Self-Help for the Hand, Wrist, Elbow, Forearm, Through Novel Movements

Posted on: Thu, 08/04/2011 - 9:09pm By: Alice

Musicians. Computer users. Massage therapists.  What do they have in common? They all use their hands and arms a lot in very repetitive ways. Anyone suffering from tight forearms, carpal tunnel syndrome, elbow pain, or wants to avoid those problems should take note.

We have habits and tend to move in limited ways. Our muscles develop habits. We use muscles in certain ways and neglect other muscles by not using them. Those unused muscles can end up going "dormant." If you've ever been in physical therapy, you may have had the experience of your PT giving you deceptively "easy" exercises that are impossible to do! That's because some of your muscles have become inactive. Those exercises are designed to wake them back up, to neurologically program them to start functioning again.

Our muscles are controlled by the nervous system. Every movement we make, every muscle fiber that is fired, is caused by the nervous system instructing it to contract or relax. Ultimately, the brain controls everything.

Our muscles and our brain like variety. When our movement becomes limited, we grow stiff. Bringing variety into our movement wakes up our brain, wakes up our nervous system, wakes up our muscles. It breaks patterns. This is a good thing.

Try These Novel Movements from Cory Blickenstaff

Cory Blickenstaff, physical therapist, is founder of Forward Motion Physical Therapy, in Vancouver, WA. He's one of a growing number of PTs who are incorporating new understanding of the nervous system into physical therapy. Cory has developed some "novel movements" designed to mobilize joints in ways that we don't usually do in our normal lives. These movements may be a bit challenging because they are unfamiliar, but they are not difficult and should not be painful. Personally, I find them kind of fun!

Musicians, computer users, massage therapists, anyone with hand, wrist, forearm, or elbow pain should give this a try. As with any stretching or exercise, if it causes pain, stop! This should feel good!

Try them out and let me know what you think.

And if your forearms are still feeling tight, try some therapeutic massage to help those muscles relax.

Thanks, Cory for sharing this with us!

What is the question about active insufficiency?

As for potential gain: breaking established patterns is one potential gain. Established patterns do not always work to our benefit and so movement that is outside of our usual pattern can help interrupt neuromuscular habits. And an unfamiliar movement is something that the brain has not yet "formed an opinion about," as Cory put it. So, if certain movements have become painful and the brain has become programmed to associate a particular movement with pain, moving in a way that is not yet associated with pain reinforces movement without pain. Finally, since the brain likes variety, increasing our repetoire of movements could be argued to be a good thing.

I also think these could be a good warm-up series before sitting at a computer or playing music. Or a good change of pace when one has been engaging in those sorts of activities for a period of time.

active insufficiency - Active insufficiency occurs ina two-joint muscle when it cannot shorten enough to cause full range of motion of both of the joints it croses at the same time. Examples:
- triceps brachii during shoulder extension and elbow extension
- gastrocnemius during ankle extension and knee flexion

and thus when you flex the wrist and the fingers - what is the gain you get from this

shortening a muscle across more than one joint can lead to cramping

the new movement being 'established' does not appear to be functional or practical - how would these new movements be incorporated into daily activities to improve them?

I can rub m&m's on my head before i use the computer and if my wrists don't seem to get as tired, have i found a new therapeutic intervention??

what is the gain of these novel movements - please explain and provide sources

please address how these 'novel' movements are not much more than playing with active or passive insufficiency and setting the individual up for a cramp in the 'acting' muscles

please explain and provide references for the benefits which folks can gain from performing these actions, please refer to someone other than just the individual in the video clip, where is this person getting their evidence from that this is good stuff??

so it makes my muscles do something different, how does that relate to the pain i have when i use my computer?? or the stress that builds the longer i play my instrument??

why would one do this and what would be the experienced gain to doing this

First I’d like to thank Alice for posting my video and also for inviting me to respond to these good questions.

First, I’ll agree that these movements in this particular video are consistent with the concept of active insufficiency. In fact, I’d argue that the mechanical disadvantage of the scenario is what makes them novel. We don’t tend to put ourselves at such a mechanical disadvantage during daily function because more efficient means of moving exist. That said, the novelty is what I consider to be important and not the active insufficiency. There are other scenarios that create novelty that are not through an active insufficiency scenario.

As for the cramping, this of course can occur, is not comfortable, but usually improves quickly. If they are not sufficiently irritating I usually recommend to my patients that they stop the movements at the first sign of this and that it usually improves quickly with practice. In my practice, when used with particularly symptomatic individuals I will often advise that they use only those portions of the movements that can be done comfortably. This video is a general demonstration and not a specific treatment regimen. If you are having particular issues with any of the movements it would be a good idea to seek an assessment and guidance on how they may be best altered for your specific situation. Why is novelty important? Well, there are a couple of levels that we can look at this from. From a physiologic perspective we know that when the brain encounters something it considers to be novel it “alerts” the rest of the brain through release of dopamine, as if to say “hey, pay attention. This is something new and we need to decide what it is and what we think of it.” I’d be happy to supply references on this physiologic mechanism if desired. So, from a plausibility standpoint if pain is an opinion, as neuroscientist VL Ramachandran has posited, it would make sense that novel movements create a window of opportunity. I’ve blogged about this if you are interested in my thoughts further, here:

Blog.forwardmotionpt.com

As for evidence of effectiveness, this is at the lowest level of the evidence hierarchy as there are no studies that have looked at these particular movements and we are left at the level of anecdote. While I of course wish that I could point to peer reviewed evidence to guide the path in using these particular movements, the lack of such support is unfortunately the norm at this point for much of movement based therapy. So, we are left at the level of clinical decision making and some things we do know. We know that, in absence of fracture or dislocation that moving as best you can is advised. I would argue that these movements would fall within the current guidelines of general movement. I tend to follow the guidelines and path set forth by Nortin Hadler MD of the University of North Carolina.

I believe the mechanism to be a felt sense of reduction of threat through application of novel movements that bring about an increased movement repertoire. I posted a 3 part series this morning on this that may further clarify. This is a hypothesis and I may very well be wrong. But, the movements are safe when applied appropriately.

Thanks again and I hope my response helps add to this healthy critical discussion.

Cory, thanks so much for taking the time to write such a thoughtful and thorought response. Cory's blog can be found at http://blog.forwardmotionpt.com/. I recommend it highly. I'll be posting more of Cory's movement videos in the future.

P.S. I apologize to Cory and my readers that the formatting to Cory's response got lost in translation and I seem unable to restore it. I'll ask my webmaster and see if I can get it straightened out. Sorry for the difficulty in reading.

Kimber, I hate to say it but I rarely post on Twitter. However, I think you can subscribe to the blog. (I'm really going to show my ignorance now. Although I write all the content, my webmaster is the website genius. I think one can subscribe, that there's RSS feed. Does that sound right?)

I do usually send out an email on my email list when I write something new. If you'd like to be included on my email list, send me a request at Alice@massage-stlouis.com. I won't spam you to death. You will get notices when I offer classes, and emails about gift certificates, but I don't send out lots of emails. I'm a bit erratic about when I write. It depends on time and mood. There's lots more I'd like to write about. Thanks for your kind words and encouragement.

I really should start posting on Twitter - let folks know when I've got a new blog article and maybe share short bits of information that I think would be interesting. Maybe you have inspired me to do that.

You can foliow me on Twitter at massagestl.