Soft tissue release for carpal tunnel

Several thousand individuals each year will miss work, change careers, spend millions of dollars in medical care and suffer untold pain over the chronic repetitive use injury known as carpal tunnel syndrome. Blue Cross and Blue Shield of California assessed that a single case of carpal tunnel syndrome can cost as much as $100,000 in lost work, surgery and retraining. The successful treatment of this sometimes severe and crippling injury can at times baffle traditional medicine. The direction of treatment is usually in one of four focuses: rest; immobilization with braces or splints; corticosteriod injections; physical therapy, stretching and biomechanical modification (ergonomics); and, if symptoms persist after one or more of these approaches, surgery. So, what do I think I can do as a massage therapist?-- plenty.

Before we talk about a program of stretching and soft tissue release, let's look at the anatomy of the hand, wrist and the ''dis-ease.'' Carpal, pertaining to the carpus, or wrist, carpal tunnel refers to the connective tissue that forms a passageway for the median nerve that innervates a portion of the hand and the tendons. The pain, numbness, loss of grip, weakness and sometimes loss of muscle is caused by an overgrowth of the carpal ligament pressing on nerves. The overgrowth of the ligament is caused by inflammation and micro trauma directly related to the individual's overuse of the wrist through repetitive motion, sometimes hundreds or thousands of times in a day's work.

Having worked several years for a surgeon and having seen the anatomy of the wrist and the disease, the nerve can appear compressed or flat and is described as an ''hour glass'' in appearance. The overgrown carpal ligament is partially excised relieving the pressure on the nerve. The surgery is usually successful but in some cases scarring from the surgery will cause recurrence of symptoms, or when the individual returns to the same job without modifying their repetitive wrist movements and does not utilize appropriate stretching exercises, symptoms quickly return.

Carpal tunnel syndrome is of particular interest to bodyworkers, as those of us who do not use their wrists correctly, over use, or do not do appropriate stretching will find themselves out of a job. Massage therapists and bodyworkers view dysfunction including carpal tunnel syndrome related to motion somewhat differently. As injury continues, part of the nervous system will respond by setting up the inflammatory response. The memory for this response is stored in the muscles.

To treat carpal tunnel syndrome with massage, you have to move ''up stream'' from the wrist to the larger muscles of the forearm where carpal tunnel really starts. Massage helps realign scar tissue and the message then being sent to the nervous system is one of healing, slowing the inflammatory response. Also, working with the body of the muscle, the meaty part of the muscle, erases the memory of pain and dysfunction and relengthens the muscle. This in turn immediately reduces tension in the tendons and pressure on the median nerve.

Self care stretches include locking the elbow out and, with palm facing up, extend the wrist and fingers back. At the end of that movement, with the other hand, assist that stretch for two seconds. Repeat 10 times, changing the angle of the stretch each time.

With elbow straight and palm facing down, extend the wrist and fingers as far back as possible. At the end of the stretch, take your other hand and assist that stretch for two seconds. Repeat 10 times, changing the angle of the stretch each time.

Extend the elbow and slowly flex the wrist downward. With the other hand, apply a two second stretch. Repeat 10 times, changing the angle of the stretch each time.

Extend the elbow and make a firm fist. Flex the wrist downward as far as possible. Then with the other hand assist the stretch for two seconds. Repeat 10 times, changing the angle of the stretch each time.

Try these exercises daily for one week and I believe you will find your wrists feeling better. I use them frequently and have in my practice of five years never suffered the symptoms of carpal tunnel syndrome. What have you got to lose?

Till next time, Rebecca.

Uploaded to The Zephyr website April 27, 1999

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