Massage Techniques
Massage therapy can be a safe and highly beneficial approach for clients with CTS. At the least, massage is an excellent preventive measure that could reduce the advancement of CTS to a more severe stage.

There are several important factors to note when considering massage for CTS. As mentioned earlier, direct manipulation of the damaged nerve is detrimental and may cause further problems. Practitioners should use great caution in applying any further pressure directly on the carpal-tunnel region. However, there are other beneficial techniques that can be used.

In cases where nerve compression is not severe, myofascial stretching applied over the flexor retinaculum has proven helpful in reducing the aggravating symptoms of CTS (see Figure 1, right). It is unclear how this technique works, as the transverse carpal ligament does not have contractile properties. Also, this ligament is not actively shortened in CTS. There are, however, repeated reports of its benefit. This technique should not be used if it causes an aggravation of symptoms.

In many cases of CTS, overuse and hypertonicity in the flexors of the wrist and fingers is the central problem. Attention to these muscles is important. If the condition is severe, the practitioner should be gentle at first. More significant pressure may be used if the condition is not severe, or when the client is in the later stages of therapy.

Deep longitudinal stripping and compression-broadening methods (see Figures 2 (left) and 3 (right)) can be used on the forearm flexors to regain optimum tone in those tissues. In both of these methods a moderate pressure and slow stroke is used to reduce tension and increase mobility in the myofascial tissues.

As therapy progresses, more vigorous methods, such as an active-engagement technique, are effective (see Figure 4, below). This technique is performed by engaging the flexors in an isometric contraction. The client is then instructed to slowly release the contraction as the practitioner performs longitudinal stripping on the flexors. This method helps reduce tension and encourage elongation in the muscles.

In addition to specific techniques that focus on the wrist flexors or the carpal-tunnel region, for CTS it is important to address all the regions of the upper extremity and the neck. The median nerve may be compressed in a number of other locations, and this could further irritate the nerve at the carpal tunnel.

In some cases the median nerve is entrapped in one of these other locations, and not in the carpal tunnel, though the symptoms may be identical. For example, the nerve could be trapped where it travels between the two heads of the pronator teres muscle, which is called pronator teres syndrome. Too frequently, median-nerve entrapment is not thoroughly treated because attention is focused only on the carpal tunnel and not on these related areas throughout the upper extremity.

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