February/March 2009

Metamorphic Massage Newletter

Thoracic Outlet Syndrome

Hi,
Do you experience any of the following symptoms-- tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and hand; cold or cyanotic hands?

Do you need some help to overcome these symptoms?
If so, then read on...

Nikki Nichols LMP, RN,BSN

Join our mailing list

In This Issue

Thoracic Outlet Syndrome

Bethe Lyndon-Griffith,
a great PT and
world bike racer

Thoracic Outlet Syndrome
( nerve compression in the shoulder that causes many symptoms)

The NW cycling season officially began with the Chilly Hilly bike ride on Bainbridge Island, on 2/22/09. Could you ride the Chilly Hilly- a 33 mile ride with 2,675 feet elevation gain- without problems? Are you in shape?

If not, be careful because there are several potential injuries that plague cyclists includingThoracic Outlet Syndrome (TOS).
The most common cycling problem is knee pain (see June/July '08), other common injuries are: achilles tendonitis, neck, back or elbow pain, (March '08), and tingling or numb hands, which may be caused by Carpal tunnel syndrome (CTS) (Summer '04) but frequently is the result of TOS.

To accurately determine the cause, it's crucial to have a skilled practitioner, like Beth Lyndon-Griffith,MPT,(see next article) make the diagnosis so that appropriate treatment can occur.

Cyclists may present with TOS because when riding, the cyclist's neck is extended and the back flexed for prolonged periods of time. In addition, if riding with drop handlebars, the load on the arms and shoulders can lead to muscle fatigue and pain which also affects TOS. One way to reduce neck hyperextension is by making sure the bike fits the rider by adjusting the bike's handlebars, stem and/or saddle.

The posture that may lead to TOS - repetitive over-hyperextension of the neck and exaggerated upper thoracic kyphosis - can also be seen in the workplace as people slump over a keyboard, or carry heavy objects, or carry backpacks with shoulder straps (that compress the shoulder girdle). Some sleeping positions may aggravate TOS.

TOS symptoms may include tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and hand; cold or cyanotic hands. TOS is often due to postural problems caused by repetitive over-hyperextension of the neck and exaggerated upper thoracic kyphosis (humpback).

TOS is a term that encompasses several variations of nerve compression--primarily the brachial plexus nerve, which lies near the base of the neck and upper rib cage. (Rarely (5%) TOS can be due to vascular compression.) There are 4 variations of TOS depending on which nerves are entrapped. TOS affects the ulnar nerve which innervates the 5th and half of the 4th fingers.

TOS is not directly visible but using special tests and palpation the diagnosis can be determined. One can palapate tight neck muscles (anterior and middle scalenes) and chest (pectoralis) muscles can also be hypertonic (tense)

Massage treatments, including compression, effleurage and stretching, can help reduce the nerve compression by decreasing the tension in the neck and chest muscles. Massage also helps improve posture, which would decrease the neck hyperextension and upper thoracic kyphosis and reduce the potential of getting Thoracic Outlet Syndrome.

Regular stretching, during rides and or at work, for the neck and pectoralis muscles are valuable for preventing the occurrence of TOS.

For further information, see the resources that I used:
http://www.roadcycling.com/cgi-bin/artman/exec/view.cgi/6/1026
Orthopedic Assessment in Massage Therapy, Whitney Lowe

I recommend Beth Lyndon-Griffith,MPT, who owns True Balance Training!

Beth Lyndon-Griffith, MPT, is a superb physical therapist, world class bicycle racer, coach / trainer and bike fitter. She has experience racing at a high level on all kinds of bicycles including mountain bikes, road bikes, track bike and cyclocross bikes. After my ( Nikki's) North Cascade Loop bike ride this summer, Beth assessed and treated my TOS, fitted my bike to me and in a very short time made a huge difference in my life. So that you may get to know her, I interviewed her for you.

What was one of the highlights of your bicycle racing? Winning the Masters World Championships in mountain biking in Australia in 1996!"

What motivates you to keep racing (to finish a race) even when you are hurt?
"Early in my racing career (spanning the last 19 years) I quit a race a race after "blowing up" on a hill and have always regretted that. So since then, even if I break a chain I will run or if I break an ankle, I will crawl to the finish line and throw my bike over the line."

What life lessons have you learned from your racing and PT career?
"I must be focused, work hard, be enthusiastic and passionate about what I do, and then I notice that I can share my positive energy. I love making discoveries about a client's body and how that figures into how they pedal and fit on their bike. Sometimes a small change can bring about a major transformation. I feel that I specialize and excel at kinesiology and understanding how the muscles affect movement, and especially the movements of the pelvis while cycling. I love my work so much that I almost forget to charge for it. Also, having had various injuries, I know what it feels like to be off the bike, which gives me empathy and understanding as a physical therapist."

What advice do you have for injured people?
Have patience and perseverance and realize that it can take a long time to get better.
If you return too soon to your activity, the healing process may not be over and it can become a chronic condition.

Beth's final words today:
"I am thankful to be an active 46 year old mother of 6 and 8 year old children, and to be able to combine my two passions: cycling and understanding how to heal the body. This allows me to blend the things I love to do for fun and sport into my job. I strongly recommend that people exercise regularly to improve their overall fitness and achieve balance in their lives."

To contact Beth: 206-920-8342, www.TrueBalanceTraining.com

Metamorphic Massage
"where injuries are transformed into wellness"
Specializing in athletes with injuries

Nikki LMP -- provider of massage at 3 Olympic Games
WA Sports Massage Team - active member for 12 years

Call or e mail to schedule a massage.
Nikki Nichols LMP, RN, BSN
Metamorphic Massage
206-499-4281
Nikki@metamorphicmassage.biz