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Feldenkrais Method
Carpal Tunnel Syndrome

is a specific dysfunction involving the compression of the median nerve in the forearm and wrist. (See ill.1) The Carpal Tunnel (the small opening on the underside of the wrist where the tendons, nerves and blood vessels pass through into the hand) is the structure most often blamed for causing constriction. (See ill. 1.5, 1.75, 2) Carpal Tunnel involves irritation of this nerve, which is often accompanied by inflammatory swelling within the tunnel. (See ill. 2.5)


A great majority of carpal tunnel cases are caused by nighttime flexion of the wrists. Most people are unaware that they may be crimping their wrists as they sleep. Others have a Repetitive Strain Injury (RSI), the cause of which is repeated light motions of hand and wrist or multiple movements requiring considerable force. People at risk for developing RSI are those using computer keyboards for long periods of time; workers performing repetitive tasks in assembly-line production; massage therapists; people who perform prolonged gripping of tools, musical instruments or manual control mechanisms and mechanics who have to exert great force with tools.

A one time gripping strain against considerable resistance can injure the muscles of the hand, wrist or forearm. If unresolved this can result in chronic inflammation leading to swelling, nerve irritation and carpal tunnel symptoms. Swelling from inflammation, fluid retention during pregnancy, as well as infection, (though not as common) can also contribute to the development of carpal tunnel syndrome.

Diagnosis: The most common diagnostic procedure is Phalen's Maneuver. The patient places the backs of their hands together, fingers pointing out away from the body, for one minute.

If symptoms of pain, numbness, tingling, fatigue, burning or coldness occur, then Carpal Tunnel Syndrome is likely. Symptoms usually extend to the first 4 fingers not the 5th (see ulnar neuritis below).

Common Findings:

  1. Tight over-contracted muscles in the forearm (from heavy use, constant use, or old injury). (See ill 2.75)

  2. Irritation of the median nerve accompanied by contraction of the smooth muscular sheath surrounding the nerve causing a tight "ropey feel" to the nerve.

    1. Unresolved swelling (edema) which further constricts the median nerve.

    2. Weak thenar (thumb) muscles leading to the strained use of lateral pincher grip instead of oppositional grip. Hold a book in your hand. Are you using the palm surface of your thumb and finger? Great. If not, you may be squeezing the book between the sides of your thumb and first finger using a lateral pincher grip. It is a weaker grip and sets you up for strain.

    If there are no signs of nerve involvement there could simply be tendonitis. With tendonitis we can see pain, tight muscles (which pulls the tendon tight), swelling, and fatigue or weakness in hand and forearm movement.


    The first thing to try is to wear nighttime cock-up splints. This will prevent unconscious flexion of the wrists. Since compression of the nerve and blood vessels can be accompanied by swelling it is important that the splint not be too tight. For this reason I would opt for going to the Walgreen's and trying on several brands and styles to get the right fit, rather than buying through the internet or catalogues.

    With some cock-up splints you can bend the metal stay on the underside of the splint to get a better contour. You may also be able to find ways to position your hands that keep them from flexing. In side lying I like to place my top hand on my opposite upper arm, whilst the bottom hand rests on its backside, on the bed.

    The traditional surgical approach is to cut and release the ligaments that run across the top of the tunnel. This approach does not treat any of the other tissues problems listed above. Deep massage to the wrist is the worst treatment for this condition. Deep massage causes blood vessels to contract, actually reducing the blood flow to the area, further causing congestion and reducing healing.

    Congestion causes more compression and pain. Stretching exercise done during the painful stage of Carpal Tunnel Syndrome can aggravate the symptoms.

    The Kurashova Tissue Re-education Techniques for Carpal Tunnel Syndrome aim to:

    1. reduce swelling
    2. calm the irritated nerve
    3. improve blood flow for healing
    4. normalize muscle elasticity thus reducing tension on the flexor tendons
    5. eliminate compression on the nerve
    6. hand strengthening exercise is added after pain and numbness are gone

    Long-term Care

    Strengthening and retraining oppositional grip is particularly important. Many Carpal Tunnel sufferers have been using a weaker lateral grip and straining their thumb muscles. Oppositional grip offers better mechanical advantage and ultimately more strength without strain. Begin with gentle isometric gripping of your thigh using your finger tips. For long term rehabilitation the Alexander Technique and Feldenkrais work can be very instrumental in helping a person notice and reduce excess tension while using their hands and use more of their whole body to support the use of their hands. Consider ergonomic organization of your workstation.

    Stretching exercises done before and after using one's hand are particularly important as well as varying the tasks, and pacing your work with short breaks. Buy tools with cushioned, thicker grips or add pipe foam insulation for greater cushion. You may want to consider using padded bicycle gloves when working with un-padded tools. See for tools with ergo-handles.

    Ulnar Neuritis is similar to Carpal Tunnel Syndrome in that one can experience numbness, pain and swelling, but the irritated nerve involved is the ulnar nerve instead of the median. (See ill. 3m, 3.5)

    The ulnar nerve runs along the little finger side of the forearm and passes more superficially to the carpal tunnel. Ulnar Neuritis symptoms tend to found on the little finger side. Nerve compression around the elbow, or in the wrist as well as nerve irritation from forearm inflamation can be the cause. If you have these symptoms you should assess whether you are leaning your forearm or elbow on an armrest or table. I personally do not recommend armrests on desk chairs because of the undo pressure they can cause on areas of forearm/elbow nerves.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area