Massage Therapy and Carpal Tunnel Syndrome

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.

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 trails 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. 2015Fernández-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. 2015Vigotsky 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

Related Links
• Massage Therapy and Postoperative Care
• Traumatic Muscle Fibrosis:  From pathway to prevention 
• Massage Therapy and Compartment Syndrome 
• The Role of Massage in Scar Management 
• Research on Massage and Cancer 
• Sports Massage - The Science is Emerging 
• Massage Therapy and Dupuytren's Disease 

Research Links
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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.
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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).
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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.
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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.
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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.
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