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Guide to Treating Carpal Tunnel

Dr. Z • May 17, 2021

Treating Carpal Tunnel Syndrome

Treating carpal tunnel effectively, and without surgery, is not terribly difficult nor complicated. It just takes know-how and daily dedication for about one month.

Actually, there are 4 excellent options for treatment. Most patients experience the greatest amount of relief when they combine all 4 treatment options at the same time. This article describes each one of those treatments.

Be certain you have carpal tunnel and not tendonitis: take this self-test.

Majority of patients use non-surgical remedies

Ask any doctor and they'll tell you that the vast majority of people (over 95%) who have carpal tunnel syndrome treat it successfully without surgery. In fact, carpal tunnel syndrome will spontaneously disappear in 28-60% of patients without any treatment whatsoever.

So why are carpal tunnel patients encouraged to have surgery?

It's because surgery does work in about 50% of patients. Carpal tunnel surgery means experiencing a week or two of post-surgical pain. Then a few weeks of aftercare and hand rehabilitation are needed. By then, symptoms will begin to disappear in about half of surgery patients.

But what about the other 50% who don't see their symptoms resolve? Either they have a second surgery (where only 20% will be successful ) or they simply live with the problem forever.

So these facts beg the question, "Why not start treating carpal tunnel with a non-surgical remedy first? Actually, most patients do.

Effectively treating carpal tunnel without surgery

Physical therapists and chiropractors have been treating carpal tunnel successfully for years. They most often use a regimen called B.R.E.M. which stands for:

Bracing
Rest
Exercise
Massage

B.R.E.M. represents the 4 key ways of treating carpal tunnel syndrome. In fact, studies show these 4 methods provide results that are equal to (and most times, better than) surgery. And the results are permanent.

It's best to use a combination of these 4 methods at the same time whenever possible. Doing so amplifies the effects of each individual treatment method.

Using the combination of all 4 treatments is especially recommended if your carpal tunnel symptoms are more advanced or severe. Milder symptoms may not require such aggressive application.

Finally, pregnant women are encouraged to use the B.R.E.M. techniques. Pregnant women are highly prone to getting carpal tunnel syndrome. B.R.E.M. is often advised because all of the techniques are natural healing treatments.

1. Bracing

The advantages of nocturnal bracing

Wearing a wrist brace while you sleep is one of the best ways of treating carpal tunnel syndrome. Here's why.

The reason we get carpal tunnel syndrome is because of fluid pressure that's built-up inside the wrist joint. That pressure pushes on the median nerve, thereby damaging it.

The pressure can be increased even more if you bend your hand forward or backward. And that makes carpal tunnel symptoms much worse.

Unfortunately, when we sleep we unconsciously hyper-bend our wrists. This is very harmful if you have carpal tunnel syndrome. And it's one of the reasons symptoms wake you up at night. It's also why symptoms are frequently worse in the morning.

But wearing a wrist brace while sleeping prevents you from hyper-bending your wrist. In fact, it keeps your hand in a "neutral" position. (Basically, that means "straight".) Therefore, as you sleep with a brace it helps keep the internal wrist pressure low.

Additionally, night time rest helps tendons heal. This is especially important when you're treating carpal tunnel with the three other B.R.E.M. techniques.

Never brace during the daytime

If you have carpal tunnel syndrome, you should never wear a wrist brace during the daytime (as you work). The reason? Your wrist joint is already damaged by carpal tunnel syndrome. Wearing a brace while your hand works makes it perform "double work".

That means it has to perform it's regular activity, but at the same time it must fight against the brace's restriction. This double work translates into double-stress and double-damage to the wrist joint.

The only exception to this rule is if you know in advance that you'll be lifting something heavy. (Although you shouldn't do so if you have carpal tunnel syndrome!) The brace can help support your wrist, preventing it from hyper-bending during the lifting.

Use a "certified" carpal tunnel brace, not a pharmacy brace

Wearing an ordinary "pharmacy brace" (like those from CVS, Walgreens, etc.) at night for treating carpal tunnel is harmful. It will worsen your carpal tunnel syndrome. That's because those braces typically contain a "palmar spine". That's a metal spine on the palm surface of the brace.

Here's the problem if you sleep with a brace containing a palmar spine. Any unconscious backward bending of your wrist will push the spine into your joint. This will further increase pressure inside the wrist, making your carpal tunnel syndrome much worse.

Below is a current list of the most common certified carpal tunnel braces. They are not available in pharmacies (only available online.)

List of "certified" carpal tunnel braces

2. Rest your hand

Every disease state known to man - without exception - is benefitted by rest. Rest is the body's way to combat trauma, fight infection, and restore balance to stressed tissues. Rest as a method of treating carpal tunnel is no different.

Carpal tunnel syndrome causes inflammation, swelling, and damage to the median nerve inside the wrist joint. But rest restores blood flow which facilitates oxygen and nutrient influx. Simultaneously, worn-out and damaged cellular components are swept away.

If you're treating carpal tunnel with rest, then you should develop a "rest routine". For every hour that you work with your hands, take a short break. It doesn't mean you have to lie down and sleep. Just a 30 second break from your hand activity will be enough.

This "mini-break" means stop what you're doing. Then drop you hands to your sides and shake them out. If they feel warm while shaking, it means blood is flowing and bringing in oxygen and nutrients to your hands.

Better still, take another 30 seconds of your mini-break and do the stretching exercises below. The combination of rest PLUS exercises is a great carpal tunnel fighting combination.

3. Exercises

As a stand-alone way of treating carpal tunnel, exercises are perhaps the most useful. Stretching exercises targeted to relieve carpal tunnel syndrome work at the tissue level (specifically on tendons), from the fingers to the elbow.

If you don't have time for exercises, don't worry. The best carpal tunnel exercises take less than a minute to complete. These are the "core exercises" for carpal tunnel syndrome.

The core exercises perform 3 distinct functions.

They lubricate flexor tendons. These are the tendons responsible for curling your fingers, and for causing carpal tunnel syndrome. If the tendons are lubricated they glide smoother and won't irritate or push on the median nerve.
The exercises break up fibrous adhesions on the flexor tendons (see photo of adhesions below). This reduces restrictions and helps the tendons glide smoother.
The stretches enhance blood circulation. Good circulation results in faster healing.

Important Exercise Instructions

Do each of the 4 exercise below, one after the other.

After each individual exercise, drop your hands to your sides and shake them out briefly. Doing so should make them feel warm. That means blood is flowing well through your fingers and hands.

Do these exercises at least 4 times per day for mild symptoms. More advanced or severe symptoms may require doing them every 30-60 minutes.

Core exercise 1 (for fingers)

Core exercise 2 (for the wrist)

The next exercise for treating carpal tunnel targets the flexor tendons inside the wrist area. This is where swelling and inflammation cause pressure on the median nerve - which in turn causes carpal tunnel syndrome. This stretch, sometimes called the "stop" stretch, removes adhesions and restrictions from tendons at the wrist joint.

Hold one hand out in front of you as if you're demanding to "stop!" With the other hand, use all fingers to pull back on the upward turned "stop" hand. Pull backward as hard as you can tolerate. Hold it for 10 seconds. Then drop your hands and shake them out.

Core exercise 3 (for the forearm)

This exercise is widely known as the "prayer" stretch. The advantage of this exercise is that it stretches flexor tendons from the palm all the way to the forearm muscles. Therapists consider it a good, all around way for treating carpal tunnel syndrome because it dislodges adhesions along the tendons' length.

Begin by pressing your palms together, fingers up, as in a prayer. Keep your hands close to your chest. Then slowly raise your elbows while maintaining your hands at the same level. Lift your elbows as high as you can. Then hold it for 10 seconds. Then drop your hands and shake them out.

Core exercise 4 (for the thumb)

4. Massage

Not just any old massage will work

The final - and most effective - carpal tunnel treatment is massage. But not just any old massage is good for treating carpal tunnel syndrome. In fact, some types of massage (like vibration massage) can be harmful) if you have carpal tunnel.

Instead, you must use a specific technique called myofascial release massage. When properly performed, it has a 97% effectiveness rate against carpal tunnel syndrome.

Ordinary massage moves the skin and underling tissues in a rhythmic fashion. This increases blood flow, facilitates lymphatic drainage and generally feels good.

Myofascial release does the same thing. But it has another result that's crucial to treating carpal tunnel syndrome: it breaks up adhesions.

More effective than surgery

At it's core, carpal tunnel syndrome is due to swollen tendons. Tendons swell because they acquire fibrous adhesions on their surface. This impedes smooth gliding and restricts their motion. So the key to reducing tendon swelling is to destroy the adhesions.

Myofascial release massage destroys these adhesions using counter-rotating fingers. The counter-rotating thumbs and forefingers of the therapist create a "kneading" motion.

When applied to the area just below the wrist crease, it affects the flexor tendons directly below. The kneading motion helps dislodge adhesions and un-restricts the tendon. See this link for specific directions about how to perform myofascial release massage yourself.

This specific carpal tunnel treatment must be applied:

At least daily (twice daily is best), and
For at least 30 days

It takes 30 days of daily treatment for adhesions to disappear in mild cases of carpal tunnel syndrome. For more severe cases, 30-60 days of the same daily treatment may be required.

Most therapists opt for for treating carpal tunnel using this massage along with night bracing. That's because myofascial release massage plus nocturnal bracing is more effective than surgery. The only downside is that visiting a therapist once or twice daily for 30 days is expensive. Note that the CarpalRx device performs this identical massage automatically and in your own home.

Conclusion

The most effective carpal tunnel treatment is a non-surgical regimen of 4 combined therapies called B.R.E.M. It stands for Bracing, Rest, Exercise and Message.

Mild cases of carpal tunnel syndrome may be relieved by only one or two of the B.R.E.M. therapies. But more severe symptoms likely require all 4 therapies simultaneously.

Most patients will see complete relief in about 30 days. More severe cases may require up to 60 days of treatment.

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