Carpal Tunnel Syndrome

With the 94.7 Cycle Challenge having taken place recently, I thought I’d write about a common injury amongst cyclists, namely carpal tunnel syndrome. This injury is not only prevalent amongst the active population who are involved in sports requiring repetitive movements of the wrist, but also in the less active population.

What is Carpal Tunnel Syndrome?

The carpal tunnel is a sheath through which the tendons of the flexor muscles of the hand, as well as the median nerve, pass. Any irritation of this sheath will cause inflammation which puts pressure on the median nerve, causing pain and tingling.

http://health.rush.edu/HealthInformation/graphics/images/en/10206.jpg

Causes

Any repetitive compression of the carpal tunnel can lead to this condition. Carpal tunnel syndrome can be caused by a traumatic injury to the wrist, repetitive overuse of the wrist joint or structural abnormalities in the wrist itself. The following sporting activities can predispose one to carpal tunnel syndrome:

·         Cycling

·         Racquet sports

·         Throwing sports

·         Archery

·         Gymnastics

Certain infections, such as pneumonia and malaria, as well as metabolic diseases, such as diabetes, rheumatoid arthritis and gout can also cause carpal tunnel syndrome.

Signs and Symptoms

·         Pain that wakes one in the middle of the night that is often relieved by shaking the hands

·         Pain, numbness, tingling or a burning sensation into the palm of the hand and fingertips

·         The ability to grip and pinch is often diminished

·         Generally, only one hand is affected – usually the dominant hand

·         Fine motor skills, such as fastening buttons, is often difficult

·         Symptoms recur when direct pressure is placed on the median nerve in the carpal tunnel for approximately 30 seconds

http://www.handshoemouse.com/images/Carpal-Tunnel.jpg

Treatment

Individuals with carpal tunnel syndrome should see a physician for treatment. Initially, the wrist should be immobilized using a splint. Rest, ice and anti-inflammatories are also used to reduce the initial pain and inflammation. However, compression bandages should be avoided, as they place additional strain on the already compressed median nerve in the carpal tunnel. Most people respond well to this conservative treatment; however, if symptoms continue, a cortisone injection into the site may be required. The final resort is surgical treatment which may be required in severe cases.

Exercise

Any sporting activities that contribute to this condition should be stopped immediately to allow the inflammation and pain to subside. Certain exercises can be performed to maintain mobility of the wrist in mild cases; however, these exercises should not be performed in severe cases, as they may exacerbate symptoms. Exercise therapy alone is not likely to relieve symptoms, but may be useful when used with other treatment.

References

Foundations of Athletic Training: Prevention, Assessment and Management

http://www.eatonhand.com/hw/ctexercise.htm

http://www.mayoclinic.com/health/carpal-tunnel-exercises/an01984

World Spine Day

Today, 16 October, is World Spine Day, so I have decided to recap some important tips on maintaining a healthy spine. I have previously written articles on lower back pain, neck pain, scoliosis, and good seated and standing posture. Here, I will revisit some of the important things to remember in order to prevent these conditions and maintain a good posture.

With gravity, age, muscle weakness and bad ergonomics (how we carry out our daily activities), most of us tend to develop poor posture. This can often lead to lower back pain, neck pain and disc problems, which can be extremely debilitating and affect our ability to work, play, and perform our daily activities. In most cases, this can be avoided by strengthening the muscles around the spine to support it, and by correcting one’s posture.

First, I will recall some important things to remember while sitting at your desk. The following image shows the recommended way to set up your desk space for good seated posture.

http://www.ergonomics-info.com/image-files/desk_ergonomics.jpg

Important tips:

·         Ensure that you have a good chair with decent back support, especially in the lower back region.

·         The top of your computer screen should be at eye level and you should not have to tilt your head downwards more than 15 degrees to look at the screen. If your head is tilted too far downwards all day, it may result in neck pain.

·         The screen should be directly in front of you, not to one side, as this will cause you to constantly rotate your spine, which may cause pain.

·         Sit with both your feet on the floor, rather than with the legs crossed, as this changes the alignment of your pelvis, which can cause lower back pain.

·         Your elbows and wrists should be at the same level, with your shoulders relaxed.

It becomes very easy to slouch over your desk, especially as the day passes. Therefore, one must constantly remind oneself to sit up, keep the shoulders back and the head looking straight forward. A good way to remind yourself of this is to get up out of your chair at regular intervals throughout the day. Movement is essential in preventing bad ergonomics, as it allows us to move and stretch our postural muscles, as well as reminds us of how we should be sitting. If you have a desk job, you must get up at least once every hour and walk around. Stretching the neck and back muscles periodically will also assist in preventing poor ergonomics. Movement is good for both the mind and body!

Next, I will recap good and poor standing posture, which can be seen in the image below:

http://noend-insight.com/wp-content/uploads/2013/02/skeleton.jpg

For good posture, the ear, shoulder, hand, knee and ankle should all be in the same line. In the picture showing poor posture, you will see that the head protrudes forward, the shoulders are rounded and there is a severe arch in the lower back. This ‘hunchback’ posture puts undue stress on various parts of the body, particularly the neck and lower back regions, which will result in pain.

Some helpful tips:

·         Gently squeeze the muscles between the shoulder blades together, pulling the shoulders slightly back and down.

·         Don’t lock your knees while standing; keep them slightly bent.

·         Pull your belly button in towards your spine at all times.

·         Grow tall – feel as though someone is lifting you up by a string attached to the top of your head.

·         Don’t simply say to your children: “Stand up straight and pull you shoulders back”. Explain why by pointing out the way the old lady next door walks.

With age, the postural muscles become weaker, while other muscle groups become tighter, which often result in the ‘hunchback’ posture. Also, eye sight often deteriorates with age, resulting in elderly individuals looking down and therefore hunching over. Such age-related factors are inevitable. However, if individuals are educated at a young age about the importance of maintaining good posture, they will carry this with them throughout their lives and be able to maintain a better posture for longer. It is never too late to improve poor postural habits. By strengthening certain muscles and stretching others, as well as creating more awareness about posture and spinal conditions, poor posture can be improved.

Your posture – the way you carry yourself – says a lot about your character and attitude. Walk tall and feel proud of who you are! Keep moving and look after your spine, as it has to carry you for the rest of your life!

http://www.worldspineday.org/

The Importance of Regular Physical Activity for Children

With the rapid rate of development in technology, computers, iPads, Play Station, amongst others, children tend to stay indoors and do as much as they can sitting at a computer, including entertainment. Before such technological gadgets existed or weren't so readily available, children were forced to go outside and play with a soccer ball to entertain themselves. Because it was a game, children did not see this as exercise; it was merely playtime. However, they were reaping the benefits of an active lifestyle. Now, physical activity has to be planned and thus is seen as a torturous hour of the day that is a hassle and very unpleasant. Thus, many children look for every excuse not to do it.

Childhood Obesity

Childhood obesity has become a major health problem over the past few decades. According to the CDC (Centres for Disease Control and Prevention): “obesity has more than doubled in children and tripled in adolescents in the past 30 years”.

Childhood obesity poses numerous health risks:

·         Increased risk for developing heart disease, including high blood pressure and high cholesterol

·         Increased risk for developing diabetes

·         Increased risk for developing bone and joint problems

·         Social and psychological effects, such as stigmatization and poor self-esteem

Childhood obesity is easily preventable if appropriate lifestyle choices are made, such as a healthy, well-balanced diet, together with adequate regular physical activity.

Societal Changes

Changes in society have influenced our ability to keep active and stay healthy. Parents work late, so healthy, home-cooked meals have been replaced by fast-foods. We drive everywhere, instead of walking or riding because of security concerns. Television and computer games have become far more attractive than physical play. We live in smaller homes where little or no garden is a common feature. Parents no longer have time to play with their children. Despite these changes, a plan can always be made to keep active, such as going to the local park and playing with your children on weekends or making time during the week to do so. We must stop looking for excuses and rather look for solutions!

How much physical activity should one do?

It is recommended by the American College of Sports Medicine (ACSM) for adults to do 150 minutes of aerobic activity per week. This equates to a 30 minute brisk walk 5 days per week. Children should participate in 60 minutes of physical activity per day, at least 5 days per week. It is most beneficial to do a little bit of exercise on most days of the week, than to walk for three hours on one day of the week. For children, the obvious place to be physically active is at school – play during break time and participate in sports after school.

  

Developmental Stages and Physical Activity

Regular physical activity throughout the developmental years helps to build gross and fine motor skills, stamina, strength, cardiovascular fitness, spatial awareness, balance and co-ordination.

Ages 5-7

·         Focus is on body management and control

·         Development of large muscle groups

·         Development of hand-eye co-ordination and perceptual abilities, balance, co-ordination, spatial judgement, and directional movement

·         Identification of body parts

·         Short attention span – small group activities

Ages 8-11

·         Refinement of fundamental skills

·         Start to learn to perform specialized skills

·         Explore, experiment and create activities

·         Move towards team play

·         More co-operation with peers

·         Develop an interest in sports

·         Learn more about activity patterns

·         Very active at this age

·         Longer attention span

·         Develop the desire to excel and seek recognition for their achievements

Ages 12-18

·         More emphasis on specialized skills and sport activities

·         Technical aspects of sport, such as rules and game strategies, become more important

·         Team and individual sports may appeal, with a desire for recognition of achievements

·         Consider gender differences and puberty

Parents’ Role

·         Set the example by being physically active yourselves

·         Take time to learn about healthy dietary and exercise choices for yourselves and your families

·         Play WITH your kids

·         Limit television and computer time to no more than 2 hours per day and encourage outdoor playtime every day

·         Show interest by watching their school sports fixtures – offer praise and encouragement

·         Get involved in school and community sports programmes

·         Encourage your children to be physically active at home – play in the garden

·         Provide transport to extra-murals

·         Make physical activity part of your lifestyle, so that your children learn to live an active lifestyle from a young age 

References

http://www.cdc.gov/healthyyouth/obesity/facts.htm

American College of Sports Medicine (2006). ACSM’s Guidelines for Exercise Testing and Prescription (7^th ed.). Philadelphia: Lippincott Williams & Wilkins.

Roux, J.C. (2011). Curriculum Development: Post-Graduate Certificate in Education (FET) Mathematics and Physical Education. University of Johannesburg: Department of Sport and Movement Studies.

Scoliosis

Scoliosis is defined as lateral curvature of the spine (Foundations of Athletic Training). Often rotational deformity is present, together with the lateral deformity, and the severity of the deformity can range from mild to severe. Scoliosis is usually seen in the thoracic (middle) or lumbar (lower) spine, or both, and appears either as a ‘C’ or ‘S’ shape.

http://www.texashealth.org/images/PHP/Scoliosis_Spine/adam_image.jpg

Scoliosis can be structural, which means that both the curvature and rotation are present even with forward and lateral bending, or non-structural (functional), where both the curvature and rotation are flexible and disappear with corrective movements.

http://health.bwmc.umms.org/graphics/images/en/19465.jpg

Structural scoliosis is usually caused by congenital abnormalities or certain neuromuscular diseases, such as cerebral palsy and muscular dystrophy.  Non-structural, or functional, scoliosis is generally caused by a problem elsewhere in the body, such as a leg length discrepancy or muscle spasm. But 70-90% of all cases are idiopathic, that is, of unknown cause. Idiopathic scoliosis can be seen at any age, but is most commonly diagnosed between the ages of 10 and 13 years, and is more prevalent in females. Degenerative scoliosis is more likely to develop in adults, where degeneration in the spine and surrounding musculature can result in abnormal curvature.

Mild cases of scoliosis are generally asymptomatic, as there is minimal deformity. Such cases can, therefore, be treated with appropriate stretching and strengthening exercises. In moderate to severe cases in children who are still developing, it is important to monitor and re-assess the condition on a regular basis. In these cases, the use of a brace is usually necessary to manage the scoliosis and prevent further curvature and rotation. In severe cases that cause pain and deformity, surgery to straighten the spine may become necessary. If a severe scoliosis is left untreated, the rotation places too much pressure on the lungs, resulting in an individual struggling to breathe.

Structural scoliosis is usually more difficult to treat and requires external assistance, such as a brace. Functional scoliosis, on the other hand, is usually easier to treat, as the contributing factors can usually be treated. A leg length discrepancy can be fixed by a podiatrist with an appropriate orthotic or heel lift. A physiotherapist can release muscle spasms. A Biokineticist should be consulted to assess what functional aspects may be contributing to the scoliosis, so that appropriate stretching and strengthening exercises can then be prescribed to manage the scoliosis and prevent further deterioration.

References

Foundations of Athletic Training: Prevention, Assessment, and Management

http://www.medicinenet.com/scoliosis/article.htm#scoliosis_facts

Exercising during Pregnancy

Although you may feel very tired and uncomfortable during pregnancy, exercise – believe it or not – can help you to feel better, keeping you fit and strong and helping to manage your weight. By exercising during your pregnancy, you will also find it easier to regain your pre-pregnancy physical fitness. There are, however, some important points to be considered to ensure safe exercise for both you and your baby.

If you were participating in a regular exercise programme before falling pregnant, then you can generally continue with a similar programme for the first trimester. If you were not physically active on a regular basis before you became pregnant, then you need to start off very slowly and some guidance may be necessary. Either way, you must check with your doctor before starting an exercise programme, as each person is different and every pregnancy is unique!

During the first trimester, one can generally continue at a similar exercise level to what you were previously doing, although the intensity level may need to drop. Keep your heart rate below 140 beats per minute! Abdominal exercises can be done as usual. Because you will probably feel more tired when you are pregnant, adjust your cardiovascular and weight training to a comfortable level.

During the second trimester, light weight exercises can still be done, although you should avoid lifting weights above your head, as this increases your already elevated blood pressure. Avoid abdominal crunches and exercises performed lying flat on your back. Prolonged time on your back causes your heavier uterus to put pressure on the vena cava, the vein that returns blood from your lower body back to your heart. This interference with blood flow can make you feel dizzy. Cardiovascular exercise should continue, although the intensity must be decreased according to how you feel. Don’t do any running, jogging or other activities that will impact on your joints. Walking, swimming and cycling are best. It is important to always remember to keep your heart rate below 140 beats per minute. Stretching and breathing exercises can also be done. Always remember, depending on how quickly you’ve grown, do what is comfortable for you.

During the third trimester, you will start to feel much more uncomfortable and tired as the baby grows. Do what you can manage comfortably during this final stage. Cardiovascular exercises – walking, cycling, and swimming – can be continued, still keeping the heart rate below 140 beats per minute. Keep exercise sessions to a maximum of 30 minutes, as the increased blood flow associated with exercise can induce contractions if prolonged. Avoid heavy weights and movements that involve changing direction quickly. During pregnancy, your body releases a hormone called relaxin, which causes the ligaments around your pelvic joint to become lax, allowing for more space for the baby to be born. Because all the joints become more lax, the risk of spraining a joint, such as the ankle, increases. Therefore, it is important to wear comfortable shoes at all times and avoid uneven surfaces that could cause falls.

Kegel exercises can be done to strengthen the pelvic floor muscles, which help to minimize bladder leaks, a common problem during and after pregnancy. These exercises are easy to perform and can be done anywhere and anytime.

Lower back pain is a common symptom experienced during pregnancy. Due to the development of your stomach in front, your centre of gravity shifts and it puts a lot of strain on the lower back. If your lower back muscles aren’t strong enough, you will struggle as your baby grows. A Biokineticist can provide appropriate exercises to strengthen these muscles and, therefore, manage this condition.

http://alaskabirthnetwork.org/wp-content/uploads/2011/05/pregnancy-exercises-saidaonline.jpg

Tips to remember:

·         Keep your heart rate below 140bpm at all times.

·         If you feel out of breath, slow down.

·         Wear comfortable, loose clothing with proper shoes to support your ankles.

·         Exercise in the morning or evening when it is not too hot.

·         Avoid jerking movements.

·         Avoid lying on your back for too long.

·         Exercises sitting on a big ball are usually very comfortable, but avoid bouncing.

·         Listen to your body – it will tell you if you are doing too much!

Stop exercising if you experience any of the following:

·         Vaginal bleeding

·         Dizziness

·         Faintness

·         Shortness of breath

·         Contractions

·         Nausea

Speak to your doctor before exercising again.

As I have already said, each person is different and every pregnancy is unique, so it is important to consult your doctor before starting any exercise programme! If you are struggling to start or maintain an exercise programme during pregnancy, consult a Biokineticist to assist you with safe and appropriate exercises for you and your baby.

References

http://www.virginactive.co.za/wellness/view/category/38

http://americanpregnancy.org/pregnancyhealth/toprecommendedexercises.html

http://pregnancy.about.com/od/symptoms/qt/backsleeping.htm