Carpal tunnel syndrome

The other day in class I remarked that the cause of Carpal Tunnel Syndrome is that people don't extend and contract their fingernails when doing repetitive motions with their fingers or hands like typing. Needless to say, this led to an attack on my authority. Have we entered the era of: 'Everyone Is An Expert?' To modify something my Indian Dance teacher was fond of saying, " A little Google is a dangerous thing." Of course, it is reasonable to ask a teacher, on what basis they are making a claim. Unfortunately, thirty years of martial arts experience seems to be about on a par with one feisty Google search. Nasty Beware of any problem ending in "syndrome." That means it is difficult to diagnose because there are many things which could cause the same symptoms. In this case what we are talking about is a narrowing of the Carpal Tunnels in the wrists accompanied by swelling, pain and numbness or tingling. 9 tendons along with nerve flow and blood pass through each Carpel Tunnel. Surgery for "fixing" this syndrome involves the cutting of the ligament(s) that contain the underside of the wrist. I've never had Carpal Tunnel Syndrome myself, and I've never cured anyone of anything. (I have offered suggestions for treating problems in which it was later reported back to me that, due to having followed my suggestion, the problem went away-- but I will always remain skeptical of my own ability to invoke healing.) I have had students who were diagnosed with Carpal Tunnel Syndrome before coming to study with me, but it is very hard to say with any confidence that a recommendation I made was more important than the 20 other things they were doing to try and cope with the problem. One student I recall was convinced that wearing wristbands with magnets in them completely cured her Carpal Tunnel Syndrome. Forepaw_skeleton_ cropThis all came up because I was teaching a two person partner exercise called joint pulsing (kaihe), the opening and closing of the joints. When I first started teaching this years ago, nobody had seen anything like it. Then one quarter a student who was an assistant chiropractor said his boss had an expensive machine that he hooked people up to which did the same thing. Another quarter, a student said she worked with autistic children and the staff had been taught to pulse the children's wrists and elbows because the compression was calming. This quarter a student said she had already learned joint pulsing as an assistant physical therapist. Ugh!  Of course, nobody had been told that this information came from Chinese internal martial arts. Nobody had been taught that the purpose of pulsing the joints was to have a passive experience of what one's body can do naturally, on one's own. That is, that the manual experience of having one's joints pulsed reminds us of how we moved in the womb, as toddlers, and even up until age 5 or so. Once we are reminded of the experience of this quality of movement, we can recover the ability to move this way at will. The ability to move and animate our bodies the way we did in the womb is sometimes called Yuan Qi, or original qi. While becoming a human rubber band is a cool trick, the purpose here is to make our movement simpler. Simpler movement is more efficient. Efficient movement is more sensitive. Sensitivity to the ways in which we habitually waste qi, allows us to conserve qi. Conserving qi, is the equivalent of non-aggression- wuwei. Needless to say, none of these student "experts" had learned the easiest part of of joint pulsing which is extending and contracting the fingernails. In Chinese practical anatomy, the nails are considered the ends of all the tendons (Perhaps sinew is a better term because it is more general but tendons works fine for this example.)

  1. Place any finger tip on the side of the index finger of the opposite hand and then place the thumb on top of that finger nail.

  2. The thumb needs just enough pressure so that if it moves it will not slip but will maintain traction on the nail.

  3. Gently move the nail inwards for 3 seconds and outwards for 3 seconds, repeating continuously for up to 20 minutes per nail. The motion is gentle and fluid, not forceful. It should feel like you are a cat that can extend and contract its nails/claws, albeit, much less movement than a cat can achieve.

After practicing this for a while, you will be able to extend and contract your nails at will. This is fundamental to internal martial arts training. For instance, in Taijiquan, the fingernails extend during ji and an, and contract during lu and peng. (Note: This is Jin level training. At the next level up, kaihe is left in a potential state.) Human clawWhen extending the finger to push down on a typing pad, one's nail should extend out first. For most people this is normal, unconscious, and happens at lighting speed. Carpal Tunnel Syndrome is caused by unconsciously contracting (or drawing in) the fingernails while performing some repetitive finger motion like typing. I know this because when I contract my nails while typing I can feel my carpal tunnels narrowing. After a while they start to swell from the internal friction. But I'm not going to give myself carpal tunnel syndrome just to prove it to anyone else's satisfaction, and I don't know how to cure it once damage has been done to the nerves. So I'm not claiming curative powers here, just that I can teach people a skill that if maintained, will insure they don't get Carpal Tunnel Syndrome at some time in the future. Traditional Chinese long life practices have for centuries been a source for remedial knowledge about the body. Unfortunately the modern tendency to seek out individual methods, fractured from the source, results in a loss of information at best--and a complete obscuration of purpose at worst.

UPDATE: Jan, 2011:

Having just had an older student of mine go through a really bad case of Carpal Tunnel Syndrome, including surgical intervention, I've changed my views somewhat. I still maintain that kaihe (open/close) skills are key to avoiding this syndrome.  However, nail pulsing should really just be seen as an introduction to whole body shrinking and expanding.

I now believe that there are a whole host of inhibitory movement constraints which can wear out the functional uses of the hands.  Carpal Tunnel should be understood as part of a larger picture with many possible contributors, which is why simple solutions like magnets or massage might work some of the time.

I believe what happened in the case I watched progress is that the inhibitory factors on both the top and the bottom of the hand/arm were both activated at the same time.  This effectively compressed the joints, made stretching very difficult and painful, and slowly reduced all mobility.  (Imagine two pulleys tightening up on opposite sides of  a tent pole at the same time, or pressing on the gas and the brake at the same time.)

The reason the exercise I described above is so good is that it is passive, which means that you can see or attend to the movement without putting your mind into the hand.  Once the mind is in the hand, the inhibitory muscles are on, and if that is the cause of your problem, no amount of "trying" to pulse is going to help.  To get an effective release, the movement has to cut the controlling frontal cortex out of the loop.  I can theorize that unconscious typing like the kind that used to happen in typing pools is not a problem, it is linking up the thinking part of your brain with the action of typing which causes stress.  And simply practicing pulsing an hour a day is a losing battle if you are thinking with your fingers for the other 23.  Like all qigong, the method has to change one's everyday behavior to be effective.

Unfortunately it's a safe prediction that Smart phones are going to make this problem worse.  I imagine people are already "air texting" while they are thinking about what to say to their partner when they get out of the shower.

Post surgery, in the case I watched progress, there was immediate pain relief and increase in mobility.  Very positive results.  However, there is a very strong continuous pulling of the palm downward.  This is an inward contraction from deep in the torso which is causing flexion of the wrist.  It is of course inhibiting expansion of the underside of the arm/hand and inhibiting extension of the wrist.  In other words, the cause, what ever it is, appears to still be there.

(Also see Comment #10 to Belbe below in the comments section.)