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Craig Roberts, Chiropractor, Grass Valley CA
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Carpal Tunnel / Tarsal Tunnel

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is one of the most misdiagnosed conditions in healthcare.  CTS occurs when the median nerve is compressed in its “tunnel” in the wrist (the tunnel is created in part by the wrist bones—called “carpals”).  Symptoms include tingling, pain, and/or aching in the palm side of the hand in the area of the thumb and first and second fingers.  See the picture below (areas in blue are symptomatic with CTS):

  median dist_1.gif

 

As mentioned above, CTS is often misdiagnosed.  The median nerve can be compressed not only in the carpal tunnel, but also in a muscle that it pierces in the forearm called the supinator.  Before becoming the median nerve, nerve roots originate in the neck, then go through a switching station called the brachial plexus.  These nerves can be compressed in the neck by parts of the spine, or in the brachial plexus by tight muscles.  All of these areas should be checked carefully to prevent misdiagnosis!  A circumstance called "double crush" is not at all uncommon in people with CTS symptoms.   "Double crush" is a situation where a nerve is compressed in 2 different areas—these areas of compression are minor enough that either one alone would not be enough to cause symptoms.  When the two occur together, however, they summate and create the symptoms associated with CTS.

 

What is Tarsal Tunnel Syndrome (TTS)?

Tarsal tunnel syndrome is similar to CTS in that it involves compression of a nerve (in this case the posterior tibial nerve), it is often misdiagnosed, and often involves the “double crush” phenomena described above.

Common compression sites of the nerves that make up the posterior tibial nerve are the lumbar spine (low back), the buttock, the calf muscle, and the area just behind the big bump on the inside of your ankle.  The tarsal tunnel itself is just behind the "bump" on the inside of your ankle (the medial malleolus).  Symptoms can include pain and/or tingling and numbness on the inside of the heel, in the arch of the foot to the big toe, or fanning across the arch of the foot to the little toe.  People with TTS are at increased risk for a painful foot disorder called plantar fascitis.

  tibial_nerve2.png

 

What Causes TTS and CTS?

The most common cause of both of these syndromes is repetitive injury.  As your body performs the same task again and again, hundreds and thousands of times, it adapts.  Connective tissues such as tendons and ligaments thicken in response to stress, muscles get stronger, and in the absence of stretching often get tighter.  As a result of these stresses and adaptations joint mechanics change.  The net result can be compressive forces on nerves that should be able to move freely.  Common examples of repetitive stresses leading to CTS are keyboard use, keypad use in retail business, meat cutting, and playing musical instruments.  The most common scenario leading to TTS is foot pronation, a condition where the foot and ankle flare out during walking, running, and standing.

 

How are CTS and TTS Treated?

Many CTS and TTS treatments fail because the point(s) of compression of the median nerve or posterior tibial nerve are not located.  Too often symptoms are labeled CTS or TTS before appropriate testing is done.  Simple orthopedic tests that challenge the various compression points can accurately determine the cause of symptoms—and better direct effective treatment.  The good news is this—there are many strategies that you can safely use in your own home that affect all of these areas. 

Chiropractic Care 

No one is better trained to assess the mechanical function of your joints and wrists than a chiropractor.  A chiropractor can locate and correct restrictions to proper movement may be causing pressure in the carpal or tarsal tunnels.  A chiropractor can also assess the path of the nerve to the spine to be certain that it is free of interference.  

Low Level Laser

Numerous studies have shown that low level laser therapy helps nerves to heal quickly and function better.  This unique therapy has no side effects and often results in improvement in symptoms after 3-5 treatments.   I offer this therapy in my office--if you live outside the Nevada County area call around to find a holistic provider who uses this powerful modality.

Nutritional Strategies

Several studies have linked vitamin B6 deficiency to both tarsal tunnel and carpal tunnel symptoms.  This vitamin, found in beans, nuts, eggs, meats, and whole grains, plays a critical role in maintaining the sheathing around nerves.  This sheathing, called myelin, is necessary for nerves to function properly.  It is possible to get too much vitamin B6.  For this reason I recommend taking no more than 50mg/day for one month.  If this helps your symptoms, decrease your dose to 10mg/day after the initial month.  You are especially at risk of being deficient in B6 if you are on oral contraceptives, are pregnant or nursing, or have a history of depression or anxiety.

Stretches for CTS and TTS

The following stretches can be very helpful in treating CTS and TTS.  Take each stretch just to the point of discomfort, never to pain.  Hold the stretch for 30 seconds.  You may feel some numbness or tingling during the stretch.  This is okay as long as you experience no pain and the numbness discontinues within 10 seconds of completing the stretch.  With tarsal tunnel syndrome you should see a chiropractor to rule out spinal injuries before attempting the stretches listed below.

  • CTS Stretches

EXTENSOR STRETCH

 

FLEXOR STRETCH

WRIST STRETCH

 
WALL STRETCH

  • TTS Stretches
  • HAMSTRING/CALF STRETCH 

 


  • Orthotics and TTS

Wearing othotics that support and correct the arches in the feet can be effective in the treatment of TTS.  By lifting the arch some of the stretch in the tibial nerve is relieved.  This often results in relief. 

Self-Massage

Self-massage techniques can be helpful with both CTS and TTS.  These techniques help to relax muscles that can compress nerves, and to break down scar tissue that can limit the normal movement of nerves.  These techniques are best learned from a chiropractor.  Below you will find some simple techniques that you can use at home. 
If you experience intense or lingering pain with these massage techniques stop and consult an expert.


CTS Pressure Point:  Pronator Teres.  Apply deep pressure to this muscle and hold for about 30 seconds while gently moving your wrist in circles.

pronator_trigger_point.JPG 

TTS Pressure Point: Calf.   Apply deep pressure to this muscle and hold for about 30 seconds while gently moving your ankle in circles.

  calf_trigger_point.JPG

Transverse massage at tarsal tunnel:  Find the indentation just behind the bump on the inside of your ankle.  Using 3 fingers and moderate pressure, rub back and forth cross-wise (not length wise) across your ankle.  It will be uncomfortable, but should not be painful.  Do this for about 1 minute once per day.

  tarsal_tunnel_massge_point.JPG

 

If the above strategies do not bring you relief, see your chiropractor.  Chiropractic manipulation, muscle work, and low level laser therapy are all effective means of treating CTS and TTS.  Good Luck!