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Carpal tunnel, pregnancy and massage

Carpal tunnel can be an extremely painful and uncomfortable condition that can affect anyone. However, during pregnancy the chances of suffering from carpal tunnel syndrome are greatly increased, particularly in the latter stages of pregnancy. The reason for the greater incidence of carpal tunnel syndrome during pregnancy is that there is greater retention of fluid (due to varying hormones during pregnancy) and that relaxin can soften the ligaments that form part of the carpal tunnel.

Carpal tunnel and pregnancy massageCarpal tunnel syndrome will normally manifest in the form of pain, numbness and/or tingling in the outside three fingers of either hand. In more extreme cases, the compression on the nerve through the carpal tunnel can lead to the forearm feeling numb. The fingers and the hands will feel weak and have poor grip strength and pain may radiate up the arm as far as the shoulder.

For pregnancy induced carpal tunnel syndrome the symptoms will be worse either during the night or first thing in the morning due to greater fluid retention as the arm is relatively inactive.

There are a number of steps to you can take to reduce the impact of the condition. These include:

  • Avoiding any task or action that causes pain
  • Elevate the affected arm to attempt to reduce the amount of oedema and swelling
  • Be aware of your posture. There is a tendency amongst pregnant women (+ office workers + people who drive a lot etc) to have their neck protracted ie their chin juts out. Even a little can add compression to the lower cervical vertertae so try to keep your chin back in a more neutral position.
  • Try to keep your wrist in as neutral a position as possible (some physiotherapists recommend the use of splints to maintain a neutral wrist while you sleep. If you are suffering from carpal tunnel from breast feeding then remember to bring the baby to the breast rather than move the breast to the baby and again be aware of your wrist position.
  • Some professionals may suggest modifying your diet (and/or lifestyle) to reduce your body’s general propensity for swelling

Massage for Carpal Tunnel Syndrome During Pregnancy
An effective massage for carpal tunnel syndrome is primarily aimed at reducing the amount of swelling in the arm through lymphatic drainage techniques and, when performed by a therapist who has a good understanding of the condition, it can be a highly effective treatment.

Routine for Carpal Tunnel Pregnancy Massage
This routine can be considered as being relevant for during pregnancy and also post-partum when the new mum can have wrist problems when breast feeding.

Start at neck with little or no lubrication and work very and gently. The movement of lymph at the level of the skin is the objective for the routine. Always proximal to distal with the order of the strokes but work each individual stroke in a distal to proximal direction. Stretch the skin and work down the arm all the way down to the hand. Again need to reiterate that the pressure should be very light as working deeply can be ineffective.
Repeat this series of strokes a few times.

Perform a lymphatic compression on the arm – scooping up and then hold each compression for a count of about 10. Pressure is still very light.

Compressive tissue release – keep wrists neutral and stroke down the forearm (both top and botton of the forearm) using thumb and fingers whilst applying traction to the wrist. This stroke can free up the nerve sheaves through the carpal tunnel.

If you feel that you need to stretch the fascia of the palm make sure that you keep the wrist in neutral. Work the joints of adjacent fingers in opposite directions.

By Richard Lane

Massage Techniques – Static Strokes

Check out any massage teaching website or text book on massage techniques and you will come across a myriad of different massage strokes. For many newcomers, this can be confusing and daunting although once you realise that much of the confusion is the result of using different terms for the same strokes then you will begin to feel more comfortable with understanding and practising the various strokes. For example, one therapist may refer to trigger point therapy, another to acupressure and another to shiatsu. Yet they are all effectively talking about the same physical technique of applying static pressure to a specific point.
This article will just introduce some of the possible static massage strokes that are available. It is suggested, however, that if you do wish to learn and use them that you should enrol at a suitable massage teaching establishment so that you can understand in a safe and proper learning environment.
When we use the term static massage strokes, we are referring to the fact that the body part that is being massaged is stationary. We will discuss technique where passive and active movement is incorporated into the strokes in a later blog.

Effleurage strokes are the most common technique used by massage therapists and they are simply the flowing, gliding stroke along the length of body. It is used to spread lubricant (either oil or lotion), to warm up the muscles and to relax the recipient. The pressure applied and the speed of the stroke can vary considerably although it is rarely the case that effleurage strokes should be painful for the recipient. Generally the massage therapist will use their palms to perform the stroke although fingers, thumbs and forearms can be used depending on the particular body part being massaged. The strokes are performed along the length of the muscles, parallel to the muscle fibres.

Petrissage strokes are kneading techniques whereby a therapist will pick up, squeeze or wring soft tissue. For example, Petrissage of the calf muscle at the back of the lower leg is often used to warm up and relax the muscle. The therapists will use two hands and gently knead the calf with flowing action.

Static compression is simply the action of applying pressure at a particular point on the body without any movement from the therapist. Any massage “tool” (fingers, thumbs, knuckles, forearms or elbows) can be used to apply the pressure depending upon the specific body part and the amount of pressure required. Generally this stroke is performed to deactivate myofascial trigger points and pressure can be applied for as little as a few seconds or for as long as a couple of minutes depending upon how long it takes to achieve the desired therapeutic response.

Compression Broadening
Healthy muscles need to fully elongate and contract. With contraction, comes a broadening of the muscles as the sarcomeres within the muscle fibres overlap. A compression broadening strokes attempts to mimic this action (on a macroscopic level). To perform this stroke then you apply pressure to the relevant muscle using two massage tools and then slowly move the tools apart as you simultaneously stretch and compress the muscle. It is important not to have too much lubricant for this stroke as the objective is not to slide over the muscle.
As an example, the flat of the fists are often used on hamstrings muscles to perform a compression broadening stroke. The therapist will apply pressure with both fists side-by-side on the belly of the hamstring and then slowly move the fists apart across the muscle fibres.

Longitudinal stripping
This technique utilises a slow long gliding stroke parallel to muscle fibres in an effort to increase the length and elasticity of the muscle fibres. The pressure required should be sufficient to grip the muscle rather than glide along the superficial layers and can be bordering on the uncomfortable for the client. Any massage tool can be used to perform longitudinal stripping strokes and if you require more pressure then the tool chosen will use a smaller contact area.
The critical factor is the speed of the stroke. If the therapist works too quickly then the bodywork will be more painful and less effective.

Friction strokes can be a little confusing for the new massage therapist but once mastered then generally easy to perform and most remedial massage therapists would incorporate them at some stage during a session. A friction massage stroke moves adjacent superficial tissues in relation to the underlying soft tissue with a repeated forward and back or circular action. Any massage tool, fingers, knuckles, thumbs, elbows, etc can be used to perform the stroke and the important factor for the therapist to be aware of is that there is no movement of the massage tool relative to the skin. There is no gliding and the tool used maintains contact with the skin and moves it as the stroke is applied.
These strokes are typically used by massage therapists and physiotherapists for treating soft tissue injuries particularly where there may be scar tissue. The intention is to break cross-fibre bonds with the shearing nature of the stroke. However, it should be mentioned that research supporting the effectiveness of friction strokes is limited and some question whether it does achieve this goal.

By Richard Lane