A quick Google search of ‘massage gun’ and ‘carpal tunnel’ and you will see a whole range of weird and wacky treatments that claim to be the cure to your wrist pain.
Can a massage gun really be the holy grail of treatments for carpal tunnel syndrome?
A quick look at a few manufacturers’ websites certainly suggests they want you to believe this is the case. In this article, we will explore the evidence and practical implications in detail to find out.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is the most common entrapment neuropathy of the upper limb in adults, according to the ‘National Institute for Clinical Excellence’ in the U.K.[1]
The carpal tunnel is a small space between the intercarpal ligaments of the hand and a broad, superficial ligament called the flexor retinaculum. Passing through this space are the flexor tendons and the median nerve.
Crucially, the median nerve is responsible for the sensory and motor function of certain areas of the hand and fingers, forearm, and upper arm as it descends from its origin in the neck.
When the space in this tunnel is reduced the tendons can become inflamed and compress the adjacent median nerve. This results in the classic symptoms of carpal tunnel syndrome, including wrist and hand pain, weakness, tingling and sensation changes of the fingers, and reduced wrist mobility.
There are many well-documented risk factors for the development of carpal tunnel syndrome, including but not limited to: smoking, wrist injury, diabetes, hypothyroidism, and repetitive occupational hand tasks.[2]
What is Percussive Therapy/ What Does a Massage Gun Do?
Massage guns work using percussive massage therapy. If you have read my previous article on massage guns for DOMs then you will know all about percussive massage and its benefits.
In short, percussive massage purportedly helps to reduce muscle tone and increase blood flow and elasticity in soft tissues.
Using various-shaped attachment heads vibrating at high frequencies to create percussive vibrations, a user or therapist can target different areas of soft tissue. This stands true for the carpal tunnel of the wrist.
Historically, the first instances of use for percussive massage guns are with professional and amateur athletes alike for warmup and physical recovery. There are very few published clinical trials or evidence-backed reviews detailing their benefits, indications, contraindications, and even side effects.
What Does the Evidence Suggest?
According to the available literature, massage therapy demonstrated a significant change in the severity of carpal tunnel symptoms and hand function after only two weeks when performed twice per week.[3]
It is worth noting that both studies here only looked at conventional massage, with one of them also combining stretching into the intervention[4]. It may therefore be a bit of a stretch to infer that massage guns will definitely have the same effect. Further studies would be required to cement that claim.
In truth, there is a paucity of literature available to substantiate the claims made by many massage gun manufacturers.
Even from a logical point of view, we know that carpal tunnel syndrome involves an entrapment of the median nerve within a narrow space surrounded by small bones. Anyone who has ever accidentally hit the bone with a massage gun knows that is not a pleasant feeling.
This leaves us with muscles of the forearm, upper arm, and perhaps the trapezius muscles as the only real option for targeting. What is the clinical value of doing this? Again, we don’t really know…
For sure, we could target these muscle groups with the intention of reducing associated muscle tension and so-called trigger points. We may even be able to make a case for increasing flexibility and flooding the nervous system with a deluge of proprioceptive input, which will achieve no more than a temporary distraction from the pain.
The more speculative pro massage research, of which there is generally very little, will even claim a positive effect on reducing inflammatory chemicals circulating around an injured area.
The unfortunate reality regarding all these claims is that they are speculative at best, based on small scale studies with serious questions regarding their methods lacking appropriate power and perhaps subject to institutional bias given that most are funded by the manufacturers of the devices themselves.
Practical Use of Massage Gun for CTS
The good news is, when used appropriately a massage gun does not seem to have any harmful effects. And for that reason, it might still be worth giving it a go!
Here is what I would recommend:
- Start with a soft, small-medium sized treatment applicator head around the pectorals working just below the collar bone from chest toward shoulder in the direction of the muscle fibres.
- Move on to upper trapezius, again following orientation of muscle fibres. Be careful not to drift too far toward the front of the neck. Work outwards to inwards across the tops of the shoulder blades.
- Work on the Biceps, starting above the elbow and moving in the direction of the shoulder. Be gentle here around the bony protuberances and don’t use too much pressure around the tendons.
- Finish with the forearm flexors (the side you see when looking at the palm of our hand). As you move down towards the wrist be mindful of the bony areas and do not spend prolonged periods of time around the carpal tunnel itself. This will likely only irritate the nerve further!
Combine these techniques with some gentle stretching, neural mobility exercises, occupational and lifestyle changes, and consideration in conjunction with your specialist/ physiotherapist of a 6-week trial using a nocturnal night splint in a neutral position. This is what the best practice guidelines currently advise[5].
Some with persistent symptoms may go on to receive a corticosteroid injection or surgery. Again, this needs to be under the guidance of an orthopaedic upper limb specialist.
When using a massage gun, you are advised to ‘float’ across the soft tissues. This always means light pressure, allowing the gun to do all the work and requiring little pressure from the user. Start with the wider and softer attachment heads before moving on to the smaller heads used for trigger points and specific use.
Summary
In summary, I would never discourage from trying a massage gun if they think it might be of use. Do I think that it is the new ‘quick-fix’ or super-gizmo which will revolutionise the way we treat carpal tunnel syndrome? No, unfortunately, I do not.
Whilst we wait for further, more extensive research to substantiate the perhaps optimistic claims that you see on the internet, my advice would be to see a suitably qualified clinician with experience treating this condition.
[1] https://cks.nice.org.uk/topics/carpal-tunnel-syndrome/
[2] Guan W, Lao J, Gu Y, Zhao X, Rui J, Gao K. Case-control study on individual risk factors of carpal tunnel syndrome. Exp Ther Med. 2018;15(3):2761-2766. doi:10.3892/etm.2018.5817
[3] Elliott, R. and Burkett, B., 2013. Massage therapy as an effective treatment for carpal tunnel syndrome. Journal of Bodywork and Movement Therapies, 17(3), pp.332-338.
[4] Salehi, S., Bohlouli, M., Shahpar, F., Esfahani, M., Lahiji, F. and Aslani, H., 2016. P-50 The impact of stretching and massage therapy on pain and function of females suffering carpal tunnel syndrome. British Journal of Sports Medicine, 50(Suppl 1), pp.A59.2-A59.
[5] https://cks.nice.org.uk/topics/carpal-tunnel-syndrome/
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