Carpal Tunnel Syndrome and Manipulative Therapy

By Bonnie Jenkins, Advanced Natural Medicine

No doubt you've seen them at the supermarket checkout or maybe one of your co-workers is sporting one at the office. I'm talking about wrist splints - those Velcro-fastened wraps that entomb the arm from fingers to elbow. The last time I was in the grocery store I noticed that Beth, my regular checker, was wearing one. Unfortunately, she’s joined the 2.5 million new cases of carpal tunnel syndrome diagnosed each year. While Beth isn’t thrilled with the splint, she thinks it’s better than the surgery her doctor recommended. She’s probably right.

Carpal tunnel release surgery has a 57 percent failure rate. And yes, the procedure comes with it's own set of irreversible complications. Don’t get me wrong – surgery can be an amazing thing when it’s successful . . . it can also be a nightmare when it is not.

A Failing Grade

Let’s back up for a minute and get some background on this debilitating condition. CTS occurs when the tendons and ligaments encased in the median nerve (the major nerve responsible for sensation and movement in the wrist and hand) are repeatedly irritated. The result of moving your hand and wrist in the same way over and over is pain, swelling and the eventual compression of the nerve. In mild cases, CTS sufferers experience a tingling and numbness in the thumb and fingers. More severe cases can cause pain so debilitating it often wakes people up in the middle of the night and grasping small objects can be difficult.

Without treatment, CTS can eventually cause permanent weakness, a loss of sensation or even paralysis. But is surgery the answer? Not necessarily. Surgery only addresses the symptoms, not the actual cause of CTS, so many people find that pain, numbness and tingling reappear. Even if your doctor isn’t anxious to get you into the operating room, he’ll probably prescribe a splint and plenty of anti-inflammatory medications. But here are some bleak statistics: splints and NSAIDs don’t work for 81.6 percent of people on a long-term basis. And another popular option, steroid injections, fail 72.6 percent of the time.

Manipulating Medicine

So if conventional CTS treatments don’t work, what does? There’s a lot of evidence that manipulative therapy can help ease the pain and pressure of CTS.

Most of this research has focused on acupuncture. One investigation, which combined acupuncture with Chinese herbs and omega-3 fish oil capsules, found that more than 90 percent of the subjects reported a significant reduction in pain after treatment. In a more high-tech study, 36 patients who had been diagnosed with CTS were treated with low-level laser acupuncture three times a week. After 5 weeks, 33 of the 36 participants either had no pain or their pain was reduced by more than 50 percent. Two years later, only two of these patients experienced recurring pain. Now, those are amazing results! But don’t count on your doctor getting too excited. Most mainstream physicians discount the therapeutic effects of acupuncture – even if they’re proven to work. It seems that conventional medicine has trouble believing in anything they can’t get their heads around. And acupuncture, which is based on the movement of “chi” (the body’s energy or “life force), is a little much for them to handle. But you might get a better response for another type of manipulative approach – yoga. Researchers have found that the bending and flexing of the wrist in many yoga positions can maintain wrist strength and relieve CTS symptoms. One double-blind study by the University of Pennsylvania showed significant improvement among 42 patients following a twice-weekly yoga routine for eight weeks. In the study, 250 patients were assigned to one of two groups. One group did a series of yoga strengthening, stretching and balancing exercises while the other group's wrists were immobilized with a splint. Both groups improved during the eight-week study. However, the actively treated yoga patients were rewarded with less pain and better grip strength than those wearing the splints.

B Good to Your Hands

You can get even more relief, by combining manipulative therapy with anti-CTS supplements. In fact, many people report that taking supplements for their CTS caused the condition to disappear completely. If there’s one supplement that has emerged as a superstar, it’s vitamin B-6. Research shows that B-6 can reduce pain, tingling and morning stiffness. A study by Kaiser Permanente Medical Center in Hayward, California, found that pain scores improved significantly among 20 CTS patients after taking 200 mg. of vitamin B-6 per day for three months. The researchers don’t know why it works, but they suspect that B-6 helps reduce inflammation and maintains healthy nerve tissue.

Once your symptoms have improved, most integrative physicians recommend reducing the B-6 dosage to 100 mg. a day. When your symptoms have disappeared completely, you can probably get by with a multi-vitamin containing 50 mg. of B-6. But keep a bottle of B-6 handy in case you experience a flare up. A couple of herbs have also been found to help relieve the pain of CTS – one you can apply topically and the other works from the inside out.

Arnica is a popular remedy among athletes because it quickly eliminates the pain of muscle injuries. It turns out that this homeopathic herb can do the same for CTS. And it works particularly well if you do end up opting for surgery. In one double-blind, randomized trial of 37 patients undergoing CTS surgery, those treated with an arnica cream experienced significant pain relief within just two weeks of the treatment. If your hand or wrist is painful and swollen, Devil’s claw might be just what you need. French researchers analyzed the herb and found that it contains potent analgesic and anti-inflammatory properties. It’s no wonder Europeans have relied on devil’s claw for years to treat muscle and tendon-related injuries. Just be aware that, unlike OTC and pharmaceutical drugs, herbs like devil’s claw don't give immediate relief. Instead they act over a period of weeks to gradually reduce pain and swelling.

One Last Thing ...

There are a lot of anecdotal reports on the benefits of bromelain, a protein-digesting enzyme derived from pineapples that has anti-inflammatory properties. A report in Alternative Medicine Review noted that "the therapeutic use of bromelain can be of significant benefit and may decrease the need for carpal tunnel release surgery." I know a lot of people who have tried bromelain and most have found that taking 100 to 200 mg. a day helps keep inflammation from getting out of hand (pardon the pun).

Two other herbs often recommended by CTS sufferers are tumeric and ginger. Both are strong inflammation fighters that seem to enhance the healing properties of bromelain. By the way, I shared this information with Beth a few weeks ago and she immediately started seeing an acupuncturist. She’s also begun taking B-6 and devil’s claw. The last time I went grocery shopping, she couldn’t wait to tell me how much better her CTS is. But the best news – that clunky wrist splint is history!

This Just In ...

About a month ago, I told you about an article that has generated lots of controversy over the safety of soy (“Does Soy Have a Dark Side?”) – most of it based on rumor and speculation instead of science. I also gave you a number of reasons why you shouldn’t give up soy just yet – and here’s another one. New research out of Japan suggests that eating foods rich in isoflavones may reduce the risk of breast cancer. Scientists from Japan’s National Cancer Center tracked nearly 22,000 Japanese women for ten years and studied their consumption of soy products. While soy foods like tofu didn’t have a significant impact, the women with the highest consumption of miso soup (a soy-rich broth that’s a staple in traditional Japanese diets) and a high overall isoflavone intake cut their breast cancer risk by nearly 50 percent.

*** References:

Branco K, et al. “Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, mocroamps transcutaneous electrical nerve stimulation, and other alternative therapies – an open protocol study.” Journal of Alternative Complementary Medicine. 1999; 5:5-26.

Garfinkel M, et al. “Yoga-based intervention for carpal tunnel syndrome.” Journal of the American Medical Association. 1998; 280:1601-1603.

Holm, G. et al. “Carpal tunnel syndrome: current theory, treatment and the use of B6.” Journal of the American Academy of Nurse Practitioners. 2003; 15:18-22.

Jeffrey SL, et al. “Use of Arnica to relive pain after carpal-tunnel release surgery.” Alternative Therapies in Health and Medicine. 2002; 8:66-68.