From: Marcia Woolf Subject: Re: Therapy for TOS. Some Questions. Status: RO Even though I understood about half of your message (I'm not familiar enough yet with all the body part lingo), I'd like to offer a couple of suggestions, for what they're worth: 1) Scalene stretch -- (I read the suggestion about sitting on your palms and my pain level went up several points. I'm afraid to try that, but might if I get my nerve up.) This method may not be any easier depending on your symptoms, but here's what my PT suggested (may be impossible when nerve pain at elbow is present): Place the right palm at the base of the neck with fingers over left clavicle (sort of like doing "The Pledge" only higher, and pressing as firmly as you can). Now lean your head back at about halfway and then lean right at about the same angle until you feel the stretch. Hold 10-20 seconds. Repeat on other side. 2) Pectoralis stretch A -- Stand just inside a doorway facing the jamb without hinges. Place forearm closest to door against doorjamb, from elbow to palm. Lean/Step forward and to opposite side to stretch pecs. I do this against my bookcase and window sill also. B -- Another stretch is to place both forearms on wall with one foot back away from wall, and other foot forward halfway to wall and then lean into the wall. (While I offer this one, I never feel like it does the trick, but maybe for you... ) C -- Sitting, arms in hold-up position, lean back in chair and press arms back -- move hands up and down to vary the stretch (I made this one up, and I hope it's safe; I think it's effective). D -- This one is advanced, when you can handle it. Lying on side in fetal position (hip and knees at 90 degrees), do arm circles with uppermost arm leaning forward when arm is in front, and backward --even looking back over shoulder -- when arm is in back. I think this one might have set me back a bit, because I wasn't ready for it -- be careful. Also, I have just sent away for Dr. Bernard Sucher's TOS exercises. He offers a set of 7 articles on TOS (published in J. Am. Oseteopath. Assoc., if you have access) for $30, and a set of exercises (4 dbl sided sheets of paper) for $14. I'm hoping they'll be good. His address/phone/fax: Dr. Benjamin M. Sucher Center for Carpal Tunnel Studies 10555 North Tatum Blvd. Ste A-104 Paradise Valley, AZ 85253 (602) 483-7387 Fax (602) 483-3684 Good luck to you-- Marcia From: Jacqueline A Manley Subject: Re: Therapy for TOS. Some Questions. Status: RO John, I've got TOS, too, and had similar difficulties. Here are some things I've come across in my quest (or, as I sometimes refer to it, my Journey Through Hell). Hope they help. I don't have the command of terminology that you have, but hopefully it will be understandable. You ask: >(2) How does one stretch the scalene muscles? Bending my head to the side only >stretches my sternomastoid muscle. How can I be sure I am getting a good >stretch of these muscles? How can you tell if they are tight in the first >place? An exercise recently given to me has been the most effective I have encountered yet. Take a towel, or small blanket (from your 2-yr-old) and fold it into a kind of flat roll so it's 3-4 inches wide. Drape it across your shoulder so that it is resting on top of your clavicle near where it meets the first rib, and then pull on it with your arms from both the front and back. The purpose of this is to hold that first rib down. Now gently move your ear toward your shoulder (facing forward). Feel the stretch? With the towel in the same position, face forward and then slowly turn your head left and right. I have found that the towel stabilization was the missing piece for me. This is also supposed to be combined with deep diaphramatic breathing and I find it even more effective when performed that way. Another good one (for me) is to sit and take the fleshy part of your thumb near the base of the hand, and maneuver it up close to the clavicle and 1st rib, then gently push and pull downward -- very gently -- and maintain this position for 2-5 minutes. This will release the fascia in the scalene area. Because I've also got epicondylitis and forearm tendinitis, I can't do this one very much. (3) Most of the TOS strengthening exercises make my symptoms worse. This is most >likely due to involuntary static contraction of my neck muscle while I am doing >the exercises plus increase pressure on inflamed nerves in the back of my neck and >shoulders. Any idea on how to resolve this problem? Lighten the load, don't do as many reps, even eliminate some of the exercises. Come back to it when stronger. I still have serious problems with the nerves in the back of my neck and with muscle spasms any time I try to do shoulder abduction (I think that's what it's called - pushing both arms forward using a resistance band). But I have been able to do a little -- only after completely eliminating that from the physical therapy for a good 8 weeks until the other muscles could pitch in a little. One thing that I have "proven" to myself more than once is that the best thing for me to do is to LISTEN TO MY BODY. If that inner voice from your body tells you "I don't like this" -- even though the physical therapist says it is good, and you really want to push to do it, and even CAN push through the pain to do it -- stop. Listen. Don't insist on understanding or justifying the feeling. Just listen to your body. It'll tell you when to try that particular thing again. I have found that when I do listen my body (and especially if I listen when I do not "agree"), I feel better the next day or so. When I don't listen and push forward ANYWAY, I usually get a setback of a week or so. Your mileage may vary. Mine does all the time! >(4) How does one get a GOOD stretch of the pectoralis minor muscle? Most >stretches I have seen work the pectoralis major muscle more than the minor plus >put undue strain on the shoulder joint. I don't know major from minor so excuse me if I answer about the wrong muscle. Different exercises have worked for me depending on where I am as far as pain and muscle ability. Here are a few I've run across that weren't already in another post: Stand in a doorway, and put ONE arm on the jam (most exercise I've seen use both at the same time). Pull yourself through the doorway so that your arm is *below* shoulder level and your body is facing out while your arm stretches back. An alteration of this one is to open up your free hand, and rest the palm part (emphasis on PALM not fingers) on your pec's where you feel solid tissue mass (fascia /scar tissue) and hold this while stretching. I was amazed at how effective this was. I'm seeing a PT that specializes in myofascial release now and am learning some really different stretches. One was to get rubber ball (they provide them, about 4" in diameter and lay on it with the ball in your pectoral region or wherever feels tight. Have the arm of the same side folded above your head, preferably resting the arm and head on a pillow or similar support so everything around the area is relaxed. Lay there for 2-3 minutes. To comment on stretching, have you read Sharon Butler's book "Conquering Carpal tunnel syndrom and other RSI's"? Her approach to stretching is quite different. Instead of looking for a "good" stretch, by which I assume you mean a strong, heavy, forceful stretch, look for a GENTLE, CONSISTENT stretch that you can use to SLOWLY get your muscle and fascia to let go. Stretching in a relaxed, rather that a straining fashion, is incredibly more effective -- or at least it has been for me. And works faster. >(6) I have noticed that I contract the muscles in my neck >A LOT for no obvious reason. Is there anyway I can determine if this is normal >(a reaction design to protect the spinal cord), due to some muscle imbalance, >or purely a >unconscious reaction which must be controlled? Are most people's neck muscle >relaxed most of the day? Another theme that has been coming up for me from many different professionals is breathing. My muscles in my neck were tensing as you describe as part of my breathing. Look closely at yourself. Is your chest rising with every breath? Do you breath more with your chest than your belly? Then you're using your neck muscles to raise your chest (and crushing your nerves in the process). Try to use your diaphragm more and your chest less. It takes a long time to get used to. I've been working hard at it for the last 3-4 weeks and I have very definitely seen a reduction in my neck contraction. I'm also stretching the area, but I believe it's mostly related to breathing. If I fall back to my tense breathing pattern, I see the muscles there, popping up all around my clavicle.... The muscles in the back of my neck contract and tighten, too. I haven't made very good progress on them. Anybody out there have any suggestions? Jacqui Manley From: Vicki Subject: Re: Yes, there is life after carpal tunnel syndrome Status: RO >> Which four exercises did you do? (I looked through the book and made some >> guesses, but I wanted to ask for sure.) Hi, Jamie: I no longer have the Pain Erasure book, but can remember the exercises: 1. Stand and extend your right arm out to your side parallel to the floor, palm up. Then turn your palm counterclockwise to make a complete revolution. (This rotates the entire arm.) Repeat with the left arm. 2. Stand with your feet wide apart. Extend both arms out to the side parallel to the floor. Then turn your left side in an arc, toward the floor, so that your entire right side from below your waist to your fingertips is stretched out. Your left fingertips will be trying to touch the floor. Your right fingertips will be trying to touch the sky. Repeat with the other side. (This is similar to the yoga posture called "The Triangle.") 3. This exercise had to do with putting your forearms together in front of your chest and then moving them back, so that your chest is stretched out (your back muscles are also affected). It was similar to the old gym-class exercise when I was a kid called "We must, we must, we must increase our bust!" 4. This was called, I think, the catback (it's commonly done in yoga classes). It just stretches/exercises the spine. I did these exercises every day, 8 repetitions each side, 4 times a day. I also tried to do the yoga exercise called "spinal rocking" every day or almost every day. I also did a one-hour yoga class twice a week. I believe that the Triangle and spinal rocking in particular are great exercises and still do them often. These exercises may or may not help any particular person with any particular problem. Vicki Meagher Date sent: Sun, 27 Jul 1997 12:29:02 -0400 Send reply t From: Subject: Re: slow recovery Judy wrote: > > i.e. where the stretch point is, so see if I can see changes. It's hard to be > > patient (surprise!) I tend to do the stretches at home in the morning and Matthew wrote: > I agree. I find it very hard to be patient and not to overstretch. I > also don't do the stretches regularly. How long does it take you to do, > for example, one of the forearms ones where you lay down (such as 2 or 3)? > I can't tell if you're supposed to reach the stretch point, wait for it to > go away, and then push to the next stretch point, or if you are supposed > to just go to the stretch point, let it go away, and then move on to the > next stretch. Also, I find myself holding a continuous stretch on the > muscle/tendon, where as it relaxes, i push it farther back into a > stretch... i'm sure this is probably incorrect, but it is hard not to! You're asking here about what you're supposed to feel in your stretching. It's a difficult question. I found it helpful to unravel for myself what all the various different sensations mean. In one sense, whatever you feel is what you're supposed to feel; recognizing that can itself be difficult. And then once you've recognized that, there's a couple of further questions: what is it that what I'm feeling is telling me about what's going on structurally, functionally in my body? And what is the healthy thing for me to do with that information? (I think that's what Matthew is asking about what to do once a stretch point has been released.) One of the things that is confusing as we start our own programs of RSI stretching is that our instructions are often given to us in terms of what it feels like to stretch healthy muscles! So you'll be told to move to the point where you feel a stretch, but not a sharp pain, or to the point where you feel a "good pain" and not yet a "bad pain". It can be hard to apply these instructions to muscles that are always in pain, or giving you a variety of unusual and confusing sensations. The variety of things you might feel when you're stretching goes quite beyond that simple schema. I was in a chronic pain class where we were encouraged to brainstorm different images or words that we would use to describe our various pains -- I found this gave me very helpful vocabulary for discriminating the different things I was feeling in doing my stretches. This is the stage of getting some sense of just what the different things you're feeling are, how you would group them together, how you would describe them. This is the stage at which "what I'm supposed to feel" is whatever I do feel, and the point is to be aware of that. A good massage therapist or physiotherapist will really like it if you're very self-aware when you do your stretching exercises -- if you treat them almost as a daily routine in self-diagnosis. They'll be able to work with and respond directly to your changing experience of what's going on your body. (Using a mirror can help.) When I told my physiotherapist this week that the right side of my neck feels ordinary muscle-stretching sensations when I stretch, but the left side of my neck feels like a "brick wall" after certain point, she poked around, encouraged my second cervical vertebra to change positions, and now I can stretch out the left side of my neck just like the right! This is the stage of figuring out what the sensations have to do with what is going on in my body structurally or functionally. Owning an anatomy book helps with this! It's useful to stretch out un-injured parts of your body, in order to give yourself some sort of baseline idea of what a normal stretch feels like, and what a normal release of muscle tension feels like. But you'll probably feel very different things in different parts of your body. The extensor muscles in my forearms for example give me a stretch sensation that is quite unlike the sensations I get anywhere else in my body. (Like a pine twig being pulled, its fibers rubbing one against another.) I've come to know that stretching to a certain point in that sensation will cause me pain hours later, even though the stretch itself is not painful. So that's one of the kinds of things you can look out for. That's a point where I'm using what I feel when I'm stretching in order to decide what to do about it. It's up to me to figure out whether stretching to certain point, which may be painful at the time, is going to result in less pain one hour later or one day later, or the opposite--not painful at the time, but pain later--and I can decide whether I'm supposed to continue that stretch based on what I notice happening as a result of it. Of course, your physiotherapist can give you some advice here about what you can expect in terms of immediate physical discomfort and long-term payoff. Matthew asks about whether you're supposed to move on from one stretch point to another: if I remember correctly, that is what Sharon recommends in her book. But remember to be guided by what your body wants to do, and whatever gives you pain relief! Judy talked about the general difficulty about telling what works. I don't have too much to say in general about this (except "yes! It's hard!"). One thing to watch out for is that some activities cause pain on the spot (for me, clothes shopping, or being angry at someone (!)), some cause pain hours later (for me, typing), some a full day later (for me, maintaining second through fifth positions with my arms in ballet class). Some cause pain that goes away when the activity stops, some pain that persists. I've found it necessary to quiet down my life quite a bit to begin to get a sense of what causes what. I've found that the best cure for its being difficult to make myself do my stretches consistently is to find stretching and strengthening exercises that really work! I do about an hour of stretching and strengthening first thing every morning, and for some months now this hasn't seemed like a giant burden that I'm always trying to avoid, because I can notice that it makes a real difference to my well-being. One day last week, I slept in and then was busy all day and didn't do my exercises once. For the next five days my body woke me up at 6 a.m. on the dot, as if to say "you're not going to pull that one on me again!" As for the difficulty of being gentle on yourself, this was (and continues to be) a real difficulty for me. The thing that has helped the most with this is my Feldenkrais classes. Feldenkrais is a movement awareness method that works with very small, gentle movements and gradual change, and if you practice it, it helps you get used to the idea that small, gentle movements really do help and effect change. It also helps you develop the self-awareness that you need to get benefit out of your stretches. (Actually, for both those things psychotherapy has been helpful too.) Patience, persistence, trusting my body: those sum up what I've found most helpful for stretching. -Lynette Subject: Re: Nerve stretches Here are a couple of descriptions of the nerve stretches I was given to do (described as well as possible). I wouldn't recommend trying them unless you've been shown how to do them properly by an expert: However here goes: 1) Stand side on to a wall, move your arm out sideways and slightly backwards and put you palm flat on the wall, keeping your shoulders down and back at all times. Then move your neck sideways towards your other arm, as if trying to touch ear to shoulder until you feel a small stretch down the neck/shoulder/arm. Repeat this 15 times. Turn around and do the other arm. (I think this one works on the median nerve) 2) Lie on your side with your head propped on your hand, while in this position with your other hand move your supporting elbow slightly back ( to make it more inline with your body) until you feel a comfortable stretch in the underarm. Hold this position for 1 minute. Repeat 5 times. Both the above should be repeated at least twice a day. There are others but as you can no doubt gather describing them is not easy and thus I say again do not attempt them without getting an experts opinion because if you do them wrong you could irritate the nerves further and give yourself more pain! I have on occasion overstretched and had a relapse because of it! Adrian. Date sent: Wed, 2 Jul 1997 11:29:59 -0700 From: "Lauriann Greene (Wasser)" Subject: Re: Massage Therapy Hi, As a former massage therapist, I can wholeheartedly recommend massage for CTS. HOWEVER, I would not recommend massage directly to the wrist or forearms. What I WOULD recommend is general relaxation massage, especially to the shoulders and upper back, which can become very tight as a result of the "guarding" that takes place when you're injured. Stress and muscle tightness that result from RSI's can impede healing and also contribute to the injury - general relaxation massage can help you counteract that stress and tension. Also, if you can find a massage therapist who does Manual Lymphatic Drainage, this is also a great technique for CTS. This is a very light technique that helps drain fluid accumulation away from the carpal tunnel and back into the general circulation. Lauriann Greene author, Save Your Hands! http://www.infinitypress.com/fredwert/ip/syhome.htm From: Doug Alexander Subject: Re: File: "RSI-EAST LOG9608" Status: RO Dear Daniel: I am writing regarding the idea of 'resting' the wrist in a hard cast. It is possible that you might get some relief from the cast, but then the solution will create a bigger problem. By immobilising the inflammed area, the natural maintanence processes of the body continue and make the tendons more adherent to themselves and neighbouring structures. This will make the tendons MORE vulnerable and MORE easily irritated when you finally do try to use them. A good non-drug, local anti-inflammatory is cold applications, either by cold pack or cool water very frequently during the course of the day. Sometimes it is helpful to think of the wrist as the terminal (no pun intended!) part of a kinetic chain including the neck, shoulder, elbow, forearm and hand. One way to place less strain on the wrist, is to reduce stress upstream in the forearm muscles, and the shoulder and neck, in particular. Massage therapy can be a very useful way to reduce the knots and trigger points in the forearm muscles without stressing the tendons at the wrist. Doing this yourself by stretching will only aggravate an inflamed wrist. If you suffer from forward rolling shoulders, this places more strain on the forearm extensor muscles (on the back of the forearms) as you must fight this posture at the keyboard. Check this by typing with the shoulders rolled towards the midline and you will notice that the muscles in the back of the forearms must contract to pull your fingers 'off' the keyboard. This posture also places stress on the nerve structures heading out to the arm and hand. Address the forward rolling shoulders by stretching the pectoral muscles. The classic doorway stretch commonly taught is not great for stubborn pectoral muscles. I have found a stretch technique called post-isometric relaxation very helpful for releasing the pectoral muscles. Lie on your back with one arm out to the side either at 45, 90 or 135 degrees from the arm at the side position. Pick the position which is tightest if your condition is not very irritable. For more irritable conditions pick the looser feeling position and work towards the tightest over time. In the position on your back with the arm out to the side, imagine a thread attaching from the ceiling to your elbow. Contract the pectoral muscles by imagining the thread gently pulling your elbow up towards the cieling. Do this very slightly only. If someone was watching you the movement is so slight they might not even notice it! At this point take a deep breath in and hold it as long as you comfortably can. When you need to exhale, let your breath out and snip the imagninary thread, allowing the arm to fall back to the floor. Repeat this cycle several times. Perform the exercise on the other side. Over days, weeks or months (depending on the severity of your condition and its responsiveness to challenge) as you drain irritability and tension from the pecs you can roll from your back towards the opposite side of the body from the arm you are stretching. This will place more and more of the weight of the arm on the shoulder, so you can actually begin to lengthen the muscle. The other component to placing the shoulders where they belong is to learn to activate the muscles at the back of the shoulder blades. This is a tricky process and usually requires some coaching. A simple method for people who are not too advanced with RSI is to attach a very weak piece of exercise tubing to a door handle at their office. With a loop in each hand and facing the door handle as they sit in their office chair they 1) sit nice and tall 2) breathe into the belly 3) pull the shoulder blades down towards the buttocks and back towards the spine against the pulling of the tubing to a count of one-two-three. 4) allow the tubing to pull your shoulder blades forward just to an anatomically correct position (not as far as the blades will go - we want to teach them a new place to 'stop') to a count of one-two-three-four-five. 5) repeat several times at a sitting, and several sets during the course of a workday. Having a friend apply some masking tape to the skin between the shoulder blades when you are holding them just a little back of the anatomical position is also a good reminder of positioning. The alignment of the neck and the pattern and quality of breathing also need attention in most people. Additionally, the nerves themselves begin to shorten(!) and may need stretching. I will address these issues in a subsequent note if anyone is interested. Doug Alexander, Massage Therapist, Editor-in-Chief: Journal of Soft Tissue Manipulation. Subject: Re: RSI-EAST LOG9608 (Pec stretching) Status: RO Dear Polly: The pecs are stubborn customers. They naturally graviate towards tightness. The muscles between the shoulder blades (the rhomboids and mid to lower trapezius) fight the pecs pulling in the front by pulling backwards. In this type of tug of war it is the losing muscle that speaks most loudly. This leads many people to trying to quiten the posterior blade muscles down by stretching. Injudicious stretching will only aggravate the situation, increasing the forward roll pattern. It is the tight pecs (the quiet winners in the tug-of-war) that need challenging by stretching. If you check out massage for the pectoral muscles, may I suggest you do the pir pec stretch for at least one week before tackling the muscles directly. What you will likely find during the massage is that the pectoral muscles really complain for the first time when challenged by massage manipulations! Good luck, Polly Doug :) Dear Doug, Thank you for another way to stretch. I have a terrible time with rolling shoulders and faithfully do the doorway stretch, with very little progress. I realize my age and the length of time they've been rolling forward is a problem but I should see some progress! Your post-isometric relaxation sounds wonderful, that combined with massage may do the trick. Thanks! From: Doug Alexander Subject: RSI-EAST LOG 9608 Pain between the shoulder blades Status: RO Dear Polly: If that pain in the 'blades' is between the shoulder blades (as opposed to right on the back of the blade) then it is probably from the strainded rhomboid and trapezius muscles. The longterm answer is to achieve muscular balance between the front and the back. However, those knots can be wicked in the back! The question arises, how do I release the knots without stretching aggressively and training the rhomboids and mid to low trapezius from being too long and even more prone to getting beaten up by the pecs? To get the knots out of these muscles which tie the backs of the blades to the spine I get people to put a can of soup or two in a handbag and wrap the wrist strap of the bag around the wrist of the hand of the worst side. Then they bend at the hips and knees and support their body weight on their feet and the 'good' arm on the kitchen table or counter top. Then they let the weighted arm dangle from the pull of the handbag (fingers relaxed). Tune into your shoulder blade and sense its position. Pull the blade towards the spine for a count of 1,2,3 and then allow the weight to pull the blade forwards for a count of 1,2,3,4,5. Do not let the bag pull your shoulder so that it is 'forward' where it usually likes to be, but only let the blade move to a 'square' position of someone with good posture. This is not a strengthening exercise, but a relaxing one. Breathe in as you pull the blade towards the spine, and exhale slowly and fully as the blade moves back out to the 'square' position. Repeat several times and do as often as you need to get relief. This exercise can be converted to a strengthening exercise by adding weight to the purse and emphasising the contracting, pulling towards the spine part of the exercise! In time it is possible to bring balance to the shoulders, but it takes work and dedication. From: Carmen Klapperich Subject: Re: Tennis ball accupressure In a message dated 97-11-19 22:23:24 EST, you write: > I just wanted to say...BE SURE to do some warming up exercises/massage > before.> I tried this and I had bruises( now mind you my shoulder pain is > indistinguishable from current pain) I learned how to use a tennis ball (and other implements of torture!) in massage school. It is very easy to get carried away and hurt yourself. I do it all the time! To avoid bruising yourself try using a 1-10 discomfort scale like many bodyworkers use when doing deep pressure trigger point work. We can't feel what the client feels so we have to rely on feedback. On this scale 1-3 equals little or no discomfort. At this level you have not sufficiently engaged the attention of the muscle to affect any change. 4-5 equals awareness of the problem area and some beginning discomfort. You have gotten the muscle's attention but probably will not release any long standing spasms at this level. 6-7 is the optimal level of awareness/discomfort. You have engaged the muscle in trouble and now can communicate with it through the pressure you are applying. After 10 seconds or so the muscle will either release, stay the same, or contract further. You will know that the muscle has softened because it will feel like you have let up on your pressure. You can then choose to follow the muscle deeper or move to another spot. If you feel no change occur you can shift around to get a different angle on the muscle or apply a little more pressure. If the muscle reflexively contracts you are applying too much pressure and need to back off. Resist the temptation to apply more than a level 7 of pressure. In trigger point work as well as many other areas of life LESS IS MORE. 8-10 is unexceptable discomfort and pain. At this level you will jump off the table and slap your grandmama (like they say in the South). Seriously, at this level of discomfort - EVEN IF YOU THINK YOU CAN TAKE IT - you are being counterproductive. Pressure at this level of discomfort will cause your whole body to instintively tense. The problem muscles will contract even more and resist any pressure applied to them. Remember that the 1-10 scale is personal. Only you can determine the value of each level. Calli's advice to warm up before using the tennis ball is sound. I usually roll my back over a large beach ball for a few minutes, then progress to a soccer ball. Many of the minor kinks and spasms will be worked out leaving the major bad boys for the tennis ball to deal with. If you do get carried away you can always ice. And don't neglect your stretching exercises. Carmen Subject: Tennis ball accupressure Hi folks, I just wanted to share an amazing tip with everyone, and a cheap one too. Tennis ball accupressure! Buy a pack of tennis balls at wallmart for maybe 3.99, and you have your own personal massage kit. It has helped me a great deal. The way it works: There are a number of things you can do. I like to just take a couple of balls, one for each side so I apply equal pressure, and if I'm sitting, watching TV, etc, I just take them and apply them to areas of the body that are stiff. Ie, you can put them against a wall or firm piece of furniture, and just lean back into them, placing it against the tender spot. It may hurt at first but after a few minutes the knot often dissipates with a palpable smushy feeling. (eww..but it works), followed by a brief lightheadedness and "humming" feeling in head (for me). You can do it lying on the floor too, either face down or face up. You can do this on virtually any sore part of the body, just position the sore spot against the ball (I work on the sides of my calves, sitting down w/legs folded). Don't do it too long, or you will (trust me here) get an "inflammatory reaction" in the muscle fascia. I do this on my jaws, neck (I have to hold it against the neck, or do it against a pillow), feet (a golfball works better for little feet areas), forearms...the whole 9 yards. If you feel you realy need a massage but can't afford one, this is the way to go. It gets out the really rough spots and makes you feel in control of your life again! Sarah Subject: Re: Nerve Stretches The type of "stretch" or "pull" that is felt when neural tissue is stressed is quite different from that which is felt when a muscle tissue is stretched. It is a sort of deep pull that gives the impression that something is "stuck". I was fortunate enough to find a PT who is quite familiar with the work of David Butler (see below) and Robert Elevey, among others. The "5 second rule" goes something like this: "Perform the designated stretch just to the very edge of pain and hold it for no more than 5 seconds. Upon release, all symptoms should subside nearly immediately, otherwise you have gone too far." Actually, if you have good body awareness, you will be able to detect your body tightening up or resisting the movement just before you enter the pain zone. This is the optimal point to be at. The stretch is designated by the PT who has carefully studied your condition. It must be a very gentle movement or you will cause more harm than good. The reason is that neural tissue does not stretch or give like muscle tissue. An interesting finding was that when the PT rotated my shoulder blade back and downward, my range of movement (before encountering the "neural stretch") increased 5-fold. And echoing Greg's point about bloodflow, the PT constantly challenges me to get more aerobic conditioning, good advice for most of us... Subject: stretching X-UIDL: 00326db3c9cf34d465fb3f8bd35bae8f Status: RO I left one factoid off the list of miscellaneous factoids the other day. I saw a study about stretching. It was done with people with short hamstring muscles. They wanted to establish whether it helped to hold each stretch any longer than 30 seconds at a time, or do stretches any more often than once a day. They found that it didn't. But it's important to note that the point of stretching in this study is lengthening shortened muscles. If you're stretching before and after using your muscles, or as part of your routine in keeping your muscles relaxed, both of which are typical sorehand reasons for stretching, then this study doesn't tell you to stop doing that, and to do it only once a day instead! On the topic of stretching: I hate to introduce unnecessary paranoia, but we all proceed here as though stretching is the safest possible physical activity for any of us to be doing. But I have heard more than once in the last month from physiotherapists that I have overdone it in my last year of conscientious stretching, particularly in the shoulder area (door frame stretches) and my upper traps (side-bending neck). Stretching without strengthening is not a great idea **in the long run**: you end up lengthening and lengthening increasingly weak muscle. Again, if your shoulders are tight while you work, or you are spending time at the keyboard typing, then you *are* working those muscles, and don't need to worry about stretching them. In that case, you do have the balance. But for someone like me doesn't type any longer, working hard at stretching those muscles that you're no longer using much *can* be inappropriate. Subject: Nerve mobilization and fascia stretches (Butler and Butler) I'm going to try to explain everything in extra detail in this note, because there seem to be a lot of new people around sorehand these days. This note is going to be confusing to write, because I'm comparing (David) Butler stretches and (Sharon) Butler stretches. David Butler's stretches are designed to mobilize the nerves, and Sharon Butler describes her stretches as working with the fascia, the connective tissue that surrounds all of the muscles. Like most people on the list, I've been using Sharon's stretches for some time, and like her book a lot. ("Conquering Carpal Tunnel Syndrome.") As I wrote a few weeks ago, I had some tests in Calgary over Christmas with Greg and people he works with, and neural tension tests from David Butler's "Mobilization of the Nervous System," which they did there, were the first tests I've ever had that have reproduced my symptoms. Just to explain what that is about: everyone here seems quite familiar with the idea of nerve compression and NCV or EMG tests to see whether the nerve is transmitting its signals, or being blocked somewhere along away by compression. The idea with neural tension is that a lot can go painfully wrong with the nerve before it gets to that point. Apart from conducting signals, nerves also need to be able to stretch a little and move in their sheathes as the body moves. If they are pinned down or stuck, and can't move, this is quite painful, not just at the point where they are stuck, but all along the pathway. So, for example, the pressure in the carpal tunnel might not be sufficient to keep the nerves from transmitting enough signal to appear normal, and so the problem won't show up on an NCV or EMG, but pressure or something else might be enough to keep the median nerve from sliding back and forth in the carpal tunnel as you flex and extend your wrist. If it can't slide, then it has to stretch, and it can only stretch a little bit before it loses its blood supply, and gives you a very characteristic burning sensation. (I say "burning", actually, because my physio calls it a burning sensation. I don't think I would've attached that word to it myself. Madeleine has been writing about pain language, and it frustrates me no end that clinicians are impatient with weird sensation reports. Some people find it easier than others to use the standard pain vocabulary. And those of us who can't quite figure it out need to be taken seriously... No one has ever suggested nerve involvement to me, because when they ask about numbness and tingling I say "no; well, not exactly...". Greg was the first person who had the patience to listen to me rambling on about "pins and needles in molasses," and figure out the nerve involvement.) Anyway, I just started doing nerve mobilization exercises with my new physiotherapist. I'm struck by the resemblance between some of these stretches and some of Sharon Butler's stretches, and I can recognize now the different sensation when a Sharon Butler stretch is mobilizing the nerve and when it is stretching soft tissue (not that these things happen entirely separately). So, in case anyone is curious about this neural tension stuff and doesn't have access to a physiotherapist trained in the technique, here's a few words about some of the stretches I've found get at neural tension, and modifications you can add to them with neural tension in mind. Caveat: I'm a philosopher, not a physiotherapist. What do I know about any of this anyway? But since you get lousy advice from most of the people you pay for advice (present company excepted), I believe in us amateurs sharing this kind of information for free. The ones that I get the most nerve stretching sensation out of are Forearms 3 (median nerve: burning sensation in thumb and first two fingers and the palm below them), Forearms 1 and Wrists 3 (both median and ulnar nerve sensation -- median as above, and ulnar: pinky and ring finger, and the palm below those), and Wrists 7 (either median or ulnar, depending on placement of hand). I think that Thumbs 5, Forearms 2, and Wrists 6 would give the radial nerve some mobilization (back of thumb and back of part of the first two fingers and back of the hand below them), but I don't have problems there myself, so I don't know (I've asked Greg about Thumbs 5, on the suspicion that it might be the reason I don't have radial nerve tension). The particular median nerve stretch my physio has given me is like Wrists 3, only with the arm rotated, so the fingers point back instead of forward. You start with your hand behind you, and not in front of you. Anyway, here are two points to work with if you want to try these stretches as nerve mobilizations. One is that it helps put tension on the nerve if you depress the shoulder. So you might try doing the stretches one arm at a time, with the hand of the arm that you're not stretching holding down the shoulder of the arm you are stretching. If you start the stretch, and stop just short of pain, and then add shoulder depression, you will learn something about the source of the stretch if this shoulder depression makes a difference to the sensation in your forearm or hand. The same goes for my second point: you can also increase nerve tension by flexing your head to the side (ear to shoulder, continuing to look ahead) away from the arm you're working on. So, if you're doing Forearms 3, and you have opened your hand out so that it is straight in line with your arm, and you haven't reached pain or the stretch point yet, instead of opening your hand further, try flexing your head to the side away from the hand -- if that suddenly brings on the stretch point or a pain, this suggests that it is the nerve pulling that you're feeling. You can work with Sharon's description of finding the stretch points and waiting 10 seconds for them to relax, or you can try this nerve mobilization method: you go to the point where the pain starts, and back off it, and then do some slow movements back and forth right at the top edge of the comfortable zone. Or, using the information in the last paragraph, back off the stretch point and use movement of the shoulder or of the neck back and forth to mobilize the nerve from that end right at that edge of the comfortable zone. (A more aggressive approach can be appropriate for a long-standing problem, but I wouldn't try that at home without paying a trained professional to hurt me. That's what physiotherapists are for.) Anyway, if I have said anything that puts anyone's health in danger, I hope Greg or someone will correct me. Subject: Re: Cubital Tunnel Exercises There are two exercises that I do off and on during the day, depends how much I am keeping my elbow bent and how it feels. I try at least three times a day and some days I think I've done them 6 or 8 times. They're called Ulnar Nerve Glides. I'll do my best to describe them: First hold your arm straight out in front of you, palm up. Make a fist and bend your wrist as far up as you can while you keep your arm straight (your fist should be at about a right angle to the floor) (my wrist still does not bend that far, but the exercise works anyway). Then flatten out your hand and tilt it to the floor, bending your hand the other direction (so your fingers are pointing down, your palm is still up). Then bend your elbow at a right angle keeping your hand flat. (At OT we nicknamed this the "Egyptian.") You can feel it in the inside area (ulnar nerve area) of your elbow. Do 10x. Next one: This time hold your arm straight out to the side from your shoulder, palm up, and make a fist keeping your wrist straight. Then try to turn your arm back keeping your arm straight and your hand in a fist (my arm doesn't really turn more than a fraction of an inch, so just do your best). While keeping your arm straight out and turned, try to touch your opposite ear to your shoulder. Do 10x. They both feel really good to me. Sometimes I feel like its just a stretch so it'd feel good on both arms, but it doesn't feel like anything on my right, only on the left. FWIW, my cubital tunnel is being treated with iontophoresis, the glides, hot packs, massage, and a sleeve and splint at night. It is a lot better. Doesn't burn and throb anymore (just tingles and feels numb) and the funny bone aching isn't nearly so constant and deep, and it doesn't wake me up nearly so much at night. Most of the time it's more a nuisance than painful. It also helps to know what it is, my funny bone ached for months before the tingling and burning started at night. I didn't know the two were related until I was having one of my periodic evaluations at OT and got a lot of attention when I mentioned two seemingly unrelated symptoms! (I also don't use the armrests at the movies and hold the phone left handed anymore, etc.) Good Luck. I hope my descriptions make sense! Subject: Re: what is this tingling? I am not a doctor, PT, etc. I get this when my trapezius muscles are spasming. When this happens, I stretch it out. Now, this may not be what you need, but if you feel you are up to trying it, then do. Just make sure you dont hurt yourself more! : ( While sitting or standing, cross your right arm, palm up, breast height, shoulder DOWN, over to your left side. Take your left hand and grab your right bicep (under your right arm by the arm pit) and pull your shoulder towards the left. You should feel a stretch in the upper traps. My PT calls this, "passing the pizza." There is another stretch a chiropractor taught me. He calls this the "Bruegger." While standing with your arms at your sides... turn your palms forward with your fingers outstretched, thumb up. Raise your arms away from your sides at about a 30 degree angle. To get the correct head postioning, stick your chin out like a "chicken", all the way forward. Pull it back as far as you can comfortably. Don't let your head drop forward. Once your head/neck is in the right position, and your arms are away from your sides, palms out, thumb up, pinch your shoulder blades together, while pulling your shoulders down. Hold for 30 seconds. This will strengthen the shoulder blade muscles and will hold your neck in the right place. Make sure when you are doing this that you are rotating your thumbs/arms BACK as far as they will go. You will feel the stretch the most when your palms are rotated back almost flat. Hope this helps, Anne in MN Subject: Re: stretching X-UIDL: bea20742522393515ed0d7d8dcdde571 Status: RO Hello all, I have had some success with a style of stretching I learned from Aaron Mattes. It goes something like this: 1) Take the muscle to be stretched, up to where you first feel the slightest pull. I am guess this is similar to what Sharon Butler refers to as a stretch point (please correct me if I am wrong). To do this you contract the antagonist muscle. So to stretch extensors contract flexors. To stretch the muscles on the top of my forearm (while my hand is palm down position) I hold my arm out straight in front of me, elbow straight and bring my hand towards me, palm down. 2) Hold for approx. 2 seconds or one inhale exhale. 3) Release and let the muscle return to "normal", I even shake it out gently between stretches. You want to let blood flow into the area before the next stretch. 4) Repeat 8-10 times. Some times giving a gentle assist with the stretch is helpful, but gentle is the key idea. This way of stretching seems easier to teach to my clients and they seem less likely to overstretch and cause more damage.Of course, I use it myself as well. The muscle is warmed as it is stretched, so people can do this without walking in place for five minutes first (or whatever), which we are all supposed to do but no one ever really does.. Mr Mattes has a web site which I find is not very helpful. The best application I have found of his work is from his students Jim and Phil Wharton. I like their book , The Whartons' Stretch Book : Featuring the Breakthrough Method of Active-Isolated Stretching. Its on Amazon, etc. ========= Subject: Re: Stretches that aggravate I tried this posture this morning. I have a few comments. First, I'm not sure that it can be that effective for someone with a "true" case of RSI, even if it hurts the first few weeks you do it. This posture reminds me of an "exercise" developed by Ida Rolf and Moshe Feldenkrais. If any one is interested, you can do a modified form of this posture and get the benefits without the pain. Lay on your back. lengthen your arms out to the side (in a T-position), thumbs pointed headward, pinkies pointed footward. Bring your hands together overhead towards the ceiling, with palms together, and pinkies pointing towards your feet. Do this twice. Rest with hands on floor. Now, turn hands quarter turn, with thumbs going towards the floor and bring pinkies together. Same arm position as described in earlier post. Do this twice. Rest with hands on floor. Take the movement further and explore the other two directions, starting as in first position with thumbs headward. Rotate hands downwards toward feet. Bring hands overhead, with thumbs coming together. Do this twice. Rest with hands on floor. Rotate hands another 1/4 turn, with thumbs pointing towards the floor, and bring the back of your hands together. Do this twice. Rest. The point of this "exercise" is that it reorganizes the entire upper body, shoulder girdle, rather quickly. If you have pain when doing this lesson, then do it in your imagination. Notice how your scapulae (shoulder blades) move as you turn your hands, arms, shoulders. At first, you might hear some cracking and popping, most likely due to tight ligaments, but if you do this lesson with awareness, you'll regain functional use with your entire self very quickly. Elise No, it's not the nerve glides. Enough people have requested this that I will send it to the list again. Dr Seradge used to give away diagrams that show how to do this stretch. I didn't really catch on to it until I saw a video. It's a sequence of ~25 movements that takes about 2 1/2 minutes to perform. Dr Seradge recommends doing the entire exercise at the beginning and end of the work day, and doing just the first 10 movements (using one arm at a time) at breaks, or roughly every two hours. If this description isn't clear, please let me know and I'll try to clarify. cheers, Penney Do each move or hold each position while you count to 10. Swing and shake gently both arms at sides for count of 10. Stick right arm straight out in front at shoulder height, palm up, fingers pointed down. Same arm position, form fist with right hand and bend knuckles up toward ceiling. Bend arm so that fist touches shoulder, elbow out in front, face forward. Swing elbow out to side, turn head to look at it. Straighten arm out to side, shoulder height, palm up, fingers pointed down. Turn head to look over other shoulder. (Slowly! this is where you'll feel it.) Swing arms & shake for count of 10. Repeat with other arm. Then: Bend elbows, bring both hands together chest-high if you can, back of wrists together, palms out to side, fingers pointing down. Same position for arms & elbows, hands with palms together, fingers pointing up, in prayer position. Raise arms so hands are over head in prayer position, like an Indian (South Asian) dancer. Bend elbows so that hands fall backwards behind your head, still in prayer position. Stretch arms straight out to both sides, hands in fists, knuckles pointing down. Put hands behind back as if you were leaning back, palms down, wrists extended, hands straight. Raise your face and look at the ceiling. Then shake 'em out. This is a compilation of my experience using stretching to recover from RSI.   It represents my own experience and opinions as a layperson only. However, I have been able to go from essentially unable to type more than a paragraph or two without pain to being able to do mostly as much typing as I need to, and be completely pain free.  This has so far lasted 8 months.  I credit most of this success to a combination of postural improvement through Rolfing and Alexander Technique, along with stretching.  I think the stretching was the most important part though, maybe 70% responsible for my improvement. Many of the stretching ideas are either directly taken from or expansions on the ideas of Sharon Butler, both from her book and from a phone consult series I did with her.  I suggest her book, CONQUERING CARPAL TUNNEL SYNDROME AND OTHER REPETITIVE STRAIN INJURIES A Self-Care Program. Three Types of Stretching There is a lot of confusion about how often and how to do stretches.  Some people recommend stretching very often, even every few minutes.  I think it is important here to talk about a couple of distinctions.  I believe there are three mechanisms by which stretching can decrease RSI pain, two good and one bad. The first, undesirable case is the ?counter-irritation? stretch.  Here, your tissues are experiencing some minor pain.  You subject them to a relatively strong stretch.  The stretch causes the body to blank out the minor pain in favor of the much stronger stretch stimulus.  Thus, the pain temporarily goes away because your body is distracted, but no beneficial changes occur. This type of stretch should be avoided, as it leads to a vicious cycle of more pain leading to stronger and more-frequent stretches, which in the end lead to actual tissue damage and irritation caused by too much stretching. The second, temporarily beneficial stretch is the ?range of motion? stretch.   Here, you simply move your body through the comfortable range of motion, like taking your arms and moving them slowly around in circles, over your head, etc.  You never feel a significant stretch but increase circulation and relax tissues.  This is the stretch that should be done often through the day, every few minutes, just moving your body around so that no tissues remain in place too long.  The distinctive feature of this stretch is that it feels positively good, the way your shoulders feel if you circle them up by your neck in a massaging motion.  This kind of stretch, I believe, can help prevent RSI but will not quickly heal it. The third, permanently beneficial stretch is a gentle stretch which causes a ?release? in the sense written about by Sharon Butler.  The first key to recognizing that this kind of stretch is occurring is learning to recognize the ?release?, the feeling that your tissue is actually lengthening.  The second key is to observe your actual range of  motion increasing on a daily or weekly basis while doing these stretches.  This kind of stretch can permanently improve your pain, but the improvement may come several days later, unlike the first kind of stretch where you feel immediate improvement but it is only temporary.  The rest of this essay describes advice on how to achieve this third type of stretch. Stretching Tips Stretching is an art as well as a science and can be difficult to do effectively.  These are some suggestions specifically for the third type of stretch mentioned above?the ?tissue-lengthening stretch?. I often describe stretches in terms of stretching muscles.  Note though that other tissues are also stretched such as the fascia.  The word ?muscle? should be taken as a shorthand for general soft tissue. Pick a time of day to stretch and do it then on a daily basis.  I find mornings right after showering to be best.  Make sure you are relaxed and in a tranquil setting. Only try to do these ?tissue-lengthening? stretches once or twice per day or at most every couple of hours. Stretch very gently, never to the point of pain.  You should rarely even go as far as slight discomfort.  Your goal is to coax the tissues to release, not rip them apart. Find a way to relax as much of the body as possible when stretching a given muscle.  Lying down is best.  The body has a limited amount of attention to use in reporting on tension in muscles and it tends to report the most significant tension.  That means that if you are standing up your body is wasting way too much attention on the feeling of your leg muscles holding you up, with not enough to spare for feeling the subtle tension in your forearms. For the same reason, try to support the muscle and other body structures nearby as much as possible.  If the body feels unstable or unsupported it will not easily relax.  An extreme example would be standing on one foot while trying to stretch your wrists; sure the wrists aren?t involved in holding you up but the entire body _feels_ the instability and prepares itself to grab onto something if you lose your balance.  This is another reason why lying down is best. Focus on the muscle being stretched.  Make sure you can feel the EXACT muscle and the exact part of the muscle that is under stretch, and make sure you can feel the difference between a light stretch and a strong stretch on that particular muscle.  You should be able to put your finger exactly on the area of the muscle (though you wouldn?t actually do so while stretching) and know the depth under the skin of the tissue that is actually being stretched. Make sure you aren?t tensing up either the muscle you?re trying to stretch or anything nearby.  It seems obvious, but I often find that I?m actually tensing up the very muscle I?m trying to stretch. Try to go into the muscle/tissue with your mind.  Close your eyes and focus your attention on that particular section of muscle or tissue.  Feel the slight tension of the stretch.  Feel the area around it.  Try to send your mind into both it and nearby areas.  Imagine deeper parts of the muscle nearby, and imagine parts of the muscle farther down or up your limb.  For example, if you are stretching your forearm, send your awareness also into your upper arm and armpit to see if you are holding tension there. Try to ?breathe? into the muscle; inhale slowly and imagine the air going directly and specifically to that part of the body. Imagine the muscle under stretch letting go.  Try to give it all the conscious direction you can to release. On different days, try different stretches for the same muscle area.  The body can be resistant to change and can learn to resist the same approach if you keep trying it.  These injuries are in some sense caused by always doing things the same way, to cure them it helps to consciously do things in different ways as much as possible. If you successfully release stretch points and increase your range of motion, you may feel increased pain for a day or two afterwards.  Judge the overall success no sooner than 1 week after you have felt the distinctive release in a given tissue. For the reason above, it is best not to try to change too quickly.  If you release some stretch points, you might want to stop and continue the next day. Remember that the body functions as a whole.  If your pain is in your wrists, the tight tissues needing correction may be in your wrists or anywhere between them and the spinal column.  It often helps, in fact, to stretch the tissues closer to the core of the body first then work outwards. When reading books or other sources about stretching, do not necessarily try to imitate the positions as shown immediately but instead consider them as end-points.  A given stretch may be too difficult if you have lost a lot of range of motion.  Instead of trying to go directly to the final position, approach it over a period of days or weeks. It is difficult to know when you have stretched a given area ?enough?, that is, when you have reached a normal and healthy range of motion.  You might want to compare with others.  This is one point where you will want to look at pictures in stretching books or yoga books.  Can you now duplicate those positions?  If not, you may have farther to go.  I personally had the experience of thinking 4 separate times that I had stretched my forearms enough, then after a period of months or years found they could stretch farther and decrease my pain in so doing.  Obviously, at some point though a given area of tissue has reached its maximum healthy flexibility and you only want to maintain it there, not stretch farther. The most important thing is to learn to create and feel the ?release? sensation written about by Sharon Butler.  All these tips are merely advice on what has helped me do that.  If you feel the distinct sensation that your tissues are letting go of tension and lengthening, you are doing them some good. i Stephen, Hi James; Here's a stretch developed by Dr Houshang Seradge of the Oklahoma City Hand Institute. An orthopedist, Dr Seradge got tired of performing Carpal Tunnel Release surgery on workers, only to have them come back a year later, reinjured. This stretch has been clinically proven to reduce the risk of CTS in factory workers, and anecdotal evidence suggests that it can relieve tendinitis as well as CTS symptoms. Dr Seradge recommends doing the entire 2 1/2 minute sequence at the beginning and end of the work day, and doing the first 12 stretches (first one arm and then the other) at every break, or every hour or so. Do each move or hold each position while you count to 10. Swing and shake gently both arms at sides for count of 10. Stick right arm straight out in front at shoulder height, palm up, fingers pointed down. Count to 10. Same arm position, form fist with right hand and bend knuckles up toward ceiling. Count to 10. Bend arm so that fist touches shoulder, elbow out in front, face forward. Count to 10. Swing elbow out to side, turn head to look at it. Count to 10. Straighten arm out to side, shoulder height, palm up, fingers pointed down. Turn head to look over other shoulder. (Slowly! this is where you'll feel it.) Count to 10. Swing arms & shake for count of 10. Repeat with other arm. Then: Bend elbows, bring both hands together chest-high if you can, back of wrists together, palms out to side, fingers pointing down. Count to 10. Same position for arms & elbows, hands with palms together, fingers pointing up, in prayer position. Count to 10. Raise arms so hands are over head in prayer position, like an Indian (South Asian) dancer. Count to 10. Bend elbows so that hands fall backwards behind your head, still in prayer position. Count to 10. Stretch arms straight out to both sides, hands in fists, knuckles pointing down. Count to 10. Put hands behind back as if you were leaning back, palms down, wrists extended, hands straight. Raise your face and look at the ceiling. Count to 10. Then shake 'em out. Please let me know if you have trouble following this. Also, below is Sharon Butler's post on stretches for TOS. From Sharon Butler: I highly recommend that you try stretching your armpits. Start by lying on your back on the floor and extending both arms straight out to the side. If this causes too much aching, prop your arms up on a folded towel, but keep them straight out to the side. Remain in this position until all aching and stretching sensations are gone. You might have to repeat this posture several days in a row until all the sensations are gone. Once you have achieved a sensation-free state, then raise your arms a few inches toward your head. Repeat the same waiting until all sensations are gone. Again, raise your arms a bit higher and keep repeating this cycle until your arms are all the way up next to your ears. Don't rush any part of these positions. It may take you several weeks to get all the way to the top position, but your condition will continue to improve as you do the exercise. WIth any of these exercises, working gradually and listening to your body is basic. Considering the shoulder and joint challenges you have described, you might consider doing them for a physiatrist or a physiotherapist who has experience with situations like yours, and get feedback. 1. An isotonic neck strengthening exercise I was given to do 3x/day, and it helped overcome my whiplash, was as follows: Place palms of hands with fingers laced together, cradling the back of the head, arms relaxed with elbows forward. With shoulders relaxed and breathing comfortably and deeply, press the head back against the hands while pulling forward so that head remains in place, for about 5 seconds of gradually increasing intensity, sustained intensity for about 5 seconds, and gradually diminishing intensity for 5 seconds. Do the same from the front (elbows up to the sides so that wrists are aligned with forearms) and the same from each side, continuing to use both arms and hands. I have found using a minimum of muscular effort, i.e., as relaxed as possible for any muscles not directly required in the main effort, and comfortably deep breathing are helpful. 2. Here´s the other exercise I found useful, especially as a stretch following the above. It´s adapted from a stretch taught by R.H. Rossiter (for a book and reviews, see for example the following found from a Google search for Richard H. Rossiter RMI Way: http://www.dancer.nu/1572241349-Overcoming-Repetitive-Motion-Injuries-the-Rossiter-Way.html ). Remember to listen to your body -- muscle pain seems to be OK but I am careful not to push it when it comes to nerve or joint pain. Standing (preferably) or sitting upright, arms at sides and hands hanging down, turn the head slowly up to 90 degrees in the direction opposite the tighter side, over a duration of around 10 seconds. Keep the shoulders down. While continuing to maintain the stretch, nod s l o w l y down to the shoulder over 5 to 10 seconds. Continue to nod very slowly into and back out of the maximum of the range of movement you are experiencing at this iteration of the exercise, for about another 5 to 10 seconds, then slowly and gradually bring your head back fully into the upright position *before* starting to turn it back to the front. Breathe and relax the whole time, particularly during the slowest part of the movement, i.e., through the end of the range, and keep the shoulders relaxed and down. Relax a moment, repeat the exercise, relax, repeat a second time for a total of 3x. Do both sides at least once, with the reps for one side that needs it more, or for both sides. The two repetitions are an important contribution to reshaping the connective tissue which helps gradually to extend the range of motion. This stretch is also really good for lengthening a strain-injury-adapted shortened trapezius muscle in the shoulder, when it´s combined with someone leaning their weight vertically on the trapezius through their forearm while holding their wrist with the other hand. To get that right, you can read Rossiter. For the shoulders you might consider t´ai ch´i chuan. Cheng Man Ching, in his classic work by the same title (published in English in Taiwan 1963, re-issued in the last 10 years) that the breathing and movement in t´ai ch´i eventually will make the bones benser and the tendons springy (again). -------------------------------------------------------------------------------- Here's one other thing that I found useful with the "guitar string" pain in the neck. I found this "string" was very reactive to my moving my head, especially looking up. Besides massaging it and doing the stretches, I tried to get that muscle to relax and not be so reactive about being in certain positions. A technique that seemed to help was this: Lock the fingers of your hands nice and tight together and place your folded hands firmly around the back of your neck, so your palms are wrapping around the sides of your neck. The weight of your arms when you do this should keep your hands nice and snug around your neck. Keep your head up, and in fact allow it to relax backwards a bit, where it will be supported by your hands. The base of your skull will be resting on your folded pinky fingers. Not only does this put some pressure and warmth on that sore muscle, but I find my neck muscles kind of say to themselves, "Hey, we don't have to hold the head up. We can relax." So after letting things relax like this a bit, I wiggle and release my pinky fingers to get them free from my interlocked hands, and this allows my head to tip back a little farther, so the weight of my head rests on my ring fingers. Again, I let in rest there a while, and the muscles "realize" they can be in that position without having to twang tight. Now I try to get my ring fingers loose and let my head go back some more. Same story. Depending how sore things are there may be a limit to how far I can take this before something gets uncomfortable, but done carefully, this procedure seems to help muscles that are painful and "fearful" unwind a little.