Carpal Tunnel Massage Techniques and Exercises

Massage and exercise can be effective in relieving pain, stiffness, numbness, and tingling caused by carpal tunnel syndrome. Techniques like myofascial release and trigger point therapy are commonly used by physical therapists and may help ease pain without the need for medications or surgery.

While the American Academy of Orthopedic Surgeons (AAOS) neither endorses nor advises against massage therapy for carpal tunnel syndrome, a growing body of research suggests that it may improve outcomes in people with mild to moderate symptoms.

On the other hand, there are exercises that the AAOS does endorse that can be performed safely and effectively at home.

This article describes the various massage and exercise techniques that can help treat carpal tunnel syndrome, either on their own or as part of a holistic treatment plan.

Massage Techniques

Your physical therapist may recommend massage every day for three to four weeks as part of a treatment plan for carpal tunnel syndrome. A partner can be trained in the massage techniques, but they can be difficult to do on yourself since they are best performed with two hands.

Myofascial Release

A specific type of massage—called myofascial release—is thought to be effective for carpal tunnel syndrome by relaxing tendons in the wrist and reducing pressure on the median nerve. By doing so, pain may be relieved while grip strength, range of motion, and functional hand use may be improved.

Myofascial release involves the kneading of tissues to break up adhesions (stuck-together tissues) in the wrist and forearms. "Myo" refers to muscles, while "fascial" refers to the membranes surrounding muscles (called fascia).

Myofascial release involves a series of different movements:

• Effleurage: These are light circular strokes made with the palm of the hand to increase blood flow to the forearm and wrist and prepare them for a deeper massage.
• Friction: This involves applying pressure to the base of the wrist with both thumbs and then gliding the thumbs toward the elbow with sustained pressure to break up any adhesions.
• Petrissage: These include movements like kneading, wringing, skin-rolling, and deep squeezing to help stretch and loosen tight muscles.
• Shaking: Shaking the arms helps muscles loosen and relax.

Each myofascial release session takes about 15 minutes, repeating the movements in the following order in five sets:

1. 30 seconds of effleurage 
2. 60 seconds of friction
3. 30 seconds of petrissage
4. 30 seconds of shaking
5. 30 seconds of effleurage 

Trigger Point Therapy

Trigger points are hypersensitive bands of taut muscles that can transmit pain to other parts of the body (called referred pain).

Trigger points associated with carpal tunnel syndrome are located on three parts of the arm:

• Four centimeters (2 inches) below the crease of the elbow on the top of the forearm.
• Four centimeters (2 inches) above the crease of the wrist on the underside of the forearm.
• Two centimeters (1 inch) below the crease of the wrist at the base of the thumb.

As with myofascial release, trigger point therapy is best performed by a physical therapist who knows the exact location of the trigger points. The therapy takes around 15 minutes and can be performed with myofascial release as part of the treatment plan.

Trigger point therapy involves the following steps:

1. Start by locating the trigger point,
2. Place firm pressure on the trigger point with the thumb.
3. Maintain the pressure for 20 to 30 seconds and then release.
4. Stretch and massage the surrounding tissues.
5. Repeat as needed.

Nerve-Gliding Exercise

The nerve-gliding exercise treats the median nerve rather than the tendons and muscles that support the median nerve. It can be performed at home and works by stretching the nerve and allowing it to move more freely.

To perform the nerve-gliding exercise, the hand is moved through six positions, holding for five seconds between movements:

1. With your palm facing down in a neutral position, clench your hand into a fist.
2. Extend your fingers straight, keeping your thumb in line with your fingers.
3. Extend the wrist back as if signaling someone to "stop."
4. Move your thumb to the side as far as it can go.
5. Rotate your palm toward the ceiling.
6. Use your other hand to gently pull the thumb toward the ground.
7. Repeat steps 1 through 6 for a total of five sets.

This routine should be performed four times daily and before any activity that causes carpal tunnel pain.

Tendon-Gliding Exercise

The tendon-gliding exercise can increase the range of motion and flexibility of the tendons of the thumb and fingers. When these tendons are tight and inflamed, they can compress the nearby median nerve. When these tendons are stretched, pain can be relieved.

To perform the tendon-gliding exercise, you will move your hand through five positions, holding for five seconds between each movement:

1. Start with your hand held out as if signaling someone to "stop."
2. Bend the tips of your fingers toward your palm without bending the knuckles.
3. Clench your hand into a fist.
4. Extend your fingers horizontally so that your hand forms a 90-degree angle.
5. Bend the tips of your fingers toward your palm, maintaining a 90-degree angle.
6. Repeat steps 1 through 5 for a total of five sets.

As with the nerve-gliding exercise, the tendon-gliding exercise should be performed four times daily.

Wrist Flexion and Extension

Wrist flexion and extension exercises are more active in that they use gentle pressure to bend the wrist back (extension) and down (flexion). They are best performed after warming up with nerve- and tendon-gliding exercises.

These two exercises should be included as part of your at-home exercise plan. With that said, they may need to be avoided if you are having excessive pain as they can make symptoms worse.

The wrist extension exercise is performed four times daily as follows:

1. Straighten your arm and lift your wrist as if signaling someone to “stop.”
2. With your opposite hand, gently pull back your palm until you feel a slight stretch in your forearm.
3. Hold for 15 seconds and release.
4. Repeat five times.

The wrist flexion exercise is performed four times daily as follows:

1. Straighten your arm with your wrist bent down and fingers straight.
2. With your opposite hand, gently pull the back of your hand until you feel a slight stretch in the back of your wrist.
3. Hold for 15 seconds and release.
4. Repeat five times.