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Carpal Tunnel Syndrome
Prescription for Relief

By Michael Young, NCTMB

Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.

Colleen entered massage school with all the hopes and dreams of someone searching for the perfect, mid-life career change. She simply wanted to help people, while making a decent living in the process. Little did she know the repetitive use injury she would fall victim to began early in her training -- while she was still attending massage school. Unfortunately, as a new massage therapist, Colleen could help her clients' pain, but she didn't have the knowledge necessary to remain pain-free herself.

Working in a chiropractor's office for several years, Colleen's clients came in with numerous complaints. She offered them many techniques, including Swedish massage, neuromuscular work, trigger point therapy, cross-fiber work and deep tissue massage (the technique leading to early retirement for many massage therapists). After several years in the profession, Colleen thought her muscles were getting stronger from all the bodywork she was doing. Unfortunately, many massage therapists fall victim to this assumption. Eventually, the inevitable happened -- Colleen's muscles crossed the fine line from being strong and healthy to short and tight. This chronic condition caused excruciating pain in her hands, thumbs and arms with each massage she gave.

In school, Colleen was trained in the importance of receiving regular massage therapy treatments herself. She did as she was trained and scheduled her regular appointments. The massages she received helped to relieve the constant pain, however, that relief was only short-lived. Soon the pain returned and Colleen began to wonder if the pain would force her to give up the profession she loved so much. She wondered if there would be any relief for her condition.

Colleen finally sought help from her family doctor, but found herself on a journey of drugs and referrals. She was sent to physical therapy and told that her muscles needed to strengthen. Then it was on to acupuncture, chiropractic treatments and Rolfing.

When none of these therapies gave her the relief she was seeking, Colleen was referred to a neurologist. A nerve conduction test was performed and the results were positive. She was given the dreaded diagnosis of carpal tunnel syndrome (CTS). Colleen explained to her doctor she wanted to try anything and everything to avoid surgery. The doctor prescribed more physical therapy treatments. She was put on another strengthening program by the physical therapist, but her symptoms continued to worsen. She returned to her doctor to explain the dilemma and was told her problems had now progressed to the point where he considered surgery the only option. Colleen sat in the doctor's office and convinced him she did not consider surgery an option at all. The doctor contemplated her request and told her about the claims of another one of his patients. This patient claimed to be able to help people suffering from CTS by utilizing a bodywork technique. Colleen thanked her doctor and went home to make the call. That was three years and one workshop ago and Colleen is now completely pain-free. Instead of being forced out of the career she loved, she now has her own office and is doing more massages than ever.


What is CTS?
When a person uses a muscle over and over again, the muscle tightens and restricts circulation. When this occurs, muscle memory is lost and the muscle is unable to go back to a full resting length. The result is inflammation, swelling and nerve entrapment. As the inflammation and swelling increase, the symptoms also increase. For example, if you were to put a belt around your arm just below the elbow and pull it tight enough to restrict most of the circulation, what symptoms would you experience? Likely numbness, tingling, throbbing, aching, swelling and inflammation. These symptoms are also the symptoms of CTS. Couldn't the muscles in the forearm produce these same symptoms if the muscles got tight enough? Yes. To rid yourself of the symptoms produced by the belt, you simply remove the belt. The powerful muscles of the forearm are like the belt. By releasing them, circulation is restored, and the symptoms of CTS disappear.

CTS is a repetitive use injury preying on literally thousands of massage therapists, not to mention office workers, construction workers, truck drivers, hairdressers and more. In this profession, many are leaving massage altogether after four to six years of practice. They are in more pain than the clients who come seeking their help. It need not be. Therapists simply need to learn how to release the culprit muscles responsible for their repetitive use injuries. With constant muscle use, these same injuries can occur in any part of the body.


Could All This Really Be Muscles?
Short, tight muscles are responsible for most pain syndromes with which people are diagnosed. Don't give up simply because of the diagnosis. In his book, Healing Back Pain Naturally, Dr. Art Brownstein (1999) states: "Even if you've been told by your doctor that your back problem is the result of degenerating disc disease, bone spurs, spinal arthritis, a pinched nerve, scoliosis or some other condition, remember that all of these conditions started with problems in the muscles of your back. When you restore the health of your back muscles, these conditions will be reversed, and you will, ultimately, be free of your pain."

In The Whartons' Stretch Book, by Jim and Phil Wharton (1996), the authors write: "There is a big difference between a strong muscle and a tight one. A tight muscle can be very weak. Tightness doesn't help, in fact it hurts....To avoid carpal tunnel syndrome, concentrate your flexibility work on arms, elbows, wrists and hands." They go on to say we can avoid problems like plantar fasciitis scoliosis, arthritis, tendinitis, tennis elbow, chronic low back pain, hammer toes, bunions and Achilles tendon contracture by simply concentrating the flexibility work on that portion of the body. In other words, stretch. A brilliant and revolutionary stretching technique -- Active Isolated Stretching by Aaron L. Mattes -- could help therapists avoid falling victim to these repetitive use injuries. What's so extraordinary about this stretching technique is the stretch reflex of the muscle is never engaged because each stretch is only held two seconds. I know this goes against traditional stretching techniques, but it works.

Once Colleen had developed her repetitive use injury, stretching alone would not repair the problem because the adhesions and scar tissue had built up in the belly of the muscle. Stretching alone will not break up scar tissue as effectively as a comprehensive treatment plan. When a person stretches a muscle that is full of adhesions and scar tissue, the muscle is more prone to damage. Most people stretch too hard and hold the stretch too long, creating more scar tissue which keeps the muscle even tighter. But there is hope for permanent relief.


Treatment Plan
Use your massage table or find a tabletop that is a good height for you. Place the palm of the hand (on the arm you're going to stretch first) down on the table with your fingers pointing behind you. Use your legs to move your body up and down in order to stretch the flexor muscles of the forearm. Hold each stretch for no more than two seconds. This is very important. Use your other hand or thumb to apply moderate pressure, stroking down the "stretching" arm during each stretch. Be sure to move the stroking hand over all the different flexor muscles in the forearm. The elbow, of the arm that's being stretched, should be locked. Repeat this technique 20 to 30 times.

Next, stretch the extensor muscles. Make a soft fist and put your fist flat on the table. Again, using your legs, as you bend at the knees, roll your wrist forward to stretch the extensors. It is important to hold the stretch for only two seconds, returning back to the neutral position between each stretch. Use your other hand or thumb to apply a moderate amount of pressure, stroking down the extensor muscles. Keep the elbow, of the arm you are stretching, locked. You only need to stretch hard enough to feel a good firm stretch. If you stretch too hard, you will cause your muscles to tighten up even more. Repeat the stretch for the extensors approximately 20 to 30 times.

Everyone suffering from CTS will begin this routine in a different place, so do not be discouraged if your range of motion (ROM) is not the best. The tighter the muscles, the less ROM you will experience. It is important to start where you are, and stretch only until you feel a good, firm stretch. You will be amazed at how quickly your ROM will increase. This technique allows the muscles to be released, thus circulation is increased. No healing will ever take place without circulation. When moderate pressure is applied to the muscle during the stretch, scar tissue is broken up more quickly and the muscle is lengthened, restoring muscle memory. When scar tissue re-forms, it forms in a more organized, elastic way.

A person does not need the diagnosis of carpal tunnel syndrome to reap the benefits of this work. If you experience tightness in your arms or hands, try this technique to avoid the possibility of your problem progressing into a chronic pain condition.

Follow this stretching routine daily and you will be absolutely amazed with the results. The symptoms of CTS will soon disappear. It is wise to continue to perform this muscle release even after the symptoms completely vanish. These muscles did not become short and tight overnight. Therefore, it will take some time to train the muscles to remember the original relaxed state we all were blessed with at birth.

Michael Young, NCTMB is an injury and rehabilitation therapist who has a private practice in Evergreen, Colo. He is an author and the founder of Repetitive Use Injury Therapyâ„¢, P.O. Box 358, Evergreen, CO 80437-0358; phone 303/674-7948; fax 303/679-0805. He holds workshops across the United States, designed to train therapists in the Muscle Release Technique.TM For more information on workshops, articles, etc., visit his website at www.mrtherapy.com.








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