It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures.
Recent studies have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
By incorporating nerve flossing into a comprehensive treatment plan, chiropractors are now able to offer patients a powerful combination of professional care and self-management strategies.
Carpal tunnel syndrome (CTS) is a prevalent and potentially debilitating condition that affects the median nerve in the wrist, resulting in a constellation of symptoms including numbness, tingling, and weakness in the hand and arm. This common peripheral neuropathy impacts approximately 5% of the general population, with a higher incidence in women and office workers due to repetitive hand and wrist movements.
As the most frequent peripheral neuropathy, CTS accounts for a staggering 90% of all such cases. Its progression can lead to significant impairments, including muscle atrophy, diminished hand strength, and reduced dexterity. These symptoms not only affect physical capabilities, but also have far-reaching consequences on an individual’s quality of life, ability to perform daily activities, mental well-being, and social engagement.
Chiropractic Care for CTS
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures, thereby opting for conservative intervention for long-term relief of the symptoms.
Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Skilled chiropractors employ a range of sophisticated techniques to alleviate CTS symptoms including manipulation techniques on the cervical spine, gentle mobilization of the wrist and elbow, ultrasound and electric stimulation, stretching and strengthening exercises, instrument-assisted and manual soft-tissue mobilization, and strategic bracing for support and protection.
A Game-Changing Adjunct
Recent studies have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing. This innovative self-treatment technique, which patients can perform both in-office and at home, has been shown to significantly enhance outcomes and accelerate recovery times.
By incorporating nerve flossing into a comprehensive treatment plan, chiropractors are now able to offer patients a powerful combination of professional care and self-management strategies. This holistic approach not only provides immediate relief, but also empowers patients to take an active role in their healing process, leading to more sustainable and satisfying results.
A recent study in the Journal of Clinical Medicine1 reviewed 12 RCTs with assessments on 1,003 participants in order to establish the effectiveness of neurodynamic techniques (nerve flossing) as a nonsurgical treatment option for CTS. Primary outcome measures included outcomes from the Boston Carpal Tunnel Syndrome Questionnaire, while secondary outcomes included nerve conduction velocity, pain, and grip strength.
This study demonstrated significant benefits of neurodynamic modulation techniques such as nerve flossing to treat CTS, specifically that it reduces symptom severity, pain, and motor latency, while at the same time improving nerve conduction velocities. Although grip strength was not significantly different, pain was reported as significantly reduced. This study demonstrates a clear benefit of neurodynamic techniques to improve recovery from CTS.
Manual therapy facilitates nerve gliding through various techniques including soft-tissue and wrist-joint mobilization and neurodynamic techniques.2 Neurodynamic modulation (NM) involves three key treatments: (1) functional massage of the descending part of the trapezius; (2) wrist opening and closing; and (3) gliding and tensioning mobilization of the median nerve through nerve flossing.
As the median nerve glides longitudinally during the upper limb movements, NM promotes the normal physiological and mechanical movement of the nerve in CTS.
Nerve-flossing techniques aim to move the nerve along its distribution by lengthening or shortening the path that the nerve must travel. Although this study demonstrates its effectiveness for the median nerve, it can also target the ulnar, and radial nerves.
There are two types of nerve-flossing exercises: (1) nerve gliding and (2) nerve tensioning. Nerve gliding encourages the nerves to glide normally as you move your joints, which is performed by pulling the nerve from one end and shortening it from the other end.
Nerve tensioning entails tensioning one end of the nerve while simultaneously releasing tension on the other end. Performing this repeatedly aims to release adhesions that have developed along the nerve. This is accomplished by stretching the nerve from both ends.
It is recommended to start with gliding exercises and slowly work toward tensioning exercises. These exercises are simple, do not require equipment and can easily be done at home.
To determine if these exercises will benefit your patient, have the patient reach their palm away from them in a pressing motion, with their wrist extended, and hold. If they begin to get symptoms of numbness or tingling in any one of the following: thumb, first two digits or palm, then they may benefit from nerve flossing exercises.
Nerve gliding exercises:
Start with the involved arm extended out to the side of the body with wrist extended and palm facing out; neck laterally flexed toward involved shoulder.
Slowly bend the involved arm toward your face while internally rotating and flexing the wrist toward your ear, and flexing the neck laterally away from the involved shoulder.
Hold each position for two seconds and repeat 10 times.
The goal of this nerve-gliding exercise is to stretch the nerve from the hand as we lessen the stretch of the nerve at the neck, and then stretch the nerve at the neck and lessen the stretch of the nerve at the hand.
Nerve tensioning stretch:
Start with the involved arm extended out to the side of the body with wrist extended and palm facing out; neck in neutral position.
While maintaining this arm position, laterally flex the neck away from the involved shoulder.
Hold this position for two minutes and repeat 10 times.
Discussion / Clinical Pearls
It is normal for your patients to feel increased symptoms like numbness and tingling while performing nerve-flossing exercises. However, if these symptoms do not subside within five minutes after the exercise is complete, have them reduce the repetitions and the aggressiveness of the stretch.
Performing these exercises will help stretch and mobilize the median nerve, which can reduce pressure on the compressed nerve and help it glide more smoothly through its natural pathway. This can improve nerve function, increase range of motion, and help fluid flow more easily inside nerve cells.
The next time you are treating a carpal tunnel patient, consider introducing these nerve mobilization techniques. Not only can they provide immediate relief, but they also empower patients to actively participate in their recovery process. Patient education is crucial, so be sure to demonstrate and explain the purpose of these exercises to ensure proper execution and maximize therapeutic outcomes.
References
Zaheer SA, Ahmed Z. Neurodynamic techniques in the treatment of mild-to-moderate carpal tunnel syndrome: a systematic review and meta-analysis. J Clin Med, 2023 Jul 25;12(15):4888.
Basson A, Olivier B, Ellis R, Coppieters M, et al. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. J Orthop Sports Phys Ther, 2017 Sep;47(9):593-615.
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