Carpal Tunnel Counsel

I have worked with many patients who have had carpal tunnel syndrome in my 20 years as an occupational therapist and certified hand therapist. Although I agree with many of the comments regarding the role of posture, wrist braces, body mechanics and muscular imbalances in this condition [as presented in Tricks of the Trade, January 2011], I have to write a response.

Carpal tunnel by definition refers to a painful local progressive condition caused by compression of the median nerve. Symptoms start gradually with pain, weakness or numbness in the hand and wrist, usually in the thumb, index and middle fingers. As symptoms worsen, you might feel tingling during the day and decreased grip strength. The best initial treatment involves resting [the area] for at least 2 weeks, avoiding activities that worsen symptoms and wearing a splint, according to the NINDS (National Institute of Neurological Disorders and Stroke).

It is not an umbrella condition. I do not understand why exercise professionals are making recommendations for treating this condition. Isn’t this beyond their scope of practice? Any client who has carpal tunnel syndrome should be referred to a certified hand therapist who can recommend appropriate nerve gliding exercises and provide a splint that fits that individual. Over-the-counter splints do not always fit properly and need to be adjusted at times. Work recommendations should also be made by a therapist who is trained in this area. In the interim, strengthening the cervical and back areas to improve posture—if these are relevant issues—can be helpful. Pilates would be great as long as there is no weight bearing on the wrist.

Naomi Aaronson, MA, OTR/L, CHT, CPI
Bayside, New York

Hallo und Danke!

Hi to the States from Germany, and thank you for IDEA Fitness Journal!

The [January 2011] issue was great because it offered so much interesting information, including research about training and meditation, the industry compensation trend report, and the wonderful article from Len Kravitz, “What Motivates People to Exercise?”

I have read IDEA Fitness Journal for many years, and it always helps me inform my students at the German Institute of Prevention and Health Management about the news in the world of fitness!

Uschi Moriabadi
Herrsching, Germany

Motivating Your Newbies

Editor’s Note: Our Question of the Month in the [January 2011] Mind-Body-Spirit News section asked what strategies you are using to encourage newcomers to stick with their exercise program. Here’s a glimpse of what one reader is doing.

Great magazine. Congratulations! I keep my clients motivated by offering them material that is different from the gym, yoga or Pilates. They are not up to these methods, yet they need to improve their function—without feeling wrecked. Feeling wrecked sends them away. My clients are midlife and older women who are all gym dropouts. They have lost their innate patterns of body organization. They get them back in my 3-D Workout™ (www.3dworkout.com)—a subtle and deceptively simple way of restoring basic functional patterns in the body while progressively improving strength and flexibility.

Dianne L. Woodruff, CMA, PhD
Oakville, Ontario

Black-Bean Brownie Bonanza!

Editor’s Note: In the November 2011 issue’s Food for Thought section, we offered a brownie recipe that substituted puréed black beans for oil and eggs. A few readers tried it and reported back.

I took your brownie challenge, and overall the results were quite favorable. I puréed the beans with the liquid and added a couple more tablespoons of water to a box of brownie mix from Aldi. The batter was a little thinner than normal brownie batter. I didn’t time the baking but took the brownies out of the oven when the edges began to pull away from the side of the pan. Then I let them thoroughly cool before I cut them.

The brownies were taken to a New Year’s Day event, where I made my husband promise not to say anything. When two of the ladies there said they liked the brownies, he “spilled the beans.” They both wanted the recipe. Brownies are the favorite of another friend who was there, and he liked them, too. We didn’t tell him about the beans. A week later, at another event, he asked if I had brought more brownies.

This brownie recipe is more like a very dense, rich chocolate cake. Even though it doesn’t quite have the “fudginess” of a regular brownie mix made with oil, it is a very good alternative. We will make it again. Thank you.

Gwynn Lindler
ACE Certified Personal Trainer

I have been making these brownies, substituting black beans for almost all the flour and oil, for about 5 months now. I have found that I have an intolerance to wheat and soy, and I am also a vegan. So this is a great way for me to get a bit more protein in a portable snack. My husband loves them, and he is not a vegan.

Ruth Mannich
Centreville, Alabama

So today was a snow day, home all day; a perfect day to try brownies with a can of black beans. It was a total success! My son never had a clue and asked for another! Just one note—while I did not have to add any water, the baking time needed 2–3 extra minutes.

I will pass this recipe on to my friends; they were skeptical when I told them about it.

Lisa Meola
ACE Certified Personal Trainer
Malden, Massachusetts

I just read your snippet in IDEA Fitness Journal on [black-bean brownies] and I thought I’d tell you I’ve been making these for a while now (3 years) for potluck parties, and they are always a hit! Unless you’re a real foodie, you really can’t tell the difference (especially kids … shhh!!).

I use the Ghirardelli® Triple Chocolate Brownie mix, and they come out divine! [We were] full on just one serving. The brownies have more fiber and fewer calories!

Katherine Victorio
Founder, Wellfit Events
Toronto, Ontario

Expanding the Blue Zones

I, too, have been spreading the word—through my blog—about The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest [Fitness Handout, “How to Live Longer,” February 2011]. But you are missing author Dan Buettner’s most compelling point if you read it for self-help tips. Buettner is not just interested in changing individuals’ behavior to match that of the 100-year-olds he found living vibrant, active lives in Sardinia, Italy; Okinawa, Japan; Loma Linda, California; and Nicoya Peninsula, Costa Rica. He wants to transform whole communities into blue zones where the physical, social and cultural environment leads naturally to healthy behaviors and longer lives.

In a project with AARP, Buettner brought the lessons from the blue zones to an ordinary American town—Albert Lea, Minnesota. After a little less than a year, residents of Albert Lea were seeing positive changes in their health and well-being—changes already reflected in lower costs for providing health care to city workers. Buettner then invited other cities to join what he calls the Vitality Project to see if the blue-zone benefits can be transplanted to other American communities.

As fitness professionals, we should be involved in such projects within our own communities. Helping to implement the larger lessons from the blue zones could improve the health of not only our clients but also their families and even their neighbors.

Laurie Leiber, MPH
Certified Pilates Instructor
Oakland, California

Erratum

I just read in IDEA Fitness Journal an article by Scott Josephson, MS, RD, “Perimenopause and Nutrition” [February 2011]. I thought I should clarify two errors.

On page 59, [Josephson] writes that “estrogen acts as an osteoclast. . . .” In fact, estrogen acts more as an osteoblast facilitator, or an osteoclast inhibitor; the mechanism is still not quite determined (http://courses.washington.edu/bonephys/esteffects.html).

On page 58, [Josephson] writes that “ingesting about a half gram of high biological protein . . . per kg BW/d” is appropriate for active women. However, a female weighing 132 pounds (60 kilograms) would then need only 30 grams of protein. I suspect he meant to say “per lb BW/d,” as that would bring her up to 61 grams, a more credible amount of protein.

Irv Rubenstein, PhD
President, STEPS Inc.
Nashville, Tennessee

Editor’s Note: Dr. Rubenstein is correct in saying that “one half gram of protein per kg BW/d” would be insufficient for active females. However, please note that the author’s original manuscript correctly stated that “in most cases ingesting about 1 gram of high biological protein per kilogram of body weight per day seems to be the ideal protocol for active females.” The author did not originate the error; the editors introduced it during the editing process. We regret the error.

The author agrees that estrogen can act more as an osteoblast facilitator; however, as Dr. Rubenstein points out, “the mechanism is still not quite determined.”