Carpal Tunnel Syndrome: How physiotherapy can help relieve pain

Carpal tunnel syndrome is one of the most common compressive neuropathies of the upper limb and can have a significant impact on quality of life. It is characterised by compression of the median nerve at the wrist, causing pain, tingling, numbness and, in more advanced stages, reduced strength in the hand.

According to the most recent international clinical guidelines, physiotherapy is considered a first-line approach in mild to moderate cases, and is a safe, effective intervention supported by the best available scientific evidence.

What is carpal tunnel syndrome?

The carpal tunnel is an anatomical structure located in the wrist, formed by the carpal bones and the transverse carpal ligament. The flexor tendons of the fingers and the median nerve pass through it.

When there is an increase in pressure in this space - due to inflammation, fluid retention or structural changes - the median nerve can become compressed, causing the symptoms characteristic of this condition.

Risk factors

There are several factors that can increase the likelihood of developing carpal tunnel syndrome:

• Repetitive hand and wrist movements, especially in flexion or extension positions
• Heavy manual labour or prolonged computer use
• Pregnancy and menopause (due to hormonal changes and fluid retention)
• Metabolic diseases, such as diabetes or thyroid disorders
• Rheumatoid arthritis and other inflammatory diseases
• History of wrist trauma or fracture
• Female
• Aged between 40 and 60

Identifying and managing these factors is essential to prevent symptoms from worsening.

Most common symptoms

Symptoms tend to set in gradually and can include:

• Numbness or tingling in the thumb, index finger, middle finger and half of the ring finger
• Sensation of “spikes” or electric shocks
• Pain in the wrist or hand, often more intense at night
• Weakness or difficulty holding objects
• Frequent dropping of objects

In more advanced stages, there may be a decrease in muscle mass at the base of the thumb.

Physiotherapy for carpal tunnel syndrome

Current scientific evidence shows that physiotherapy can:

• Reduce pain and paresthesia
• Improve manual function
• Reduce compression of the median nerve
• Prevent progression of the condition
• Reduce the need for surgery in many cases

The interventions with the most scientific support include:

Median nerve sliding exercises

They promote nerve mobility and reduce the sensitivity of the nerve to compression.

Manual therapy

Specific techniques can improve the mobility of the surrounding tissues and help reduce pressure in the carpal tunnel.

Orthosis in neutral position

The use of a night orthosis with the wrist in a neutral position is one of the strategies with the best evidence for controlling nocturnal symptoms.

Progressive strengthening programme

It includes specific exercises for the wrist and hand, promoting functional recovery and preventing relapses.

Education and ergonomics

Modifying risk factors is one of the pillars of treatment. Ergonomic adjustments in the workplace, postural correction and proper load management are key to preventing recurrences.

Benefits of physiotherapy

Reduced pain and tingling

It reduces irritation of the median nerve and improves symptoms, especially at night.

Improved hand function

It recovers dexterity, coordination and strength, promoting greater autonomy in everyday and professional activities.

Prevention of the progression of the condition

Early intervention can prevent symptoms from worsening and reduce the likelihood of surgery.

Recovery of mobility and strength

Structured programmes help prevent long-term functional limitations.

Post-operative support

After surgery, physiotherapy is essential for edema control, progressive mobilisation, recovery of strength and scar treatment.

When should I see a health professional?

If you experience tingling, numbness or persistent pain in your wrist, especially at night, it is advisable to seek an assessment by a healthcare professional. The earlier the intervention, the greater the likelihood of effectively controlling the condition and preventing its progression.

Carpal tunnel syndrome is a common but treatable condition. An early, evidence-based approach can help reduce symptoms, improve hand function and prevent long-term complications.

Physiotherapy plays an important role in the management of this condition, both in mild to moderate cases and in recovery after surgery, promoting functional recovery and a better quality of life.

At Integrativa, we try to approach these situations in an individualised way, through careful clinical assessment and interventions based on scientific evidence, adapted to each person's needs.