Anyone who knew me in the last two years of high school and the last two years of college knew that I had some issues with my hands, wrists, and - to a lesser extent - my elbows.
Throughout the entire ordeal, I was told that I didn't have carpal tunnel, and that all I had was a "repetitive strain injury." In hindsight, I'm pretty sure I should have been given the diagnosis of thoracic outlet syndrome, but I gave up seeking medical answers pretty quickly, since none of the medical advice I got ever seemed to be much help.
I'm actually quite glad I never got that official diagnosis, as it seems the current conventional advice is that once it gets bad enough, you should have muscles cut and part or all of your first rib removed. Based on what I've read on that operation, it's extremely difficult to recover from and likely impairs you in noticeable ways for a long, long time.
Because I stopped asking for medical help, I went on a journey to figure out how to fix my thoracic outlet symptoms on my own. That I've typed all the content you see on this page here on my own without issue is evidence of my success. I hope you gain some useful perspective from the information that follows.
The beginning of my hand, wrist, and elbow problems
The first bout in high school was painful and disconcerting. I'd get numbness, coldness, tingling, and aching in my hands and wrists, but it eventually passed when I went to college and started lifting weights and playing even more hockey than I had ever played in my life.
The second bout of hand and wrist pain came after I stopped playing hockey and stopped lifting weights.
If you've read anything about the Upright Health program The Shoulder Fix, you've read a little bit about my shoulder injury. To keep it brief, my shoulder popped out of place while I was snowboarding and sent me into a tailspin of pain that lasted years.
I was told that I needed to stop sports. I needed to stop lifting weights. I needed to just "rest." I took that advice, and waited for my shoulder to get better.
Within 9 months to a year, my hands and wrists were causing me major problems.
What was wrong with my hands and wrists?
At the peak of my hand and wrist problems, I couldn't type on a computer for more than a few seconds without paying a heavy price of pain, numbness, and coldness (and the attendant panic that would set in). The doctors I saw insisted that what I had did not fit the description of carpal tunnel syndrome. The wrong fingers were affected, my doctor reassured me. Because it wasn't carpal tunnel, it was clearly just an overuse injury. With rest, the doctor said, the tendons of my forearms and hands would heal on their own.
I just needed to rest.
If there ever has been a time in human history where a person could completely rest their hands from any work at all, it was not 2003. I was in college with papers to write (i.e. type), friends to contact (often via computer), and internet searches to get lost in. I tried doing things that didn't involve typing, but it was a struggle to do even the most basic things without feeling like my hands were being choked and frozen off my body. Even sitting and playing cards with friends was a challenge; the numbness in my hands made fine movements like grabbing a playing card seem absurdly difficult.
I wore gloves to keep my hands warm. I wore Chinese herbal patches all around my forearms to draw out the toxins in my body. I tried countless massages. I tried acupuncture. I saw chiropractors.
I took my doctor’s advice and tried to do things that would “reduce inflammation” in my hands and forearms. I took anti-inflammatories on a regular basis. It helped mildly. My mother warned me not to take them too regularly for fear of organ damage, but I ignored her. I placed more faith in the doctor’s advice than in my mother’s perspective. Her ideas were shaded by Chinese medicine (she being Chinese), and I didn’t think much of Chinese medicine or my mom’s life experience at the time.
Then, one day, I mis-timed dosages on my ibuprofen. I was on 600-800mg doses to keep the pain bearable (I’ve come to learn that some people think that’s actually a small amount, but for someone of my size and genetic makeup, those are strong doses). One afternoon, my hands and wrists were feeling particularly painful, so I popped another 3 pills, thinking I had had my previous dose at least 6 hours before.
Within 20 minutes, I was writhing on the bed, feeling like an angry cat was trying to claw its way out of my stomach.
I decided not to rely on anti-inflammatories anymore.
Everyone seemed to think that if I just rested enough, the problems would go away. With rest, I'd get my fingers back. With rest, the blood would come back to my skinny forearms. With rest, my elbows would no longer zing me with electric shocks whenever I put them down wrong on a hard surface. With rest, I'd be able to go to sleep without feeling throbbing and aching.
Did rest help my hand and wrist pain?
In one sense, it did. For instance, if I spent three hours away from typing or doing anything particularly strenuous for my hands, the level of pain and discomfort was certainly better. My hands would eventually get warmer and feel less achy.
But as soon as I had to do anything with my hands like typing -- any improvements quickly dissolved into a cloud of gnawing agony.
Rest helped only for as long as I rested. In the long term, it was doing absolutely nothing to improve my symptoms. This was extremely frustrating. And at the same time, it wasn't all that surprising because all the rest I had done for my shoulder still hadn't helped the constant feeling of instability in my shoulder.
Did anything help my hand and wrist pain?
There were two things that obviously helped.
First was seeing a doctor of Chinese medicine who specialized in specific Chinese massage techniques (Tui Na). He worked on muscles on my shoulders and on the shoulder blades, and then focused a heat lamp on my arms and wrists for 5-10 minutes to improve blood flow. As soon as he massaged the muscles on my shoulder blades, I'd feel like my hands were mine again. I was surprised that he could restore that feeling of "wholeness" like that. I was excited and heartened, and my mom kept taking me to see him.
Sadly, what I found over time was that the feeling didn't last. I'd feel wonderful - so relieved! - for only as long as I could keep myself away from the computer keyboard. The moment I touched the keyboard, all the sensations would come back again. I would feel the cold line of tension tugging from my elbow down into my hands, and then all the pain would be back as if I had simply hit a switch.
The second thing that helped was taking massive quantities of B Vitamins. I remember trawling the internet, looking for remedies for my problem, and I somehow came across someone suggesting that B vitamins would help with nerve pain. Again, this was 2003, and the internet was not yet full of this kind of information as it is today. But, with little to lose, I went out and bought some B vitamins and started off with my first dose.
I no longer remember which B vitamins I bought, but I do remember they were tiny little tablets, and they worked like magic.
I could not believe how effective they were! I could feel the relief spread down into my hands. The cold cable of tension around the elbow and down into the hands would melt away, and I could function! Not only did I have papers to write, but I also worked in a computer lab, so it was as if I were getting my life back!
I kept a supply of B vitamins with me at all times, and whenever I started to feel the cold ache creep back into my arms, I’d pop a pill to make everything okay again.
This strategy worked very well for a while. I can no longer remember how many of these pills exactly I was taking on a daily basis, but I know that there were plenty of days where I exceeded the recommended dose. I vaguely remember looking up what a toxic dosage might be. Having satisfied myself that the relief from pain was worth whatever risk might exist on the high end of the dosage scale, I kept on my regimen. The number of pills per day gradually increased. And increased. And increased.
And then one day the pills no longer worked.
I tried upping the dosage even more, but the effect was gone. The B vitamins just weren’t working anymore.
Rest seemed like the only option left again
Once the vitamins stopped working, I didn’t have many options left. Resting was only useful in the short term. No pills of any kind seemed to be helpful.
So I started thinking that maybe exercise might be helpful, even though doctors kept telling me my problem was from overuse.
It was totally impractical for me to use my hands and wrists any less…so I started thinking I might able to make things better if I used them more.
It took me a long time to put the solution into practice
I didn’t go back into the weight room to lift weights. I just started doing little wrist curls here and there with weights. They didn’t seem to help that much, but then they didn’t seem to harm me either.
I kept doing little wrist exercises here and there, and I did eventually feel like I could at least function on a computer without so much terrible pain. Still, I limited my use of the computer and just tried to survive the waves of discomfort that would flare up.
I lived like that for years, suspecting that there might be some way to clear this all up, if only I knew enough or met the right person. I went through various jobs, lived in different countries, and generally tried to make my way through the world without having to use my hands more than they could tolerate. It wasn’t easy, but I managed.
Finally, I met almost the right person
On a recommendation from my brother, I sought out the help of a Rolfer. My shoulder was still unstable four years after its injury, and my hands and wrists were still gnawing away at my life. I was feeling weak, off balance, out of breath, and just not as healthy as I felt I should.
I found a local Rolfer and decided to see what this guy could do for me. Ever since my experience with the Chinese tui na practitioner, I still held out some hope that someone could fix these problems for me. I was cautiously optimistic.
After the first session, I knew we were on to something. I was able to breathe better. Really noticeably better. My hands and wrists felt markedly better and actually maintained their improvement for nearly an entire week!
The standard protocol with Rolfers is 10 sessions of treatment. I was excited, looking forward to being fully functional and fixed at the end of those 10 sessions.
Sadly, I wasn’t fully fixed at the end. But I had learned something extremely important. I learned the most valuable piece of information I’ve ever learned in my entire life.
HAPPY MUSCLES MAKE FOR A COMFORTABLE BODY.
By working on my muscles in particular way, it was possible to make my problems better - or worse! By loosening up some muscles, symptoms in seemingly unrelated parts of the body could go away! Loosening up muscles on the front of my chest made instability in my shoulder feel noticeably better! I could start seeing my veins on my forearms again - a clear visual sign that there was blood coming back into my hands!
This was made all so clear to me…and even more clear was that if I put myself in front of a computer, I could undo the positive changes relatively quickly. While this was frustrating, it meant that there was rhyme and reason to the problems.
I told myself, “if other people are able to sit at a computer for long periods of time without the symptoms I have, then there is a way I can train my body to be able to tolerate it as well. I used to be able to sit at a computer without pain. Even now, I’m able to sit at a computer longer without pain because of what we’ve done with my muscles. What more can I do with my muscles to make me even more resilient?"
That has been the guiding thought process of every ache and pain I’ve since had to combat in my body. Whether it was my feet and calves burning, my hands and wrists aching with cold numbness, my knees feeling unstable and wobbly, or my hips popping and snapping with alarming regularity, I’ve taken the same approach. I think about the muscles that influence the motions, and I gradually try to improve the way those muscles interact with one another.
So what has helped my thoracic outlet symptoms?
In short, exercise.
It wasn’t the wrist curls or stretches that helped me. As I’ve found from talking with clients, those are often just exercises in futility. What helped me the most was gradually retraining the muscles that control my shoulders, my shoulder blades, my thoracic spine, and my cervical spine. That may sound daunting. That may sound ridiculously hard. That may sound like it requires a doctorate in physical therapy.
But the reality is that training your body to move well requires one thing more than anything else — and it’s NOT expertise. I cannot tell you how many well-meaning experts I have encountered in my life who gave me extraordinarily bad advice. I cannot tell you how much bad advice is actually part of the status quo for educational programs for experts. The state of knowledge for taking care of muscles and joints is abysmal. It’s based on assumptions that are demonstrably false, but that are convenient given the way our medical system currently operates.
The thing that you need most in retraining your body is persistence.
This doesn’t mean you keep exercising when you’re clearly making something worse. That's a wrong-headed persistence that will get you in trouble. You must persist by adjusting your approach to things whenever you hit a roadblock.
If one motion makes things worse, try the opposite motion or a motion that may make it possible to do that motion better! Try different things, and make sure you try them long enough (at least a week or two) to gauge the effects properly.
You must gradually increase your ability to do more and more things. It's that simple. Reducing the number of things you can do will only succeed in making you worse off.
The truth is: nobody gets stronger by moving less.
Would you say to a child, “Honey, if you want to be able to jump really high, never practice jumping”?
Would you tell a friend, “If you want to reach the top shelf, the best way to do it is to surgically implant a longer forearm”? No. These are absurd when you see them explicitly, but they are what many pain sufferers are being implicitly told.
You want to be able to pick up your child again? The best way to do that is to never lift anything more than 10 pounds again.
You want to be able to type on a keyboard again? The best way to do that is to stop typing on a keyboard for 6 months and take anti-inflammatories.
Many times, what’s unspoken is that the medical system doesn’t believe you can do what you want to be able to do ever again. That's a losing perspective that results in losing strategies.
Practical advice for you
Make yourself stronger.
What has made the biggest difference in my hand and wrist health is making sure all the muscles that control my upper body work well together. When I first started on that journey, I could not believe how weak I was. Doing something as simple as a shrug or as innocuous as arm circles was incredibly challenging. But over time, I got a little stronger, and then I forced myself to do something a little bit harder. I kept thinking that I wanted to be as strong as I was in college, and I never let that out of my mind. Eventually, I got stronger than I ever was in college.
You can of course keep doing wrist stretches and exercises if you feel them being helpful (some people do), but shift your focus to learning to control your shoulder blades and thoracic spine. You’ll find a blog post here that will give you a few helpful ideas.
Do NOT focus on doing pushups or planks for at least a few months while you retrain your shoulders. This is probably one of the biggest killers for people with hand/wrist/shoulder issues. Pushups and planks may be good for your triceps, chest, and core (which is why they are SO common in group exercise classes and in P.T. programs), but they also encourage your shoulders to go into positions that can make your hands and wrists worse. They can also encourage more thoracic kyphosis which will jam you up at the brachial plexus even more. Put these exercises and exercises like them on hold for just a little while, and come back to them once your shoulders feel more stable and your hands and wrists no longer bother you so much.
Finally, be exploratory. Problems in the hands and wrists can come from a variety of places, not just from the medically accepted bone, nerve, disc, etc. abnormalities. I’ve had countless clients (myself included) who had a lot of their hand and wrist pain nearly instantly relieved by working on muscles on the shoulder blade. This may work for you, and it may not. Everyone has very different contributing issues, so you’ll need to be wiling explore all kinds of options.
Sometimes it’s muscles that are too weak, sometimes muscles that are too strong, sometimes muscles are just overtaxed. It really does vary, and these are variations that go completely unrecognized and unappreciated in the medical world. You'll probably benefit from finding a good P.T., movement therapist, and/or trainer who can help you increase your basic competency and then gradually increase your strength. Your long term solution is not just weak stretches and passive massage. Your partner will need to make you do some work!
The journey forward can be really frustrating. Be wiling to be frustrated, but don't let it stop you from gradually increasing your strength, control, and coordination. It pays off in the long run.
Typing this post would've been horribly painful for me years ago. I'm happy to be able to have typed this whole thing up without any trace of that horrific cold/numb/nervy suffering that used to plague me.
It can happen for you.