I recently ran into three people who are suffering from what they have self-diagnosed as carpal tunnel syndrome. They have pain and stiffness in their wrists, forearms, and hands, some with shooting pain, weakness, and tingling into parts of their hands. This is a source of concern as their ability to perform their job is at stake.
According to the University of Maryland Medical School, carpal tunnel symptoms include: nighttime painful tingling in one or both hands, frequently causing sleep disturbance, inability to freely move ones fingers, swollen sensation in the fingers even though little or no swelling is apparent, daytime tingling in the hands, an inability to clutch or squeeze things, loss of strength in the muscle at the base of the thumb near the palm, and pain shooting from the hand up the arm as far as the shoulder.
Carpal tunnel syndrome proper is when the median nerve, which travels through the tunnel made by four carpal bones in the wrist, gets too crowded or trapped by swollen connective tissues or tendons. From the chiropractic perspective, this also can happen when the carpal bones at the base of the wrist get subluxated, or move out of their normal position and get stuck, thus decreasing the space which normally exists for the median nerve.
Contributing factors include many of the common sense reasons why the tissues in this tunnel would increase: obesity, alcohol, tobacco consumption (think retaining water due to toxicity and free-radical inflammation), and pregnancy (also think retaining water). By far, the biggest cause I see is traumatic inflammation caused by banging one’s wrist day in and day out on a keyboard laptop edge or other non-ergonomic surface.
Repetitive stress can swell these tissues because your finger muscles and tendons are being contracted and released each time you hit a keystroke. Moreover, the wrist itself is held in a certain position continuously for hours in some cases, a position which can stress and strain the median nerve. For the majority of these people, stretching is not in their lexicon of self-care. Most people I meet never stretch these muscles, infrequently stretch, or perform the stretching improperly so that it is ineffective.
Moreover, there are some researchers who claim that stretching is ineffective to prevent injury. However, this research was done on professional athletes not office workers and has not been reproduced in another study. In my professional experience, most of the injuries I see related to repetitive stress stem from workstations that are set up improperly, and the workers’ lack of stretching.
Try this experiment to discover how far up your arm these muscles and tendons run. Take your pointer finger and wriggle it while you hold your forearm just above the wrist. Now keep wriggling your finger as you move up your forearm and see how far you have to go before you stop feeling that muscle and tendon moving underneath your hand. The tendons and meridian nerve need to have freedom of movement in order to function properly.
Just as we stretch after running or exercising, if you want to prevent carpal tunnel, you need to think about stretching your small muscle groups when you spend time on the keyboard. When we overuse our muscles, we can get micro tears in the muscles and tendons. These get inflamed, bringing water (a.k.a. swelling) into the tissues, thus impinging the nerve. Stretching is a way to keep the tissues flexible and prevent micro tears and scar tissue.
In treating carpal tunnel and carpal tunnel-like symptoms, I use a very effective combination of active release techniques (a soft tissue technique developed by a chiropractor) to treat scar tissue and myofascitis, along with adjustment of the carpal bones and any other subluxated joints that could be contributing. Unfortunately, the spine is one of the most overlooked contributors to the pain and tingling in the hands and wrist.
Sitting is now considered the new smoking. People are rarely properly educated about posture and ergonomics at their workstations. One of the biggest influencers of impingement of the peripheral nerves is subluxated (misaligned) bones in the neck. The origin of the median nerve is spinal nerves C5, 6, 7, 8 and T1, which are at the lower part of the neck and the upper part of the back. These exit from the spinal cord between the fourth cervical vertebrae and the second thoracic spinal bones making up the median nerve. The median nerve controls some muscles of the hand and carries sensation information therein. According to John Hopkins University, “The median nerve provides sensation to the thumb, first, second, third, and half of the fourth finger. It innervates muscles in the forearm and hand that allow pincher grasp (the ability to grasp an object between the thumb and forefinger).”
A common postural sign of subluxations in the neck is anterior head carriage. With proper posture we should see the middle of the ear located over the middle of the shoulder. With most of us looking down at our devices and straining forward and (usually) down to look at our monitors, anterior head carriage and the problems that accompany it are becoming endemic. This posture is what leads to a “dowagers hump.”
In the case of carpal tunnel and carpal tunnel-like symptoms, adjusting these misaligned spinal bones is essential to take pressure off the peripheral nerves. Only treating the wrist is usually inadequate and may ignore a larger problem in the cervical spine or really anywhere from the neck to the fingers.
Impingement of the median nerve can be caused by muscles, which are chronically tight, or by muscle scar tissue wrapped around the median nerve as a result of the repetitive injury of the small tendons in the forearms, most commonly from repetitive stress of typing. I have also seen carpenters, telephone workers, and electricians with this type of injury because of their repetitive use of screwdrivers and power tools. Thankfully, active release technique along with adjusting is a very effective treatment for both of these situations.
In addition, as mentioned above, the median nerve can be impinged between the bones of the spine or between muscles and misaligned bones of the arm. Bones, which are misaligned from the collarbone to the elbow to the carpal bones, can put pressure on the median nerve and cause much the same symptoms. While carpal tunnel proper is an impingement only in the tunnel, I have rarely found that someone who has it only has problems in their wrist.
Daily effective stretching along with regular spinal and extremity adjustments are the prevention formula I like. While there are drugs and things like acupuncture, which can relieve symptoms, making sure you are getting to the root of the problem is always preferable.
The key to knowing you are stretching correctly is afterwards you feel looser and your muscles feel relaxed and stay relaxed. If stretching does not provide long lasting relief, this indicates that either you are not doing the stretch correctly or that there is already damage and treatment should be sought.
There are a series of stretches that I teach my patients and they are intense. But they are also effective. Unfortunately, much of what I see on websites and workplace stretching programs, would not do the job.
This is the second or third decade where the majority of the workforce is working at computers. It boggles the mind how the awareness of prevention and workplace ergonomics are still rarely taught or utilized. The majority of people still sit at work stations that are not ergonomically correct. At least wrist pads are being used more often. This, however, is not enough.
With handheld devices more and more taking the place of a workstation, it is predictable that people will be suffering more cervical spinal problems, a common, but often overlooked root of carpal tunnel-like symptoms. As always, I am an advocate of taking care of our bodies preventatively, through regular chiropractic check-ups. However, if you have postural issues that developed because of poor workplace ergonomics, those changes are hard to reverse. You may have to go a step further and look for a chiropractor trained in postural corrective care.