Raynaud’s syndrome – ideas for working with movement
Wed,Jun 20, 2018 at 03:00PM by Carla Mullins
And a heaven in a wild flower,
Hold infinity in the palm of your hand,
And eternity in an hour.
(William Blake – Auguries of Innocence)
My father died from complications associated with systemic scleroderma in 2005. In the years before his death I would sometimes notice a blue tinge to his hands and feet, the result of a short-term loss of blood supply to his peripheries. This interruption to his blood supply was part of a condition known as Raynaud’s syndrome, which is also known as Raynaud’s disease and Raynaud’s phenomenon.
Raynaud’s syndrome can be a sign of underlying autoimmune disorders such as scleroderma, lupus, and rheumatoid arthritis, however, the condition can also occur on its own without any of these autoimmune diseases. So if you suspect you have Raynaud’s syndrome, it is important to have your doctor diagnose the condition. I have also seen this condition in otherwise healthy athletes; in one case the person was a cyclist and it caused him significant problems when gripping onto the handlebar.
What is Raynaud’s syndrome?
People with Raynaud’s syndrome will experience an inexplicable spasm in their blood vessels. The spasm means that the tissues of the body don’t receive sufficient oxygen and at first the fingers (if in the commonly affected hands) turn white then, as oxygen deprivation continues, the fingers start to turn blue. Once the blood vessels reopen the hands will flush red. My father used to joke that his hands were like the French flag in the colours of white, red and blue! The lack of oxygen can result in sensory nerve irritation and therefore ongoing pain. In very bad cases it can result in gangrene and loss of the digits or limbs.
There are some people who experience this disease without any other conditions and in those cases they can be said to have Primary Raynaud’s. Those who experience this condition in conjunction with other of autoimmune conditions are said to have Secondary Raynaud’s. Some people can develop Raynaud’s because of things such as:
// Medications used in cancer treatments
// Rheumatoid arthritis
// Long term smoking
Raynaud’s can affect any of the peripheries as well as the face. In this article we will talk mainly about the hands, however, the principles can be applied elsewhere.
What should you consider if a person has Raynaud’s syndrome?
Has the client seen their doctor and is there is a management plan in place for the condition? Such a management plan can include medications, temperature regulation, strategies to manage (e.g. wearing gloves or having additional heating). If some of the management strategies are environmental, ensure that your studio space is able to meet those environmental requirements (e.g. temperatures of the airconditioning whilst the person is at the studio/clinic).
Cold conditions can seriously affect the blood flow and aggravate symptoms. As an example, for those living in subtropical Brisbane it would at first seem to be an ideal setting for someone with Raynaud’s. Unfortunately many of us forget that air conditioning settings can affect these people with the fluctuation in temperatures. As a result it is important to ensure that you maintain a moderate temperature for the person when they are exercising, or even just in a waiting room, or when getting something out of the freezer. I remember my father would often have mittens with him just in case he had to sit around in a cold waiting room.
For people living in colder climates the mittens are generally part of their daily wear and precautions and are part of many strategies. Some other ideas people have given me when working with Raynaud’s disease is to make sure you have a cup with lukewarm water or tea for a person to hold onto (preferably with mittens to start). The warmth can help slowly increase circulation. You don’t want to have something too hot as it can be too much too soon and cause pain and damage. In a way, it can be easily incorporated into a waiting room as a welcoming cup of herbal tea.
Encourage breath and mindful focus on breathing to facilitate movement. For some interesting ideas about breath look at our article Pilates exercises for the thoracic spine and diaphragm.
Avoid power plates and vibration machines with Raynaud’s phenomenon clients
Ensure that you as a teacher do not have long fingernails or jewelry that could accidentally scratch the client. This disease means that people can easily get small scratches infected and ulcerated, not nice, and potentially dangerous. With this group of clients, it is important that they regularly see a podiatrist ensure that their feet and nails are well maintained and that there are no ulcerations. It is important that they are regularly supervised by a podiatrist if they are badly affected in the feet.
Observe your client, notice if their extremities are changing colour, and if that is the case change their position. Seek to find ways to encourage the return of circulation to the area. Observation also means touch the person’s skin and feel if it is cold, as this can affect circulation. If the skin is cold try changing the environment, e.g. turn off the air conditioning or increase the heating; have the person put on their gloves and socks. This is where it can get a little bit tricky. In cases where a person’s Raynaud’s disease is very bad they should be encouraged to wear their mittens and socks and a hat of some sort a lot of the time, to help maintain thermo-regulation to avoid the spasms in the circulatory system. All of this is good but it can mean that you cannot observe the changes in the system because the person is covered up. In these cases, you need to observe their face, which can also be affected by the blood supply colour changes but also the facial expressions of pain and discomfort.
Also, encourage the person to report what they are feeling and stop immediately if there is a specific pain starting to develop. Ensure the person regains a more consistent temperature level and have them wiggle their fingers and toes and do some of the exercises listed below to encourage circulation.
Be careful with four-point kneeling exercises or gripping exercises in which there can be pressure on the wrists and the circulation to the hands. If you notice that your client’s hands are starting to go white, get them out of the position. I find that for these clients I have modified the four-point kneeling work so instead of having their hands underneath them on the reformer or mat, they will work with their hands on a wall or slightly higher on a box or bar. Exercises like wall elephant are great because they can still use the wall to help the close chain sensation for shoulder girdle organisation, but they are not putting excessive pressure onto their hands in a way that affects circulation.
I have also used a lot of the ideas from our peripheral neuropathy work in order to help people. Here is a video class of ideas to help maintain hands and feet and their strength. There are two videos I have shared here one specifically for feet ( which can be affected by Raynaud’s Disease) and one for Hands
Try some of these simple exercises for Raynaud’s disease
I find that the sensory wakening exercises used in gyrokenesis and the Feldenkrais Method are very useful ways to start to bring circulation and sensation into the hands.
Webbing rubs exercise
In this exercise you have the person rub between the webbing of each finger with the webbing of the other hand.
Church piano fingers
The purpose of the church piano fingers exercise is to:
// Mobilisation of the nerves and fascia in the upper limb;
// Strengthen the flexors of the forearm;
// Increase mind-body awareness, concentration and focus.
We also have an ebook Periphery Neuropathies which details information about other diseases that affect the hands and includes many exercises that can be of assistance to those with Raynaud’s Disease or Peripheral Neuropathy
This video was produced by the American Raynaud’s Association and explains some of the medical tests that are conducted for this course.
Courses covering Raynaud’s syndrome
Raynaud’s syndrome is one of the topics that we cover in the Cancer and Automimmune course. This topic is also discussed in the Upper Limbs 2: Hands, Wrists and Elbows courses. For more information see our full schedule of upcoming Anatomy Dimensions courses. We will be offering all of these courses online from October 2020. If you want to learn more information about the courses you can email us firstname.lastname@example.org
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Carla Mullins is co-director and co-owner of Body Organics, a multidisciplinary health and body movement practice with studios in Brisbane, Australia. Carla is a Level 4 Professional Practitioner with the APMA and has also studied pilates with APMA, PITC as well as Polestar. She also has a LLB (QUT), M. Soc Sc & Policy (UNSW), Advanced Diploma of Pilates Movement Therapy (APMA), Diploma of Pilates Movement Therapy (APMA), Diploma Pilates Professional Practice (PITC), Gyrotonic Level 1, Gyrotonic JSB, Gyrotoner, CoreAlign Level 1, 2 and 3 and Certificate IV in Training and Assessment. Carla also has returned to University to complete an Occupational Therapy Degree.