Has the carpal tunnel brace outlived its usefulness?
Years ago, when I was a student under Dr. Michael Leahy, the founder of Active Release Techniques, he told us his method resolved carpal tunnel syndrome and braces made the condition worse. His work with carpal tunnel syndrome had shown that most wrist, hand, and arm syndromes had more to do with nerve entrapment along the length of the arm instead of by the carpal tunnel. His new understanding of hand numbness, wrist pain, and thumb pain replaced the old methods of endless therapies, wrists restricted at night and during the day with splints. His methods became written into the worker’s compensation laws in Colorado.
After learning his methods, I worked with Johnson and Johnson’s worker’s comp department and resolved many wrist, elbow, and arm syndromes, often in less than 10 visits. The worker’s compensation companies noted our effectiveness but wanted to reduce us to only working on the arm. We won these arguments by helping them understand why we were effective as we went beyond Dr. Leahy’s methods during our analysis of Repetitive Strain Injuries (RSI) to the arm and forearm, also referred to as carpal tunnel syndrome. We looked at people, how they moved and walked and stood, connecting the dots to better understand why the person had wrist, hand, and shoulder pain, and numbness.
The secret to a quick and long-term resolution to these problems is understanding that problems in the lower body, even if asymptomatic affected wrist, arm, and shoulder function result in many patients waking up with hand numbness, experiencing thumb and wrist pain, and even developing neck and shoulder problems. Our holistic way of thinking had Johnson and Johnson sending us many patients until they replaced their medical director who was unfamiliar with our office. Eventually, he began to send us company executives who benefitted from our approach to care as well.
While those who promote the use of splints continue to rack up sales, splinting the wrist and physical therapists massaging and treating the point of pain has been costly, ineffective, and results in the chronicity of an often curable condition.
Why has the medical profession failed to embrace this sensible solution?
Most doctors continued to call these problems carpal tunnel, giving their patients braces and making them think all their physical painful joint and numbness problems were separate, when in fact they were connected. Better knowledge for treating repetitive strain now exists and more healthcare providers embraced methods that were holistic and avoided ineffective and potentially harmful surgeries of the wrist or elbow nerve relocation procedures or endless therapy regimens. Unfortunately, sales of braces continued to be supported by many doctors who failed to embrace newer scientifically proven ways of resolving these syndromes.
While some people who have wrist sprains or hairline fractures may continue to benefit from these braces, those who have repetitive use syndromes in the arm would be best treated by chiropractors who are trained in myofascial release treatment, Graston, and other proven soft tissue methods. Avoiding segmented care which is commonplace in the medical world where you see many practitioners treating problems that would best be treated with a single practitioner through a chiropractic primary care approach to the musculoskeletal system. Most of these patients should be referred for a chiropractic evaluation first.
Why patients who get wrist splints don’t improve.
The idea that carpal tunnel syndrome is only an entrapment of the median nerve at the wrist has been promoted by internet sites such as the Mayo Clinic. Most doctors are taught that the condition occurs at the wrist and most treatment is directed at that area. Typing is continually blamed for problems such as carpal tunnel syndrome. The problem is, the malfunction in the wrist, arm, and forearm develops over years. Overuse is often assumed when the real problem may be related to how we move and adapt over the years. The same failed medically taught approach is echoed on the internet which includes ineffective treatment approaches of splinting at night, therapy to the arm, paraffin baths, etc. Surgery to the carpal tunnel, once common is not performed as frequently since initial symptoms may improve at the wrist, but dysfunctions throughout the body that caused the arm and wrist pain now cause other dysfunctions over time can reside in the lower back, knees, and even the shoulder and elbow.
Dr. Leahy had said that the wrist splinting at night worsened the problems by stretching the median nerve. The splints may also decondition the hand and wrists, not unlike shoes can with the feet.
There is a better way that is evidence-based and requires a holistic drug-free approach.
Most sports chiropractors have been trained to diagnose holistically and view mechanical problems in the body as systemic problems rather than just regional problems occurring where the area is painful.
A primary care patient-centered approach that offers best practices is always preferred to a segmented approach with numerous specialists. Chiropractors are the only physicians trained to holistically diagnose and treat the musculoskeletal system without the use of drugs or surgery.
An example of this would be the chiropractor doing the rehab, giving the exercises, doing the treatments and looking at the entire body, and attempting to understand the mechanism behind why the wrist or thumb is painful each visit. The treatment is geared towards improving the mechanism behind the pain rather than just treating the painful region with injections, therapies, and other methods which often cannot possibly work.
Having one provider perform treat test treat protocols each visit improves results because functional improvements the day of the visit is a good test for treatment effectiveness. Treat test treat is the future of effective rehab and treatment. Our office performs this on most patients to determine the effectiveness of the visit.
Do you experience wrist, arm, thumb, or even shoulder pain and wonder if there is a more effective way to resolve the pain than splints, injections, or surgeries? Book online here to find out how we can help you. Feel better in as little as one visit.