Treating Carpal Tunnel Syndrome through Advanced Massage Techniques
If the national statistics are correct, a large proportion of you reading this article will have experienced pain, numbness and tingling in your hands, wrists or forearms. You probably know others like you- not just bodyworkers but musicians, hairdressers, journalists, plumbers and increasing numbers of the general public who use computers for the majority of their working day. Carpal tunnel and hand/wrist RSI's are on the increase and a recent TUC report states that 5.4 million working days are lost each year because of RSI. This indicates a large number of people are in chronic pain. Sadly conventional medicine has little to offer - patients are caught between a "Hobsons choice" of painkillers or invasive surgery.
Massage therapists can be the experts!
Now what if I told you that massage therapists were in a unique position to not only prevent the onset of these debilitating symptoms but to reduce and in many cases eliminate pain within their clients in 1-6 treatments. Imagine the increase in your clientele and the personal satisfaction you would gain from mastering non-invasive, effective techniques that would enable you to really give results. Most of us are not taught these powerful advanced techniques. In our experience, most bodyworkers in the UK feel at best unconfident, and at worst, terrified about touching someone in pain! Yet these techniques are easy to master once you understand some basic principles and the different pathologies involved.
What is Carpal Tunnel Syndrome (CTS)?
In recent years, CTS has become a catchall diagnosis for any pain in the hand and wrists. It is important to realise that there are many other conditions that can cause symptoms in these areas and some of these will be discussed later in this article. True CTS has quite a specific definition: it is impingement of the median nerve within the carpal tunnel .
The carpal tunnel is an oval passageway created by the structures of the wrist. The carpal bones create the bottom of the tunnel and the transverse carpal ligament, also known as the flexor retinaculum, forms the top of the tunnel.
The median nerve : This is one of the three nerves that innervate the forearm and hand: the other two are the ulnar and the radial nerves.
The median nerve has to pass through the fixed space of the carpal tunnel together with other soft tissue structures including the nine tendons of the forearm flexor muscles. With so many structures passing through a small space, it is easy to see how carpal tunnel syndrome can develop. If the amount of space in the tunnel is decreased, the pressure on the median nerve can increase causing the classic nerve impingement symptoms of CTS including:
- Pain, numbness and weakness of the hand. Pain is classically felt in the palmar side of the wrist radiating into the hand, typically affecting the palm, thumb, index finger, third finger and lateral half of the ring finger. (This is the innervation pattern of the median nerve)
- Increased pain in the morning as compared to the evening
- Loss of function of the hand if severe and not treated. Untreated CTS can result in permanent nerve damage, as nerve tissue cannot regenerate.
So why would carpal tunnel syndrome develop?
Compression of the nerve may be caused by:
- Excessive pressure within the tunnel due to enlarged flexor tendons-due to overuse and misuse.
- Subluxation (partial dislocation) of carpal bones
- Excessive fluid retention.-due to inflammation from misuse and injury or other reasons.This is why pregnant women are susceptible to the condition as increased fluid volume can cause pressure on the median nerve.
Other conditions causing pain in hands and wrists
It is important to realise that there are other conditions causing pain in hands and wrists including:
Overuse Syndrome
Imagine if you went to the gym every day and worked the same muscles in the same way for 8 hours without a break. Wouldn't you expect to be sore the next day? And that over time those muscles would sustain micro-trauma from such repetitive motion without rest? This seems like common sense and we would not dream of doing this to our bodies. Yet this is exactly what many of us are doing when we spend hours at computers (or at our massage tables!), using the same small muscles over and over again. These muscles are simply not designed to be over-used in this fashion, leading to pain and injury that gets worse over time.
Over-use injuries are often of slow onset; you start to get some pain, you ignore the pain and keep typing or massaging, re-injuring the tissues, causing more tissue damage. Tendons become irritated, the repetitive stress causes micro tearing of the muscles, leading to inflammation and scar formation. In the early stages of injury the pain may be mild and only when doing the offending activity. Without intervention, the severity of the pain increases and may also be present at rest and during activities such as writing, picking up a kettle, carrying a bag or picking up a child.
Tendinitis
- Tendinitis is inflammation of the muscle tendon and usually develops as a result of overuse; some classic tendinitis injuries include tennis elbow and golfer's elbow which can cause pain and swelling at the lateral and medial epicondyle of the humerus respectively.
Thoracic Outlet Syndrome (TOS)
Like CTS, Thoracic Outlet Syndrome is a nerve impingement syndrome. The crucial difference in this case is that the nerve impingement does not take place near the carpal tunnel but instead at the neck or the chest. If we trace the nerves of the hand and forearm back "upstream" to their source, we find that they all come from a common origin- the brachial plexus. The brachial plexus is a network of branches of spinal nerves C5-T1. The brachial plexus passes not only between the scalene muscles in the neck but also between the pectoralis minor and the ribs. It then branches into the nerves of the arm, the most important of which are the radial, median and ulnar nerves.
So what do you think might happen if the scalenes or the pectoralis minor become tight as they do from our habitual rounded shoulder/ head forward position of desk and computer work? That's right! Put pressure on the nerve and produce tingling, numbness and pain down the arm - your classic "carpal tunnel" symptoms! Yet TOS can be very easily resolved through massage therapy and stretching.
And don't forget our old friends- Trigger Points!
Those of you who are regular readers of our articles in "Today's Therapist" will be familiar with the chronic pain patterns that can be caused by trigger points. Incorporating trigger point therapy into your massage work will enable you to provide dramatic relief to many chronic pain conditions - hand and wrist problems are no exception. Very often myofascial trigger points are the sole cause of pain, numbness, tingling, stiffness, burning or swelling in the hands and fingers. Trigger points in the scalenes or pectoralis minor can cause the muscle to shorten leading to Thoracic Outlet symptoms. Numbness in the hands and fingers can also be caused by trigger points in the serratus posterior, triceps, coracobrachialis, brachialis, supinator, extensor carpi radialis brevis, flexor carpi ulnaris, flexor digitorum and pronator teres.
The Importance of Fascia
One factor that is often overlooked when treating pain and dysfunction is the huge influence of fascial restriction.
The fascia of the body is the tough connective tissue that holds us together, like a 3 dimensional body stocking. It surounds all structures like a tight "sausage skin". Because all body parts are interconnected by the fascial system, abnormal tension patterns in the fascia may be transmitted from one body part to many others, so any restriction and can lead to a variety of problems including pain of the wrist, arm and hands.
Advanced Massage Approaches
So how can massage help to bring people out of pain and avoid unnecessary surgery?
- Appropriate Use of Heat or Cold : Both heat and cold can be used effectively for treating RSI's. Generally ice is used for acute injury where inflammation is present and heat for chronic pain. "Contrast bathing"-alternating heat and cold, maximises blood flow to the injured tissues. It can be very effective for treating chronic repetitive stress injuries.
• Myofascial Release Approaches : Myofascial release work can be extremely helpful in relieving CTS symptoms, even when the condition has been unresponsive to other treatment. Techniques such as skin rolling and cross hand stretches can release the fascia and lead to dramatic relief of symptoms.
- Trigger point therapy : How to find and treat trigger points is vital in the treatment of hand and wrist pathologies. Use a logical approach to "search and destroy" trigger points that are causing the primary pain pattern.
- Stretching techniques: Knowing how to stretch the muscles involved will substantially increase your chances of a successful treatment approach. Static stretches, PNF or active isolated stretches will all be useful.
Want to learn more?
Our 3-day foundation course in holistic medical massage will enable you to master the theory and application of these advanced bodywork approaches so that you can immediately incorporate them into your existing massage practice. Our 1 day carpal tunnel workshop will teach you a full protocol incorporating advanced massage techniques which will enable you to reduce pain in clients within 1-6 treatments.
Remember you can be the expert!
About Jing. www.jingmassage.com
Jing Advanced Massage + Training is an organisation dedicated to excellence in all aspects of postgraduate massage training. Offering a unique range of Holistic Medical Massage workshops for treatment of pain, we also offer courses in Hot Stone Fusion, Amma Fusion, Advanced Stretching and Pregnancy Massage. Based in Brighton , we offer courses around the country
Tel: 01273.628.942.
Email: info@jingmassage.com
Text Copyright Rachel Fairweather and Meghan Mari 2004
Photos by Meghan Mari