How Can Phys­io­ther­apy Help?

Great Health Guide - - CONTENTS - Mar­garita Gure­vich & Justin Bal­bir

Causes, di­ag­no­sis & phys­io­ther­apy treat­ment of Carpal Tun­nel

Phys­io­ther­a­pists see many pa­tients with wrist pain. Given that it is such a preva­lent problem, let’s re­view some com­mon causes and more im­por­tantly, talk about what treat­ment op­tions are avail­able. When it comes to di­ag­nos­ing the cause of pain in the wrist, the first step is to de­ter­mine whether it’s a true wrist problem or whether the pain is ‘mas­querad­ing’, i.e. be­ing re­ferred to the wrist from an­other part of the body. The most com­mon ar­eas which can re­fer pain to the wrist are the neck, shoul­der and el­bow. To un­der­stand how this can hap­pen we will use the neck as an ex­am­ple. Imag­ine that you have a bulging disc in your neck. This disc can put pres­sure on the nerves which sup­ply the wrist and con­se­quently, you will feel pain in the wrist. Treat­ing the wrist, how­ever, will not re­sult in an im­prove­ment as the problem is in the neck, not the wrist. Thus, in this ex­am­ple, it will be nec­es­sary to treat the neck, not the wrist, to abol­ish the symp­toms.


• Wrist frac­ture • Arthri­tis • RSI (repet­i­tive strain in­jury) • Carpal tun­nel • Ten­dini­tis There are also other, more se­ri­ous, causes of wrist pain. It is im­por­tant to see your doc­tor first to be cleared of th­ese. Once you have been cleared, treat­ment by a phys­io­ther­a­pist should be your next point of call. So, what treat­ment is avail­able for wrist pain suf­fer­ers? In phys­io­ther­apy prac­tice there are a wide range of treat­ment op­tions which in­cludes elec­trother­apy, ul­tra­sound, drug phore­sies and ex­er­cises. To de­cide which treat­ment will be most ben­e­fi­cial for each pa­tient, it is im­por­tant to carry out a de­tailed as­sess­ment first. This as­sess­ment will in­clude an anal­y­sis of wrist range of mo­tion and strength, as well as some spe­cific tests which help to di­ag­nose the cause of the symp­toms. Spe­cific in­ves­ti­ga­tions, such as di­ag­nos­tic ul­tra­sound and X-Rays, can also be help­ful in cer­tain cases, par­tic­u­larly if there is a sus­pected frac­ture. We will now re­view some of the above­men­tioned causes of wrist pain and specif­i­cally dis­cuss which treat­ments can be help­ful for th­ese. In this ar­ti­cle, we will dis­cuss carpal tun­nel syn­drome. The fol­low­ing ar­ti­cle will fo­cus on os­teoarthri­tis and RSI.


This dis­or­der of the hand arises be­cause of pres­sure on the me­dian nerve as it runs through the carpal tun­nel of the wrist. It typ­i­cally oc­curs when there is swelling in­side the wrist. Swelling can oc­cur be­cause of repet­i­tive tasks per­formed with the hand, arthri­tis and preg­nancy. Trau­matic in­jury can also be a cause of carpal tun­nel syn­drome. Com­mon symp­toms in­clude numb­ness, pins and nee­dles and pain. Weak­ness may also be felt in the hands and cramp­ing of mus­cles is not un­com­mon. This is due to a com­pro­mised nerve sup­ply to the af­fected mus­cles.


Ed­u­ca­tion: re­gard­ing which ac­tiv­i­ties and po­si­tions may be most provoca­tive and best to avoid.

Hands on ther­apy: where in­di­cated, wrist mo­bi­liza­tion and pas­sive stretch­ing may be use­ful, while mas­sage can help ease the sur­round­ing mus­cle ten­sion.

Ex­er­cises: nerve and ten­don glid­ing, as well as mus­cle stretch­ing may be pre­scribed, with strength­en­ing and fine mo­tor skills be­ing a fo­cus in the later stages of re­ha­bil­i­ta­tion.

Ul­tra­sound: this has been shown to re­duce in­flam­ma­tion and as­sist with eas­ing of symp­toms.

Mar­garita Gure­vich is Se­nior Phys­io­ther­a­pist and uses Clin­i­cal Pi­lates, SCENAR Ther­apy & other ev­i­dence-based tech­niques, in­clud­ing Real Time Ul­tra­sound and McKen­zie Treat­ment. Mar­garita spe­cialises in sports in­juries, women’s health (in­clud­ing in­con­ti­nence) and gas­troin­testi­nal is­sues. Mar­garita may be con­tacted via her web­site.

Justin Bal­bir has a Bach­e­lor of Health Sci­ences & Mas­ters of Phys­io­ther­apy Prac­tice. He has worked for five years as a sports trainer for the Ajax Football Club, with ex­pe­ri­ence in soft-tis­sue mas­sage & in­jury man­age­ment. Justin spe­cial­izes in man­ual ther­apy & sports in­juries and may be con­tacted via web­site.

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