Thoracic Outlet and Carpal Tunnel Syndromes

In this next installment of the Back Pain Series we jump up a little to the upper back and problems associated with tightness and misalignment in this area, and the similarity to the more localised Carpal Tunnel Syndrome.

Thoracic Outlet Syndrome

Most common in women between 20 and 50 years of age, Thoracic Outlet Syndrome (TOS) is an umbrella term to encompass pain in the neck, shoulder and arm.  For this article we will look at non-specific TOS which is usually triggered by trauma to the upper body or repetitive strain/overuse injury.

The pain is usually a dull, aching pain felt anywhere from the neck, through the shoulder to the arm and hand.  It originates from compression to the nerves and/or veins running between the neck and the upper ribs, through the clavicles (collar bones) and down through the armpit.  The compression may occur along any of these points and pain or tenderness may be felt locally at the compression site or radiate down into the arm and/or hand.  This may be accompanied by pins and needles or tingling in the 3rd and 4th fingers, the palm of the hand and in extreme cases a weakening of hand grip.

The pain associated with non-specific TOS usually worsens with activity and improves with rest.  Physical therapies to help release overtight or strained soft tissues can be beneficial as can a programme of gentle stretching, strengthening and using hot and cold therapy.  If poor posture is the cause then learning correct posture can improve symptoms by removing the stresses on the soft tissues.  A postural assessment and necessary correction can also help by realigning the body and therefore reducing the presure on overcompensating areas.

Symptoms of Thoracic Outlet Syndrome are similar to those more commonly associated with Carpal Tunnel Syndrome:

Carpal Tunnel Syndrome

Another repetitive strain/overuse injury, Carpal Tunnel Syndrome (CTS) also presents with pain, numbness, tingling and pins and needles in the hand, thumb and 1st and 2nd fingers.  It is usually caused by compression to the medial nerve in the front of the wrist.  This runs through a small compartment called the Carpal Tunnel and if this becomes inflamed due to overuse it reduces the space for the nerve to pass through and pinches it.  Due to the similarity in symptoms of CTS and Thoracic Outlet Syndrome it is important to check the neck and shoulders on any client presenting with these symptoms even if the pain is felt locally at the hand/wrist.

Rest is often advised for CTS with the wearing of a splint to keep the wrist stable and prevent overuse, however this may in turn lead to loss of muscle and strength in the arm and wrist which can lead to further problems.

Cold packs can be applied to help reduce inflammation of the wrist and massage of the arm, shoulder and neck can help to relax muscles that may also be involved.  Depending on the level of inflammation, gentle massage directly over the carpal tunnel area may also help to release, soften and stretch out the soft tissues that are contributing to the compression.  This can be particularly beneficial in the very early stages before the swelling becomes too bad.

 

As with any symptoms that persist or worsen there is no substitute for medical advice and you should check with your GP if you are concerned about your health.

 

Degenerative Disc Disease, Osteoarthritis and Spinal Stenosis

In this second part of Lumbar problems we are looking at the more serious conditions of Degenerative Disc Disease, Osteoarthritis and Spinal Stenosis.

Degenerative Disc Disease

The term Degenerative Disc Disease sounds frightening and permanent.  However, it is not as serious as it may suggest.  As we get older our spinal discs start to degenerate.  For some people this will result in chronic pain, most commonly in the lower back or neck, yet for others there will be no physical discomfort at all.  The ‘degeneration’ occurs as the disc’s water content reduces and it starts to lose its spongy quality and shrink.  This subjects it to greater pressures from the vertebrae which can lead to tears and the build up of scar tissue.

There is some debate within the medical community as to the actual cause of pain with this condition, with some suggesting that the pain is due to inflammation of the soft tissues surrounding the damaged disc, and others looking more to the vulnerability of the nerve roots in the affected area.  The pain pattern reported is often a persistent low to moderate ‘baseline’ pain with intermittent high pain flare-ups (described as the back ‘giving out’) following particular activities.  Acute episodes can last a few days to a few weeks before settling back into the low level chronic state.  The pain may stay localised in the lower back or there may be pain, numbness and/or tingling down the leg.  This makes it a very difficult condition to identify as the pain pattern can be similar to Sciatica and Piriformis Syndrome.

This seems to be a condition that is more common amongst the 30′s and 40′s age group, and whilst the disc will continue to deteriorate the pain usually does not get any worse over time.

Treatment for Degenerative Disc Disease includes physical therapy such as Dorn Method and McTimoney Chiropractic, both of which gently help realign the spine and rebalance the body to help minimise irritation to the surrounding soft tissues and nerves.

Spinal Osteoarthritis

Osteoarthritis of the spine is a more serious and permanent condition, most common in people over 50. It is associated with Degenerative Disc Disease as the stresses placed on the vertebrae of the affected area can, over time, develop into osteoarthritis.  The under-lubricated joints rub against each other leading to damage of the protective cartilage and the formation of painful bone spurs.  That is not to say however that one will automatically lead to the other.

Symptoms commonly include pain and stiffness in the affected joints which can also lead on to secondary muscular tension and restricted mobility.  Lower back pain is typically worse first thing in the morning aftar prolonged immobility overnight, easing off during the day with normal movement and then worsening again as the day goes on and the joints become inflamed.

Risk factors for osteoarthritis include ageing, being overweight and physical trauma or prolonged stressing of the joints over time. There may also be a genetic disposition.

Osteoarthritis also occurs in the facet joints of the spine, small joints that assist with flexibility and stability of the spinal column wihch can lead to Spinal Stenosis.

Spinal Stenosis

Most common in the over 50′s, Spinal Stenosis occurs when extra bone is laid down as a reaction to physical repetitive stresses on the spine. When this is laid down between two vertebrae and where the nerve exits the spinal cord, then eventually the nerve is compressed and extreme pain on extension is felt .

The name comes from the Greek word  meaning ‘choking’.  In the neck (cervical spine) pain in the arms is experienced due to the nerve compression.  In the lower back this can lead to sciatica and leg pain, which worsens when walking.  The symptoms may fluctuate in severity, easing when at rest or when leaning forward - for example leaning on a shopping trolley to get relief from the pain is a classic sign of spinal stenosis.

Spinal Stenosis pain management includes ice for the inflammation and heat to help relax the surrounding muscles.  Massage therapy is also very effective to help release the muscles associated with back and leg ache.

 

Need a reason for Massage?

In the words of Gerry Pyves, NO HANDS Massage creator, a great reason for having a massage is NURTURANCE!

“From the moment of birth until our death we experience less and less touch.  You could say that our ‘touch quota’ steadily reduces from the moment we are born!

Yet touch is one of the primal needs of every human being.  Safe touch that demands nothing of us is probably the most powerful touch there is.  That is why NURTURANCE is one of the major reasons to have a Massage.  We all need to top up our touch quota.

There is nothing that soothes the mind or soul more powerfully than Massage.  You can take all the therapies in the world and wrap them up in a sack and bung them into the river when it comes to finding anything that comes even close to the rich smorgasbord of touch that is Massage.

Massage quite literally represents a tsunami of sensory nerve stimulation to the body and mind.  As a consequence of so many nerve endings being stimulated at the same time, we experience literallly hundreds of benefits.

Perhaps the most important reason for giving yourself the nurturing power of Massage and touch is simply getting a bit of extra support on this difficult journey called life.  No matter how you look at it, being human is tough.

Massage can soothe your journey.  Every human being needs and deserves the support that Massage can provide on life’s journey.  It’s really that simple.”

 

If you need a reminder of how nurturing a Massage can be, or you want to try it for the first time, book yourself in for a NO HANDS Massage treatment with Natalie at Ananda Clinic.  Click here for more details.

Sacral and lumbar problems

So, continuing with the Back Pain series, we move up to the sacrum – the large flat bone right at the base of your back and then up to the lumbar vertebrae, the five large flexible bones at the bottom of the spine.

The sacrum consists of five bones that are fused together to form a flat, triangular shape.  This is a very important part of the spine as it is a connecting point for the back of the pelvis bones on either side, the base of the spinal column at the top and the coccyx below.  There is little movement within the sacrum itself but each of the joints to the other bones are under a huge amount of stress as they form part of the pelvic girdle upon which our whole upper body is supported.

The sacrum is an attachment point for many of the deep muscles in the buttocks, particularly the gluteus group, the piriformis, the core stabiliser muscles of the lower back and the hamstrings of the back of the leg.  As you can imagine, if any of these muscles tighten and shorten there will be an effect on the sacrum, often a tilting pattern that then puts the lumbar area under strain.

Pain in the sacrum may be a hot, sharp pain or it may feel more a dull ache.  If the pain has been caused by muscular tightness – poor posture or a sedentary lifestyle can be contributors to this – then a physical therapy may be all that is needed to give those muscles a hand in releasing the tight holding pattern they may have got stuck in.  Highly effective treatments include Massage, using a TENS machine or a regular exercise and stretching programme to encourage the muscles to release and relax back to ‘normal’ function.

Sacral pain may also be due to damage to the ligaments that hold the structures in place and keep the attachment points strong.  The ligaments that connect the sacum to the illium of the pelvis – the sacroilliac joint – can be susceptable to the usual soft tissue injuries of strains, tears and inflammation.  Sacroilliac joint pain commonly presents as pain in the very lower back, the buttocks and sometimes radiating down towards the knees.  It may also refer as groin pain in the front of the pelvis.  These type of injuries may be the result of a trauma such as a fall landing hard on one buttock, jarring or occur over time due to a leg length discrepancy or repeated, long term, poor posture.

Again physical therapy plus gentle stretching can be beneficial – particularly Massage Therapy, Dorn Method and McTimoney Chiropractic.

The lumbar section of the spine has to be strong enough to support the weight of the body above as well as flexible to act as a shock absorber during movement, so these five lumbar vertebrae are larger than the rest of the bones that make up the spine.

Due to the extreme stresses this section of the spine is exposed to, it is a common area for back pain to occur.  Muscularly, the quadratus lumborum and erector spinae take a lot of the strain and these often become extremely tight, or hypertonic.  Muscle spasm frequently occurs as a protective reflex and the back ‘locks’ up.  Massage is extremely effective at treating this, especially NO HANDS massage which gently helps these muscles to release at a deep level and find a more neutral holding pattern in their own time.

More serious problems of the lumbar spine include slipped (prolapsed) or herniated discs, spinal stenosis, arthritis, degenerative disc disease, infections and tumours.

Prolapsed discs occur when the disc, which acts as a cushion between the vertebrae, gets squeezed out of place - one article I read described it as being like a burger sliding out of the bun!! – and presses against the spinal cord.  Herniated discs are similar but the strong outer casing of the disc tears and the soft tissue bulges out.  Both can cause severe symptoms – including pain that spreads to the buttocks and legs, tingling or numbness, muscle spasms or weakness – but equally both can present no pain symptoms at all.

The severity of the prolapse or herniation will determine the treatment required – low level prolapse can be manipulated back into place through stretches or physical therapy such as Dorn Method or McTimoney Chiropractic.  If more severe, surgical intervention may be required to repair the damage and prevent reoccurance.

As well as disc herniation and prolapse it is possible for the vertebrae themselves to slip, a condition called Isthmic Spondylothesis.  We are lucky enough to have a guest blog from Caroline who has kindly written about her experience of this, the initial symptoms, the gruelling treatment that followed and finally the surgical intervention and life afterwards.  Caroline has been a massage client of mine for a number of years now as well as receiving regular osteopathy, both of which help manage her pain and mobility.  You can  read the blog here.

In the next installment we will look closer at other pathologies of the lumber spine including degenerative disc disease, arthritis and spinal stenosis.

 

Excellent understanding from a great client!

I received this lovely email from a client following the newsletter on Sciatica and Piriformis Syndrome.  Paul has been coming for regular treatments for a while now and shows a real understanding of the importance of allowing things to heal and repair at their own rate.  As impatient as we might be, we cannot hurry the body’s own processes along and gradual release and realignment can often lead to much longer term results than a quick fix.  Well done Paul, a great client!

 

Hi Natalie,

Thanks for your email.

The Sciatica or Piriformis article is interesting, It seems to make me feel better just knowing where the muscles are and how they work in relation to nerves etc. sort of gives you the feeling of being in the “driving seat” rather than just a victim of random pains!

I think that just knowing these things makes a big difference to how we feel about what’s going on in our bodies, and as I said, gives us more of a feeling of being in charge of them, or at least some understanding of why things are happening.

I’ve been doing lots of the stretches that you mentioned along with other stretches most days now and I am pleased with the results.

I think that was a good thing you said about “gradual progress” when we last met. I was definitely being too impatient and the funny thing is that, along with the massage treatment, since I relaxed about the whole idea of increasing flexibility back to what it used to be the progress has been a lot more rapid.  It seems like I am a good 10% looser now.  Funny how it works isn’t it?

Thanks for a great treatment last time, I felt really good following that and think I have experienced some differences since; particularly last week when I noticed a lot of changes in posture/muscle tension and I am really pleased with how things are going!

Having a great week so far this week, hope you are too.  Looking forward to my treatment on Friday.