Using Sports Massage Therapy as a Complementary Therapy: Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is a neuromuscular disorder with symptoms brought about by an irritation of the median nerve in the wrist. Having CTS can cause pain, tingling, pins and needles, weakness and numbness in the lateral part of the hand, so the thumb, index and middle fingers, and half of the ring finger. Dependant on the severity of CTS, symptoms could include motor problems as well, dexterity can become impaired. It is possible that the thenar pad could flatten as the thumb muscle atrophy. Signs and symptoms gradually worsen often at night when people sleep on the affected arm or turn the wrist awkwardly, so pain is often increased in the morning. Sometimes pain, numbness and tingling can extend to the proximal wrist and forearm. The skin can become less sensitive to touch, and often dry, with colour changes and sometimes swelling.
The symptoms of CTS are caused by the entrapment of the median nerve between the carpal bones in the wrist and the transverse carpal ligament that holds down the flexor tendons. It can be caught, pinched or squeezed in between these surrounding structures. It is a common occupational hazard for massage practitioners and other people who perform repetitive movements of the wrist, such as typing on a keyboard, playing string instruments, or working using a cash register or on an assembly line. Women, due to this cavity between structures using being smaller than that of a man, are more susceptible to problems occurring and developing CTS. Less irritation to the area would be required to lead to the symptoms of this condition presenting. Certain health conditions appear to increase the chances of CTS developing, such as arthritis, due to joint inflammation, and diabetes. Injuries such as sprains and fractures of the wrist could also lead to symptoms following swelling placing pressure on the median nerve.
CTS is predominantly attributable to nerve dysfunction caused by chronic mechanical compression of the median nerve. Compression like this can also cause ischemia, so a reduced number of nerve messages are sent and received, as well as an inadequate supply of blood to the nerve cells themselves.
Unless untreated and prolonged ischemia occurs, causing irrepairable damage to the nerve, most cases of CTS can be managed with small alterations to day to day living. A splint can be worn to help keep the wrist in a neutral position, where the carpal tunnel is in a position where the most space is available for the median nerve to sit without compression. Anti-inflammatories and corticosteroid can help in the supporting tissues and structures, reducing swelling and inflammation, therefore increasing the space available for the median nerve to lay in. Complementary therapies can also help, by stretching and mobilising the tight tendons in the wrist. If chronic, surgery can be successful by splitting the transverse carpal ligament. CTS can affect every day activities, so treatment should be sought to reduce symptoms. Small changes, especially in the workplace, such as more ergonomic machinery or positioning can make a huge difference to the severity of pain experienced.
Massage to proximal muscles, tendons and ligaments, as well as fascia, can be beneficial and improve strength and function, therefore decreasing symptoms presented. Specific work to the hand, wrist, arm and shoulder can help to have a positive effect on the decompression of the median nerve by helping to open up the space in which it runs through.
Occupational therapy could help to find a way to reduce the identified factors that exacerbate symptoms and irritation to the median nerve and should be explored if not done so already. Prevention of symptoms occurring should definitely be addressed to avoid progression of CTS for a client being chronic. Physiotherapy and stretching would also have positive effects.
If you think Sports Massage Therapy could help and benefit you, please contact me.