Massage Therapy as alternative treatment for managing Carpal Tunnel Syndrome & Gout

1. Massage Therapy as alternative treatment for managing Carpal Tunnel Syndrome & Gout James E Strozier, LMBT

2. Carpal Tunnel Syndrome (CTS) • CTS is a repetitive strain injury that causes compression of the median nerve located in the wrist. • Compression of the median nerve causes impaired neuromuscular function of the hand and fingers. • The median nerve is responsible for feeling and movement in the thumb, index finger, middle finger, the thumb-side of the ring finger and the palm.

3. Carpal Tunnel Syndrome (CTS)

4. Causes & Symptoms of CTS • Inflammation, injury, fluid accumulation, or disease can affect the median nerve thus shrinking the size of the carpal tunnel and cause the following in the fingers, wrist, palm, or elbow: • Numbness • Tingling sensations • Difficulty with coordination • Muscle atrophy and weakness of grip • Pain

5. Causes & Symptoms of CTS

6. Signs and Tests of CTS • Tinel’s Sign • Shooting pain from the wrist to the hand when tapping over median nerve. • Phalen’s Test • Numbness, tingling, or weakness resuling from bending the wrist completely forward for a 60 second duration. • X-rays • Nerve Conduction Test

7. Risk Factors Associated with CTS • Repetative motion(s) and or strains of hand and wrist or overworking muscles in the arm due to : • Typing on a keyboard • Occupation (massage therapy) • Sports (golf, raquetball) • Sewing • Writing • Tool use (vibration) • Some musical instruments (piano) • Driving • Affects 30-60 year old demographic. • Occurs more frequently among females.

8. Treatment of CTS • Rest • Splinting • Hot and cold compresses • Alterations in lifestyle and to workplace to reduce stressors on the wrist. • Medications • Anti-inflammatories • Diuretics • Corticosteriod injections • Surgery • Massage Therapy

9. Massage Therapy for CTS • Research confirms that techniques such as petrissage, compression, circular friction, and skin rolling, applied once a day for 15 minute intervals, effectively reduced pain and improved symptoms associated with CTS. Field, T., Diego, Miguel, Cullen, Christy, Hartshorn, Kristin, Gruskin, Alan, Hernandez-Reif, Maria,Sunshine, William. (2004). Carpal tunnel syndrome symptoms are lessened following massage therapy. Journal of Bodywork and Movement Therapies, 8, 9-14.

10. Massage Therapy for CTS • Techniques for prevention • Massage hands and forearms routinely. • Stretching and range-of-motion (ROM) to hands, neck, shoulders and forearms. • Strengthen muscles in the forearms and hands using isometric (muscle contraction against stable resistance) and isotonic (muscle contraction resulting in muscle shortening and movement) exercises.

11. Massage Therapy for CTS • Avoid local massage over affected area if inflammation is acute. • Special techniques: • Cold applications • Deep moist heat • Lymphatic drainage • Contract-relax muscle energy • Myofascial holding • Cross-fiber friction • Trigger point • Reflexology

12. Arthritis-Gouty (Gout) • Gout is a common form of arthritis characterized as inflamation of joints in conjunction with crystaline deposites of sodium urate (salt formed from uric acid) therein. • Gout is a metabolic disorder, also known as urate crystal deposition disease, in which blood urate has decreased elimination or less commonly overproduction. • Can affect any joint, but most commonly occurs first in the big toe.

13. Symptoms & Causes of Gout

14. Signs & Symptoms of Gout • Characterized by a sudden onset (often at night) of redness, swelling, heat, and extreme pain. • Affects peripheral joints • Metatarsophalangeal • Knees • Elbows • Thumbs • Fingers • Ankles • Can be accompanied by fever, nausea, headache, and or mood change.

15. Symptoms of Gout

16. Risk Factors Associated with Gout • Predominates in males 30-60 years old and less frequently in postmenopausal women. • Diets rich in protein or purine • Disease • Kidney disease • Leukemia • Diabetes mellitus • Obesity • Hypertension • Psoriasis • Strenuous physical activities • Starvation • Lead poisoning • Enzyme deficiencies

18. Treatment for Gout • Anti-inflammatories or steroid injections in acute phase. • Increase fluid intake • Weight loss • Determine if causation is increased urate production or decreased elimination. • Prescription drugs to lower urate in blood (increase alkalinity in urine and solubility of uric acid). • Lifestyle change • Herbal remedies • Massage Therapy (during certain stages)

19. Massage Therapy for Gout • Generally massage and range of motion (ROM) contraindicated in acute phases due to intense pain and potential to exasperate inflammation. • Heat and cold therapy can be used to reduce inflammation. • Light massage indicated in surrounding areas in subacute stage. • Light to medium brisk stroke massage indicated for short duration in chronic stage. • Accupressure

20. Massage Therapy for Gout • Touch Research Institute at University of Miami • Studies show participants that received massage 1x/week for 4 weeks and performed self massage daily reported a decrease in pain and increased relief from hand and wrist arthritis. • Adam I. Perlman, et al. 2006. • Randomized controled trial for osteoarthritis of a knee joint (commonly affected by gout) using Swedish Massage, 2x/week, reduced pain and improved function to the knee joint(s) of the treatment group.