Physiotherapy Case Study

Carpal Tunnel

A 28 year old individual came into the clinic with right sided dull forearm pain, tingling with pins and needles into the hand. The pain started without any cause and has just gotten worse over the last two months. It also seems that the hand is worse at night and in the morning.

They have started having difficulty holding heavy pots and pans, and opening tight jars – which they don’t recall having difficulty with before.

 

Although there are many reasons why someone may have pain in the forearm, wrist, and hand, let’s go through some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

 

What causes carpal tunnel?
To have a true Carpal Tunnel Syndrome, the issue is specifically coming from the wrist – the tunnel in which one of the nerves (the median nerve – see above) of the arm goes through and into the hand. More often than not, there will be other contributing factors to wrist and hand pain!

The median nerve is the culprit in Carpal Tunnel Syndrome, and although there can be issues in only one spot causing problems, the nerve is kind of like a garden hose… the hose starts at the tap (the neck), and then runs to the end (the hand). You can lose pressure at the end of the hose by pinching it right at the end (hand symptoms), but you can also lose pressure by pinching it just a little bit on other points through the hose, ending up with the same reduced pressure (hand symptoms!)

So how can we determine what the contributing factors are? Some people will find that if they are looking one direction that their hand symptoms will get better or worse. Others will find that the chair that they are sitting in will seem to impact their symptoms.

If you have hand and forearm symptoms like pain, tingling, or numbness, a physical therapy assessment could benefit you!
What you may expect from this assessment is a postural assessment to look at your alignment, flexibility of the upper body muscles, mobility of the spine and neck, shoulders, elbows, and wrist, with an evaluation of how you move.

In many instances by the end of the assessment there is a clear driving factor to the pain and symptoms that can begin being addressed by home programming. This will put you in charge of feeling better, and not relying solely on having to come to the clinic to improve. Your therapist may provide you with a variety of homework items including stretching of muscles that are providing too much tension, strengthening of muscles that aren’t providing enough support, give exercises that will help the nerves slide and glide, and to help the joints move with more symmetry to restore balance.

A common question we are asked is how long until I’m better?

The recovery period will vary from client to client, depending on the severity and frequency of signs and symptoms, the duration of symptoms, the activity level the client is needing to maintain, and the commitment to their program. Typically, with a straightforward case we tend to see client’s 1x every 1 to 2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy to help restore joint, neural, and muscle mobility as well as progressing exercises for your home program to help you help yourself.

 

Treatment Results for our Case Study

This individual having experienced pain for a relatively short period of ended up having stiffness in the neck and the position of the head changed their symptoms quite a bit. Getting started with some stretches and movements to help the neck, shoulder, and forearm move better, was the first step along with some manual therapy in clinic. The client at the next appointment the following week had a significant improvement in symptoms and found the stretches very helpful with managing their pain. Treatment continued to progress and included range of motion, stretching, and strengthening. When the client came in for their last appointment (a short 5 weeks later!) they were pain free, and able to manage their symptoms quickly themselves if things started to get sore.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic. At Warman Physio clients are encouraged to bring their infants and children to treatment. Warman Physio has been nominated as a finalist for the 2018, 2017, & 2016 WMBEXA, is a WMBEXA award recipient of 2017 New Business Award, and a finalist in the ABEX 2018, 2017 & 2016, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, and has been nominated for the 2019 SABEX and WMBEXA Awards.

At Warman Physio our therapists focus on excellence. Providing excellent, comprehensive, up-to-date care, as well as a personable and compassionate care.

This is why going to courses, reading research, is so important… and being a little bit “nerdy” comes in handy 😉

 

This past weekend I took a course from Antony Lo, an outstanding therapist and physiotherapy educator from Australia, called The Female Athlete. This course was designed to challenge the status quo on current standard practice recommendations for women’s health related to Diastasis Recti, Prenatal, & Postpartum care.

During this course my belief system was challenged in some ways, and affirmed in others. My take-away from this course? First, we need more research in pretty much everything – we have far more questions than we do answers, and although we would like to have specific YES and NO answers for our clients’, everyone is individual with unique needs (not surprised here!) – basically, you are your own person, and the rules may not apply, and may need to be broken in your instance.

Another thing that we need to consider is pain. What is pain exactly?

 

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

What does this mean? Sensory and emotional experience – does anyone find they have more pain when they have more stress? How about if you have pain with something that doesn’t actually damage your tissue – like when your foot falls asleep and you get the painful pins and needles. We do not need tissue damage for pain, and no matter what is going on, your pain is exactly that, YOUR PAIN. Not the therapist, not your family, yours. No one can tell you that you don’t have pain, because it is your experience alone. Because of this reason, some pain can be resolved and changed very quickly, and some may take longer.

Last, our bodies are extremely strong, capable, adaptive, and resilient (SCAR)! We can change our perspective and make our weaknesses into strengths.

It boils down to WHY is continuing education so important? Why do we at Warman Physio put such an emphasis on continuing education? The answer is that it is our belief that being up to date, learning new information, making sure we are at the forefront of practice changes benefits our clients. We are open to education, views that challenge our current beliefs, and learning something new in expected, as well as unexpected ways. There are more ways than one that I find myself learning not only from colleagues and coworkers, but also from my clients and those I meet in day to day life. The curious mind, and attitude of intrigue, and being able to take new information and integrate it into practice is something that at Warman Physio we are striving for, not just on weekends we are learning formally, but every single day!

Do you think this is AMAZING? Have some questions? Want to tell me how it resonates with you? Send me a message!

 

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2018 WMBEXA, is a WMBEXA award recipient of 2017, and a finalist in the ABEX 2016, 2017, & 2018. Haylie was also recognized as YWCA Women of Distinction for Health & Wellness in 2017. 

I am a UK based physio working in Exeter and Totnes. My focus is in helping people to develop a positive relationship with their body allowing them to become injury free, taking control of their own health and enjoying an active life.

When learning new choreography there is often a pressure to get the moves right quickly. This can energise us and enables us to focus our effort but it can also increase stress and tension. By focusing on what we’re trying to achieve it’s easy to forget our bodies, the very thing we need to be tuned in to. In my experience as a physiotherapist, tension is the major risk factor in triggering an injury.

How can I stay relaxed when learning choreography?

As a physiotherapist I work closely with breath. When we are stressed it is easy to lose our natural breathing pattern. This results in breathing into the chest rather than using our full abdomen, increasing tension and reducing performance.

Instead, take opportunities to breathe in softly through the nose feeling the lower abdomen gently expand. Avoid pulling in or tensing the stomach muscles. If you sense tension or discomfort you can take a long, slow and gentle out breath exhaling through the nose. Feel the muscle tension melting away, you can focus relaxation on specific parts of your body.

Dancing is fun and it is important to not be hard on yourself but to treat your body with patience. Often my clients put a lot of pressure on themselves and find that their performance improves when they just relax into their practice. Trust that you’re doing your best and your body will follow. If you have an injury it can be both stressful and frustrating, you may feel unable to train and this stress is likely to slow down recovery. I encourage clients to use imagery in their recovery process, softening breath and imagining yourself doing the choreography. Imagery has been shown to improve sports performance and helps connect the body and mind.

Michael Otto BSc MCSP  Holistic Physio in the UK.

As many of you know I, Haylie Lashta, will be going on maternity leave soon, with my last day scheduling clients being June 2, 2017. I have searched for the perfect person to come in to cover for my maternity leave that can also complete women’s health assessment and treatment, and she has been found!

Kendra Usunier BMR(PT), MClSc, FCAMPT will be joining our team starting on May 23, 2017!

Biography

Kendra graduated from the University of Manitoba in 2008 with a Bachelors of Medical Rehabilitation in Physiotherapy. She went on to complete a Masters of Clinical Science in Manipulative Therapy from Western University in 2015.

Since graduating Kendra has worked in Saskatchewan and Manitoba. She returned to Saskatoon in 2012, and is excited to begin working in Warman. Having grown up in a smaller community, she is happy to return to that environment.

Kendra’s primary focus has been orthopaedics and women’s health. She has taken extensive additional training in orthopaedics, becoming a Fellow of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) – an internationally recognized qualification in manual and manipulative therapy. For more information on CAMPT therapists please click here.

In addition to orthopaedics, Kendra has a passion for women’s health and pre-and post-natal care. She has also taken additional courses in treatment of temporomandibular joint dysfunction, acupuncture, pain management, and myofascial release.

Kendra has a passion for ongoing education in physiotherapy, striving to provide the most up to date, evidence based treatment for patients. She assists in instructing muskuloskeletal courses at the University of Saskatchewan and within the Canadian Orthopaedic Division Syllabus.

Kendra enjoys spending time with her husband and daughter, running, playing soccer and doing yoga in her spare time.

Areas of Practice Interest:

  • Spinal Assessment & Treatment
  • Osteoporosis Management
  • TMJ Dysfunction
  • Sports Rehabilitation
  • General Orthopedics
  • Prenatal & Post-partum
  • Urinary Incontinence
  • Pelvic Pain
  • Acupuncture

Kendra’s schedule has been provided and is available for appointments. Contact us to book your appointment today! Don’t want to wait? Cole Digel has availability as early as the week of May 15, 2017.