Resolving Carpal Tunnel Syndrome – PART 2
Updated: Oct 14
A restful night, a comfortable grip, or the ability to work without tingling in your fingers can make a meaningful difference to daily life. For someone with carpal tunnel syndrome (CTS), treatment is about protecting hand function and returning to the activities that matter.
In Part 1 of our Resolving Carpal Tunnel Syndrome series, we explored symptoms, anatomy, and assessment. Part 2 examines conservative care options, including manual therapy, appropriately selected exercises, activity modifications, and wrist splints.
The accompanying videos demonstrate MSR procedures and exercises that practitioners may consider within an individualized treatment plan. The choice of care depends on symptom severity, examination findings, and response to treatment. Regular reassessment helps determine whether conservative management remains appropriate or whether specialist evaluation is needed.
Article Index:
Manual Therapy for CTS
For those with mild to moderate Carpal Tunnel Syndrome, manual therapy offers a highly effective, non-invasive treatment option. Often, it delivers noticeable improvements within just 4-6 weeks, sometimes even sooner. Surgery should only be a last resort if progress stalls after consistent therapy.
Manual therapy focuses on nerve mobilization, nerve gliding exercises, and targeted mobilization of the carpal bones, providing significant relief for most patients. Regularly monitoring your progress and consulting with a medical professional ensures your treatment stays on track and can be adjusted as needed.
Three Strong Reasons to Choose Manual Therapy First
Before considering surgery, here are three compelling reasons to try manual therapy:
Enhanced Pain Tolerance: Studies reveal that manual therapy significantly increases pain-pressure thresholds, meaning patients experience less pain sensitivity and can handle more pressure before discomfort sets in.
Relief Through Structural Change: Research shows that manual mobilization of the carpal bones can alter the dimensions of the carpal tunnel, effectively reducing pressure on the median nerve.
Comparable Long-Term Outcomes: After one year, patients who received manual therapy combined with exercise showed outcomes similar to those who underwent surgery. Even better, manual therapy often provides faster relief within the first month than surgical intervention.
Treatment Demonstrations
In the three videos below, we showcase techniques commonly used at Kinetic Health to enhance the mobility of the median nerve along its entire pathway, from the neck (cervical spine) to the hand—going beyond just the carpal tunnel area. Additionally, the fascial expansion video blends fascial manipulation with the powerful benefits of acupressure.
Brachial Plexus Release
In this video, we demonstrate MSR techniques to release the nerves connecting the neck to the shoulder, focusing on the cervical plexus, brachial plexus, and neurovascular sleeve. Properly addressing this area is essential before targeting the median, radial, and ulnar nerves, ensuring a comprehensive approach to relieving Carpal Tunnel Syndrome.
MSR Median Nerve Release
In this video, Dr. Abelson showcases how Motion-Specific Release (MSR) techniques are used to effectively release the median nerve and tackle common entrapment syndromes. While Carpal Tunnel Syndrome is the most common, entrapment can occur along the entire nerve pathway. This video highlights the use of MSR techniques to resolve median nerve entrapment comprehensively.
Fascial Expansion: MSR Wrist & Hand Protocol
This video demonstrates how fascial expansion techniques can effectively treat wrist and hand pain by integrating a modern understanding of fascia, kinetic chain relationships, and principles from acupuncture and traditional Chinese medicine. We explore how fascial layers connect with acupuncture points such as PC7, LU9, TH4, TH5, LI4, LI5, and SI4 to target and alleviate symptoms of Carpal Tunnel Syndrome.
Tailored Treatment Frequency CTS
Treatment Phases Overview:
Our approach to treating CTS is customized to each patient's needs, progressing through acute, subacute, and maintenance phases. We regularly reassess progress to ensure treatments are effective, aiming to reduce symptoms and promote long-term joint health.
1. Acute Phase
Goal: Relieve immediate symptoms and reduce inflammation.
Frequency: 2-3 times weekly for 2-4 weeks.
Reevaluation: At week 2. Transition to subacute care early if significant improvement; otherwise, continue current plan.
2. Subacute Phase
Goal: Build on acute care progress and begin rehabilitation.
Frequency: 1-2 times weekly for the next 2-4 weeks.
Reevaluation: At week 4. If consistent improvement, transition to maintenance; if symptoms persist, adjust treatment.
3. Maintenance Phase
Goal: Maintain symptom relief and prevent recurrence.
Frequency: Once every 2-4 weeks.
Duration: Ongoing.
Reevaluation: Every two months. Adjust plan if symptoms recur.
This structured, adaptive approach ensures optimal outcomes and long-term relief for CTS patients.
Exercises for Carpal Tunnel Syndrome
CTS is often linked to low aerobic fitness, increased body mass, and lymphatic edema. Therefore, exercise programs should address a diverse range of concerns. When prescribing exercises for CTS, consider the following factors and select 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 we recommend for CTS. These videos showcase just a few of the exercises 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 shown to reduce pressure on compressed or tethered nerves, making them an essential part of our treatment plan for Carpal Tunnel Syndrome (CTS) patients. These exercises are typically recommended four to five times daily for optimal results.
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; they are about maximizing your grip strength. A stronger grip will boost your overall strength.
Tai Chi for Carpal Tunnel Syndrome
Tai Chi is an exceptional low-impact exercise with extensive research supporting its numerous benefits, making it an excellent addition to Carpal Tunnel Syndrome (CTS) treatment. Studies have shown that Tai Chi:
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 these advantages, Tai Chi is a fantastic exercise option for patients. The following two videos showcase Tai Chi-related exercises that can be integrated into your CTS exercise program.
The first video combines Tai Chi with traditional stretching exercises, while the second focuses on loosening the shoulders and reducing edema.
Tai Chi Computer Break
As remote work increases, so does the risk of upper body injuries like Carpal Tunnel Syndrome (CTS). To address this, I've developed a Tai Chi pushing-hands and stretching routine that effectively releases tension in the wrists, hands, and arms. This dynamic routine, combined with nerve flossing exercises, has shown impressive results in preventing and alleviating CTS symptoms, helping patients maintain health and mobility.
Tai Chi Shoulder Release for Carpal Tunnel Syndrome
In this modification of "Fair Lady Works at Shuttles," I demonstrate an effective method to reduce shoulder tension, which can indirectly benefit those with Carpal Tunnel Syndrome (CTS). Research on Tai Chi shows impressive benefits, including improved balance and cardiovascular health, increased neuroplasticity and nerve conduction velocity, enhanced bone density, and reduced stress (specifically cortisol).
Braces & Taping for Carpal Tunnel Syndrome
Braces and taping can help correct biomechanical alignment in Carpal Tunnel Syndrome (CTS) by maintaining proper wrist positioning. Night splints, in particular, can relieve symptoms by keeping the wrist straight, but they must not be too tight, as this can decrease blood flow and oxygen, worsening the condition. While effective for temporary pain relief, prolonged braces use can lead to joint stiffness and muscle weakness, so they should be used cautiously.
Conclusion
Managing carpal tunnel syndrome begins with understanding how symptoms affect your sleep, hand function, and everyday activities. Conservative care may help some people manage symptoms, but treatment should be guided by measurable progress rather than a fixed schedule or commitment to one technique.
Useful signs of improvement include fewer nighttime awakenings, reduced tingling, and greater comfort during daily tasks. Exercises, splints, and hands-on care should be adjusted to your response, with reassessment when improvement stalls or symptoms worsen. Persistent numbness, progressive weakness, or wasting of the muscles at the base of the thumb requires prompt medical assessment.
The goal is to preserve nerve function and restore dependable use of your hand. A collaborative approach helps you make informed choices, including recognizing when surgical consultation may offer the most appropriate next step.
References
American Academy of Orthopaedic Surgeons. (2024). Management of carpal tunnel syndrome: Evidence-based clinical practice guideline.
Bueno-Gracia, E., Ruiz-de-Escudero-Zapico, A., Malo-Urriés, M., Shacklock, M., Estébanez-de-Miguel, E., Fanlo-Mazas, P., Caudevilla-Polo, S., & Jiménez-Del-Barrio, S. (2018). Dimensional changes of the carpal tunnel and the median nerve during manual mobilization of the carpal bones. Musculoskeletal Science and Practice, 36, 12–16.
Chammas, M., Boretto, J., Burmann, L. M., Ramos, R. M., dos Santos Neto, F. C., & Silva, J. B. (2014). Carpal tunnel syndrome: Part I (anatomy, physiology, etiology and diagnosis). Revista Brasileira de Ortopedia, 49(5), 429–436.
Coppieters, M. W., Hough, A. D., & Dilley, A. (2009). Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: An in vivo study using dynamic ultrasound imaging. Journal of Orthopaedic & Sports Physical Therapy, 39(3), 164–171.
Fernández-de-las-Peñas, C., Arias-Buría, J. L., Cleland, J. A., Pareja, J. A., Plaza-Manzano, G., & Ortega-Santiago, R. (2020). Manual therapy versus surgery for carpal tunnel syndrome: 4-year follow-up from a randomized controlled trial. Physical Therapy, 100(11), 1987–1996.
Fernández-de-las-Peñas, C., Cleland, J., Palacios-Ceña, M., Fuensalida-Novo, S., Alonso-Blanco, C., Pareja, J. A., & Alburquerque-Sendín, F. (2017). Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial. European Journal of Pain, 21(7), 1266–1276.
Fernández-de-las-Peñas, C., Ortega-Santiago, R., de la Llave-Rincón, A. I., Martínez-Perez, A., Fahandezh-Saddi Díaz, H., Martínez-Martín, J., Pareja, J. A., & Cuadrado-Pérez, M. L. (2015). Manual physical therapy versus surgery for carpal tunnel syndrome: A randomized parallel-group trial. The Journal of Pain, 16(11), 1087–1094.
Karjalainen, T. V., Lusa, V., Page, M. J., O’Connor, D., Massy-Westropp, N., & Peters, S. E. (2023). Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2023(2), CD010003.
Lusa, V., Karjalainen, T. V., Pääkkönen, M., Rajamäki, T. J., & Jaatinen, K. (2024). Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2024(1), CD001552.
Page, M. J., O’Connor, D., Pitt, V., & Massy-Westropp, N. (2012). Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2012(6), CD009899.
Werner, R. A., & Andary, M. (2002). Carpal tunnel syndrome: Pathophysiology and clinical neurophysiology. Clinical Neurophysiology, 113(9), 1373–1381.
Yeh, G. Y., Wang, C., Wayne, P. M., & Phillips, R. (2009). Tai chi exercise for patients with cardiovascular conditions and risk factors: A systematic review. Journal of Cardiopulmonary Rehabilitation and Prevention, 29(3), 152–160.
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The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
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DR. BRIAN ABELSON, DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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