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(d) Phalen's Maneuver
Athletes and Carpal Tunnel Syndrome
Have you ever been lying in bed asleep and all of the sudden woke up feeling a tingling sensation in your thumb, index, and middle finger? You try shaking your hand to wake it up, thinking maybe you were sleeping on it wrong, then your eyes grow heavy and you fall back asleep thinking nothing of it. Over the next couple weeks, this tingling slowly becomes a nightly routine, and before long you start to notice your hand burn or possibly go numb during daily activities
like working out, gripping smaller objects like cooking utensils or a toothbrush, or while
gripping the steering wheel on the drive to work. You might get to the point of having pain
shoot up to your elbow during activities where your wrist is flexed upward to lift a gym bag or
purse (a), and your hands and fingers feel weaker on one side than the other. If left untreated,
you might start to notice the muscle on the palm of your hand just below your thumb (the
thenar muscle) start to look smaller on one hand than the other. If any of this sounds familiar,
you could be experiencing carpal tunnel syndrome.
What is Carpal Tunnel Syndrome?
Effecting 3% - 6% of the adult population, carpal tunnel syndrome is the most common nerve entrapment condition we experience (2). It was traditionally thought of as a condition that only plagued older women with secretarial or administrative assistance positions that required them to type on computers all day. Even though women are three times more likely to get it than men (1), it’s a condition seen in a lot more instances than just typing on a keyboard.
Let’s talk some anatomy for a second. The carpal tunnel is in the wrist (b). Just
like the name states, it’s a tunnel made up of carpal bones on one side (the back
ofyour hand), and the median nerve along with nine tendons that control wrist
and fingerflexion (flexor tendons) on the other side. These tendons, along with
the median nerve, are held in place by a wide ligament (the transverse carpal
ligament) that acts like saran wrap keeping the tendons close to the bone rather
than letting them sit like a bowstring. When the space inside the carpal tunnel is
reduced for one reason or another, pressure pushes on the median nerve causing
numbness, tingling, muscle atrophy, and shooting or burning pain down into the
thumb, index, and middle finger(the areas that it supplies). As we stated earlier,
the pain typically starts occasionally at night, and over time will start to affect daily
life if left untreated.
Our friend Mindy Harley, fitness model, owner of the social media consulting
and management agency, Social Empire, and head of marketing
for Rock Solid Nutrition, spoke with me about her experience with carpal tunnel
syndrome while being a Black Jack dealer in Winnipeg, Canada. The consistent
and quick wrist flexion and extension needed to flip cards caused the equivalent
of an overuse injury in her wrists, and things like opening a jar or lifting a dumb
bell or her purse began to send a shooting pain through her wrist. She also noticed
that about three hours into her shifts she would consistently get a sharp pain coupled
with a lingering dull ache when she had to grip something, and it would get worse
throughout the day. She eventually needed to take time off work and completely stop
her lifting routine for about two weeks. Things like NSAIDs and ice helped very little,
if at all, and she was ultimately put on modified duties at work for a couple months.
She dealt from 2001 to the summer of 2009, and says that she didn't really feel any
better until after she quit. Since then, she says there's been a definite decrease in the
level of pain, but it does still act up on her occasionally.
What Causes Carpal Tunnel Syndrome?
There’s numerous ways the space inside the carpal tunnel can get crowded, and it depends on your sport. Anatomically, women tend to have a smaller bone structure, which already puts us at a disadvantage and increases our likelihood for developing the condition. For both men and women, chronic overuse without any sort of active recovery technique like stretching, massage, or a cool-down will cause those nine tendons that flex the wrist to become
chronically inflamed. This is what Mindy experienced while she was
dealing cards. A good self-check to see if your wrist pain might be from
carpal tunnel syndrome is calledPhalen's Maneuver (d). Pushing
the palms together and extending the wrists back stretches out those
nine tendons, and if they're very tight and inflamed, this will NOT be a
very comfortable position to hold.
Other examples that can cause an overuse injury leading to carpal
tunnel syndrome include consistently using gi grips (e) and wrist
locks (f) during grappling in jiu jitsu, gripping underclings and
slopers with your wrists in extreme flexion while rock climbing
(g, h), or letting your wrists flex forward during things like bicep
curls, tricep kickbacks, or rows due to poor technique or fatigue.
Chronic overuse can lead to increased swelling of those 9 tendons
or of the transverse carpal ligament and possibly a lack of venous
blood flow (3) -- meaning that once the blood naturally circulates
down to the hand, it struggles to return to the heart. So in this
instance, either the fluid from the swollen tendons or the pooled
blood compress on the median nerve sending jolts of burning
pain down through your fingers. In this case, the ligaments can
become thick and stiff (fibrotic), and the nerve may begin to
degenerate over the next 30 days (3). Nerves are responsible for
both allowing us to feel sensations (the difference between hot
and cold, something sharp versussomething dull) AND for sending
electric impulses from our brain to our muscles to make them
move, so when the nerve degenerates we ultimately can lose
sensation and the muscle can wither away causing that decrease
in hand and finger grip strength.
Trauma to the wrist can cause a sprain of the ligaments sitting between the
carpal bones or to the flexor tendons of the wrist. Just like in chronic overuse
injuries, when a tendon or ligament sustains trauma, say from falling on an
outstretched hand (a “FOOSH”) (i) during a takedown in wrestling, or
punching low just as the heavy bag decides to buck during a sparring session,
the ligaments swell as part of the body’s natural inflammatory response
decreasing the amount of available space in the carpal tunnel and causing
compression on the median nerve. Damage due to a fracture would cause
the same, if not more magnified, results. Carpal tunnel syndrome doesn’t
automatically happen every time an athlete sustains a sprain or fracture of
the wrist, it simply increases the risk for it to develop.
Carpal Tunnel Syndrome and Cold Laser Therapy
Athletes with mild carpal tunnel syndrome can typically expect to spend anywhere from six weeks to three months in physical therapy or some other type of rehabilitation program, and moderate to severe cases are typically considered for surgery (2). Don’t panic quite yet though. Carpal tunnel syndrome was the first condition approved by the FDA to be treated with cold laser therapy. Cold laser therapy works with the body’s natural inflammatory response to injury to release a larger amount of serotonin and endorphins in addition to decreasing swelling and improving blood supply to nerves, leading to faster and greater pain relief and less fluid pushing on the median nerve and flexor tendons, all while bringing more blood to the injured nerve allowing it to actually heal rather than simply mask the pain it produces (4).
A meta-analysis included in the journal Medicine in 2016 showed that cold laser therapy used on mild to moderate cases of carpal tunnel syndrome improved hand-grip strength and decreased pain for up to three months compared to a placebo (3). In a second study included in the journal Photomedicine and Laser Surgery, patients with mild to moderate carpal tunnel syndrome received cold laser therapy five times a week for two weeks (a total of 10 sessions). They experienced significantly decreased pain both immediately after the completion of the 10 sessions and at the two week follow-up, and saw statistically significant differences in hand-grip strength and functional ability at the two week follow-up in favor of cold laser therapy (1). In a third study included in the journal Electromyography and Clinical Neurophysiology, patients with mild to moderate carpal tunnel syndrome received cold laser therapy five times for three weeks (a total of 15 sessions), and saw an increase in their hand-grip strength (4). All of these studies achieved these results with zero negative or harmful side effects.
Up to 19% of patients have recurrent symptoms after surgery and up to 12% of those patients need to be re-evaluated, whereas mild cases can recover spontaneously. With this in mind, in addition to cold laser therapy, the meta-analysis in Medicine (2016) suggests athletes with mild to moderate cases of carpal tunnel syndrome try specific guided exercise programs with a physical therapist or other rehabilitation specialist, wearing a splint at night, and in cases where it’s absolutely necessary, NSAIDs and corticosteroids (3). One of Brian's favorite forearm and wrist strengthening exercises is
the rice bucket workout. It's great for building functional strength because an athlete's
able to equally strengthen the forearm and wrist flexors and extensors at the same time,
keeping everything balanced. Some examples of exercises in this workoutinclude the
athlete putting his fingers straight down into a 5 gallon bucket of rice and alternates
between making a fist and strengthening the hand back out, and the athlete sticking
his fists deep into the bucket and circling his wrists clockwise and counter-clockwise (j),
and moving them side-to-side like scrubbing dishes. We have theopportunity to work
closely with Sean Harley, IFBB Pro, CPT, and co-owner of Rock Solid Nutrition and
iThinkFit Gymin Omaha, NE. In regards to protecting yourself during weight lifting,
he personally uses and encourages his clients who think
they may be experiencing carpal tunnel syndrome to
use wraps (k) and/or athletic tape for more support
during workouts involving lifts that incorporate
pushing movements like a dumbbell press, and
straps (l) for added grip during workouts involving
lifts that incorporate pulling movements like a lat pull
down or bent over rows to ensure better and safer
Do You Have Carpal Tunnel Syndrome?
M&B Wellness Solutions offers multiple services to help relieve the burning pain and heal the specific sources of mild to moderate cases of carpal tunnel syndrome. Whether it’s cold laser therapy, traditional, insurance-based physical therapy, or our PT Squared Program where our physical therapist works together with the highly qualified trainers at iThinkFit to design the perfect plan that will help athletes train through the recovery process, we have what it takes to help athletes recovery quickly and stay at the top of their game.
The best way to start your road to recovery is to see a healthcare professional specializing in movement and rehabilitation who can assess your range of motion, strength, and quality of movement to determine if your pain is due to chronic overuse, from strength and flexibility imbalances, or something more severe like a sprain or fracture. Stop by M&B Wellness Solutions located inside iThinkFit Gym for an evaluation with a licensed physical therapist so we can get you on your way to moving the best you possibly can.
Michaela Cantral, PT, DPT
March 14, 2017
(1) Chang W-D, Wu J-H, Jiang J-A, Yeh C-Y, C-TT. Carpal Tunnel Syndrome Treated with a Diode Laser: A Controlled Treatment of the Transverse Carpal Ligament. Photomedicine and Laser Surgery. 2008;26(6):551-557. doi:10.1089/pho.2007.2234. PMID: 19025407.
(3) Li Z-J, Wang Y, Zhang H-F, Ma X-L, Tian P, Huang Y. Effectiveness of low-level laser on carpal tunnel syndrome. Chou L-W, ed. Medicine (Baltimore). 2016;95(31). doi: 10.1097/MD.0000000000004424. PMID: 27495063. PMCID: PMC4979817.
(4) Shooshtari SM, Badiee V, Taghizadeh SH, Nematollahi AH, Amanollahi AH, Grami MT. The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome. Electromyography and Clinical Neurophysiology. 2008;48(5):229-231. https://www.ncbi.nlm.nih.gov/pubmed/18754533. PMID: 18754533.
(a) Mindy Harley
(d) Phalen's Maneuver. Mindy Harley
(c) Mindy Harley on stage at the 2016
IFBB North American Championships