Carpal Tunnel Techniques

[orlando_salcido]

I have a client who was just diagnosed with Carpel Tunnel. She asked me if I could do a specific treatment for CT. Is there one? What kind of techniques, and stretchs can I do to ease her symptoms? I want to help her. Thanks for your advice!

Jen

 

[This is my avatar]

cts treatment

There is a video that is called Heal Your Wrist Pain about CTS. I have it.. it is a good starting point.. pretty basic, but effective. You can order it online.

 

[Soldiergeneral]

The video cosmictouch recommended is available through massagewarehouse.com or from it's creator, Sean Reihl at http://www.realbodywork.com.

Here's a link to the section about the video:
http://www.realbodywork.com/wrist/wrist.htm

You might want to look into brachial plexus syndrome as well, as some people actually have a problem in both areas. I read once that 80 percent of people diagnosed with CTS have a problem higher up in their neck or shoulders.

In addition, Sean has his own message board which you might want to check out. But CTS does not appear to be addressed much there. Feel free to check it out, though I have to comment it doesn't appear to be as well moderated as our forum here @ MassagePlanet!
http://www.deeptissue.com/cgi-bin/yabb/YaBB.cgi

 

[Mike Hunt]

Something else that will help carpal tunnel syndrome is good massage work over the carpals into the forearm and into the thenar eminence and center of the palm. After doing that intertwine your fingers with those of your client and gently rotate the wrist clockwise and counterclockwise using a slight stretch at the same time. Place a finger under the wrist and gently flex and extend the wrist using the same hand hold.

This martial arts stretch of the hands also assist in keeping the wrists loosened and working smoothly. I've been doing it since I was in massage school and have had no recurrence of CTS since I learned it.... and I have worked more hours than I care to number as a waitress, bartender, and secretary since then while in school [and for a while after] with no repeat of CTS since doing this stretch.

place hands together in "prayer" fashion, chest level with arms held at chest height as well - fingers pointing upwards. gently push heels of hands together and rotate hands backward so that the tips of the fingers are now pointing toward your chest. it can hurt like crazy, but, keep the heels of the hands together if at all possible -- if not possible, get them as close together as you can. KEEP YOUR SHOULDERS RELAXED!!! that will help facilitate turning the hands toward the chest. this will stretch the wrists, the forearms, and even up into the arm itself if the person is really tight.

For all of my clients with CTS I have done the massage routine given above and taught them the stretch given above and 3 others I learned from a martial arts instructor that I cannot describe, but can demonstrate. None of them have had repeats of the CTS if they do the stretches on a semi-regular basis.

OH! try having the client learn to stretch the wrists by placing hands palms down on a flat surface and then bring the forearms/body to a 90 degree angle while keeping the hands flat...... hopefully you'll understand what I mean with that weird description.

Best of luck,
J

 

[Boba Fett]

Michael Young's mrtherapy course or repetitive use injury teaches ways to deal with carpal tunnel. You can visit his website at http://www.mrtherapy.com. There is a video on there specifically for carpal tunnel that I'm sure is easy to follow.

I attended his class several years ago and I can't even tell you how many people have come to me with carpal tunnel who don't suffer it anymore. One client ( a couple years ago) of mine wrote for the local newspaper and came to me with carpal tunnel, he'd suffered for eight years and was about to have surgery. After several weeks of doing the self-stretches, he no longer suffers it and on Thanksgiving, he wrote an article thanking me in the paper! Needless to say, it brought me a lot of business. The only times there wasn't effect was because of a doctor misdiagnosed the pain when it was really from the pec's or scalenes. But working there will bring relief.

Using the self-stretches, after giving at least two thousand massages, fortunately haven't had any of the wrist, shoulder problems that many therapists suffer. Just can't say enough good things about that technique!!

**just want to add, this isn't a cure-all or the one and only modality but its a great accompaniment to anything you do**

 

[Aubrey]

Ring/Write the Biofreeze people and ask them for their Prossage sample and DVD. It's FREE!
There is a nice mini hand/arm treatment on it.

RObyn

 

[Mike P]

Thank you! Thank you! Thank you everyone for all the great advice. I needed it and I'll check out all the DVD's you mentioned.

Jen

 

[jerem]

Don't chase the pain! In other words, just because a person has pain/numbness in the carpal tunnel does not mean that's where the problem is coming from. In most cases the problem is actually caused by tight pectorals, specifically pec minor, which impinges on the brachial plexus. You can massage the carpal tunnel all day and the problem will not resolve because it's actually caused higher up. Start by releasing the shoulder girdle and pectorals first (look for a low/anterior shoulder on the ipsilateral side of the pain) and the problem is usually resolved quite rapidly. People who work at a desk or computer all day will have anteriorly rotated shoulders and tight pecs. Educate your clients to do stretches at home EVERY day to counteract the forward shoulder/forward head position they most likely have that's causing the problem.

 

[Pompal 09.]

Educate your clients to do stretches at home EVERY day to counteract the forward shoulder/forward head position they most likely have that's causing the problem.

what are the stretches you recommend? this is the only good one i know of http://www.exrx.net/Stretches/ChestGeneral/Doorway.html

thanks

 

[Tressa Marie]

If there is swelling in the wrists/hands because of the CT syndrome, there is a "home remedy" that works quite well, learned it from an instructor in massage school when my R hand cramped up like a crab claw in practicum class one night.


Cut a 3 inch wide strip of flannel [cotton or wool], pour castor oil onto it until the flannel is wet, not squishy [easiest to roll up like an ace bandage for this part]. Wrap this flannel strip around the hand/wrist as one would for a sprained wrist. Wrap a strip of plastic wrap [OR, put a plastic glove w/ fingers cut off] around wrist in same fashion, being VERY CAREFUL not to wrap too snugly, THEN, wrap with ACE bandage, or cover w/ cotton glove minus fingers, or an old sock with appropriate holes for fingers.

Wear this concoction over night. THe extra layerings over the original flannel wrap keep the circulation to the area boosted thus increasing the decrease in swelling. AND, the linoleic acid in the castor oil has a mild analgesic and anti-inflammatory property of its own. In the morning, take the whole concoction apart. Put the flannel strip in a "zippie" bag, throw it in the fridge till that night, put in on again - try 3 to 4 days minimum.

Worked like a charm for me when I was in school for my wrists, and does wonders for ankle, knee, and elbow problems as well.

FWIW

 

[Paco]

Everyone has covered everything quite well so far. I will repeat those things that I agree with for completeness.

- CTS is often misdaignosed. Radiculopathies can be caused anywhere upstream from the wrist due to nerve and/or vascular entrapment or compression. Starting at the spine, subluxation or a herniated disc could be reducing the space of the intervertebral foramen, causing nerve compression.

Next in line is the often forgotten ANT and MID scalenes entrapment point. Strip them both, and teach diaphragmatic breathing. Downstream from that is the pec minor point, strip both pecs and teach facilitation and strengthening excercises for scapular retractors, and stretches for pecs.

The upper arm has no pinch points, everything is soft and has a large amount of play.

Next is where the nerves run under pronator teres. Remember how you'd break a pencil in grade school by weaving it under and over the first three fingers and smacking it on the desk. same thing. it runs under, then over. Strip pronator teres while the client does active movement. Shorten it first, get a bite on teres with your reinforced thumbs, and have them move through supination, wrist extension, and finally elbow extension. Start position is the opposite of these.

I would do no more than these three points in one session, and see how it goes. If there are decreased pain and paresthesias on reassessment, continue like this. Even if the source is upstream, this may have caused actual inflammation in the tunnel, so work here some too. Think PROM, lymph drainage, and joint mobes, esp to each carpal you can get your fingers on.

Be careful about how you tell your client this, but the surgical procedure of cutting the flexor retinacula will usually lead to more inflammation, and more scar tissue, and then a further decrease in space in the tunnel. Which makes it worse than they started off as. Go figure.

I love the concoction someone suggested. I don't get into anything but water and hydrotherapy, so maybe I could start learning about these fancy oils and such.

Hope this helps, I can clarify and expand on anything if necessary.

Pearl