Physiotherapy is an effective treatment for carpal tunnel syndrome, a medical condition that causes pain and numbness in the hand and wrist. Through specific exercises and stretches, physiotherapists can help reduce the symptoms of carpal tunnel syndrome, improve grip strength, and increase range of motion.
As with all injuries, this information is simply a guide, and it is always best to check in with a Physiotherapist or Athletic Therapist to have a personalized assessment and hear recommendations for what you and your body may specifically need.
Physiotherapy can be an effective treatment for CTS, helping to reduce pain, improve grip strength, and prevent further injury. This article outlines what physiotherapists should consider when treating patients with CTS and how physiotherapy can help improve outcomes for people with this condition.
Carpal tunnel syndrome (CTS) is a medical condition caused by the entrapment of the median nerve in the carpal tunnel, a narrow passageway at the wrist. It results in pain and dysfunction of the hand, wrist, and forearm. The prevalence of CTS increases with age and is twice as common in women as in men. An analogy can be made to a garden hose that has been pinched; when water is flowing through it, pressure builds up until eventually it bursts and causes flooding. Similarly, when the median nerve is compressed within the carpal tunnel, it causes symptoms such as numbness, tingling, and pain which can worsen if not treated properly.
Physical therapy can be an effective treatment for CTS. A physiotherapist will assess your elbow and shoulder joints to identify any restrictions that may be causing compression of the median nerve at these levels. They will also provide education on preventing CTS from recurring, including exercises to increase mobility in the wrist joints, stretching exercises for tight muscles around the thumb and fingers, and postural advice to reduce strain on the joint structures at work or during leisure activities. Additionally, they will recommend lifestyle changes such as taking regular breaks from activities involving repetitive use of your hands (e.g., typing). With proper treatment from a physiotherapist, individuals with CTS can expect improved function, reduced pain levels, and decreased risk of recurrence.
The causes of CTS can be divided into two categories: biomechanical factors and health conditions.
Biomechanical factors include repetitive wrist motions, such as typing or using a computer mouse for long periods, holding one's wrists in awkward positions, and carrying heavy loads with one's hands. These activities can increase tension on the tendons in the carpal tunnel and cause them to swell, compressing the median nerve. Health conditions that increase one's risk of developing CTS include diabetes, arthritis, pregnancy, obesity, and thyroid problems.
The treatment for CTS depends on its severity. Mild cases can often be managed with lifestyle changes such as taking regular breaks from repetitive activities and wearing a wrist brace. For more severe cases, physical therapy techniques like massage, stretching exercises, and nerve flossing may be recommended to reduce swelling in the carpal tunnel and improve the range of motion in the affected area. In some cases, surgery may be necessary to create more space within the carpal tunnel to relieve pressure on the median nerve.
Symptoms typically begin gradually and are often worse at night or during certain activities. Pain relief can be achieved by wearing a wrist brace or splint at night, taking breaks from activities involving repetitive wrist and fingers motion, and avoiding activities that increase pressure on the median nerve. Physiotherapists can provide exercises to improve flexibility in the hand muscles and facilitate wrist flexion. Other treatments may include ultrasound therapy, laser therapy, electrical stimulation, manual therapy techniques such as soft tissue massage, joint mobilization/manipulation, Kinesio taping, and acupuncture. In addition to symptom relief through these treatments, physiotherapists will educate patients on how to modify their daily activities to prevent further aggravation.
Diagnosis of carpal tunnel syndrome includes a clinical examination which may include special tests to assess the median nerve and muscles. Physiotherapy for CTS involves conservative treatment such as wrist flexion, stretching, and strengthening exercises. In cases where the patient has rheumatoid arthritis, splinting in a neutral position may be beneficial.
The physiotherapist will also evaluate the patient's posture and workplace ergonomics to identify any potential risk factors that may have contributed to their CTS symptoms. The therapist may also advise lifestyle modifications such as avoiding prolonged activities aggravating symptoms and providing education on self-management strategies. Follow-up visits are usually scheduled to monitor progress, review prescribed exercises and reinforce the education provided. If conservative management fails, referrals for further medical intervention might be indicated.
If carpal tunnel syndrome is the cause of your symptoms, your Physiotherapist will work to mobilize the joints in the area, reduce tension in the surrounding tissues and correct any muscle imbalances that are contributing to your condition. When pressure is removed from the median nerve, pain and symptoms are decreased or eliminated.
Your Physiotherapist or Athletic Therapist will also provide you with customized exercise and postural strategies to help you recover from the injury and help prevent the issue from recurring.
Your Physiotherapist or Athletic Therapist will instruct you on the best options for reducing inflammation at home. Quite often ice, heat or contrast through either packs or water immersion are recommended in either acute or chronic inflammation control.
Physiotherapy is an effective treatment for carpal tunnel syndrome due to its capacity to reduce chronic symptoms. Treatment usually begins with positioning the upper extremity in a neutral position so that the pressure on the median nerve is minimized. Then, a physiotherapist may use different treatments such as massage, joint mobilization, and stretching exercises to decrease repetitive strain on wrist and hand muscles and tendons.
In addition, strengthening exercises can be used to improve muscle performance and endurance, as well as postural correction techniques. Therapeutic modalities such as ultrasound or transcutaneous electrical nerve stimulation (TENS) may also be applied to decrease pain levels. Moreover, splinting can maintain the median nerve in a neutral position during sleep or work activities, which may increase carpal tunnel syndrome symptoms.
Overall, physiotherapy is an effective treatment for carpal tunnel syndrome by reducing chronic symptoms and providing patients with techniques to prevent worsening of their condition.
Splinting and bracing are two common forms of carpal tunnel physiotherapy used to reduce pain, inflammation, and numbness associated with carpal tunnel syndrome. Splints can be worn for various activities, including typing, sports, or other manual tasks. Braces provide more stability than splints and can be used for more strenuous activities such as weightlifting.
The following are five considerations for splinting and bracing:
- The material should be lightweight and breathable
- It should provide a snug fit without binding or pinching
- It should not limit movement or cause additional discomfort
- It should stay in place during the activity
- It should not interfere with the healing process.
When deciding whether to use a brace or splint, it is important to consider the patient's lifestyle and activities. For instance, if the patient is involved in vigorous physical activity, they may benefit from a brace, while those who engage in less strenuous activities may benefit more from a splint. Patients may also require custom braces or splints depending on the severity of their carpal tunnel syndrome symptoms. Ultimately, the best way to determine which type of support is needed is through consultation with a qualified physiotherapist experienced in treating carpal tunnel syndrome. With the right treatment plan and support device in place, patients can gain symptom relief and return to their normal routine with improved function.
Median nerve flossing is a simple exercise that can help prevent or reduce the severity of the symptoms associated with CTS. It involves moving the median nerve through its full range of motion, often using a towel or band to provide resistance to the motion.
When performing median nerve flossing, it is important to start slowly and progress gradually as you become comfortable with the movement. Start with your arm at your side and slowly move it up overhead while resisting against the towel or band. Then bring the arm back down to your side while maintaining tension on the towel or band. This exercise should be repeated 10-15 times per session, two to three times daily.
Taking caution when performing these exercises is essential as they can cause increased pain if performed incorrectly. If you experience increased pain during any part of this exercise, stop immediately and consult a physiotherapist for further advice before continuing. Physiotherapists are experts in treating CTS and can provide individualized guidance on properly performing median nerve flossing for maximum benefit and safety.
Registered Massage Therapy can also be used in the treatment of a carpal tunnel syndrome. Massage Therapy can help relieve muscle tension that may be putting pressure on the median nerve and can also help to release muscles that have tightened up due to improper nerve conduction.
With your elbow straight, bend the wrist and turn the hand slightly outward (pronation).
Using your opposite hand, add a little pressure over the second knuckle and keep your fingers curled in your hand.
Hold the stretch for about 20 seconds.
With your elbow straight and your palm facing up (forearm in a supinated position), extend the wrist and grab the fingers with your free hand.
Gently pull your fingers and wrist in extension toward the floor.
Hold the stretch for about 20 seconds.
Hold a hard ball, such as a Lacrosse ball, between both hands and roll it around while pressing your hands together to massage the palm with the ball.
You can also roll the ball on a countertop with one hand at a time.
Put your forearm on a ball.
Turn your palm to massage both sides of the forearm.
Roll the ball slowly under your forearm focusing on tender spots.
Put your forearm on a ball.
Turn your palm downward to massage the underside of the forearm.
Roll the ball slowly under your forearm focusing on tender spots.
Place your forearm along an armrest or table with wrist hanging over the edge and palm facing up.
With a weight in your hand, lift the hand towards the ceiling.
Lower slowly and repeat.
Hold a weight in your hand and rest your forearm on a table with, so your wrist is over the edge-palm facing down.
Lift the weight up while keeping your forearm on the table.
Then, slowly lower the weight completely.
Repeat the exercise.
Carpal tunnel syndrome is typically caused by excessive repetitive motions or long duration static holds of the wrist. It is most common in factory workers or those that work at a computer, but can also happen in sports such as tennis from gripping the racquet. Avoiding excessive prolonged postures of the wrist or use is the best way to prevent carpal tunnel syndrome.
The fastest way to heal from carpal tunnel syndrome is to address the condition as quickly as possible once symptoms arise. Seeking help from a Physiotherapist or Athletic Therapist right away can get you on the path to healing.
In some cases, where conservative treatment is not providing results, you will be referred to a Sports Medicine Physician who may consult with you on the possibilities of surgery or injections.
Inertia Physio+ offers Kanata and Stittsville exceptional Physiotherapy, Athletic Therapy and Registered Massage Therapy with private treatment rooms, one on one care, a maximum of two patients per hour and treatment focused on the evidence-based practices of manual and exercise therapy. Don’t suffer any longer. If you have pain or injury, our Kanata and Stittsville Physiotherapy, Athletic Therapy, and Registered Massage Therapy team is here to help you get back to living pain-free life and activities. Please reach out to us at (613) 672-2200 or info@inertiaphysio.ca for an appointment today! You are also welcome to book online. We also offer direct billing on Physiotherapy and Massage Therapy services whenever your plan allows.
