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Guide: Carpal Tunnel & How to Treat

Dr. Z • Sep 14, 2020

Review: Carpal Tunnel & How to Treat

Anybody suffering with hand or finger pain and numbness should know this about carpal tunnel: how to treat it depends upon your severity. Just as importantly, how well you restore your hand depends on how many treatments or remedies you simultaneously employ.


There are several good remedies to treat the miserable symptoms of this condition, all without carpal tunnel surgery. And that even goes for patients with intense or severe symptoms.


All of the treatments described here have one thing in common: they require persistence. That means none will work if you don't commit to a daily regimen of therapy - especially for more intense symptoms.


So what are the methods to treat carpal tunnel syndrome? I discuss them in detail below. They're listed by what's required according to your severity: mild, moderate or severe.



How many treatments you need per day, and how aggressively they need to be applied depends on your severity. In general, most people require several treatments per day (of each therapy) for about 30 days.


It's sobering to recognize that you didn't develop carpal tunnel syndrome overnight. This disorder takes many months or even years of repetitive stress or other mechanical strains to cause it. Therefore, reversing the damage in your wrist and eliminating symptoms will also take a bit of time. 


I always tell patients, "Eliminating carpal tunnel symptoms is a marathon, not a sprint."

carpal tunnel sufferer

Carpal tunnel: how to treat with 4 key therapies

The "tried and true" ways to treat carpal tunnel syndrome and eliminate symptoms for good is by using a combination of therapies simultaneously. This combination is called "B.R.E.M." It stands for the individual treatments consisting of:


  • Brace
  • Rest
  • Exercise
  • Massage


You use the B.R.E.M. treatments whether you have mild, moderate or severe symptoms. But you use each treatment a little differently, depending on your severity. In other words, with increasing symptoms severity, you must:


  • Take more time per day to perform each treatment and,
  • Perform each treatment more aggressively.
endoscopic carpal tunnel surgery

IMPORTANT: You must use ALL of the B.R.E.M. techniques SIMULTANEOUSLY. That's how you get maximum results. In other words, don't just pick the "B-part" and "M-part".


It's the combination of the 4 remedies that will eliminate your symptoms. That's because the techniques build upon and support each other. This is especially true if you have more advanced or severe symptoms.


In short, each level of severity uses all of the B.R.E.M. remedies. But the time devoted to them and how aggressive you are increases according to the severity of your symptoms.

Carpal tunnel: how to treat MILD symptoms

1. Bracing your hand at night for MILD symptoms

bad carpal tunnel brace

Wear a wrist brace at night only. Doing so takes the stress off your median nerve. 


Never wear a restrictive wrist brace during the day as you work with your hand. Doing so only makes your wrist subconsciously fight the restriction in addition to doing its regular job. Such stress makes carpal tunnel syndrome much worse.


Also, be sure to wear a certified carpal tunnel night brace. Wearing the wrong kind of brace can do more damage to your wrist. For instance, NEVER wear a night brace that contains a palmar spine (see illustration). The spine will push into your carpal tunnel space and compress your median nerve. This makes symptoms worse, especially when you first wake up in the morning.

2. Resting your hand for MILD symptoms

resting the hand

Rest is the body's way if repairing just about everything, even carpal tunnel syndrome. But nobody can rest their hands 24/7. The next best thing is to take short "mini-breaks". 


This means while you work, stop and drop your hands. Then shake them out for a couple seconds. This increases blood flow and relaxes the tendons that were stressed during the hand activity. If your hands feel warm after shaking them out, it means blood is flowing through them.


But what's better than rest is avoiding the stressful hand activitiy altogether. Unfortunately, for most workers complete avoidance of daily hand activities and tasks is nearly impossible.

3. Exercises for MILD symptoms

forearm stretching exercise

Whenever most people hear the word "exercise" they usually think, "I don't have the time for that!" But carpal tunnel syndrome exercises are different. 


The best ones stretch flexor tendons so effectively that symptoms often melt away rapidly. And they do it with only 30 seconds of stretches! 


There are many web-based carpal tunnel syndrome exercises. I created this core stretching exercise regimen to be both effective and quick - taking only 30 seconds to complete.


For MILD symptoms, do these carpal tunnel syndrome exercises at least 4 times per day.

4. Massage for MILD symptoms

myofascial release massage

Perhaps the best treatment for carpal tunnel syndrome - even better than surgery - is massage. But not just any massage will do. Carpal tunnel syndrome is caused by adhesions and restrictions on tendons deep inside your wrist joint. Breaking the adhesions apart allows your tendons to glide smoothly. The best way to break them apart is using myofascial release massage.


As the name suggests, this massage technique releases the adhesions causing carpal tunnel syndrome. The massage is best performed using both of your thumbs. (No, you can't perform it on yourself.) Dig your two thumbs into the patient's forearm. Then rotate the thumbs in opposite directions. This kneads the tissues below, causing tendon adhesions and restrictions to rip and break.


As mentioned, to properly perform myofascial release massage, you need a helper. But MILD symptoms usually respond well if you do it yourself, using only your opposite thumb. See this link for directions and tips to perform this powerful treatment. 


For MILD symptoms, this massage is not actually REQUIRED but will help nonetheless. Perform it once daily, for 15 minutes, just before going to sleep. Try to get a helper. But if you can't, use your opposite thumb.

Carpal tunnel: how to treat MODERATE symptoms

1. Bracing your hand at night for MODERATE symptoms

CarpalRx night brace

Just as with mild symptoms, MODERATE carpal tunnel symptoms require night bracing. This will prevent you from over-bending your hand (backward) and further compressing your median nerve. And NEVER wear a wrist brace during the day for the same reasons given above. 


Once again, make sure your night brace is especially designed for carpal tunnel syndrome (many braces advertise they are, but really are not). 


You can tell it's NOT a certified carpal tunnel brace if it contains a "palmar spine" (see brace illustration above). That spine will damage your wrist joint as you sleep, causing symptoms to be worse when you wake up.

2. Rest for MODERATE symptoms

rested hand

You'll need more than a few daily mini-breaks to rest your hand adequately when you have MODERATE carpal tunnel symptoms compared to mild symptoms. 


This illustrates the best approach to eliminating symptoms of carpal tunnel: how to treat it is proportional to how bad it is. 


If you have moderate symptoms, you must take serious avoidance measures in your occupation RIGHT NOW. That's because it's likely your job is stressing your hand. But if you can't switch jobs or job functions, do everything possible to avoid hand stresses. 


For instance, wear gloves if possible. Keep you hands warm. And MAKE SURE to take the same mini-breaks as above. But do them HOURLY. For best results, work the stretching exercises (next paragraph) into your break time as OFTEN as you can.  

3. Exercising for MODERATE symptoms

hand stretching exercise

The MODERATE stage of carpal tunnel syndrome is when most symptoms can be completely reversed if they're attacked with regular stretching exercises. And you don't have to take time off work to complete them. 


See the core stretching exercise regimen I developed because you can do them quickly without sacrificing effectiveness.


For MODERATE symptoms, perform these carpal tunnel syndrome exercises at least hourly.

4. Massage for MODERATE symptoms

myofascial release massage

Myofascial release massage for MODERATE stage carpal tunnel syndrome has the power to reverse symptoms when performed regularly. Period.


The downside is that it cannot be properly performed by yourself. You must have a helper or trained therapist to apply the massage at least daily. Twice daily will give you maximum results. If you have a partner who can help, be sure to see how to perform this technique in this link.


For MODERATE symptoms, myofascial release massage is necessary. Morning and evening (just before going to sleep) sessions lasting 15 minutes are preferred. But at least one evening session is REQUIRED.

severe pain

Carpal tunnel: how to treat SEVERE symptoms

1. Bracing your hand at night for SEVERE symptoms

wrist braces

Severe carpal tunnel syndrome requires the most aggressive B.R.E.M. therapies. Nocturnal bracing is required, just as it is for mild and moderate symptoms.


Just as with mild and moderate carpal tunnel symptoms, SEVERE symptoms also necessitates night bracing. This will prevent you from over-bending your hand (backward) and further compressing your median nerve.


As a reminder, NEVER immobilize your wrist during the day. And DO NOT use a night brace that has a palmar spine.


At this severe stage, you should take particular precautions. If you have severe symptoms, your chances of developing carpal tunnel syndrome on your other hand (called bilateral carpal tunnel syndrome) is 80% within 12 months of symptoms appearing on the first hand.


Therefore, if you're in a job at high risk for developing carpal tunnel syndrome, you should be proactive. Get ahead of the symptoms immediately. That means nocturnally brace your "good" hand so it doesn't develop symptoms at all. Keep using the night brace on the "good" hand until symptoms have subsided on the first hand.

2. Rest for SEVERE symptoms

hand tools

Resting your hand is secondary to avoiding the stress causing injury to your hand. Severe symptoms can ONLY be relieved by first stopping the stressful activity.


This is a sad reality for most workers. But be assured that if you don't quit the activity, you will NEVER restore your hand.


And whatever job you do, don't forget the mini-breaks during the day. They must be performed every 30 minutes to be effective.


And during those breaks, it's REQUIRED you perform the stretching exercises below. SEVERE carpal tunnel should not be ignored, so a dedicated B.R.E.M. schedule is important.


Once again, it's no joke having SEVERE carpal tunnel, & how to treat it is MUCH MORE involved than treating mild or moderate stages. It requires lengthy and aggressive application of each B.R.E.M. treatment.

3. Exercising for SEVERE symptoms

finger & hand stretching exercise

In the SEVERE stage of carpal tunnel syndrome, the pathology in your wrist is well-developed. But it's not beyond repair! One of the major ways to treat such severe carpal tunnel syndrome and restoring your hand and fingers are stretching exercises.


It's crucial you incorporate them into your regular daily schedule. If you don't, then don't bother with bracing, rest or massage because those alone are not enough.


Perform these core carpal tunnel syndrome exercises every 30 minutes. Since they only take 30 seconds to do, I call it the "30-30 routine".

4. Massage for SEVERE symptoms

pregnant & CarpalRx

Just like the stretching exercises above, having myofascial release massage for SEVERE stage carpal tunnel syndrome is REQUIRED. If you leave out this important part of the regimen, then don't bother with the others. They won't help severe symptoms by themselves.


Having myofascial release massage therapy at this stage is FAR MORE IMPORTANT than when treating mild or moderate symptoms. 


Unfortunately, a thorough massage is nearly impossible without some training. Your partner can certainly obtain such training. But most people see a physical or massage therapist or else use the CarpalRx in order to have properly applied myofascial release massage.


For SEVERE symptoms, YOU MUST HAVE myofascial release massage mornings AND evenings. Sessions should last 15 minutes. Resolution of symptoms occurs in 30-60 days.

Remember....

For more severe symptoms, you cannot exclude one of the B.R.E.M. treatments or take short-cuts in their application. It's especially important to use ALL aspects of B.R.E.M. for severe carpal tunnel syndrome. In severe carpal tunnel syndrome, myofascial release massage must be expertly performed, or else you risk not getting the results you need. If that happens, symptoms can worsen even more.

Conclusion

This is the most important things to learn about carpal tunnel: how to treat it depends on your severity. That means milder symptoms require less time and less aggressive aspects of B.R.E.M. than more severe symptoms. B.R.E.M (BRACE, REST, EXERCISE, MASSAGE) treatments work together and support each other in the fight against this progressive disorder.

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