Carpal tunnel syndrome (CTS) affects MANY individuals from all walks of life and in many occupations. Today’s discussion centers around CTS among musicians, and most importantly, what can be done about it.
It’s thought that CTS affects musicians because of their rapid, repetitive finger movements. The “formula” for CTS risk includes: Repetition + Speed + Force = CTS. This means highly repetitive movements at a fast pace using forceful movements significantly increase a person’s risk for developing the condition. If we add other risk factors of CTS including, but not limited to, obesity, age over 50, female, the presence of diabetes, arthritis (especially rheumatoid), thyroid disease, and others, then the risk increases dramatically. We can modify certain factors by losing weight, reducing practice time, changing the speed at which we practice (mixing it up between fast vs. slow tempos), taking mini-breaks from practicing, and more. However, we may not be able to change other factors like the presence of diabetes, arthritis, thyroid disease, and other hormonal imbalances. So the question arises, what can chiropractic do for CTS?
Chiropractic management focuses on the goal of treating what causes CTS—which frees up the nerve from being compressed. It is well-established that compression of the median nerve ALONG ITS ENTIRE COURSE from the neck to the hand can create CTS or CTS-like complaints. Therefore, we determine the location(s) of compression by placing pressure over the points of common nerve entrapment, which include the wrist’s carpal tunnel, the forearm near the elbow (pronator tunnel), the inner upper arm near the elbow (Struther’s ligament), the shoulder and the arm pit area (behind the pectoralis minor muscle), as well as under the collar bone, and importantly, between the anterior and medial scalene muscles in the front/side of the neck (frequently missed). Chiropractic treatments may include manual release techniques such as active release technique (ART), myofascial release (MFR), trigger point therapy (TPT), joint manipulation of the wrist, forearm, elbow, shoulder, neck and/or home self-applied treatment which includes activity modifications, using a night time splint, and exercises (which your doctor can teach you how to do). Nutritional considerations are also important (see last month’s article)!
Treatment may also include exercises like the Carpal Stretch and the First Rib Stretch. The Carpal Stretch (median nerve flossing) involves standing sideways to a wall with your elbow straight, fingers pointing down with palm against the wall at shoulder height. Feel for the deep stretch in the forearm palm-side muscles. Follow this by bending your head sideways away from the wall. Using your opposite hand, gently pull your head over further sideways (no sharp pain allowed). Hold for up to 30 seconds and repeat two to three times or until you feel it loosen up. This can be repeated multiple times a day. If you don’t have a wall, do the same thing but with the arm extended forwards from the body (rather than sideways). Reach under your hand and gently pull your thumb back feeling for a similar deep stretch through the carpal tunnel (palm side wrist) and forearm. To perform the First Rib Stretch, place a towel over the shoulder close to the neck. Reach behind with the opposite hand and grasp the towel pulling downwards while the other hand grasps the front of the towel also pulling down. Drop your head sideways to the opposite side to increase the stretch. Your doctor of chiropractic can OFTEN help you avoid surgery so PLEASE try these exercises and their treatments BEFORE granting permission for surgery!