I am asked all of the time, is it better to stretch before or after a workout or both? Once in a while I will get the question from people, who cut right to the chase and ask, if I only have time for a small stretching routine, is it better before or after a workout. My answer is yes!

To explain I need to look at human anatomy for the correct answer to the questions. As we use our muscles, tiny fibers shorten (or contract), when we stop using our muscles these fibers relax (or extend).

If we maintain good muscle symmetry or balance, most muscles in our body are equal in size, shape, and function in relationship to each other. This balance is our basic goal but is rarely the case.

Just looking at the average person we see hunched or rounded shoulders (which mean the chest muscles are too dominate compared to the upper back muscles). I treat a multitude of people with low back stains because their hip flexor muscles are too tight and the lower back muscles are too weak.

If we identify our weak muscles and strengthen them more during our workout, this will improve our muscular balance, but we need to take it a step further.

Postural imbalance should be addressed because repetitive sitting will shorten our hip flexor muscles and all we need to do is hunch or round our shoulders repetitively and all of the hard work we have done in the gym to create balance of our muscles is thrown out the window.

To clarify what this does to our body is to make our hip flexor muscles too dominate, along with shortening our already tight hamstrings, which added up strains the low back.

Making matters worst is not sitting correctly. If we slouch when we sit  it puts all of the weight of the upper body on the sacroiliac area. The ligaments that hold the sacrum and sacroiliac joint overtime become weak or stretched. Medical research is starting to show that this prolonged improper posture is being linked to vertebral disc strain which eventually weakens supporting structures of the spine.

All of this can be corrected with a few changes in behavior and bad habits.

1. First, knowing that prolonged sitting is not good for us, try to sit less. If you must sit, stretch your hip flexor muscles as much as possible throughout the day.
2. Second, sit on your ischium bones (sit bones), instead of slouching on your sacrum.
3. Below is an exercise and stretching card I recommend daily that can be done in a few minutes.
4. See if you can find a “better back” yoga class in your area to support your new routine.

After our orientation, we convened in our first breakout session on Optimizing Sports Nutrition by Dr. Ted Lambrinides of the University of Kentucky. Dr. Ted covered poor eating habits in relation to young athletes and everything in between pre, during, and post workouts. One interesting fact I remember was on nutrient timing. He said, when isocaloric diets are compared in athletes, carbs and  proteins that are taken in after exercise rather than either earlier or later in the day were shown to have a greater impact of protein balance.

Next session was on the field with Jim Kielbaso from Total Performance Training. Interesting speaker who demonstrated acceleration mechanics with three volunteers, pushing and pulling sleds and finished with acceleration mechanics into agility training.  Because of Jim’s class I will be able to appreciate  watching the NFL games even more with a better understanding of acceleration and agility basics.

Last up in the weight-room was Strength Training with Ted Rath of the Lions. Thank goodness Ted had two young men to train. The man was brutal! I also found it interesting that workouts are specific to a players position. An example would be that the quarterback does not perform certain shoulder lifts that could strain or over-train an already vulnerable area. I was happy to see this department utilizes Myofascial Release sometimes during the cool down phase.

And last but not least was the highlight of my day talking in dept to Dean Kleinschmidt, Coordinator of Athletic Medicine. Dean oversees the team’s athletic training and medical operations and with a distinguished career as an athletic trainer that includes 35 years in the NFL and three seasons in Division I college athletics.

The day ended with a question and answer period, raffle of fabulous gifts, and sponsor gift bags that every participant received. Thank you Detroit Lions! If you have an opportunity to attend next year, I highly recommend it.

Deep Tissue and Trigger Point Therapy (seated) 

At the base of the head, place the thumb inside of the bump behind the ear, stabilizing the forehead with the other hand. Push up (toward the center of the head). Hold for 8 to 12 seconds, and then repeat on the other side.

An alternate technique is to stand on the opposite side of the body being treated. Push into the starting point with two fingers while stabilizing the forehead with the other hand and have the person rotate their head toward you, while you attempt to keep your fingers stationary.

Rolfing (seated)

Place the wrist on the side of the neck while stabilizing the shoulder with the other hand. Have the person rotate their head away from you slowly as you push with good pressure into the body and glide until your elbow is where your wrist started.

In my clinical experience I have found that the Median nerve may be compressed at a different site in the neck, chest, shoulder, and forearm, or any combination of these sites.

The structures in the neck and chest are major players of compression because this narrow passageway of this region is crowded with blood vessels, muscles, and nerves. Many patients are found to have cervical disc degeneration, Thoracic Outlet Syndrome, or anterior rotated shoulders.

Prolonged and/or abnormal postures can usually be traced back to the cause of many of these conditions, if forceful injury can be ruled out.  

Contributing factors

To be truly effective when treating Carpal Tunnel Syndrome one must look at the list of all possible contributing factors to find the cause and not just treat symptoms.

• Posture – A large number of cases can be traced to a forward head posture, rounded shoulders, pronated forearms, constant flexed wrist position during the day or while sleeping.
• Vitamin B6 deficiency – Pyridoxine is an especially important vitamin for maintaining healthy nerve and muscle cells.
• Pregnancy (edema) – Any condition in the body that would cause fluid retention or swelling could put excessive pressure on the nerves.
• Use of vibrational tools – Vibration Syndrome and Vibration-Induced White Finger, and Carpal Tunnel are major health hazards related to the use of smaller hand-held vibrating tools.
• Long periods of time in cold environments – Poor blood circulation would mean oxygen starved tissue and possibly undue pressure on the nerves.
• Repetitive movements – Do not allow adequate resting time for overworked muscles as well as the surrounding tissue.
• Soft tissue dysfunction – This classification would describe trigger points in the tissue that can send referral pain and lack of blood circulation to an area.
• Misdiagnosis or Lack of information about the condition – A misdiagnosis may include compression of the Median nerve in many areas not at the wrist. Patient education is also a key step in preventing a reoccurrence of Carpal Tunnel.
• Contributing factors that were not addressed – Few health care professionals discuss a list of contributing factors in addition to congenital predisposition and rheumatoid arthritis.
• Denial and taking responsibility for ones own actions – For many, this is most difficult. Knowing a particular action is harmful but continues anyway. An interesting passage titled “An Autobiography in Five Chapters” from the book “The Tibetan Book of Living and Dying” by Sogyal Rinpoche illustrates this point very well.

Prevention

Regardless of a person’s profession the best prevention for Carpal Tunnel Syndrome is to develop body awareness. This awareness helps to stay in tune with the body, so your work will be most efficient, with limited stress on your joints and muscles. This helps us to understand the physiology and warning signs of injury. By having this awareness you should realize that your muscles can be overworked and the stage will be set for injury to occur.  It is also helpful to become aware of our own physical advantages and disadvantages. Develop an exercise and stretching program, and improve your posture.

Self help stretches 

Try these stretches I use daily to retard the effects of overuse. If pain is present, ice massage is helpful in calming down the nerves.

Rubber Band Extension

Place a rubber band around all fingers. Open and close the hand for a maximum of 30 seconds. This exercise strengthens the extensor side and takes pressure off of the flexor side.

Thumb Extension Stretch

Using the index finger of the opposite hand push the thumb into extension to stretch, and then with the opposite thumb stroke the base of the thumb of the outstretched palm.

Wrist Extension Stretch

Put your arm straight in front of you. Make sure that your elbow is fully extended but not locked. Use your other hand to pull up and extend the hand by pulling up the fingers. Pull for five seconds, then release.

Forearm Wringing

Twist the forearm muscles with the other hand in both directions.

Scalene Stretch

Gently bring the ear towards the shoulder, and drop the opposite shoulder. Using the hand, push the side of the head toward the shoulder.

References:

Paul St. John. “Neuromuscular Therapy Pain Relief Seminars-NMT #4”.

Repetitive Motion Trauma Corporation. “Carpal Care”.

Norman Allard, D.C. & Glenn Barnett, D.C. “Carpal Tunnel Syndrome”.

Massage & Bodywork Quarterly, Fall 1993.

 Benjamin M. Sucher, D.O. “Palpatory diagnosis and manipulative management of carpal tunnel syndrome”. The Journal of the American Osteopathic Association, August 1994.

 Mark A. Pinsky. “The Carpal Tunnel Syndrome Book”. Warner Books, Inc. 1993.

 Stanley Hoppenfeld. “Physical Examination of the Spine & Extremities”. Appleton-Century-Crofts. 1976.

 Janet G. Travell, M.D. “Myofascial Pain and Dysfunction, Volume 1”. Williams & Wilkins. 1983.

 Irene S. Gauthier. “The Science and Practice of Myomassology”. Irene’s Myomassology Institute. March 1995.

 John F. Barnes, P.T. “Myofascial Release”.

 Kate Montgomery. “If I only knew Carpal Tunnel Syndrome, The Invisible Threat”. Stay Well Audio Library. 1993.

 American Academy of Orthopedic Surgeons Public Information. AAOS On-Line Service. February 1999

A: The principle features of the two conditions are not the same, and their treatment is very different. In OA, the cartilage in the joint becomes damaged and, ultimately, the joint degenerates. The joint is not primarily inflamed, although inflammation may occur as a late result.

On the other hand, in RA, there is initial inflammation of the lining of the joint. This produces a soft, tender swelling in contrast to the bony enlargement of OA. Cartilage damage occurs later as a result of this inflammation. The pain of OA is often least troublesome in the morning but may gradually worsen during the day. With RA, the pain and stiffness usually is worst on waking, but gradually improves during the day.

Rheumatoid arthritis is not just a disease of the joints, it is a systemic disease, meaning it affects the whole body. Abnormalities occur in the blood vessels, circulating cells and proteins, as well as connective tissue. Not surprisingly, RA is associated with more generalized disturbances – such as anemia (low red blood cell count) – which are proportional to the activity of the arthritis. Usually more than one joint is involved in RA, with the hands almost always affected.

Rheumatoid arthritis is a systemic autoimmune disease which initially attacks the synovium, a connective tissue membrane that lines the cavity between joints and secretes a lubricating fluid.

Facts About Osteoarthritis

Osteoarthritis is an inevitable part of aging and can affect any joint.

It is the oldest discovered health problem having been found in dinosaur joints and Egyptian mummies.

Osteoarthritis is the most widespread form of arthritis, affecting about 16 million people throughout the United States. The Arthritis Foundation estimates that some 59 million Americans – nearly 20 percent of the population – will have arthritis by the year 2020, as age catches up with the baby boomers. Exciting research to replace damaged cartilage is showing much promise.

Glucosamine and Chondroitin

Glucosamine sulfate and chondroitin sulfate are two nutritional supplements that have been reported to “cure” arthritis.

Because glucosamine and chondroitin are produced within the body and are used in the manufacture or repair of cartilage, some people suggest that the synthetic versions work the same way. Preliminary reports indicate that glucosamine may indeed relieve the pain and stiffness of osteoarthritis, especially when combined with exercise, weight loss, physical therapy, and other measures. Unfortunately, there is limited information about the long-term effects of both supplements and their potential interactions. 

Some European studies have reported pain relief and increased movement in the knees of osteoarthritis patients who were treated with glucosamine sulfate or chondroitin sulfate. And, although the results are encouraging, these studies have not yet appeared as full-length papers in peer reviewed journals.

According to the Arthritis Foundation: “While European studies on glucosamine sulfate and chondroitin sulfate in the treatment of osteoarthritis of the knee are promising, the Arthritis Foundation cannot formulate a definite recommendation on the use of glucosamine sulfate or chondroitin sulfate in the treatment of osteoarthritis (OA) until more substantive data are available.”

Glucosamine and chondroitin usually need to be taken for many months before any benefit is felt.

Every Monday morning in the shower I test my elbow’s. If they are sore I ice after I get out. Same thing each day until the pain is nonexistent. The cross-fiber action of the test with ice after will actually break up the adhesive scar tissue.

Self cross-fiber test

Place finger or thumb just below the medial epicondyle and cross fiber the tendon of the forearm. If pain is present, apply ice to the area for a minimum of 1 minute and a maximum of until the area is numb. Repeat test with the lateral epicondyle.

deQuervain’s tenosynovitis

Tenosynovitis implies inflammation of a tendon and its enveloping sheath;  deQuervain’s tenosynovitis is a specific type of this entity which involves the tendons of two specific muscles on the thumb side of the hand – the abductor pollicis longus and the extensor pollicis brevis.  

The precise cause of deQuervain’s tenosynovitis is unknown. It is thought that excessive friction from overuse of the thumb and wrist (excessive and repetitive gripping and grasping actions) may be a factor.

Finkelstein’s test

                                            Finkelstein’s test is a good indication the person 
                                            has this disease.

                                            In this test, the person makes a fist with his/her
                                            thumb placed under his/her little finger, and bends
                                            the wrist.

                                            This test is mildly painful to many of us, but to
                                            someone with de Quervain’s tenosynovitis, it is
                                            very painful.

Myofascial release technique

Grasp the thumb and gently traction out and down to feel the stretch at the base of the wrist. Hold for as long as you can.

 Tendon scraping technique

Scrape a straight edge over the tendons to work them directly.

Tendon Terminator

Inter lock fingers, as person squeezes fingers together, stroke the thumb up the dorsal side between the thumb and index fingers to the wrist.