Carpal Tunnel Syndrome – Median Nerve – Peripheral Nerves

Introduction

There are many different peripheral nerve treatment methods on the “market”. In general, I would recommend any peripheral nerve problem to be examined by a soft tissue specialist. Always try conservative treatment approaches prior to surgical interventions!

The technique I am about to describe is working remarkably better than any other method I have tried for soft tissue treatments. Active Release Techniques® (ART®) is a manual soft tissue system that involves precision in touch, tension, movement and function. Before looking deeper into this subject, some background information is needed.

Active Release Techniques®

ART® = encourages structural gliding through nerve receptors and longitudinal muscle fibers, breaks down adhesions by intervening in the repetitive injury cycle, releases peripheral nerve entrapments by using specific patient movements and manual tension at the correct cause.

ART® provider

In order to perform this technique (ART®), the practitioner needs to be certified in the different ART® modules (Upper Extremity, Lower Extremity, Spine and Long Tract Nerve Entrapments). In order to become an ART® provider, the practitioner needs to have mal-practice insurance. In general, all medical professions need to have these insurances in order to be licensed to work with patients and athletes. Examples of medical professions; chiropractors, physiotherapists, manual therapist, osteopaths, sports med’s., GP’s etc. After the practitioner has completed the 3 basic modules, Upper Extremity, Lower Extremity and Spine, he or she is licensed as Full Body. The ART® provider needs to re-cert every year in order to maintain the title.

Recognized as a manual treatment method

ART® is recognized by OSHA and the department of labor as a wellness, prevention, or first aid measure. These course modules also provides practitioner with continued graduation credits for chiropractors and manual therapists.

Why ART® vs surgical interventions for median nerve entrapments

I am convinced that establishing freedom of nerve gildings by non-surgical interventions is absolutely the best option for the patient, environment and the society. I suggest Active Release Techniques® to patients present with median nerve entrapment’s, or any other peripheral nerve problems.

When the ART® provider conducts the diagnostic session, he or she is able to determine where the median nerve is entrapped. The median nerve can be compressed by several structures, but the most common is by active structures and/or adhesions. It is of high importance that the ART® provider knows the history of the complaints. Patients where symptoms have gradually set and increased are much more common than acute conditions. Already now, we know that it is more likely that the compression is caused by active structures and therefore as a result of our daily loading pattern. The median nerve travels from the neck and all the way out to your fingers. On this pathway, the nerve is guided through several structural tunnels. Patients with carpal tunnel symptoms usually have a compression of the median nerve at one or more of these tunnels.

When the ART® provider has concluded with his or her findings, the treatment session begins. The patient is carefully instructed in what to expect from the treatment session. Before manually releasing the peripheral nerve, the patient is instructed in movement patterns and body positioning. Related muscles, tendons and/or ligaments are treated before releasing the nerve at the entrapment site. It takes at least 3 – 5 repetitions on each area of the structure that needs to be treated. Patients should expect results within the 5 first treatments sessions.

The median nerve is often entrapped by the pronator teres muscle (an active structure), not the transverse carpal ligament (the median nerve can be irritated in the carpal tunnel due to lack of gliding abilities from the involvement of the whole kinetic chain). The pronator teres is a strong, two-headed muscle that twists your forearms inwards (pronates). The median nerve runs in between the two heads. Think about your forearm positioning while typing on the keyboard.

ART® treatments are often combined with home exercises. These need to be carried out with precision. The exercises aims at restoring optimal function by encouraging gliding of the muscle fibers and structure vs structure. Exercises are typically dynamic stretching/gliding in specific orders, combined with dynamic nerve gliding movements and/or strength-coordination exercises.

Prevention

It is very important that the ART® provider makes sure that the patient is instructed in ways to prevent symptoms to re-establish. Exercises at the work place or other environments should be demonstrated to our patients.

Case tests in Norway

One of the orthopedic surgeons in the Regional hospital near Moss wanted to test ART® for Carpal Tunnel Syndromes. Two patients who were originally included for surgical intervention by the carpal tunnel were referred to our clinic in Norway. Both received 6 treatments with duration of 30 min. Both patients were symptom free after the 6th treatment. The orthopedic surgeon followed up his patients to check results after 6 months. Both were still symptom free.

Our carpal tunnel syndrome cases at the clinic are generally getting good (no symptoms) and long lasting results (more than 12 months) after completing our treatment regime. Please take into consideration that patients often are misdiagnosed or mislead; meaning the primary cause(s) of the compression/friction/pressure on the nerve is actually higher up the chain (pronator teres, subscapularis, scalenii, disc). The computer worker is always a good example. Think about how the loading pattern looks like for 8-9 hours a day? What is turned ON (active structures such as pronator teres, flexor dig., flexor carpi ulnaris and the rest of the wrist/hand/elbow flexors + extensor side of hand/wrist/elbow), what is turned off (passive structures in the position and/or structures overloaded for one or more biomechanical reasons) and how does this affect our symptoms as the real primary cause. Well, when the damage is done (the nerve is compressed, lost gliding potential etc.), you can always find professional help who is willing to help you avoid surgical intervention. A soft tissue specialist will always be willing to give it chance. Your outcomes look good. I know that you would be in good hands and that you will notice results after a couple of visits if your practitioner is trained and certified in ART®. Google your home town + Active Release Techniques or check out the Provider Listing if you are looking for a provider near you.”

Pilot Study: The effects of active release technique on carpal tunnel patients: A pilot study.

Article by Dr. Leahy: Improved Treatments for Carpal Tunnel and Related Syndromes.

Peripheral nerve patterns can be difficult to detect and understand. They are often misdiagnosed as a “Trigger Point”, or simply referred to as a spine or neck problem. Visit your ART® soft tissue specialist before letting the knife cut you open (leaving a lot of scaring/adhesions).

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Written by Nicolai van der Lagen

Manager and Lead Instructor - Active Release Techniques® Europe Manager - Helsehuset Moss AS ART practitioner - ART Klinikken AS
Website: http://www.activerelease.com/europe