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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.

Lack of Internal Hip Rotation Relates to Low Back & Hip Pain

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Improving internal hip rotation is important for a variety of reasons including:

  • It allows us to go into a deep squat position safely

  • Key contributor to knee and low back pain

  • Poor movement for rotation sport athletes like baseball or even golf

  • For runners, it doesn’t allow the athlete to extend the hip to engage the glute.

Hip IR should be tested in two positions, because different structures can limit your range of motion depending on whether the hip is extended or flexed. The second test is actually a mobilization for improving hip IR if and when progressed properly.

Testing Seated Internal Hip Rotation

Sit at the end of a table, with your knees bent over the side, and hold onto the table itself.

Now internally rotate the hip, without abducting or side bending, which is a sign of compensating with the lower back.

Generally speaking 35 degrees is good in the general fitness population and 40-45 degrees in competitive athletes.

A quick check to see if you may simply have a "lazy" side if one leg has better hip IR than the other. Perform a side plank on the side that's lagging and reassess. It should improve if it's simply an activation problem, otherwise it helps to narrow down the problem to a structural/muscular or alignment (though not very common) problem. 

Mobilizations to Improve Hip IR

Kneeling Glute MOB

  • Set up on all fours with hands under the shoulders and knees under the hips.

  • Maintain a slight arch in the lower back and place your right foot on the back of your left knee.

  • With your back set sit back into your right hip and hold for a 1-2 count before moving back. Perform 5-10 reps on both sides.

Lying Knee Pull Ins

  • Lie on your back with your knees bent and your feet flat on the floor.

  • Exaggerate the width between your feet.

  • Think about trying to internally rotate your femurs which as a result have your knees touch together while keeping your feet on the floor. Hold for a two count and return to the starting position. The stretch should be felt in the hips and not the knees.

  • Perform 8-12 reps before working out.

  • Good for those with muscular restrictions.

Prone Windshield Wipers (TEST #2)

  • Lie on your stomach with your knees together and feet up in the air.

  • Keeping the knees together, let the feet fall out to the sides.

  • Hold for a two count and return to the starting position.

  • Perform 8-12 reps prior to workout.

  • This is great in particular for those with a capsular restriction.

Passive Internal Rotation Stretch

This goodie comes courtesy of Dean Somerset. This is more of an advanced stretch and would be sure to be able to knock out all the above aforementioned ones before using this one to help maintain proper hip IR.

  • Sit at the end of a table or elevated step and lift one leg back into internal rotation as shown.

  • Progressively work your work close to the table, and hold for 30 seconds.

  • Repeat on the other leg.

I hope that this post will help steer you in the right direction to improve your lifts in the gym and your times on the trail.

If you should have any specific questions please shoot me a message and I'll be happy to try and help out. If any of this information was insightful, helpful or funny please share it with a friend!

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I'm All In: What Poker Taught Me About Life and Business

The photo above was taken in 2010 I believe while I was playing in the World Poker Tour LA Poker Classic at the Commerce Casino. 

I used to take playing poker very seriously. I spent countless hours playing out hands in my head, reading forums and books to go along with thousands of hours spent playing online (before it was deemed illegal). My best stretch was when I was 22 and cleared a shade under $10,000 in 4 months during a summer. I was pretty good but I really disliked the unhealthy lifestyle that came with playing for 8-12 hours daily to make a living.

Poker is a zero sum game. This means that in order for there to be a winner, there has to be a loser. And at times the best play was to target those who would exhibit signs of addiction as those people aren't playing a sound game, mathamatically speaking, This is not something I feel particularly proud of but that's the game. 

And while I no longer play to pay my bills there were a lot of lessons I picked up playing cards.  Many lessons that translates over to life and business. Here are a few of them.

Expected Value (EV)

In probability theory the expected value of a random variable is the sum of the probability of each possible outcome of the experiment multiplied by the outcome value (or payoff). 

Simply stated EV (in poker) is the amount of money you can win or lose on your average bet. It's often explained by flipping a coin, which is an example of neutral EV. What are the odds it will be heads or tails? Over a small sample size it's 70% tails, extrapolated over 1,000 or 10,000 flips, it will be closer to 50/50. 

No one, not even the best players win every tournament, let alone every single hand they play. Whether you play well or poorly, you'll win some and lose some. Good players are profitable over the long haul because they maximize their spots when they're winning and minimizing losses when cards aren't running their way. They focus on making good decisions regardless of the outcome.

This rings true in business. If you continue to put yourself in the best position by playing the positive percentage plays, more often than not you'll be a winner. 

Which leads me to the next point. 

You can do all the right things and still lose

This one drove me insane. How can I be an overwhelming 95% favorite and STILL LOSE!!!

Because like in life, you aren't in control of everything so anything can happen. Yes you should've won, you should've gotten that business because you're better than your competition, but a'las they've decided to go with Joe-Trainer instead. That's completely out of your control and you need to accept the cards of life as they fall even if they're not in your favor. Move on to the next play.

Always Moving Forward

Piggybacking off the last point, even if you don't get the business, you can't dwell on it for long. Continually beating yourself up for mistakes isn't going to help you change for the better. It's only a complete failure if you fail to learn from your mistakes.

There were so many times I made the wrong move at the table which cost me tournament wins and money! I was angry/sad for a bit but ultimately I would reflect on what I could've done differently. There's no point in being upset with something that's now in the past.

Learn from the past, be in the NOW, and always be preparing for the future

Bankroll Management

If I bring in $1,000 and spend $900 of it on going out. I'm not left with much else for anything else. Let alone any unanticipated expenses. 

Knowing how to budget your money is an invaluable skip to learn. You need to stay within your means because you never quite know what might happen. In the case of Poker it might be a few dry months where your cards couldn't hit the side of a barn; in life it could be a car accident or broken appliance you clearly weren't expecting.

It goes without saying again: Always be saving and stay within your means so you can weather the bad times. If you take one too many risks, you might play yourself right out of the game. 

Know Your Numbers

What are the odds of flopping a third Ace when you have two of them in Texas hold em?
Odds of flopping a straight?
How about completing a flush on the river if I only need one last card?

I know these numbers off the top of my head like the back of my hand. I'm not rain man, I just memorized them. But knowing your numbers is just as important in business. 

What's your conversion rate for free consultiations to paid clients?
Run any marketing campaigns? What's your CAC (customer acquisition costs)?
What are your food costs? 

You don't need to know these things at an accountant level, but you should know what's going on behind the scenes. Knowing the lingo helps you communicate with experts and understand what's going on in your business. 

In case you were wondering:
Flopping 3 of a kind 8.5:1 or 10.5%
Flopping a straight about 1%
Completing a flush on the river, assuming you have all 9 remaining cards of that suit, is roughly 18%. 

Understanding basic human psychology

Most people have watched high level poker on ESPN and imagine that pros can detect any facial tick or lean which gives them an edge. While this is sort of true, what great players pick up on are patterns. I would often pay close attention to deviations in patterns:

How did they play after losing a hand?
Does that change if it was "unlucky" versus playing poorly? Do they even think that was a poor play?
Are they more talkative when they're nervous? Do they always take a sip of water when making a borderline decision?

It comes down to understanding how people normally act and if or when there's a change, deciphering what it means. When dealing with clients who are resistant to change, knowing how to pick up on non-verbal cues has been an invaluable skill to have cultivated.

Implied Odds

This is calculating the odds of completing your hand and the future bets you would collect if you do. You need to take stock of the percentage chance you have to complete you hand versus the amount of money already sitting in middle of the table. 

Simply stated: Calculating risks is a little more cut and dry in poker since it's all math. But the same basic principles apply where you need to take stock of what an investment of time or money will cost you, and whether or not it's going to be worth doing. If you make decision"x" what will be your return on investment? And how long will it take for you to break even?

Poker is a game that's easy to learn but hard to master. There are only a few of the lessons I've picked up from this game. I believe poker is a fantastic training camp for those looking to cultivate skill necessary for business and critical thinking. 

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Social Media: Where Pros Give Unsolicited "Advice"

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It's late one night and you're scrolling through a social media feed on your phone and come across some friends working out. Like most individuals you might give them a like or comment about how that's awesome or congratulating them on a new accomplishment in the gym.

You go to the comments and see:

"Not hitting depth, smh"
"I'd be careful, your back shouldn't be like that"
"Shoot your hips back more and focus on arching"
"Leg drive! Arch! You'll push more once you learn to do that"

The "Fit Pro" Commenth

You click on the profile of the individual who left one of these types of comments and discover they're trainers and coaches who've decided they know best on how EVERYBODY should train.

Now I'm not talking about the fitness enthusiast who fancies themselves an uncertified trainer because they have a six pack or competed in a powerlifting meet. I'm talking about a true "professional" who puts food on the table training others. These are the guys I have a gripe with. I used quotes because these "pros" aren't very professional. 

Here's why it's a load of bull for one fitness "professional" to call out another publicly on social media.

I'm ACE, NASM, NCSA, ISSA, ABC123 CPT

While you may not agree with what you're seeing, it's also not your job to be judge and jury for all things fitness simply because you passed the most rudimentary of Personal Training certifications. Nor does ripping off someone else's training philosophy and system suddenly make you an expert. As a professional it is your job to help YOUR clients and contribute to the fitness industry. It's easy to move on and not waste your time being the form police. Instead of tearing others down why not be a positive beacon building others up by reaching out. Don't try and hijack someone else's feed by putting them down and trying to show how superior you are and why they or their followers should add you, they won't.

Did it ever cross your mind that the person you're critiquing is the very person in the video, a person who is NOT a professional but a paying customer? Now I know what you're thinking, hey if that coach did a better job the client would be moving better. Heres the problem with that line of thinking. You have no context as to how long this client's been training and more importantly how much progress said client has made.

While you may be watching someone perform a squat to a less than desirable depth or deadlift with a slightly rounded back, you didn't know that the coach wanted the client to be focused on hip positioning today. They're crushing their hip position and in time I'm sure they'll fix that back position as well. This often can be the case for very untrained individuals because they can easily become overwhelmed with dozens of cues and checkmarks. A good coach breaks things down into easy manageable steps. Sharing progress is that, progress and not the final product. Critiquing the technique of a beginner is as ridiculous as over analyzing a T-ball swing, really man what are you doing?!

Social Media Crusader

Here's my biggest gripe I have with other fitness "professionals" criticizing other pros via social media: Your critique can be the sole reason another person loses business and is unable to keep the lights on in their home. Said client may read your comment and decide that maybe their trainer isn't good and decides to stop. While you may think you're doing a service to the industry, all you're doing is a being a jerk. I've meet thousands of trainers, some good and some needing more CEU's, but for the most part they've been good people. Judging others coaching abilities isn't up to you! Who are you to be reaching in and taking money out of somebody else's pockets?! Don't be upset with them, be upset you aren't better at marketing your services to help more people. 

I firmly believe the cream rises to the top. If a coach is good they'll succeed on their own, just like they'll run themselves out of business all the same if they don't deliver results. It shouldn't be because you're planting the seed of doubt into their client's head. Yes sometimes these coaches have their clients performing less than stellar technique on a regular basis but also remember that their poor training only highlights how good you are without saying a single word. 

If you really feel the need to criticize another coach, for all that is good and holy just send them a private message.

Lastly lets stop being lazy with these bot comments and copy+paste DM's. I get you're trying to build up your following but you're trying to do so by being lazy and trying to take a short cut. Some of these comments don't even make sense, I'd ask for a refund for that bot if I were you.

I continue working on my own social media presence, it takes work and if you're a true professional, you'll be working on it yourself. 

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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.