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Conservative therapy provides the highest rate of recovery for Repetitive Strain Injuries affecting the upper extremity. Tendonitis, Carpal Tunnel Syndrome, Trigger Finger and countless other Repetitive Strain Injuries can be eliminated with the implementation of a few simple training techniques. The combined effects resulting from soft-tissue therapy, and a good stretch and exercise program have astoundingly quick, yet long-term results.

Surgery, cortisone injections add other invasive procedures are no longer necessary in more than 90% of those receiving "proper" conservative treatments. The term "proper" is very important as many therapists, although conservative in their treatments are performing inadequate therapy/ techniques, often creating treatment protocols that contribute to an increase in patient symptoms and dysfunction.

Below is a list of conservative treatment techniques that are being utilized for Repetitive Strain Injuries.

  • Rest the Affected Area. This is often the first recommendation. Moving the affected area is important, but avoid stressing the joint. In conservation, this is often not practical without taking time-off from work. Too much inactivity can cause atrophy of muscles and increase the severity of the disorder.
  • Stretching Routines are implemented to help reduce hypertonic muscles and increase their flexibility and dexterity.
  • Splinting and Analgesics may help "mask" symptoms for a while, but unless the "real" cause of dysfunction is eliminated, the symptoms come right back. The long-term success rate of Splints and Anti-Inflammatory Medications is extremely low.
  • Wrist Braces and Splints are not effective in treating carpal tunnel syndrome and repetitive strain injuries, but can assist if worn during nighttime only. These devices are meant to keep the wrist from dropping into flexion so that the wrist stays in the straight, neutral position in order to reduce impingement of the carpal tunnel. But instead, wrist braces often increase the symptoms of carpal tunnel syndrome and repetitive strain injuries, especially if worn during the daytime.
    • Daytime use of wrist braces while performing daily activities is not recommended because the wrist braces / splints hold your own wrist up for you instead of the extensor muscles having to do it. Since the wrist brace is doing all the work in order to hold the wrist in the straight, neutral position, the extensor muscles atrophy and become even weaker than they already were, and the muscle imbalance between the flexors and extensor becomes even greater. Another major problem is that even though the wrist is still held straight, you can still use your fingers to perform repetitive or static flexion, such as typing, writing, etc., which again, will contribute to the muscle imbalance even more.
    • Nighttime use of wrist braces and splints is more appropriate in keeping the wrist in the straight, neutral position. Wearing splints/braces at night for those with severe symptoms can be very crucial as it prevents individuals from making a "fist" or "curling" their wrist into flexion. Sleeping with the hands in this position causes the flexor muscle group to become even tighter and shorter; causing further impingement and more damage to the median nerve with the carpal tunnel.
  • Squeezing and Gripping Devices tout themselves as the cure-all for Carpal Tunnel Syndrome and Repetitive Strain Injuries, but they exercise and strengthen the flexor muscle group that is commonly already overdeveloped from performing repetitive and static flexion activities that require "closing" of the hand. Using gripping and squeezing devices duplicate the exact same motion that caused the muscle imbalance, and will only continue to increase the strength and rigidity of the flexor muscles; exacerbating the injury even further.
  • Vitamin B6 Therapy can help increase the health of damaged nerves, although it does not correct the real cause of dysfunction; which is a "muscle imbalance" between the stronger, shorter and tighter flexor muscles that "close" the hand and the weak, underdeveloped extensor muscles that "open" the hand. The tight, restrictive flexor muscles compress/impinge the underlying nerve(s) blood vessels, causing the nerve "signal" to travel at a much slower speed. If the muscle imbalance is treated/corrected, nerve conduction/velocity is normal and the symptoms disappear.
  • Anti-Inflammatory Medications to reduce swelling and relieve pressure on the median nerve, but again do not correct the underlying cause of dysfunction. (Extended use of Anti-inflammatory medications often leads to irritation of the stomach lining.)
  • Steroid Injections into the wrist may be prescribed, but are usually painful and not effective. Steroid injections cause the tendons to develop a "rubber-like" consistency, which can easily be damaged further (Usually due to being overstretched), if the individual continues to perform the same tasks that caused the original injury. If steroid injections are utilized, the injury needs to be immediately addressed / corrected through a conservative physical therapy program utilizing stretching and strengthening techniques. (This form of treatment is suggested for all areas of injury.)
  • Contrast Baths (Hot/Cold) (contrast baths) are often recommended by a physical or occupational therapist. Typical treatment protocol is approximately three (3) minutes of heat followed by one (1) minute of cold alternating 3x, ending in cold. Heat alone is not recommended.
  • Ultrasound: Ultrasound is ok if used in conjunction with a treatment program that includes soft-tissue work, stretching of the flexor muscle group, and the strengthening of the extensor muscle group. Ultrasound can help reduce inflammation in an acute case of tendonitis, carpal tunnel syndrome, or other form of injury, but does no good when used alone.
  • Massage: It is good to have the flexor muscles massaged and stretched-out, but unless followed immediately with strengthening exercises for the extensor muscles that extend the fingers, elbow and wrist, and the abductor muscles of the fingers, it will have little effect on correcting the muscle imbalance that causes carpal tunnel syndrome and repetitive strain injuries.

    Massaging and stretching the stronger, shorter and tighter flexor muscles will only result in temporary relief because the longer and weaker extensor muscles have not been shortened and strengthened through extension exercises which will ultimately hold the stretching and lengthening of the flexor muscles in place.
    • EXAMPLE: If your flexor muscles that close your hand are 6-inches long on one side and they are normally 8-inches, (but they've shortened in their relaxation state from overuse), and your extensor muscles on the back-side of the hand and forearm are10-inces long and they are normally 8-inches, but they have lengthened because of no direct stimulus through exercise and movement), than a muscle imbalance has been created.

      Now if you stretch the flexor muscles which were 6-inches to the point where they are now the normal 8-inches long that they should be, and the extensor muscle have not been strengthened so they remain 10-inches long, the flexor muscles will just tighten right back to their original position because there is nothing to hold them in their stretched position. Now, if the 6-inch flexor muscles were stretched to where they were 8-inches long, and the extensor muscles were strengthened and shortened to where they are 8-inches instead of the 10-inches they had been, than you now have equal pull on both sides of the joint. Both muscle groups are now 8-inches long, and the extensor muscles can now provide enough counteractive support to keep the stronger, tighter flexor muscles from narrowing the carpal tunnel and impinging the structures within.
  • Extension Exercise Devices: There are a number of extension exercise devices on the market that ALMOST provide the correct motion in order to treat the dysfunction of Carpal Tunnel Syndrome and Repetitive Strain Injuries. But they all fail in providing the correct biomechanical hand, wrist and elbow movements, and varied resistance levels that will result in the successful treatment of these injuries.

    This is because most of the extension devices on the market:
    • Do not allow a complete range of motion of the fingers, wrist and elbow joints from flexion into full extension, and full abduction (splaying) of the fingers, which is absolutely critical in effectively rehabilitating carpal tunnel syndrome and repetitive strain injuries.
    • Provide finger extension of only 1-5 of the digits, and with most of the emphasis on the Metaphalangeal joint (most proximal finger joint). This means that there is only one joint being exercised, while the others stay stiff and are only affected by isometric, (non-moving) exercises.
    • Provide only wrist extension without finger extension and finger abduction!
    • Do not include finger, wrist and elbow extension, along with full abduction (splaying) of the fingers, all in one exercise motion, without any type of gripping or squeezing action required.
"According to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), repetitive strain injuries are the nation's most common and costly occupational health problem, affecting hundreds of thousands of American workers, and costing more than $20 billion a year in workers compensation. "
Treatments consist of both invasive and conservative therapy.

Invasive treatments include cortisone injections and surgical procedures while conservative treatments include massage therapy, stretching, exercising, ultrasound, sine wave, cold laser, physical therapy, chiropractic, hot/cold therapy and more.

Articles focusing on repetitive strain injuries of the upper extremity .

Repetitive strain injuries affect millions of individuals each year. Here you can find information and resources regarding treatment options, injury symptoms, testing procedures, workplace injury prevention techniques and more!

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