Massage Therapy Newsletter Winter ’09/1

Diagnosed with carpal tunnel syndrome, Marie displayed the classic symptoms: soreness in her forearms, pain in her hands at the end of a long day at the computer, and a feeling of tightness that had spread from hands and wrists all the way to her elbows. And recently, she’d been getting headaches.

Marie has a couple of different options for treating the problem. “My doctor tells me he can operate, but the surgery isn’t always successful,” she says. “He recommends I try bodywork first.”

Because Marie does the same motion in the same way many times a day over a long period of time, she has literally worn out the tissues involved in that motion. This type of injury — called a repetitive strain injury, or RSI — creates tiny tears in the fibers of the soft tissues of the body. While they don’t immediately cause loss of function, these micro-tears set up conditions for chronic inflammation that will eventually manifest as pain, soreness, tightness, tingling, and burning.

CTSThe hand and wrist combination work together as an amazing, mechanical anatomical wonder. Imagine a set of ropes and pulleys that travel from the elbow through the wrist to the finger tips. The muscles reside in the forearm, moving the fingers via long tendons that run through channels in the wrist. The nerves that send and receive sensory and motor information from the brain run alongside the tendons through these same channels.

When bending or straightening a finger, these tendons slide back and forth, just like cables. When continually working at a keyboard and using the same motion in the same position thousands of times a day — like millions of Americans do — the cables begin to wear. And just like threads in a rope, some of the collagen fibers will tear. This process progresses until enough fibers are torn that the body develops inflammation in the tendons and sheaths. Swelling ensues, which pinches the nerves, producing the classic symptoms of tingling, swelling, and even loss of grip strength.

The Bigger PictureThe symptoms of carpal tunnel syndrome may reveal an even bigger problem. The nerves that carry sensory and motor information to the hand arise from the spinal cord in the neck, travel under the collar bone, through the armpit and elbow, all the way to the wrist. A nerve can become entrapped at the neck, shoulder, elbow, or wrist, and an impingement in any of these places can have a cumulative effect on the tingling felt in the hands. These entrapments are usually caused by poor postural habits. The soft tissues become shortened around habitual positions of rounded shoulders and forward head from working long hours at the computer and the channels where the nerves travel through the shoulders and arms can close down. Sound familiar?

Can Bodywork Help?A recent study conducted at The Touch Research Institute at the University of Miami School of Medicine looked at the efficacy of bodywork in treating carpal tunnel syndrome. Researchers found that after the completion of four massage sessions, the participants experienced an improvement in grip strength and a decrease in pain, anxiety, and depression. Participants also showed improvement in specific medical tests used to diagnose carpal tunnel syndrome.

This landmark study verifies what bodyworkers have observed clinically for years: Massage — and especially deep tissue techniques, such as neuromuscular therapy, Rolfing, and Hellerwork — can reorganize the connective tissue fibers, break up scar tissue, and reduce or eliminate the cause of inflammation. Soft tissue work helps realign these tiny fibers of the tendons and sheaths, and the body can then heal itself — and ease or even eliminate carpal tunnel syndrome.

Bodywork to the entire arm, shoulder, and neck will also free soft tissues where hidden tightness can contribute to the problem. Soft tissue inflammation can travel through the continuous connective tissue framework from fingertips to head and even cause headaches — as was the case with Marie. Massage can restore these tissues to normal function.

Other ConsiderationsIn addition to bodywork, it’s important to evaluate postural habits, work station positioning, and movement patterns. When workers become so focused on their work that they forget their bodies, they tend to maintain positions that contribute to the cause. It’s important to identify several ways and several positions to accomplish the same thing. Moving the mouse from one side to the other, even during the same day, can help prevent fatigue and tissue failure. Wrist rests and keyboard trays are important, and a regular stretching routine is essential.

Finally, along with exercise and good nutrition, include bodywork as part of your regular health maintenance program. Regular massage reduces connective tissue inflammation and prevents scar tissue from forming. Movement education, such as the Alexander Technique, Feldenkrais Method, structural integration, and Trager Approach can help correct postural issues that also contribute to the problem. Bodywork is a treatment of choice to keep carpal tunnel syndrome from slowing you down.