Carpal Tunnel syndrome: Avoid Surgery

March 24, 2017 • By

Carpal Tunnel Syndrome is very, very common with nearly 50% of all work-related injuries linked to carpal tunnel syndrome.  Fortunately, there are effective and evidence-based Carpal Tunnel syndrome exercises and conservative treatment that can help fix carpal tunnel pain and avoid surgery! (1)


Firstly, what is carpal tunnel syndrome?Carpal tunnel syndrome avoid surgery

The Carpal Tunnel is a channel at the front of your wrist which is covered by a band of strong connective tissue (retinaculum). Through the tunnel that is formed, runs tendons, a blood vessel, and your median nerve. Carpal tunnel syndrome occurs when these structures don’t slide nicely through your tunnel and with repetitive or sustained tasks, can lead to pain, numbness, and weakness.

Note that symptoms are variable due to the different structures that pass through the tunnel – Sometimes there is more median nerve involvement that tendons and vice versa.

What causes it:

Anything that causes compressed, irritates or effects mobility of the median nerve in the carpal tunnel can cause this which can be from a huge number of causes, with many cases not having a clear cause.

Carpel Tunnel syndrome can be caused by wrist or hand sprain and fractures, inflammation involved with rheumatoid arthritis and commonly certain activities or jobs that require a lot of bending of the wrist, gripping or vibration, among other things.

Some known risk factors are

  • diabetes – a chronic (long-term) condition caused by having too much sugar (glucose) in the blood
  • any kind of arthritis – a condition where the joints become painful and inflamed
  • hypothyroidism – an underactive thyroid gland
  • obesity in young people
  • some drugs used to treat breast cancer – such as exemestane (Aromasin)
  • pregnancy



Carpel tunnel syndrome can be treated with Physiotherapy or surgery, with surgery often only for the more severe or unresponsive cases as one-third of patients don’t return to work within 8 weeks after an operation as it has a significant recovery period and is not always straight forward and the quick fix that people want as surgery can lead to scarring.

The main aspects of non-surgical treatment that need to be covered for best results are:

    • Brace: Wearing a splint during aggravating activities and at night time can be very beneficial and help speed up recovery by decreasing load on the wrist and holding it in the optimal position for maximal space in the carpal tunnel. The best braces have a metal bar in the palmar aspect specific to carpal tunnel syndrome, so ideally don’t just get any old wrist brace. A good example of one is theMueller Carpal Tunnel Brace
    • Reduce load: Even though there is often 1-2 risk factors such as swelling in pregnancy, inflammation from a fracture close by or a congenitally narrower tunnel – That does not often cause carpal tunnel syndrome by itself. In the majority of cases, you still need repetitive or sustained movement of the wrist or hand, more that it is used to. So, to give the wrist a chance to settle down, you need to figure out what it was that over-loaded the wrist, whether it be using a hammer a lot, writing or typing all day or obsessively cleaning your house and then decrease how much you do that where possible. You don’t need to completely stop the task often, just change how you’re doing it, decrease it and maybe even become a little ambidextrous for a while.
    • Exercises to improve: The third and final thing is home exercises to address any excessive neural tension, muscle tension or lack of joint mobility. The exercises should look to address:
      • Muscle tension and nerve mobility through the side of your neck
      • Forearm muscle flexibility
      • Nerve and tendon mobility/gliding through the carpel tunnel
      • Grip and thumb strength

So there you have it, a rough blueprint on helping lessen the pain from carpal tunnel and start on the road to recovery. We will be putting up another post in in two weeks detailing effective home exercises for Carpal tunnel pain so stay tuned!


Are there any benefits of Compression Socks??

January 17, 2017 • By

meb, compression socks, recovery performanceCompression garments provide a means of providing external pressure to your muscles and so potentially stabilizing and supporting the underlying tissues. But are the claims backed up by results? Do compression socks help with circulation and blood flow? Or performance and recovery?

It doesn’t take much for a new trend to start – particularly when elite athletes are seeing using them and performing well!(1)

So, even though anecdotally, they have some benefit, it is prudent to check the research and see what the studies show.

So what do the manufacturers claim compressions socks help with?

  • Aids return to de-oxygenated blood to the heart through the veins
  • Increases the flow of oxygen-rich blood through the arteries to your muscles

This is proposed to help reduce muscle fatigue, enhance performance and speed up recovery… but do they?


What they do help with:

They DO seem to help with improving recovery. Recent studies have proved that compression socks have a moderate effect in reducing DOMS (delayed onset muscle soreness), which will help you bounce back faster between training sessions. (2) Although this may be partly due to perceived ratings of recovery and not all studies agree (5,6)


What they don’t help with:

The don’t reduce the size or hematoma or shorten the time to recovery after acute muscle injury (muscle contusion or strain)3

The definitely don’t improve performance. The hard work you put into training is going to do this – there is no quick-fix! 4

that the use of compression garments had a moderate effect in reducing the severity of DOMS (Hedges’ g=0.403, 95% CI 0.236 to 0.569, p<0.001), muscle strength (Hedges’ g=0.462, 95% CI 0.221 to 0.703, p<0.001), muscle power (Hedges’ g=0.487, 95% CI 0.267 to 0.707, p<0.001) and CK (Hedges’ g=0.439, 95% CI 0.171 to 0.706, p<0.001). These results indicate that compression garments are effective in enhancing recovery from muscle damage.


So all in all, there is no harm done wearing compression socks or any compression clothing for that matter but they aren’t going to improve your performance except for some possible placebo effect. They may, in fact, help with recovery though so, throw them on for recovery afterward or have an ice bath but the only real reason to wear compression socks during an event would be to look the part and psyche out the opposition. (7)



Injuries: How to Heal Faster

December 12, 2016 • By

I am often asked about how to heal faster, so here is the answer. It isn’t a magic bullet but through mechanotherapy, you can heal faster, and stronger.

In the clinic, it is sometimes blindingly obvious whether someone has been doing the exercises I asked of them or not. If they have, they are getting a whole lot better. A large part of why Physcial Therapy (or physiotherapy) works is through challenging your body to adapt and make changes for the better. It encourages your body to heal and improve itself. There is often a hands-on treatment component such as manual therapy and soft tissue releases, as well as effective education on diagnosis and prognosis but these are nothing without you, the patient, taking charge of your rehab.

You can sit back and rely on a clinician to work on you and get you better, or you can take an active approach by following advice and diligently doing the homework given to you. Do them regularly, you are going to get better faster – So why not?

passive vs active rehab physioThe two approahces are often called active and passive therapy, or active and passive rehab and the main point is that active therapy gets you lasting changes and a more bullet-proof body so that you have less chance of future pain or injury and don’t end up with a “bad shoulder” or “bad ankle” because it wasn’t rehabbed properly


So how does active rehab work so well?

Results and effected through what is called mechanotherapy, which simply can be described as:

active rehabMechanotransduction is the physiological process where cells sense and respond to mechanical loads

This means that your tissues respond to the load put through them. Here is a brief description from the above study: Mechanotransduction refers to the process by which the body converts mechanical loading into cellular responses. These cellular responses, in turn, promote structural change. A classic example of mechanotransduction in action is bone adapting to load. A small, relatively weak bone can become larger and stronger in response to the appropriate load through the process of mechanotransduction

This is the same process by which you’re muscles get stronger from training in the gym  or on the sports field. So you want to know how to heal faster? Load them and they will adapt, as long as they have adequate time to do so between work-outs.(1,2,3)



Self myofascial release

November 22, 2016 • By

Self myofascial releaseFor years, myofascial release has been used by massage therapists, physiotherapists, osteopaths to improve mobility and function and more recently self myofascial release have been utilized to improve recovery and boost healing times through self-treatment at home.

Self myofascial release is becoming a common prescription for patients and something that is now all over the internet and readily available. This isn’t just a fad either, there are a lot of benefits to it and it can be far more effective, time efficient and easier than stretching.

So what is a myofascial release?

Myofascial release works in a few ways:

  • As an inhibitory technique that decreases overactive tissue via stretching of the Golgi tendon organ. this leads to improved flexibility and mobility
  • Increasing  blood flow to the area (and all the goodies that it bringswith it)

Here are just some of the proven benefits of self myofascial release

  • Improves joint range of motion (1), particularly when combined with either postural alignment exercises or stretching
  • Reduction in arterial stiffness and increase in vascular endothelial action = more blood flow(2)
  • Immediately improved flexibility (3)


So how can you now give it a go? Get a Massage Ball, lacrosse ball or Foam Roller and get to work on your muscles

For guidance, check out our recent Ebook release and search through our past posts.

Health, Mobility

Muscle Knots: What, Why and how to get rid of them

November 14, 2016 • By

Muscle knots, self releaseIf I had to pick one question that I am most often asked when treating patients is, what are muscle knots? And what causes them?

And fair enough too, I would be asking some serious questions too if someone told me that I had some kind of ball of tissue within my muscle… That’s not normal right?


This excerpt by Paul Ingraham gives a good little explanation:

Does your body feel like a toxic waste dump?

It may be more literally true than you realized! Some evidence shows that a knot may be a patch of polluted tissue: a nasty little cesspool of waste metabolites. If so, it’s no wonder they hurt, and no wonder they cause so many strange sensations: it’s more like being poisoned than being injured. Back pain is the best known symptom of the common muscle knot, but they can cause an astonishing array of other aches and pains. Misdiagnosis is much more common than diagnosis.(1)

Muscle knots are very helpful. They are like signposts in our body, pointing to the areas that are overworked and struggling. If you come across a point in your muscle that is reasonably uncomfortable and causes you to grimace a little, then you know this is a spot that needs working over.

Muscle knots are localized, irritable points in skeletal muscle, not caused by any one specific event. This can basically be explained as a small permanently contracted part of a muscle. They can also act like tensioners, pulling at bones and joints via their tendons and causing all sorts of grief, including making you feel “out of place”

To add even more fuel to the fire, knots can also refer pain elsewhere, again, not where the actual knot is.

Take the Quadratus lumborum (QL) for example. This muscle in your back does a lot of good work but when irritated, can cause some confusing pain at times.

Ql Quadratus lumborum trigger point muscle knots

This muscle that runs down the side of your lumbar spine often refers pain into the hip and glutes, not at all where the muscle is.


So how do we get rid of muscle knots?

1. Heat

Heat increase blood-flow, eases pain and helps with muscle relaxation so definitely worth the effort of warming up your wheat bag!

2. Self-massage and self-myofascial release

Get a Foam Roller or massage balls into those tight areas. If you need a whole lot more guidance and self-treatment techniques, grab our New Ebook that has just released!

3. Exercise

Normalise muscle function through good exercise with and around the troublesome area. Whether it is upper trap pain and you need to get the lower traps firing better, hamstring pain because the Gluts aren’t doing their job or because you just aren’t moving right – exercise can help address this.


Hopefully that has cleared things up a bit! Give these tips a go and feel free to check out our new Ebook that is full of helpful tips and self-treatment exercises.