♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet. - In our opinion, of course.
- In my opinion too.
Well, that's our opinion, I guess, isn't it?
- Yes.
- Okay. Today, Brad, we're gonna talk about carpal tunnel.
How to avoid surgery with a three step program.
Self-treatment, something you can do yourself.
Doesn't work out all the time.
I've had patients that have definitely,
it's worked for them and they've avoided the surgery-
- Sure. - and that was cool.
So let's start off with
what carpal tunnel is.
- Sure.
- It's carpal tunnel syndrome.
People say a lot of times "I have the carpal tunnel."
- Right.
- Well, the tunnel is a tunnel right in your wrist here
where the nerve goes through.
- Around the carpal bones.
- Right around the carpal bones, which everyone has.
- Everyone has carpal tunnel, two of them.
But what we have here is,
the median nerve is the culprit here.
And that nerve starts up here in the neck, C5 to T1.
- Here, this way so they can see it.
- Yeah. I don't know if you can see any of this, Lonnie.
I can come to you, Lonnie.
Let's come to you.
- We got wheels.
They don't roll, but we got them rolling now.
- We close enough?
All right.
It's not Gumby.
Gumby's not causing the problem here.
We can take this out of his mouth, too.
Open up.
Stop that.
Okay. So you're gonna have a couple nerves coming
out of the neck here
and they go down up over the first rib here.
Cause we're gonna be doing a treatment here
to show you that, comes down to the front of the arm,
front of the forearm, down into the wrist.
- Right, and Bob is gonna come in here
and if I could get my finger right under there, there we go.
And it comes under here through the armpit, if you will.
And they kind of go to the inside of the arm.
- Yeah. - And they start branching off
and the median one will come right down
through the carpal tunnel.
- Why is this so important to know, Brad?
Because quite often with carpal tunnel,
you get what is called the double crush syndrome.
- Mhm.
- And that is, the nerve as it's coming
out is actually getting some stress on it up here.
- Mhm.
- And then it comes down here and it's already sensitive
so that when it gets a little extra pressure down here,
it starts reacting and give you the pain
and numbness and tingling into your hand.
- Right, so we don't only want to treat
the wrist or the hand,
but we wanna look at the... - Up here.
And that's quite often what we'll find,
we treat up here and sometimes this goes away.
- Right.
- So we wanna do both.
- And they're not hard treatments.
- No, they're not hard at all to do.
So let's start off with, and you know,
with carpal tunnel syndrome, what you're gonna see,
the telltale sign is you're gonna get numbness
and tingling into the, generally, thumb.
What's that, the ring?
No, ring finger. - Pointer.
Pointer finger, middle finger.
Half of this finger here, usually.
- Right. - The ring finger.
- Typically not the pinky.
So this one, this one, this one, half of this one.
- Right.
- And that's the telltale sign.
You're gonna get, like I said, numbness, tingling.
If you had it for a long time,
this muscle here actually might start to waste away.
- Right. - You can see it.
You'll look at the two, compare the two,
and one side will be worse than the other.
- Sure. - So, what the first thing
you're gonna try to do,
again, we wanna make sure
that the nerves have plenty of room to come through
and provide this sensation to your hand.
So you're gonna wanna do a chest stretch.
- Okay.
- So you can do a chest stretch.
A lot of times, you just put your hands up
like this and you gotta bring your elbows back,
and that's gonna stretch your chest
and leave room for the nerves to come out.
- Yeah, we don't want to get 'em pinched cause
of tight chest muscles.
- Right. The next one you wanna do is go ahead,
and because a lot of times
people are kind of collapsed like this,
and it squeezes all this up and puts pressure on the nerves,
you're gonna go ahead and stretch back like this.
Brad, you wanna show from the side view?
- Sure. You bet.
And not only that, I did wanna mention, with this stretch,
you're gonna hold it for 20 to 30 seconds
or you could do pressure on, pressure off,
for ten or fifteen repetitions.
- Right. - Okay.
This one, Bob said,
make sure you get your posture good first
and try and get those shoulders open.
Okay.
And then we're gonna do that stretch and lean back.
And actually with this,
you can kind of combine the two as well,
Bob, don't you think?
- Yeah, exactly.
Absolutely. So, you're gonna start off with that stretch,
and then we're gonna go into nerve glides.
And these are very popular and they often work well,
but I really want to caution you
that you want to be very gentle with these.
- Sure. - I think a lot of people
start these and they go, oh, I'm gonna do a nerve glide.
And they start really stretching it.
- Right. - And they fire things up
and then they're all mad at me
and they're gonna make comments
and you have to answer 'em and...
- Right.
- So this is a very gentle thing.
You're not trying to increase the pain.
You're trying to just maybe bump up
and feel the pain slightly when you're doing it.
- Right. - But to do a nerve glide
on the median nerve, what you're gonna do,
let's say this is the involved side, Brad.
- Sure. - You're gonna go ahead
and start off by just putting the hand out like this -
you got my whole arm, Lonnie? -
and you're gonna start bringing the wrist down like this.
Just very gently.
For some people, when they start off with this,
they can barely just go this far
and it starts to feel the symptoms already.
- So just extending the wrist right here.
- Yeah. Now, after a while you might be able to
go a lot further, and that's great.
And eventually, you might even be able to put this
up against the wall.
Can you be my wall, Brad?
This'll be the wall.
- Okay.
- Okay? So now I can go ahead
and stretch it against the wall,
and really, that's when you start to make headway here.
- Sure. - And then the final part
of that stretch is you can actually
even stretch your neck this way a little bit.
Now you're really getting the full stretch,
full flossing of the nerve.
- Right.
So, again, you're stretching a nerve here,
not muscle or tendon.
So it's very gentle.
- Right. Nerve is very sensitive.
An alternative to that, one that you might try instead.
This is the McKenzie technique.
You'll hear us say "McKenzie" quite often,
cause we're big fans of his,
really kind of a pioneer in our field.
- Sure.
- So this is the same thing on this one.
Very similar.
You're gonna just start gently bringing
the arm forward like this.
So I'm stretching the wrist this way,
and eventually you can actually go stretch like that.
- So the elbow is straight.
- Yep. The elbow is straight.
Pressure on, pressure off.
So you're gonna be doing pressure on,
pressure off.
Pressure on, pressure off.
- And let's do it from a profile once.
- Okay. I'll do it from the side.
- Yep.
- So I'm gonna start here just very gently.
- We'll get down.
- We're going like this.
And then eventually, we're gonna go ahead
and put a little pressure on it.
- Again, this is not an aggressive stretch.
You're not gonna be pushing everything
and trying to stretch it like crazy.
- Right.
Do not blame us if you fire things up,
because we told you not to.
- That's right.
- All right.
Brad, we talked about how that nerve comes down
and it goes over the first rib.
Sometimes people even have what we call a cervical rib,
where they have an extra rib.
- Sure. - And that can
put a stress on that median nerve.
So sometimes, with that elevated rib,
what we wanna do is a stretch for it.
The first thing, before you even do the stretch, though,
I wanna make sure that you're not a chest breather.
- Okay. - Some people,
they wanna learn how to do diaphragmatic breathing.
That's kind of a different video,
but with the diaphragmatic breathing,
when you breathe in, your stomach expands, right?
- Your abdomen expands.
- So I breathe in, this comes out.
Now I breathe out
and it goes back in again.
- Chest breathers do this.
And if they're constantly chest breathing,
that moves that rib cage up and down.
It can be irritating that nerve.
- Right.
- That's a minor thing,
but it still can make a big difference.
- That one takes practice,
- That takes practice.
- because we're so, gotta keep the stomach in and tight.
(crosstalk) society.
- So show the first rib stretch, Brad.
- Okay. So the first rib,
it's a small little rib, actually.
It's right in here.
You saw it on the skeleton if you were looking.
- Yep.
- You can take a belt or you can take a sheet.
Doesn't matter.
You're gonna put it -
and this works better on a table,
not so much on a bed -
and you're gonna sit right on it, right there,
so it's locked in.
It has to be long enough to come over the shoulder,
and right where the neck meets the shoulder.
So those big strong guys where they don't have a neck
or a shoulder, whatever,
it's a little harder for those guys.
- Are you talking about me, Brad?
- Yeah. (laughs)
And then you pull, let that shoulder drop down.
- Start with your head up, though.
- Yep. There you go.
Thanks, Bob.
And then pull down.
So you lock in that rib.
- You're pulling that rib down.
- Yep. And then...
- Gently pull to the side.
- And it is amazing what this support really does,
and it's - I can feel that stretch now.
It feels good, Bob.
- With some people, what I do, Brad,
is I actually have them do this first,
and not even do the bend first.
I just have 'em take some deep breaths.
- Sure.
(Brad breathes deeply) - And then I go ahead
and have them go ahead and stretch over to the side.
This one feels good.
I actually, sometimes, Brad, just take my hand,
- Yep. - and I'll push down like this
and I'll go to the side.
Oh, that feels good.
- Right.
- That's just a great stretch to do.
I just, I really like it.
Did we get a five from you yet, Lonnie?
Oh yeah.
Long time ago, probably, eh?
All right.
Now we're gonna talk about positioning,
cause if you do all these things
and you're working at your computer
and you're still typing like this
with your hands up like this,
no matter what we do here,
you're not gonna take away the symptoms.
- Right. - So you wanna make sure
you're positioned correctly at the computer.
The screen should be up high so that you don't go like this.
- Right.
- You want to have it high enough up.
The other thing is...
I actually, what you wanna do
is you want to have your arms vertical here.
- Sure.
- They should not be forward at all.
So I use a lap tray like this, Brad, believe it or not.
And I put my keyboard down here and I go like this.
Now, if you have a drawer or something
where you can put your keyboard and go like this,
you won't need this.
But this is exactly how my arm is when I'm typing.
- And that's what you want.
You want to have it as low as possible and not up here.
- But we also wanna mention, by the way,
a company sent us a couple of these pads.
This is eBoot. E-B-O-O-T.
I'll put it down below, and I'll put a link to it below.
Really nice pad, Brad.
Feel that. - It's gel.
- So we were talking about the eBoot, Brad.
Again, you called it, like, a memory foam.
- Right, and I couldn't remember it.
- Yeah, that's right.
- Couldn't remember that name.
- He loves the joke.
So again, this works out really well.
So you're gonna keep your arms at your side.
This is gonna go ahead and support the wrist,
and it keeps your wrist in neutral,
wrist and hand in neutral.
You don't wanna be like this.
So this, you know, the keyboard's right in front of it.
It's gonna put it in a good position.
- And it feels comfortable, too.
- Yeah. It's very comfortable.
I'll put the link down below.
And it works out really good.
Now this is one that you put
in front of your mouse and gives you support.
I wasn't a big fan of this one.
I just didn't like it.
I don't know.
- Yeah. - But for some people,
I think it would work out really well.
- Yeah. I think so.
- I mean, some of these are a matter of preference
of how you use your mouse and stuff like that.
I could see how it puts your wrist in neutral.
- Yep. I had one patient once,
when she typed she had a habit,
she didn't even know it.
She would tap her wrist on the corner.
- Oh, no kidding.
- Yeah. And it was all this repetition
of really light taps caused a problem.
We put this on there and it really took care of it
and she didn't even realize it.
Just a little side note.
- Yeah. And by the way,
as we're in this section of positioning,
people that any, you know,
if you do a lot of knitting or crochet and stuff like that
where your hand is like this all the time.
- Yeah. Right.
- That's, a lot of that stuff
is what causes the carpal tunnel, you know?
So you're gonna have to hold
off on that stuff for a while.
- Right. - The last thing
I wanna talk about, Brad, is sleeping at night.
Sometimes they recommend wearing a splint at night
because it'll hold the wrist into neutral.
And studies have shown this does have some benefit.
- I'm a big fan of this.
I don't care what the studies show, cause I've had success
with this with patients and my wife uses it a lot.
- Oh, does she really?
- Yeah. And there's a surgeon, a wrist surgeon in the cross
that this is one of the first,
he won't even send his his people to PT,
he's taking business away,
but he'll have 'em wear this first.
And he says he has great success
and they don't even have to have surgery or PT.
- Yeah, cause a lot of people
tend to sleep with their wrist curled.
They put it underneath them.
You wanna avoid sleeping on that side
if you're having carpal tunnel syndrome
symptoms on the right side, don't sleep on that side.
- Exactly. - Crunch it all up.
Avoid sleeping with your wrist curled up.
And if you sleep on your back, even, Brad,
like this, what's nice to do is a lot of times
just go ahead and put a pillow
underneath that arm and support it like this.
- Sure. You bet.
- And then you got that wrist splint on there.
You keep it in position.
- You're supposed to look at the camera.
- Hi!
All right.
Brad, I think that's a fairly comprehensive video.
- Yeah. I think that is.
- And remember, we can fix just about anything but?
- The broken heart, Bob.
- We can fix wrists, even. - Yeah.
- But we can't fix broken hearts.
- We could make a splint for it, possibly.
Wrap it around.
- That's a good idea.
- Tighten it up.
- You're a genius.
- Thanks.