Nerve Flossing – Light at the End of the Carpal Tunnel?

Imagine for a second that you are waking up in the morning.

Your alarm is blaring and as you reach to snooze it, realize that you can’t feel most of your hand.

As you begin to move it more, sensation slowly returns.

Anyone who’s experienced carpal tunnel syndrome can understand the discomfort that accompanies it, with commonly experienced symptoms like numbness, tingling, and weakness experienced in the hands.

The first step to properly treating this condition with nerve flossing is understanding it.

What is Carpal Tunnel Syndrome?

The outside of the carpal tunnel is made up of ligaments and bones.

Inside the tunnel, a large nerve passes through along with tendons to the muscles of the hand.

The nerve passing through is responsible for providing feeling to all of the fingers in the hand, except the pinky finger.

Carpal tunnel syndrome is first triggered when there is swelling within the carpal tunnel, placing excessive pressure on the nerve and causing symptoms.

Nerve Flossing: Carpal Tunnel
Nerve Flossing: Carpal Tunnel

Specific hand or wrist positions, repetitive activities, genetics, and health conditions can lead to an increased likelihood of developing carpal tunnel syndrome.

Diagnosing carpal tunnel syndrome quickly and efficiently is key to avoiding more severe complications.

Prolonged pressure on a nerve is never good news, and in the case of carpal tunnel syndrome can lead to muscle weakness and other permanent damage.

Identifying and treating carpal tunnel syndrome early is key to preventing this cascade of symptoms and costly surgical procedures down the line.

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The American Academy of Family Physicians reports carpal tunnel syndrome is the most prevalent entrapment neuropathy, ranging from 2.7% to 5.8% of the general adult population having a confirmed diagnosis (1, 2).

A clinician should rule out symptoms from other conditions that imitate carpal tunnel syndrome.

Fortunately, chiropractors are well trained to confirm the presence or absence of carpal tunnel syndrome!

Chiropractors can use a series of tests for sensation, strength, and general palpation to begin their differential diagnosis.

Nerve Flossing: Chiropractic
Nerve Flossing: Chiropractic

Most helpful, however, are specific functional tests that can reproduce the symptoms of carpal tunnel syndrome: the Tinel test and the Phalen test.

By putting a small amount of extra pressure on the median nerve through these maneuvers, any reproduced symptoms can help confirm a diagnosis of carpal tunnel syndrome.

Surgery for carpal tunnel syndrome is one of the most frequently performed surgeries on adults in the United States.

Two types of surgeries are commonly performed for carpal tunnel syndrome, 1) open release surgery and 2) endoscopic surgery.

The former involves completely severing the carpal ligament, which serves as the ‘roof’ of the tunnel.

This allows the excessive pressure in the tunnel to be released.

Endoscopic surgery is a more complex procedure with its pros and cons.

While it can make for a quicker recovery functionally, there appears to be a greater chance of postoperative difficulties, which create the need for further surgery.

Many patients who receive surgery report short-term improvements with their carpal tunnel syndrome symptoms.

Fully regaining functional capacity can take months, and grip strength is nearly always diminished.

Following surgery, most patients must modify their job duties until they are completely recovered.

The most current clinical practice guidelines for treating carpal tunnel syndrome recommend a course of conservative care before considering surgery for mild to moderate cases.

These patients may benefit from a variety of conservative therapies to both alleviate uncomfortable symptoms and increase functionality.

Treatments can include any combination of splinting, oral drugs, electrotherapy, manual techniques, and – you guessed it – nerve flossing exercises (3).

What is Nerve Flossing?

Flossing exercises for tendons and nerves have been common in treating peripheral nerve entrapments since 1990 (4).

Nerve Flossing: Glide and Stretch
Nerve Flossing: Glide and Stretch

Various upper limb entrapment syndromes, such as carpal tunnel syndrome, have been treated with exercises to mobilize the peripheral nervous system (5).

The mechanism of nerve flossing involves utilizing specific motions of the extremities that cause pulling on one end of a nerve while concurrently relaxing the other end.

Nerves are flexible and must be able to glide and stretch to work correctly and efficiently.

Normal movement can be obstructed by adhesions and swelling, leading to the neurologic symptoms, like numbness and tingling, that many patients report.

By sliding a nerve along its anatomical course repeatedly, the goal is to break up adhesions that may have formed along its path and reduce any associated swelling by increasing motion in the area. (4)

Nerve Flossing Exercises
Nerve Flossing Exercises

Any peripheral nerve in the body can be flossed.

Still, because the median nerve is the nerve affected and compressed in carpal tunnel syndrome, nerve flossing exercises should target this nerve to treat the condition.

Some clinicians liken the median nerve floss to ‘tipping over a serving tray.’

Let’s review how it looks! To start the median nerve floss, position yourself like you pretend to carry a serving tray at your side.

You want your wrist bent so that your palm is facing the sky and your elbow bent.

Slowly straighten your elbow to the side and tilt your head away from the extended arm.

Return to the starting point, and make sure you keep your palm up to the ceiling the whole time.

Check out this video to see it in action!

There is a risk of irritating the nerve if the nerve flossing maneuvers are not performed correctly.

Chiropractors can educate patients on nerve floss while in the office and then utilize it as part of a home exercise plan.

Carpal Tunnel and Nerve Flossing – The Research

Now that we understand what carpal tunnel is and what nerve flossing is, let’s put the pieces together with some research.

Several systematic reviews commend the use of nerve flossing exercises as treatments for carpal tunnel syndrome (3, 4, 6, 7).

The bulk of the findings indicate an optimistic approach for further research on nerve gliding exercises’ specific therapeutic effects, as improvements were largely seen concerning pain and function.

The National Institute of Health also supports non-surgical treatments, including chiropractic, for alleviating symptoms caused by carpal tunnel syndrome.

If that isn’t enough to convince you to, patients in another study who utilized nerve flossing improved their visual analog scores by almost two points (8).

One showed positive outcomes of the nerve flossing exercises, including improvements with pain relief and functionality changes (6).

The same study concluded that while traditional conservative treatments, like splinting and pain-relieving drugs, are clinically effective, adding nerve gliding exercises to the mix can help speed up the healing process and potentially avoid surgical procedures.

We’ll let you be the judge, but for us, it seems like there’s a ray of light at the end of the carpal tunnel!

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