art of Manliness on standing posture

Great little infograph from The Art of Manliness on standing posture

  • Focus on sitting up straight, shoulders neutral, and keep the chin in and head straight. By making sure you're sitting and standing upright, it will take the tension of the muscles that might be causing your CTS-like symptoms in the first place.
    Releated: Thoracic Spine and Breathing to help unlock better posture

  • Keep your wrists in a neutral position, not bent backwards. This can help prevent a lot of the tightening of the muscles which can possibly entrap a nerve.

2. Stretch

As stated above, something as simple as poor posture can give you CTS-like symptoms. Here are three main areas of the body and their stretches to relieve poor posture:

  • Upper shoulders and neck (upper trapezius, levators, SCM, scalenes)

  • Upper chest/shoulders (pectoralis major and minor, serratus anterior)

  • Forearm (numerous muscles, including pronator teres.)

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Upper Shoulders and Neck (Trap) Stretch: 

  1. Reaching your right hand down at your side towards the floor, let your head tip to the left.

  2. Slightly vary the angle of your head to feel different versions of the stretch.

  3. Hold this to each side for 15-30 seconds and repeat 2-3 times per side.

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Chest and Shoulder Stretch:

  1. Standing up straight with a tightened belly, reach your arms straight out to your sides at shoulder height (as seen above).

  2. Move your arms straight back as far as they’ll go without arching your back. You can do this with assistance from a doorway or wall to help your hands move back.

  3. Hold for 10-30 seconds, without pain. Repeat 2-3 times.

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Forearm Stretch:

  1. With your right arm held out in front of you, use your left hand to stretch the wrist stretching the hand up (shown above).

  2. Hold each for 15-30 seconds, 2-3 times. Repeat on other side.

3. Manual Therapy & Corrective Exercise

In conjunction with the improving your posture, wrist position, and stretching, manual therapy from a Licensed Massage Therapist can greatly relieve CTS-like pain. After finding and relaxing the contracted muscles in the above mentioned areas, corrective exercises are performed to offset any problems associated with poor posture and poor breathing patterns.


Has a doctor suggested wearing a wrist brace for extended periods of time (all day and all night, even when you're sleeping)? Restricting wrist movement isn't a solution and doesn't address the true underlying problem.

If this sounds like you and the tests above show you don't have true carpal tunnel syndrome, schedule a consultation in person or online and get rid of your tingling, numbing, debilitating wrist pain for good.

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Fad Diets

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Fad Dieting

"I've tried everything, I lose some weight but when I go back to eating regular food I regain it all back."
  • I only eat veggies and drink water for two months.
  • Detox juices
  • The Blood type diet
  • Cabbage soup diet
  • Paleo diet
  • Cucumber and milk
  • I only eat fruit 
  • Drink this tea and lose weight

These are all examples of fad diets. Some better than others but really what they all have in common is that they tell you NOT to consume certain foods for the sake of maintaining a specific "diet". 

What is a Calorie?

A Calorie is chemistry. It is the measure of energy stored in food. More specifically the amount of energy it takes to raise the temperature of 1L of water by 1 degree Celsius. Food energy is turned into eat which is how we measure what we understand to be food calories.

Science and Your Body

70% of weight and body shape is hereditary. This is where we get body shapes like the ones below. 

Photo Courtesy: Precision Nutrition

Photo Courtesy: Precision Nutrition

However I believe that while you may be predisposed to a certain body shape it isn't an excuse to blame your parents for why you can't lose weight. No matter your body shape there's no reason you can't look the best YOUR body can be. You can lose some weight on any diet, but it comes right back on if it wasn't built upon proper nutrition habits. 

Psychological Aspect of Weight Loss

John goes on a diet to lose weight. And he is able to lose 10 lbs in 3 weeks. John proceeds to tell everybody how great his diet was. He gives full credit to the diet. The problem is John proceeds to go back to his usual eating habits and regains the weight. Instead of blaming the diet, he blames himself.  Does this sound familiar?

Often times these diets restrict and cut out a large macronutrient. That alone will force weight loss, albeit mostly water and glycogen stores. The diet had very little to do with the person's success and now it damages the individual's psyche because they don't believe they're able to succeed. And that alone is large enough of a reason to not entertain trying these types of diets. 

Many fad diets have little science to back-up their crazy ideas and claims. This is why the results aren't what you're hoping for. Just because something works for someone else doesn't mean that it works for you. When you're looking to lose weight like getting a thinner waist or smaller thighs, your body doesn't know that's all you want. Metabolically speaking, it adjusts and when you continue to consume the same amount of food you ate to lose weight; you stop losing weight. In the same way that exercise needs to be progressed so too does your nutritional protocol. 

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The Best Workout For Your Butt

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What I want to lay out for you is the framework for a program you can alter accordingly based on how you're feeling and what you see staring back at you in the mirror. 

I'll outline a few guidelines and you can increase weight, reps and exercises as you see fit along with the rationale for why.

Progressive Overload

This is the concept that you're continually be trying to get your body to adapt to the stresses you're placing on it. It's a key component to both growing a muscle and decreasing body fat to improve muscle tone.

When discussing progressive overload, it's about building strength. You want to build strength because:

  • Stronger muscles are generally larger muscles
  • Strength gets rid of nagging pains (I.E: Nagging low back pain)
  • The stronger you are the heavier your rep work will be (more on that in a moment)

Getting Your Reps In

After the main strength component will be more targeted repetition work. Think of this as supplemental work to the squats, deadlifts, and thrusts you'll be doing. Often this includes things like lunges, step ups, and squat-deadlift variants. Even here we still want to be moving the weights in an upward trajectory albeit not as aggressively. 

Targeted Glute Work

You'll be performing some sort of glute work EVERY SESSION. This is a concept borrowed from High Frequency Training. Short band exercises will be included every time. Skip the abductor/adductor machine, band work is a superior option since it will maintain structural balance of the joints and muscles.

Program Overview

Day 1: Main Strength Day + Rep Work

Strength will be a Squat, Deadlift or Hip Thrust in a progressive manner. The numbers listed below simply mean a percentage of your one reputation max. You would test then plan your month accordingly. Your warm up sets DON'T COUNT towards the 5 work sets.

For example lets say your 1RM is 200lbs.
You warm up: Barbell-5x, 55lbs-5x, 80lbs-5x, 100 lbs-5x, 125lbs- 5x. NOW you perform 5 sets of 8 at 70% which would be 140lbs.  

  • WK 1: 5x8 @70%
  • WK 2: 5x5 @75%
  • WK 3: 5x3 @80%
  • WK 4: 5x2 @85%

Rep work (5 sets of 8-12 reps) can entail:

If you Squatted: Reverse lunges, step ups, front squats
If you Deadlifted: KB Swings, cable pull throughs, Romanian deadlifts

Afterwards you would perform a superset (back to back) of core and a side lying clamshell (3-5 sets of 15-20 reps). 

Day 2: Main Thrust Day

Today you'll be performing a lot of prone hip extension movements. If you're someone who's happy with the size and shape of their legs I would opt for the glute bridge over a hip thrust.

I would treat it similarly as the squat and deadlift strength days where I'm progressing clients through the rep ranges while simultaneously increasing the weight on the barbell. The one difference would be the final set or two. 

EX: 5x10 Hip thrust @70% of best thrust. 
185lbs- 5 sets of 10 repetitions. 

On the final 2 sets of 185 lbs I would perform a hard long isometric hold at the top squeezing the glutes as hard and as tightly as possible.

Now where the real magic happens: perform 2 more sets decreasing the weight about 30-50% for no less than 20 repetitions. Even better if performed as a continuous hip thrust.

Supplemental Work: I would include MORE thrusts or bridge variations like single leg and stability ball leg curl+bridges along with a seated band abduction for no less than 20 repetitions.

Day 3: Unilateral Day

This day would include split squats, Bulgarian lunges and reverse lunges. These days will often be a variation of 5-8 sets of 8-12 repetitions each side.

I would then include a superset of side lying clamshells with frog pumps (4 sets of 20) and core work. 

Day 4: Power

This day you can pair however you like:
Squats + Vertical Jumps
Deadlifts + Broad Jumps
Thrusts + Swings

I'd keep the weights more conservative on this day, your goal is to get a good pop from the weights and train explosiveness. 

Afterwards I would include more band work: Seated band abduction into bodyweight weight hip thrusts off the seat (5 sets of 20) and core. 

Notes:

  • You should perform some sort of upper body pulling every day, examples include: Rows, pulldowns, inverted rows, and chin/pull ups. 
  • 2 days of upper body pressing, examples include: Push ups, dumbbell bench presses, dips, landmine press variations, dumbbell overhead press
  • Core work should include: rollout variations, paloff presses, side planks, planks, and offset loaded carries like a one arm farmers walk. 

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Personal Training and Massage

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Walk through your local gym you'll see dozens of personal trainers stretching their clients. No doubt this has been going on forever, but is technically outside of the personal trainer's scope of practice.

Scope of Practice- Procedures, actions, and processes that a healthcare practitioner is permitted in undertaking. 

Scope of Practice for Personal Trainers (according to NSCA)

 "Developing and implementing appropriate exercise programs, assisting clients in setting and achieving realistic fitness goals, and teaching correct exercise methods and progression.” 

Nowhere in there does it mention any sort of muscle manipulating techniques.

Ouch That Hurts

Hey can you move back to that other spot...a little lower....YEAH! OUCH! You got it. 

This was a typical exploratory palpation session with clients whenever they were unable to release muscle on their own and so it made sense for me to get it out for them so we could get back to training. When I started doing bodywork I had already been a trainer for over 5 years and was decently versed on anatomy and biomechanics.

This all is a rationalize for what I was doing, which was outside the guidelines of my liability insurance and scope of practice. The results I got were positive across the board, but I also knew I wasn't allowed to do what I was doing. The more injuries I would encounter, the better I got at feeling healthy tissue and fibrous restrictions in the fascia and muscles. Though in the back of my mind I knew what I was doing was illegal.

I observe dozens of coaches, many of whom I see jam their elbows and fingers in areas where they shouldn't be. And not because now that I'm a manual therapist I'm on my high horse but because they're actually pressing down, rather hard I might add given the discoloration of the skin around said area, into a place where there's way too many nerves or organs.

Pot Meet Kettle

I will never tell any other coach they shouldn't be placing their hands on their clients, because that would make me a giant hypocrite. I do however advise these coaches to exercise ALOT of caution. In an effort to add value to sessions coaches range from the harmless assisted static stretching to downright dangerous let me dig my elbow into your anterior triangle. 

What I've Learned

I Didn't know WHY only how
A Manual therapist, massage therapist or LMT has undergone more extensive training than personal trainers where it pertains to understanding of how and more importantly WHY to work in a given area. They learn more manual muscle testing and specific assessments to address movement compensations. I could copy a technique but didn't fully grasp the methodology behind it.

Most trainers who perform assisted soft tissue via foam roller, ball or roller stick think: harder is better. It's not.

Getting work done on you doesn't in turn show you how to treat your clients
Copying a given technique performed on you might help YOU, but could injure your client. In the same way you wouldn't give a 65 year grandma the same exercise protocol a 25 year old would receive, the same goes for soft tissue manipulation. In the past I've seen coaches receive a quickie treatment only to see them performing the exact thing on their clients that same evening.

I hadn't earned the right to put my hands on clients. Trainers are not therapists.
Many colleagues who are both manual therapist and trainer had to juggle massage therapy school and a full slate of clients at the same time. Depending on where they're located, schooling can range from 500 hours to over 1000 hours. And while this may be a lot or a little depending on how you look at it, it's a large commitment for anyone with full time obligations. 

Trainers are not physical therapists. Most of the corrective exercises seen today don't work because the coach implementing them lack an understanding that the issue needs both manual therapy and corrective exercise.

I of course will not fool myself thinking that I am anywhere near the level of a DPT (Doctor of Physical Therapy) either. I always had a firm grasp on anatomy, or so I thought. I came to see that I lacked a comprehensive understanding of:

  • Origin and Insertion sites
  • Layers above and below muscles
  • Feeling the difference between muscle and organ
  • Progressions for treatment
  • Contraindications with degenerative and acute diseases or injuries

I understand now I had not earned the right to put my hands on a single client because I had not committed to fully understanding the topics above. I had not put in the time, literally. I thought because I could recite muscles and actions off the top of my head that I could manipulate muscles. I was wrong. On one hand all the clients I've helped has allowed me to get a head start on my education in treating soft tissue restrictions but I also understand I probably shouldn't have ever laid a hand on a single person, no matter the outcome. 

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3 Reasons Your Lower Back Hurts That Has Nothing To Do With Your Back

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Lower back pain is something most of us will deal with at some point in our lives. You bend over to pick up your kids or tie your shoelaces and BAM! out of nowhere your back goes out. An overwhelming number of low back injuries stem from chronically poor body mechanics and even more likely from poor everday posture.

If you’re reading this on your phone, take a moment to sit up straight and pull the phone up so your neck isn't being cranked downwards.

Here are three things you need to know about back pain:

1. Back Pain Worse After Standing- Extension Based
 Back Pain Worse After Sitting- Flexion Based

For those who suffer from extension based back pain this is likely caused by: Short Hip flexors, poor glute activity and a lack of anterior core stabilization. The combination of weak glute function with shortened hip flexors often leads to lumbar extension substituting for hip extension during activities such as deadlifting, jumping, and running. Put simply if you aren’t putting your glutes into it, you back will be. 

A sure fire postural sign a person is a candidate for extension based back pain is viewed from the side via anterior pelvic tilt, or the back of your pelvis is higher than the front.

I meant to take a buttfie

I meant to take a buttfie

Flexion based back pain often afflicts those who sit for long periods of time like office workers or truck drivers. The main muscle that creates problems for these individuals is the Psoas. This is the only hip flexor that remains active once you draw your leg up above 90 degrees. Those seeking hip flexion like during a squat will get lower back rounding instead. Their problems are aggravated by a host of other factors such as: Poor glute function, cervical spine positioning, lack of thoracic spine extension and poor anterior core stability.

Someone with this type of back pain is in a catch-22. They need to stop sitting so much but they likely sit a lot due to work. For this individual I would recommend setting a timer to periodically stand up and stretch to break up the monotony. Along with taking time each day to use a foam roller or lacrosse ball to break up any soft tissue adhesions formed in the hip flexor muscles.

2.     Not All Back Pain is Due to “Tight” Hips

From an anatomical standpoint the hip flexors are a combination of muscles: illiopsoas, sartorius, and rectus femoris.

Lets focus on the Psoas.

The psoas attaches through the side of the lumbar spine and connects to the discs in the area of T12-L5. Because of this vertebral origin point, the psoas is also involved in 360 degrees of spine stabilization.

For those who believe they have chronically tight hip flexors, stretching them isn’t going to magically solve the problem because the underlying cause may not be tight hips but an unstable spine and poor core strength. If a muscle is short and tight, stretching it won’t release any neural tone which only leads to it tightening back up afterwards.

Their issues may be solved simply through core and glute activation.

A properly performed plank will solve all that ales you. Not only because by staying in a neutral position will you decrease recruitment of the illiopsoas but also by squeezing the glutes hard you’ll force the muscle to relax due to reciprocal inhibition.

Talking about hips and glutes leads me to the final point

3.     Poor Internal-External Hip Rotation

A quick screen for both:

Need Internal Rotation 35 degrees

External Rotation 45 degrees

Less than stellar results?

Corrections:

Need Internal Rotation- Side Plank

External Rotation- Prone Plank

The muscles that resist internal rotation are all located on the outside of the hip. By stimulating these muscles it forces them to all stabilize the spine and possibly allow your hips and core to work correctly.

On the other side of the equation are the muscles that resist external rotation found on the inside and anterior aspect of the hip. All these muscles co-mingle when it comes to core stability. Like in the aforementioned tip, when a properly performed prone plank is performed, the hip flexors are held in a tight stretched position to help the hips and spine stabilize.

Correcting these restrictions can bring relief to those suffering from chronic lower back pain. These screen are the beginning to figuring out if you need more mobilization or simply needed more stability.