Pain-Free and Fit with Dr. Ric Alexander

Carpal tunnel syndrome (CTS) is a cumulative trauma disorder (CTD), which is also called a repetitive strain or repetitive stress injury (RSI). Cumulative trauma disorders are currently the number one job related ailments in the United States. They cause almost all lower back and neck problems, as well as the majority of shoulder, knee, foot, and other joint pains. The wrist is the most common injury with the hand being second. By 1995, Carpal tunnel syndrome had increased to 50 percent of all reported job-related injuries. Symptoms include pain, numbness, tingling or weakness in the forearms or hands. Pain is often felt in the wrist, thumb and first two fingers. This is the area of the hand supplied by the median nerve. No matter what your job or how you developed it, carpal tunnel syndrome can be very debilitating. 

There are eight bones in your wrist known as carpal bones. They form a U-shape that has a wide band-like ligament across the top (palm side) known as the flexor retinaculum (a.k.a. transverse carpal ligament). Together they form what is known as the carpal tunnel. When someone uses their hands and wrists excessively, the wrist flexor, forearm pronator and numerous finger muscles receive repetitive stress. This causes a build-up of fibrotic adhesions or scar tissue that makes the muscles shorter and tighter. It is sort of like adding straw to a camel’s back until his back eventually breaks. Of course, a severe injury to the muscles can add a lot of scar tissue at one time. When the tightness in the muscles reaches a certain level it leads to misalignments of the wrist, hand and forearm bones. The tightness also causes tendinitis of the wrist and finger flexor muscles. The increased stress causes the muscles to build up more scar tissue at an ever-increasing rate. 

As the tendinitis progresses and the misalignments worsen, there is eventually enough inflammation and swelling to put pressure on the median nerve that goes through the carpal tunnel. This pressure causes neuritis (nerve inflammation) and neuralgia (nerve pain) in the palm side of the wrist and hand. It also affects normal nerve flow to the muscles that the median nerve innervates (controls). These key muscles involved in carpal tunnel syndrome are now weaker and more easily over-stressed. As they accumulate more damage and become tighter, the CTS progresses more rapidly. 

Many of my patients were misdiagnosed with CTS prior to coming to my office. Most of them had only a simple tendinitis of the wrist, hand, thumb or finger muscles. If a problem is musculoskeletal, when you move the joint or use it, the pain is generally worse. Whether you have minor or acute carpal tunnel syndrome, please check out my instructional video – Treat Your Own Carpal Tunnel Syndrome.  My patients who use my instruction experience major to full relief of their CTS symproms, so now I invite you to take your condition into your own hands.  Feel free to comment and a response will be made!

Manifestation of neuritis occurs the exact same way in which acute and chronic tendinitis begins.

This scar tissue formation as a result of an injury causes muscle to become shorter and tighter than normal.  The increased tension and stress on the muscle then makes it more susceptible to strain during future physical work, recreational activities, or even activities of daily living.  If the muscle is over-stressed or re-injured further, enough scar tissue will form, which results in a muscle shortening to the degree that it can pull the bone it is attached to out of normal alignment. The result is a joint misalignment, which causes a chronic condition to develop over time.  If a tendon receives most of the stress from the joint misalignment, then chronic tendinitis develops. If the bursae around the joint receives excess pressure and stress from the misalignment, then a chronic bursitis develops. If the cartilage of a joint is receiving abnormally high pressure on it from the joint misalignment, then a chronic arthritis condition will develop.  Now, last but not least, if a nerve is stretched or has excess pressure on it from abnormal swelling caused by joint misalignment, then a chronic neuritis condition will develop.  This happens most often when the spinal vertebrae are pulled out of their normal alignment, which is also known as spinal subluxation.

Learn more about the treatment of neuritis as well if you are having trouble with it.

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You can now read the cause of neuritis, but there are five primary factors that determine the severity of the condition.

The first is simply the degree of misalignment in the joint. Obviously, the worse the misalignment the greater the stress or pressure on the nerve and subsequently the more inflammation and pain normally created.

The second factor is time. Usually, the longer a misalignment is present the more stress and increased scar tissue the muscle and tendon accumulates. This is why neuritis often gets progressively worse. As people live, work and play they accumulate muscle damage leading to joint misalignments. As time passes, more damage accumulates. Since many of these imbalances are minor the person doesn’t notice a problem until they are 40 or 50 years old. At that time, they begin to have pain in whatever joints have been misaligned. Most just assume that it’s a natural part of aging and are unaware that a successful treatment exists, so they just live with the pain or use drugs or other treatments that just cover up their symptoms. Unfortunately, as the condition progressively worsens, stronger drugs and more radical treatments are required to deal with the pain.

A third factor influencing the severity of neuritis is the amount of use the affected joint receives. If someone is physically active in their job, sports, exercising or other activities, more inflammation and pain will be created than if they are physically inactive.

The fourth factor is weight. It should be easy to see that weight-bearing joints such as feet, ankles, knees, hips and spine are going to receive more stress in a 250 pound person than in a 125 pound person. Reducing and maintaining a more normal body weight could reduce the pain of a neuritis condition.

The fifth factor comes from the bodies power of adaptation. When a joint is imbalanced the body actually creates other joint imbalances to compensate and reduce stress to the original imbalanced joint. This can often result in pain relief in the original injured area and explains why a lot of therapies appear to have resolved a problem when they really haven’t. Unfortunately, the compensating area will usually develop a problem of its own after a period of time because of the excessive stress it then receives.

When someone does a physical activity to excess, they strain the muscle which was overused. This can happen to a well-trained athlete who is striving to excel, or a retired person who overdoes it working in their garden. This scenario is often seen in the “weekend warrior” athlete who sits at a desk all week, and then goes all out during the weekend with a physical activity like softball or tennis. The resultant muscle strain (mild tear) creates inflammation and pain. This strain usually occurs near the end of the muscle where it attaches to a bone or blends into its tendon. This creates a condition known as acute tendinitis. This condition could also be created if the muscle is strained from trauma.  The usual treatment for acute tendinitis is to rest the area, apply ice periodically for the first 24 hours, and then to use moist heat. Rest prevents further muscle injury, the ice reduces the initial inflammation and swelling. and the moist heat circulates blood through the area to speed the healing process. Now, if you added gentle massage and stretching to this treatment plan the muscle would probably heal totally back to normal.

However, this is not what the average person usually does!  They may ice once or twice and rest a bit, but most often just take an over-the-counter pain medication and continue on with their normal activities. If the strain was minor, their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions, or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.

Formation of scar tissue in an injured muscle causes it to become shorter and tighter than normal. This places more tension and stress on the muscle, making it easier to strain during future physical activities. If the muscle is over-stressed or re-injured further, eventually enough scar tissue will form to shorten the muscle to the degree that it can pull its attached bone out of normal alignment. The result is a joint misalignment which causes a chronic condition to develop. If a tendon receives most of the stress from the joint misalignment then chronic tendinitis develops. If a nerve is stretched or has excess pressure on it from abnormal swelling caused by the joint misalignment then a chronic neuritis condition will develop. This happens most often when the spinal vertebrae are pulled out of their normal alignment (subluxated). If the cartilage of a joint is receiving abnormally high pressure on it because of the joint misalignment, then a chronic arthritis condition will develop. Now, last but not least, if the bursae around the joint receives excess pressure and stress because of the misalignment then a chronic bursitis develops.

You now know the cause of osteoarthritis, but there are five primary factors that determine the severity of the condition.

The first is simply the degree of misalignment in the joint.  Just like our tire example, the worse the misalignment the greater the stress on the cartilage and the faster it will degenerate. If someone has a severe hip misalignment created at age 15, they could have severe arthritic degeneration by age 25.

The second factor is time. Obviously, the longer a misalignment is present the more wear and tear there will be on the cartilage. This is why arthritis gets progressively worse. This also explains why so many people get arthritis in one area or another. As people live, work and play they accumulate muscle damage leading to joint misalignments.  As time passes, more damage accumulates. Since many of these imbalances are minor the person doesn’t notice a problem until they are 50 or 60 years old. At that time, they begin to have stiffness and pain in their knee, hip, fingers or whatever joints have been misaligned. Most just assume that it’s a natural part of aging and are unaware that a successful treatment exists, so they just live with the pain or use drugs or other treatments that just cover up their symptoms. Unfortunately, as the condition progressively worsens, stronger drugs and more radical treatments are required to deal with the pain.

A third factor influencing the severity of arthritis is the amount of use the affected joint receives. If someone is physically active in their job, sports, exercise, or other activities their misaligned joint is going to wear out faster than if they are physically inactive. If you rarely drive your car with the misaligned wheel, the tire will last a lot longer.

The fourth factor is weight. It should be easy to see that weight-bearing joints (those most commonly affected with arthritis) such as feet, ankles, knees, hips and spine are going to receive more stress in a 250 pound person than in a 125 pound person. Reducing and maintaining a more normal body weight will not only reduce the pain of arthritis but will slow the progression of cartilage degeneration.

The fifth factor comes from the body’s power of adaptation. When a joint is imbalanced the body actually creates other joint imbalances to compensate and reduce stress to the original imbalanced joint. This can often result in pain relief in the original injured area and explains why a lot of therapies appear to have resolved a problem when they really haven’t. Unfortunately, the compensating area will usually develop a problem of its own after a period of time because of the excessive stress it then receives.

Feel free to comment!

When someone does a physical activity to excess they strain the muscle that was overused. This can happen to a well-trained athlete who is striving to excel, or a retired person who overdoes it working in their garden. This scenario is also often seen in”weekend warrior” athletes who sit at desk all week, and then over-exert themselves with a physical activity such as playing softball or tennis all day.  The resultant muscle strain (mild tear) creates inflammation and pain. This strain usually occurs near the end of the muscle where it attaches to a bone or blends into its tendon. This creates a condition known as acute tendinitis. This condition could also be created if the muscle is strained from trauma such as a fall. Keep reading, this really is about osteoarthritis.

The usual treatment for acute tendinitis is to rest the area, apply ice periodically for the first 24 hours and then to use moist heat. Rest prevents further muscle injury, the ice reduces the initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. Now, if you added gentle massage and stretching to this treatment plan the muscle would probably heal totally back to normal.

However, this is not what the average person usually does! They may ice once or twice and rest a bit, but most often just take an over-the-counter pain medication and continue on with their normal activities. If the strain was minor, their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.

Formation of scar tissue in an injured muscle causes it to become shorter and tighter than normal. This places more tension and stress on the muscle making it easier to strain during future physical activities. If the muscle is over-stressed or re-injured further, eventually enough scar tissue will form to shorten the muscle to the degree that it can pull the bone it is attached to out of normal alignment. The result is a joint misalignment which causes a chronic condition to develop. If a tendon receives most of the stress from the joint misalignment then chronic tendinitis develops. If the bursae around the joint receives excess pressure and stress because of the misalignment then a chronic bursitis develops. If a nerve is stretched or has excess pressure on it from abnormal swelling caused by the joint misalignment then a chronic neuritis condition will develop. This happens most often when the spinal vertebrae are pulled out of their normal alignment (subluxated). Now, last but not least, if the cartilage of a joint is receiving abnormally high pressure on it because of the joint misalignment then a chronic arthritis condition will develop.

A lot of people seem to believe that osteoarthritis is something that just happens naturally when they get “old”.  The truth is, osteoarthritis is totally preventable and usually curable! Let me tell you a story to illustrate.

A man 80 years of age goes to see his doctor because his right knee is hurting. After the doctor takes X-rays and examines him, he informs the man that he has osteoarthritis in his right knee. The man then asks the doctor what causes osteoarthritis and he replies, “old age”.  The man then says, “But doctor, my left knee is 80 years old too and it’s just fine” – an intelligent and logical response.  The point is that age has nothing to do with whether you get osteoarthritis or not. An acquaintance of mine had a hip replaced at age 33.  He had injured that same hip while playing football years earlier.  This injury created muscular scar tissue that led to a hip misalignment, which then caused the cartilage in his hip socket to wear out by age 33.

Consider an automobile with the front wheels properly aligned and new tires designed to last 50,000 miles. Let’s say that the right wheel hits enough ruts and potholes to throw off its alignment to a slight degree. Now, what will happen? Right! That tire will begin to wear out too quickly because the misalignment places excessive stress on certain areas of the tire. The weight of the car is no longer evenly distributed over the entire width of the tire. After 25,000 miles the left tire will still be in very good condition while the right tire could be totally worn out. This is essentially how arthritis of the hip or knee develops.

Now, consider a woman who injures her right hip in an auto accident or from falls taken while learning to ice skate, or even from accumulated stress of sitting with one leg under the other for many years. Any of these things could injure the muscles of her hip area and cause the muscles to heal with fibrotic adhesions or scar tissue. This causes the muscles to become shorter than normal and to pull her pelvic or thigh bones out of their normal positions. This creates a misalignment of her hip joint. Now, just like the tire, the weight is not evenly distributed on the cartilage of that hip socket. This will cause her right hip socket cartilage to wear out faster than the left. She may occasionally notice a tightness in her right hip during certain activities, but will probably think nothing of it, or falsely assume that it is a natural part of getting old. By age 50 she will start having right hip pain which will progressively worsen as the joint continues to wear out. By age 60 or 65 an X-ray will show that the left hip is still in good shape while the right one is totally worn out. It’s ready for a hip replacement which could have easily been prevented.

Now, let’s go back to our tire example. What if you notice around 10,000 miles that the right front tire on your car is wearing out abnormally fast. You will take the car in and have the wheel realigned. This will stop the excessive wear and tear. The tire will now probably last for 40-45,000 miles instead of being totally worn out at 25,000 miles.

The hip joint is quite similar. What will happen if you notice around age 40 or 45 that your right hip feels tighter than the left and occasionally hurts a little. You could get your hip joint realigned with PMBT treatments, thereby stopping the excessive wear and tear. Your right hip socket cartilage will now probably last well over 100 years instead of being totally worn out by age 60 or 65.

I have studied the human body for over 30 years and believe that our hip cartilage was designed to last 150 or more years.  In other words, it should last well over a lifetime.

You now know the cause of tendinitis, but there are five primary factors that determine the severity of the condition.

The first is simply the degree of misalignment in the joint. Obviously, the worse the misalignment the greater the stress on the tendon and the more inflammation and pain normally created.

The second factor is time. Usually, the longer a misalignment is present the more stress and increased scar tissue the muscle and tendon accumulates. This is why tendinitis will often get progressively worse. As people live, work and play they accumulate muscle damage leading to joint misalignments. As time passes, more damage accumulates. Since many of these imbalances are minor the person may not notice a problem until they are 40 or 50 years old. At that time, they begin to have inflammation and pain in whatever joints have been misaligned. Most just assume that it’s a natural part of aging and are unaware that a successful treatment exists, so they just live with the pain or use drugs or other treatments that just cover up their symptoms. Unfortunately, as the condition progressively worsens, stronger drugs and more radical treatments are required to deal with the pain.

A third factor influencing the severity of tendinitis is the amount of use the affected joint receives. If someone is physically active in their job, sports, exercising or other activities, more inflammation and pain in the tendon will be created than if they are physically inactive.

The fourth factor is weight. It should be easy to see that weight-bearing joints such as feet, ankles, knees, hips and spine are going to receive more stress in a 250 pound person than in a 125 pound person. Reducing and maintaining a more normal body weight will usually reduce the pain of many tendinitis conditions.

The fifth factor comes from the bodies power of adaptation. When a joint is imbalanced the body actually creates other joint imbalances to compensate and reduce stress to the original imbalanced joint. This can often result in pain relief in the original injured area and explains why a lot of therapies appear to have resolved a problem when they really haven’t. Unfortunately, the compensating area will usually develop a problem of its own after a period of time because of the excessive stress it then receives.