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Carpal Tunnel Syndrome (CTS) and Repetitive Strain Injury (RSI) are modern epidemics. They are the result of our digital lives. CTS causes numbness, tingling, and pain in the thumb, index, and middle fingers. It often wakes you up at night with a “dead hand.” RSI is a broader term for pain in the forearm and wrist caused by overuse.
Standard treatment involves splinting the wrist to stop movement, or surgery to cut the Transverse Carpal Ligament to make more space for the nerve. While surgery can be effective, it is invasive and requires significant recovery time. Crucially, it doesn’t always work if the nerve is compressed elsewhere.
At Breakthrough Pain & Performance, we treat the entire nerve path. We understand that the Median Nerve (the nerve involved in CTS) travels from the neck to the hand. Compression can happen anywhere along this line. By clearing the upstream blockages, we can often relieve the pressure at the wrist without a scalpel.
Nerves are like hosepipes. If you step on a hose near the tap (the neck), the water flow reduces. If you then step on it near the nozzle (the wrist), the flow stops completely.
This is Double Crush Syndrome. A nerve that is irritated at the neck (due to poor posture or “Tech Neck”) becomes swollen and vulnerable. It doesn’t take much pressure at the wrist to tip it over the edge into symptoms.
Treating the wrist alone is dealing with the second crush but ignoring the first. We trace the nerve back to the spine. We mobilise the neck vertebrae and release the scalene muscles. By relieving the “first crush,” the nerve recovers its health, and the symptoms in the hand resolve.
The Median Nerve passes through a muscle in the forearm called the Pronator Teres. This muscle turns your palm downwards (pronation).
If you type all day, drive, or use tools, this muscle is constantly active. It can become hypertrophic (bulky) and tight, strangling the nerve before it even reaches the Carpal Tunnel.
This mimics CTS perfectly, but it is actually a muscular entrapment in the arm. Surgery on the wrist will not fix this. We can differentiate the two. If we find the entrapment is in the muscle, we use Active Release and neurological reflex techniques to relax the Pronator Teres. This frees the nerve and restores sensation to the fingers.
Why is Carpal Tunnel worse at night? Because when you lie down, fluid redistributes from your legs to your upper body. If your lymphatic drainage is poor, this fluid pools in your arms.
The Carpal Tunnel is a fixed space. If there is excess fluid (oedema) in the tunnel, the pressure rises and crushes the nerve.
We improve the venous and lymphatic return. We treat the “drainage points” in the shoulder, armpit, and neck. We give you exercises to pump fluid out of the arm before bed. By reducing the fluid volume, we reduce the pressure on the nerve, allowing you to sleep through the night.
RSI is often driven by Cortical Smudging. If you perform the same micro-movement (clicking a mouse) thousands of times a day, the brain’s map of the hand gets blurry.
The brain loses the ability to differentiate between the muscles. It fires them all at once in a clumsy, inefficient way. This co-contraction creates friction in the tendons and fatigue in the muscles.
We use Sensory Discrimination drills. We might have you identify different coins with your eyes closed or trace shapes. This forces the brain to sharpen its map of the hand. A sharp map leads to precise, efficient movement, reducing the strain on the tissues.
Nerves need to slide. In CTS and RSI, the nerve often gets stuck to the surrounding fascia. When you move your arm, the nerve stretches instead of sliding. This causes shooting pain.
We use Neural Flossing. This involves moving the arm in a specific wave-like pattern that pulls the nerve through the tunnel at one end while feeding it in at the other. It breaks down adhesions and restores the “slide and glide.” It is gentle, rhythmic, and highly effective at reducing nerve sensitivity.
1. The Audit: We check the neck, shoulder, elbow, and wrist. Where is the crush?
2. The Decompression: We open the nerve tunnels using manual therapy and P-DTR.
3. The Drainage: We clear the fluid congestion to lower pressure.
4. The Ergonomics: We don’t just say “get a new mouse.” We teach you how to use your whole arm to move the mouse, sparing the wrist.
This clinic is for you if:
We restore the flow to your nerves.
