Manual Therapy and Carpal Tunnel Syndrome: How Effective is it?

Carpal Tunnel Syndrome is thought to affect around 3% of the adult population, and is one of the most commonly described neuropathies of the peripheral nervous system [1, 2]. Characterised by numbness, tingling, pain and weakness in the thumb, index and middle fingers, carpal tunnel syndrome is caused by compression of the median nerve in the wrist. Although the risk factors include heredity, overuse, wrist injuries and a range of autoimmune and inflammatory conditions [1], therapeutic options usually major on anti-inflammatory drugs or surgery.

Physical therapy has long been used as a management technique for carpal tunnel syndrome, and this usually includes splinting and stretching, along with steroid injections or oral pharmacology interventions [2]. Still these treatments are often thought of as conservative, and the efficacy of both pharmacological and physical therapy treatment options have been the subject of much debate.

Questions and debate still surround this condition and the best options for management and treatment – is surgery the best option? Or is there a better way? Can manual therapies like chiropractic care help with Carpal Tunnel Syndrome?

A recent randomized controlled trial published in JMPT took aim at the latter of these questions, and the results are encouraging. The study took a sample of 140 Carpal Tunnel Syndrome (CTS) patients who had physician-diagnosed mild to moderate CTS, and assigned them to either a manual therapy (MT) intervention group or an electrophysical modality (EM) group.

The manual therapy group was treated using a variety of manual therapy and neurodynamic techniques including functional massage or carpal tunnel bone mobilisation techniques, while the electrophysical modality group were treated using lasers and ultrasound [2].

For the manual therapy group:

• Neurodynamic techniques were directed at the median nerve.
• Functional massage lasted three minutes per session and worked on the descending part of the trapezius.
• Wrist mobilisation techniques were also used.
• Further details of the specific interventions can be found in the original study (reference below [2])

The study took place in Poland, at two separate clinics where patients were assigned randomly to either the manual therapy or the electrophysical modality groups. Data was collected over five years, ranging from 2007 to 2012. During the study, participants in the electrophysical modality group received twenty laser and ultrasound treatments, and the manual therapy group received twenty rounds of manual and neurodynamic treatments, both over a ten-week treatment cycle.

Participants answered a questionnaire to measure nerve conduction, pain and symptom severity, and functional status (the Boston Carpal Tunnel Questionnaire) prior to and after treatment. Over time, the differences in results became apparent, and seem heavily weighted in favour of the manual therapy intervention.

Key findings included:

• Beneficial results were recorded in both groups, giving encouraging indications that therapeutic benefit can be gained before resorting to surgery or pharmacological means.
• “Baseline sensory conduction velocity was significantly worse in the MT group than in the EM group, but there were no group differences in this parameter after therapy [2].” This indicates that improvement was greater in the MT group.
• After the therapy, sensory conduction velocity had improved by a significant 34% in the MT group. The EM group saw a non-significant improvement of just 3%, again illustrating greater improvement from manual therapy.
• Despite the fact that motor conduction velocity was within normal limits for both groups prior to therapy, improvement was again greater for the MT group.

The researchers remarked that the patterns of sensory conduction velocity and motor conduction velocity before and after therapy observed during the study “may reflect the efficacy of manual therapy including the use of neurodynamic techniques [2].” They also remarked that:

“If nerve conduction is within normal limits, then manual therapy can only produce a very limited improvement, which appears to have been the case in our study with respect to motor conduction velocity. Both groups experienced a significant reduction in pain, but there was a group difference in the magnitude of the reduction. The mean reduction in pain was 290% for the MT group and 47% for the EM group…

The MT group achieved a much greater reduction in pain, combined with a reduction in subjective symptoms and an improvement in function and sensory conduction velocity. This pattern of results suggests that manual therapy, including the use of neurodynamic techniques, may be more effective than electrophysical modalities in treating some CTS symptoms.”

This is an encouraging indicator that manual therapies can indeed help sufferers of CTS regain function and reduce pain. Of course, this does not cover the ways in which chiropractic care could possibly assist in addressing the risk factors such as inflammation, autoimmunity or ergonomics, nor does it include the impact of a specific chiropractic adjustment on CTS or CTS with double crush syndrome.  Still, it is a strong indicator that at least on the frontier of pain and function, we can indeed have a positive impact.

References

[1] Staff Writer (2004), “Carpal Tunnel Syndrome,” My Virtual Medical Clinic, https://www.myvmc.com/diseases/carpal-tunnel-syndrome/ retrieved 18 May 2017

[2]  Wolny T, Saulicz E, Linek P, Shacklock M, Mysliwiec A (2017), “Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial,” Journal of Manipulative and Physiological Therapeutics, Vol. 40, No. 4, pp. 263-272