Massage Therapy as alternative treatment for managing Carpal Tunnel

Syndrome & Gout

James E Strozier, LMBT

Carpal Tunnel Syndrome (CTS)

• CTS is a repetitive strain injury that causes compression of the median nerve located in the wrist.

• Compression of the median nerve causes impaired neuromuscular function of the hand and fingers.

• The median nerve is responsible for feeling and movement in the thumb, index finger, middle finger, the thumb-side of the ring finger and the palm.

Carpal Tunnel Syndrome (CTS)

Causes & Symptoms of CTS

• Inflammation, injury, fluid accumulation, or disease can affect the median nerve thus shrinking the size of the carpal tunnel and cause the following in the fingers, wrist, palm, or elbow:• Numbness• Tingling sensations• Difficulty with coordination• Muscle atrophy and weakness of grip• Pain

Causes & Symptoms of CTS

Signs and Tests of CTS

• Tinel’s Sign• Shooting pain from the wrist to the hand when tapping

over median nerve.

• Phalen’s Test• Numbness, tingling, or weakness resuling from bending

the wrist completely forward for a 60 second duration.

• X-rays• Nerve Conduction Test

Risk Factors Associated with CTS

• Repetative motion(s) and or strains of hand and wrist or overworking muscles in the arm due to :

• Typing on a keyboard• Occupation (massage therapy)• Sports (golf, raquetball)• Sewing• Writing• Tool use (vibration)• Some musical instruments (piano)• Driving

• Affects 30-60 year old demographic.• Occurs more frequently among females.

Treatment of CTS

• Rest• Splinting • Hot and cold compresses• Alterations in lifestyle and to workplace to reduce

stressors on the wrist.• Medications

• Anti-inflammatories• Diuretics• Corticosteriod injections

• Surgery• Massage Therapy

Massage Therapy for CTS

• Research confirms that techniques such as petrissage, compression, circular friction, and skin rolling, applied once a day for 15 minute intervals, effectively reduced pain and improved symptoms associated with CTS.

Field, T., Diego, Miguel, Cullen, Christy, Hartshorn, Kristin, Gruskin, Alan, Hernandez-Reif, Maria,Sunshine, William. (2004). Carpal tunnel syndrome symptoms are lessened following massage therapy. Journal of Bodywork and Movement Therapies, 8, 9-14.

Massage Therapy for CTS

• Techniques for prevention• Massage hands and forearms routinely.• Stretching and range-of-motion (ROM) to hands, neck,

shoulders and forearms.• Strengthen muscles in the forearms and hands using

isometric (muscle contraction against stable resistance) and isotonic (muscle contraction resulting in muscle shortening and movement) exercises.

Massage Therapy for CTS

• Avoid local massage over affected area if inflammation is acute.

• Special techniques:• Cold applications• Deep moist heat• Lymphatic drainage• Contract-relax muscle energy• Myofascial holding• Cross-fiber friction• Trigger point• Reflexology

Arthritis-Gouty (Gout)

• Gout is a common form of arthritis characterized as inflamation of joints in conjunction with crystaline deposites of sodium urate (salt formed from uric acid) therein.

• Gout is a metabolic disorder, also known as urate crystal deposition disease, in which blood urate has decreased elimination or less commonly overproduction.

• Can affect any joint, but most commonly occurs first in the big toe.

Symptoms & Causes of Gout

Signs & Symptoms of Gout

• Characterized by a sudden onset (often at night) of redness, swelling, heat, and extreme pain.

• Affects peripheral joints• Metatarsophalangeal• Knees• Elbows• Thumbs • Fingers• Ankles

• Can be accompanied by fever, nausea, headache, and or mood change.

Symptoms of Gout

Risk Factors Associated with Gout• Predominates in males 30-60 years old and less frequently in

postmenopausal women.• Diets rich in protein or purine• Disease

• Kidney disease• Leukemia• Diabetes mellitus• Obesity• Hypertension• Psoriasis

• Strenuous physical activities• Starvation• Lead poisoning• Enzyme deficiencies

Treatment for Gout

• Anti-inflammatories or steroid injections in acute phase.• Increase fluid intake• Weight loss• Determine if causation is increased urate production or

decreased elimination.• Prescription drugs to lower urate in blood (increase

alkalinity in urine and solubility of uric acid).• Lifestyle change• Herbal remedies• Massage Therapy (during certain stages)

Massage Therapy for Gout

• Generally massage and range of motion (ROM) contraindicated in acute phases due to intense pain and potential to exasperate inflammation.

• Heat and cold therapy can be used to reduce inflammation.

• Light massage indicated in surrounding areas in subacute stage.

• Light to medium brisk stroke massage indicated for short duration in chronic stage.

• Accupressure

Massage Therapy for Gout

• Touch Research Institute at University of Miami

• Studies show participants that received massage 1x/week for 4 weeks and performed self massage daily reported a decrease in pain and increased relief from hand and wrist arthritis.

• Adam I. Perlman, et al. 2006.• Randomized controled trial for osteoarthritis of a knee

joint (commonly affected by gout) using Swedish Massage, 2x/week, reduced pain and improved function to the knee joint(s) of the treatment group.