Originally Posted by JacoNOT
The simple suggestion was: Bring all five fingertips together (so your hand forms a shape like the head of a bird) and put a relatively strong rubberband ("elastic" for you in the UK) around the fingers, near the fingernails. Then open your hand, moving all your fingers out, away from one another and away from the center. The back-of-hand muscles work against the rubber band and after a few sets of 10, you'll really feel it.
This is one of the most simple and effective exercises you can use.
I posted on this concept a long time ago here on TB about the use of elastic bands to exercise the hand and more over...how to use them correctly. So I will quickly re- cap it again.
Elastic bands come in different grades that relate to there thickness, length, and width. The idea is to start with loose then work up to a resonable tension..then stop. The idea is not to keep on moving to more resistance, but find your own resistance level then use that for ever.
The resistance is just part of it, not all of it. Get this part wrong and rather than un-doing tension, you are re-introducing it. We have to remember it is the action that is important not the resistance, the use of the elastic bands introduces a very important muscle movement which is to relax the hand.
It is the elastic band that closes the fingers, not the Flexors. So without an elastic band we pull open with the Extentors, and pull close with the Flexors, two very distinct actions using a balanced muscle tension.
But with the elastic band in place we pull open with the Flexors, then relax the hand and allow the tension in the elastic band to close the hand. Then open the finger again and repeat for however you feel necessary. Watch out that the finger use is evenly spread, do not allow the thumb to dominate the stretching, in other words ensure that the thumb is not just stretching the elastic band against the combined resistance of the fingers.
Make sure that the fingers move away from the thumb as well, and it is not the thumb moving away from the fingers that is stretching the elastic again this will cause problems at the base of the thumb...so look very carefully at the action you use.
The elastic band should negate the use of Flexor action, since this is the one we are trying to balance against the under use of Extensors, to allow a more balanced exercise of the hand.
In the UK the red elastic bands you find on the street, discarded by postmen, are ideal in size and resistance....and are free.
From my point of view and personal situation, I have used many different exercises to my hands, as well as develop exercises to help in many areas of playing, as well as apparatus, with in-sight from some of the leading medical specialist in the UK.
So very quickly here is part of my story and how a freak accident gave more insight about the body mechanics and medical knowledge I have. I am not a registered medical anything, all I have is over 30 years experience, study, reading and private research in to such matters, tied to the 40+ years I have been playing.
Being a musician, especially on the road, is travel intensive, so back then before iPods, Internet, etc. we read books, and the books I read were based on anatomy, physiology and health, APH for short. A subject introduced to me in school and one that stayed with me to this day
My situation came about as a result of a car accident in which I broke my neck and in the years of recovery and re-habilitation.
My situation was way beyond CTS, my right arm was paralysed, and my left arm weakened. This was due to the nerve damage in my neck robbing my muscles of stimulation, and without stimulation muscles lose, elasticity, mass etc.
But because of what I do and the information, experience and knowledge I had..I knew I could fix it to a degree of basic use if the nerve damage could be addressed.
So as the swelling in my neck started to reduce after 5-6 weeks so the sensation returned to my fingers, and then the hard and long road to developing the hands again begun.
Here I am over four years later, playing teaching, writing etc again, but in a very managed capacity. The nerve damage I have is permanent, but manageable because I understand its parameters. I do not have the skills I used to have, but I now use the skills I do have, I drew a line under the old playing me, and started again on the new playing me to make the most of what I get back. That was a big mental approach that helped speed my recovery because I was being positive about my situation, not negative, resentfully, self pitying...but positive because not only did I survive, but I have got arm and body use many crave but will never have because their injuries were worse than mine from the same crash situations. ( please note, lucky for me I was a passenger, asleep in the back seat after a show returning home in the early hours of the morning...I knew nothing of it till days after words and I was sort of concious enough to be told of it )
To cut a long story short one of the devices I "developed" was this thing in the pictures below.
Now the device looks scary, but its purpose was to exercise the hand and the hand only and was used lying down, as I was at the time, and was constantly return to, in my recovery. You can see the sweat mark on it where my forearm lay in using it. But once it served its purpose I stopped using it, there is no real benefit in continuing it ( I switched to a bucket of silversand, which is fine sand,it my fingers together, pushed it into the sand, then opened them...the weight of the sand now provided the resistance ) as it had, and was only beneficial for the use.
What I needed was a way to move my fingers without activating other muscle groups in my arm.
This was simply because when my upper arm moved the interconnecting muscle/nerve process put pressure directly on the area where I had the nerve damage, this in turn caused the nerve to compress and the hand shut down again. So I had to find away in which I could lie back, only use my lower arm (forearm, hands and fingers) in isolation. As I am lying on my back looking at the ceiling I cannot see what is happening, and as I cannot feel my fingers I cannot be sure anything is happening.
So I used a mirror to see my hand, and the different colour elastic bands have me a visual reference to what finger should be responding and what fingers should not. Now the colours were a very important part of it,un-known to me at the time, as I found out later on from a neuro-surgeon.
The colours helped reinforce my brain with a visual reference of what I was doing. The fact was brain now had another reference in as much as, if I cannot feel the finger to move, it could see it. The tied association of colour was just another sub-conscious layer being used as my brain tried to make sense of why things are not responding.
Again to cut a long story short, I used the same idea to learn to play again. My problem now was to work out "how can I play an instrument I cannot feel"?
This is where the similarities to CTS start.
For me an operation to free the nerve was looked at, through MRI and CTS scans, deep nerve condition test, and action reflex tests. Because my neck was broken in the C7 area of the spine ( this is where the main nerve branch leaves the spinal column, (central nervous system) to become part of the Peripheral nervous system, which serves the upper limb amongst other things) an operation to try and relieve was ruled out because it was right on my spinal cord.
As I was making such a great recovery, most of it under my own guidance, the general opinion was that because I have movement of source, any operation runs the risk of doing more damage than good if it has complications.
Now this is part of the problem that applies to CTS as well, the doctors and medical team were not there to help me play guitar, they were there to see of they could improve or help the recovery to become stable. As far as the were concerned I had movement of sort, and that was good enough, because the sort of movement I had was way beyond the expectations of all, and was exceeding the prediction of the medical reports expectations. So I had to get other opinions, seek out new advice, till I got the full picture that, yes they all agree that an operation may not be any more beneficial than time itself.....I was healing, so let it continue and see how far that goes.
So CTS sufferers may find a similar thought process, in as much as it is about the hand not its use. In this day and age an insurance company may view that because you play and instrument then you are not covered...that is may do.
The insurance company that commissioned my medical reports for an operation had two options, one was a keyhole option to go in and try and scrape off some of the bone thickening around the fracture to see if that made an improvement. ( where the nerve passed though the bone, the fact in repairing itself the actual new bone material had closed the opening the nerve used so that was contributing to the problems I was dealing with ) Or a full open, go in through the front of my neck, move the windpipe, oesophagus, a few spinal discs etc, to come at the problem with my spinal cord to the back of the area. Rather than risk trying to pass it or work without to the front of the operation area.
Due to costings the keyhole was ruled out because if they were to operate it would be only once and they would take the option that best suited them.....NOT ME. It seems the have a legal right to base treatment on costings to them, if they need to, rather than any costing to address the full outlying problems created by the injury. They then ruled out any medical procedure.
So if you suffer CTS symptoms, you may have to consider not playing till it gets better, then understand and mange your life to keep its interference in it to a minimal. An operation is an option, and a good option if it fits the criteria regarding the current state of the injury.
It's about how bad the damage is and whether it is to late for any treatment to be effective. It is also about your attitude to deal with what is needed, at some point if you do not make the decision to stop playing and rest, your body will do it for you and not give you that option.
CTS is not the end of the world, it is a warning shot for you to modify your hand use, change or adapt to minimise its intrusion on your life.
Not all tingles in the hand are CTS, but if you never get it checked out, if you keep putting it off, then you will never know what the problem really is, if it can be treated, or if what you do to get round it, actually makes it worse not better. A bit of a long post, but hopefully if you read that I got passed my problems, then if you suffer CTS it is not the end of the world if you are prepared to do what is needed for the sake of your hands, rather than any playing situation.....after all without your hand use any playing situation no longer becomes an issue, because your body has made the 'decision' for you and you no longer have any say in it.