Carpal tunnel syndrome (CTS) is a common condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. This can lead to pain, numbness, tingling, and eventually weakness in the hand, particularly affecting the thumb, index finger, middle finger, and the thumb-side of the ring finger. In mild-to-moderate cases, research has shown that non-surgical approaches can be as effective as surgery, without the added costs or risks of surgical intervention. One area of conservative management includes manual therapies commonly used by doctors of chiropractic.

Manual therapies are hands-on (or instrument-assisted) techniques designed to restore musculoskeletal function by addressing joint, muscle, and soft tissue mobility. Here are some manual therapy techniques a chiropractor may employ when managing CTS:

• Neurodynamic mobilization: Gentle, controlled movements to restore median nerve mobility along its path through the wrist and forearm.
• Carpal bone mobilization: Subtle gliding or distraction movements between the carpal bones to enhance joint motion and alignment.
• Soft tissue mobilization: The application of manual pressure to release adhesions within muscles, fascia, and tendons.
• Transverse friction massage: Repetitive, cross-fiber strokes to promote circulation, reduce adhesions, and encourage tissue remodeling in tendons and ligaments.
• Myofascial release: Sustained pressure, stretching, or gliding movements applied to the fascia to restore normal tissue mobility and reduce inflammation or irritation around the median nerve.
• Trigger point therapy: Pressure or massage to deactivate hyperirritable spots in muscles such as the pronator teres or flexor carpi radialis, which may refer pain or mimic CTS symptoms.

These techniques are often combined based on physical examination findings. Research supports the use of multimodal care, which tends to produce better outcomes than isolated techniques alone. Additionally, manual therapies may be applied along the entire course of the median nerve—including the neck, shoulder, elbow, and forearm—since compressions at multiple sites (a concept known as double crush syndrome) may contribute to CTS symptoms. Chiropractors may also incorporate physiotherapy modalities, prescribe home exercises, recommend workplace or activity modifications, suggest nighttime wrist splinting, and provide nutritional guidance to support the rehabilitative process.

It’s important to note that non-surgical methods may be less effective in severe cases, particularly when there is significant muscle atrophy or constant numbness. That’s why individuals experiencing symptoms of CTS should seek care early to improve the likelihood of recovery and potentially avoid surgery.