Pain Relief Chiropractic

When it comes to the conservative management of a condition like carpal tunnel syndrome, care will usually focus on reducing inflammation along the course of the carpal tunnel and improving mobility of the median nerve as it travels from the neck and into the hand. This treatment approach may also include the use of nutritional supplements, of which alpha-lipoic acid (ALA) is starting to show promise.

Alpha-lipoic acid (ALA) is an antioxidant that naturally occurs in the body and can also be found in organ meats, spinach, broccoli, and potatoes. However, it’s often consumed as a supplement in order to get enough into the body to have an observable effect. Though research is ongoing, two benefits of ALA that are important for potential carpal tunnel treatment are its ability to reduce inflammation and to protect nerves from damage.

In a 2020 study involving 134 patients on a surgical waiting list with mild-to-moderate CTS, researchers observed that taking a 600mg ALA supplement once a day for 60 days reduced both daytime and nighttime hand and wrist pain, with 14% of participants in the ALA group canceling their surgery. The authors of this study add that previous studies that combined ALA with either curcumin or gamma-linolenic acid provided similar benefits to participants.

A 2018 study that included 31 CTS patients reported that ALA, N-acetyl-L-carnitine, turmeric, vitamins B, E, and C formulated for peripheral neuropathy (taken twice a day for one month) led to similar improvements in pain, symptom severity, and function as extremely-low frequency electromagnetic fields (ELFEF) therapy, but the benefits persisted in the supplement group for another two months while the ELFEF participants reverted to their baseline pain and function levels.

A systematic review conducted in 2020 concluded that ALA is safe, even in groups normally observed to be at risk like smokers, cardiovascular disease patients, diabetics, pregnant women, children/adolescents, and individuals with neurological disorders, rheumatic disorders, and severe renal disease.

While further research is certainly warranted on the benefits of a supplement like ALA for the CTS patient, it is certainly showing promise, and a patient may consider it as part of a multimodal approach that can include manual therapies, specific exercises, nocturnal splinting, heat/ice, and an anti-inflammatory diet.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed or restricted as it passes through the wrist. Because repetitive wrist and hand motions can inflame the tissues in the wrist and place pressure on the median nerve, workers in jobs that require such movements—such as those seated at a computer workstation all day—tend to have an elevated risk for the condition. That said, what can be done to minimize the risk?

A January 2021 study looked specifically at 1,000 office workers under age 50 from 30 workplaces in China. Participants completed a questionnaire that included information on demographics, work type, related physical and psychosocial factors, and wrist and hand symptoms using a body chart and a rating of the intensity of symptoms, nocturnal symptoms, and aggravating activities. Then, participants were clinically evaluated, and CTS was confirmed using standard testing protocols.

The authors reported that 22% of participants had wrist symptoms and 15% had hand symptoms, with 9.6% meeting the clinical criteria for CTS. Further analysis identified the following risk factors for CTS among office computer users: smoking, working with hand/wrist pain, prolonged computer use time, and working without breaks.

Mandatory breaks spread throughout the workday may be an effective strategy for reducing the risk for CTS among office workers. There is also strong research supporting the health benefits of integrating exercise with meditation during such breaks.

Meditation has been found to reduce stress and anxiety, as well as reduce chronic neck pain—another common complaint in the office environment. Incorporating physical activity during a short break will not only help lower the risk for CTS, but it may also reduce the risk for chronic ailments like cardiovascular disease and diabetes that are associated with high levels of sedentary behavior.

While it may not be possible to eliminate one’s risk for CTS, if hand and wrist symptoms are present, it’s important to seek care sooner rather than later because earlier intervention improves the odds for a satisfactory result. Doctors of chiropractic are trained to examine the whole person and look for all contributing factors in a patient’s chief complaint. With suspected CTS, it’s not uncommon to find additional areas along the course of the median nerve (the neck, shoulder, elbow, forearm) that need to be addressed to resolve the patient’s pain, numbness, tingling, and weakness symptoms.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy affecting approximately 3% of the general adult population. Individuals with jobs or hobbies that involve fast, repetitive movements and forceful gripping with little-to-no rest may be at increased risk for CTS, as are those with metabolic/hormonal conditions that can lead to increased swelling/pressure/inflammation in the wrist. In most instances, treatment guidelines recommend utilizing conservative treatment approaches, like chiropractic care, before consulting with a surgeon. In addition to workstation modifications, manual therapies, nutritional recommendations to reduce inflammation, nocturnal splinting, and co-management with other healthcare professionals, doctors of chiropractic will also advise patients to perform exercises at home to speed recovery and prevent recurrence.

Below is a description of four CTS-specific exercises recommended by the American Academy of Orthopedic Surgeons (AAOS).

Exercise 1: Wrist Extension Stretch. With the elbow straight (but not “locked”), bend the wrist back (as if saying “STOP”) and use the other hand to apply “over-pressure” to assist to a maximum tolerated stretch. Hold for fifteen seconds. Repeat five times for each wrist.

Exercise 2: Wrist Flexion Stretch. With a straight elbow (but not “locked”) and the palm facing down, bend the wrist downward until the fingers point toward the floor and use the other hand for to achieve the maximum tolerated stretch. Hold for fifteen seconds, repeat five times for each wrist.

Exercise 3: Median Nerve Glides. Make a fist (with the top of the hand facing upward) and then open the hand, but not the thumb, and bend the hand backward toward the forearm and extend the thumb backward. Rotate the palm up toward the ceiling, keeping the wrist/fingers/thumb extended. Grasp the thumb with the other hand and extend back (assist) to tolerance (but not too hard). Hold for three to seven seconds and repeat on the other hand.

Exercise 4: Tendon Glides Type One: Start with the hand pointed outward with the fingers straight out, palm facing down. Bend the fingers upward and then curl them downward into a fist. Tendon Glides Type Two: Start with the hand pointed outward with fingers straight out, palm facing down. Bend the fingers downward touching the end of the fingers to the base of the palm.

The AAOS recommends warming up the hands and wrists with heat for about 15 minutes before performing these exercises and using ice for 20 minutes to cool down afterward. If your symptoms to worsen, cease these exercises and consult with your doctor of chiropractic about modifications.  

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

While many people may consider carpal tunnel syndrome (CTS) to be the default cause of any pain, numbness, tingling, or weakness in the hand and/or wrist, the condition is more complex. In some cases, a patient with such symptoms may not have CTS at all. So when a patient comes into the office to be evaluated for CTS, how does their doctor of chiropractic determine if CTS is the culprit and how is the condition managed?

To begin, CTS occurs when the median nerve is compressed as it travels through the wrist, which can result in pain, numbness, tingling, and weakness in the thumb, index, middle, and the thumb side of the ring finger. Traditionally, investigators believed the compression of the median nerve itself was responsible for generating these symptoms, but recent studies suggest it may be reduced mobility of the median nerve that’s to blame or it may be a combination of both compression and loss of nerve mobility.

If the patient’s symptoms are localized to the thumb and the first three fingers, as described above, then the median nerve may be affected. However, if symptoms occur on the other side of the ring finger and the pinky, then a different nerve, the ulnar, may be entrapped.

The median nerve itself doesn’t just appear at the wrist. It arises from the neck, passes through the shoulder, and runs down the arm. Compression of the median nerve at any of these locations can result in CTS-like hand and wrist symptoms, even in the absence of symptoms further up the course of the nerve. Additionally, compression can occur in multiple locations, which is described as double- or multi-crush syndrome. This was first reported in 1973 by Upton and McComas, and since then, multiple studies have reported that when a nerve is compressed in more than one location, it becomes hypersensitized and is more susceptible to damage or injury.

When median nerve entrapment is suspected, a doctor of chiropractic will examine the entire length of the nerve to identify all possible issues that should be addressed. If the contributing factors are musculoskeletal in nature, then treatment may include manipulation, mobilization, soft tissue work, modalities, nocturnal splinting, workstation modifications, stretches, and at-home exercises to reduce pressure on and increase the mobility of the median nerve. Changes in hormone levels can also lead to swelling of tissues that surround the median nerve. In which case, co-management with the patient’s physician may be required to achieve an optimal outcome.

The good news is that the non-surgical, multi-modal approach used by doctors of chiropractic is highly effective in patients with CTS, especially if the patient seeks care early in the course of the disease when the symptoms are milder.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The early symptoms associated with carpal tunnel syndrome (CTS) are often easy to overlook or ignore because they don’t interfere too much with one’s ability to carry out their daily activities. As such, many people don’t consider it worthwhile to take the time to make and attend a doctor appointment to deal with the issue. In fact, many individuals with CTS wait months or even years before seeking care when their symptoms become too activating, limiting, and bothersome to ignore. But what if there was a way to figure out if those small complaints were indicative of early CTS from the comfort of home?

In a 2019 study, researchers evaluated the hand movements of 22 CTS patients (seven with CTS in both wrists) and 11 age-matched controls in search of simple diagnostics that could be performed outside of a clinical setting. Investigators ended up focusing on the movement of the thumb as it moved through its full range of motion.

Researchers found that the thumbs of CTS patients moved significantly slower in certain directions when compared to those without CTS. This criterion was consistent in 27 of the 29 CTS-positive wrists, a 93% sensitivity, with a 73% specificity in the non-CTS wrists.

The researchers are using this data to program a mobile app that can be used by individuals outside of a clinical setting determine if their early symptoms warrant contacting their healthcare provider for further examination. The app can also be used in workplace settings to identify workers who may be at increased risk for CTS so that preventative measures can be taken (such as changes in ergonomics, tools, or work processes).

Perhaps the most important benefit from an app that helps identify CTS patients early on is that the condition is much easier to treat when the symptoms are mild. When a patient delays care, secondary issues can manifest, scar tissue can form, and associated soft tissues can weaken. If a patient waits too long, a full recovery may not be possible, even with surgery, and they might have to learn to live with ongoing and life-limiting symptoms.

Doctors of chiropractic are trained to diagnose and manage CTS, often with a combination of manual therapies, specific exercises, anti-inflammatory recommendations (ice and nutritional), nocturnal splinting, and ergonomic modifications. They will also check elsewhere along the course of the median nerve to make sure there are no issues in the neck, shoulder, elbow, or forearm that may contribute to the patient’s CTS symptoms. If non-musculoskeletal causes are suspected, the patient may be referred to a specialist or their medical physician for additional care.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Because the early symptoms of carpal tunnel syndrome (CTS) can be mild and tolerable, many patients put off seeing a doctor until the pain, numbness, tingling, and weakness in their wrist and hand is no longer bearable. The current research supports chiropractic care as an excellent non-surgical option for new-onset CTS, but what about patients with chronic CTS?

In a case series study of 18 women with chronic CTS (defined as CTS lasting more than six months), researchers looked at the potential benefits of soft tissue mobilization combined with nerve slider neurodynamic technique on pain and pressure sensitivity at various points along the course of the median nerve from the cervical spine into the hand before, immediately after, and one week following just a single treatment.

The treatment session consisted of a 30-minutes of soft tissue techniques (including soft tissue mobilization, nerve slider neuromobilization, myofascial release, stretching, and cross-fiber friction over the muscular interfaces through which the median nerve travels) at four locations: the front/side of the neck (anterior scalene muscles), the distal to middle anterior upper arm (biceps brachii), the proximal palm-side forearm (pronator teres), and stretching the transverse carpal ligament and soft tissues on the palm-side of the hand. The patients reported a reduction in pain following treatment that persisted for up to one week following just one treatment.

Another study looked at the long-term effects from manual therapies on patients with chronic CTS. In this study, patients received two treatments a week for three weeks. Not only did the patients report improvement in their CTS symptoms following the conclusion of care, but these benefits persisted when researchers followed-up with participants six months later.

Manual therapies are a primary treatment approach utilized by chiropractors for both acute and chronic CTS, along with many standard management strategies such as night splints, physical modalities, and specific home-based exercise recommendations. This multi-modal approach places chiropractic at the top of the list as the ideal choice for the CTS patient!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.