Carpal tunnel syndrome (CTS) is a painful condition of the flexor retinaculum. It has been categorized under a variety of physiological classifications, including repetitive stress injury (RSI), cumulative trauma disorder (CTD) and repetitive use injury (RUI). Although representing slightly different viewpoints, each of these classifications refers to the same physiological conditions.

Merck Manual1 reports, "Carpal tunnel syndrome is caused by deposition of mucinous ground substance in the ligaments around the wrist and ankle, producing nerve compression."
Here is how this happens. When fingers dance on the stage of a hand, wastes from cell respiration and breakdown get trapped in the tissues because the static contractions (which could be either isotonic or isometric) of the gross motor muscles impede the lymphatic draining of the area. Muscles get their full strength from their ability to elongate and contract through a full range of motion. Waste buildup in a muscle reduces its ability to contract, causing muscle weakness.

Tissue waste is usually removed by the lymphatic system. Initially, only the drainage is affected, which causes the swelling and increases hydraulic pressure in the tissue. Blockages to normal lymphatic fluid flow are like dams in rivers that create water reservoirs. The blockages limit muscle contraction and create a variety of other phenomena, including numbness and pain. 

Most of the body's sensors work on its hydraulic pressures. When pressure increases beyond normal tolerances, it triggers a pain response. In addition to weakness, waste buildup in the gross motor muscles can also lead to a pipeline effect: Waste compacts in the outer tissues of the arm due to the isocontractions blocking the lymphatic drainage and the infusion of materials via the blood system. This eventually leads to increased tissue pressure.
The most active area of the body is usually where the challenges are noticed first. In the case of CTS, the high-traffic area is the carpal tunnel itself, which is about the size of an index finger. It contains nine tendons and their synovial tissues, the medial nerve, veins, arteries, and lymphatic vessels-that is a lot of traffic in such a confined space. That is what makes the area very vulnerable to the pipeline effect.

Balloon Model

To understand this effect, take a long (not round) balloon, inflate it, and tie it off. The balloon uses air pressure to take on form and function. Your arm uses fluid and bone for similar purposes. 

Bend your balloon. Notice that both parts increase in diameter in response to the volume shift caused by the bend. 

The same action occurs when you flex a joint and the corresponding volume shift stretches the tissues beyond their comfort range. This leads to pain and tissue tearing, which, in turn, leads to adhesions and repetitive use injuries. Bend your arm and notice how the upper and lower arm increase in diameter.

Notice also that the balloon is rigid while having an open center. This is like the pipeline effect in your arm: Hard-packed muscles surround an open core that is gradually reduced as time passes and the wastes continue to build up.

Physiology

In order to understand how this treatment program works, you need to review soft tissue functions and components. 

The lymphatic system is the most extensive fluid system in the body. It represents about 60 percent of our fluid volume. By contrast, the blood system represents only about 33 percent of our fluids. These are the body's two largest circulating systems.

 
The lymph fluid flows one way in lymph ducts, from the extremities (hands and feet) to the ports at the junction of the subclavian and jugular veins. The duct walls, which are one to two cells thick, are valved to flow in one direction only, with the rate of flow determined by gross motor movement.

The terminal lymphatic vessels consist of a widely distributed closed-end network of highly permeable lymph capillaries that resemble blood capillaries in appearance. However, they generally lack tight junctions between endothelial cells and possess fine filaments that anchor them to the surrounding connective tissue. During skeletal muscle contraction, these fine strands may distort the lymphatic vessel and open spaces between the endothelial cells. This will permit protein, large particles, and cells in the interstitial fluid to enter the lymphatic capillaries. 

The blood capillary filtrate and the protein and cells that have passed from the intravascular compartment to the interstitial fluid compartment are returned to the circulation by virtue of tissue pressure, facilitated by intermittent skeletal muscle activity, contractions of the lymphatic vessels, and an extensive system of one-way valves.2

Lymph is like broth. When the broth cools off, it forms a hard, white, top layer (fat) and a gel underneath (protein). When lymph temperature drops below normal body temperature, the fats solidify and the proteins gel. This accounts for knots, stiffness and a large percentage of muscle injuries. It is the character-the consistency-of lymph that is affected by the use of hot and cold on the body.

To all this information we add the Eastern concept of organ stress. Imagine the body as a barrel in which all the organs are held in place by connective tissue attachments. To do what they do, organs only require fuel and rest. When they are tired and hungry, they pucker up and pull on their attachments. This in turn crushes the plumbing at the attachment site, which impedes the flow of the body's aquifer. Thus, the beginning of a soft tissue condition.

The Program

This program evolved from my workshops aimed at massage and medical professionals. Among the attendees were always a number of people who had a repetitive stress injury or were close to those who did. These people were interested in learning how they could apply these techniques to themselves and others. 

The keys to successful lymph massage are the following senses: touch, direction, flow and timing. The main challenges are positioning and relaxing.

Touch

he "down pressure" that your hand applies when massaging the soft tissues should be extremely light-much lighter than you probably expect. Remember that the vessels you will be working on are very thin-walled. They crush easily. Fortunately, they also are very resilient and reform when the pressure lessens.

You want to use a light-enough pressure to keep the vessels open so the tissue contents can pass through quickly and efficiently. There's another important reason to keep the touch light: A light touch will not trigger the body's defense mechanisms. A hard, intrusive touch will cause the body's defense mechanisms to contract the vessels, minimizing content flow through the tissues. Finally, a light touch is really appreciated by the client when the area is already painful.

The recommended pressure is about the weight of a nickel when held on a fingertip.
Place a nickel on your arm. Now remove the nickel and place your hand on the same location. The pressure from your hand should be the same as the pressure you felt from the nickel. Note, too, how it feels on the inside of your hand. This is the amount of "down pressure" you will use during this massage. Generally, it is easier to maintain light pressure on larger, flatter surfaces, while it is more difficult to maintain a light pressure on smaller, pointed surfaces.
Practice your light touch until you are comfortable with it.

Stroke

Because of the need for intense concentration and ultrasensitive control, the strokes are usually short: about 0.25-inch to 0.50-inch long. 

As a rule, the harder or tighter the tissues, the lighter and shorter the stroke.
When the tissue content gets liquefied and mobile, a longer stroke (about 0.75-inch to 1.0-inch long) works better. This light touch is often helpful in clearing the superficial tissues after the tissue pressures in the muscle envelopes have been reduced.

Positioning

It is possible to work on oneself in any position. These work best for me:

• Neck and front of shoulder-Lie on your back with both arms supported by pillows.
• Back of shoulder and upper arm-Lie on the side opposite the shoulder and arm you want to work on. Use the hand of the arm you are lying on to work on the other shoulder and upper arm.
• Elbow, forearm, wrist-Sit down with both arms supported by pillows.
  Forearm

Continue