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Most Effective Carpal Tunnel Massage

Dr. Z • Apr 13, 2020

How Carpal Tunnel Massage Works

There's one question patients always ask me about carpal tunnel massage: Does it really work? The answer is "Absolutely Yes, but you must use the right kind of massage."


Doctors and therapists know massage therapy will help patients with carpal tunnel syndrome. But not just any old massage can be used. It must a treatment known as myofascial release massage. 


I'll explain how this massage works below. Then you'll see that it not only helps relieve carpal tunnel symptoms but it's the best way to get rid of this condition permanently.


The agony of carpal tunnel syndrome

Symptoms of carpal tunnel syndrome typically include numbness or pain in your hand or fingers. Maybe your fingers or hand tingle (also called "pins & needles") or burn.


In the beginning, finger numbness usually keeps patients up at night as they try to shake it out. If the little (pinky) finger feels normal, then you have the classic signs of carpal tunnel syndrome. 


Without treatment, carpal tunnel symptoms almost always worsen. Typically symptoms go from mild to severe in 6-12 months. And in 80% of patients, the condition occurs in both hands (called bilateral carpal tunnel syndrome).


A big topic in medicine today is how to treat this condition without having carpal tunnel surgery. The answer that keeps coming up is myofascial release massage. It's the “go-to” remedy prescribed by doctors and physical therapists for lasting carpal tunnel relief. 

When to use carpal tunnel massage

Unlike an ordinary pressure massage, myofascial release massage therapy is a reliable treatment for all symptoms of carpal tunnel syndrome. Most physical therapists (and chiropractors) uses it to treat carpal tunnel as well as other neuromuscular disorders.


When can massage help carpal tunnel patients? 


Patients in every stage of carpal tunnel syndrome (even "end-stage") see benefits from carpal tunnel massage using myofascial release. Most patients seek help when they have moderate or severe signs of carpal tunnel syndrome. It’s rarer for patients to have end-stage carpal tunnel syndrome (with non-functional hands) before they seek medical help.


Most people begin a treatment plan that requires once daily massage therapy. The therapy can last for 4-6 weeks. That length of therapy time depends on:

 

  • How bad (or advanced) your carpal tunnel symptoms are, and 
  • How long you’ve had them 
pins & needles

Therapists encourage patients to also perform self-massage at home. This is solely a maintenance treatment because actual myofascial release massage requires TWO hands to do it properly.


Unfortunately, many patients cannot afford visiting a therapist every day for a month or more. In fact, most medical insurance generally pays for only 8-10 visits. Therefore, the patient’s massage treatment regimen might be cut short. 


A full-term (4-6 week) treatment of myofascial massage is necessary. If it's cut short or incomplete, the treatment may not be successful.

How tendons cause carpal tunnel syndrome

tendon illustration

To better understand what carpal tunnel syndrome is, it’s important to know it all starts with damage to your wrist tendons. It’s easy to understand what goes on using a simple model (Figure 1).


Normally tendons glide effortlessly inside their sheath. It’s like a pencil gliding inside a plastic tube. Now think of the tendon’s microscopic surface as smooth and clean, like the pencil. A normal tendon will then slide back and forth effortlessly inside the tube. However, with stressed tendons something else happens.


Tendons are made of microscopic strands of collagen. That’s what creates their smooth surface.  But tendons are also under a lot of mechanical stress. When you overwork your hands, tiny rips occur on some of these collagen strands. With more stress, even more collagen strands rip. Much like what happens when fabric pulls out of a shirt, the collagen retracts and then curls up on the surface.

tendon adhesions illustration

With enough tiny rips and collagen bumps, the tendon’s surface is no longer smooth. As a result, the tendon doesn’t glide smoothly anymore (Figure 2).


The body senses the ripped collagen pieces and tries to repair each strand. In the pencil model, the body tries to fix and flatten the bumps on the pencil. 


But the current theory with carpal tunnel syndrome says there’s a malfunction in how the collagen is repaired. It’s as if the body cannot flatten out the collagen bumps properly. Thus, they continue to stand out and inhibit smooth gliding.

Ripped collagen leads to rough tendons

It’s bad enough that the ripped collagen on the tendon surface prevents smooth gliding. But the more rips and bumps you have, the more roughly the tendon will glide. This causes a cascading effect that makes gliding increasingly more and more difficult.


Making matters even worse, the faulty collagen causes irritation between the tendon and sheath. As a result, the body scrambles even faster to repair the collagen. But in the process, adhesions develop between the collagen on the tendon’s surface and the sheath.


That means there are tiny anchors or "restrictions" between the tendon and the sheath. This further inhibits the tendon’s gliding movement within the sheath.

collagen adhesions

As the tendon tries to glide (when moving a joint) it breaks the adhesions. This rips collagen from the tendon as well as the sheath. Now the body begins to work double-time to repair the tattered surfaces of the tendon and sheath.


But as the tendon continues to glide, more rips and adhesions occur. This is the beginning of a “rip and repair cycle ” that gets worse the more the tendon tries to glide. The “rip and repair cycle” is why it takes so long for stressed tendons to heal.


Moreover, in time this process causes the tendon and sheath to inflame. This means swelling. And that leads to physical expansion of the tendon’s diameter. Therefore, at its root, the tendon swelling is the start of carpal tunnel syndrome.

Carpal tunnel syndrome is all about tendon swelling

As tendons stress, they get damaged and repaired. The body senses there’s injury happening. Under such conditions, the body has a natural defense against further harm called inflammation. Therefore, the “rip and repair cycle” that goes on between the tendon and sheath is the reason for tendon inflammation and swelling.

the carpal tunnel of the wrist

Normally, inflammation is a good thing. It means the body is diverting blood to the concerned area in order to provide nutrients. It’s also carrying away broken and damaged cell components (like broken collagen or even bacteria) from the area. 


Inflammation and swelling also makes the region tender or painful to the touch. That’s so that you leave it alone while it heals.


But the problem in carpal tunnel syndrome is that the inflammation and swelling happens inside a very confined space. This space is called the “carpal tunnel” (green area in diagram at left). It’s actually a passageway formed mostly by a cradle of wrist bones. The roof of the passageway is formed by a tough ligament (Figure 3).


It’s important to understand that the tunnel is rigid and does not stretch apart or expand. In fact, the ligament is what a surgeon cuts during carpal tunnel release surgery to relieve the swelling pressure underneath.

Swollen tendons crush the median nerve

Inside the carpal tunnel space are the flexor tendons, their sheaths, and the median nerve. The median nerve is one of the main nerves providing sensation in your hand.


All of these structures supply your hand and fingers. As the tendons inflame and swell (due to the collagen “rip and repair cycle”) they expand inside this confined carpal tunnel space. 


As they expand, they push against each other and the bony side walls. But the median nerve is caught in the middle. It’s crushed on all sides by the expanding tendons.


Again, visualization helps. Think of the tendons as a tube of toothpaste where the median nerve is the actual toothpaste gel. Squeezing the closed tube increases the pressure many-fold on the toothpaste inside. To be sure, just unscrew the cap and the toothpaste will squirt out. That’s the kind of crushing pressure the median nerve is under.


As the median nerve gets crushed more and more, you feel pain, numbness, tingling, soreness, and weakness in the area the nerve supplies. And that’s why carpal tunnel syndrome patients have those unpleasant feelings in their fingers and hand.

trouble opening a jar

Eventually, the body replaces the defective collagen correctly. It may take several tries and several weeks or even months. But in time fewer and fewer adhesions remain. This is the basis of the healing process.


The speed at which the collagen is properly repaired depends on how stressed the tendon is. If the tendon is mechanically stressed more often during the “rip and repair cycle”, then the healing process is long and drawn out. 

vibration massager

How does carpal tunnel massage help?

To understand how carpal tunnel massage helps this condition it's helpful to visualize the healing process. In effect, daily myofascial release massage artificially rips apart bumps and adhesions between the tendon and sheath. That forces the body to accelerate the repair and healing process. Doing so also accelerates the probability that “correct” collagen is replaced. 


The current thought is that the body eventually “figures out” that it was producing collagen incorrectly. It makes adjustments and then starts making collagen appropriately. This is essentially a trial-and-error process. 


Actually, much of the body’s protein production process follows this plan. Through complex physiological feedback mechanisms, an inappropriate protein is usually flagged for replacement.


That trial-and-error protein replacement process is why the body must keep repairing the collagen defect until it gets it right. By extension, that’s why it’s important that you get myofascial release massage every day. It facilitates the speedy replacement of the faulty collagen.


Performing carpal tunnel massage less often delays the replacement process. As a result, the healing process takes much longer.


Of course, if you work your tendons hard after they heal, the problem arises all over again. More tendon adhesions will occur. Then the “rip and repair” cycle begins all over again until the body starts to make the correct collagen once again.

Does just any carpal tunnel massage work?

For effective carpal tunnel relief, just any old pressure-type carpal tunnel massage will NOT help you. Neither will vibration massage. Actually, any vibration massage can do more harm if you have carpal tunnel syndrome.


To be effective, it must specifically be myofascial release massage. That’s because regular pressure massage aims to move a mass of tissues around. This loosens the tissues, especially muscles, and generally feels very good. But it's not what carpal tunnel syndrome requires for relief.


In contrast, carpal tunnel massage using myofascial release means manual movement that releases the adhesions between muscle and fascia (hence, “myo” and “facsial”). Actually, the term is used when any tissue has adhesions that anchor it and inhibit its movement.


With a carpal tunnel massage using myofascial release, the movement of the massaging fingers pushes the tendons in one direction. Simultaneously, fingers push tendon sheaths in another direction. And in the process both structures shear from side to side.


Properly preforming myofascial release massage takes some training. Almost every physical therapist, massage therapist or chiropractor is skilled using this treatment.

How myofascial release massage releases tendons

myofascial release massage

In the simplest form of carpal tunnel massage using myofascial release, the therapist uses TWO thumbs simultaneously. 


First, they press both thumbs deep into the tissue. Then they rotate their thumbs in counter-rotating directions over the tissue. At the same time, the rotations move from side to side. Doing so provides a shearing force to the tissues below (see Figure at left).


The result of this motion is that tendons and their sheaths move in opposing directions. Therapists describe this as a “kneading” motion. In effect, the motion pulls at the adhesions in three dimensions. Doing so insures the adhesions break apart.

As explained above, the ripped collagen encourages the body to replace the damaged, improper collagen with "correct" collagen.


In time, the “rip and repair” cycle fades because the body properly repairs the damaged collagen. 


This collagen replacement is a key factor in healing. And carpal tunnel massage using myofascial release is the quickest and most efficient way to achieve healing. However, you can also do so with prolonged rest. But that takes months. 


In fact, for rest to be successful, you cannot use your fingers and hands even for minor tasks. In other words, you would need to refrain from anything more than slight moments. And you would have to refrain for two months for complete success. For most people that’s nearly impossible.

CarpalRx and pregnancy

Can carpal tunnel massage make symptoms worse?

Carpal tunnel massage therapy using myofascial release can only help – not harm – carpal tunnel patients. In fact, this treatment is the most often used remedy by therapists for patients with carpal tunnel syndrome. It's safety is also a main reason the therapy is used during pregnancy.


Additionally, myofascial release massage is beneficial for many other tissues where adhesions are a problem.


Often, such adhesions cause weakness and pain. For example, muscular adhesions are well known to occur in athletes. Tennis players usually develop adhesions that result in tennis elbow. Muscular adhesions also occur with the constant pounding of leg muscles in runners and joggers. In addition, hypoxia and trauma are well-known contributors to adhesions in various tissues. In any situation where adhesions occur, myofascial release massage therapy is the indicated treatment of choice.


The only situation where myofascial release massage cannot be used (called a contraindication) is when the skin is compromised. This happens when skin is burned, bruised or exhibits an infection or diseases. Also, cuts, abrasions, sunburn, inflammation, varicose veins or undiagnosed lumps should resolve before you have any type of massage.

Summary

Many patients ask, “Can can carpal tunnel massage help me?” It’s a great question because you wonder how such a simple and ancient therapy can resolve a modern problem like carpal tunnel syndrome. But the answer is simple.


Not only does a special type of massage (myofascial release) help this condition, it can even reverse symptoms completely. So yes, you can restore your hand to normal again.


However, there’s one big caution to consider. You have to commit to 15 minutes of myofascial release massage therapy on your wrist every day for 4-6 weeks. If you do, you’ll be free of symptoms. But anything less will probably not give you good results.

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