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Resolving Carpal Tunnel Syndrome – PART 2

Updated: Dec 4, 2023


In part two of "Resolving Carpal Tunnel Syndrome," we will delve into suggested manual therapy techniques and complementary exercises. I will offer video demonstrations of the treatments and exercises that we frequently recommend to our patients. Additionally, we will examine the advantages and disadvantages of using splints and taping as supportive measures.


Article Index:


Treatment

Exercises

Support

Conclusion & References

 

Manual Therapy for CTS


For those with mild to moderate CTS (lacking muscle wasting or notable sensory issues), the initial recourse should be conservative management, such as manual therapy. However, if there's no marked progress within a set period, surgery should be considered.


The timeline for discernible results from manual therapy can fluctuate based on CTS severity and individual response. Generally, progress is observed within 4-6 weeks, but this varies by patient. It's crucial to track improvement and liaise with a medical expert to tailor the treatment.


Most CTS patients benefit from nerve mobilization treatments combined with nerve gliding exercises. We advocate pairing these with manual mobilization techniques targeting the carpal bones.


The Research - Three Good Reasons


Here are three reasons to consider manual therapy before exploring surgical options:

  1. Studies have shown that patients who undergo manual therapy experience more significant improvements in their ability to tolerate pain caused by applied pressure, also known as pain-pressure thresholds, compared to those who opt for surgery. (16) Pain-pressure thresholds are a measure of the minimum amount of pressure that causes pain, and an increase in this threshold indicates a reduction in pain sensitivity.

  2. Research indicates that manual mobilization of the carpal bones leads to dimensional changes in the carpal tunnel (14), which can help alleviate pressure on the median nerve.

  3. Evidence suggests that after one year, patients who received manual therapy combined with exercise had outcomes similar to those who underwent surgery. Furthermore, those treated with manual therapy saw faster improvements within the first month compared to surgical patients. (24)


 

Treatment Demonstrations


In the two videos below, we showcase some of the techniques we often employ at Kinetic Health to enhance the mobility of the median nerve along its pathways. This approach extends beyond the carpal tunnel region, encompassing the entire path of the median nerve, from the neck (cervical spine) to the hand.


Brachial Plexus Release


Brachial Plexus Release - Welcome to this video on Brachial Plexus Release. The main objective of this video is to demonstrate how to release the nerves connecting the neck to the shoulder, which includes the cervical plexus, brachial plexus, and the neurovascular sleeve, using MSR procedures. It is essential to cover this region thoroughly before addressing the median, radial, and ulnar nerves.


MSR Median Nerve Release


In this video, Dr. Abelson demonstrates the use of Motion Specific Release procedures to release the median nerve and address common median nerve entrapment syndromes. Entrapment can occur anywhere along its pathway. In this video, we will focus on resolving median nerve entrapment using Motion Specific Release procedures. Carpal Tunnel Syndrome is the most common form of median nerve entrapment.


 

Treatment Frequency Recommendations


Our treatment frequency recommendations for Carpal Tunnel Syndrome (CTS) are thoughtfully designed, reflecting a progressive and adaptive approach. We recognize that CTS, like many conditions, doesn't follow a one-size-fits-all trajectory. Thus, our strategy encompasses distinct phases: acute, subacute, and maintenance care, each tailored to address specific stages of the condition. Regular examination reviews are embedded within these phases, ensuring treatments are precisely calibrated to the patient's evolving needs. This structured yet flexible approach aims to optimize recovery, reduce symptoms, and maintain long-term joint health, all the while emphasizing the criticality of consistent communication between the patient and the healthcare provider.


Acute Care:

  • Objective: Alleviate immediate symptoms, reduce inflammation, and prevent further damage.

  • Frequency: 2-3 times per week.

  • Duration: Typically 2-4 weeks, depending on individual response.

  • Examination Review: At the end of the 2nd week.

    • If the patient shows significant improvement, consider transitioning to subacute care early.

    • If there's minimal to no change, continue with the current frequency and reassess the treatment approach.

Subacute Care:

  • Objective: Consolidate gains from acute care, further reduce symptoms, and initiate the rehabilitation phase.

  • Frequency: 1-2 times per week.

  • Duration: Continuing for the next 2-4 weeks or until the cumulative 4-6 week period is achieved.

  • Examination Review: At the 4th-week mark (from the start of the acute care).

    • If the patient has experienced consistent improvement, transition to maintenance care.

    • If symptoms persist, consider an in-depth re-evaluation to determine if modifications to the treatment or additional interventions are required.

Maintenance Care:

  • Objective: Ensure sustained relief, prevent recurrence, and maintain joint and soft tissue health.

  • Frequency: Once every 2-4 weeks or as needed.

  • Duration: Indefinite.

  • Examination Review: Every two months.

    • If the patient remains stable with no recurrence of symptoms, continue with the current plan.

    • If there's any resurgence of symptoms or new concerns, initiate a thorough examination and adjust the treatment plan accordingly.


Throughout the treatment journey, open communication between the patient and the healthcare provider is paramount. Regular feedback ensures that the treatment remains responsive to the patient's condition and needs.


 

Exercises


CTS is often connected to low aerobic fitness, increased body mass, and lymphatic edema. Therefore, specific exercises should address a diverse range of concerns. When prescribing exercises for CTS, consider several factors and choose exercises that:

  • Relieve compression on the median nerve.

  • Promote improved nerve gliding.

  • Correct postural issues and enhance strength.

  • Improve aerobic fitness.

Below are examples of exercises that we could consider in cases of CTS. Please note these are just a few of the examples we could prescribe.


Median Nerve Flossing

In this video, you'll learn how to perform median nerve flossing exercises to effectively mobilize and release the median nerve from surrounding tissues. Nerve flossing exercises have been demonstrated to reduce pressure on compressed or tethered nerves (17, 18). These exercises are typically recommended for our CTS patients, and they should be performed four or five times per day.


Hands and Thumb - Self Myofascial Release

This self-myofascial release video demonstrates excellent ways to release tension in your hands and fingers. These techniques combine compression, rolling and several pin and stretch procedures.


Wrist Strengthening Exercises at Home

Our wrist strengthening exercises at home are not just about rehabbing wrist injuries, it is about maximizing your grip strength. A stronger grip will boost your overall strength




TAI CHI


Tai Chi is an exceptional form of low-impact exercise with a wealth of research supporting its numerous benefits. Studies have shown that Tai Chi: (25, 26, 27, 28, 29, 30, 31)

  • Enhances balance and cardiovascular health.

  • Boosts neuroplasticity and nerve conduction velocity.

  • Increases bone density.

  • Alleviates pain.

  • Reduces stress (specifically cortisol levels).

  • Improves lymphatic drainage and much more.

Given its wide-ranging advantages, Tai Chi is an excellent exercise option to incorporate into patient exercise routines. The following two videos showcase some Tai Chi-related exercises that can be integrated into your prescribed exercise program.


The first video combines Tai Chi with traditional stretching exercises, while the second focuses on loosening the shoulders and reducing edema. The second is designed to loosen the shoulders and decrease edema.


Tai Chi Computer Break - Releasing Wrist, Hand, and Arm Tension


With the growing trend of remote work, many individuals are spending a significant amount of time working on computers at home. As a result, it is crucial to prevent upper body injuries and maintain good health and mobility. To address this, I have developed a Tai Chi pushing-hands and stretching routine that focuses on releasing tension in the wrists, hands, and arms. This routine involves stretching with motion, which is more effective than static stretches alone. I often combine these movements with nerve flossing exercises to assist patients in their recovery and have seen impressive results.


Tai Chi Shoulder Release


In this modification of “Fair Lady Works at Shuttles”, I show you an easy way to decrease the tension in both shoulders. The research on Tai Chi is pretty amazing in that it: improves balance, and cardiovascular health, increases neuroplasticity & nerve conduction velocity, increases bone density, decreases stress (specifically cortisol), and much more.


Note: Alongside these exercises, we also prescribe suitable strengthening and proprioceptive exercises when we assess that the patient is prepared to undertake them.


 

Braces & Taping


In some cases of CTS, braces can be used to correct biomechanical alignment, which refers to the proper positioning and movement of body parts. Custom-made braces are most effective when they provide three degrees of ulnar deviation (the angle between the wrist and forearm) and two degrees of wrist flexion (a slight bend in the wrist to maintain a neutral position) (12).


CTS patients often experience increased symptoms at night due to wrist bending. A night splint can offer significant relief for many individuals. Since the splint helps keep the wrist in a straight, neutral position, it's important not to tighten it too much, as this can increase pressure on the carpal tunnel and worsen symptoms.


It's important to understand that while braces/splints may help reduce pain in the short term, they don't offer a long-term solution or relief. Using a brace/splint can alleviate pressure on the wrist during lifting or repetitive motions, but constantly wearing it could lead to increased joint stiffness and loss of muscle strength in the arm and wrist.


EQUIPMENT

Wrist Braces at Amazon: https://amzn.to/3Ub02EA



Taping for CTS


Taping can help enhance the stability of the ulnar-carpal joint, which is the connection between the wrist bones and the small finger side of the hand. Moreover, carpometacarpal radial taping, which targets the base of the thumb, can reduce swelling (edema), alleviate pain, and provide support. Taping can also serve as a biofeedback tool, reminding the patient to maintain their wrist in a neutral position when typing or engaging in other repetitive activities (11).


EQUIPMENT

Athletic Tape at Amazon: https://amzn.to/3fjXKEI


 

Conclusion


In conclusion, Carpal Tunnel Syndrome (CTS) is a prevalent condition that can cause significant discomfort and functional limitations. However, with a comprehensive approach to treatment that includes manual therapy, targeted exercises, and lifestyle modifications, many patients can experience substantial relief and avoid surgery. The key to effectively managing CTS is early intervention and understanding the importance of addressing the entire CTS kinetic chain. By incorporating a combination of manual therapy techniques, nerve flossing, Tai Chi, and the appropriate use of braces and taping, individuals can improve their condition and maintain their overall hand and wrist health.


Always consult with a healthcare professional before starting any new treatment or exercise regimen to ensure it is appropriate for your specific needs.



 

DR. BRIAN ABELSON DC. - The Author


Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.

 


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MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.


Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.


Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.


With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!

 

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