London Acupuncturist Roisin Golding for the Los Angeles Times Syndicate
If you are being driven mad by numbness and tingling over your palm, clumsiness when picking things up, and nights of sleep interrupted by your own ‘dead hands’, you are almost certainly suffering from carpal tunnel syndrome. The offer of having the problem cut away by the skillful slicing through of the transverse carpal ligament – which forms the roof of the tunnel – tempts many who are otherwise surgeon-shy. Some may even grab (if that option were still open to them) at the chance of a total ‘hand-ectomy.’
But, hold off with the scalpel for just a while. Those maddening symptoms are not the only thing at the end of the tunnel, (the pun was irresistible.) For carpal tunnel syndrome is as curable as it is preventable, and by much less drastic means. (I know you get eight weeks off work for your operation, four for each hand, but think of the long term.)
An important first is to check your nutritional status. A supplement of 100mgs. of Vitamin B6 -Pyridoxine – for three months, has proved effective in many cases. Pregnant women, diabetics, and those taking oral contraceptives need more of this vitamin. Certain types of anti-depressant drugs are linked with B6 deficiency and CTS. B6 is not only important for nerve conduction, but it also acts on collagen and elastin fibres (the important fabric in muscles and tendons.) It also acts as a diuretic, and therefore helps when there is swelling of the extremities (typical complaints with CTS and pregnancy.)
Repetitive strain brings on the symptoms only if it is severe enough to cause swelling from overuse, or if your wrist is already constrained because of inflammation.
A useful analogy might be the carpal tunnel as a freeway tunnel. Instead of cars and lorries you have tendons, blood vessels and the median nerve (a super communication highway carrying sensory signals from most of the hand as well as motor signals for the thumb and wrist flexion.) The floor of the tunnel is made up of eight small carpal bones and capped by a roof of ligament (like a stretched-tight tent.) Activities such as typing all day is the equivalent of rush-hour traffic. With many of the nine tendons in the tunnel flexing all at once, jams are bound to occur. The median nerve, which is a pencil-size cord carrying thousands of nerve fibres, is the first to feel the squeeze and can become damaged. Swelling can be seen, with a small stretch of the imagination, as a flooding of the tunnel, again causing traffic disruption.
Initially what one needs is to manage the flow of traffic going through the wrist. Sometimes it’s necessary to stop traffic altogether to repair flood damage or for other repairs. In other words, take frequent breaks from your work.
But what is needed at the end of the day is more space. This is the idea behind using a wrist brace, as maximum room in the tunnel is provided when the wrist is bent neither forward nor back.
However, researchers at the University of Pennsylvania, in a study involving 51 patients, found that yoga was more effective than wrist braces in treating this condition. This is because yoga actively stretches the muscles and ligaments. By improving posture and releasing tension in the neck, yoga also prevents compression of the nerve root as it emerges from the spine.
After all, when you do any other form of exercise you know you must stretch to avoid tightening and injury to muscles and joints. Typing all day is a fairly rigorous workout.
Mark Gray, a Heller Worker and lecturer on bodywork at Westminster University, London, emphasises the need to create space in the joints. He suggests several exercises which are particularly useful.
To release tension at the neck and shoulder, stand up and shake out your whole hand from your neck and shoulders down. With hands still hanging down by the sides while keeping the elbows still, shake the hands loosely for several minutes. Sitting at your desk, with the elbow planted firmly on top, rotate the hands at the wrists in both directions, three times with the hands open, then again with the hands closed. Keeping the elbow planted firmly on a desk, make a falling movement with the wrists. Finally, open the hand wide and close again tightly several times.
Massage of the hands and arms is also important and is easily done by yourself, or by a partner who wants to spoil you a little. Use firm rotating movements with the thumb over the palm of the hand and wrist. Use finger and thumb pressure on both sides of the hand to increase the space between the bones of the hand and to stretch the fingers. Gray also emphasises creating space between the long bones of the arm, as many of the muscles of the arm end as tendons in the carpal tunnel.
Creating space is the mechanism which will allow the return of function and normal sensation. It is the mechanism which orthodox medicine uses in its own way, and, in a more gentle way, the alternative therapies of yoga, physiotherapy, massage, and acupuncture.