massage therapy for carpal tunnel syndrome

Why Give Massage Therapy A Try?

Massage therapy as a therapeutic intervention is being embraced by the medical community, it is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of massage therapy for patients who suffer from carpal tunnel syndrome.

What is Carpal Tunnel Syndrome?

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). - CC BY 3.0.

Carpal tunnel syndrome is a condition characterized by tingling, numbness and pain in the hand and fingers (particularly the thumb, index, middle and ring fingers). These symptoms are often the result of median nerve irritation in the wrist or forearm.

A short list of structures to consider as part of a rehabilitation program includes, but is not limited to: the median nerve, scalene muscles, costo-clavicle space, pectoralis minor, biceps brachii muscle, bicipital aponeurosis pronator teres, transverse carpal ligament, anterior interosseous membrane, palmar aponeurosis and lumbricals.

Surgery or Massage?

Randomized clinical trials have demonstrated that for some patients who suffer from carpal tunnel syndrome there is no significant differences in pain and functional outcomes at six and twelve months when surgical and conservative care are tested (Fernández-de-Las Peñas et al. 2015, Fernández-de-Las Peñas et al. 2017).

Systematic reviews have also concluded that localized relaxation massage combined with multimodal care may provide short-term benefit for treating carpal tunnel syndrome (Piper et al. 2016).

Why Does Massage Therapy Work?

The responses to massage therapy are complex and multifactorial - physiological and psychological factors interplay in a complex manner. Research has looked at the bioplastic and neuroimmune responses at both the peripheral and central levels elicited by massage therapy treatments.

Pain Management
Massage has a modulatory affect on peripheral and central processes via input from large sensory neurons that prevents the spinal cord from amplifying the nociceptive signal. This anti-nociceptive effect of massage therapy can help ease discomfort in patients who suffer from carpal tunnel syndrome (Bishop et al. 2015, Vigotsky et al. 2015).

Peripheral Response
Massage therapy may diminish intraneural edema and/or pressure by mobilizing neural tubes (Gilbert et al. 2015). The median nerve passes through many structures and it may be exposed to mechanical irritation at many different points (Filius et al. 2017). Prolonged irritation may result in a reduction of intraneural blood flow. In turn, local hypoxia of a peripheral nerve leads to a drop in tissue pH that triggers the release of inflammatory mediators, known as “inflammatory soup”, this noxious substance can disrupt the normal function of nerves (Fisher et al. 2015).

Carpal tunnel specific work may also involve specific soft tissue treatment to optimize the ability of mechanical interfaces to glide relative relative to the median nerve. Ongoing tissue hypoxia or inflammatory responses lead to molecular signaling that promote the development of fibrosis, this may contribute to further peripheral nerve dysfunction (Fisher et al. 2015). The application of appropriate shear force and pressure impart a mechanical stimulus that may attenuate tissue levels of fibrosis and TGF-β1 (Bove et al. 2016).

Summarizing Points

Massage therapy has been shown to improve symptoms, decrease disability and improve function for patients who suffer from carpal tunnel syndrome.

The next step for researchers is to look into what sort of dosage and duration would be needed to optimize the effects of this non-pharmacological approach.

More to Explore

Research Links
Ballestero-Pérez, R., Plaza-Manzano, G., ... Romero-Franco, N. (2017). Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review. J Manipulative Physiol Ther.
https://www.ncbi.nlm.nih.gov/pubmed/27842937

Berrueta, L., Muskaj, I., Olenich, S., Butler, T., Badger, G. J., Colas, R. A., . . . Langevin, H. M. (2016). Stretching Impacts Inflammation Resolution in Connective Tissue. Journal of Cellular Physiology.
http://www.ncbi.nlm.nih.gov/pubmed/26588184

Bishop, M. D., Torres-Cueco, R., Gay, C. W., Lluch-Girbés, E., Beneciuk, J. M., & Bialosky, J. E. (2015). What effect can manual therapy have on a patient's pain experience? Pain Management.
https://www.ncbi.nlm.nih.gov/pubmed/26401979 (OPEN ACCESS)

Bove, G. M. (2008). Epi-perineurial anatomy, innervation, and axonal nociceptive mechanisms. Journal of Bodywork and Movement Therapies.
https://www.ncbi.nlm.nih.gov/pubmed/19083672

Bove, G., Harris, M., Zhao, H., & Barbe, M. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. Journal of the Neurological Sciences.
http://www.ncbi.nlm.nih.gov/pubmed/26810536 (OPEN ACCESS)

Chaitow, L. (2016). Dosage and manual therapies – Can we translate science into practice? Journal of Bodywork and Movement Therapies.
https://www.ncbi.nlm.nih.gov/pubmed/27210835

Elliott, R., Burkett, B. (2013). Massage therapy as an effective treatment for carpal tunnel syndrome. J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/23768278

Filius, A., Thoreson, A.R., Wang, Y., Passe, S.M., Zhao, C., An, K.N., Amadio, P.C. (2015). The effect of tendon excursion velocity on longitudinal median nerve displacement: differences between carpal tunnel syndrome patients and controls. J Orthop Res.
https://www.ncbi.nlm.nih.gov/pubmed/25640903 (OPEN ACCESS)

Filius, A., Thoreson, A.R., Ozasa, Y., An, K.N., Zhao, C., Amadio, P.C. (2017). Delineation of the mechanisms of tendon gliding resistance within the carpal tunnel. Clin Biomech (Bristol, Avon).
https://www.ncbi.nlm.nih.gov/pubmed/27939953

Fisher, P., Zhao, Y., Rico, M., Massicotte, V., Wade, C., Litvin, J., . . . Barbe, M. (2015). Increased CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury. Journal of Cell Communication and Signaling.
https://www.ncbi.nlm.nih.gov/pubmed/25617052 (OPEN ACCESS)

Fernández-de-Las Peñas, C. F., Ortega-Santiago, R., . . . Cuadrado-Pérez, M. L. (2015). Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.The Journal of Pain.
https://www.ncbi.nlm.nih.gov/pubmed/26281946

Fernández-de-Las-Peñas, C., Cleland, J., Palacios-Ceña, M., Fuensalida-Novo, S., Pareja, J.A., Alonso-Blanco, C. (2017). The Effectiveness of Manual Therapy versus Surgery on Self-Reported Function, Cervical Range of Motion and Pinch Grip Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial. J Orthop Sports Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28158963

Fernández-de-Las-Peñas, C., Cleland, J.,... Alburquerque-Sendín, F. (2017). Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial. Eur J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/28295825

Gilbert, K. K., James, C. R., Apte, G., Brown, C., Sizer, P. S., Brismée, J., & Smith, M. P. (2015). Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: Implications for the treatment of neuropathic pain and dysfunction. Journal of Manual & Manipulative Therapy.
http://www.ncbi.nlm.nih.gov/pubmed/26917940 (OPEN ACCESS)

Guimberteau, J., Delage, J., & Wong, J. (2010). The role and mechanical behavior of the connective tissue in tendon sliding. Chirurgie De La Main.
https://www.ncbi.nlm.nih.gov/pubmed/20537576

Huisstede, B.M., van den Brink, J., Randsdorp, M.S., Geelen, S.J., Koes, B.W. (2017). The Effectiveness of Surgical and Post-Surgical Interventions for Carpal Tunnel Syndrome-A Systematic Review. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/28577858

Madenci, E., Altindag, O., ... Gur, A. (2012). Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome. Rheumatol Int.
https://www.ncbi.nlm.nih.gov/pubmed/21953301 (OPEN ACCESS)

Maeda, Y., Kim, H., Kettner, N., Kim, J., Cina, S., .... Napadow, V. (2017). Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain.
https://www.ncbi.nlm.nih.gov/pubmed/28334999

Martínez-Merinero, P., Lluch, E., ... Falla, D. (2017). The influence of a depressed scapular alignment on upper limb neural tissue mechanosensitivity and local pressure pain sensitivity. Musculoskelet Sci Pract.
https://www.ncbi.nlm.nih.gov/pubmed/28319883

Padua, L., Coraci, D., Erra, C., ... Hobson-Webb, L.D. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol.
https://www.ncbi.nlm.nih.gov/pubmed/27751557

Park, D. (2017). Ultrasonography of the Transverse Movement and Deformation of the Median Nerve and Its Relationships with Electrophysiological Severity in the Early Stages of Carpal Tunnel Syndrome.
https://www.ncbi.nlm.nih.gov/pubmed/28433831

Piper, S., Shearer, H. M., Côté, P., Wong, J. J., Yu, H., Varatharajan, S., . . . Taylor-Vaisey, A. L. (2016). The effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities: A systematic review by the Ontario Protocol for Traffic Injury management (OPTIMa) collaboration. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26386912

Pratelli, E., Pintucci, M., Cultrera, P., Baldini, E., Stecco, A., Petrocelli, A., Pasquetti, P. (2015). Conservative treatment of carpal tunnel syndrome: comparison between laser therapy and Fascial Manipulation(®). J Bodyw Mov Ther.
https://www.ncbi.nlm.nih.gov/pubmed/25603750

Roll, S.C., Hardison, M.E. (2017). Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review. Am J Occup Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28027038 (OPEN ACCESS)

Schmid, A.B., Brunner, F., Luomajoki, H., Held, U., Bachmann, L.M., Künzer, S., Coppieters, M.W. (2009). Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system. BMC Musculoskelet Disord.
https://www.ncbi.nlm.nih.gov/pubmed/19154625 (OPEN ACCESS)

Schmid, A.B., Elliott, J.M., Strudwick, M.W., Little, M., Coppieters, M.W. (2012). Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome--an MRI study to reveal therapeutic mechanisms. J Orthop Res.
https://www.ncbi.nlm.nih.gov/pubmed/22231571

Schmid, A.B., Nee, R.J., Coppieters, M.W. (2013). Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther.
https://www.ncbi.nlm.nih.gov/pubmed/24008054

Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/26637643 (OPEN ACCESS)

Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment.
https://www.ncbi.nlm.nih.gov/pubmed/26788367 (OPEN ACCESS)

Wang, Y., Filius, A., Zhao, C., Passe, S.M., Thoreson, A.R., An, K.N., Amadio, P.C. (2014). Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome. Acad Radiol.
https://www.ncbi.nlm.nih.gov/pubmed/24594417 (OPEN ACCESS)

Waters-Banker, C., Dupont-Versteegden, E. E., Kitzman, P. H., & Butterfield, T. A. (2014). Investigating the Mechanisms of Massage Efficacy: The Role of Mechanical Immunomodulation. Journal of Athletic Training.
https://www.ncbi.nlm.nih.gov/pubmed/24641083 (OPEN ACCESS)

Werthel, J.D., Zhao, C., An, K.N., Amadio, P.C. (2014). Carpal tunnel syndrome pathophysiology: role of subsynovial connective tissue. J Wrist Surg.
https://www.ncbi.nlm.nih.gov/pubmed/25364632 (OPEN ACCESS)

Wolny, T., Saulicz, E., Linek, P., Shacklock, M., Myśliwiec, A. (2017). Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28395984

Wong, R., Geyer, S., Weninger, W., Guimberteau, J., & Wong, J. K. (2016). The dynamic anatomy and patterning of skin. Experimental Dermatology.
http://www.ncbi.nlm.nih.gov/pubmed/26284579

Yamanaka, Y., Gingery, A., Oki, G., Yang, T.H., Zhao, C., Amadio, P.C. (2017). Blocking fibrotic signaling in fibroblasts from patients with carpal tunnel syndrome. J Cell Physiol.
https://www.ncbi.nlm.nih.gov/pubmed/28294324

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Massage Therapy and Carpal Tunnel Syndrome