What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition caused by the compression of the median nerve, which controls sensation and movement in specific parts of the hand. This nerve travels from the arm through the wrist. The carpal tunnel is a canal composed of ligaments through the palmar side of your wrist, through which the median nerve passes. Increased pressure inside this canal can compress the median nerve, leading to pain, numbness, and tingling sensations in the hand, wrist, and arm.¹

Carpal tunnel affects approximately 1-5% of the population, where prevalence is higher in females than in males, with a three-to-one ratio. It typically occurs in individuals aged between 40-60 years old. However, increased computer use has contributed to cases occurring outside the typical age range. Other risk factors for carpal tunnel include pregnancy, diabetes, obesity, arthritis, menopause and thyroid problems.³

As carpal tunnel syndrome worsens, the median nerve may suffer permanent damage, leading to pain, loss of sensation and impaired function in parts of the hand. This occurs as the median nerve controls motor information to the hands, specifically the thumb and first three fingers, and damage can diminish this pathway.³

 Carpal tunnel tends to start mildly, with some loss of sensation, tingling or slight discomfort at the wrists and hands. Once identified, it can be treated either at home or, in more severe cases,  with surgery. Generally, at-home treatment methods include the use of a splint when sleeping, and resting your wrist from specific activities that involve excessive engagement, such as typing, drawing, and playing video games.³ Oftentimes, these will yield some results. However, in cases where such methods are not effective, physical therapy, electrophysical therapy, steroidal injections, and/or surgery may be necessary.³ 

This article focuses on physical therapy as a method of treatment for carpal tunnel syndrome. If you wish to learn more about electrophysical therapy, steroidal injections, or surgery, we slightly touch on them below, but feel free to click the links to find out more. 

Physical therapy for carpal tunnel

Physical therapy describes treatment methods that are non-invasive and require mild physical movement or stretching, either done to oneself or by others, such as a masseuse. Physical therapy treatments for carpal tunnel syndrome include massage therapy, nerve and tendon gliding exercises, and trigger point therapy.⁵

Massage therapy

As the name describes, this type of treatment involves the handling of soft tissue in order to affect its state. Usually, this is done by a professional masseuse; however, specific techniques can be taught to the individual with carpal tunnel for everyday practice at home.

Massage therapy can be administered in many different ways:⁶

• Effleurage: this entails gliding and fluid movements through the tissue in order to improve blood circulation and relax the muscles
• Petrissage: a kneading movement performed on the muscle to reduce soreness and swelling
• Friction: often performed with the fingers, especially the thumbs; it involves applying consistent pressure to the area while doing continuous back-and-forth movements. This is used to increase blood circulation and can initiate a local inflammatory response

The type of massage required can be different depending on the symptoms presented and the severity of the condition. Studies have found moderate evidence for this type of therapy for carpal tunnel syndrome, stating that it can reduce symptoms such as pain and improve hand and wrist function.⁶

Nerve and tendon gliding exercises

As mentioned before, the carpal tunnel is composed of the median nerve and several tendons. Nerve and tendon gliding exercises mobilise and stretch these parts of the body. These have been shown to be able to reduce pain and improve grip strength and nerve conduction in carpal tunnel syndrome.⁷

Tendon and nerve gliding exercises can be performed in many ways:⁸

• Folding the fingers to touch the bottom of your palm
• Having the thumb touch the base of the pinkie finger
• Try to have the middle or ring finger touch the palm
• Stretch the arm, palm up, so it is perpendicular to the rest of the body

Performing these exercises frequently for a couple of weeks can improve the symptoms of carpal tunnel. 

Trigger point therapy

Trigger point therapy shares a lot of characteristics with massage therapy; however, it focuses on so-called “trigger points”; areas that, when massaged, can alleviate symptoms of specific conditions. In this case, the trigger points for carpal tunnel syndrome lie in the hands, wrists, and arms. Specifically, the points through which the median nerve travels through.^6,9

Trigger point therapy then involves applying pressure to these areas, releasing, and repeating the exercise. A usual practice of trigger point therapy at home can consist of the following:

• Finding the trigger point
• Applying pressure with your fingers for around 30 seconds
• Slowly releasing the pressure
• Repeat
• After enough repetitions, massage and stretch the general area

Is physical therapy for you?

The first and most convenient treatment for carpal tunnel, once identified, is the use of a splint, usually when sleeping. This can help the wrist rest. However, when this proves insufficient, physical therapy can be a good option since it is cheap and can be done at home. It is recommended to consult a doctor prior, both to properly diagnose the condition, and to get advice as to what the best physical therapy exercise may be for you. Once you start physical therapy, it is recommended that you stick with it for at least a couple of weeks to ensure enough time to see results.⁴

If treatment is not enough, your doctor may recommend another type of physical exercise or another therapy type altogether. However, the final decision is up to the patient, and you should always consider all your options carefully before making a decision. 

Alternatives to physical therapy

As mentioned previously, physical therapy is not the only treatment for carpal tunnel syndrome. We have already touched on splinting and generally resting from triggering exercises like excessive typing at the computer. However, there are various electrophysical therapies which can also be used to treat carpal tunnel, as well as the option of surgery and steroidal injections.¹⁰

Electrophysical therapies can include:¹⁰

• Application of heat to the affected area, such as through paraffin wax
• Laser therapy
• Ultrasound therapy
• Magnetotherapy
• Iontophoresis
• Shock wave therapy

The use of steroidal injections to the wrist is also a possible treatment, as the anti-inflammatory properties of the injection can improve symptoms.¹¹ Finally, surgery requires the performance of a small incision to the carpal ligament to relieve pressure from the median nerve and thus treat the carpal tunnel. This operation is generally mild and release from the hospital on the same day as surgery is common. Still, it is often the last resort.¹²

FAQs

Can carpal tunnel be fixed with physical therapy?

No one treatment can completely fix carpal tunnel. Some find that the use of a splint is sufficient to treat their symptoms, while others require surgery. As such, physical therapy will be helpful to some and not others. It is important to understand that carpal tunnel can be chronic, meaning it cannot be fully healed. As such, preferred treatment would just be that which helps you best deal with the symptoms. 

What is the best therapy for carpal tunnel?

The best therapy for carpal tunnel is the one that works for each individual. Every treatment has its merits. This is why understanding and learning about all therapy options is important. For most, splinting and rest can be enough to treat the syndrome; however, for others, physical therapy may be better.  

Can exercise fix carpal tunnel?

Specific exercises can help alleviate some of the symptoms of carpal tunnel syndrome like pain. It can also help improve wrist mobility and hand dexterity. However, studies show that there is only moderate evidence for the effectiveness of physical therapy. 

As mentioned before, obesity can be a risk factor for carpal tunnel syndrome. If so, a healthy lifestyle including exercise and a healthy diet could be the treatment that solves the condition. 

Summary

Carpal tunnel syndrome is a condition where the increased pressure in the wrist can compress the median nerve and cause pain, numbness, and tingling in the hand, wrist, and arm. Physical therapy is a treatment option for carpal tunnel syndrome that involves physical manipulation of the muscles and tissues. 

The three categories of physical therapy are massage therapy, nerve and tendon gliding exercises, and trigger point therapy. The first involves the handling of the affected tissue areas to relieve pain and inflammation. The second consists of specific exercises to move the tendons surrounding the nerve and the nerve itself. Finally, in trigger point therapy, specific trigger areas in the wrist and hand are pressed and released repeatedly. All of these have some merit, although more research is required to solidify their place as treatments of carpal tunnel syndrome. 

However, physical therapy is not the only treatment for the condition. Rest, splinting, electrophysical therapy, steroidal injections, and surgery are all options as well. When choosing a therapy for carpal tunnel syndrome, it is recommended to first consult with a doctor for proper diagnosis and advice.