Carpal Tunnel Syndrome – Another Point of View
Saving Our Own Hands and Arms
By Stuart Taws, LSSM Dip Hon
Back in the early 90's I wrote articles for our Massage Magazines on Carpal Tunnel Syndrome. This resulted in considerable research to verify the devastating effect upon the individual and the monetary cost to insurance companies and loss to the productivity of the nation. Ten and twenty years later have there been significant improvements in the treatment of a daily painful experience that effects millions of hard working women and men as they have to use their keyboards eight hours a day?
It is still true that Carpal Tunnel Syndrome (CTS) costs billions of dollars in treatment and lost work time each year and causes undue stress and suffering to millions of people. That is 50 out of every 1000 or 3% of the total population. It is also true that CTS is a misnomer as this is a whole nerve entrapment syndrome.
After the many wondrous improvements in the medical world dealing with the most serious of conditions and diseases, have their been any improvements in dealing with CTS? The medical approach is still mechanical and focuses on the 'tunnel' and the specific site of pain.
The first recommendation by the medical community is to stop the activity that causes the pain, but many cannot simply stop working. As a Massage Therapist and perhaps a single mother, if you have hand and wrist pain, can you simply stop work until such time as the pain 'goes away'. No, the first line of recommendation to stop work is just not viable. Anti-inflammatory medications such as Ibuprofen, Naproxen, and the infamous Celebrex and Viox, along with wrist splints and bracing are prescribed. Next steroid injections at the site and perhaps physical therapy with a strengthening regimen (which can make the problem worse). Finally the inevitable surgery.
"Because the problem is not in the wrist the failure rate of surgery is calculated to be between 50 – 70% "(Lehey and Mock)
"After a one year follow up steroid injection failure rate is 72%" (Irwin et al Journal of Hand Surgery) Pain returns in two to four months for most people.
"Failure rate of Wrist Splints and Anti-Inflammatory Medications is 82.6%. Curative rate is 18.4%". (Kaplen et al)
The National Institute of Occupational Safety and Health reported that only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous professions following surgery. If they can return to work it is not before four weeks. The Bureau of Labor Statistics determined that CTS is the second longest reason for time away from work (28 days) next to major disabling diseases and illnesses in all private industries.
"Carpal Tunnel surgery has about a 57% failure rate following patients from 1 day to 6 years. At least one of the following symptoms re-occurred during this time, pain, numbness and tingling sensations." (Nancolas et al Journal of Hand Surgery)
"Surgery should be considered as the initial form of treatment when patients are diagnosed with CTS confirmed by nerve conduction studies because surgery provides symptom resolution with a favorable cost analysis". (David A Fuller, Director of Hand Surgery, Cooper University Hospital, New Jersey.)
The research group Balance Systems Inc reported that surgeons will make between $4,000 to $5000 for each 30-minute surgical procedure, so it is presumed that this is more cost effective than 'lengthy' non-surgical recovery.
How successful are the non-surgical recommended therapies? Over 200,000 CTS surgeries are performed each year; so all the above alternative suggestions fail 200,000 times a year. Can we ask a more personal question, are you in hand or arm pain? How can we take clients out of pain if we ourselves are in pain? It diminishes our power of intention and personal energy.
It is too easy to point out how the traditional approaches to CTS are failing on a daily basis, but how about us, how effective are we taking our clients out of pain quickly with long lasting results?
Obviously we need not only to work on the hand and wrist, there is the need to follow the Median nerve up through the flexors, through the distal brachial plexus, the pecs major and minor, the scalenes and posterior cervicle neck muscles. What is an effective way to work these muscle groups.
We all use pressure in our work and we all use stretch. Can we modify both of these and use them at the same time in such a way that we obtain a predictable fast release?
The pressure should be light and moving all the time. Deep pressure work is contraindicated for injury. The pressure is lightly applied during a stretch that lasts no longer than one second or a second and a half.
Any stretch longer than that evokes the stretch reflex so that the CNS is working against you. (Ref: Aaron Mattes and Active Isolated Stretching.) Never hold a stretch more than a second or two. After a second or two you release the stretch go back to the starting position and repeat.
So consider any stretch of any muscle group, the hand flexors or extensors for example, the stretch is momentary and light with slight gliding pressure through the muscle length At the end of the stretch, which lasts only a second, you resume the original flexed position and repeat.
All the traditional stretches for the flexors look good, but the devil is in the details. No matter what you have told about how long to hold a stretch, consider this. I was told twenty years ago that if you didn't hold a stretch for thirty seconds it was useless. Technology has moved along. Repetitions of a one second stretch are far more effective, believe me, this is tried and tested.
Try this for yourself. Standing by your table extend your arm with the back of your hand facing down toward the floor. As much as you can, actively take the back of your hand down toward the floor so that the tips of your fingers then catch the edge of the table. As you gently lean into the stretch use slight pressure with the other thumb or fingers, gliding down the flexors and over the wrist and into the hand. This lasts only a second. Go back to the original flexed position and repeat. You can train your client to do this ten or twelve times several times a day just sitting at their desk. Their Carpal Tunnel problem will be gone in a week never to return. Do this for yourself even if you think you don't need to, you will be surprised how tight this feels and it will prevent problems down the line.
I wish you well,
Stuart Taws LSSM Dip Hon