Curing Carpal Tunnel Syndrome

(Median Nerve Entrapment) and Tendonitis

By Malcolm Kogut

Symptoms:

Numbness
Ache
Tingling
Sharp pain

What is a Symptom?
A symptom is not what is wrong but a sign that something is
wrong.
If you are barefoot and step on a nail, pain is the symptom,
the nail is what is wrong. You wouldnt just take an aspirin
to solve your problem, you would take out the nail.
If a cars tires wear out unevenly and faster than normal, that
is a symptom that the alignment is bad. Getting new tires
will not solve the problem.

If your wrist and arms hurt, that is a symptom that your

alignment is bad.
If a tennis player loses a match and smashes his racquet on
the court, the broken racquet is a symptom that his
sportsmanship is bad.
In all of these cases, you wouldnt treat the symptom, but the
problem.

Traditional Treatment
Rest
If you have the time and mental fortitude to rest
long enough to heal, when you go back to doing
the same activity with the same bad habits that
created the problem in the first place, your
problem and pain will probably reassert itself
because nothing has changed.

Anti Inflammatory Drugs

These simply mask the pain. The problem with drugs is that
if you cant feel the pain, you may continue moving
incorrectly causing more damage and be unaware of this
continued problem until it gets so bad that the drugs have no
more effect. Drugs can easily contribute to a downward
spiral.
Pain tells us that something is wrong. Dont
eliminate the pain.

Brace/Splint
These are the beginning tools of a downward spiral.
The body is designed to move. If you hinder natural
movement by isolating a specific part, your body will
have to compensate for the lack of movement and
overuse other parts. Splints treat the symptom and
not the problem while at the same time they create
new problems. Braces are good for broken bones but
not necessarily soft tissue. Pain is good. It tells us
that something is wrong and needs correction.

The body is designed to move sympathetically. For

instance, when you walk, as your left foot and hip
move forward, your right shoulder will go backward.
If you walk with your right hip and right shoulder
locked together, you will develop knee pain. The
problem is the shoulder but your doctor will treat
your knee because that is where the pain or symptom
is. Take heed of the childhood song The toe bone is
connected to the foot bone . . .

Surgery
Before you consider surgery, read my slide about
what CTS is.
Physical Therapy
When considering PT, read my slide about stretching.

Treating A symptom
Think of the pain your foot would be in if you had a
nail in your shoe. If you take off the shoe for a week
(rest) your heel will heal. If you then put the shoe
back on, the nail will just re-puncture your foot.
Nothing has changed.

You can take medicine to mask the pain, you can

even splint your foot (brace) and do leg lifts (PT) to
strengthen the leg. None of these will help after you
put the shoe back on. You have to treat the problem,
not the symptom. Blood and pain is the symptom, the
nail is the problem.
In the case of MNE, CTS or tendonitis, pain and
numbness are the symptoms. Improper movement is
the problem.

Causes of Median Nerve Entrapment

(or Carpal Tunnel Syndrome)
Improper movement
We are taught when lifting heavy objects how not to
bend our backs but lift with our knees. How come
nobody ever teaches us how to use our arms and
hands properly?
Dual Muscular Pull
Our bodies are capable of many movements and just
because we can, doesnt mean we should. See Dual
Muscular Pull.

Over Stretching (warm ups)

There is a myth that stretching "warms up" the body.
What it actually does is create micro tears in the
muscles and tendons so the body's response is to rush
blood to the site in an effort to heal and immobilize
the area of damage caused by stretching. That rush
of body temperate blood gives us the sensation of
"warming up." In actuality we are setting the stage
for tendonitis. Stretching to the extreme range of
motion is not healthy. It would be better to warm the
body than its isolated parts. Olympic athletes sit in
saunas or hot tubs to achieve this.

Sympathetic Movement
Don't do this, but from a sitting position, turn your
head as far back around as you can. Make note of
how far you can actually go. You can mark your spot
by picking an object to look at. You probably only
turned your head approximately 90 degrees. If you
moved to your extreme range of motion, because you
isolated your neck, you probably felt discomfort,
pain, strain or gave yourself whiplash.

Now, working with your shoulders, stomach muscles and hips;

turn from your hips, then add the shoulders, then the neck and
you should be able to see about 180 degrees or, almost directly
behind you. Keep in mind that every motion has an equal and
opposite motion. While turning, if you were turning to your left,
as your right shoulder moves forward, your left shoulder must
also pivot backward.
Don't anchor it. That sympathetic
movement should be natural for most people but it isn't always.
Whenever you isolate any part of the body, you run the risk of
injuring a sympathetic part. If your right and left shoulders don't
work together in the turn, you will not be able to turn as far, or,
you run the risk of straining something. This is how many people
incredulously get whiplash while simply turning their head to see
if there is any oncoming traffic.

Now, stand up and add the knees and ankles to that mix. If
you were looking to the left, keep your left foot anchored flat
to the floor and pivot on your right toe. You can probably
see at a 270 degree angle by turning and using all your body
parts (of course, you could just turn your head to the right).
All those movements as I dictated probably have you moving
at your extreme ranges of motion. You should only turn you
neck about 40 degrees, then your hips aiding you to about
90, then your shoulders about 130, and your ankles and
knees to about 170. Your eyes can do the rest.

Herbs and Nutrition as a Cure

I dont know. If the gasket lining your cars engine
has wear and tear, upgrading the oil quality and
octane of the gasoline you burn may help but wont
solve the problem of the worn gaskets. YMMV. Try
dietary supplements. I hear pectin works. It is still
treating the symptom.
Even if the additional
nutrition helps to rebuild damaged tissue, you may
still be damaging tissue by moving incorrectly.

What is a Dual Muscular Pull?

Hold your hand out in front of you and while
keeping your fingers together, like a little child
wave bye bye. Now abduct your fingers, that
is, spread them out as far as they will go, now
try waving bye bye. Feels awful, doesnt it.
Those are dual muscular pulls. You are using
your muscles to do two things at the same time:
spread out and flex.

When many people play the piano or type, they

spread their fingers out and although momentarily
and often imperceptibly, they are doing these pulls to
their fingers. The same thing happens when you do
the pop gun gesture. Pianists create dual muscular
pulls with their thumbs when they cross it under their
palm. It happens in the forearm when you extend or
curl a pinky or thumb while moving other fingers. It
happens when you raise a single finger high in the air
as instructed to do in the ubiquitous Hanon exercises.
Those movements are all bad.

Fingers are not designed to do the work we subject

them to. Our arms are designed to do much of the
work and the fingers are designed to attend to the
finer details but in unison. Although they are very
flexible, your hand and fingers should only do one
thing at a time. The fingers are part of the hand. The
hand can only move in one direction at a time so all
the fingers should only work in that same direction.
They can isolate but it isnt efficient. That is the
difference between a child prodigy and a life long
amateur. The prodigy has learned to move all five
fingers in one direction at a time. More on that later.

What is Tendonitis?
Within your wrist your long flexor tendons run from the
forearm to the finger tips and on top of your wrist are your
extensors. Hold your forearm with your other hand and move
ALL YOUR FINGERS at the same time (never ever isolate a
finger). Feel the muscles work? Those are the muscles which
move your fingers. Those muscles become tendons which
then attach to your finger bones. They move the bones much
like a pulley. Now lay ALL your fingers across your opposite
wrist like you are taking your pulse but DON'T squeeze with
your thumb. Feel the tendons glide within? Many people
mistakenly think their tiny and weak finger muscles move
their fingers but it is the strong and powerful forearm
muscles.

As the tendons move, they are in a sheath lubricated with

synovium fluid which helps them to glide within. If you
overstretch that tendon, you can tear it and scar tissue can form.
Those scars can adhere to the sheath making it painful to move
since each movement will tear at more tissue. If your doctor
prescribed rest and braces, you will not be able to move properly
and this gives the body a chance to make the scar tissue more
permanent. Think of it like a room you never use and soon,
cobwebs will form in the corners and spread from there. Not
moving also dries out the synovium fluid because your body will
think it doesnt need it. Much like the engine oil in an unused
vehicle will settle to the oil pan below, the lubricant within your
tendon sheath will dry up. This is a perfect example of why
PROPER MOVEMENT PROMOTES HEALING and rest and
splints dont.

What is Carpal Tunnel Syndrome

(Median Nerve Entrapment)?
Your wrist is made up of bones on the top, then tendons, then
your median nerve, and it is all capped off by a sheath called the
traverse tunnel ligament. It is a tightly packed structure with no
room for anything else. When you move your fingers, the tendons
glide back and forth like a pulley system. If you bend your wrist
and move your fingers, the tendons are now grinding down on the
nerve. Using wrist rests for keyboards and letting your arm rest
on a desk when using your mouse are bad movements for your
median nerve since they are putting added pressure on the tunnel
and tissues within. What idiot came up with the idea of wrist
rests?

As a cure for your symptom, a surgeon will cut the

traverse sheath so that there is more room for the
inflammation. This is a great cure for the symptom but not
the problem. Inflammation is the symptom, the problem is
you are probably moving wrong and causing inflammation.
Your surgeon just created more room for your inflamed
tendons. While this extra room will alleviate the pain and
symptom, it also made it so you can inflame the tendons
even more because you think you can now move with
impunity. But dont worry, if you continue to move
improperly you can have secondary surgery in a few years.
Or, you can just fix the movement problem and not have
surgery at all.

Bending the Wrist

If you were playing tug of war with a friend and the
rope was taut, it would just go back and forth
effortlessly through the air with no friction. Now
imagine your friend on one side of a shed and you on
the other and the rope is dangling over the roof and
you play tug of war, you are now sawing, grinding
and chewing into the roof.

If you move your fingers and bend your wrist up, down, left
or right, you are sawing through the median nerve, much the
same as the rope through the roof. This causes tendonitis and
the dreaded carpal tunnel syndrome.
It is okay to bend the wrists but only in the mid range of
motion. Never to the extreme. Read up on Dorsiflexion,
Palmar Flexion, Radial Deviation and Ulnar Deviation.
They are noble capabilities which have a place in our
repertoire of movement but, just because you can, doesnt
mean you should.

Avoiding Dual Muscular Pulls

First let me warn you not to try any of this without
the guidance of an Argus eyed, experienced and
knowledgeable teacher. In the case of piano playing
or typing, there are several simultaneous movements
which need to coalesce into one. If you are devoid
of one of these movements or even executing one of
them incorrectly, you could hurt yourself further as
they all need to work together. I will cover a few of
them here.

Go write on a chalkboard. Notice that you use your shoulder

and whole arm as you write. You don't bend or twist the wrist
but you write and use the arm as one unit. That is how you
need to learn to type, play an instrument or use the mouse.
Never bending or twisting the wrist, not resting it on the
table or some stupid wrist guard. Never isolating a finger but
using arm weight, forearm rotation, forward shifting and
shaping to depress the keysmuch like you did writing on
the chalkboard. Once you learn all of those movements and
apply them to your instrument or workstation, every
movement you make will become effortless and pain free.
You will also heal.

If you have tendonitis, ringing a doorbell can be painful.

Keeping your hand relaxed and all your fingers together, not
extended but with a nice and natural slight curve. Use the
longest finger to depress the button only, push from your
elbow. You will not engage the long flexor tendons at all.
Your bone structure will ring the bell.

If you have tendonitis, depressing the left click button of the

mouse can be painful. That is because the finger is flat and
that weak position places tremendous strain on the tendon in
order to depress the button in that prostrate position. While
in the flat position, the tendon is at its weakest and can easily
be injured. The tendons main purpose is to align the bones
so that they are stacked for optimum strength utility. The
tendons are there to make the bones do the work. Consider
hovering over the mouse and forward shifting onto the
button rather than flatly pressing it.

Look at an x-ray of a finger. There are three bones and then

the knuckle. They are all held together by soft tissue. Each
joint is very powerful when properly aligned. If you
hyperextend the first joint, you lose power. If you fully
extend the second joint, you could hurt yourself. The power
of the finger is in the curve of properly aligned bone joints.
If you were to lay a two by four on the ground and try to
poke something, it would strain both you and the board, and
would not be very efficient. If you were to pick up the board
and poke your object while holding the two by four in the air,
you would achieve maximum strength and stress would be
minimized.

Consider the domed ceiling of a Cathedral Apse. They are

often curved with five or so support columns holding up the
ceiling or roof. This is architectural genius. Now place all
five fingers on a table with the palm arched, like your hand is
a spider on the table. Feel the strength and power of the
position and alignment? Just like the dome of a ceiling.
With both hands on the table you could support a lot of
weight but just because you can, dont.

It is important that none of these fulcrum be broken.

Consider casting a fishing pole. Its flexibility gives
it power. If it were broken and you taped it back
together, it would lose a lot of power and most of its
flexibility. Never break a finger fulcrum. Many
pianists and typists break the first one. This is called
the distal phalange.

Playing the piano is more complicated. When playing the piano,

consider the see-saw. If a light person is sitting on the seat of one end
of the see-saw, and a person three times their weight is sitting opposite
but closer to the center fulcrum, the light person will be heavier and
have the advantage. Try it. The key on a piano is lightest on the end
and heaviest in the black area. The dilemma in trying to play on the
end of the keys is that the fingers are different lengths so this requires
an in/out motion with the whole arm while forward shifting into the
keys with a straight wrist. The arm places the fingers where they need
to be, rather than the fingers dragging the whole arm where it wants to
go or contorting to fit some position. Some pianists and typists will
equalize all their fingers so that they are all touching the keys at the
same time. This adds tension to the muscles which may not be readily
noticeable but can cause fatigue, aches and will definitely hamper
technique. If your hands or arms are sore or ache after playing, there is
something wrong.

Think of equalizing the fingers this way: If five people of

differing heights were standing in a room and you lowered
the ceiling so that two or three of them had to bend their
necks and backs, that is what happens when you try to
equalize your fingers. Something will have to be strained.

Bone alignment
All five fingers are equally strong. Many people regard the
fourth and fifth fingers as being weak. They are not. Look at
your hand with your fingers abducted (spread out). Notice that
the forefinger or middle finger is probably in a straight line with
your forearm. That is why those finger are considered strong,
because they are naturally aligned. Now radial deviate just a bit
(bend your wrist toward the thumb). Notice that the pinky is now
in a straight line with the forearm. It now has the power of the
forefinger because all the bones are aligned (provided, you
maintain the fulcrum at the knuckle when you play or type).

There is another movement which must come into play here:

Rotation
Every action has an equal and opposite action. If I were to
swing a tennis racquet, I would back swing then forward
swing to hit the ball (not taking into account the dozens of
other body parts which allow me to do that). To swing a
baseball bat, you stand there packed with coiled energy, then
back swing, then forward swing to hit the ball. Golf,
slapping someones face, swatting a flythey all have equal
and opposite movements.

When playing the piano or typing, our fingers can acquire

tremendous power, effortlessness and speed when rotation is
employed. The pinky, when aligned and rotation is applied
and the knuckle fulcrum is maintained, can set up the rest of
the fingers for their execution when following through from
the rotation. An up movement of the arm is needed too, as
the keys are located down. Applying rotation, up and down,
in and out and constantly adjusting alignment so that the
hand (including all the fingers) does only one thing at a time
and moves in only one direction at a time, will not only
promote healing but is the first step toward effortless
mastery.

The thumb has special needs, too.

Many pianists are taught to pass the thumb beneath the palm
then play down. This is both abducting and adducting at the
same time. It is a dual muscular pull. Not only that, it is
pulling on other muscles which get in the way of what they
are doing or going to do next.
The thumb is very content simply rotating down from the
forearm to play play a key. The arm has the speed and power
to move the hand out of the way so that the next finger can
depress the next key without the thumb crossing under.

Think about the thumb and pinky when you extend them or
curl them up or under. If there was something just out of your
reach and you were going to lean over to grab for it, and I held
your other arm and pulled you in the opposite direction, you
probably wouldnt be able to grab the object. That same thing
happens to the hands when you isolate fingers. A lot of
pianists miss notes or have poor technique because one finger
is pulling in the opposite direction the hand is trying to go.
Just because you can, doesnt mean you should. Over time
this can cause fatigue, aches, injury and definitely hamper
your technical efficiency. This is why some people are
prodigies and other people are not.

Another reason not to cross the thumb beneath the palm is

that the thumb and forefinger tendons intersect. When you
cross under and move one of the fingers, you grind the two
tendons against one another. Just because you can, doesnt
mean you should. Over time this can cause fatigue, aches,
injury and definitely hamper your technical efficiency as it
is pulling the hand in two opposing directions at the same
time. Crossing the thumb under the palm also causes De
Quervain's Syndrome.

Keep in mind, as I warned you earlier, dont try this at home

without the guidance of a knowledgeable teacher. The
rotation must come from the elbow, with gravity and with a
little bit of up motion. But even if you think your are
rotating from the elbow, you also need to apply arm weight
and all the fingers have to move in the direction the arm is
going. Sure, the fingers can go in the opposite direction of
the arm but I wouldn't advise it.

Arm Weight and Up and Down Motion

Many piano players complain about the stiff action of some

pianos. Organists who play on tracker organs face the most
resistance. How come musicians such as Bach were reputed
to be able to play these instruments with blistering speed,
fire and power? Im sure the answer is that their bones were
aligned, they didnt isolate their fingers, they played with
rotation and they employed arm weight allowing gravity to
play the key instead of using their tiny muscles.

It doesnt require an ounce of finger strength to depress a key if

you let gravity depress the key with your arm weight, much like
the aforementioned doorbell. The trick here is to only allow
enough weight to fall on the key to depress itand no more. We
never press into a key. Once the key goes down, it rests on the
bed of the board and can go no further. Pressing not only does
nothing further to augment the tone but you are also moving
downward and you cant move to the next key since the arm
needs to go up to get to it, and you can hurt yourself. When you
stand, you are not pressing into the ground. All your weight is
just there. If there was a low ceiling above you and you pushed
on it to go down, you would only be straining and could hurt
yourself. If you chose to do battle with the key bed of a piano, it
will win. The only pressure that is needed is what is required, no
more. Why press further?

Here are some tips for Healing

Proper movement. Ive already said enough about that.
Contrast Baths. Fill one side of a sink with ice cold water and the
other side with hot water. Soak your arms in one side for one minute,
then soak them in the other side for one minute. Go back and forth
several times. You may have to add more hot water halfway through.
The heat helps promote circulation which rushes tissue repairing blood
to the site of injury and also flushes out toxins, damaged tissue and
acids which may be causing pain, aches and fatigue. The cold helps to
reduce inflammation. If your hands are sore, a contrast bath can help
take away some of the ache and pain. But it is not a cure, it is only
alleviating the symptoms. If this takes away your pain, dont use this
tool as a way to go back to doing something which is harming you.

Deep Tissue Myofacial Massage Therapy

This is not the same as a feel good Swedish massage. The therapist
will locate the scarred tendon and massage it along its fiber and break
up the scar tissue. This kind of massage can be painful and make you
feel like you just got beaten up or had a grueling physical workout.
This is good. Drink a lot of water after the massage in order to aid the
body in flushing out the toxins the therapist just released. It can be
tricky finding a massage therapist who can effectively do this. They all
think they can but only someone who is trained properly and has
knowledge of the muscles and tendons can promote healing.

Woe Is Me
I had tendonitis for two years before I discovered how to
heal myself. During my final six months I was in constant
pain. My arms ached and stabbed with sharp pain with every
movement. I sought relief from several doctors and none of
them were able to help. After only one hour of moving
properly, I was pain freewhich is not the same as healed,
but I was on my way. After a few weeks of moving properly,
I was experiencing painless snapping sensations in my arms
and wrists as the proper movement was helping to release my
tendons of their tethered scar tissue.

Not everyone has the mental capacity or patience to heal

themselves. You must be in tune with your body, willing to
re-learn how to move, you need the discipline to never
perform those activities with improper movement again, and
you need to possess a basic and visual understanding of
physics and geometry. Without any one of those components,
I'm sorry but you wont heal.
The alternative is that there are surgeries, splints, drugs and a
copious assortment of quack nostrums for you to try.

Once you do, you will be able to transpose this skill to

everything you do: Walking, running, hiking, skiing,
hammering, sawing and swimmingif you feel tension
you will be able to analyze your movement and
immediately realign your body for optimal efficiency and
correct whatever was causing the fatigue.
As I said, not everybody has the capacity to heal
themselves. Either they don't have the patience to break
old habits and retrain the body to move differently, or
they just don't comprehend the mechanics of their body.
It is very much like a machine with levers, pulleys and
rubber bands designed to move efficientlyand capable of
moving inefficiently.

I posted a recording of me exaggerating a few of the

aforementioned movements. Take note of the forearm rotation,
the up and down, all the fingers going in one direction at the same
time and the in/out motion. There are sections where my tone
and lines are uneven. My excuse is because I was concentrating
on exaggerating my movements for your benefit. The truth is that
I have much more work to do.
The song is Sweet Georgia Brown and it is located here:
http://youtu.be/ADT5vt4evfc
(If the hyperlink doesn't work, go to YouTube and search for my
channel: malcolmpk88 It will be among the recent uploads.