Issue link: https://www.massageandbodyworkdigital.com/i/70551
@WORK Because of the positions office workers frequently adopt, the ulnar nerve is susceptible to compression in two key locations. When the elbow is flexed for long periods, as it is in many desk job tasks, there is increased compression of the ulnar nerve in the cubital tunnel of the elbow (Image 3). Ulnar nerve compression is another common reason for surgery, and also responds to soft-tissue treatment of the tissues around the nerve. Encouraging the client to resist repetitive bending of the elbow (using an earpiece instead of the hand for phone calls, for instance) can be helpful. The ulnar nerve can also be compressed at Guyon's tunnel (also called Guyon's canal) in the wrist. Tendons do not travel through this tunnel alongside the ulnar nerve. Rather, nerve compression in Guyon's tunnel results from external pressure when the base of the hand gets pushed against something for long periods, for example against a desk when using a mouse. The long periods of compression can lead to ulnar nerve irritation, which can be confused with CTS. However, note that the region of nerve symptoms in the hand is different between these two complaints as two different nerves are affected. Using a softer wrist support or moving the support up the forearm is key; rest and changing behavior usually solves this problem. Muscle and tendon overuse problems, such as medial and lateral epicondylitis, are also common in the office due to chronic isometric contractions in the flexor and extensor muscles of the forearm combined with the repetitive motions of keyboarding. The finger tendons travel back and forth rapidly and frequently during typing, which may lead to tendon sheath irritations such as tenosynovitis. Recent research indicates that an important factor in encouraging healthy tendon repair is pressure and movement applied to the tendon, which is the primary benefit of deep-friction massage applied to chronic overuse tendon disorders like epicondylitis. There still appear to be inflammatory reactions and fibrous adhesions present in tenosynovitis, so the mechanical forces of friction help break up the adhesions and restore proper mobility to the tendon. GENERAL TREATMENT PRINCIPLES Reducing muscle and tendon overuse is a key factor in the prevention and treatment of these problems. Massage therapy can clearly play a role—sometimes a central one—in addressing these disorders. It is also advantageous to teach office workers self-massage and stretching to reduce the onset of these disorders. The more frequently the client can intervene to reduce cumulative muscle tension, the greater the chance for keeping these tissues healthy. Your assessment can shed light on why the client is suffering from a particular problem. Exploring details of their workstation is paramount; this way the biomechanical causes of the problems can be addressed through changes in ergonomics and behavior. An excellent resource is the Occupational Health and Safety site (www.osha.gov). This site helps clients evaluate their workstation and make appropriate changes. (Search "Computer Workstation eTool.")1 Want more treatment options? Visit ABMP.com to see Whitney Lowe's webinars where he explores specific treatment approaches for common pathologies. Even minor equipment changes can make significant contributions to reducing pathology: changing the height of a desk or keyboard platform, changing the keyboard to one with less tension in the keys, decreasing keyboard slope, lowering or raising a monitor, and replacing the office chair (expensive, yes, but injury and lost production cost more). A new trend is the "sit-to-stand" workstation, in which one rotates positions throughout the day, going from sitting to a standing position. Frequently changing position, stretching, and doing stationary exercises all contribute to relief by getting the body out of a static position. Office work is what it is, and while often there is little to be done to improve the impacts on the body, there are few health-care interventions as effective as massage therapy for dealing with cumulative musculoskeletal and psychological stress. For this reason, a regular massage is just what the doctor should order. Notes 1. Occupational Safety and Health Organization, "OSHA Ergonomic Solutions: Computer Workstations eTool," accessed June 2012, www.osha.gov/SLTC/etools/ computerworkstations/index.html. Whitney Lowe is the author of Orthopedic Assessment in Massage Therapy (Daviau-Scott, 2006) and Orthopedic Massage: Theory and Technique (Mosby, 2009). He teaches advanced clinical massage in seminars, online courses, books, and DVDs. Contact him at www.omeri.com. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 107