December 20, 2023 by Dr. Stephen Fose, PT, Cert. MDT, CSCS

Decoding Carpal Tunnel Pain: Unveiling the Spinal Connection | Dr. Stephen Fose, PT, Cert. MDT

Carpal tunnel pain is a common complaint and major reason for desk-workers and manual laborers using their hands to have pain. Carpel tunnel is often attributed to overworked hand and wrist muscles. However, what if the root cause of this discomfort lies beyond the muscles? In this blog, we'll explore why traditional physical therapy may not always yield the expected results and delve into the importance of examining the spine, specifically the median nerve roots. By integrating the principles of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT), a deeper understanding of carpal tunnel pain emerges, potentially transforming treatment outcomes.

Carpal tunnel pain is traditionally viewed as a consequence of repetitive hand and wrist movements, leading to compression of the median nerve. While muscles certainly play a role, there's growing recognition that the source of the problem may extend beyond the local musculature. The McKenzie Method advocates for a broader perspective, encouraging physical therapists to explore the spine's role in nerve function and pain referral.

Why Traditional Physical Therapy Falls Short:

Conventional physical therapy often focuses on localized interventions, such as stretching and strengthening exercises for the hands and wrists. While these approaches can provide temporary relief, they may not address the underlying spinal factors contributing to carpal tunnel pain. The McKenzie Method emphasizes the need for a comprehensive assessment that includes screening the spine to identify potential mechanical dysfunctions affecting the median nerve roots.

Screening the Spine: The Missing Link:

Understanding the spine's involvement in carpal tunnel pain requires a shift in perspective. The spine serves as the highway for nerve signals, and any dysfunction along this pathway can manifest as symptoms in the hands and wrists. By incorporating spine screening into the assessment process, physical therapists can pinpoint issues like disc herniations or nerve root impingements that may contribute to carpal tunnel symptoms. This holistic approach aligns with the principles of MDT, ensuring a thorough examination to reveal hidden contributors to pain. In a study by Rosedale et al in 2019, they found a over 40% of all non-spine related conditions having significant improvements just by screening and addressing the spine. It confirms things physical therapists have already known, that the body "is all connected". The sheer numbers on the other hand, were a bit surprising and may shed light in why some patients don't fully resolve with diagnostic based treatments.

The Role of Median Nerve Roots:

The median nerve, originating from nerve roots in the neck and upper spine, travels down the arm and passes through the carpal tunnel in the wrist. Dysfunction at the level of the spine, such as disc herniations or nerve compression, can lead to referred pain in the hand and wrist. The McKenzie Method recognizes the interconnectedness of the body and encourages therapists to assess not only the local symptoms but also their potential spinal origins. By addressing issues at the root of the problem, more effective and targeted treatment strategies can be implemented.

MDT Principles in Action:

MDT provides a systematic approach to understanding and treating musculoskeletal issues. In the context of carpal tunnel pain, MDT principles guide therapists in classifying the pain based on its response to movement and positions. This classification informs the development of a personalized treatment plan, which may include specific exercises and movements aimed at addressing spinal dysfunctions. By tailoring interventions to the individual's unique presentation, MDT maximizes the chances of resolving carpal tunnel pain at its source.

In this video, Dr. Stephen Fose, PT, Cert. MDT performs 3 exercises that are part of a spinal screen to check the role of the spine in conditions like carpal tunnel syndrome.

Carpal tunnel pain is a complex condition that goes beyond the muscles of the hand and wrist. Understanding the spine's role in mediating nerve signals and recognizing the influence of median nerve roots is crucial for effective treatment. Traditional physical therapy approaches, while valuable, may fall short if they neglect to consider the spine's contribution to carpal tunnel symptoms.

By integrating the principles and ideas of MDT, physical therapists can embark on a comprehensive journey to uncover the underlying causes of carpal tunnel pain. Screening the spine and addressing potential dysfunctions at the source open new possibilities for more targeted and sustainable relief. As we continue to advance in our understanding of musculoskeletal health, embracing a holistic approach that incorporates the principles of MDT offers a promising avenue for unraveling the complexities of carpal tunnel pain.