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Monday, December 01, 2008

I am a massage therapist with overuse injuries affecting my wrists and arms

Hi Gary,
I was just doing some research online about the risks of cortisone injections and came across your web page. I was wondering if you could give me your opinion about my wrist problems?

I'm a 26 yr. old female massage therapist. I've been working as a massage therapist for the past 3 years. I have been having a lot of pain on the ulnar side of my wrist next to the carpal bones.
 Ulnar deviation is very painful while I'm working and just doing everyday activities. I just took three months off to rest my wrist to see if the pain would go away. It did a little... but not too much. I have been receiving ultrasound treatments, but they don't seem to do too much. I had nerve conduction testing done because I was having some numbness, but the doctor said my nerves were fine. I'm extremely flexible so the doctor thinks the extreme range of motion in my wrists leaves me vulnerable to injury when I'm massaging. I need to build strength, but I also have tennis elbow from doing massage. Every time I try to use bands to do light strength training, the tennis elbow is aggravated. I feel like I'm stuck in a big catch-22. I just went back to work this week and the pain is right back to what it used to be. My doctor said the next thing we could do is cortisone injections. I'm going back to school to get into a different career because I know I won't be able to do massage for much longer. I wanted to be able to work my way through school by doing massage just part time. Even if I can't do that, I want the pain to go away so i can at least do everyday activities pain

I wanted to know if there are any other options other than cortisone injections to help relieve my pain? I massage it and stretch it. Warm up before doing massage and ice after. Wear a wrist brace to bed at night. Wear a magnetic bracelet during the day. I would really appreciate any advice you could offer.

Thank you,
Lisa, I usually massage several clients daily, so I can identify with the problems you have.
  Massage can be a tough workout; especially when working on gristly male athletes who have run themselves into the dirt!  I do not do relaxing massages - they are hard work designed to restore diseased muscles, tendons and ligaments to a healthy state.  To answer your questions, let me explain how I manage to cope....

I recall it taking the best part of 6-8 months to get my arms up to scratch and this was on top of a background of decades of competitive sport, including kayaking and constant gym work.  there were times that I struggled with tendonitis in the wrists and even now the finger joints are not 100%.  Massaging full-time is repetitive, exhausting and every bit as tough on the upper body as, say doing an all day paddle down a river.

Here is how I cope:
  • I try to limit massages to no more than 4-6 hours per day
  • I try to space the males out so that I do not get too many of them in a row
  • I have a quick snack between clients just as I would if I was competing in an all day multisports event
  • I am a stickler for good nutrition, including tissue salts and the occasional dose of joint food, otherwise how can my body recover and heal?  You can find heaps of information on this website about nutrition
  • My partner, Alofa, is very strong and very good at massage.  Twice or more a week, she gets stuck into my arms and shoulders to work out the knotts and inflammation that builds.  Without this ongoing maintenance massage work, I would be disabled with tendonitis and arthritic joints
  • If I take a break from doing massage, the longest has been about 10 days - any longer and the body deconditions and the risk of injury is high if one then dives back into it full-time
Lisa, if you look at the arms and hands of an experienced professional massage therapist, you will see strong, well defined muscles, tendons and ligaments and huge, profuse blood vessels.  It
 takes years to build these.  I will make the observation that many, if not the majority of young women and men nowadays are fragile as compared to what I recall of my 20's.   Young people generally do not eat well due to low fat diets.  Lack of sunshine ensures general fragility including weak bones and sinews.
  These young people are consequently not well suited for hard manual labour.  You may very well be one of these young people with the extreme range of

 motion being an indicator that this may be the case.  

Picture: Moller family portrait, with the strongest legs belonging to the teenage daughter - Point is strong muscles, sinews and bones like these are less common nowadays

I am not about to tell you to give up.  Better still; train and eat like an athlete preparing for Olympic competition:  Get onto a nutrient rich diet, get regular massages on your upper body and arms and pace yourself.  Restrict massage to every second day with 2 days complete break during a week.  I would not bother about trying to do additional strenghtening exercises.  Use the massage sessions as your workouts and concentrate on recovery and growth between sessions (workouts).

Cortisone is not an option unless you want to become a long term client of mine!   Read my articles about cortisone injections.
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