Editor’s note: This article first appeared in Midwifery Today, Issue 122, Summer 2017.
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Recently, I had a client who was 15 weeks pregnant ask me to help relieve pregnancy-induced pain she was experiencing in her hands. Upon palpation of the lower arms there seemed to be a cramp or spasm in the muscles of the forearm area. The client reported that she had done some research on her own and found that carpal tunnel syndrome was a common symptom of pregnancy, but one that usually begins later in pregnancy. As an experienced bodyworker, it didn’t make sense to me that this particular woman would suddenly develop carpal tunnel syndrome simply due to pregnancy—even though this is a common belief in maternity care. I decided to do my own research on what is known about the physiological cause of pregnancy-induced carpal tunnel syndrome. What I read was a general consensus that during the second half of pregnancy these symptoms may be caused by excess fluid retention.

In my professional opinion, the symptoms presented—which frequently lead to a carpal tunnel syndrome diagnosis—are not actually carpal tunnel syndrome but a mild yet chronic incidence of compartment syndrome. Compartment syndrome is a painful condition that occurs when pressure within the muscle of a specific area of the body, such as the arm, builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. Fascia (tough membranes throughout the body with a tensile strength that some have compared to that of aluminum) surrounding the arm will only allow for so much pressure to occur, eventually leading to severe pain from pressure and loss of function to the nerves controlling the hand. This is similar to carpal tunnel, but different enough that an improper approach to treatment can leave a client with compartment syndrome and continued pain of the hands and wrists.

After reading that the most common treatments for carpal tunnel during pregnancy were cortisone shots, wearing a (reportedly often ineffective) splint or minor surgery, I thought there had to be a better way to treat this common pregnancy complaint. My diagnosis and treatment hypothesis were based on the description of pain from my client and the idea that excess fluid was being retained in the body.

The treatment I chose to try on this particular client was one I had been using for years to help with lymphedema in women who had had a mastectomy. During the treatment, I have the pregnant mother lie on her back, if possible, or side lie with her arm elevated vertically in the air. I then place a heating pad in the axilla (armpit) next to the lymphatic duct. The heating pad is used to vasodilate the lymphatic duct. In the raised hand, I place a cool-to-cold ice pack, which will cause vasoconstriction at the upper part of the extremity. The pushing action of vasoconstriction from the cold and the pulling action of vasodilation from the heat into the lymph duct, with some added light massage and flushing of the arm tissue, causes the fluid to flow more quickly into the drain at the axilla. Within a one-hour session we were able to alleviate the pain in the arm, restore dexterity and function back to both hands and almost fully restore grip strength.

Upon checking with my client at 24 hours post-treatment, she reported that a dull ache remained in her left hand, but the severe levels of pain she had been waking up with had been “reduced by 90–95%.” I advised my client to perform the treatment function at home for approximately 20 minutes for each hand prior to sleep at night. This recommendation was based on the lack of movement during sleep, which slows the drain process of the lymphatic system. (This simple treatment can be taught to families by midwives, physicians and doulas to bring relief to mothers who suffer from what is commonly diagnosed as pregnancy-induced carpal tunnel syndrome and, perhaps as a side effect, will decrease unnecessary medical intervention for pain and discomfort.)

Over the course of the following month, we continued treatment and research, based on my belief that compartment syndrome was the appropriate diagnosis for this particular client. We experimented with using compression sleeves post-session to try to keep the fluid closer to the torso before it filled the arm, but we discovered that the fluid would still pass the compression sleeve and get caught in the hand, causing increased pressure there.

Through continued research I hypothesized that because lymphatic fluid is mainly pumped by the diaphragm on the inhale breath, either a higher level of stress and a more shallow breath pattern or lack of movement/exercise could be a cause. During the inhale breath, increased abdominal pressure pushes lymph into the less pressurized thorax. The pressure reverses during exhalation, with valves preventing lymph from being pushed backward. Working with positive abdominal pressure in athletes and the general population, I have found that diaphragm function is not being completed down to the pelvic floor. The common breath, which is frequently limited in the general population, would be even more limited in pregnant women whose fundus level has reached above the navel region. Without the diaphragm engaging properly and causing pressure to disengage the pelvic floor, the abdominal pressure does not complete a cycle. During pregnancy, increased respiration (deep, focused breathing) or movement may help alleviate the stagnant fluid.

Additionally, I discussed this treatment technique with clientele over the age of 50 and to determine whether the treatment may have been used in the past, but forgotten over time. None of these clients indicated that they had received or had the treatment suggested during any of their pregnancies.

Professionally, I’ve spent more than six years working with children and adults with various neurological, mental, and developmental disorders in a variety of settings.

While I was never a medical provider, I became a jack of all trades for assisting providers. I was a chaplain on an acute care psychiatric ward, a sensory-motor coach at a neurology-based tutoring center, and an on-site caregiver to adults with developmental disabilities. Of all the treatment modalities I saw in use in all of those settings, those which focused on neuro-plasticity were far and away from a step ahead of the rest.

For that reason, I highly recommend what Joe Kleman does at Neural Movement therapy. I’ve been seeing him for care for myself for the past several months and have been really pleased with the results. I’ve been impressed both practically and intellectually, as someone with an above-average appreciation for the skill he displays.

His major invention, the cube room, focuses on skills like coordination of bilateral movements, sequencing of movements, motor planning, proprioception, balance, etc. In laymen’s terms, it’s all about, “Where is my body in space?”

I find the motor planning in the cube room more challenging than any of the exercises I’ve ever done or assisted someone in doing (for example, more challenging than the Interactive Metronome or eye-exercise software like VisionBuilder). I don’t mean “harder”, I mean more progressively challenging in the way that keeps me always on the edge of growing.

Because the cube room uses so many skills as once (vs. something like optokinetic exercises that focus on one very specific skill), I could see the cube room being especially useful for patients who are trying to integrate a lot of isolate changes they have already made with other treatment modalities. Or, for patients who have never tried a neuro-plasticity based treatment model, have co-occuring physical limitations, and need to focus on growing skills “in three dimensions”.

Unique to Joe’s setting is his insistence on “games” — not “treatment” — to help the person learn that movement is fun, normal, and part of who they are. Neuro-plasticity treatments are different than say, taking a pill for an acute infection because the challenge is to convince the patient not only to do the exercises but to let doing the thing that makes them grow to become part of who they are, what their habits are in the long-term.

When I worked with providers, our hardest challenge was getting patients to do their home exercises. Joe’s approach — presenting things as “games” — is much easier to follow through on. Even when I know it’s a trick!

I had a full evaluation at the Carolina Brain Center right before I started therapy with Joe. I will go back to them for follow-up evaluation in a few weeks, but I can tell that I’ve improved on most if not all of the neurological metrics they tested me in. Without knowing what their results were or having the benefit of all their computerized test equipment, Joe easily pinpointed the same weak places in my brain and how to strengthen them. He did it by observing how I moved and how skilled I was in my movements.

Respect for the man whose intuition is as honed as that!

Why we need to place more importance on, play. In a world full of tasks, when do we find time to not do any, and relax. As we continue to glamorize being busy, seeing how many plates we can keep spinning while riding a unicycle balanced on a basketball. The idea of play is quite simple, play is in of itself. It is something you choose to do, that no matter how great, or terrible you are at it, nothing in the world changes. If you blow air through a trumpet and it makes noise, its either going to make beautiful sound, or a terrible sound, and the only thing that changes is how you feel. 

I recently had a client that came to me for anxiety, and we spent some time discussing play. She mentioned to me that she tried arts and crafts, but it made it worse. Why is that, you think? Well even though it may seem trivial it isn’t play, it is a task. You are still comparing your work to someone else, the person that you copied. Yours doesn’t look as good as theirs, now you feel terrible again. If you chose to do arts and crafts because you were called to do it, and you enjoy creating something unique then that would be play. She could have chosen to do arts and crafts and create her own one of a kind work of art, this may have made her more content. 

One of my favorite scientists, Nikola Tesla once quoted “Most people are sick because they forgot how to play”. Nature is playful, and we are part of that plan. We are simply grown up children that still need time to run, and play. This allows our muscles and our minds to continue to grow, long into old age. If you really stop and think, how many diseases that are affecting our elderly could be prevented by continually engaging in play, play that is filled with discovery, learning and struggle. 

I encourage you if you have children, drum up some creativity and imagination, sit down on the floor and play with trucks, and answer the plastic phone when it rings. If you don’t have kids find yourself out in the forest, my suggestion is to take a day off from work and head to the forest in the middle of the day. I play this game where I run around like a little kid, singing “Nobody can hear me, nobody can see me”. If you want to throw rocks, or pick up sticks, sing a song that makes no sense, then who cares. No one can see you anyways, and the birds surely don’t care. 

I will include a great excerpt from a book about growing up. The book is called “Somatics: Reawakening The Mind’s Control Of Movement, Flexibility, And Health” Thomas Hanna

“To become an adult means that we no longer have to do the things we did as kids. Kids run, but we adults walk. Kids climb, but we take the elevator. Kids scoot under bushes, but we go around them. Kids stand on their heads, but we sit on our bottoms. Kids roll on the ground, but we turn on the mattress. Kids jump up and down, but we shrug our shoulders up and down. Kids laugh with joy, but we smile with restraint. Kids are exuberant, but we are careful. Kids want to have fun, but we want to have security. 

In short, to become a successful adult means to cease acting like a kid. It is the customary sign of adulthood to cease functioning like a young person. But this conception of adulthood has an unavoidable result: As soon as we stop using these functions, we lose them. And we lose them because our brain, which is a highly responsive organ of adaptation, adjusts to this lack of activity. If certain actions are no longer part of our behavioral inventory, our brain crosses them off”.

Discussing the importance of teaching children the importance of cause and effect. How this can apply to life, career or starting a business.

The six dimensions of wellness are: physical, emotional, spiritual, intellectual, environmental and social. They are discussed in greater detail below.

Physical: Maintaining a sound substantial body through regular exercise, proper nutrition, sleeping well and avoiding harmful habits. Maintaining a consistent well-rounded exercise program is crucial to physical wellness.

Emotional: Being in touch with your emotional presence and being aware and comfortable with your own thoughts and feelings. Emotional wellness relies on being able to express one’s thoughts and sensations and to be able to absorb those of others.

Spiritual: Having a sense that life is meaningful and has a purpose and that we are guided in our journey. Spiritual wellness is about embracing the meta-physical and reaching beyond the physical realm of existence and experiences.​

Intellectual: Being able to engage in lively interaction with the world around you. The intellect is about flexing the mind’s muscle and opening the mind. One’s intellectual being is about continued learning, problem solving, processing and creativity. Intellectual wellness involves connecting with others on a cerebral level.

Environmental: Surrounding yourself with a healthy work and living environment free of hazards and focused on conservation of all natural resources and the role we play in bettering the environment. Environmental wellness is about respecting nature and your surroundings and in gaining personal fulfillment from our surroundings.

Social: Social wellness is about relating, interacting and communicating well with others. Social wellness is also about being comfortable in your own skin to be able to contribute and engage in a healthy living environment. Including people in all aspects of our lives is tantamount to social wellness.