Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (23 page)

ANTERIOR SHOULDER

Purpose:
To strengthen the muscles of internal shoulder rotation and to return proper function to the anterior deltoid, subscapularis, coracobrachialis, and pectoralis major, and to improve their interaction. This will warm them up and increase shoulder stabilization.

Starting out:
Stand with your feet shoulders’ width apart. The treatment arm should be bent with the elbow touching your side and the forearm parallel to the floor. Squeeze the shoulder blades in and down to help achieve this. The grip of a flex-band should be held in your hand, with the tension of the flex-band coming from the treatment side at the same height as the hand.

How to do it:
Pivot the arm at the shoulder and move the hand toward the opposite side of the body, keeping the hand parallel to the floor and the elbow touching your side. Repeat with your other arm. Do ten repetitions, held for no more than two seconds each. If no flex-band is available, the same exercise can be done with a hand weight in a side-lying position.

Troubleshooting:
Do not let the shoulders ride up or tense the neck. Remember to squeeze the shoulders back at the start of each repetition. Don’t use the rest of your body by twisting or leaning.

THE ELBOW/WRIST/HAND

INTRODUCING THE ELBOW/WRIST/HAND

Outside of the brain itself, the elbow, wrist, and hand, with its opposable thumb, comprise the area of the body that best defines us as human. The flexibility of our upper extremities, culminating in those dexterous hands, have helped drive the
evolution of our problem-solving species …and given us the modern tools that we sometimes overuse and misuse to wind up in pain.

When we talk about issues at the elbow, wrist, and hand we’re mostly talking about overuse injuries. Typically when you wield a computer mouse or a screwdriver or a tennis racquet for hours on end, you forget to use the leverage of the whole upper body. The muscles of the neck and shoulder grow fatigued and tense from
not
moving, and the smaller muscles in the forearms tire from performing repeated small movements without a break. Clicking on a computer mouse seems so innocuous that you don’t realize you’ve overdone it until the muscles have been pushed over the edge into irritation and inflammation. Then you can’t bend your wrist or elbow without wincing. These overuse injuries, sometimes labeled repetitive stress injuries or RSIs, are the bane of both the work and sports worlds. Lateral epicondylitis (tennis elbow) is one of the most common upper-extremity musculoskeletal complaints and carpal tunnel syndrome the most notorious workplace injury, both contributing to the many millions that RSIs cost the nation in medical care, lost wages, worker’s compensation, and other indirect expenses.

IMMEDIATE TREATMENT/WHEN TO SEE A DOCTOR

Chronic injury that includes shooting pain and numbness usually means nerve involvement and should be looked at by a doctor. Prolonged numbness and muscle weakening are signs of a serious problem. Trauma to the wrist that results in pain and swelling should be checked out by a doctor. Older people often suffer severe sprains and fractures after a fall; these injuries require splinting or casting to heal properly. As with any joint problem, check for any signs of infection—redness, heat or fever, pain not connected to changes in activity. If there are any, see a doctor immediately. When the dire possibilities have been ruled out, you can assume you have some less serious form of soft-tissue damage such as a mild ligament sprain or a muscle/tendon strain. The normal rules of RICE apply: Rest (keep weight off the area); Ice it; keep inflammation down with Compression (a compression bandage); and Elevation (bring the affected area above the level of your heart).

In the forearm, as in the spine, a lot is going on in a relatively cramped space: muscles, tendons, and nerves are moving together in close proximity. That’s a recipe for nerves getting compressed, triggering pain and dysfunction. Once again, it pays to analyze what goes wrong in terms of the three major elements of the system: bones, joints, and muscles. Let’s take the popular diagnosis of carpal tunnel syndrome (CTS): it’s a set of symptoms created when the median nerve is compressed within the carpal tunnel. This sounds plausible and it gets a lot of attention in the media, so people with numb, achy hands are often convinced they have it. We agree with our colleague at the Hospital for Special Surgery, physiatrist Dr. Jennifer Solomon (see the box on page 89), that CTS is overdiagnosed. Many, perhaps most, cases are caused by tight muscles clamping down on the nerve above the wrist. In these cases, manual therapy to relax the muscles works wonders; surgery to release pressure on the median nerve (the standard remedy for severe CTS cases) needn’t be considered.

If we are to achieve complex movement patterns, the movement of individual body parts must be coordinated. The resulting sequence of movement is called a kinetic chain. Trouble high on the chain usually translates to trouble below. The arm is a perfect example. The shoulder muscles act on the shoulder joint to move the upper arm, the upper-arm muscles act on the elbow to move the forearm, the forearm acts on the wrist to move the hand. The elbow joint, the middle link in the chain, is pretty straightforward. The single bone of the upper arm, the humerus, meets the two bones of the forearm, the radius and ulna, at the elbow. The longer ulna fits into the humerus to create a one-way hinge: it opens, it closes. The shorter radius pivots on the ulna and humerus next to that hinge, allowing you to twist your forearm. The elbow is held together by ligaments and protected by the bony protuberance of the humerus.

The wrist is more complicated. At the opposite end from the elbow, the radius and the ulna come together to cradle a row of four irregularly shaped wrist bones. In front of them lies another row of four bones, all together, the carpals. The whole system is tied together by a series of small, flexible ligaments that give the hand/ wrist unit its unparalleled versatility. The wrist flexes forward and back and from side to side. Just beneath the underside of the wrist is the transverse carpal ligament, which forms one wall of the famously crowded carpal tunnel of bones and connective tissue through which passes veins, arteries, three major nerves, and the tendons of the four fingers and the thumb muscles.

COMMON PROBLEMS AND CULPRITS

The muscles that power the forearm—the biceps and brachialis in the front of the arm that flex the elbow, and the triceps in the back that straighten it out—are big guns that don’t overload easily. But people do strain or tear the biceps by lifting heavy objects. Weight-room regulars can overdevelop the biceps at the expense of the triceps, setting themselves up for imbalance injuries.

The smaller muscles of the forearm that control the wrist and hand are the most likely candidates for repetitive stress injuries. The extensor muscles that run down the back of the forearm pull the wrist back, or “extend” it, as the name implies. Repetitive motion at work (wielding a screwdriver or a scalpel, for instance) or at play (tennis, bowling) can irritate and inflame the muscles and tendons, creating what we call lateral epicondylitis or “tennis elbow.” Repeatedly flexing the wrist does the same number on the flexor muscles that run along the front of the arm and attach at the inside knob of the elbow, the medial epicondyle. Golfers, bowlers, baseball pitchers, and people who work with their hands can suffer the somewhat less common “golfer’s elbow,” or medial epicondylitis.