Sharon Butler’s Sorehand emails

The following are emails contributed to the sore hand discussion list by Sharon Butler, Hellerworker and author of the singular Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries: A Self-Care Program.

Subject: Proper stretching technique Status: RO

Joanne Ratigan mentioned that when she uses the stretches from my book she can sometimes feel tremendous stretching in her armpit. Perhaps others who are using the material from my book will have had similar strong sensations from the stretches you have tried.

If you think back to my description of the stretch point, you will remember that you should NEVER let the sensation get so strong. The stretch point is always meant to be a light sensation. Once it gets so strong, it signals that the body is activating the stretch reflex which basically prevents anything from releasing. What you are feeling is essentially the tug-of-war between you and your body. You will not accomplish anything of value from this stretching session. You must release the pressure of any stretch that causes such strong sensations. Always moderate the stretch sensation so that it remains very light. If you do this properly, you will find that the sensation of stretching fades away until it is gone completely. This is a release of the tight restricted tissue that was contributing to your symptoms.

The task at hand for any RSI sufferer is to find all the spots in their body that can cause a stretch sensation, or stretch point. Then they must use the proper technique to get a complete release of that restriction. Done properly and consistently, the stretches in my book will bring about complete relief from just about any symptoms. As a matter of fact, I have not yet found a single RSI symptom that cannot be relieved using this technique, no matter how complex, or deeply entrenched in the body.

Best of luck!
Sharon Butler

Subject: Sharon’s helpful stretches

Mike Rosenheim reported that he is being helped by my stretches and I am very pleased. He mentioned a reaction he is getting to the exercises, which he describes as getting “that sickening feeling” in thumbs, forearms, etc. Perhaps others have experienced something similar, maybe even when using my stretches, so I thought a few comments would be in order to help understand what might be happening here.

What Mike describes as the “sickening feeling” might be characterized as the body saying “Uh-oh…we’re getting close to that point that hurts.” I like to think that this is a sort of roadmap indicating where the body has created a restriction or where tissue may be damaged. This is definitely the right spot to be. The main thing to understand is that there is a right way to approach this spot, and a wrong way. I’d like to describe the difference between the two.

The body has all sorts of defense mechanisms built in that will tell us if something we are doing with our body is likely to cause injury or other damage. Some of those defense mechanisms include feelings of strain, pain or that “sickening feeling”. To continue to stretch the body to this level of sensation will probably not help at all and might even cause some additional damage. You will know this because your body is telling you so. But, at the same time, these sensations indicate that this is the spot, this is the plane of strain, this is where release must occur to bring about some healing. So, you don’t want to avoid or ignore this spot. It’s a specific roadmap that your body is giving you about where change needs to occur. So, how can you effectively use this information being sent from your body?

The key is to approach the area with caution and gentle exploration. If you find a stretch that causes that “sickening feeling”, then back off a bit on the stretch and see if the sensation becomes more acceptable–still a very light stretch and certainly without the “sickening” attached to it. That is the point where real healing can begin to occur. You sort of have to trick the body into not reacting negatively by stretching so lightly that the body does not become alarmed by the stretch.

For some people with extensive damage to the tissues, this will take almost no stretching at all. Mike said that when he extended his hand and arm off the edge of the bed, he found that he could not open his fingers fully. A good place to begin this stretch would have been to open his fingers only 1/4 inch. Just a tiny stretch. Done in this manner, you will begin to feel the tissues change and lengthen in about 15 – 30 seconds. The is an effective release of that tight tissue – at that level. To reach more (a deeper area) of the same muscle it is necessary to continue doing the same stretch (without taking a break) and simply stretch a little farther, say, opening the fingers another 1/8 – 1/4 inch. Then, you hold this position until there is no stretch sensation remaining, which I call the “release”. Keep on repeating this very gentle stretch/release cycle until you run out of time, or the muscle reaches its fully extended length. You have now performed an effective, non-invasive stretch that will not cause further damage to your hands, arms, etc.

So, whether you are using my stretches or ones given to you by a P.T., try them with the technique I describe. You will have a different experience of stretching that should be more pleasant, and will certainly be safer and more productive than before.

Sharon J. Butler Butler
RSI Solutions Berwyn, PA

Subject:      A Great Stretch for Forearm Pain

Ann Becker wrote about forearm pain located on the top portion of the forearm, closest to the elbow.

I have found this to be a tough area to get to let go. First, it is very difficult to figure out a stretch that will access that area. Second, this is the location of 2 muscles that rotate the forearm (the anconius and the supinator), allowing you to rotate your palm up. Because of the orientation of these rotators, and the muscle bellies that pass beneath them leading to the fingers, this is a common area of adhesion. I have found that it is this adhesion that creates most of the symptoms.

People who use tented keyboards or any other repetitive activity that brings the palms to face one another will be constantly activating these muscles, further aggravating the strain present in the muscle as well as promoting the adhesions. Oddly enough, many people who have these adhesions will initially feel a sort of relief while in this palm-facing position, but the relief will generally be short-lived.

The best stretch I have found is to let the arm hang softly at your side. Rotate your arm so the back of your hand faces the side of your body. Hold this position until you feel the tissue soften somewhat. If it doesn’t soften, then back off on your stretch until the sensation is very light. Now, wait for the sensation to soften. It should do so within 10-15 seconds. Next, stretch a little farther in the same direction, continuing to work in this way (might take several sessions over several days) until the back of your hand is totally facing the side of your body.

The next step is to S-L-O-W-L-Y wiggle your fingers in big, curling motions, with all your fingers moving separately from each other (in other words, do not make a fist). Work carefully and gently as this is the phase of the exercise that will begin to release the adhesions that are there. Once you can do this with NO discomfort whatsoever, you are ready for the next step.

Next, S-L-O-W-L-Y start to bend your wrist palmward. Constantly keep your awareness level high about the sensations you are feeling. You should never continue the stretch if you feel pain of any kind. This indicates that you have gone too far, too fast. Hold the bend of your wrist for about 10 seconds, then return to the straight (but rotated) position. Repeat several times. When you can do this wrist bending with NO discomfort of any kind, go on to the next phase of the stretch.

Now you are ready for the final phase. DO NOT ATTEMPT THIS PART OF THE STRETCH IF YOU ARE JUST BEGINNING TO RELEASE THIS AREA OF YOUR BODY. YOU COULD DELAY YOUR RESULTS IF YOU DO. This is a very strong stretch and must be undertaken with care. Start with all the preceding steps, allowing your body to release at each step of the way. Do not rush this. Allow your body the time it needs to heal. With your wrist bent palmward, S-L-O-W-L-Y begin to wiggle your fingers in the same big, separate movements you used before when your wrist was straight. This creates the maximum separation of each muscle belly from its neighbors. You will probably experience much relief from your symptoms before you ever get to this step in the stretching process. But, if you want your symptoms to stay away for extended periods of time, then you must complete all the steps.

I can’t emphasize enough the importance of going thru this stretching process slowly and carefully. I find this part of the forearm the most resistant to change and release. I, too, have set my healing back by several days by going at it too fast or for too long a period of time in one session. Remember, if you feel more soreness after doing this stretch, you stretched too hard. If you do it properly, you should feel an ever-increasing range of motion without pain, less nerve-like sensations and longer periods of repetitive motion without recreating your symptoms. But, you can only do this by carefully paying attention to what you are feeling at every step of the way. And, do not hesitate to stop any stretching session if you get a gut feeling that you’ve had enough for the time being. That’s your body’s way of saying, “Stop!”.

I used this exercise on myself. It took several days for the pain to go away completely, but I would guess that my symptoms were less severe in this area than what others report. The long-term effects, however, are that I never have pain in this area near my elbow anymore, no matter what I do. I do, however, occasionally stretch this area to make sure that it is remaining released.

I hope this is helpful to many of you. I’d be interested to hear if it works for you. I save all the comments people make about my stretches.

My best wishes for a pain-free future,
Sharon Butler

Subject:  Suggestions to prevent CTD’s in cashiers

Next time you are in the grocery store, watch the cashier and how they are using their body as they scan the groceries.

In my observations, most cashiers face the cash register. The right hand stays on or near the keys and the left hand pushes items thru the scanner. If an item does not have the bar code facing in the right direction, I have often seen the cashier twist their entire upper body to reach for the item (pelvis remains facing the register, shoulders, head, neck and arms twist to reach the item), leading to a tilted, reaching, straining position. Often, if the item they are handling is something like a 5 lb. bag of flour, this can lead to a tremendous amount of strain in the arms, wrists, shoulders, upper back and neck. You’ll also notice that most of the bar code scanners are placed next to the register, not next to the cashier’s body. So, the scanning process must begin as much as 12 inches or more forward of the cashier’s body. This leads to even more reaching and straining.

What I think would be a better, although slightly more cumbersome, technique would have the cashier turning their entire body to face the conveyor belt with the scanner directly in front of the cashier’s body. (If you look hard enough, you can see that the position of most cash register/conveyor set-ups are moveable, so this could actually be acccomplished.) The items should be scanned with the left hand pushing the item onto the scanner and the right hand off-loading it to the bagging area. When an item needs to be entered into the cash register, the cashier should turn their entire body to face the cash register. This should eliminate much of the stretching and straining that can ultimately lead to an injury.

This concept of directly facing the work at hand is a good, general rule of thumb. I learned it in my bodywork training. It can be surprising to notice how much we tend to resist such a common sense bit of ergonomics. I have found that it can make a great deal of difference in the mechanics of doing any job. Check it out the next time you are doing your work. Are you twisting and straining, or are you facing your work head-on?

Hoping for an early Spring,
Sharon Butler

Subject: Automatic transmissions

A lot of the strength problems that people are writing about that affect how well they operate manual transmissions and the buttons on the gear shift of automatic cars often is due to the muscles of the inner forearm becoming adhered to one another. A good way to begin releasing this kind of adhesion is to VERY GENTLY begin bending one finger back until the slightest of stretches is felt. Hold this position until this and all associated stretch sensations that may appear in other areas of the hand and arm disappear. Then, still holding the position, SLOWLY wiggle the remaining fingers. This holds the muscle and tendon still for the bending finger and the wiggling causes all the muscles and tendons nearby to move independent of the bent finger. Working carefully (cause this can sometimes make you feel sore temporarily if you overdo it), repeat with the remaining fingers of both hands. The thumbs are different as their muscles and tendons usually do not get stuck to those that operate the fingers. For the thumbs, make a loose fist with your thumb inside and then VERY SLOWLY make circles with your fist in the widest arc you can comfortably manage. Pause in any position where you feel a stretch sensation and wait until it releases.

These two exercises, performed slowly and carefully, will help tremendously in restoring strength to the hands and thumbs.

Subject:  Ulnar nerve relief surgery

Try this (and ANYTHING else you can come up with) before going for ulnar nerve surgery.

I have often found that elbow pain stems from the tripeps muscles, or, more correctly, with the layers of fascia at the elbow end of the triceps muscle.

Look at an anatomy chart. There is a sort of triangular shaped area of white stuff at the elbow end of the triceps muscle. This is actually several layers of fascia and the ulnar nerve passes beneath this area. Adhesions seem to occur at this area. The fascial covering around the ulnar nerve can adhere to the layers of fascia at the elbow end of the triceps when strain is present in this area.

Here’s something you can try on yourself to relieve these adhesions. (Remember to use good judgement…if it feels wrong, don’t do it!) Straighten your arm. Grasp your upper arm so that your fingers are at the area just above your elbow, your thumb will be on the other side of your arm ( at the biceps, on the inside of the elbow). Squeeze moderately, pressing your fingers into the area of fascia at the elbow end of the triceps. While squeezing, bend and straighten your arm, SLOWLY, several times. Release your grasp, move to a slightly different area of the same bunch of fascia and repeat. Keep doing this until you have covered the entire area of fascia. Don’t squeeze so hard or so long that you give yourself any bruises.

Another thing you can try is this simple exercise. Put your hand on your hip and slowly press your shoulder down (using internal movement). You will feel a stretching in your elbow area. Hold a GENTLE stretch until you feel the stretch sensation go away. If it does not go away, then you are stretching too hard and you are not accomplishing anything. Lighten up and try again. If, when doing this stretch, you feel other areas of your body or arm stretching, then wait for them to release also. These restricted areas are, in all liklihood, related to the pain you are feeling in your elbow. They must be released also for the pain in your elbow to be most effectively eliminated.

Good luck in your quest for relief!
Sharon Butler

Subject: You can’t hide…

Dear RJ,   I have been specializing in the treatment of RSI’s for several years now. The primary modalities I use are myofascial release and stretching. I don’t know where you live, but if you can find someone in your area who does that sort of work, you should experience a great deal of relief.   In the meantime, I would recommend that you do the following: It sounds as if the retinaculum, which is a bracelet of tissue around your wrist, is tight and sticking to the tendons and bursae that are meant to slide unimpeded under the retinaculum. Try this to release the retinaculum…

Press firmly (about the same amount of pressure it would take to dent a tennis ball) into the top of your wrist, near the bone that sticks out below your pinky, using the pad of your thumb. While pressing, bend your wrist palmward. If you do this properly, you will find that the pressure of your thumb causes your skin to “drag” as it slides under your thumb.

Continue to press and bend over the whole top of your wrist. For variation, you can also try to wiggle your fingers as you press and bend. BTW, you won’t be able to feel the retinaculum…it is too thin to be felt by an untrained hand. But, it’s there, nevertheless. Repeat this exercise whenever the symptoms return, but not more than 2X per day as it can make the tissue in the area sore if it’s handled this firmly more than twice a day. Another BTW, don’t press to the point of pain. The pressure should be firm but not painful.

Subject:  A burning right wrist

Dear Bob,

I would suggest that you try to stretch your armpit area. I have found that the source for much burning pain in the wrists can be found there. And, since most people do not pay attention to the armpits, they don’t realize that a problem has been building there for many months, perhaps longer.

A second area to stretch is the lats. Whenever I have aching on the inside of my wrists, I get immediate relief by stretching the lats (they extend from the low back to the inner upper arm). A good lat stretch is to lay on your left side, both arms extended straight up over your head, both legs straight. Roll your torso slightly forward so your face turns toward the floor and your right arm reaches slightly in front of your face. At the same time, extend your right leg about 4 inches behind you. Now stretch gently from your right fingertips down through your right toes. This gets the lats. Make sure to repeat on the other side.

Best of luck! Sharon Butler

Subject: Fascia

I understand your confusion about fascia and its role in the body. I will try to explain it for you. But first, set aside all the concepts you have heard before (mine included) and try to look at this information with new eyes.   Fascia is a form of connective tissue. It specifically is the type of connective tissue that supports and gives form to muscles. Inside a muscle, the tiniest muscle fiber is wrapped with fascia. Then, bundles of those fibers are wrapped together with fascia. Then, bundles of bundles are wrapped with fascia, then the whole muscle is wrapped with it. Can you begin to see the three-dimentionality of it all? Now, at some point in the anatomy of that muscle, the muscle fibers end. But, here is the kicker…the fascia continues until it joins, attaches to, and blends into the bone. (Some schools of thought actually believe that bone is hyper-calcified fascia!)

This band of fascia that used to be permeating through the muscle now become a tendon. The same fascia that was spread in many layers, running lengthwise through the muscle, now joins together (because there are no more muscle fibers holding the planes of fascia apart), becoming tendon. You can feel this and see this in your lower calf.

The belly of your calf muscle is very thick up near your knee, then narrows and becomes the achilles tendon. The same anatomy is present in every muscle in the body. But, some tendons are long like the achilles tendon and some are very short like the tendon at the top of the calf muscle, at the knee.   Muscle fibers are what contracts to make movement happen. But, muscles are not attached to the bone…the tendons are. So, when the muscle contracts, it creates a shortening in the planes of fascia wrapping its sections and it is the tendon (made up of that fascia) attaching to the bone that actually causes the bone to move.

Now, here is where it gets really tricky. Take your arm, for instance. When you bend your elbow, your biceps muscle shortens, but the triceps muscle on the other side of the arm  has to lengthen. They are protagonist and antagonist to each other. There must be a fluid balance between them. If there is imbalance in the amount that each muscle can move in relation to the other, then one muscle will have to work harder, making it feel fatigued.

So, now what about ligaments? They are fascia too, 100% fascia. The fascia that forms ligaments has a slightly different job. While tendons connect muscle to bone, ligaments attach muscle to muscle, or bone to bone. Some ligaments are soft and filmy like the ones that suspend organs in place, and other ligaments are tough and fibrous, like the flexor retinaculum that is cut during carpal tunnel surgery. The thing that concerns me is that when ligaments are missing (or cut as in surgery) then the organized structure of the body suffers. Ligaments are just as important as tendons in holding everything together in the body.

So, now how is fascia related to carpal tunnel syndrome, or any other kind of repetitive strain injury? Try to imagine that fascia is running in three-dimensional planes through the body, connecting everything to everything else. Now, when the fascia is strained, it has the truly unique characteristic of being able to chemically change in order to protect the body. When it goes through this change, the collagen fibers that make up the fascia bunch together, forming a sort of thickened or denser bunch of fascia. The body creates this so that the overworked muscles can have some support and protection.

Now, remember that this thickened bunch of fascia is somewhere in the middle of a muscle, or is a tendon or ligament. If the body creates enough sites where the fascia has changed, then this restriction begins to affect the quality of movement, making one muscle (the biceps, for instance) work harder to pull against the restriction present in the opposing muscle (the triceps). This causes more strain in the muscle, affects more of the fascia in the area, it in turn changes chemically and becomes thicker and more restricted, and the downward spiral continues…

Now, imagine that this is what has happened in your body. Also imagine that your profession requires you to use a computer that adds additional strain to the tight and restricted muscles and fascia in your forearms. Now, you’ve really got strain! All these shortened and restricted muscles pulling against one another with fast, precise movements. It’s enough to make anyone seize up! The human body is so miraculous in its design that even this often won’t create horrible symptoms.

BUT, if the fascia that wraps the median nerve passing through the arm is some of the fascia that has become tight and restricted, then the symptoms of carpal tunnel syndrome will inevitably arise, because all the tight fascia is tugging and pulling on the nerve imbedded in it.

So, what can you do about it? This is really a problem, because the fascia does not have the mechanism to reverse the thickening and tightening all on its own. What Dr. Ida Rolf (the originator of Rolfing and a PhD. in Physiology) found was that stretching the restricted fascia in specific ways was the most efficient way to restore the fascia to its normal loose and fluid, non-binding state.

In Rolfing, and later, Hellerwork, the therapist applies pressure to the restricted fascia and then manually stretches it. This is by far the fastest way to change the fascia back to its normal state.   So, how does this relate to trigger points? Trigger points appear to be areas where the bunches of fascia are more pronounced. When pressure is applied to this bunched and sore spot, the release travels down through the planes of fascia for a little distance.

This is an OK technique, but in my experience (of doing this work for ten years) it is not as efficient as following the restriction down the whole plane of fascia to the point where it ends. When treating a case of carpal tunnel syndrome, it is essential to find all the planes and all the spots that are contributing to make the symptoms show up, as well as all the planes and all the spots that are interfereing with the quality of the movement asked of the affected muscles.

Without the thorough release of all these areas, symptoms will recur, because part of the restriction that causes the strain is still present and will eventually add up to more widespread restriction in the near future.

The interesting thing about every single one of the conditions people have been writing about is that they all function following the same exact system. Carpal Tunnel Syndrome, tendonitis, thoracic outlet syndrome, tennis elbow, tenosynovitis, cubital outlet syndrome, even tarsal tunnel syndrome of the ankle, are ALL created the same way.

And the solutions for all these conditions come about in the same way. The affected tissue must be stretched in order to be restored to health. All the injections, surgery, PT, ergonomics, etc in the world cannot change that fact. These measures may assist in reducing symptoms but, alone, they will never get rid of them entirely.   So, start stretching, everyone. And, if you want really fast results, go to a Hellerworker, or a Rolfer. You’ll be glad you did.  Hope this helps…   Sharon Butler   President, Butler RSI Solutions Berwyn, PA

> Subject:      Re: stretch technique (fwd) Status: RO

>I asked Sharon Butler about her opinion on using short, repeated stretches as >therapy as opposed to her recommended technique of long, gentle stretches. > > Sharon refers to the stretching of facsial tissue and the importance of prolonged steady stretch, which is quite necessary.  There are, however, stretches given for different reasons including those for neurodynamic tension (neural tension).  It was this concept that Vicki Meagher posted about with reference to the British physiotherapist.

‘Stretching’ of neural tissue isn’t really stretching at all in the traditional sense (too long to explain right now, sorry).  When working at these problems, frequent short burst movements are effective because they stimulate other more dynamic processes including increased blood flow.

Stretching that Sharon refers to is of very passive tissue and it requires the long steady approach.  We must always be careful to categorize any comments made about treatment protocols.  There are lots of different and good reasons for the wide variety of approaches available.

By the way, anyone who is interested in the concept of neural tension (it is heavily involved in RSI in many cases and can mask as a soft tissue injury, not to mention its potential particiapation in chronic pain disorders) they should investigate writings by Elvi (sp?), Salter or Shacklock to get an idea of what it is all about.  The latter two names are quite active in current research of the subject.

See ya!

Greg Hart, Kinesiologist Human Effort
Calgary, Alberta Canada

Subject: Great upper back exercise

I find myself doing this exercise almost every night. It occurred to me that it might be helpful to many of you, too. It does not appear in my book, but I certainly will consider it for a second edition!

Here it is:

Lay on the floor on your back, knees bent, feet firmly planted. Hug yourself by criss-crossing your arms across your chest and grasping the shoulders. Keeping your hips on the floor, gently rock your upper body back and forth, from side to side. Variations can include tilting your elbows toward your forehead, or down toward your feet as you grasp your shoulders and rock. You can also try this with your arms extended straight up towards the ceiling, palms together, as it places a different amount of pressure on the area between your shoulder blades.

Done properly, this exercise should create a sort of massage for the area between your shoulder blades, an area which certainly takes a beating when sitting at a computer all day long.

I hope you find it helpful!

Subject:      Relieving pain in outer wrists Status: RO

Robbin asks:

>I also have pain on the outside of my wrists.  COULD this be caused by the DeQ’s and/or can the surgery help this tendon also?<

Pain on the outside of the wrists (pinky side) can often be tracked back to bending your wrists in the direction of your little finger as you type on the keyboard. I have seen lots and lots of people who have unconsciously done this for many years, and all of a sudden start having symptoms. If there is indeed a shortening of the tissue at the outside of the wrist, you will notice that as you bend your wrist palmward that the body of your hand stays tilted toward the little finger.

Several things can help you overcome this. First, I would get a split keyboard. This encourages your hands to remain in alignment with your forearms. Second, try bending your wrist palmward, slowly, making sure that your wrist tilts toward your thumb. It’s pretty hard to do in the beginning because the ligament that surrounds your wrist tends to form adhesions in the outside of the wrist from this type of continual stress (hand tilted toward little finger). These adhesions make it a real lesson in concentration to keep your hand tilting toward the thumb. But, eventually, the adhesions will begin to release and you will find it more and more easy to do this movement.

Another common area of adhesions is along the ulna bone. This bone goes from the boney bump at your wrist to the elbow. By tilting the wrist toward the little finger, the muscles that are located along the ulna have to be in a contracted state all the time. Add to that the strain of repetitive motion and voila! Adhesions!

Most of the time I would recommend that someone receive bodywork to reduce these adhesions in this area. But, upon thinking about it, it might work if you do the following…

Let’s say you want to work on the right arm. Hold your right arm out in front of you, elbow bent. Firmly grasp the muscles of your forearm with your left hand. Now, roll your right arm as if you are trying to turn your hand palm-up. As you do this, begin bending your wrist back and forth, always tilting your hand towards your thumb. As the adhesions release, you will feel more and more muscle activity under your fingers as you grasp your forearm. Try grasping in different positions on the forearm, following the same twisting and bending procedure. Be sure to do the other arm as well.

So, there’s my tip for the day. Let me know how it works for you!
Sharon Butler

Subject:  Ulnar nerve damage

Jason writes:

>More to the point, when I flex my elbow out to the side and extend my wrist (as in Sharon’s exercise Forearms 5B), I feel a pulling much like the pulling I get from the standard adverse mechanical tension test (reaching down and extending the wrist), but into my ring and pinky fingers instead of my index and middle fingers.  As I understand it, this feeling is caused by pulling the nerve sheath taut. <

Keep stretching in a way that causes you to have this sensation, Jason, only VERY lightly. You are indeed pulling on the nerve sheath when you get this sensation. If you stretch lightly enough and do it for long enough time, the adhesions that are hanging up your nerve at this spot will let go.

I have found that most bodies can tolerate a little tingling when stretching the nerve sheath, with no damage to the body. But, the tingling should always be light and should not be increasing in intensity. If the tingling becomes more intense, you should lighten up on the stretch until there is almost no tingling left at all. Then, wait in this position until all tingling goes away completely.

If you want to, you can stretch a little more deeply into this same stretch to find the next stretch point, then wait for the release. If you do this carefully enough, you will very effectively release the adhesions located at this spot that might well be causing your symptoms.( UNDER NO CIRCUMSTANCES SHOULD YOU STRETCH TO THE POINT WHERE ANY PART OF YOUR BODY GOES NUMB!!! This is too much stretching for the nerve to handle safely and it will only delay your getting better, or prevent it altogether.)

It is possible, however, to have adhseions in several spots along the route of the nerve. It is up to the patient to find all of the adhered spots. You can do this by simply moving around until you feel a stretch sensation (stretch point). Just hold in this position until the stretch sensation (or tingling) goes away. Now you have at least partially released another adhesion.

You can tell if the adhesion is fully released by moving around slowly, focusing your attention in roughly the same area that the original adhesion was felt. If you feel no further sensations of stretching, the adhesion is fully released and you should begin feeling, immediately, relief from the symptoms that that adhesion was responsible for.

Many people who come to my office and get these adhesions released through bodywork have an amazed look on their face when they finally realize that they can move any way they want and feel no more pain. The trick is to find all the adhesions and release them completely. The exercises in my book are a great place to start looking for these adhesions, but they are by no means the only places where adhesions will be found. It is up to the individual to search for them in their own body. Each of us is highly individual in the way we have mucked up our bodies and it is up to us to find the way out.

But, you can do it yourself…You really can.
Sharon Butler

Subject:  Dealing with Upper Arm Pain

Long ago I learned from Joseph Heller, the founder of Hellerwork, that much of hte upper arm pain that clients feel actually occurs as a result of restriction in the ARMPITS. And, if you think about it, it actually makes sense…

In the act of raising the arms, several muscle actions must occur, and the more balanced they are, the more effortless and painfree the movement. One muscle action is that the muscles of the outer arm, along with help from some muscle fibers in the front of the chest and upper back and shoulder begin to contract to pull the humerus (upper arm bone) up. At the same time, the muscles and soft tissues under the arm, primarily in the armpit, must release and lengthen.

The most common thing I see in my practice working with RSI sufferers is that their armpits are extremely restricted and tight. And, I haven’t had a single client yet, out of the hundreds I have worked with, who realized that a problem was going on in their armpits. We just don’t think about that area.

Most of the people on this list spend a great deal of time at the computer. While working on a computer, your upper arms are down alongside your torso. They stay relatively stationary. This is a classic opportunity for restrictions and adhesions to begin occuring in the armpits.

Nearly every day, I get down on the floor and find some position to stretch my armpits. It isn’t important what exercise you use. The important thing is to find a position where your armpits are fully open and you are trying to open them further. I like to lay on my side, extend my arm over my head and roll, trying to press my armpit into the floor. It works great, but I also try any other position or stretch that seems to affect that area.

Another thing to consider is that often, the armpit can’t release because the shoulder blades are stuck and can’t fully rotate when lifting the arm up. Watch a child’s shoulder blades move as they raise their arm overhead. Then, look in a mirror to see if your shoulder blades move as completely as theirs do. If not, start doing shoulder exercises that emphasize the rotation of the shoulder blades. If fuller movement still eludes you, start working with a Hellerworker or some other myofascial therapist who can reduce or eliminate the adhesions in the area that are causing the restriction.

Treatment of the site of the pain when it comes to upper arm pain is rarely the most direct pathway to relief. Try these suggestions I have just offered and see if you get better results.

Best of luck to you all!
Sharon Butler

Subject:  thumb “popping out”/ DeQuervien’s?

Alli Robertson  lists her symptoms as follows: >lateral epichondilitis in both elbows >bursitis in both shoulders >DeQuervein’s in both thumbs >chronic pulls and strains to innumerable small tendons and >muscles in my hands and lower arms

She describes a rather complex series of symptoms throughout her arms and shoulders. I have some suggestions for her and thought others on the list might find some value in them. Thus I am posting my response to her to the whole list.

When I see someone in my office with symptoms that affect so much of the upper body, my first inclination is to release tight and restricted tissues in the torso. The image I get is that the arms are like big rubber bands that run thru the shoulders and attach to the spine at the center of the torso. Of course, that is not what they actually do, but from my myofascial perspective, it’s almost like they “function” that way.

Anyway, when I work with a patient who has extensive symptoms like this, I usually start by releasing tight tissue in the torso. I make sure that the shoulder blades can move freely, that the ribs and vertebrae can move/twist easily and that all of the tissue that runs to the shoulder is free of adhesions.

It’s amazing how this reduces the stress on the tissues that run through the arms. If I had started by working on the tissues in the arms, they would only have been irritated. The way I think of it, they have no “slack” to release with until the pulling that originates in the torso is lengthened. I would suggest that Alli begin by stretching her sides, neck, between the shoulder blades and works to improve the flexibility of her spine.

Next, I proceed to the shoulders and work on them A LOT. Most people, without realizing it, have lots of adhesions, as well as unconscious holding patterns, in the armpits. Often the shoulder blades are restricted in how much they can move (like they are stuck to the ribs beneath them). Releasing this entire area brings a motherload of healing potential.

Only then will I begin to work deeply in the arms, elbows and hands. This way, the irritated and overworked tissues in this area are spared additional strain and sometimes, they even “learn” to let go when the tissue in the torso releases. I will also work for a short period in the forearms, then move to another area, only to return to the forearms later. This also saves the smaller and more delicate muscles in this area from additional strain.

I would suggest that anyone who experiences symptoms over a broad area of their upper body stretch their upper bodies and arms in the same order I have just described. The more sore and irritated the tissue is, the less time you should spend stretching that area in one sitting. Give this type of tissue a gentle stretch for a short period of time, then move on to another area. You’ll be amazed at how the body works to resolve its own restrictions if it is given slow, gentle, and brief hints as to where it should “let go” next.

One last comment to this rather long post…Thumbs must be stretched VERY gently. I usually tell my clients to choose only one stretch for the thumbs per day and to practice that stretch for a brief period only. Thumbs seem to be very susceptible to overstretching and can get more sore very easily.

So, there you have it. More “hints” from the trenches. I hope you all have a healthier and happier holiday season and new year than you had this year.
Sharon Butler

Subject:  Stretches for elbows from Sharon’s book

Gema asks:

>>A lot of the exercises in your book require bent elbows. Having ulnar neuropathy in both of my elbows, I wonder whether it is ok to do those stretches at all in case they aggravate the ulnar nerve. What do you think? (fyi: also have bilateral tennis elbow) Thanks! <<

Sharon responds:

Here’s what I have discovered in working with LOTS of people with all sorts of nerve entrapment problems. First, a little background…

The nerves are designed to “float” or “slide” in relation to the muscles and other structures they are adjacent to. They don’t have the capacity to slide much, maybe a centimeter or two. But, the idea is that as you bend your elbow, the nerve should be able to slide a bit so it can round the bend of the elbow without interference.

The problems begin when the nerve becomes tethered to some neighboring structure, somewhere along its route, limiting its ability to slide. Then, every time you bend your elbow, the nerve gets tugged, then irritated, then encased in thicker protective fascia, until persistent symptoms develop. This tethering usually begins as a result of strain in the area, limited range of motion, increased effort, or possibly a previous injury. This is probably the state that Gema finds herself in now.

The only way to restore the nerve to its previous ability to slide when neighboring muscles move is to GENTLY, GENTLY stretch the tissue that surrounds the nerve. You want to proceed gently because you don’t want to stimulate the nerve in a way that will delay its healing or cause a flareup of symptoms. I tell my clients that they have to think of what they are doing as if they were trying to peel a very sticky label off a glass jar without tearing the label. They have to start very carefully at the corners, then along the edges, then very, very slowly and gently, begin lifting the label off the jar.

The same is true with reducing adhesions related to the nerves (and the same applies to all other forms of adhesions in RSI’s as well). I would suggest that Gema, and anyone else who is using the stretches in my book, go back and re-read the section on the “stretch point”. Chances are, you are attempting to duplicate the position in the exercise illustration, and not listening to what your body is telling you. When doing any stretch to correct RSI symptoms, and especially stretches that involve the nerves, you will get much better results if you close your eyes and pay attention to the sensations you feel.

I learned a technique from a colleague years ago that ultimately lead me to the development of the “stretch point” concept. She said to “Kiss the Pain”. By this she meant, go right up to the point where you can feel the pain just beginning, acknowledge its presence, stay with it for a moment, and then back away. For RSI, I recommend that you approach the pain, acknowledge it, and remain in the same position until you feel the pain recede (which I call the “Release”).

This brings me back to Gema. She is afraid of bending her elbow, lest she cause some discomfort or damage. I contend that it is very important to bend the elbow, but only to the point where you “Kiss the Pain”. For some, this might mean that you only bend the elbow 1/2 inch! But, that is where you start.

I keep telling my clients to “honor” their pain. By this, I mean that they should recognize the limits that their pain places on their range of motion, symptoms, etc. They should never abuse their pain by barreling through it, forcing it, working through it or covering it over. Pain is the grand indicator. It tells you that there is a problem and gives you pointers on where that problem might be located. (I say “might be located”, because in the case of nerves, the pain or nerve sensation is often in a different place than the actual site of adhesion.) You should meet your pain, get to know it and nudge it lightly. When you do this, it often disappears. Then you go looking for it again, but now in a new place.

If you apply these concepts to virtually any RSI symptom, you will find that you not only learn a lot about your body, but your pain also goes away. But, learning to understand your body’s sensations is like learning to speak a foreign language. It takes practice, but you will eventually get it.

I wish you all well.

Subject:               Re: Wooden Knots in neck and blades

In a message dated 12/16/97 6:27:51 AM, you wrote:

<< My question concerns the undiagnosed pains and knots which I continue to have in my upper back, around the shoulder blades, shoulders and neck.  I am starting to severe headaches which originate from the base of my neck.  And, I have incredible knots in both sides of blades, top of shoulders and neck.  Tried PT with some success (3 mos is limit on treatment, deep tissue massage which made the knots, pain much worse,and NSAIDS—which I do not take reguarly, don’t seem to help all that much.

When I get a massage from a friend, this region is described as feeling like an old wash board—-the knots feel and sound like pieces of wood and the knots are all over.  And, the pain goes deep.  If someone were to walk on my back, I am not sure it would be hard enough.  I often ask my friend to pound my sore spots.

Can anyone relate?  Also, the pain, knots increase any time I am stationary for any length of time. such as sitting at the computer, sitting in a car for any length of time.  I know that no one can give diagnosis over this internet, but does anyone have expertise that might shed some light on this for me?  With your information I can do some research and present the information to my treating physician.

What treatment method would be helpful- either lessen the pain or successfully work it out to where the symptoms were gone?  I am limited for medical treatment.  Any treatment must be approved by my WC insurer, and they have already paid for treatment that hasn’t turned out to be real successful. >>

In my experience, a person with your symptoms often has a forward head. In other words, when you are standing, your head is forward of your shoulders. This creates tons of unnatural strain in the neck and upper back muscles, becasue they are constantly working to hold up your head.

Ideally, your head and neck should be positioned directly over your shoulders. If you are not naturally falling into this position, then Hellerwork or Rolfing would be the fastest way to restore your body to the desired balance.

People who spend their days with their arms at their sides (computer users are prime offenders) often have short and tight latissimus muscles. These muscles extend from the low back up to the upper arm. When they are short and tight they tend to pull down on the shoulder girdle, creating excess strain in the upper back and neck muscles. This creates incredible amounts of pain in just the areas you described and a “ropey” feeling to the muscles in question.

The best way to counteract this downward pull is to stretch the lats. One easy way to do this is to lay on your side on the floor with the arm you are laying on extended straight upward in line with your body so your head is resting on your upper arm. Gently and slowly rock forward and backward, only a few inches in each direction. Press your armpit in the direction of the floor with each forward rock. Continue until you feel the area soften and you no longer feel a stretching sensation in your armpit area. Especially in the beginning, go very slowly and gently so you don’t strain any part of your arm or shoulder muscles.

I’ll be offering lots of other helpful information and self-care tips in my upcoming phone course, “Self-Care and Self-Recovery for the RSI Sufferer”. If you are interested in receiving free info about the course (the first class begins January 18), email me your postal address and I will send you a course brochure.

Best of luck in your healing program,
Sharon Butler

Subject: Helpful tips for talking

In a message dated 1/14/98 Madeleine wrote:

<<I am now into major TMJ flare-up and lower back pain (new).

I can barely open my mouth to talk. >>

Madeleine and anyone else who uses voice recognition software – THIS IS IMPORTANT!!

Structurally speaking, tension inthe muscles at the back of the neck, at the base of the skull, can seriously affect the functioning of the jaw joint. If someone sits in a slouching position and sort of thrusts the front of their neck forward while at the same time compressing the muscles at the back of the neck, this translates into an excess accumulation of muscular holding at the jaw and can lead to TMJ symptoms. If this is the posture you often find yourself in, lift your chest and tilt your chin down so that it’s level. You should find that this position creates a lot less tension in your jaw as you speak.

There are other, slightly more obvious tips that can also be helpful. Let your jaw go slack while you are not talking. In other words, let your teeth separate in your mouth during any break in speaking, no matter how short. Don’t clench your teeth. Take frequent breaks during which you turn your head from side to side, slowly and then tilt it up and down, slowly. Do some really slow, really big shoulder circles periodically throughout your day. Always pause at positions that seems particularly tight or uncomfortable, allowing the tissue there the time it needs to let go. When you get up for a break, make sure that you move your hands and arms in directions that are different from whne you are working. For most people, this means putting your arms over your head, twisting your torso (gently and slowly), touching your toes, etc. Just break up the habitual movement patterns.

Let me know if these tips prove helpful for you. Best of luck in your recovery!
Sharon Butler

Subject:  Nerve mobilization and fascia stretches

In a message dated 2/8/98 11:28:57 PM, Lynette wrote:

<<This note is going to be confusing to write, because I’m comparing (David) Butler stretches and (Sharon) Butler stretches.  David Butler’s stretches are designed to mobilize the nerves, and Sharon Butler describes her stretches as working with the fascia, the connective tissue that surrounds all of the muscles.  Like most people on the list, I’ve been using Sharon’s stretches for some time, and like her book a lot.  (“Conquering Carpal Tunnel Syndrome.”) >>

Thanks for your interesting post on how you are using my stretches in comparison with David Butler’s work. I hope others will benefit from it as well.

My work is similar to David Butler’s in that all nerve tissue is surrounded and supported by fascia and this fascia is continuous with the fascia that surrounds and permeates through muscle tissue. So, when the whole system gets strained, the whole system responds by becoming stickier or more plastic-like.

The trick in healing RSI is to find the places in the body where fascia has changed from its normal loose and fluid state and restore it back to that state through stretching. When using stretches, whether they are mine or David Butler’s, it is important to play around a bit with your positioning as you do the stretch. As Lynette points out in her post, sometimes something as simple as tilting your head in one direction can help you access the stuck and tight tissue. This is how you can customize the stretches to be of maximum benefit in your own case.

Keep up the good work, Lynette, and all others who are using stretches to enhance their recovery. It is totally possible to significantly reduce your recovery time by becoming familiar with these simple, non-invasive self-help skills.

Sharon Butler

Subject: Butler’s exercises

In a message dated 10/1/98 1:30:49 PM, you wrote:

<<the trouble with Butler’s exercises I’ve had probably do stem from difficulty I seem to have had, according to the negative results, with the ‘stretch point’. Although I did read all the instructions, apparently I was not able to achieve understanding of this specific instruction on a practical level, so to speak.  I probably overworked my muscles too, taking (undeliberately) as a measure the amount and intensity I employed with Bob Anderson’s desktop stretches. I’m shocked though how serious of a relapse one can get from not the most exact rendition of these exercises. >>

The first and most impportant thing that people who have an RSI must remember is that the soft tissues of your hands, arms, shoulders and neck are damaged. You simply cannot use these tissues with the intensity that you used to use them and expect them to respond normally. These tissues, for the time being, are not normal and they will not respond to exercise, stretching, etc. in a normal manner. It’s like asking a person with a severely sprained ankle to take up jump-roping and not expect further injury from the overuse of the damaged ankle.

The stretch point, as it’s presented in my book, is a method of stretching the injured tissues without causing further damage. If you can actually grasp the delicateness of these stretches you will immediately see that they will cause no further harm to the body. But, most people superimpose their previous beliefs of what a stretch should look and feel like and begin practicing my exercises in that manner. Believe me, you will not get the best results this way.

If you have a gut feeling that you are stretching too hard, then stop, or at least back off on the intensity of the stretch. The stretch point means that you position the body part in question in such a way that you barely feel anything at all. It’s a sensation that ordinarily could be easily ignored. It takes time and practice to “lower the volume” of your intensity to get the best results. But, with all the years I have been working with RSI patients, this is the fastest way to heal, in my experience.

If you find that you simply cannot feel the stretch point, then there might be another way for you to get relief. (Again, I must caution you that you cannot stretch in an aggressive way and expect the tissues to respond with healing.) I have found that if you stretch to the point where you feel a MILD sensation and hold it for no more than 30 seconds, you can get maximum results by then placing your body in a neutral position (hands resting in your lap, or head in a straight and upright position, or even your body resting flat on the floor) and waiting until all the sensations created by the stretch (buzzing, throbbing, pressure, tickling, or even an effervescent feeling) disappear completely – and I mean COMPLETELY.

Only then can you go on to the next stretch, or get up and go about your business. If you miss this critical “resolution phase”, as I’ve begun to call it, you will almost surely not experience any positive change as a result of the exercise you just did. When the tissues are damaged, they must be treated with the utmost respect. And, in this case the utmost respect is giving them the time to calm down after they are asked to change through stretching.

The stretch point concept works. I have tried it over and over again in my own body, with my own injuries, as well as with my clients and their injuries. (It even worked when I used it to heal from a sprained ankle!) It does require making some changes in technique, and it requires time. You should expect that even the simplest injury will probably take a couple of months to completely resolve if you use stretching alone. It’s as if you are trying to learn how to speak the language of “Body”. Think of how long it would take you to learn to speak French. The process is not dissimilar.

Relax, be gentle with yourself, have realistic expectations, and carefully observe what your body is saying to you through your sensations, both during and after your stretching sessions. Have respect for this tissue that is damaged through no fault of its own. You CAN recover from this injury and go on to lead a comfortable life.

My very best wishes,
Sharon Butler

Subject:      Sharon Butler on Sharon Butler stretches

Wonderful New Years Greetings to all fellow Sorehanders,

I see that there has been some new discussion about my stretches in the last day or so. I appreciate seeing the number of people whose lives I have been able to affect through my work. Here are some of my thoughts about doing the stretches that might help Sorehand newbies understand the concept behind them.

The stretches are meant to restore damaged tissue to a more normal state. As a result, you have to think differently about doing them compared to stretching routines you might have followed in the past.

In order to get the best possible results from my stretches, you must try to become aware of the sensations you feel that are part of your injury. Use the book to find an exercise that addresses the part of the body that you feel is injured and try the stretch. If the stretch duplicates the symptom, or amplifies it, then you are doing the right stretch. You have also chosen correctly if the stretch makes you feel like you are stretching something that  is tight.

Now comes the challenge. You have to imagine that the sensation you feel from the stretch is a volume you can control. You control it by the amount you have a joint bent, how firmly you are pressing into the stretch, how open your fingers might be, etc. With my stretches, you always want to have the sensations in the low to mild range. What this actually accomplishes is that by using the stretch you have accessed some part of the damaged tissue that leads to your symptoms. By stretching it lightly so that sensations remain in the light to mild range, you are gently encouraging that tissue to change. The stretch is completed when you feel the sensation disappear.

In a message dated 1/5/0 1:05:03 AM, Nancy wrote:

<<How often to people do them?  Are they typically done in sets of, say, 10 at a time 3 times per day?  Is another approach to scatter smaller numbers of stretches more frequently throughout the day?  What have Sorehanders found works best for them? >>

Nancy brings up a common misconception about doing the stretches. In her post, it is clear that she is used to doing exercises of any kind in sets with reps, etc. I see that as a way to exercise using a formula or routine. That is not the correct way to do my stretches. My stretches are meant to provide feedback from your body that tells you how far to stretch so that the tissue is not overwhelmed, how long to hold the stretch so that a release of the adhesion is accomplished, and, if you pay attention carefully to what your body is telling you, you will be able to figure out how long you should do each group of exercises so you are getting the best possible results.

In this way, you do only the stretches that you body needs, and for only as long as it needs them on any particular day. This is a real challenge to shift to this new perspective of paying attention to body-feedback, but it is one well worth pursuing. It will lead to a lifetime of being aware of when a problem is brewing so you can take corrective action early and never be overwhelmed with an injury again.

In my treatment practice, I recommend that clients do no more than 4 or 5 different exercises at a time. Since more tissue is injured at the beginning of a treatment regimine, you will have to plan on spending more time at stretching in the beginning and less as time passes and more and more tissue is restored to normal.

Since RSI’s of all types are the result of strained patterns of use, it is best if you can figure out how to break up your daily patterns of strain by injecting a few minutes of stretch here and there throughout your day. This gives the tissue the rest it craves and will result in great improvements in your symptoms.

Here’s an additional tip: If you have any form of tendonitis, thoracic outlet syndrome, or elbow injury, I would suggest that you stick with exercises only from the “Upper Body” section of my book for a week or two, until they no longer create much sensation for you. Then progress on to more specific exercises for the areas of your body that are injured. This helps create some “slack” in the tissue that leads to your hands and fingers which then helps them to release their adhesions.

I hope this long-winded answer is helpful to you all.

Many blessings for a healthy and happy New Year.

Subject:      Re: CTS causing shoulder pain…why?

In a message dated 12/8/99 6:14:11 AM, you wrote:

<<Could someone (if they have time) please explain to me, in medical terms, how CTS causes between-the-shoulders pain?>>

It isn’t that CTS causes between-the-shoulders pain.It’s just that RSI’s in general are the result of a complex pattern of correction and adjustment that a person adopts for one reason or another, usually highly individualized from person to person. Pain occurring between the shoulder blades is often the result of too much tension in the latissimus dorsi muscles which originate in the low back and rise up to attach on the inner, upper arm. Tension in these muscles creates a downward pull on the upper arms and shoulders that displaces the shoulder blades, which in turn creates a shift in the muscles that attach the shoulder blades to the spine (the rhomboids). This is usually the casue of the pain you describe.

To counteract this problem, here is a simple stretch that really helps. Sit facing your desk and lean forward, bringing your head closer to the desk surface. Take your right arm and reach, pulling gently, for the left, far corner of the desk. Take a few deep breaths into your ribcage as your extend your arm. Come back to the starting position, sit up and wait until all the residual sensations from this stretch have disappeared. Now, stretch the left arm toward the right, far corner of the desk and go through the same process.

Best of luck in your recovery!

Subject: Tips for Butler’s Stretches

Several people have commented that they are having trouble figuring out which of the stretches from my book they should be doing. Others have contacted me privately for help. I figured that perhaps I should address this to the list in the hopes of helping those who are still stuggling to figure it out.

Since my book was first written in 1994, I have learned a lot more about the idiosyncrasies of RSI’s. The most important thing I have learned is that the injury almost always involves the shoulder area or the armpits. Imagine that your body is strung like a marionette’s. String passes through the shoulders and continues down the arm into the hand. If tension is pulled into the string at the shoulder, it takes up all the slack in the string passing down the arm into the hand. It’s this “slack” that we have to restore first.

I recommend that users of my book begin with upper body exercises alone. Do not do any stretches for the forearms, wrists, fingers or thumbs yet. I find the slow shoulder rolls a universal necessity and the head rolls, done with support for the head is almost needed as often. try these two exercises and if your neck and/or shoulders feel tight when doing them, then include them in your list of exercises.

Choose a total of three or four exercises to start. The ones you should choose are any exercise that creates a stretch sensation when you do it. Don’t get upset about choosing the “right” exercise, because you may need, eventually, to try all of them. Remember, these exercises are merely tools to get access to tight tissue. So, each different exercise merely helps you address potentially damaged tissue differently. There is nothing particularly magic about them.

You should find that as you continue practicing these stretches, your symptoms will simply become less severe. Once your shoulders and neck produce fewer stretch sensations, then it is time to go on to stretches from the rest of my book, and you can choose which ones to do from the charts provided in the book. Just don’t do more than four stretches at a time. This doesn’t need to become your full-time occupation.

Eventually, I try to get patients to develop their own stretches, because these are the ones that will do the most good. You just simply find any position that creates a stretch sensation and hold that gentle stretch until the sensation disappears. My favorite position for doing this is while laying on the floor. That way, you do not need to use muscles to hold parts of your body up while you are trying to release tight tissue.

I hope this proves helpful to many of you.
Sharon Butler

Subject:  Good Lat Stretch

A good lat stretch goes as follows:

Clasp hands together in front of you. Bring both forearms together, similar to the illustration in my book for  Upper Body Exercise #5, Step A. Instead of continuing to follow the exercise in the book, do this instead…Place clasped hands and forearms down on a desk or table in front of you. You will be bending forward at the hips. Take one step backward so your feet are slightly behind your hips. While leaving the hands and forearms on the desktop, not allowing them to slide, lean back into your hips. You should feel a stretching thru the arms and sides of the body. Remain in the stretch for 10-15 seconds, then stand and put the arms at your sides until the residual sensations have disappeared. Then, try the exercise again. You can repeat this process up to 3 times at a setting.

Subject: Stretches for epicondylitis

<The worst of all the “mouse” injuries was the medial epicondylitis. It is really hard to design stretches that effectively reach the elbow tissues affected with this injury. After lots of trial and error, I developed a single stretch that proved most effective for those symptoms. >

Amy and others,

Here are two stretches that work well for epicondylitis:

1.  Put your hand on your hip. Your wrist should be bent at a 90 degree angle and your elbow straight out to the side. (If your wrist cannot bend to a 90 degree angle, or if you cannot get your elbow straight out to the side, then you have to work on that before this stretch will work for you.) Now, imagine moving your shoulder blade down, as if you are trying to tuck it into your hip pocket. In doing this, you should begin to feel a deep ache in your elbow. That is the stretch. I recommend holding this position until the ache gets on your nerves, or you feel like stopping. I have not found any problems with holding this position for a long time, just the annoying ache. Relief comes from frequent repetitions.

2. Hang your affected arm straight down at your side. Twist your arm so your palm is facing out, thumb to the rear. If this creates a stretching sensation anywhere in your arm or elbow, then hold this position for 30 seconds. Return your arm to its untwisted position and wait until remnants of the stretching sensation are completely gone. Repeat.

When you do this stretch and you no longer get stretching sensations anywhere in your arm, then go to the twisted arm position and bend your wrist about 1 inch. (Your palm will be bending toward the ceiling, fingers away from your body.) This will create new, hopefully light, stretching sensations. Hold until the stretching sensations begin to fade. Return to the untwisted position and wait until all traces of the stretch have  disappeared. Repeat. Continue repeating until you no longer get stretching sensations in this position.

You are now ready to try  the next position, which is the same as the others, only your wrist is now bent 2 inches. Follow the same procedure as before. NEVER try to go to a new position unless ALL traces of stretching sensation have completely disappeared in the old position. This will probably take a week or two of daily repetitions, so don’t rush it!

As you continue practicing the stretch, you will progress through several more stages of bending your wrist farther. When you get to the position where your wrist cannot bend any farther, and this position does not generate any stretching sensations whatsoever, then begin wiggling your fingers in this bent-wrist, twisted arm position. This is the final step of the stretch.

Expect this stretch to take several weeks to get you all the way through to the final position. During this time, it is preferable not to participate in activities that flare up your elbow symptoms, if possible. While the stretch takes an extended amount of time to get the results you are looking for, it is worth its weight in gold. It really works.

Sharon Butler


I highly recommend that you try stretching your armpits. Start by laying on your back on the floor and extending both arms straight out to the side. If this causes too much aching, prop your arms up on a folded towel, but keep them straight out to the side. Remain in this position until all aching and stretching sensations are gone. You might have to repeat this posture several days in a row until all the sensations are gone. Once you have achieved a sensation-free state, then raise your arms a few inches toward your head. Repeat the same waiting until all sensations are gone. Again, raise your arms a bit higher and keep repeating this cycle until your arms are all the way up next to your ears. Don’t rush any part of these positions. It may take you several weeks to get all the way to the top position, but your condition will continue to improve as you do the exercise.


Subject:  Stretches that aggravate

<< Does anybody know of stretches which may aggravate epicondilytis (tennis elbow) ? I do a range of stretches from Sharon Butlers book and I suspect that some of them may actually be making things worse. My original RSI symptoms were and still are sore wrists, but since applying various exercises from the book my elbows are becoming excruciating, even though my computer activity has been dramatically reduced. Of course I realise that the new symptoms may merely be a reflection of the migratory characteristics of RSI.  >>

You appear to be experiencing a phenomenon that many others have experienced relating to stretching programs. Unfortunately, my book was written 6.5 years ago, well before I figured out the solution to this problem. I am putting all of the following new information on my upcoming website for RSI sufferers (I will put a notice on Sorehand when the site is operational.)

Here’s what I have found to be the problem in this case: People usually have symptoms in more than one area. Typically, they choose exercises or stretches that affect the area with the most pronounced symptoms. Sounds reasonable, eh? In your case, my guess is that you have chosen stretches that affect your forearms and wrists.

Well, in actuality, the stretches are not just stretching specific areas, they are also affecting the connective tissue matrix that goes throughout the entire upper body, feeding down into the limbs. I have discovered that if someone has an adhesion in the shoulder or armpit area, they may not feel symptoms there. They will probably feel their symptoms in the area of their body that gets the most use. In the case of computer users, this would show up in the hands and forearms. Still, the actual problem is in the shoulders and armpits.

So, the solution is to first stretch the shoulders and armpits. I am still amazed at the huge majority of RSI sufferers who have major adhesions in these areas and never feel them until we start to use stretches that affect these areas.

For you, I’d recommend that you choose stretches from the “upper Body” section of my book, and try to make up your own stretches that help you open up your armpits and move all the components of your shoulders. Example: Lay on your back on the floor. Extend both arms out to the side, palm up. This simple position often brings about stretch points and you should wait in this position until they are all gone. Next, bend your elbows at a 90 degree angle so your arms on the floor now look like goalposts.

Wait in this position until all stretching sensations disappear. Now, in one smooth, slow movement, keeping your arms in full contact with the floor, straighten your arms into a “Stick ’em up!” position, then slowly return to the goalpost position. Keep repeating, very slowly, for 5 repetitions. Now, put your hands on your belly and wait in this neutral position until all traces of the stretching you just did are completely, and I MEAN COMPLETELY, gone. (This recovery portion of the  exercise is extremely important and may take a few minutes to accomplish the first few times you do this stretch.) You are done!

This exercise is effective for moving all the componenets of the shoulder and armpit, while leaving the weight of these areas fully supported by the floor. And, as I have stressed so many times before, NEVER stretch to the point of pain, or anything even remotely like pain. This is counter-productive to damaged tissue.

I would recommend that everyone who is experiencing this type of confusing feedback from their body stop doing any stretches for the hands, wrists and forearms, and start doing exercises such as this one that affect the tissue higher up on the chain (nearer the neck, shoulders and armpits). You will begin to have more improved results very quickly. Resume stretches for the forearm, wrist and hand once you feel you have gotten at least 50% improvement in the shoulder and armpit areas.

Good luck in your continued recovery!
Sharon Butler, Certified Hellerwork Practitioner

Subject:  What are the best ulnar nerve glides???

Dear Steve and others with ulnar nerve problems,

In a huge majority of my clients with ulnar nerve adhesions I have discovered that the nerve seems to get stuck to the base of the triceps, just above the elbow (tip of the bone). The triceps in that area is a broad, flat tendon made up of dense, non-stretchy fascia. The ulnar nerve passes right along side of this tendon.

When stress is present in the area (from muscle contraction, static positions with the elbow bent, constant carrying of objects with the elbow bent, etc.), the nerve seems to have more opportunity to get stuck to this structure. This means that if your ulnar nerve is stuck in this fashion, every time you bend your elbow the nerve gets more and more irritated because it is being tugged but it can’t slide along its pathway. Here is one suggestion that you might find helpful:

Let’s assume that your nerve is affected in your right arm.  Place your bent right arm across the front of your body. Place your left hand over your elbow area and wrap your fingers around your arm to the back of your arm, in the area just above the tip of your elbow. Press your fingertips firmly into this area and while pressing, slowly straighten and bend your arm. This places pressure on the tendonous area that may be the site of the nerve adhesions and the motion of your arm encourages the tissues to become less stuck.

This little technique may not solve all of your nerve symptoms, but it often does make a considerable difference for the people I am treating for this problem. It might be necessary for you to repeat this process 2 or 3 times a day until the symptoms diminish. Note that pressing into the tendon may be uncomfortable if the tendon is adhered. Remember to never do anything to your soft tissues that cause real pain. If you find you overdo this process, stop doing it for several days until the tissue calms down. Then try again, only more gently. Remember, it does you absolutely no good whatsoever if you do something to the point where it creates lingering pain.

I hope this helps! Let me know!
Sharon Butler, Certified Hellerwork Practitioner

Subject:  More on stretching

Hello Margaret and other Sorehanders,

My comments follow this excerpt…

Sharon Butler

In a message dated 9/14/00 10:00:52 PM, ############ writes:

<< I have had some success with a style of stretching I learned from Aaron Mattes.

It goes something like this:

1) Take the muscle to be stretched, up to where you first feel the slightest pull. I am guess this is similar to what Sharon Butler refers to as a stretch point (please correct me if I am wrong).   To do this you contract the antagonist muscle. So to stretch extensors contract flexors. To stretch the muscles on the top of my forearm (while my hand is palm down position) I hold my arm out straight in front of me, elbow straight and bring my hand towards me, palm down.

2) Hold for  approx. 2 seconds or one inhale exhale.

3) Release and let the muscle return to “normal”, I even shake it out gently between stretches.  You want to let blood flow into the area before the next stretch.

4) Repeat 8-10 times.

Some times giving a gentle assist with the stretch  is helpful, but gentle is the key idea. This way of stretching seems easier to teach to my clients and they seem less likely to overstretch and cause more damage.Of course, I use it myself as well.

The muscle is warmed as it is stretched, so people can do this without walking in place for five minutes first (or whatever), which we are all supposed to do but no one ever really does..

Mr Mattes has a web site which  I find is not very helpful.  The best application I have found of his work is from his students Jim and Phil Wharton. I like their book , The Whartons’ Stretch Book : Featuring the Breakthrough Method of Active-Isolated Stretching. Its on Amazon, etc.

If any of the other list experts and worthies know of some problem with the above, please let me know.  Thanks.  >>

Sharon’s response:

I have tried this type of stretching and have discovered several problems with it that keep me from recomending it to my clients, or using it myself. Here goes:

First, when you activate or contract a group of muscles in order to stretch the opposing muscles, it makes it very hard to concentrate on the sensation of release because your brain is much more aware of the sensation created by the contracting muscles. This concerns me because I have found that extreme care must be present when stretching injured tissues and if you cannot feel the response from those tissues because something else is creating a stronger sensation, then overstretching is entirely possible.

Second, I have found that brief “sets” of stretches seem to affect only the most superficial layers of tissue. In RSI’s the injured tissue is often at a very deep level. To release this tissue, you must take a gentle stretch and hold it for an extended period of time, sometimes for minutes, all the while feeling the sensations that this stretch is creating in your tissues. When the sensation increases beyond the mild level, you need to release the stretch to a slight degree, still continuing the exercise. When the sensation fades into nothing, you need to gently increase the stretch until you find the appropriate sensation once again. The idea is to keep a constant, and very light degree of tension on the tight and restricted tissue, through all its layers, until it releases completely. If you follow this method all the way through to the end (where no more stretching sensations can be found), you will discover that the tissue is significantly improved, sometimes to the point of recovery.

I had a personal experience with this when I was trying to figure out what stretches would restore the strength to my forearms and eliminate the tingling in my hands when I was healing from my first case of carpal tunnel syndrome (bilateral). This is how I came up with Exercise #3 in the Forearms section of my book.

By just fooling around, I discovered that if I laid flat on my bed (no pillow) and stuck my arm, palm up, off the side of the bed, that I immediately felt a rather strong pulling all the way down my arm and in to my fingers. I discovered that if I moved more onto the bed so my arm was more fully supported by the bed, that this reduced the pulling significantly and made it feel more comfortable, and safe.

That first time trying that stretch, I remember that it took about 45 minutes of constant, and very light, tension on those muscles before they released completely, through all the layers. While this time was passing, I felt sensations in the superficial tissue, then in deeper tissue, then superficial tissue again, and on and on. When the sensation completely disappeared, I discovered that if I opened my fingers very slightly, the tension on the muscles returned.

So, I continued the stretch in this new position. Mind you, this was all an experiment, even though I had years and years of experience already in  working with connective tissue, as a Hellerwork Practitioner. I guess I had the courage to try this extended experiment because I had learned over the years that fascia is pretty resilient stuff and if you treat it right, it usually will let go (and this usually meant lightening up rather than beating it up!)

After a full 45 minutes of tension and release, tension and release, I got up, not knowing what to expect. To my surprise and delight, I discovered that at least 75% of my strength had returned and all of the tingling had disappeared completely. It never returned again.

So much for my personal story. I hope you have found it helpful. As I have stated many, many times before, after this initial experience of healing and discovering what appeared to work, I went on to restore a more normal condition to all the tight and restricted tissue that seemed to be associated with that first case of carpal tunnel syndrome. I just kept noodling around until I found more restricted tissue, then used the same stretching technique to restore that tissue as well. Soon, all remnants of carpal tunnel syndrome were gone.

To learn more about other RSI’s and if the same technique would work for them as well, I began to create additional RSI’s in my body. Over the years I have misused a computer mouse, sat at an ergonomically impossible workstation for months, crocheted for hours and hours daily for four months, etc. etc, to create new injuries. I know this sounds insane, but I was confident that I could heal them all through stretching alone.

Over the years I have had bilateral carpal tunnel syndrome, tendonitis, deQuervain’s syndrome, thoracic outlet syndrome, cervical strain, medial epicondylitis, lateral epicondylitis, and trigger finger. Using the non-invasive and gentle techniques I have described here and elsewhere, I have successfully healed from all these injuries and have absolutely no lasting effects from any of them. I can sit at a computer as long as I wish, and do whatever else I want.

The only concession I have to make is that I now recognize that these activities can and do change the condition of the fascia and that if I want to remain symptom-free, I have to spend a minimum amount of time (perhaps 15 minutes per week) stretching appropriately.

ANYONE else can duplicate the results I have gotten, I am sure of it. This is what I have taught to my hundreds of clients. Those who have stuck with their recovery programs and continued to learn what their bodies are telling them, and then have stretched appropriately in accordance with this information, have maintained their symptom-free status as well.

To anyone who is reading this: PLEASE do not let yourself get discouraged along the road to your recovery, especially if you are trying stretching as your method of choice for the reversal of your symptoms. Remember how many times you fell as an infant as you were trying to learn to walk. You will make mistakes along the way, but fascia is pretty forgiving stuff and you can always pick yourself up, dust yourself off, and try again. IT IS POSSIBLE! DON’T GIVE UP!

Sharon Butler, Certified Hellerwork Practitioner

Subject: When I perform Sharon Butler exercises, most of the time the pain goes away after few minutes, but it comes back after an hour or so, is this normal to these exercises?  Am I doing something wrong?

Chances are that you are doing an execise that is somewhat helpful for your symptoms, but is not getting to the biggest source of your pain. You might also be overstretching. The thumbs have very little muscle tissue and it is easy to overwhelm the tissue by overstretching it. I suggest only doing one or two thumb stretches per day, repeated twice during any 24 hour period.

The best exercise I have found that helps with pain at the base of the thumb is not in my book. It is one of my newer exercises. To do it, grasp your entire thumb all the way down to the wrist with your other hand. Slowly and gently, pull your entire thumb away from your hand and hold it there for about 10 – 20 seconds. You should feel slight resistance and a sense of stretching in the webbing between the thumb and hand. After 10- 20 seconds, release your thumb and put your hand in your lap. Allow it to rest there until all the remaining sensations of the stretch are completely gone.

Pain at the base of the thumb can feel just like arthritis. Maybe you just have a bad case of deQuervain’s syndrome. But if you indeed do have arthritis, you might want to do some research on taking SamE and/or glycosamine and chondroitin. These can be very helpful in cases of arthritis. But, I’d check resources on the Internet and then make sure your doctor gives you the OK to take these supplements before beginning.

Subject: The supraspinatus muscle

The supraspinatus muscle is part of the rotator cuff. It lies all across the top of the shoulder blade, dives under the outside of the collarbone and attaches to the very top of the humerus (upper arm bone). The supraspinatus’ job is to help shrug the shoulders up and it assists when you raise your arm up and out to the side of your body.

Since you have problems with it when you use the computer, I am assuming that you are creating those problems by unknowingly shrugging your shoulders up while you type. You could also be raising your shoulder as you rest your elbows on armrests that are too high, by propping your elbows on the edge of a desk that is too high, etc.

The bad news is that no matter what therapy you try, no matter how long you rest, no matter what other correction you make, you will never be rid of your pain if you don’t stop raising your shoulders in this manner.

The good news is that all you have to do to get significant relief from your symptoms is to stop raising your shoudlers. How great is that?

But, here’s that catch. Most people have lost touch with the ability to feel what they are doing with their shoulders, which is a HUGE problem. Tissues that pass  through the shoulders can have an effect on just about every RSI there is. So, it’s really important to become more conscious of how your shoulders are being held and what  you are doing with them throughout your day.

I have included a simple exercise in each of my self care programs to address this issue. I know it is also in the Sorehand archives as well, so you don’t have to buy a program to get it for free if you don’t want to. It’s called the “Tape Trick”. Look it up and DO IT! You will learn so much about your shoulders from this simple exercise.

K also has to pay attention to other ways she may be affecting the supraspinatus. One of the most common things that happens is that once your brain becomes accustomed to your supraspinatus being shortened by your positioning, it will search for ways to always have the supraspinatus in this shortened state. This means that you have to be on the lookout for ways that you might be propping your elbow on a car window ledge, keeping your hand on your hip, putting your hand behind your head, resting your elbow or arm on any elevated surface. All of these postures reproduce the shortened state of the supraspinatus and will perpetuate your injury.

I know it sounds like a lot to have to pay attention to, but at least it’s not surgery! You are in complete control of how much this hurts you and how long it lasts. Try the Tape Trick and be rid of your problems for once and for all.

As I said in my post about the supraspinatus muscle, finding out all the times when you are unneccessarily lifting your shoulders can go a long way to helping reduce overall strain in your entire upper body.

Subject: Shoulder roll spasms

Because you are getting spasms when doing the shoulder roll exercise, I believe this indicates that your shoulders are totally connected to your injury. Of course, spasms are unpleasant, and possibly not good for your tissues. At the very least, it indicates that things are so tight that spasms are the result of such gentle movement as the shoulder roll exercise produces. So, some modification of the exercise is probably a good idea to minimize the spasms. Here’s what to do:

First, read through the entire self care program so you have a better overview of all the things you need to understand about your injury. Next, make sure you are only going around once in each direction each time you practice the shoulder rolls. Each time you complete the exercise, place your hands in your lap and rest them there until all remaining sensations from the exercise are completely gone. This will help prevent the spasms.

If you feel you still need some additional modification, then make smaller circles with the shoulder rolls and rest afterward. Gradually build up to larger and rounder circles as you develop a better ability to tolerate the exercise.

In your case, it will probably take more than one week to work through the first level of exercises. Give yourself all the time you need to get the benefit from these useful and most gentle level of exercises. Once your tissues loosen you will be able to speed up to the normal speed of the program.

As far as the Armaid goes, try it to see if it helps you get through these exercises. But, don’t let that be an excuse to shorten the amount of time you devote to this level of stretches. Use the Armaid to help you practice the shoulder rolls now, but do not progress on to the next level of stretches until you can safely do the shoulder rolls without the benefit of the Armaid. Then it will be safe for you to go on with the program.

The good news is that since you are getting rather strong reactions to the exercise, it indicates to me that you are completely on the right track and this program is reaching your most injured tissues. Just proceed cautiously and slowly and you will get the fullest level of benefit from the program.

Subject: Pain and overstretching

If you are having pain, then stop doing all the stretches for 24 hours and give your hands a complete rest during that time. This will help the tissues calm down and relieve any strain you may have created.

Sometimes it is hard to feel when you have overdone it. You just have to pay attention very carefully tohow the stretches feel each time you do them, especially in the beginning. If you feel sore after doing them during one session, then do them lighter the following session. Sometimes it also can mean that it is not the right time to be doing that particular stretch.

Canned programs like mine try to put together the very best information that will help most of the people most of the time. But your body may respond differently. Don’t be afraid to experiment with the order you do the stretches in, you might also eliminate the strethc that you think is irritating you for a day or so, etc. You are completely unique in yor injury and your body will respond in its own way.

If you still have questions, go ahead and reqad all of the written material for the entire program so you have a better overview of all the possibilities for adding motion to your stretches, taking breaks, what to do when you overstretch, etc., etc. Experiment around a bit and see if you can find a better fit for your condition.

Remember that the thumbs are very, very sensitive to overstretching. ALWAYS err on the side of doing too little in your stretching of the thumbs. Also, DeQ is very incconsistent. One day you will feel better, the next all your pain will come back. I have found that you have to stick with it and over time, your body becomes more used to not hurting and the amount of time you feel pain in your thumbs gets less and less. It’s a very difficult condition to predict the outcome for. But, stick with it. I also have DeQ in my left thumb and almost never have any pain any more. But this came after many months of stretching, overdoing it, resting, trying again, etc. Don’t give up. You can do it too.

Look at the “Find A Practitioner” section at to see where there are Hellerwork practitioners in Spain, France and Switzerland. I think there are some, but I am not all that familiar with our European practitioners. You can find them in the directory on Helllerwork’s site.

Subject: Ulnar deviation

Rest is always a good thing, especially when it is practiced in the middle of your workday. Another really good thing to do is to reverse the motion that is causing the pain. In your case, that is ulnar deviation.

To do this, I would tilt the hand toward the thumb, which is the opposite of ulnar deviation. From this thumb-ward tilt, I’d add wrist flexion and extension, always emphasizing the tilt toward the thumb.This can be a really powerful way to eliminate the stress of constant ulnar deviation.

Let us know how this works for you.
Sharon Butler

Subject: Trigger finger

Any trigger finger or thumb is a tricky situation to deal with. If you want to do it naturally, without surgery or injections, then it is do-able, but it will take quite a bit of time and patience. Here’s how to get the trigger to release…

You need to stretch the thumb, while it is contracted, just to the point where you feel a little resistance to your stretch. Your thumb will be far from straight. You are basically “teasing” it to let go. Hold this stretch for as long as you have time for. An hour or more is not out of the question. It all depends on how much time you have. If you stretch it very, very gently, with constant, very light force applied to the contracture and hold it for very extended periods of time, you will begin to see a difference. This is a good activity to do while watching TV, sitting in a meeting where you do not have to take notes, on the bus, etc. A student I had years ago (a nurse) was dealing with several trigger fingers and tried this method. She reported that it took a few days of this constant, light stretching before the trigger released completely and never returned.

Granted, many people won’t have the patience to wait that long, or to be that in tune with the gentleness required to successfully achieve this goal. But, it can be done through gently coaxing the joint to release slowly and over an extended period of time.

Good luck. I hope you give this technique a serious try. By all means, continue with the deQuervains program for your other symptoms.

Subject: “Piano string” neck pain 

Hello All,

Several people have written about the trouble they have had with sharp “piano string” neck pain and how difficult it is to get rid of. I thought I’d share a secret I have discovered that has gotten rid of this type of pain for me on several occasions.

The first and most important thing is to not give in to bad posture. Try really, really hard to keep your head and neck in the best alignment you can muster, without straining to hold the position. Try not to slouch in upholstered chairs, twist your neck by reading in bed, etc. while trying to undo this type of pain.

Next, find a stretch that accesses your painful spot. Stretch very, very gently and hold the stretch for 10 seconds only. Return to the upright head and neck position. Wait in this neutral position until all traces of the stretching sensation you just felt from the stretch are gone away. For really tight muscles, this may take a while. Give your body all the time it needs.

Next, repeat the same exact stretch again, just as gently as before. Hold for 10 seconds, then rest once more in the neutral position. This time, the resting period should be somewhat shorter, especially if you stretched lightly enough.

Now, try doing something normal with your neck, like turning your head very slowly from left to right, back and forth several times. Again, return to the neutral position and rest until all sensation is gone.

Go back to the stretch you did that accessed your tight muscle. Hold your first position for 10 seconds. The pain should be greatly reduced at this point. (If it isn’t, then stop for now and repeat this whole pattern again in several hours. Your body needs more time to recover after stretching.) Now, vary the stretch by slightly tilting your head up or down or any other variation you can think of. You should feel some tight tissue in these new positons too. Hold for 10 seconds. Return to the neutral position and rest once again.

Now, get up and go about your business. It may still take some time for the pain to be completely gone, so don’t expect instant miracles, they are happening at the pace your body can handle. If you still have pain after several more hours, then go through the same sequence again. Be very, very careful about how firmly you are stretching, being careful to not overdo it.

The absolute most important part of this sequence is the resting phases after the actual stretching. DO NOT SHORTEN THE TIME NEEDED FOR THIS RESTING PERIOD OR YOU WILL NOT BENEFIT AS MUCH AS YOU COULD FROM THIS ROUTINE.

Try this and let me know how it works for you.

Subject: Thoracic outlet syndrome

Dear Martin,

Your symptoms sound a lot like thoracic outlet syndrome combined with a lot of tissue shortness running the length of your arms. You are doing some good things for yourself with the posture awareness, nerve glides, etc. but there are some changes I’d recommend.

I would suggest that you do not run, but walk instead. Especially the kind of walking where you can swing your arms. This will eliminate compression of your spine from the impact of running (which is especially bad for someone who has an unbalanced posture – running can make it worse) and at the same time give you an opportunity to start opening up your chest and arms with the swinging motion.

Most people with slouched posture feel it is important to strengthen the back muscles to balance out the forward pull coming from the slouch. But this is not always the best thing to do. Slouched posture causes a forward compression of the spine. By strengthening the back muscles, you add compression at the back of the body.

I would prefer to see lengthening happening instead. You should focus on lengthening the front of your body and neck. Here is a good combination exercise that can accomplish this goal, plus give you a good stretch for the tissues that are making your fingers stiff:

Simply lay on the floor with no pillow under your head. Stretch both arms straight out to the side, palm up, flat on the floor. Just rest there. You should feel all sorts of sensations coming and going as you rest there. The more time you can spend the better. I have often rested in this manner for 15 minutes at a time. Very helpful.

If the sensations get to be too much for any reason, just place your hands on your belly and leave them there until all remaining sensations that were bothering you are completely gone. Then, return to the arms-outstretched position again. Notice the difference in sensation the second time around. It is usually much lighter.

Once you get to the point where you feel little or no sensations in this position, then increase the stretch by rolling up a bath towel, placing it on the floor and resting the length of your spine on the towel. Your head and your arms should have to stretch a little farther back because your torso is now resting on an elevated surface. Again, rest there until all stretching sensations are gone, or you run out of time.

To complete the stretch, remove the towel and place your hands on your belly and rest there until all remaining sensations are gone. Once they are gone, you can get up and resume normal activity.

Another great way to stretch out the front of the body is with a big plastic exercise ball. Laying face up on the ball, letting your head fall back and your arms to stretch out are all great stretches to open the front of the body. Just remember to not overdo it. You have to slowly buildup to stretching this aggressively to avoid further injury. I’d start with the floor version first and build up to the ball.

Additionally, a head set for your telephone would be a great idea.

Subject: Pinky grasp

You can grasp either side of each pinky finger joint and while sqeezing the joint, bend and flex your pinky. This helps release tightness in the muscle attachments in the actual finger. Be careful not to overdo it, though.

Subject: Feeling a real difference

I was just cautioning a client about this the other day. When you are following a stretching program and have gotten to the point where you are feeling a real difference and a lessening of your symptoms, you have reached the most dangerous time in your recovery. By that I mean that most people are lulled into believing that they are better and can begin to re-integrate some of the things they have been unable to do and are eager to get back to. Apparently, this is what happened to you.

Instead, this is a time when you are just beginning to see the benefits of your stretching program and your tissues are still very much injured. You still need to follow your stretching program and actually enhance that program by creating small changes to the exercises, like adding small movements (pulsing), or slightly changing the line of pull that you feel from the stretch. I have sections in my self care programs that cover these changes. I call them “Adding Movement” and “Searching the Neighborhood”. Both very important concepts to employ when trying to fully recover from any RSI.

So, now that you’ve screwed things up, how do you get back on track? It’s simple really. If you stop for a moment and analyze what your body is saying to you, it is telling you that it is still sore and irritated. The very best thing you can do in that case is nothing. Absolutely nothing. I mean put your ahnds in your lap and spend the day watching TV. Don’t use your hands for anything except the most essential tasks. They are screaming for a break. You just have to listen and give them that break.

You will know you can get back to stretching when it has been a full 24 hours since you felt that last irritation-type pain from your hands and arms. Sometimes the most powerful thing to do is to take a real break. When you start practicing your stretches again, go slower and more gently at first to make sure your tissues can handle it. Be kind to your hands and give them what they are asking for and you will see a return to your former state of relief in a very short time.

Also very helpful during this time is to increase your water consumption. Make sure youa re drinking at least 2 quarts of water each day, not counting coffee, sodas, teas, or other beverages. This is very helpful for helping to flush out any toxins that have been released from your muscles that may be contributing to your discomfort.

Unfortunately, there are no shortcuts around this problem. Don’t let it get you down, however. All of us, including myself, make this mistake from time to time. You can regain your former level of relief with just a little extra care.

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