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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

Positional Release

Most people who have regular remedial or therapeutic massage in Sydney would probably prefer to have the therapist to get stuck into the muscles and the soft tissues. Certainly with our Sydney mobile massage business, deep tissue and deep pressure massage are more popular than Swedish or relaxation massage.
However, not all clients necessarily respond best to a stronger massage and recently I’ve some good results with incorporating positional release techniques within a session (particularly when the deep tissue techniques have not yielded the benefits that I would like to have seen).

Therapeutic relief through positional release techniquesPositional release is a gentle and relatively non-invasive technique that allows for pain relief effectively by the body healing itself. It relies on the use of placing the body or painful part of the body in a comfortable position so that myofascial trigger points can release.

Positional release can be incorporated into a remedial massage bodywork session to assist with reducing the pain for particularly stubborn area or it can be considered as a standalone session. In addition, once you have experienced pain relief from using positional release then it is possible to perform some level of self-positional release.
In order to perform positional release, then a therapist will locate the areas of dysfunction (most often affected by trigger points) and then they will manoeuvre the client’s body into such a position that the pain experienced from the trigger point is eliminated (or at least minimised). The client will stay in this position for up to 2-3 minutes (which may be assisted by the therapist supporting an arm, a leg or the head for example).

The philosophy behind of positional release is that painful muscles when put into such a position that they are shortened (without contraction) then the pain sensors within the muscle can in effect be “switched off”. The muscle may then be in a more relaxed state when the passive support is removed and the level of pain and discomfort can be decreased.

Self-Positional Release
If you are having problems with soreness in your neck then lie on your side on a pillow and using your fingers or thumb find a spot that is particularly tender. Often these points are just below the occiput (ie just under the bone of the skull at the back of the neck). Now very slowly and very easily move your head in different directions whilst monitoring the pain you are experiencing. You may need to tilt your head backwards, forwards or to the side or even rotate it in one direction. Hopefully you will move into such positions that the pain will be reducing – if you find that it is actually increasing then move in the opposite direction.

  
Once you have found a position such that the pain is minimised then support your head as much as possible in that position and just stay there for a couple of minutes (no need to keep monitoring the pain with your fingers at this time). Gradually ease yourself back into a normal position and hopefully your pain will be less. If you need to work on the opposite side then simply turn over and repeat.

Obviously never force your head into uncomfortable or strained positions whilst you are attempting to perform self-positional release and if you have any concerns regarding the pain and discomfort you are feeling, always consult a health care professional.

By Richard Lane

Pregnancy Massage Tables

Pregnancy massage is an important part of our Sydney mobile massage business. Although we believe that for many people there are great reasons for choosing a home massage over a clinic, these advantages are magnified for pregnant women – particularly in the latter stages of their pregnancy. It just makes sense for a woman to have a therapist visit her at home so that she can truly relax post massage rather than having to traipse to and from a clinic.

Whilst there is a fair amount of discussion about massage in the first trimester of pregnancy (check out http://www.innerwestmassage.com.au/first-trimester.php for more information) there is no debate that after the first trimester then massage can be considered effect therapy for a pregnant woman (assume that there are no pregnancy massage contraindications). However, as the pregnancy progresses then it reaches the stage that the woman is no longer able to lie prone (or on her stomach) for the massage on a normal massage table.

Often we get calls from women who are aware that there are massage tables with holes that have been cut out for the stomach (and occasionally the breasts) looking to have a massage lying on their stomach on one of these tables. Click here for an example of such a table.

Pregnancy massage in side-lying positionHowever, we only ever massage pregnant women who are too large to lie prone in a side lying position. There are good reasons for this and the vast majority of experienced pregnancy massage therapists would never consider using a table with cut out hole(s). More information about our pregnancy and pre-natal massage service is at http://www.innerwestmassage.com.au/pregnancy_massage_cushion.php

The issue about the merits (or otherwise) of pregnancy tables with holes cut-out was recently conducted and some of the comments have been included below.

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Nasal congestion and breast tenderness are some of the issues that a lot of pregnant women deal with and prone position is just going to aggravate that. Pregnancy tables don’t take different bodies into account so I think those specific tables are a waste of money but there are plenty of body cushioning systems out there so you can adjust to each woman. However, side-lying position is a widely under-used position and that is a shame because of the ability to move the shoulder and hip through it’s full range of motion and the fact of how nurturing and relaxing this position actually is. There is always a possibilty of increasing lumbar lordosis or uterine ligament pressure in prone especially if you are not monitoring her and as long as she is very good at communicating with you when she becomes uncomfortable. Oakworks also has a great side-lying bolstering system that eliminates pressure on the shoulder and hip that is being laid on. Ultimately, you are going to make your decision on what you will feel comfortable doing. I am very confident and comfortable with my side-lying routine and I know my clients leave very happy because they come back and they send their pregnant friends to me. I am comfortable with side-lying position and that is what I offer. I won’t spend my money on a body cushion system that will allow them to lay prone. I am ok with that. If I lose a client because of that, that is fine. There will be another to take her place.

I received massage throughout my two pregnancies and was side line. I went to the beach one summer and dug a hole in the sand to fit around my big belly so I could lay on my stomach. That was the best nap I’d had in a long time. There is no problem with lying on your stomach if you are supported correctly. Where I work we have a water table and so they start out on the left side to get the back and then face up for legs, arms, head and neck. The water table is wonderful.
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As I just had a baby and had several massages during my pregnancy as long as there is a sling in the belly cutout that is snug enough to not have the ligaments in a bind and there are breast recesses the prone massage wins HANDS DOWN!!! The sling in the belly recess gives enough support for an hour or 2 of massage. NOT recommended for long term use (to those of us pregnant that have a prenatal table) but I personally LOVE the prenatal table and prone massages (best naps EVER while big and pregnant!)
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As a LMT who specializes in prenatal work and had also been pregnant (3 times) before, most mama’s will lay on their belly until its uncomfortable. If their own body weight pressing on the belly is too much then it’s time for side lying. Knowing they are in early pregnancy you should not be pressing deeply on the low back area anyway so if mama is still able to lay prone this should not be an issue. I personally don’t use a cutout table, and I don’t see how one set non adaptable system can accommodate mama’s of all shapes and sizes….just my opinion though so please no negative comments. I prefer my side lying set up with a body pillow and other regular pillows to adjust the comfort of side lying or the incline when supine.
I set my table with pillows at the head and foot so my clients can lay supine in a reclining position. I am able to work on their entire body in this position. Then I will readjust the pillows for them to lie on their side to finish off on their back. My clients are very comfortable in this position
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No table with the hole. It puts strain on the lower back. Lying on the stomach, although super comfy, is not an ideal position for anyone. But for the ladies that love being prone, there is an special cushion set for them for our tables. I forgot the name though.
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I used to work in a spa that had pregnancy tables and the clients LOVED them. Especially women that normally sleep prone, for them to be able to lie prone again after months of not doing it is a real treat for them.
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There are pregnancy pillow set ups that allow pregnant women to lie on their stomach without putting undue stress on the back. Having had 2 children I would have LOVED this option!!! I have used one of the commercial body systems on a preg friend who loved being prone and didn’t feel any undue stress on her back muscles or ligaments (she is also an LMT).
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I’ve seen all the support cushions for pregnancy massage, and I too am curious to hear/see information about the benefits and contraindications. I have only been exposed to side-lying and reclining massage.
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I don’t do pregnancy massage, but we were taught in school they are not supposed to be prone at all and not to waste our money of a pregnancy table with the cut out that allows you to because it’s still a contraindication.
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In my practice I used a pregnancy pillow and my moms loved it. I had a handful of expectant mothers that were too small to be comfortable lying prone so we just adjusted to a side-lying position. Being able to lay in a comfortable prone position many of my clients were able to achieve a deeper state of relaxation. I myself have used it and I am not pregnant. The pillow reduced the tension in my back and allieveated pain due to two bulging disks.
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I have the Body Cushion system and have done a few pregnancy massages. Being able to lie prone was a relief to them. The cushions can be adjusted so there isn’t stress on the back. Just like any other client, though, you just have to adjust to each one, and each session as they get farther along. My policy is to ask for a new written Dr.’s release every thirty days, since the see the Dr. at least 1 x per month.

If you wish to receive a massage on a pregnancy massage table with holes cut-out then unfortunately we would not be able to help you but we certainly can provide a safe and effective pregnancy massage with you lying on your side.

By Richard Lane


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