Thursday, March 9, 2017

Study: Manual Physical Therapy Works Sometimes Better Than Surgery for Carpal Tunnel Syndrome

Authors of a new study on carpal tunnel syndrome (CTS) say that when you toss out the splints, steroid injections, lasers, and other treatments often lumped in with physical therapy as part of a "conservative" approach and focus solely on a debate about surgery vs specific multimodal physical therapy, physical therapy makes a compelling case for itself. 
How compelling? Researchers found similar improvement in self-reported function and CTS symptom severity for both surgical and physical therapy patients after 1 year, but the physical therapy group reported more significant gains in the first month. That speedier gain early on is worth noting, researchers believe, because it allows these patients to return to work and other activities sooner than their peers who underwent surgery. Results were published by Fernández-de-Las-Peñas C et al. in the Journal of Orthopaedic and Sports Physical Therapy.
The specific techniques included:
  • Soft Tissue Mobilization of the pectoralis, biceps muscles
  • Dynamic Stretching Stroke the wrist Ligaments
  • Mobilization of the small finger muscles found between the hand bones (Metacarpals)
  • Joint and soft tissue mobilization to the neck
  • Mobilization of the Upper ribs and collarbone

Patients in the physical therapy group also received cervical spine exercises for stretching neck muscles, which they were encouraged to perform at home during the follow-up period as needed. The physical therapy group showed average 1-month gains that exceed those of the surgery group. When reassessed at 6 and 12 months, however, both groups posted similar scores on both assessments.
Better short-term outcomes were found with manual therapy, patients may be able to return earlier to their activities of daily living and work when they receive manual therapy, compared to those who undergo surgery.
While earlier studies tended to give surgery the edge over conservative treatments, those "conservative" approaches usually lumped in physical therapy with a host of ineffective treatments including splints, steroid injections, lasers, and transcutaneous electrical nerve stimulation. Authors of the current study say theirs is the first to make a clean comparison between surgery and well-defined multimodal manual therapy.

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