Carpal Tunnel Syndrome (CTS)

by Maja Zilih

What exactly is CTS?

Carpal tunnel is a canal in the wrist formed by bones and ligaments, through which the median nerve passes; the nerve that carries information to the palm and first three fingers. When this nerve is compressed at the wrist - either because of the decrease in the canal’s size or because of the increase in the size of its contents - a medical condition called carpal tunnel syndrome is diagnosed. The person with CTS experiences anything from mild tingling sensation in the palm and fingers to considerable pain and even restriction in movement.

The carpal tunnel syndrome became common in the 1990s with the increase of office work. Studies have shown that the lifetime risk for CTS is now around 10% of the adult population.*

CTS and yoga

In 1998 a research was conducted to examine the effect that a set of simple yoga poses has on the symptoms of CTS. People diagnosed with CTS were separated in two groups: group one was to do various yoga exercises, and group two was to use wrist splints. At the end of the eight-week period, the group that used splints showed some improvement, but not as significant as the yoga group. The yoga group showed considerable improvement both in grip strength and in the reduction of pain.

If you have CTS or wish to work on its prevention, you may want to make your own daily asana program, like the ones that were used in the study ( in consultation with your doctor, therapist or yoga instructor). Even though the experiment had a number of biases making conclusions difficult to consider a 100% accurate, it can serve as evidence that alternative approaches to surgery are very well worth trying.

To see the asanas that were performed by the study group, as provided by Yogasite. com, click here.

For yet another list of various preventive and healing stretches, click here.

What to keep in mind?

1. Alignment – the big picture.

If you have already been doing yoga for some time, and have just been diagnosed with CTS, this can be a real discouragement for you with respect to continuing your practice. Doctors and therapists may advise not placing weight on the hands and wrist at all. But many Anusara yoga teachers think otherwise – they suggest that by performing poses with correct alignment, the CTS problems can be eliminated. Here is the article by John Friend about CTS in Yoga Journal:

“Clearing wrist problems is not only a matter of strengthening the wrists; a high percentage of wrist problems have their origin in shoulder misalignments, too. The first thing to do is to open and balance the shoulders through a variety of poses performed with good alignment.

The next key therapeutic step for the wrists is to strengthen the flexor muscles of the forearms (the muscles on the underside, or palm side, of the forearm). Do this through isometric actions in basic positions, while bearing light weight on your hands. It is essential to place the hands on a firm surface, shoulder-width apart; and make sure the creases of the two wrists (where the back of each hand meets the forearm) form a straight line. The fingers and thumbs should be evenly spread. The four corners of each palm (the index finger mound, mound of the thumb, little finger mound, and outer heel of the palm) should be evenly anchored on the firm surface.

To build isometric strength in the flexor muscles, claw the hand on the firm surface so that the tips of the fingers and the four corners of the palms press down and draw back toward the shoulders. Keeping the finger pads down, bend the fingers slightly and lift the center of the palms up without lifting the four corners of the palms. The flexor muscles should firm as you attempt to move the head of the arm bone backward in relationship to the torso.
It is important to note that wrist problems will be aggravated if:

Your weight falls to the outside of your hands.

Your index finger knuckle lifts away from the foundation.

Your weight collapses to the heel of the palm.

Basic positions include an L-pose with hands on a table top; Child's Pose with the arms extended forward; bearing your weight on all fours with hands in front of the shoulders; and Adho Mukha Svanasana (Downward-Facing Dog).

Start with poses that bear less weight, then increase the weight on the wrists as you are able to maintain good alignment and proper muscular action.
If you follow this general advice, you will experience some freedom from your wrist problem. With regular therapeutic asana practice, carpal tunnel syndrome and other common wrist issues can usually be eliminated."

2. Attention

There is a miraculous healing potential in paying attention. Attention is the most significant component to dealing with any kind of pain, and perhaps particularly with the chronic pain.

When your wrists are hurting, sit with the spine straight, either in a chair or cross-legged on the floor. Focus on your breath as long as you need to quiet the mind.

- Don’t fight any thoughts, just notice how they come and go, and you gently return to your breath each time your thoughts have taken you away.

- Once you feel that you are more quiet and calm, bring your attention to the area in pain.

- Don’t try to change it or even heal the area.

- Just be with it.

- Breath with it.

- Explore it without too much thinking. Explore it with senses and awareness.

- Keep the awareness on that part of the body for at least five minutes and gradually increase up to fifteen.

- You will probably notice that the thoughts are taking you away. That’s fine. That’s just how the mind works. As soon as you notice it, you are free to come back. So don’t waste energy frustrating about your mind travelling around. Use the opportunity of having noticed that, and gently bring back the awareness back to the area in pain and to your breath.

This exercise will benefit not only your sensitive body points, but your overall physical, mental and emotional health. You can try to practice this every time you catch yourself thinking negatively about the area in pain. Try to see how many times a day your mind goes to the "problem" and produces a negative thought about it. Noticing these thoughts is very helpful. By exercising neutral feeling and sensing the parts of your body every time your mind goes to it, you are learning a new kind of communication with the body, the kind that entails respect and love. In this communication no parts of the body are being either pitied, rejected, or hated for the way they are.

References:

Michelsen H, Posner M (2002), "Medical history of carpal tunnel syndrome", Hand Clin 18(2): 257–6810%

John Friend's article in Yoga Journal: http://www.yogajournal.com/for_teachers/2579