cts self care program 1 - · pdf filethe dequervain’s syndrome self care program welcome...

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© 2004 Sharon J. Butler • Selfcare4rsi.com

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The DeQuervain’s SyndromeSelf Care Program

Welcome To

An educational program to assist you in restoring normal and naturalfunction and range of motion to your thumbs, hands, wrists and arms.

Disclaimer: This is an educational publication. It is not intended to take the place ofmedical advice or treatment. Please consult with your medical professional beforebeginning this program. Review the recommendations made here with him or her tomake sure that the information contained in this program is consistent with theirtreatment plan and goals for you. The author is not liable for damages arising fromthe use of this program. The author makes no warranty, expressed or implied for theusefulness of the information in this program.

BySharon J. Butler

Certified Hellerwork Practitioner

Illustrated by:Jacqueline Entwistle Freeman

Joan PilallisDavid P. Thebus

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- Acknowledgements -

This program is the culmination of nearly twenty years of research, workand practice in the field of repetitive strain injuries. I could not havesucceeded in this task without the confidence, patience and understand-ing of many clients, family and friends over the years. I owe a huge debtof gratitude to each and every one of them.

Several people in particular have been instrumental in the production ofthis program. I’d like to thank Jacqueline Freeman, David Thebus, andJoan Pilallis for their expertise in creating wonderful illustrations andgraphics and Bonnie Butler for serving as a model for the illustrations. I’dalso like to thank Lynn Zeitlin for her legal guidance as well as herconstant referrals.

I am also very grateful for those who have served as editors and critics onthis project including Jean Augello, PhD, Patricia Thebus, and TerrySlade. Their time is precious and I appreciate every minute they havespent on my behalf.

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Introduction

Welcome to Self Care for DeQuervain’s Syndrome. You have purchasedthe most comprehensive and effective program available today for the selfcare of symptoms related to DeQuervain’s. Please read this Introductioncarefully in order to achieve the greatest success possible.

This program is designed to be a stand-alone program. While workingthrough this program for the next six weeks, I strongly recommend thatyou stop all other stretching exercises, resistance exercise, weight training,yoga, pilates, etc. Especially in the early stages of this program, I find thatother techniques that influence or act on the soft tissues of the body canslow down or stop the effects of the stretches and body awareness exer-cises contained in this program.

I recommend that you wait until this six week program is over beforebeginning other stretching exercises or bodywork programs again, unlessotherwise told to do so in the course of this program. If your doctor hasrecommended that you include any of the above activities in your recov-ery program, then it is imperative that you discuss my recommendationswith him or her before stopping those activities. Share this program withyour physician to give him or her a good overview of the whole process Iam setting forth here so they have a good understanding of the objectivesof this tissue restoration program.

How To Use This Program

You will find this program to be divided into weekly lessons. The purposeof this design is to help pace your recovery in the most efficient waypossible. It is important that you realize that full recovery will take timeand must be customized to your individual needs. By dividing the lessonsinto a weekly format, you will be able to make appropriate changes inprogressive stages, with increasing intensity and more specific exercisesthat follow your body’s changes as you move through the program.

Because of the customized and progressive nature of this program, it isessential that you do not skip forward. Everyone is eager to be rid of theirsymptoms as quickly as possible. But you must understand that yourbody will take time to heal and if you push your recovery faster than your

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body is capable of handling, you will actually delay your results andpossibly cause some significant setbacks in your progress. Take it nice andslow, following the program as it is presented here and you will stand thegreatest chance of having a successful outcome.

Each weekly lesson in this program contains several elements: Informa-tion to help you understand your injury better, self awareness exercises tohelp you change patterns that have contributed to your injury, andcorrective stretches essential to a progressive and safe recovery. Eachelement is equally important and essential to your ultimate success. Someof the lessons or information will come easily to you and some will takereal concentration, effort, and focus. It is these harder elements of theprogram that you will find most helpful. So, don’t skip them just becausethey are hard.

Consider this: You have ended up in an injury state because the way youcurrently use your body is stressful to your muscles and connectivetissues. In order to have a different outcome, you must learn to use yourbody in a different way. The lessons in this program, although sometimeschallenging, are very important in helping you learn how to use yourbody differently, thereby breaking old, more destructive habits andreplacing them with less stressful options.

Change is never easy; breaking habits can be a real chore. Unfortunately,in the case of repetitive strain injuries, there is no other way to accom-plish the goal of symptom relief without making appropriate changes.

Print out the entire program, then separate out Week One’s lesson. Setaside the others for later weeks. As you begin each week’s lesson, read itthoroughly first, then go back and begin practicing the sections andassignments. Follow through with each lesson completely. Challengeyourself with the more difficult sections and pay extra attention to theinstructions you find easiest to make sure that you are doing everythingcorrectly and as intended.

Even if you find the week’s lessons to be very easy, do not skip forward tothe next week’s lesson. Each week’s assignments and exercises take time towork, whether or not you can feel the changes as they happen. Give yourbody the gift of time and practice each exercise and assignment for thefull week. As each week’s lesson builds on the lessons before it, you standa greater chance of achieving the results you desire if you follow eachsegment thoroughly.

Ready to begin? Great! Ready? Set...Go!

While I have dividedthis material intoweekly lessons, yourbody may not be ableto change that quickly.Or, you may have aweek when you can’tdevote your consistentattention to the pro-gram. In that case, takean extra few days tothoroughly benefit fromthe current lesson be-fore pressing on.Evaluate your progressbased on how you feel,not by a timeline set byme.

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When taking on any new task, it is always helpful to gather together allthe tools you need and become familiar with them before the start ofyour task. It is no different with repetitive strain injuries. When trying torestore your body to normal, the tools you need are your body and yourmind. Here’s how we prepare them for the task ahead.

In preparing the body for the job of injury recovery, it is most helpful toreduce the overall stress being felt by the body. In other words, you needto figure out what activities are essential to your daily existence, and giveup the rest. Don’t worry, you’ll get them back.

A lot of people are particularly challenged by this recommendation. It isreally hard for them to give up the things they love to do outside of work.Sports, hobbies, family obligations all pull on us with a powerful tug.But, you are injured. If you had a broken leg with a full leg cast, youwould have to curtail lots of your activities. Well, it’s the same withTendonitis. The only difference is that there is no physical cast. It cer-tainly would be easier if we did have a cast, since it would serve as areminder not only to ourselves, but also to those around us that we areincapable of doing all the things we would like to do. Alas, we do nothave this reminder. The only reminder with Tendonitis is the aching,dysfunction and pain.

By eliminating as many sources of physical stress to injured tissues aspossible right at the beginning of the program, you free up your body tospend its muscle energy in the most important activities and save the restfor other healing work through stretches, rest, and learning how to payattention to your body’s “language”. Your body only has so much it cangive in a day. And right now, it is injured, which means that it has evenless to give than a perfectly normal, uninjured body. The less you stressyour body with normal daily activities, the more energy your body willhave to heal.

Preparing your mind for the job of healing requires creativity, patienceand attention to detail. Most of us spend our time thinking, day in andday out. We usually spend very little time actually feeling the sensorymessages being sent by our bodies. Unless we are in screaming pain, we

Preparing Body and Mind

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pay no attention to our muscles and soft tissues. Well, this has got tochange.

All throughout your life, your body is giving you feedback: accurate,helpful, important feedback. Most of us miss this essential information.As a result, the body increases the volume of its message. If this input isagain ignored at this level, then the volume is cranked up again, and soon and so on until the body’s message is so loud and so invasive, it can nolonger be ignored.

This is a very real problem with DeQuervain’s. The body creates physicalchange in the tissues according to how it is being used. It will send youmessages about whether this use is good or bad by giving you feedback inthe form of sensations. If you ignore these sensations, or you are just nottuned in enough to feel the sensations, then you will miss the opportu-nity to make appropriate corrections before the problem gets out of hand.Alas, this is most likely what has happened to you as your body developedDeQuervain’s.

To correct this problem, you must be open to tuning in to the sensationsof your body, both good and bad. There are lots of ways to accomplishthis, but you must be willing to practice them daily. Skipping yourpractice is like skipping tennis practice when you are trying to learn toplay tennis well. It just won’t happen if you don’t show up for yourpractices!

A very effective tool I have found for tuning in to your body’s sensationsis the CD, “Welcome to Earth” by Scott Gauthier, available fromAmazon.com. Your first assignment with this program is to order it nowand begin listening to it daily. Over time, you will find that you are ableto feel more and more delicate sensations, feeling them with greaterclarity. You will be able to follow sensations as they change and move. Youwill become able to determine depth and intensity. All of these skills areessential to fully recovering from DeQuervain’s. If you are able to perceiveintensity, depth, and movement in your soft tissues and muscles, then youwill have much greater success when practicing the stretches I will begiving you in this program and you will be much better prepared totroubleshoot any problems as they develop in the future.

Developing yourability to feel yourbody’s sensations isa bit like learning tospeak French.

In the beginning,you’ll only recognizebits and pieces, hereand there. But, overtime, and with prac-tice, your ability tointerpret the “code”of sensations com-ing from your bodywill get better andbetter.

In no time at all, you’llbe aware enough torealize when youhave overused yourmuscles, or whenyour body doesn’tfunction easily in acertain posture.

This information islike gold when recov-ering from an RSI.Knowing how yourbody feels in the mo-ment willprevent un-told amounts of dam-age and delay inhealing in the future.

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Prioritizing Your Daily Activities

Most of us can categorize our life’s activities into two categories: thethings we must do and the things we like to do. The things that shouldappear in the “Must Do” category are things that would catastrophicallyalter our lives if we were not able to do them. There are usually bigconsequences for not doing the activities in the “Must Do” list.

Most of us would agree that our work is pretty essential, whether we likeour work or not. Losing your ability to earn a living is catastrophic foranyone. So, like it or not, work should appear in your “Must Do” columnof life.

There are lots of other activities that should also appear in the “Must Do”column as well. Personal hygiene tasks, like brushing teeth or combinghair are pretty important. People with infant children will also have tasksthat cannot be avoided without some pretty creative planning. But, ofteneven childcare tasks are negotiable.

Activities in the “Would Like To Do” list are not as essential, but theymay certainly be desired. These are the activities that make life enjoyableor easier, that get us where we are going, that fill the balance of our days.These activities are challenges to give up, even temporarily. But, the moreof them you can give up for now, the faster you will be able to get back tothem with no symptoms. The choice is yours.

“Would Like To Do” activities include things like working out at thegym, driving, laundry, blow drying your hair, painting, housework,cooking, sports, needlework, carrying children, woodworking, householdrepair, playing cards, and so on. It’s a difficult list, isn’t it?

The job before you is to make a list, as complete as possible, of the thingsyou do in your day. Put the logical ones, like work, in the “Must Do”column. See how many things you can put in the “Would Like To Do”column. Now, take a careful look at your lists. How many things haveended up in the “Must Do” column that, if you were really creative, youcould find alternatives for? Here’s some examples:

Lots of folks like to work out at the gym. Many of them lift weights. Ihighly recommend that you stop lifting all weights or using resistence

There is only so muchenergy any musclehas in a day for work,sports, and personalactivities. When amuscle is injured, thatcapacity is greatly re-duced. You simplycannot expect thatyour injured muscleswill be able to do ev-erything they used todo without adding toyour injury.

When trying to healfrom an injury, it be-comes essential thatyou ration yourmuscle energy. Youmust choose the mostimportant things youwant your muscles todo in a day, and elimi-nate as many of theothers as possible.

This allows for essen-tial things to get done,while not promotingfurther injury to al-ready damaged tis-sue.

It’s hard to makethese choices, butvery important never-theless.

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workout equipment while you are working on this program because theaction of grasping the weights and using your injured muscles to followthrough is very costly to your muscles and connective tissues. If ahealthcare provider has recommended that you lift weights as part of arecovery program, then it is important to discuss my recommendationwith them. In my experience, it is much harder to recover from a repeti-tive strain injury (RSI) if you continue to lift weights. Don’t worry. Youwill be able to get back to them in a few weeks.

A better alternative is to start walking. I prefer that you walk outdoors ifpossible. Walking on a treadmill is usually faster and at a more constantpace than outdoor walking and most people stiffen their bodies to acertain degree while walking on a treadmill, as if there is a sort of inten-tion about the activity. Walking outdoors, provided the weather is accept-able and your environment is safe, is often read by the body as beingmore leisurely. Your body has more opportunity to soften and let go ofstrain held in arms, shoulders and neck. Plus, the fresh air is not bad foryou, either! If necessary, walking on an indoor circuit is also fine. Swing-ing your arms while your torso twists and legs and hips move is a greatexercise while recovering from Tendonitis.

Laundry is a challenge. Of course, it must be done. Is it possible for youto find some help doing your laundry? Maybe even a laundry service atyour local laundromat would be a decent option during your recovery.Instead of folding laundry, why not stack it without folding? No wrinkles,and less stress to your hands and arms!

Babies are tough. Who can resist picking up a crying baby that needsattention? Would it be possible to sit on a sofa and place the baby on theseat beside you? Resting your hand on the baby might be comforting tothe child, allowing them to feel your presence. It might be worth a try.

Feeding and clothing an infant is also a challenge. Propping your child byusing pillows, armrests, or over-the-shoulder baby carriers might helpreduce the stress to your hands and arms while feeding your baby. Perhapsyou could have another family member open all the jars or containersahead of time for you? Choose baby clothes that are easiest to get on andoff your child. A big zipper might be easier than a series of snaps.

And what about your own clothes? For ladies, how about foregoingdresses with pantyhose and switching to pants suits with knee highhosiery for the time being? Can you choose clothes that have fewerbuttons? How about clothes that require less ironing?

If you had a full cast onyour arm for six weeks,what changes wouldyou make in yourlifestyle?

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Why not consider car pooling, or public transportation?

Use a fat rubber grip on pens and pencils. They are available in moststationery supply stores.

How about switching to a hairstyle that requires less upkeep? Guys: Haveyou considered a beard or mustache?

Instead of holding a book while you read, how about using an inexpen-sive book holder and resting your hands in your lap? There is a link to agreat book holder I found in the “Products” section of selfcare4rsi.com.Check it out if reading is important to you!

Addicted to surfing the Web? How about cutting back on the time spentin that activity and switch to stretching, resting, or taking a walk?

Maybe one creative way to think about it is to imagine that you have abadly broken arm in a full arm cast, on your dominant side. How wouldyou rearrange your life to accommodate that injury?

These are not easy choices, but they will make a difference. Your injuredmuscles and soft tissues have only so much energy to give you in a day. Ifyou routinely exceed that allotment, symptoms will continue to returnand will stay for longer periods of time. If you make changes in your lifethat spare the muscles and soft tissues from strain, they will have energyto spend in recovery and your ordeal will be over that much faster.

The creative possibilities are endless if you put your mind to it. I highlyencourage you to make an exhaustive list of everything you can possiblyimagine doing in your day and see if you can find a creative and lessstressful alternative to that activity during this period of healing.

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This week I will focus on teaching you all about DeQuervain’s and theparts of the body that contribute to this injury.

This information may or may not match what you have learned beforefrom other sources. But, it is what I know and understand and what Ihave researched about DeQuervain’s based on my personal experience,both as a previously injured person as well as a soft tissue expert andtherapist for others who suffer with this injury.

This week’s stretches will begin to open and restore the muscles and fasciaat the top of the muscle and connective tissue chain. (I will be explainingwhat fascia is later in this week’s lesson.) Primarily focusing on the neck,shoulders and upper torso, these areas are important to release first inorder to create “slack” in the soft tissues that travel down your arms,through your elbows, and into your hands.

- Week One -

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So, what is DeQuervain’s Syndrome, really?

Most of us already know that typical symptoms of DeQuervain’s are theresult of inflammation in the thumb joint and restriction in the muscleand tendon extending up from the thumb into the forearm. This resultsin the arthritis-like pain and muscular tension surrounding the entirethumb structure.

But, there are a lot of things that are happening under your skin that youmay not know about. And learning about these other factors that influ-ence DeQuervain’s can mean the difference between a so-so recovery anda really complete recovery.

I have found that virtually every case of DeQuervain’s involves a destabili-zation of the joint at the base of the thumb, which in turn leads to thepain that is commonly felt there. Once the pain gets a foothold, thenmost people set up a series of unconscious compensations that furtheradd to the discomfort.

Additionally, there is a line of tension that often forms through the fascialmatrix (more about fascia later in the program) that extends from thethumbs all the way to the top of the arm. Most people miss that thesechanges have happened and as a result never try to stretch this line ofencumbered tissue.

Without addressing these two important issues, most cases ofDeQuervain’s Syndrome can never be satisfactorily resolved. We willcertainly be addressing them in this program!

Some of the more common characteristics of DeQuervain’s include thesharp pain that occurs at the base of the thumb when the thumb ismoved or strained. In some cases this pain is intermittent, but for otherpeople the pain can be constant.

One variable that helps determine how much pain a person experiencesand how frequently it happens is related to the stress patterns that thethumb structure is subjected to. Twisting motions, especially when theyinvolve pressure on the thumb, can lead to a significant degree of stress

Understanding DeQuervain’s

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to the thumb structure. Another common source of stress is when thehands are used to perform work that is too heavy for the strength of thehands. Most people, under these conditions, tend to draw the thumbcloser to the body of the hand to try to add to their sense of handstrength, but just end up adding stress.

Because of the way we use our bodies, the muscles and fascia change toconform to our posture, habits, and movement patterns. Injuries, surger-ies and other trauma can also add changes to fascia that modify how thebody feels and operates. Changing stressful habits is very important toachieving a full recovery.

So, in order to have a really successful recovery from DeQuervain’s, all ofthese factors have to be addressed. Bad habits must be broken. Newpatterns of using the thumbs need to be developed. Tissue changes thathave occurred over time, affecting the entire length of the arm, need to bestretched back to a more normal condition.

What Is Fascia?

Fascia is a form of connective tissue, also known as myofascia. Just likethe name implies, it connects parts of the body to each other.

Fascia wraps individual muscle fibers with a very thin sheath like asausage casing. It then wraps bundles of muscle fibers, then bundles ofbundles and then wraps the entire outside of the muscle.

As the muscle nears its bony attachment, the number of muscle fiberslessens but the fascia that has been wrapping those fibers continues. Itchemically changes into a more straplike form of tissue and becomes thetendon that attaches the muscle to bone.

Fascia also wraps blood vessels and nerves and suspends them in place asthey pass between and next to muscles, bones and skin. It is fascia thatallows for the nerves and blood vessels to slide and glide as the neighbor-ing muscles and joints move.

Fascia transmits movement from muscle to tendon, ligament or bone.When a muscle contracts, the fascia wrapping that muscle pulls throughthe muscle fibers, through the tendon and into the bone. The fascia

Scar tissue is fasciathat has coagulatedinto a jumbled mass.

Scar tissue interfereswith the normal mo-tion of fascia by cre-ating a “snag” in thecobweb-like fascialmatrix.

The effect of scar tis-sue can be minimizedby slow, gentlestretching that ad-dresses the scar tis-sue from all directionsand depths. While thetissue will neveragain be as God de-signed it, it can func-tion more normallywith appropriate care.

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continues to become the fascia that wraps the bone (called periosteum),then branches off from the periosteum and into the next muscle, or organspace, or wrapping around a nerve or blood vessel.

I hope you can begin to see that fascia is like one big cobweb runningthroughout the body, varying in thickness, running in planes, snaking inand out of muscles, around and between organs, and under skin in onecontinuous piece of tissue.

It is this interesting anatomy of fascia that leads to the often confusingsymptoms of many RSI’s, including DeQuervain’s. When one part offascia is injured or compromised in any way, it can affect tissues that arefar from the original site of the injury or impairment.

In the case of DeQuervain’s, this means that tissue changes in the shoul-der which are the result of an old injury can, over time, affect the condi-tion and function of fascia farther down the arm and into the hand.Symptoms may be felt in one area, but the source of the strain could belocated somewhere else.

When any source of stress causes fascia to change around a nerve, thenthe normally loose, suspending fascia that protects that nerve becomestighter and stickier. The nerve can then become stuck to nearby muscle,bone, blood vessels, or even skin. Every time muscles in the area contract,the tight casing of fascia around the nerve gets tugged and the nervebecomes more and more irritated until tingling, numbness, zinging

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sensations, and sometimes burning or weakness is felt.

In the case of muscle-based symptoms (weakness, pain, pressure, drawingsensations, congestion, etc.), the fascia surrounding and permeatingthrough muscle becomes tight, sticky and restricted. This can prevent themuscle from accomplishing the work it is designed to do by inhibitingthe full contraction and release of the tight muscle. This forces neighbor-ing muscles to pick up the slack, helping the restricted muscle do its job.

The problem is, the helper muscles aren’t designed to contract and releasein exactly the same direction as the restricted muscle, so helping causesmore strain in the helper muscle. Now you have two muscles that arerestricted and strained and the process of more adhesion and morerestriction continues.

Fascia creates a wrapping around the entire muscle and this part of thefascia can also become adhered, causing one muscle to stick to its neigh-bor. When one muscle contracts, it must drag along the muscle that isstuck to it, causing overwork and strain. Fascia tightens in the area tohelp protect the strained muscles, and more adhesions develop as a result.

Fascia molds itself over time according to how the body is used, thehistory of injury or trauma to the fascia, and even according to how wethink and feel. Here’s a simple example of how the fascia records habitualmovement patterns: Cross your arms over your chest and notice whicharm ends up on top. Now, cross them the other way, with the other armon top. Notice how funny this feels, how you are unused to crossing yourarms in this way and how unnatural it feels to do so. This is because youhave repeated your favorite way of crossing your arms thousands of timesthroughout your life and the fascia in your arms has been molded accord-ing to that pattern. The same thing occurs in any area of the body that isused in a repetitive way.

The moldability of fascia is the reason that ergonomics is so importantwhen recovering from a repetitive strain injury. If a person habitually sitsin a slouched posture, then over time the fascia in their body will molditself to that posture and lock it in place. When you have a chroniclyslouched posture, this is why you can straighten up for a while as youthink about sitting straighter, but as soon as your mind is off the subject,your posture returns to its slouched position

All of these posture-related tissue changes will be felt by the body as asource of strain. Now, add a repetitive motion using muscles in that area

Fascia molds itselfaccording to any ha-bitual pattern youhave:

• Slouched shoulders• Forward head• A raised shoulder to

carry a briefcase• A raised pinky while

raising a teacup

All of the fascialchanges recorded inyour body have be-come “normal” toyou. You may have ahard time feelingthem or recognizingtheir existence.

But, make no mis-take. They are there.And, they are affect-ing how, if, and whenyour body creates arepetitive strain in-jury.

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and you have the perfect environment for creating a repetitive straininjury.

By working to correct poor posture and by practicing good ergonomics,many sources of strain can be reduced or eliminated. The body willfunction more efficiently and with significantly less pain and restriction.When your mother told you to sit up straight, she was right!

As I mentioned before, fascia also changes consistency due to injury,surgery or other trauma, like a car accident. The more time that haspassed since the original trauma, the more likely it is that the restrictionin the fascia has effected a larger and larger area.

Let’s consider two examples of injured workers. Two people, A and B,work side by side as computer programmers. Both people have symptomsof a repetitive strain injury: aching and weak forearm muscles and tin-gling fingers. Same symptoms, same job. But, here is where the similari-ties end.

Person A broke his arm when he was seven years old. Tightness andrestriction in the fascia of his arm, which was the result of the break andwearing a cast for several weeks, was never adequately released after thecast came off. His current symptoms of a repetitive strain injury may havebegun in those earlier days. The tissue that changed to a denser state solong ago may still be creating a pull that transmits down his arm and intohis hand, helping amplify the strain that is a normal part of his job today.

Person B never suffered a broken arm. But as he works now he has poorposture when sitting at his desk. The fascia in his body is strained bystructural stress, creating opportunities for nerves to be pinched, breath-ing to be limited, and gravity to pull his body down in an unbalancedway.

Each person faces a unique challenge in overcoming his current symp-toms. The person with the previously broken arm must find and stretchtissue that became stuck and rigid many years ago. He must release oldspots of scar tissue and adhesions that may be interfering with his typingactivities today.

The second person has a different challenge to face. In addition to learn-ing how to restore stressed fascia to a more normal state by practicing thecorrect stretches for his symptoms, he must be willing to learn andpractice new posture habits while working at his desk that will eliminate

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the sources of structural stress his body now experiences.

Both people in these examples have an excellent chance of restoring theirbodies to an optimum level of performance. It is not necessary that theycontinue to suffer with a repetitive strain injury. By addressing tight andrestricted areas of their bodies by carefully practicing the appropriatestretches and eliminating old habits that contribute to strain, they canregain a more youthful, unrestricted and comfortable body.

Restricted, thickened, tight and adhered fascia responds quickly to slow,gentle stretching that addresses the area of restriction from all directions.The release of the tissue can be enhanced when slow motion is added tothe stretches.

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The Importance of Water

Having enough water in your system is very important for restoringmuscles and connective tissues back to their normal condition andfunction.

When you are dehydrated, your body will borrow the fluid it needs tokeep your kidneys going, your brain working, and your perspirationfunctioning as normally as it can. One of the prime places your bodyfinds this extra fluid is in the connective tissues throughout your body orin the synovial fluid sacks that are meant to protect your tendons fromexcessive wear and tear as they cross the joints. Irritation of these synovialfluid sacks is called tenosynovitis and is another common form of RSI.

In repetitive strain injuries, it is important to remember that the functionof connective tissue, particularly the fascia, is to allow sliding and glidingof one layer of tissue over another. It also encases and suspends the nervesand allows them to slide as the muscles contract and the joints move.

Imagine how difficult it becomes if the normal sliding and gliding ele-ments of your body are dried out and sticky! It actually compounds theeffects of any repetitive strain injury, no matter where the injury appearson your body. Not only that, but your kidneys, brain, joints, skin, andmuscles suffer as well.

A good minimum amount of water to plan on consuming every day is 2quarts, or 8 cups. If you are on restricted fluid intake on the recommen-dation of your doctor, then it is very, very important that you discuss thisrecommendation with him or her before beginning to increase your waterintake.

Keep in mind that certain common foods and beverages tend to have adehydrating effect on the body. They may include coffee or any othercaffeinated beverage, alcohol of any kind, soft drinks, and sugars. If youconsume these foods or beverages, it is important to increase the amountof water you are drinking accordingly.

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***Read This Page******Before Beginning Any Stretches!***

Stretching SafelyThe beginning of this stretching program is always a critical point. Yourtissues are as injured as they will ever be right now. If you do yourstretches properly and as directed, your tissues will be better next week,and the week after that. So, it is more important that you follow the rulesfor safe stretching at this point in the program than at any other time.

Each of the stretches I have planned for you to practice this week willcreate sensations. They may even make your hands and fingers hurtslightly. Do not panic! This is your body’s way of telling you that you arestretching injured tissue. It will always reproduce some of your symptomswhen you are stretching in the right places.

Because your fascia and muscles are so injured right now, it is criticallyimportant that you do the stretches properly so you do not add to theinjury. Remember: More is NOT better. You should never feel pain whenstretching. There is no such thing as “sets” and “reps” when stretching torecover from repetitive strain injury. In some cases, one repetition, prac-ticed correctly, is all it takes to get the most benefit from a stretch. Followthe instructions for each stretch very carefully to avoid adding strain toyour already injured hands, arms and shoulders.

Practice the stretches and exercises for this week in the order they aregiven in this program. Each exercise is designed tohelp release areas thatwill be affected in the exercise that follows. Practicing them in the correctorder will help promote a more rapid recovery.

The thumbs are particularly sensitive parts of the body and are very proneto being overstretched. Never practice any of the stretches more times perday than recommended and this will help minimize any potential foroverdoing it.

On some rare occasions, you might feel that you have gone too far oryour body may feel more sore after doing the exercises than before. Donot panic. This happens to everyone, including me, from time to time.Simply make some time to thoroughly rest your body until the sensationsdie down before resuming your daily activities. This might take a day ortwo. You’ll be fine.

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- Shoulder Circles -

This exercise can be practiced sitting or standing. Make sure that youhave room to let your arms hang down by your sides.

Raise your shoulders up, as close as you can get to your ears. In onesmooth motion, very slowly begin to rotate your shoulders forward,squeezing your chest muscles at the front of your body.

Continue around, forward and down in a very slow circle. At the bottomof the circle, pull your arms down as far as you can, imagining that youare trying to touch the top of your socks. Keep the motion slow andconstant as you continue around the circle.

As your shoulders begin rotating around to the back of your body imag-ine that you are squeezing your two shoulder blades together. As yourotate back and up to the beginning point of the exercise, note theintensity and quality of the sensations. They are usually rather intensewhen you first start practicing this stretch. This is perfectly normal.

Do one rotation toward the front, and then reverse and do one rotationin the opposite direction. Each rotation should take no less than 30seconds to complete. Go slowly and make the fullest and roundest circleswith your shoulders to get the most benefit from this exercise.

Releases:• Upper back muscles• Upper chest muscles• Lower neck muscles• Muscles under the

shoulder blades• Muscles passing through

the armpits• Upper arm muscles

Have a friend assistyou the first few timesyou practice this exer-cise. Place a square ofmasking tape or othercolored tape at the verytop of your sleeve. Thiswill help your friend seethe roundness and full-ness of the circle youare creating as you dothis exercise.

Many people, whenfirst doing this exercise,tend to flatten portionsof the circle they are try-ing to create with theirshoulders. This is dueto stuck muscles pre-venting full motion inthose areas.

Have your friend watchyou do this exercise,looking at you from theside. Have your friendlet you know where youare flattening the circleas you rotate yourshoulders forward andbackward.

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- Head Turn, Part One -

This exercise can be done sitting or standing.

Keeping your chin level, slowly turn your head to the right as far as youcan comfortably go. Hold your position for 5 seconds and then slowlyreturn to the starting position. Rest in the starting position for 5 seconds.

Slowly rotate your head as far as it can comfortably go to the left andhold for 5 seconds. Then return to the starting position and rest foranother 5 seconds.

Repeat for a total of three times to the right and three times to the left.

Finish the exercise by facing forward. Rest in this position until all thesensations you feel in your neck and upper chest disappear completely.

Repeat this exercise twice per day, but not more than three times per day.

Releases:• The upper pectoral

muscles• The sternocleidomastoid

muscle• The scalenes

If you are just begin-ning, chances arethat the muscles inyour upper chest andneck are quite tightand restricted. If thisis the case, thenpractice this exercisein a seated positionwith your hands inyour lap.

At the end of the ex-ercise be sure to restwith your hands inyour lap.

Later, when thesetissues are more re-laxed, try this samestretch in a standingposition with yourarms hanging at yoursides, shouldersdown and relaxed.This will create aslightly more intenseexercise.

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- Doorway Stretch -- Hands Low -

Place both hands on the door frame, shoulder height.

Taking tiny steps, begin to move your body forward until you feel amoderate stretch across your chest and upper arms. Keep your chin level.

Hold this stretch for 5 seconds, then step back, keeping your hands onthe door frame. Wait for 10 seconds, then step forward again to repeatthe stretch. Stretch forward, then back a total of three times.

When finished with the third repetition, step back and let your arms dropto your sides. Release any tension in your shoulders as you let your armshang. If this feels like too much, then sit down, place your hands in yourlap and rest there until all remaining sensations from this stretch havedisappeared completely.

Repeat this exercise one more time at another time of the day, for a totalof two repetitions each day.

Releases:• Upper pectoral muscles• Lower neck muscles• Intersection between

pectoral muscles andbiceps

If you are at least 5’6”in height, most house-hold doorways shouldbe the correct size fordoing this exercise. Ifyou are shorter, thenyou might need to lookfor a narrower doorway,like a pantry, closet, orpowder room doorwayfor the correct width.

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- Doorway Stretch -- Hands High -

Place each forearm flat on the doorframe with your elbows at nose height,palms flat. Keep your chin level.

Take a tiny step forward into the doorway. Stop at the point where youfeel a moderate pull across your chest muscles. Hold this stretch for 5seconds and then step back to rest for 10 seconds, leaving your forearmsin place.

Repeat this stretch another two times, for a total of three repetitions.

Drop your arms to your sides and let them hang for 10 - 15 seconds.Then sit down and rest your hands in your lap until all remaining sensa-tions from the stretch are gone completely.

One or two repetitions per day is often enough for this exercise in thebeginning. Increase the repetitions to three per day as your symptomsdecrease.

Releases:• The pectoralis minor

muscle• The lower pectoral muscles• The coracobrachialis

muscle• The upper biceps

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- Scalene Stretch, Side Lying -

Lie on your side on the floor with your head supported on a pillow.

Simply drape your arm behind your waist and let it hang there.

Completely relax your shoulders, neck and chest muscles.

Rest in this position for 20 seconds, or longer if you can tolerate it.

Roll over to stretch the other side in the same manner.

When you have finished stretching both sides, roll onto your backandplace your hands on your belly. Rest there until all remaining sensa-tions from the stretch disappear completely.

Releases:

• Biceps tendons at theshoulder

• Gentle stretch for thescalene muscles in theneck

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- Thumb Grasp -

With one hand, wrap it fully around the thumb of the other hand, all theway to the base of the thumb.The wrapped thumb should remain inalignment with the palm of the hand. Do not pull the wrapped thumbforward or back of the palm.

The purpose of grasping the thumb in this manner is to stabilize thejoints in the body of the thumb, preventing them from bending whiledoing this stretch. All of the movement in this exercise takes place in thejoint at the very base of the thumb, at the wrist.

While grasping the thumb and holding it straight, gently pull the entirethumb structure away from the palm of the hand, stretching the web oftissue between the thumb and first finger. Hold this stretch for 5 seconds.

Place your hand in your lap and allow it to rest there for 15 seconds.Repeat this entire sequence two more times, then place your hand in yourlap and rest there for at least one full minute or (preferably) until allremaining sensations created by this stretch are gone completely.

Practice this stretch only once per day.

Releases:• Tension in the tissue

between the thumb andthepalm

• Adhesions found at thebaseof the thumb

The thumb structuresare particularly sensi-tive areas of the body.One theory I haveabout why this seemsto be so is that thethumbs have vey littlemuscle tissue associ-ated with them. It istherefore very easy tooverwhelm this tiny bitof muscle by overdo-ing stretches or exer-cises.

It is very important tominimize the additionof strain to the thumbsby stretching themvery gently and onlyonce per day. Anymore than that seemsto promote an environ-ment which allows forfurther irritation.

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- Thumb Tendon Stretch -

Imagine that you are pointing with your thumb. With your elbow bent,extend your thumb forward as if trying to touch something that’s just outof reach.

Experiment with the direction of pull, straightness of your thumb,alignment of your thumb with the rest of your hand, wrist and arm.When you find the correct angle of pull, you will feel a distinctly strongerpull in the muscle and tendon that extends from the thumb, across thewrist and into the top of the forearm.

Hold this pull for 5 seconds, then place your hand in your lap and restthere for 15 seconds. Repeat two more times.

Complete the stretch by resting your hands in your lap until all remain-ing sensations from the stretch are gone completely.

Practice this stretch only once per day.

Releases:• Extensor Pollicis

Longus Muscle• Abductor Pollicis

Longus Muscle• Extensor Pollicis Brevis

Muscle• Extensor Retinaculum

After practicing thisstretch for a week, ex-periment with yourarm position. Try thestretch with a partiallystraight arm. Try itagain (at anothertime) witha com-pletely straight arm.

Also try different armplacements. Try thestretch with your armpointing straightahead. At anothertime, try the stretchwith your arm poin-ting straight out to theside, or straight over-head.

Notice how each ofthese variations cre-ates a different pull onthe tissue through thearm, wrist and into thethumb.

Continue practicingany of the variationsthat creates a height-ened stretch sensa-tion for you.

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HomeworkWeek One

The success of this program is completely dependent on how well youapply all the techniques presented here. Even though it may mean mak-ing changes to things you have done all your life, it is important to realizethat the way you have moved, worked, played and used your body hascreated the symptoms you are now dealing with. If you do not changewhat you do and how you are doing it, you will continue to get the sameresults. Your injury will remain in place and will probably get worse overtime.

Instead, take this opportunity to make some simple changes. Allowyourself to be guided by an expert. This will give you your best chance fora complete return of your body to a more normal state.

Here are this week’s assignments:

1. Increase your water intake to at least 8 full glasses each day. If yourdoctor has recommended that you drink less water, then do not followthis assignment until you discuss this assignment with your physician.

2. Order your copy of “Welcome To Earth” from Amazon.com. Listen toit and practice the relaxation exercise at least once per day.

3. Create a list of all the things you feel you “Must Do” each day. Create asecond list of the things you “Would Like To Do” each day. Switch asmany things as possible off of your “Must Do” to the “Would Like ToDo” list. Stop doing as many of the things from your “Would Like ToDo” list as possible. Be brave enough to make the hard choices. Don’tworry. You’ll get them back!

4. Practice the Shoulder Circle exercise as many times a day as youchoose, but no less than four times. Read the instructions carefully.

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- Week Two -

During this week you will learn how to tune in to pay attention to thesensations your body is sending.

By being able to feel sensations and correctly interpret what they mean,RSI’s can be better controlled now and prevented in the future.

We spend a significant part of our day thinking. We spend very little timeout of our day actually feeling what’s going on in our bodies. Ignoring thesensations our bodies send us is a surefire way to miss important signalsthat could tell us when a problem is developing or worsening.

Sensation is our body’s language. Whether it’s the sensation of an illnessor the sensation of pain as we strain our body, sensation is our body’s onlyway to communicate what is happening in the moment, good or bad.

Learning to pay attention to and correctly interpret sensation is sort oflike learning to speak French. In the beginning, it’s a challenge to “hear”all the messages. They may not mean much to us yet. But, with practice,our ability to “hear” what the body is saying grows better and better. Intime, we are able to catch all of the messages, strong as well as subtle.

Paying attention to sensation is particularly important when trying torecover from an RSI. Once you become adept at feeling sensation youwill be able to safely control the intensity of a stretch or tell when achange in your posture is reducing strain or adding to it.

The difference between success and failure in overcoming a repetitivestrain injury often pivots on the subtleties. Once your ability to sensefiner differences in intensity is better developed, your chances of success-ful recovery will be greatly enhanced.

Especially with this challenge, practice is of utmost importance. Maketime to practice the techniques you learn here every day, without fail.

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Attitude

A positive attitude is an important key to your success in overcoming theeffects of repetitive strain injury. When you believe that it is possible toovercome the effects of DeQuervain’s, which it is, your entire physiologybegins to help you achieve your goals.

I know it is hard to believe that significant improvement of your symp-toms is possible if you have already spent a lot of time and money tryingall sorts of therapies to assist you in recovering, without success. But,there is a solution and it is possible to return to the pain free body youremember.

Through this program you will be learning all the necessary steps thatlead to a successful outcome:

• Learning to tune in to feel sensations your body is sending• Recognizing and eliminating unconscious habits that lead to soft tissue

stress• How to control emotions that can lead to tension in the body• The correct order to release injured tissue through gentle stretching• How to stretch in a way that progressively changes injured tissue safely• How much and how often to stretch• How to create customized stretches that reflect the unique characteris-

tics of your own injury pattern

When you put all these pieces of the puzzle together, success is muchmore likely. You will be pleased with the results you can achieve in arelatively short amount of time. Relax. Improvement is possible if youjust learn to implement what your body really needs.

The Sensory Walk

The Sensory Walk is an extremely important foundational exercise forthis self care program. It is an enjoyable exercise designed to help youbegin to recognize the sensations that have often gone unrecognized formost people. These sensations are your body’s language and learning to

Are you scared? An-gry? Feel out of con-trol? Who can blameyou?

RSI’s are confusinginjuries with lots of“experts” telling youlots of different thingsto try.

Allow your intuition totell you if a recom-mendation feels right,sounds right and isworth your time andeffort.

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become aware of them, and later learning how to recognize good sensa-tion from bad sensation will be the foundation of a full recovery.

The Sensory Walk requires that you practice this exercise with a partner.One partner will be the Observing Listener while the other partner willbe the Relater. Pick a day to practice the Sensory Walk when the weatheris nice and conducive to outdoor walking.

Choose who will be the Relater and who will be the Observing Listener.Your roles will change halfway through the exercise, so it doesn’t matterwho plays what role in the beginning. Go outside and begin walking. Therole of the Relater is to say out loud all the sensations they become awareof. Examples might be feeling the breeze on the left cheek, becomingaware of the irregularity of the pavement, hearing a bird off to the right,feeling the warmth of the sun, etc. The role of the Observing Listener isto listen only. The Observing Listener does not comment at all on whatthey are hearing. They only listen and relate to what they are being told.

It is very important for the Relater to say out loud all they are sensing.There seems to be something magic in the actual verbalizing of yourexperience. The body seems to experience it at a deeper level and itbecomes more aware of that sensation. It is as if the body’s sensory aware-ness opens up and expands, allowing more sensory experience to come tothe surface to be felt.

Walk and talk for five minutes before changing roles. When you changeroles, the Relater becomes the Observing Listener and vice versa and youwill walk, relate and experience for another five minutes. Now, the firstRelater gets to have the experience of hearing different sensations that thenew Relater is verbalizing. Perhaps these sensations are similar to what thefirst Relater felt, and perhaps they are new. In any case, the range of feltsensations both participants become aware of increases and the level ofsensitivity to all sensations also increases.

It is through the increase of felt sensation that a person recovering fromRSI’s can heal more quickly. In order for exercises and stretches to havetheir maximum effect, the person doing those stretches and exercisesmust be able to feel and correctly interpret the sensations that are createdby those stretches and exercises. If this ability is diminished or missing,the sufferer is more likely to overstretch. The result is delayed recoveryand possibly an increase in pain and discomfort rather than the desiredlessening of painful sensations.

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The Tape Trick

This exercise is excellent for helping people determine when and to whatextent they are unconsciously raising their shoulders.

Raising the shoulders, while mostly a habit we are unaware of, can bevery detrimental to those with repetitive strain injuries of all kinds. Majorplanes of fascia covering and permeating the hands and arms begin in theneck and shoulder region of the body. Raising the shoulders, even uncon-sciously, can create an environment of perpetual squeezing and irritation.This, in time, leads to compensation and the development of adhesionsthat can contribute to RSI’s.

Raising the shoulders unnecessarily can create problems for the entireupper half of the body. The connective tissues that allow for the free andeasy movement of the hands and arms begin in the torso. When a personraises their shoulders habitually, the body perceives this habit as a strainand tries to protect the body by tightening and restricting the fluidmotion of the connective tissues as they travel down the arms into thehands. This can lead to symptoms of weakness, pain, restriction, and lossof range of motion in the joints (they don’t move as freely as they usedto).

The Tape Trick is a very simple and low cost way to find out if you areunconsciously raising your shoulders and perpetually irritating the nerves,muscles and connective tissues of your neck, shoulders and arms. Here’show to do it:

Go to the pharmacy and purchase a roll of non-stretchy bandage tapethat is 1/2 inch in width. Avoid paper tape as it tears too easily. Good oldfashioned bandage tape that is found on the metal roll is a great one tochoose. Tear off a piece that is 12 inches long. Now go find a friend tohelp you.

The Tape Trick works best if you do it on one shoulder at a time. Pick theside of your body that has the most severe symptoms of repetitive straininjury. If you can’t tell which side is worse, then pick the side that is yourmore dominant side. For right handers, that would be your right side.Have the friend stand next to you, looking at your side. Remove yourshirt. Ladies, it is very important to slip your bra strap off of your

Silly things can oftentrigger unconsciousraising of the shoul-ders. Some ex-amples I’ve observedare wearing stuffybusiness attire, beingstuck in heavy traffic,and carrying a childon one hip.

Can you identifytimes when you raiseone or both shoul-ders unnecessarily?

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shoulder. Make sure that your shoulders are down and relaxed and thatyou are looking straight ahead. Have your friend apply the tape to thebare skin of your shoulder, in the same direction that a bra strap wouldgo, with half of the tape extending to the front onto your chest, and theother half extending down your back onto the back of your shoulder. Forladies it is important that the tape is not applied in the exact same areawhere your bra strap lies because your body has become somewhatunconscious to feeling pressure in that spot. Instead, have your friendapply the tape about 1/2 inch closer to your neck.

Now your job is to get dressed and go about your normal daily activities.If you raise your shoulders at all, the tape will pull on your skin, alertingyou to the fact that you are raising your shoulders. It is important to tryto recognize when and under what circumstances you are habituallyraising your shoulders. By recognizing when you are engaging in thisunconscious activity, you can choose to change it, and relieve your bodyof untold amounts of unnecessary strain and compression.

Freely share this Tape Trick with all your friends and colleagues so theycan be on the road to less pain and stress too!

The Fear Of Pain

It is reasonable to become afraid of pain and other intense sensation whenyou have been injured by an RSI. But, I would like to suggest that theremay be another way of thinking about the pain and discomfort you feelwhen you are injured.

Your body has a language by which it sends messages and signals to you.Sensations are the body’s way of telling you what is going right and whatis going wrong. Learning to speak this language becomes a really impor-tant way to identify and then address problems as they arise in yourmuscles and soft tissues.

Not all sensation is good, however. Real pain is a sort of danger signal andshould be respected as a sign that something is wrong. Pain from aninjury calls you to pay attention and get help for yourself. Pain felt whenstretching is a sign that you are stretching too aggressively and thatfurther damage to the tissues is imminent. If you feel this, you need to

Practice the TapeTrick one or two daysa week for severalweeks. Make a noteof when you feel thetape tug on your skin.See if there are anyconsistent habits thatyou should break.

Do you hold thephone between yourear and your shoul-der?

STOP NOW!

Invest in a low-costearpiece or head-phone instead!

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back off on your stretch or discontinue it altogether for that day. Alwaysfollow up with a minute or two of rest to make sure the tissue has hadadequate time to calm down. This will help prevent any lasting negativeeffects from overdoing it.

Complete numbness (like your hand has disappeared from your body) isanother sensation that indicates danger. It means that a nerve is being cutoff completely and that is never a good thing. Again, you must decreasethe intensity of the stretch or discontinue it for that day. Always rest thearea completely until the nerve stops firing or tingling.

Lighter pain, irritation, aching, or tingling is another story altogether.Lighter pain is the only way your body can tell you that you have accessedtissue that is not functioning normally. This means you have hit pay dirt!The sensation means that this particular stretch is helping you reachtissue that has been damaged as part of your injury and is contributing toyour symptoms.

Now the challenge is to make sure that the sensation you feel whilestretching never progresses into a painful sensation. It should actuallybegin fading from a mild tingling or discomfort into no sensation at all.This is the safest way to make sure that a stretch never creates more painor injury through over-stretching.

Learn to embrace the aches, pains and other discomforts you feel fromyour body. They are the only way your body can tell you what needsattention, and when that attention is helping you achieve full recovery.

The Bank Account

Stretching is unique for each individual. The amount you must stretch toget the best results is unique to you too. The appropriate stretchingexercises are determined by the areas of the body that has been affected byyour injury. The amount of stretching you must do to restore thoseinjured tissues back to a more normal state is determined by whereadhesions are located (some areas are harder to access than others andrequire a more indirect approach in order to reach the injured tissue), bythe amount of use the injured tissues must endure each day, by the injuryhistory of the damaged tissue, and by the degree of change the injuredtissue has gone through in developing the current injury. There’s a lot to

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consider!

To get the most out of the time you spend stretching, it is most impor-tant that you master the ability to actually feel your tissues as they stretch.Be sure to refer back to the section entitled Preparing Body and Mind.

Once you have developed an ability to feel the tissue as you stretch, yourability to determine how much and how often to stretch will be a littleeasier. It’s important to remember that it took time for your injury todevelop and it will take time for you to correct the changes that haveoccurred.

I find it helpful to think of the body as having a bank account. Imaginethat when your fascia is injured, your body is like an overdrawn bankaccount. Your muscles and connective tissues have worked beyond theircapacity. They are more than fatigued and they need more help thansimple resting.

When you stretch, it is like adding funds back into your body’s over-drawn bank account. If you stretch too hard, your body does not regainmuch of its working capacity and you add only $10.00 back into youraccount. If you stretch properly, you deposit as much as $100.00 worthof healing into your account.

If you have injured tissues that are like an overdrawn bank account, itmakes sense to add as many funds back into the account as possiblebefore you start withdrawing funds in the form of more repetitive activi-ties. It is important to practice your stretches properly. Doing so willreplenish your account in the shortest amount of time.

The object of this self care program is not only to get your body out of itsoverdrawn state but also to add enough funds back into your body’saccount so that you can do just about any activity and not suffer furtherinjury or symptoms. Realize, however, that each physical activity youchoose to do comes at a cost. Funds are withdrawn out of your accounteach time you type, grasp, lift, write, and so on.

Consider the case of a person employed as an assembler. She has been onthe job for several years and in the last six months, her hands have begunto hurt. What started as a minor ache that would go away with a littlehand shaking has now turned into an unrelenting deep ache with occa-sional numbness. Her body’s account is about $500.00 overdrawn. She

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follows the exercises in this program, in their correct order and practicesthem faithfully and carefully. Within one week, her hands no longer hurtconstantly; she experiences intermittent problems only. At this point, herbody is no longer overdrawn - her body’s bank account is at about the$0.00 point.

The next day she goes back to work, performing the usual job activitiesthat ordinarily contribute to her symptoms. By the end of the day, herhands hurt again. Why? Every repetitive activity comes at a cost to thebody. She has withdrawn further funds out of her body’s bank accountand is back in a negative balance.

The solution for repetitive strain injuries is to build up your body’shealing bank account to the point where there is a surplus of funds in theaccount and then to maintain the account at that level. Every time youstrain your tissues through work or leisure activities, funds are withdrawnfrom your account. If you started your day with $250.00 worth of fundsin your account, and the days activities cost you $150.00, you wouldmost likely get through your day with no further symptoms of repetitivestrain. If you do not replenish the account by stretching at the end ofyour day, restoring the account back to its $250.00 level, you will startthe next day with an account worth $100.00. If the next day’s activitiescost you another $150.00 in healing funds, you will again be overdrawn.You most likely will begin to feel some symptoms return because you areagain overdrawn in your body’s bank account.

As you can see, if you have to perform repetitive and strained activities ina typical day, it will take longer to replenish your overdrawn accountbecause you will be putting in funds each time you stretch, but you willbe withdrawing a large amount of those funds through your normal dailyactivities. You can get a jump start on replenishing your healing accountby eliminating as many activities as possible that cause strain or includerepetitive motion.

If at all possible, try to find a period of time when you will have thefewest activities that you must perform with your hands and arms tobegin your stretching program. By starting at a time when there will befewer demands on your hands and arms, you can replenish your over-drawn healing account quickly, with fewer funds being withdrawn due tonormal daily activity. For many people, a vacation is the best time toreduce everyday stresses to the hands and arms.

If it is not possible to have a period of time when stresses to the hands

Learning to feel yourbody’s sensations isthe best way to knowhow much stretchingyou need to “payback” your body’sbank account afterworking all day.

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and arms are minimized, then try to reduce the nonessential stresses thatyou may be experiencing to lessen the amount of funds that are with-drawn from your healing account every day. Here are some examples:

• Get help with putting clothes in and out of washers and dryers• Temporarily switch to paper plates to reduce dishwashing chores• Choose a hairstyle that requires less blow drying or styling• Place small children on a sofa next to you rather than holding them in

your arms for lengthy periods of time• Carpool or take public transportation to work to reduce strain during

driving• Ask for help with household chores• Use bank by phone or bank by computer to pay bills rather than writ-

ing out a large number of checks each month

Each of these changes will reduce the total daily withdrawal of fundsfrom your body’s bank account, making it possible to build a surplus offunds in the shortest amount of time. Get creative and try to figure outways to reduce overall stress to your body with the things you do eachday.

Only you can determine how much your account is overdrawn. Only youcan determine how much exercise, practiced properly, is adding back intoyour account. And only you can tell when you have enough of a surplusin your account that you can do any activity without overdrawing youraccount all over again. You can tell all these things through experienceand practice. Each time you practice a stretch, think about how yourtissues feel as they change. Can you feel the tissues releasing? Do you get asense that other tissue in the same general area also need to be released?Do you feel tightness or stretching sensations in other remote areas whileyou are doing a stretch? This would indicate that tissue in the remote areais also playing a part in your injury and must be addressed throughproper stretching. How much tightness returns as you go through yournormal day?

There will be days when you succeed in getting the balance of surplusfunds vs. repetitive activity just right and there will be days when itdoesn’t work as well. Practice and learning through the mistakes youexperience is the only way to get consistent results. Have patience. Learn-ing to speak the language of your body, and being able to accuratelydecipher the messages your body is sending, is like learning to speakFrench. At first, you can only recognize the simplest messages and inter-preting those messages may be inconsistent. But, over time and with

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practice, your ability to interpret, analyze and act correctly will get betterand better. Stick with it. The benefits are huge.

It is possible to restore your body to a state in which you can do all thethings you want to do without pain, discomfort or further damage.Practice the techniques outlined in this program carefully, thoughtfully,and consistently. You will soon be on the road to recovery and able tolook forward to a pain free future. The only cost to you will be a fewminutes of stretching each day. What a deal!

Week Two Stretching Assignment

Practice the following exercises every day in this order:

1. Shoulder Circles, Page 192. Head Turn, Part One, Page 203. Head Turn, Part Two, Page 374. Doorway Stretch, Hands Low, Page 215. Doorway Stretch, Hands High, Page 226. Scalene Stretch, Side Lying, Page 237. Hand On Hip, Page 388. Stick ‘Em Up, Page 399. Thumb Grasp, Page 2410. Thumb Tendon Stretch, Page 25

Do not progress on to Week Three’s exercises until you can do each ofthese exercises easily and without strong sensations. Your body may takelonger than a week to progress through this list of exercises. Give it thegift of time to truly accomplish the changes that will lead to real recovery.Don’t hurry through this program.

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- Head Turn, Part Two -

Sitting up straight with hands in your lap, turn your head fully to theright and tilt your chin up as high as you can go. Hold for 3 seconds.

Tilt your chin down as far as you can go and hold for 3 seconds, keepingyour posture straight. Don’t slump!

Repeat tilting your head up and down 3 times, then turn your head tothe left and repeat the up and down motion 3 times.

Repeat two more cycles to the right and left. Rest afterward by lookingstraight ahead, chin level, until all sensation disappears completely.

Releases:• Sternocleidomastoid

muscles• Scalene muscles• Upper trapezius muscles

Only practice thisexercise immediatelyafter practicing theHead Turn, Part Oneexercise found inWeek One. This is apowerful exercisethat safely encour-ages all neckmuscles to fully re-lease, includingthose that are ad-hered to othermuscles.

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- Hand On Hip -

Place your hand on your hip with your fingers and thumb all pointingforward. Your shoulder should be down and relaxed.

Slowly press your elbow forward until you feel a pull in the base of yourthumb, palm and/or fingers. Hold this position for 5 seconds and thenmove your elbow back to the starting position. Wait for 10 seconds andrepeat again.

Place your hands in your lap and rest until all remaining stretch sensa-tions have disappeared from your hand and thumb.

Practice this stretch twice per day.

Releases:• Joint tension at the

base of the thumb• Tension in the palm• Stretches the finger

flexor muscles

Once your recoveryfrom DeQuervain’sSyndrome is com-plete, this is a greatstretch to practicethroughout your dayto relieve building ten-sion in the hands andthumbs. You can hidethat fact that you arepracticing this stretchbecause it looks justlike you are simplyresting your hand onyour hip. Still, remem-ber that the thumbtendons and tissuesare delicate andconnot stand over-stretching. So, usethis exercise spar-ingly.

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- Stick ‘Em Up -

Lie flat on the floor with nothing under your head. Your knees can be upas illustrated, or down. Place your forearms flat on the floor in the“goalpost” position. Rest there for 5 seconds to give your muscles andfascia time to get used to this position.

In one smooth and continuous motion, keeping your arms, wrists andhands flat on the floor, extend your arms up alongside your ears. Pause inthis position for 5 seconds and then return to the goalpost position.Repeat 5 times. Place your hands on your belly and rest until all remain-ing sensation is completely gone.

Repeat two times per day.

Releases:• Septum between

the bicepsand triceps muscles

• Muscles passingthrough thearmpits

• Begins to releaseadhesions restrict-ing the full rotationof the shoulderblades

It may be difficult foryou to rest your armscompletely flat on thefloor when you firststart doing this exer-cise. You can relievethe strain by folding abath towel and plac-ing it under the fullpathway of yourarms. Slide your armsup and down on topof the towel. As thetissue releases, cre-ate thinner supportsfor your arms untilyou can complete theexercise on the floorwith no support at all.

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HomeworkWeek Two

1. Continue listening to “Welcome To Earth” daily.

2. Monitor your water intake to make sure you are drinking at least eightglasses per day, unless advised otherwise by your doctor.

3. Arrange to take the Sensory Walk with a friend at least twice this week.

4. Try the Tape Trick at least twice this week on each shoulder. Make anote of times when you discover you are raising your shoulders. Try tofind new ways to move/sit/work so you can eliminate the need to raiseyour shoulders under these circumstances. Notice how it feels to let yourshoulders go. Learn to become really familiar with this sensation of ease.

5. Practice each of this week’s new exercises as directed.

6. In addition to the new exercises found in this week’s lesson, continuepracticing the Shoulder Circles as often as possible.

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- Week Three -

This week we will begin to explore the finer points about structural stresson your body and exactly how to reverse it.

Chronic stress is structural (muscle-tendon-ligament) stress that the fasciatries to protect you from. In response to chronic stress, fascia undergoes achemical change, changing from its normal loose and fluid state intotissue that is tighter, stickier and more restricted. It is in this environmentthat RSI‘s take hold.

Learning how to reduce chronic structural stress through self care tech-niques is the most effective way to stop RSI’s in their tracks. Withoutyour personal involvement in the healing process, any relief that you getwill be short lived.

More permanent relief from symptoms comes from changes occurring inmany arenas - posture changes, ergonomics, and stretching the correctway will yield startling results, better than you could ever imagine.

It’s important to embrace all the aspects of healing in order to benefit themost from this program. Read these sections carefully and put theirlessons into practice right away. Then, enjoy the relief as quickly aspossible!

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Chronic Structural Stress

The body is constantly under stress from the forces of gravity. Gravity ispulling down on us whether we are standing, sitting or lying down. Itaffects us when we are moving and when we are still.

Poor posture is a constant source of chronic stress. It’s important toremember that we are moving around in a perpetual sea of gravity.Gravity is always trying to pull us down.

If you are balanced in this sea of gravity, then gravity will actually work tosupport you. If you are out of balance in gravity , then it will pull youdown, causing muscles to constantly contract as they try to hold you up.The result is pain and compensation leading to dysfunction and injury.

If a body is in good alignment (good posture) then the forces of gravityare minimized. For example, imagine that a stone mason is constructing anew brick wall. He is very careful to make sure that the wall is straightand plumb. If he overlooks the straightness or alignment of the wall, thenit is much more likely to fall in just a few years. Gravity will tend to tearit down.

The same is true of the human body. It was designed originally to have acertain balance among all the muscles, bones, and connective tissues.When that balance is preserved, the body functions much more effort-lessly. Bones fit properly in their joints, muscles can contract along astraight line, the body is supported in its most natural state. When a bodyis balanced in this manner, it functions much more easily, needs lessenergy to make movement happen, wears out much slower over time, andexperiences significantly less pain.

Bodies can become out of balance in a number of ways. The most com-mon way is to adopt patterns of holding or moving the body that isdifferent from its natural design. Slouching, locking knees, a forwardhead, lifted shoulders, always carrying heavy loads on the same side are allexamples of really common habits of imbalance. Over time, these unbal-anced ways of holding and using the body will cause it to compensate bycontracting nearby muscles for additional support, tightening the connec-tive tissues (fascia) to further support the imbalance, etc. If these patternsare continued over a period of months and years, the fascial support of

Both postures showlots of strain. Canyou feel the pain?

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the body becomes more rigid, sticky and it begins to interfere with thenormal contraction and relaxation of muscles and inhibits the movementof the nerves and blood vessels that are situated between and next tothose muscles.

Correcting your posture is imperative in recovering from an RSI. If yougenerally have acceptable posture but tend to slouch with fatigue, thenyou can do much on your own to regain proper structural balancethrough paying attention to your posture. You can get lots of great helpabout what constitutes good posture and how to achieve it on a dailybasis by consulting an Alexander teacher or a Feldenkrais practitioner.Both techniques are excellent for developing enhanced awareness of howyou hold your body throughout your day and what constitutes a postureof least resistance. Visit the “Products” section of www.selfcare4rsi.com tofind helpful materials and videos that can assist you in improving yourposture.

If, on the other hand, you have chronically bad posture that has beenwith you for years, then you will probably need more extensive profes-sional help in regaining the kind of posture that helps prevent further RSIinjury and pain. Experts in restoring proper posture are those profession-als trained in some form of Structural Integration. The largest schools fortraining these therapists are Hellerwork, The Rolf Institute, and theGuild for Structural Integration. You can find links to these schools in the“Links” section of www.selfcare4rsi.com.

Why is posture so important? Let’s consider this example. Let’s assumethat you have what’s known as a “forward head”. This is when a personsticks their chin out and their head and neck extend forward of theirshoulders. This problem is a byproduct of slouching. If you look at aperson from the side as they slouch, you will see that their head and neckare forward in relation to their shoulders and torso.

With a forward head, the muscles along the sides of the neck change.Some get shorter, some lengthen slightly. In other words, they shift awayfrom the balance they were intended to have. This often causes the bodyto form adhesions, or stuck places, between these muscles because theyare being forced to function in a way they were not designed to function.

Another consideration in a forward head posture is that your head weighsapproximately ten pounds. When it is thrust forward it is no longersitting on top of your shoulders, which should be supporting the weightof your head. Instead, the small muscles found at the back of your neck

Gravity pulls straightdown through thesebodies, supportingthem. Can you feelthe relief?

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have to contract and hold on for dear life in order to keep your head fromtumbling forward. Now, that’s a constant source of stress!

There are many additional effects of poor posture that can be seen andfelt in an unbalanced body. The bottom line is, if your posture is out ofbalance, then work to correct it, either on your own, or with the help of askilled therapist who specializes in this sort of problem.

Unconscious habits of body use are also important factors that contributeto chronic stress. These are even more unconscious than poor posture.Simple things like holding up your little finger while typing or drinking acup of coffee can build stress in the tissues of the hand. Raising a shoul-der to carry a shoulder purse or computer bag is a huge source of chronicstress.

When you suffer from a repetitive strain injury, it is really important topay extra attention to what you are doing with your body. Sometimesyour body will send you signals of discomfort to remind you that you areusing your body in an uncomfortable way. If that happens, then payattention to the pain signal to find out where the stress is being created.Then, focusing on that area of your body, try to figure out what you aredoing in that moment that is inappropriate and work to correct it. See ifyou can determine patterns of holding and using your body in stressfulways. If you recognize that you always tilt your head to hold the phoneand this sends you a pain signal (which it should!), then figure out a wayto stop, change the pattern of body use, and break the cycle of stress.

It’s sometimes helpful to employ the help of others in recognizing waysthat you are stressing your tissues. Have a friend or loved one alert youwhen they notice you slouching, raising shoulders unnecessarily, keepingan arm bent for no reason, holding tension in your fingers or hands, etc.Often the insight of another person can be a great help in identifyingthese sources of chronic strain.

Other sources of physical stress in the body come from the varioustrauma we suffer over the course of our lives. Accidents, surgeries, sportsinjuries, bumps and bruises all contribute to the strain felt by the bodythrough the compensations that are made after the stresses occur. Scartissue, a form of tight and irregular fascia, is a good example of the kindof compensation the body makes after the trauma of surgery. Theseevents and changes cause the body to work harder to remain upright, andcreate a drag on the function of the muscles and connective tissues. Strainis the result.

Imagine holding a tenpound bowling ball atyour side, six inchesaway from your leg.Can you imagine thepain this would cre-ate in your shoulderif you held this posi-tion for more than afew minutes?

This is the same kindof stress and painyour neck musclesmust endure whenyou slouch or have aforward head. Ouch!

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Chronic stress is the sort of stress that makes RSI’s possible. It’s sneakystress. You do stressful things with your body that you are not even awareof. It’s a true challenge to identify and overcome chronic stresses that cancontribute to DeQuervain’s. If you start by making sure your posture isgood, then you will be way ahead of the game.

Here’s a stressful pattern that I often see in the hands of De Quervain’ssufferers:

Notice that the space between thethumb bone and the index fingerbone is narrowed. This tends todestabilize the joint at the base ofthe thumb, and probably stressesthe ligaments that support thatjoint. Arthritis-like pain, achingand restricted movement is theresult.

It’s important to stretch the tissuebetween the thumb and indexfinger so this joint maintainsnormal alignment and has room tofunction normally.

This is an example of normalbone alignment in the hand.Notice the space betweeen thethumb and index finger bones.The bone at the base of thethumb fits properly against thefirst wrist bone. With this align-ment, the joint functions nor-mally and pain is usually notpresent.

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Ergonomics

Ergonomics is the study of the interplay between job demands andworker performance and how they influence one another. Ergonomicsconsiders the abilities of the human body, plus its limitations, and thenlooks at the interaction between human abilities and the characteristics ofthe job being performed. The focus of ergonomics is to create a safe andcomfortable interaction between the worker and the job demands.

When a person is suffering from a repetitive strain injury, it is moreimportant than ever to reduce and eliminate as many sources of stress tothe muscles and soft tissues as possible. By reducing the overall strain tothe body through an ergonomically balanced work environment, thebody is better able to cope with the repetitive nature of the work we do.

It’s important to realize that good ergonomics alone will not heal a case ofRSI. Ergonomics is helpful in the RSI arena by reducing the ongoingstress that gets created when we use our bodies in our work. But, bodiesthat have been changed by injury respond differently than a normal bodywould to job demands. Therefore, even more correction must take placeif you are in an injured state before an injury will be truly corrected.

If you have poor posture, then much more stress is created by everydaymovements than if your posture is balanced and aligned. Using an ergo-nomically balanced workstation will help reduce the stress your bodyexperiences from your work, but it will not eliminate it altogether. Tightand unbalanced muscles will still tend to pull you down, adding to strain.

If you have good posture, then ergonomics will appear to give you signifi-cant relief from stresses that can aggravate RSI’s. But, if your fascia hasbeen changed or injured due to other bad habits, old injuries, or traumaof various sorts, which you probably cannot feel, then you will still needto add stretching and other logical changes to achieve the best relief fromyour symptoms.

Have you ever triedto use a new piece ofequipment in yourwork, like a new key-board or a new chair?Did this result in adecrease in symp-toms? And then, in ashort amount of time,did your symptomsreturn? Why?

Changing equipmentcauses the pull ofyour movements totransmit along newlines in the fascia.New equipment doesnothing to restore ad-hesions back to nor-mal. It only shifts thestress to a new area.

Use ergonomicequipment and workstations to reduceconstant stress.Then, take responsi-bility to restore yourtissues back to amore normal statethrough awareness,stretching, hydration,and body balance.

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Proper Stretching Technique

When stretching an area of injured tissue early in the recovery process, itis important to actually treat that tissue as if it is injured. It is surprisinghow many people ignore this point. They tend to continue stretchinginjured hands and arms in the same way they have always stretched,which ends up being too hard, too fast, and too invasive. Asking injuredtissue to stretch in an aggressive manner is like asking a person with aseverely sprained ankle to jump rope. You can just imagine how thiscould further injure the ankle and aggravate any symptoms that may beexperienced.

A similar phenomenon exists when stretching hands and arms affected byany repetitive strain injury. Stretching that is too hard or aggressive willonly act to irritate damaged tissues and make most symptoms feel muchworse. After making such a mistake, many people with RSIs becomedisillusioned with stretching, claiming that it does not work for theirparticular RSI. But, this is not so. The problem lies in the technique ofstretching used, not in the act of stretching itself.

In the beginning of a stretching program it is much better and much saferto stretch slowly, very gently and for brief periods of time, repeated manytimes throughout the day. This is akin to slowly nudging the tissue to letgo, rather than forcing it to make a big change in a short amount of time.With continued practice, the restricted tissue begins to release, symptomsdiminish and once symptoms reach the point where they are only occa-sionally bothersome, a slightly more aggressive form of stretching canthen begin.

It is important to remember that in the beginning, much more time mustbe devoted to stretching. The stretching process is very front-end loaded.In other words, you will have to spend a lot more time stretching in thebeginning, just to get the release process started. As time goes on andyour symptoms become less problematic, then the amount of time youspend stretching each day will reduce. Once you get to the point whereyou can work all day with no symptoms, then stretching will only be anoccasional maintenance process.

The safest way to stretch restricted muscles and fascia in the beginning isto first learn how to feel the sensations of stretching. As you practice

Safe stretching is likeasking injured tissueto take slow, carefulbaby steps. Overtime, the results arecumulative. Signifi-cant relief is the re-sult.

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focusing on body sensations your skill will develop over time and you willbecome more and more aware of these sensations as time goes by. Thiswill significantly enhance your ability to perform stretches that are saferand more effective. As you work through this program you will be readyto customize your stretches by the time you get to the end of this pro-gram. Customized stretches is the key to really complete relief from RSIsymptoms, so don’t miss out on this kind of learning by skipping this partof the program!

Once you have reached the point where the discomfort you feel fromyour injury is diminished, you will be able to use a slightly different formof stretching. Instructions for this new way of stretching will appear inthe instructions for each exercise as you work through the program.Essentially, you will be able to put a little more stress through the tissue asyou stretch, incorporating movement in the form of rocking, pulsing andchanging position of nearby body parts. Be sure to carefully read eachweek’s lesson as you progress through the program to make sure youemploy all the changes in technique that are possible as you recover fromyour injury.

Stretch Sensations

There are a wide variety of sensations that can be created when a stretch isdone correctly. Pay attention to your body as you stretch to see if you canrecognize any of these signals.

If your stretch is mainly effecting muscle then the sensation you feel isusually a pulling sensation. Quivering, bubbling or aching sensations arealso possible. If the stretch is acting on tissue that has a stuck nervepassing through it then you are likely to feel tingling or possibly evennumbness.

It is important to manage the degree of stretch so that all sensationsremain in the mild to moderate range. This means it should NEVERhurt. By experimenting, you will quickly learn how to control the inten-sity of the stretch by pressing harder into the stretch, or pressing less toreduce the level of sensation.

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Numbness indicates that a nerve is caught up in the fascial adhesion andis likely being cut off or is under too much pressure. Please avoid this.Stop the stretch if you feel complete numbness. It is likely that you needto get other nearby tissue to release first before this tissue involving thenerve will release easily. This may be your body’s way of telling you thatyou are stretching the tissue in the wrong order.

Many stretches cause a slight tingling sensation. This, in my opinion, isactually a good thing. It indicates that an adhered nerve is being lightlypulled and the adhesion will begin peeling away from its tethering. Theproper sensation to be looking for when a nerve is being affected is asensation that the tingling is fading away. Work to control the intensity ofthe stretch to make sure tingling sensations are always fading as thestretch progresses.

Ideally, the sensation caused by any stretch should be decreasing. It maynot go away completely, but may fade in its intensity. An example wouldbe a stretch that creates a rather moderate pulling sensation through theforearm muscles into the hand. As you hold the stretch, you shouldnotice that the pulling becomes weaker. Ideally, it will fade away com-pletely, but this may take several stretching sessions for the adhesion tofully let go. (Don’t worry. Stretching over a period of days or weeksshould result in the complete fading and disappearance of these sensa-tions. Especially since this program is designed with stretches that reachthe adhered areas from all directions, release of adhesions is almost certainif done correctly.)

One common change you will notice after correctly performing yourstretches is an increase in range of motion. By that I mean that you willbe able to move a limb farther, bend a joint more completely, experienceless pain when moving a finger, elbow or wrist. Sometimes, you willnotice that moving a joint feels lighter, like your limb weighs less some-how. Congratulations! You have succeeded in learning how to stretchyour injured tissues correctly!

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The Recovery Phase

The Recovery Phase is a rest period taken at the end of each stretch. It isan opportunity for the body to register the changes that you have asked itto make, and then time to actually accomplish those changes. It is anessential part of a safe stretching program.

In experimenting with the Recovery Phase I found that if I did not allowthe body the time to rest after each stretch, then the results of that stretchwere not very complete or long lasting. If instead I added the restingperiod known as the Recovery Phase, the results of the stretch were muchgreater and lasted far longer. Tissue restoration was significantly im-proved.

The Recovery Phase is really simple. It works best if you have an ability totune into your body sensations so you can determine when the RecoveryPhase is over. Basically, you perform the stretch and then follow it upwith placing your hands in your lap. If you have just done an exercise onthe floor, then you rest on your back with your hands on your belly. TheRecovery Phase is over when the residual sensations created by the stretchhave disappeared completely.

If you are unable to adequately feel the after effects of a stretch, then giveyourself thirty seconds of complete rest at the end of each stretch thatrequires a Recovery Phase. This is often enough time to get most of thebenefits of this brief rest.

If you ever get the sense that you have stretched too aggressively, then usethe Recovery Phase to help avoid pain and damage. Simply place yourhands in your lap or on your belly and rest there until all the sensation ofirritation disappears completely. Be sure to tune in very carefully to helpyou feel when the sensations are completely gone. At that point, it is safeto get up and resume your activities. This helps reduce harmful lastingeffects from overly aggressive stretching. Next time, remember to be moregentle and patient when you do your stretches!

Pay really close at-tention while you restduring a RecoveryPhase. If you havejust finished stretch-ing your right arm,then the RecoveryPhase is completewhen the sensationsin your right arm re-duce to the pointwhere they matchthe sensations inyour left arm.

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Week Three Stretching Assignment


1. Shoulder Circles, Page 192. Head Turn, Part 1, Page 203. Head Turn, Part 2, Page 374. Hand On Hip, Page 385. Stick ‘Em Up, Page 396. Criss-Cross, Page 527. Scissors, Page 538. Thumb Grasp, Page 249. Thumb Tendon Stretch, Page 2510. Palm Stretch, Page 54

Spread the various hand and thumb stretches out throughout your day.Try not to practice them all together in one sitting as this could be toomuch strain for the thumbs.

Do not progress on to Week Four’s exercises until you can do each ofthese exercises easily and without strong sensations. Your body may takelonger than a week to progress through this list of exercises. Give it thegift of time to truly accomplish the changes that will lead to real recovery.Don’t hurry through this program.

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- Criss Cross -

Begin with your hands and arms in the goal post position, similar to theStick ‘Em Up exercise you learned previously. Keep your hands and armsflat on the floor.

Keep your elbows bent as you slide both arms around and over the top ofyour head, still keeping them flat on the floor. In one smooth motion,slowly bring your arms up, then down, taking note of which arm endedup on top of the other. Repeat again, this time crossing the other arm ontop. The motion should stay smooth, slow, and constant. Criss-cross atotal of five times, then do a Recovery Phase.

Practice this stretch at least twice per day.

DO NOT practice thisstretch until you can dothe “Stick ‘Em Up”stretch without anysupport under yourarms. This is a moreadvanced stretch thatworks best when thetissues passingthrough your armpitsare more fully re-leased. Do not use anysupports under yourarms for this exercise.

Releases:• Deeply held tension in

the armpits• The septum between the

biceps and triceps• Encourages full range of

motion for the shoulderblades

Kiss the Pain:This exercise will of-ten create pain whenmoving the arms tothe overhead posi-tion. If you feel this,then stop right at thepoint where you feelthe first hint of pain(“Kiss the Pain”) andimmediately back offby slowly returning tothe starting position.With repeated prac-tice you will noticethat the point whereyou feel pain slowlydisappears.

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- The Scissors -

Lie on your side on your bed, nopillow under your head. Rest yourhead on the arm you are lying on.

Place a pillow just behind yourcalves to rest your leg on when itscissors to the rear of your body.

Extend your top arm just in frontof your face, your top leg justbehind your bottom leg. Rest yourleg on the pillow. Your body shouldbe in a straight line from fingertipsto foot. Try to relax all yourmuscles completely.

Stay in this position for 10 seconds.

Now reverse your position, twistingyour torso so that your upper bodyrolls partially onto your back. Yourleg moves just forward of thebottom leg. If it feels more com-fortable, your top leg can bend atthe knee with your foot resting onthe bed.

Try to keep a straight line in yourbody from fingertips to foot.Breathe normally. Rest in thisposition for 10 seconds and thenreverse again. Relax completely.

Repeat for a total of three forwardand backward sets.

Practice this exercise twice per day:once in the morning and once inthe evening.

Releases:• Long planes of fascia

from the fingertips tothe toes

• Adhesions throughthe armpits

• The latissimus dorsimuscles

• The serratus anteriormuscles

This is a powerful exer-cise, affecting a broadarea of the body. Takeit slow and easy. Don’tpush it if your body isunable to completely dothis exercise the firstfew times you try it. Justdo the best you can andmake sure to nevercause pain. Roll ontoyour back after you arecompletely finished andrest with your hands onyour belly until all re-maining sensations arecompletly gone.

PLEASE NOTE:If you have a historyof back problems,check with your doc-tor before beginningthis stretch!

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- Palm Stretch -

Releases:• Restriction in the small

muscles of the palm• Fascia of thepalm

With your palm facing down and fingers spread wide, place your otherhand on top of the first and interlace your fingers.

Gently close the fingers of your bottom hand into a squeeze. Hold for 5seconds. Release the squeeze slowly.

Rest your hands in your lap for 10 seconds. Repeat one more time.

Tension in the palm isthe source of much oftoday’s hand symp-toms. Regular prac-tice of this stretch willhelp eliminate thestresses of gripping,typing and squeezingactivities.

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Week ThreeHomework

1. Are you drinking enough water? If you are drinking less than 8 glassesper day, then spend time this week figuring out how to increase yourintake to the recommended level. (Remember to check with your doctorif you have been advised to control your water intake for health reasons.)

2. As you practice this week’s stretches, pay special attention to thesensations you feel. One good way to become more aware of the subtlevariety of sensation is to find a quiet place to practice your stretches.Then, as you stretch, say out loud what you feel and where you feel it.Try to describe what you feel.

• What is its intensity?• Does it have a color?• Is there a sound associated with it?• Is it hard? Soft? Throbbing? Sharp?

Try to find words that accurately describe what you are feeling. Whenyou feel a sensation shift to another location, which they often do, say outloud where it has shifted to.

• Did it change in depth?• Is it now more intense or less intense?• Can you feel the sensation is connected to another part of your

body?Identifying out loud what you are feeling is a terrific way to help tune into the vast array of sensations that are possible when stretching damagedtissue. Over time, you will learn when a sensation is really a call to attendto a problem in a new part of your body, what restricted tissue is con-nected to other restricted tissue, etc.

3. Have a friend take a video or photo of you sitting and standing, fromthe side view. Compare the result with the diagrams showing optimumsitting and standing posture. If you are far off the mark, get the help youneed to correct your postural imbalances. See the “Products” section ofwww.selfcare4rsi.com for products that can assist you., or look in the“Links” section to find referral info to a therapist who can help you.

4. Add this week’s new stretches to your program and continue to dothose from previous weeks that are still creating a stretch sensation foryou. Drop the ones that don’t feel like they are doing anything for you atthis point. But, reintroduce them again from time to time.

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- Week Four -

This week, we are delving deeper into the sublties of repetitive straininjuries.

We are going to take a look at what happens to a body under strain whereinflammation has developed. Inflammation feels angry to me, like aserious form of irritation. Once you learn to recognize the signals thatidentify inflammation and then learn the way to soothe that inflamedtissue, you will have much greater success in recovering from your RSIsymptoms.

This week we will also begin to explore the armpits. Armpits??? You sayyou don’t have any problems with your armpits? Well, my experienceshows that nearly 100% of people with a repetitive strain injury also havesignificant adhesions and loss of range of motion in the armpits. If youcan find effective ways to release the tissue that passes through yourarmpits (one of the major traffic jams of the body!) then you will have asignificant reduction in your symptoms very quickly thereafter.

This week we are also setting the stage for the more advanced portions ofRSI recovery that will come in the next two weeks. It is really importantthat you practice these sections carefully and thoroughly. You will belearning how to get creative with how you move your body and that iskey to customizing stretches that are perfect for your unique form of RSI.

We will also be looking at how to integrate stretching into your dailyactivities. This is a great way to eliminate the need for a block of time todo your stretches. Instead, it works so much better with everyone’s busylifestyle to sneak really effective stretches in throughout your day. It is alsohelpful for reducing the constant stress that may develop as a result ofyour work.

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Inflammation

Inflammation is a form of irritation to the muscles or connective tissues.It often occurs as a result of chronic contraction, strained use, or trauma.

Sometimes, when tissue is inflamed, it will actually feel warm. Sometimesthe skin becomes reddish in the area that is compromised. These aresignals that help you determine where the inflammation is occurring.

It is possible for muscles to become inflamed and it is also possible thatthe tendons that attach those muscles to bone can become inflamed aswell. Inflamed muscles usually get irritated from overuse, such as inlifting, carrying, strained movement, etc. Tendons often become inflamedas a result of too much stress being sent through the tendon from theconstant pull of chronically tight muscles. In either case, reducing thestrain that pass through the muscle bellies will help reduce the source ofinflammation in either the muscles or in the tendons.

Inflammation can occur, but not always, in any case of repetitive straininjury. In the case of Tendonitis, for instance, muscles in the forearmbecome chronically tight and stuck and the tendons that are part of thosemuscles tend to become irritated. In the case of forearm pain, anotherRSI, the same muscles become tight and restricted but they do not affectthe tendons. Instead, the inflammation is felt only in the muscles. Ineither case, stretching the forearm muscles will bring significant relief.

It’s helpful to consult with an anatomy book to determine the source ofyour inflammation. If you can identify where the inflammation is felt bylocating it on a muscle chart, then you can develop a course of action forreducing the inflammation. If you locate a tendon in the area where youfeel your inflammation, then find the muscle that the tendon is attachedto and stretch that muscle. But, be careful! Inflamed tissue is angry tissueand it can become more painful if the stretching you do is too aggressive.If you make an error in estimating how much stretching is needed andmore pain is the result, do not despair. There are additional things youcan do to help overcome inflammation.

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You will get the best results from stretching to reduce inflammation if youonly stretch when you feel inflammation upon moving your hands andarms. If you feel inflammation at times when your hands and arms areidle, then follow one of the following recommendations.

If you pay close attention, you can feel inflammation. It feels hot, mildlyfiery, sizzling, irritated. If you do much with your hands and arms whileyou have this level of inflammation, including stretching, then you willfurther inflame your muscles and tendons. If you feel this sort of passiveinflammation, then try the following before you try stretching.

Rest is one of my favorite remedies for inflammation. I mean TOTALrest. Put your hands in your lap and do nothing - that kind of rest. Don’tpick up the phone. Don’t use a fork to eat (eat later). Don’t type on acomputer. Nothing. In the beginning, it takes longer for inflammation toreduce using rest alone. As your tissues recover, you will find that inflam-mation can be resolved faster too. So, sit and rest until you no longer feelthe sizzling, fiery sensations any longer. If you have really over stressedyour tissues, this may take a couple of days. In the meantime, restrictyour use of your hands and arms as much as you possibly can.

It is often especially helpful at the end of a workday to put your hands inyour lap and rest them for a period of time before doing anything else. Ifyou pay close attention, you can usually feel some level of inflammationin your muscles if you have used your hands and arms extensively in yourwork day. Give them a real rest when work is over. Practice your stretchesafter you have rested your hands and arms for a significant amount oftime.

Lots of people like to use ice to reduce inflammation. A trick I learnedfrom a nurse was to put the ice in a plastic bag, put a thin towel over theaffected area and then apply the ice pack. Hold it in place for twentyminutes (use another towel wrapped around your arm to hold the ice bagin place, leaving your hands to rest in your lap) for twenty minutes, takeit off for forty minutes, put the ice back in place for twenty more minutesfollowed by another forty minutes without the ice, and put the ice backin place for a final twenty minutes. Basically, this is three cycles of ice,with forty minute’s rest in between. I’m not sure why, but this pattern oficing really seems to get great results.

Remember when using ice to reduce inflammation that sensation will bedulled while your tissues are still chilled. Do not resume any activity withyour hands and arms until the tissue has returned to normal temperature

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and you have assessed how the tissue feels. If you still feel inflammation,then follow the recommendations for resting (above).

Of course, there is always medication to reduce inflammation. Pleaseconsult with your doctor to determine which medication is best suited toyour needs. Keep in mind that a lot of anti-inflammatory medicationswill make it harder for you to feel the sensation of inflammation, therebymaking it much easier to overdo your activities that can lead to furtherdamage and pain. It’s your choice (and your doctor’s) as to whether or notyou choose to use medication to relieve inflammation.

If you prefer the less invasive approach, there are also things you can dothroughout your day to prevent the buildup of inflammation. One is todrink plenty of water. In addition to lubricating your tissues, you willhave to go to the bathroom more. This will give you a minute or two tofocus your attention on your hands and arms to see if they feel inflamed.If they do, then simply hang them straight down by your sides, shouldersrelaxed, for one minute. This very simple stretch can help rest your handsand arms and encourage blood flow. Don’t worry if this simple stretchfeels strong to you as you hang your arms at your sides. If the sensationbecomes uncomfortable, and it probably will in the beginning, thenreduce the amount of time you hold the stretch to 10 seconds and gradu-ally increase the time as you are able to tolerate it.

If you address the issue of inflammation on a daily basis, then it will tendto remain at a controllable level and should eventually disappear as yourtissues return to their more normal state.

Armpits

Armpits are the traffic jam of the body. In order to allow for movement ofthe arms in all directions, there are muscles and fascia that are foundrunning in every possible direction, and through several different planesthrough the armpits. Because of this, the armpits are an under-recognizedarea of significant restriction for almost everyone who suffers from arepetitive strain injury.

The armpits are a really interesting part of the human anatomy. Musclesthat make up the armpits are connected to the shoulders, the sides of the

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body, the ribcage, the shoulder blades, the arms, and the collarbone.

Many of the muscles that pass through the armpits also cross other majorjoints in the body that are frequently the site of repetitive strain injurylike the elbows. And, all of the muscles that pass through the armpits areconnected to each other and the rest of the body through the fascia.

Suspended in the same fascia passing through the armpits are the majornerves and blood vessels that feed sensation and blood flow to the armsand hands. Can you begin to imagine the effect it would have if any ofthese tissues became tight and restricted? All of the above areas would beseriously effected, often leading to the symptoms that have been plaguingyou and other RSI sufferers.

The effect of restricted armpits is much like that of a puppet whosehands, arms and upper body are operated with strings. If the puppeteershortened the strings at the shoulder of the puppet and then tied a knotthere, you can imagine how this would draw up the arms, shorteningthem and further restricting the movement possible in the arms.

The same effect occurs in the human body. When tissue is restricted andprevented from moving fully at the armpits or shoulders, then the abilityof that arm to move properly is restricted, leading to strain and then toinjury. In order to recover, all the restricted tissue passing through thearmpits must be released or the symptoms will return in a very shortamount of time.

Stretching the armpits requires real creativity. Because tissues of all sortsrun in all directions, the stretches must also stretch in all those directionsin order to free up tight and restricted fascia as well as the nerves andblood vessels that may be trapped within them. Often, stretches thatincorporate slow, full range of motion can address this interesting qualityfound only in the armpits.

If you are practicing the Shoulder Rolls or Stick ‘Em Up stretches in thisprogram, then you are already doing some great stretches that work torelease the tissue passing through the armpits. As time goes on, I am sureyou will be able to come up with more and different stretches for thearmpits on your own. In the meantime, continue practicing these and allthe other recommended stretches to get a full and complete release ofyour armpits.

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Getting Up!

As you progress through this stretching and recovery program it is impor-tant to continually add to your skills of being creative with the ways youmove your body. Here’s a unique exercise that will assist you in expandingyour options.

This exercise is done whenever you practice a stretch that is done on thefloor. Every time you get up from the floor, get up differently. If younormally do the equivalent of a sit up before getting up, then instead, rollonto your belly and do a push up before rising. There are endless ways ofgetting up from a lying position. So, each time must be different andunique. Try really hard to be creative so that no two times are the same.

Equally important is how you get down onto the floor. This should be acreative process as well. Each time you get ready to lower yourself to thefloor, make sure it is unique and creative.

So, why do I have you doing this wacky exercise? It is actually a veryimportant exercise. Over our lifetimes, virtually all of us develop patternsthat we use to get up and down off of the floor. We never vary the patternand over a lifetime, this pattern is recorded in the fascia of our bodies,locking us into that pattern. If, all of a sudden, we were required to movedifferently, an injury could be the result because we have so completelytrained our tissues to move in our habitual way.

This exercise is a way to change your regular and constant patterns ofbody use. When you become more familiar with the practice of thisexercise, it can actually be creative and fun. Challenge your kids to followalong too. Maybe they can give you some new ideas on how to get up anddown in new ways.

There is another, bigger reason I ask you to learn and practice this exer-cise. It has to do with your ability over the years ahead to develop a set ofexercises and stretches that are customized to your unique needs. Moreabout this will be covered in the sixth week of this program, so practicingthis exercise will prepare you to be able to follow the recommendationslater in this program.

When you are able to figure out and give yourself permission to move

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your body in new ways, you open up a whole new world of possibilitiesfor being creative with stretching in the future.

Let’s face it. I can only go so far in developing stretches for you that willaddress your unique condition. After you have practiced my stretches forawhile, then it will be up to you to create your own set of variations onthose stretches that are even more tuned to the needs of your body. Thenyou will experience true recovery.

This exercise of getting up and down from the floor differently every timeis a way to get you to be creative with the ways you move your body, tobreak your old habits of movement and to open up your awareness ofyour body in space. After you have mastered this technique, you will beable to be more creative in developing stretches that are ideal for yourunique injury pattern. I’ll be showing you exactly how to do that in WeekSix.

Incorporating Stretches Into Your Day

Incorporating stretches into your daily life is a challenge in creativity.Taking on this challenge to learn ways to stretch throughout your day, nomatter where you find yourself, can be a great way to extend the overallbenefits of your stretching program. It’s also a way to relieve the stressthat builds in your hands, arms, shoulders and neck over the course of aday.

The most important thing to do when trying to figure out how to stretchduring your day is to pay attention to the ways your normal stretchroutine has you position your body. For example, if a stretch has youbending your wrist toward the back of your hand, then you can accom-plish the same type of movement by pressing your fingers, wrist benttoward the back of your hand, against the steering wheel of your car asyou sit at a stop light. If your normal stretch is to lie on the floor andspread your straight arms out to the sides, then you can accomplish asimilar move by spreading your arms open as you walk through a door-way.

These adaptations are usually not quite as effective as the original

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stretches you will find in your program, but they are a very importantaddition to your overall recovery because they will help extend the effectsof your stretches into the physically stressful times of your day. This willsignificantly reduce the overall stress you load into your muscles andfascia and will help you recover faster.

Here are some additional examples of times when you might be able tofind a way to stretch part of your body:

• Sitting in a drive-through line• In the restroom• While waiting for your kids at sports practice• While on hold on the phone• In the checkout line at the supermarket

There are literally hundreds of times during the day when stretching ispossible. Of course, it is not possible to drop to the floor to do thestretches you have been given in this program, but you can still get somegreat stretching in if you allow your creativity some room to experiment.

For example, a great and almost invisible stretch is to put your hand onyour hip while talking to someone or waiting in a line. Make sure yourwrist is bent. Then, play around with the position of your elbow to findthe best position for you. Do you feel the stretch better if your elbow ismore forward? Or does it work better if your bent elbow points more tothe rear?

When I was recovering from Carpal Tunnel Syndrome, I happened to beattending a rather boring workshop. I spent quite a bit of time stretchingeach finger either forward or back, experimenting with what created thebest stretch. Perhaps this is something you might try the next time youfind your hands free?

In any case, remember to pay close attention to the sensations you arecreating as you experiment. Keep the sensations in the mild to moderaterange and be sure to rest your hands in your lap, or in a pocket, for atleast 20 seconds once you are finished to get the best and safest effectfrom your stretches.

See how many stretches you can add throughout your day!

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Week Four Stretching Assignment


1. Shoulder Circles, Page 192. Head Turn, Part 1, Page 203. Head Turn, Part 2, Page 374. Hand On Hip, Page 385. Stick ‘Em Up, Page 396. Criss-Cross, Page 527. Scissors, Page 538. Thumb Grasp, Page 249. Palm Stretch, Page 5410. Wrist Circles, Thumb In, Page 65

Spread the various hand and thumb stretches out throughout your day.Try not to practice them all together in one sitting as this could be toomuch strain for the thumbs.

Do not progress on to Week Five’s exercises until you can do each of theseexercises easily and without strong sensations. Your body may take longerthan a week to progress through this list of exercises. Give it the gift oftime to truly accomplish the changes that will lead to real recovery. Don’thurry through this program.

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- Wrist Circles, Thumb In -

Make a soft fist with your thumb tucked into your fist.

Your elbow can be bent or straight. Each one will give you a differentoutcome. Start practicing the exercise with your elbow bent since this is asofter version of the exercise. After you have practiced it for several days,alternate between a bent elbow and a straight elbow.

Slowly, rotate your wrist around in a full circle, bending your wrist andtwisting your forearm to get the biggest and roundest circle possible. Takeat least 15 seconds to go around once.

Pause for 5 seconds whenever you find a position that elicits strongerthumb-related sensations.

Rotate once in one direction, then repeat going in the opposite direction.

Repeat this exercise twice a day, especially at the beginning and end ofyour day.

Releases:• All muscles related to

the thumbs• Tight and restricted

tissues in the fore-arms

Practicing an exer-cise slowly gives thebody time to registerthe various lines ofpull you are introduc-ing with the stretch.The slower you gothe more time thebody has to allow thepull to extend all theway to the ends ofthe muscles. Stretch-ing slower is better,safer and gives amore complete re-sult.

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Week FourHomework

1. Spend time this week sitting quietly, focusing on the sensations youfeel. See if you can detect any sensation of inflammation, especially afteryou have used your hands and forearms for work. Sit, resting your handsin your lap until you can feel the inflammatory sensations fade or disap-pear.

2. Make a serious practice of getting down on the floor and then gettingup again in a different way each time this week. This will help youexpand your options for creating customized stretches that you will learnabout in the coming weeks.

3. Continue practicing all the stretches and exercises you have learned inthis program so far unless they no longer create any stretch sensation foryou. In that case, stop doing that stretch for a week or two and then try itagain to see if you get any benefit from it.

What if you overdo your stretches? Believe me, this has happenedto me many times as I experimented with new exercises.

The first impulse is to panic because you feel your original symp-toms return, or you are in pain.

Don’t panic! Remember, this is the only way your body can let youknow how it feels. So, honor the message by stopping the aggra-vating activity, i.e. the exercises, until your body feels less strained.It often takes a full 24 hours to rest well.

Remember that you are working with damaged tissue. Respect itslimits and go slower and more gently next time.

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- Week Five -

Our entire focus this week is in refining your ability to manipulate astretch so it gives you the precise result you are looking for. Once youmaster these exercises, you will have much more success at taking anordinary stretch and converting it into a powerhouse that will signifi-cantly reduce your symptoms.

Manipulating the intensity and direction of a stretch is a great way torespect the limits of injured tissue while still getting it to release. Thistechnique will help you get the most out of any stretch that you try.

Typical stretches, including the ones you have been given in this program,generally lengthen a single straight line through injured tissue. But,because of the weblike nature of the fascia, it’s entirely possible that amore injured line of fascia will be located just adjacent to the line that isbeing lengthened in that stretch.

By learning how to search through neighboring areas by manipulatingthe line of pull of a stretch you can locate the treasure chest of adhesionsthat exist in every body experiencing a repetitive strain injury. Then, it’s amatter of following all the rules for safely releasing adhesions and successwill be yours.

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Searching The Neighborhood

Searching the neighborhood is a term I have given to a technique thathelps create truly customized stretches - the ones that will help you mostin achieving a full recovery. It works with the natural configuration of thefascial matrix of the body. You use the framework of exercises I have givento you in this program, then build upon it variations of those exerciseswhich more accurately fit your specific symptoms.

Whenever you perform a stretch, you are creating a pull through aparticular line in the fascial matrix. Remember that fascia is one continu-ous system connecting everything with everything else and looks like agiant cobweb inside the body. Sometimes the exercise helps you find andstretch the exact tissue that is leading to your symptoms, and sometimesyou are a bit off the mark and not quite hitting the perfect line of pullthrough your most affected tissue. This is where searching the neighbor-hood will be of tremendous help.

When I speak of the neighborhood, I mean the tissue that is very close tothe tissue that is being pulled and stretched in your exercise. In order tosearch the neighborhood you begin your stretch as instructed and thenyou change something, anything, that will create a difference in thestretch. When you find a new line of pull that is affecting damaged tissue,you will be able to feel it.

There are lots of options for creating this change. You can spread yourfingers wide open, twist an arm, turn your head, or tilt your body. Youcan even twist a part of your body that is not actively involved in thestretch, like a leg. For example, imagine that you are practicing a stretchwhere you are lying on the floor and are stretching your arms over yourhead. To search the neighborhood, you could bend your knees and dropboth of them over to one side. This creates a new and different pullthrough the tissue involved in the stretch, higher up in the body.

You are looking for particular sensations when you search the neighbor-hood. You should be on the lookout for an increase in the stretchingsensation or in tingling, throbbing, muscular pulling, or any of thesensations that are associated with your injury or your symptoms. Do notbe afraid of feeling your symptoms with this exercise. It is the only wayfor your body to tell you, “That’s it! That’s the exact spot that is stuck!”.

Do you recall the fakecobweb that manypeople use to deco-rate for Halloween?Have you ever tried toexpand that stuff tocover a bush or porchrailing? If you pull ityou effect the entirepiece of cobweb.

Fascia is just like that.Pulling the fascia inone direction will ef-fect the whole matrixof fascia.

Recognizing thischaracteristic helpsyou understand thatstretching fascia ismore of an exercisein coaxing changesrather than a directcause and effect pro-cess.

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As you zero in on stronger sensations you are more accurately hitting theexact line of strain that exists in your body that is very likely contributingto your symptoms. Then, follow the rules you have learned so far aboutsafe stretching: Keep the intensity of the sensation in the mild to moder-ate range, and give your arms and hands a rest period following thestretch before getting up to do anything else.

The best way to search the neighborhood is to begin your stretch as usual,then begin slowly moving an inch or two around and near the originalline of the stretch. Pause when you find a stronger sensation and allowthe body time to register the stronger pull and release it. Remember thatthe release is indicated by a fading and disappearance of the stretchsensation.

It is important to follow the directions for controlling the volume of yourstretch which I will cover next. If you find a stronger line of pull youmust make sure that you never experience pain, complete numbness orany other type of troubling sensation. Instead, just back off on the pulluntil you come within the acceptable range of mild to moderate stretch-ing sensation.

Searching the neighborhood is like looking for the pot of gold and whenyou find it, you can feel it. With proper care to not overstretch throughthe new line of pull you can safely and more accurately find, and thenrelease, the exact cause of your symptoms.

Controlling The Volume Of A Stretch

Every stretch that accesses tight or restricted tissue will send you signalsabout how intense that stretch is. Those signals feel like sensations causedby the stretch. They can include tingling, pulling, aching, feelings of atight line of pull, throbbing, pressure, buzzing, fluttering and othersensations brought about as a direct result of pulling the injured tissue.

Many times, the sensation you feel when doing a stretch can be similar, oreven identical, to the sensations you associate with your injury. Don’tworry. These sensations are your body’s only way to tell you where itneeds to be released. Trust your sense to adjust the intensity of the stretch

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and you will safely release the very tissue that has been causing yourinjury.

In recovering from RSI, it is important to carefully regulate the intensityof the sensation created by each of the stretches you practice so that younever damage the tissue further or cause delay in your recovery. I call this“controlling the volume” of the stretch. Volume relates to the level ofintensity of sensation you feel as you perform the stretch.

The volume can remain constant as you practice the stretch, or it canchange. Ideally, the sensation should be mild enough so it can fade awaycompletely while you are stretching.

Sometimes the sensation suddenly changes from a mild stretch to a muchstronger sensation without any perceptable reason. I believe it changesbecause the stretch initially starts by affecting one layer of tissue. Then asthat first layer releases, the stretch goes on to affect another, possiblydeeper layer of tissue. It is when the stretch moves on to the second (orthird or fourth) layer of tissue that the level of sensation changes.

In order for the stretch to give you the maximum result, it is importantthat you develop the ability to feel this change in intensity and that youcontrol it so the level of sensation never strays into being painful, com-pletely numb, or troublesome for any other reason.

You can control the volume of a stretch by backing off on the stretch, oreasing up a bit so that the tissue is more comfortable, while still maintain-ing pull through the affected area. Remember, the sensation means thatyou are affecting tissue that is damaged in some way. To back off to thepoint where there is no more sensation means that you have essentiallystopped the stretch, which is a waste of your time and effort. You need tomaintain some level of sensation for the stretch to be getting anythingdone. It is just important that the sensation remains in the mild tomoderate range of intensity as you continue.

As your body releases deeper and deeper layers of restriction, the sensa-tions become a bit more challenging to feel and control. This is wherecontinued practice plays an important role. By practicing and developingthe skill to be able to feel sensations that occur at deeper and deeperlevels, you are best able to ensure that your stretches will result in thegreatest degree of tissue restoration possible. You will remain free fromfurther tissue damage caused by overly aggressive stretching.

Controlling the vol-ume changes withdifferent types of ex-ercises. If you aremoving during thestretch, as in theShoulder Circles orStick “Em Up exer-cises, you control thevolume by increasingor decreasing therange of motion, i.e.,bigger or smallermovements.

In static stretcheswhere you placeyour body in a posi-tion and wait for arelease, as in theFinger Stretch, youcontrol the volumeby pressing furtherinto the stretch or bybacking off.

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Now that you are in Week 5 of this program, it is very important to theoverall success of your recovery to develop and practice this sense ofcontrol. Make sure you remained tuned into the sensations created byevery stretch. Avoid distractions that will interfere with your attention todetail. Some experimentation is necessary and you will probably makesome mistakes along the way. If you do, just stop, rest your hands andarms thoroughly and begin again the next day. Learning to control thevolume of your stretches will help you achieve the best level of recoverypossible in the shortest amount of time. Keep on practicing!!!

Adding Motion To Your Stretches

Adding motion to stretches is a powerful technique that can significantlyspeed up the effects of a stretch. Done properly, it can actually be a saferway to stretch tissue that is really tight and restricted. Here is how itworks.

Let’s imagine an example of stretching a powerful muscle like the bicepsmuscle. This is a rather large, thick muscle that is capable of sendingpretty strong stretching sensations as you perform your exercise. In mostcases that strong sensation would be a signal of danger, which is not agood thing. But, if you begin moving your arm in the right way, the pullof the stretch will rotate through different muscle fibers in the muscle.No single group of muscle fibers will bear the brunt of the more aggres-sive stretch. This is much safer for a really tight muscle and helps preventinjury from over stretching.

There are several forms of movement that you can add to stretches toachieve this effect. Very light rocking is a good one. You can rock the areayou are stretching (in the case of stretching the biceps muscle, you wouldrock the whole arm). Rocking should be very tiny movements, perhapsonly going an inch or so in each direction. This is just enough to take thestrain of the stretch off of the whole muscle and instead distribute it oversmaller parts of the muscle.

Pulsing is another way to move tissue as it is being stretched. Pulsing islike very tiny bounces. Pulsing can also be as simple as opening yourfingers more fully, then relaxing them. This sends intermittent signals of

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stress to the muscles and fascia and is read more favorably by the bodythan a constant hard pull on an injured muscle. It is safer, too.

The third way of adding motion to your stretches is to reach or extend alimb. If you were performing a stretch that asked you to reach high aboveyour head, you can get extra mileage out of that stretch by reachingfarther than the current length of your arm.

You can also add motion to a stretch by moving a completely differentpart of your body. For example, when practicing any stretch, try turningyour head slowly from side to side during the stretch. Because the matrixof fascia is interconnected, by turning your head you create a new anddifferent pull through the tissue, even if you are currently stretching yourarm!

Other motions that can be effective include twisting your lower torso aswell. This is great when you are doing stretches on the floor. Let’s say thestretch calls for you to lie on your back with your arms out to the side. Atwisting option might be to drop both legs (knees up, feet flat on thefloor) to the right. Once the stretching sensations subside from thisvariation, you can add pulsing where you leave your legs dropped to theright, but now you rock your hips more to the right. Try it. It’s a funvariation and can create wonderful releases.

Once you become more adept with this technique, try combining morethan one variation to your stretch. This is like combining motion withsearching the neighborhood. Using the example above, an additionalvariation you could try would be to turn your head either left or rightwhile twisting your torso and pulsing your hip. You might find thatturning your head to the left gives you a stronger stretch than turning itto the right. In that case, turn your head to the left and continue pulsinguntil you feel the sensation fade or release.

All of these types of motion added to stretches can accelerate your results.Added motion is never appropriate when doing a beginning stretch on anarea. This is a more advanced technique. Remember to allow the tissuetime to fully release each layer of sensation before adding another varia-tion.

Because this is a way to stretch more aggressively, it is essential that youalways incorporate a resting period, or Recovery Phase, after each stretchwhere motion is added. This allows the injured tissue time to calm downand catch up with the changes you have asked it to make.

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Week Five Stretching Assignment


1. Shoulder Circles, Page 192. Head Turn, Part 1, Page 203. Head Turn, Part 2, Page 374. Hand On Hip, Page 385. Stick ‘Em Up, Page 396. Criss-Cross, Page 527. Scissors, Page 538. Thumb Grasp, Page 249. Palm Stretch, Page 5410. Wrist Circles, Thumb In, Page 6511. Forearm Twist, Page 74

Do not progress on to Week Six’s lessons until you can do each of theseexercises easily and without strong sensations. Your body may take longerthan a week to progress through this list of exercises. Give it the gift oftime to truly accomplish the changes that will lead to real recovery. Don’thurry through this program.

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- Forearm Twist -

Sit on the edge of a bed, bench or sofa. Your arm can be straight or bent.Your fingers should be pointed away from the side of your body.

Keeping your hand glued in the same spot, rotate your elbow, trying topoint it to the rear of your body. This creates a powerful twist in theforearm which helps release deep adhesions that glue the muscles to oneanother. Hold for 10 seconds. Then repeat on the other arm.

Practice this stretch only twice per day. Rest completely afterward.

Releases:• Deep adhesions in the

flexor and extensormuscles of the forearm

This exercise will cre-ate powerful stretch-ing sensations for thefirst several weeksyou practice it. Onceyou no longer feelsuch strong stretchsensations with theexercise, you cancreate a very helpfulvariation. Simply ro-tate your forearm asinstructed, then rockyour body one inch tothe left and one inchto the right as youhold the twist. Keepthis slow, small mo-tion constant, con-tinuing for no morethan 10 seconds. Beespecially sure tocompletely rest yourarms in your lap untilall remaining sensa-tions fade com-pletely.

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HomeworkWeek Five

1. Go back and practice all the stretches you have learned so far in thisprogram. For each stretch, try to figure out a way to increase and thendecrease the volume of the stretch. Pay attention when the softer stretchactually encourages the tissue to release faster.

2. With each static stretch from this program, figure out a way to searchthe neighborhood around the tissue that is being stretched. Once youhave found a new line of pull, use gentle, small, slow motion to encour-age the tissue to let go. Make a mental note about how this feels.

3. Make sure that you get down on the floor and get back up again in anew and different way each time you stretch on the floor.

4. Add the new stretch included this week to your overall program. Atthis point, I recommend that you continue practicing the stretches thatstill give you a stretch sensation and eliminate the ones that don’t. Thiswill help keep the amount of time you devote to your stretching pro-gram to a minimum. Periodically, reintroduce the eliminated stretchesback into your program in case you have developed new stress in thetissues they help release.

5. Continue drinking your water!!!

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- Week Six -

This week you get your wings. You are now ready to start creating yourown unique stretches and I’ll show you how. You have practiced feelingyour stretches, analysing the quality of the sensations, manipulating thesensations to get the best effect, and you have created your own varia-tions. You are now ready to fly!

In this week’s lesson I will teach you how to “Noodle Around”, to useyour ability to feel the messages being sent by your body to help youdevelop completely new stretches that meet your body’s unique needs.Every stretch I have ever developed has come about using this technique.It can bring you to new levels of permanent relief that you might neverhave imagined possible.

So, this week you will be coming up with your own stretches. I will notbe adding any this week. The exercises you have been given so far aregreat for reducing or eliminating the symptoms of DeQuervain’s so youcan always rely on them. But, your best chance of a 100% recovery comesfrom making up your own stretches.

Now that you are feeling better and your symptoms are under control orgone altogether, you are ready to begin to reintroduce sports and otherpleasurable pastimes back into your daily life. We’ll cover that subject soyou can begin to enjoy your favorite activities once again.

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“Noodling Around”

“Noodling Around” is an odd name that I’ve given to a very importantprocess. Noodling Around is the mother lode, the final and ultimate waythat you will ensure that your recovery is as complete as possible.

When you have finally reached the point where you can noodle around,you have gotten enough instruction and practice in finding new anddifferent ways to move your body, searching the neighborhood for the lastremnants of injury hidden in the depths of your body, and controllingthe volume of your stretches as they progress to more advanced levels ofrelease.

Now, you are ready to put it all together. And that’s what “NoodlingAround” is. It’s the whole ball of wax. It is the technique that can take aperson who has attained a level of 75% improvement to a person who hasachieved 100% improvement. But, again, it requires that you understandand have practiced the earlier lessons. You have been practicing, haven’tyou?

In any RSI, there are hidden pockets of injured tissue that are hard tofind and a challenge to feel. Most stretches will fail to find them for you.So, you have to go on a hunt for the treasure chest of remaining pocketsof injury by moving your body in creative, different ways, searching theneighborhood around the tight areas you find for signals that you havefound a new piece of tissue that remains stuck or tight, and by controllingthe volume of the new stretch so that releasing this newfound tissue willbe safe and effective.

When I practice Noodling Around, I lie on the floor and take a momentto tune into my body. Then, I begin a stretch that I know will yieldsensations of any kind. Once I find those sensations, I start to movearound, slowly twisting parts of my body, reaching with arms, turning myhead, pulling, rotating, opening, exaggerating and any of the other fineways there are to create new pulls through the tight and restricted tissue.All the while, I make sure I am paying close attention to the sensations Iam feeling so I don’t miss anything. Tight spots that you access at thispoint in recovery are usually rather small and indistinct, so paying atten-tion to what is happening in your body is essential.

Only practice “Noo-dling Around” on thefloor. When you are onthe floor, the weight ofyour body is fully sup-ported so yourmuscles can relax.When all parts of thebody are relaxed, it’smuch easier to feelnew pockets of tensionor sensation that arerevealed while “Noo-dling Around”.

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Once a new area of sensation is found, I use all the skills presented in thisprogram to control and manage the release of that tissue. I assess the levelof intensity I am feeling and I increase it or decrease it to remain in themild to moderate level of sensation. I make sure that I never begin feelingpain or numbness to assure me that I am doing no harm with this newvariation. If my body position allows it, I incorporate movement into mystretch, attempting to roll around the area of tightness. This insures thatno single area of tissue bears the full brunt of this deep stretch, anothertechnique for insuring safety.

Once I have identified and released any new piece of restricted tissue, Iturn to lie on my back, put my hands on my belly and rest there to allowa full recovery phase to take place. I remain tuned into the sensations Ifeel so I get the best results from this recovery phase.

Done properly, you will be unable to go back and find the site of restric-tion that you felt as you noodled around. It will have been fully releasedand should now begin to function as normal tissue again. You havesucceeded!

It is possible to find many sites of hidden restriction in this manner. Do afew minutes of it each and every day until you can no longer find anyrestrictions anywhere. As you do this, you will notice that you rarely, ifever, have any remaining RSI symptoms. At this point, you should feelvery close to, or at, a 100% level of recovery. Congratulations!

Controlling Future Symptoms

RSI’s occur as a result of a natural, built-in mechanism that is designed toprotect the body from unusual stresses and strain. If you live a normallife, you will continue to experience these physical stresses and possiblyeven some injuries and other trauma in your body as time goes on. Asyou return to the sports and other activities that you enjoy, or return tofull function at work, physical stress will result from those activities.

It is possible that an RSI will be the result of this stress or trauma. If youfeel a return of symptoms, then come back to these pages and review thelessons you have learned here. Start practicing the stretches that feel right

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to you now. Perhaps they will be from this program, and perhaps you willmake up your own variations that more accurately meet your needs.Either way, make time to stretch daily, following all the special techniquesyou have learned here, to maintain control of the new discomfort andeventually to restore your fascia and muscles back to an optimum level offunction.

Recognizing that stress can cause a return of symptoms, it is a great ideato get into the habit of stretching for at least a few minutes on a dailybasis. Remember that each of the activities you do each day with yourhands and arms will cost you something out of your body bank account(See Week #2), so it is important to always remain in control of thatphenomenon. Make stretching part of your every day existence and youwill seldom have to deal with the return of symptoms.

Reintroducing Sports and Other Activities

Once your injury is resolved to the point where you can get through a fullday of work with no symptoms, it is safe to slowly begin to reintroducethe sports and other activities that you chose to give up at the beginningof this program.

Please, only add one new activity at a time. Continue slowly increasingthe amount of time you spend in that activity and slowly increase thenumber of days each week spent in this activity as well. Once you havesuccessfully returned to the level of participation you choose, you cansafely move on to the next activity, and so on.

The most important concept to emphasize here is slowness. Rememberthat each activity costs you something out of your body bank account. Ifyou have done all your lessons thoroughly, then by adding activitiesslowly, you ensure that you never over stress your body. You can easilystretch away any soreness or restriction caused by returning to yourprevious activities and you can stay symptom free.

Constantly remain in touch with your body’s messages of pain or discom-fort. Remember that your body will be communicating to you how itfeels as you increase your activity levels. If you pay attention to those

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messages, your progress should be smooth and trouble-free. If you chooseto ignore the message your body sends, you stand a much higher chanceof causing new damage and symptoms will return as a result. The choiceis yours!

If you are returning to weight training, please keep in mind that yournewly released tissue will respond like it has never been trained before.You will feel like it’s the first day you ever picked up weights, or a tennisracket, or a paint brush. Respect this new limitation and slowly work upto the level of activity you had before. Just don’t expect it in the begin-ning.

Usually, an increase in activity will call for an increase in the amount oftime spent stretching. You will have to experiment with how muchstretching refills your bank account, allowing you to continue to do theessential activities, like work, personal hygiene, and family obligations, ona daily basis, plus your reintroduced pastimes. If you ever find that youhave overdone it and pain is the result, then rest completely for a day ortwo and resume your stretching program once the tissue has totallycalmed down. Reduce your participation in the new activity accordinglyuntil your body is again ready for additional levels of stress.

Have you noticed howmuch better you arefeeling because youhave been stretchingregularly? Everybody,especially as we age,needs stretching on aregular basis to man-age the changes infascia that occur as anatural result of livinglife.

Do yourself a favorand include stretchingas a part of your dailylife from now on.

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In Summary

Well, that’s it! You should be well prepared to return to the life youpreviously enjoyed, free of symptoms and able to control problems thatmay develop in the future.

I would like to receive constructive feedback from you once you havecompleted the program. If you choose to send feedback, please email itto:

[email protected]

A referral from a satisfied customer is the most sincere form of flattery. Ifyou have family, friends or colleagues who have symptoms of a repetitivestrain injury, please refer them to:

http://www.selfcare4rsi.com

Ever since I experienced the devastating pain and dysfunction of CarpalTunnel Syndrome, followed by a swift recovery, it has been my dream toshare my recovery techniques with other injured people. I hope thisprogram has been the most beneficial program you have followed forovercoming your Repetitive Strain Injury.

Thank you for the opportunity to serve you.

Best Wishes for a Symptom-Free Future,

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