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Carpal Tunnel and Golfers By Dr. Jen Milus, DC of www.backsafegolf.com
Over 100,000 people a year undergo carpal tunnel surgery. What can we do, conservatively, ourselves, at home (or on the course) to prevent this? Carpal Tunnel Syndrome (CTS) is becoming more and more prevalent with the computer generation, and increased use of small hand held devices. Someone you know has probably suffered from CTS. It is such a common problem; it baffles me that there is so little understanding among the medical community about its causes. It is linked to several diseases/conditions like: diabetes, gout, thyroid disease, and obesity. It appears to be caused by repetitive motion of the hands, arms and wrist. Many people who have it just happen to do more than one thing that involves heavy use of the area. I have treated a guitar player who rides horses, will stop neither, and getting her better will be difficult. A fire fighter who pulls hose, ropes and dummies and trains with weights is another tough cookie. A golfer who works on the computer at work all day poses the same problems. Any one of these things done alone, intermittently, will probably not cause a problem. Further: playing golf has not been shown as a direct cause of CTS. But, it could certainly contribute. And the hours a pro plays will absolutely have more effect than the 1-2 rounds a week you or I might play. So What Happens? CTS is the result of the compression on the median nerve as it runs through the “tunnel” parallel to the tendons that run the fingers. The wrist bones compress it from one side and a thick ligament can compress it from the other side. Once this area is over used, it becomes enflamed. The mediators of inflammation settle in there, increasing pressure and softening the connective tissue, causing the body to lay down more scar tissue, which irritates the nerves and it becomes a vicious cycle. How does it start? My patients tell me that they get a feeling of tightness and fullness in their wrist and forearm first. This can last from weeks to months. If it is not worked on or worked with at this stage, it will progress. (read below under conservative care). In fact, at this stage, it is not even named carpal tunnel syndrome. It is just a tightness in the forearm and wrist that will likely eventually lead to CTS. The Classic Symptoms if CTS: Numbness and tingling in the thumb, index and middle finger are the usual signs. Some complain their entire hand goes numb. The feelings may come and go from dropping of small object to dis-coordination during small motor tasks (typing, using a palm pilot/phone). Folks may complain of waking with numb hands or pain in the area. Worst Case: Surgery $50,000? I am not a surgeon. But I know some, and they do good work. I personally, would leave this option until the very last. It’s pretty invasive, and everything else should be tried first! The surgical procedure involves a snipping if the sheath that surrounds the tunnel. So, I ask: if you can snip is later, why can’t you stretch it in the early stages when the area first starts to tighten up? I treat conservatively. In the following paragraphs, I will describe some of the things I do/use/recommend. However: I have seen enough cases of this in my life to know when to quite while I’m ahead. I seldom take a case that has progressed to the stage of numbness. If I do, I will only see it for 8 visits. If I see no improvement at all, I refer both to a Physical therapist and to an orthopedic surgeon concurrently. Remember: the longer it goes on, the harder it is to treat conservatively. Best Case: Catch it early! When the tightness starts, and the numbness, pain and dis-coordination have not yet arrived is the time get conservative care. I would recommend trying all of the following before submitting to surgery.
It’s this amazing homeopathic ointment. If you get it on the internet, it’s much cheaper than retail. Apply about as much as you put on your toothbrush 4 times per day for a week, really rubbing it in deeply up in the area where you have pain. http://www.naturalhealthconsult.com/Monographs/traumeel.html
Here’s an amazing tool! This is an inexpensive padded bar about 14 inches long that comes along with an instructional DVD. It was designed by Michael Boorstein of www.wristwand.com. I have used it, recommend it for my patients and feel it’s a great tool to have in your golf bag! Get a second, and have it sitting next to your monitor at your computer work station! Use it at as recommended in the video. Go to this page to read why it works: http://www.wristwand.com/WhyWorks.html There is more information about how it works here: http://www.wristwand.com/Carpal%20Tunnel%20-%20Tunnel%20Vision.pdf Read their entire website- especially the testimonials. Stories are just that. However, these make real sense to me… and I am a REAL skeptic.
And, yes, sadly, cutting back on the time at the range, number of buckets hit, and even the round played per week might contribute to your recovery. If you try this stuff for 2 weeks, and still have problems:
Ease up on the grip during address. Replace old, worn grips. Wearing a glove on both hands might result in more friction between the hand and the club, thus requiring less pressure, along with adding some padding.
Get a recommendation from a friend for a massage for your entire upper body. Make sure they focus on your forearms. Feel free to print this out, and show it to them when you arrive. I welcome questions from you or them at any time. drjen@backsafegolf.com To the massage therapist: You probably already know this; however, if this helps you get someone some relief, then great! Hold the wrist in one hand, palm down, hand and arm relaxed. Flex the wrist in a palmer direction while using the thumb of the opposite hand to strip the extensor muscles up towards the elbow. Slowly flex while working wrist to elbow. Traveling from wrist to elbow should take 10 seconds. Relax the grip on the arm, and straighten the wrist, start at the wrist again, flex and strip, straighten and start at the wrist again. Work for 3 minutes. Flip the arm over, and do the same on the other side, extending the wrist and working the flexors from the wrist to elbow. Now, work from the finger tips up the fingers to the palm… each individual finger 3 times. Do the same on the palm. Work the palm and the carpel area, palm up, opening up the palmer aspect of the wrist. Stretch and open the palmer side of carpel tunnel using your thumbs. Then milk the entire hand, wrist and forearm up to the elbow, then to the shoulder. Each arm should take about 15 minutes.
Use yours or get a referral from a trusted friend. They should be able to adjust/mobilize and either have a massage therapist in their office to do the above, or do it themselves. They may or may not use ultrasound- I would. They may also find something that needs work in your elbow, shoulder or neck. Remember, they are links in a chain. Each area must work fluidly so that the next link up or down stream can do the same. Make sure you find someone you trust and feel comfortable with. A good one will work miracles.
Here’s another neat little gadget to place next to your desk on the mouse side of your computer work station. They make them in right and left handed models. http://www.rajala.com/cgi-bin/catalog.pl?carpel+tunnel|Carpal_Tunnel_Stretch Get well, and get back to golfing! If you or anyone you know has golf related low back pain, please visit my website at: www.backsafegolf.com for more information about how to work with that! Dr. Jen Milus, DC |
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