Yoga for Carpal Tunnel Syndrome

January 1999; Volume 2: 11-12

Source: Garfinkel MS, et al. Yoga-based intervention for carpal tunnel syndrome: A randomized clinical trial. JAMA 1998; 280:1601-1603.

To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome, we randomized 42 employed or retired individuals with carpal tunnel syndrome (median age 52 years) to either current treatment, including a wrist splint, or a twice weekly yoga-based intervention. The intervention consisted of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation, and lasted 1-1.5 hours weekly.

Subjects in the yoga groups had significant improvement in grip strength (increased from 162 mm to 187 mm Hg; P = 0.009) and pain reduction (decreased from 5.0 mm to 2.9 mm; P = 0.02), but changes in grip strength and pain were not significant for controls. The yoga group had significantly more improvement in Phalen’s sign (12 improved vs. 2 in control group; P = 0.008), but no significant differences were found in sleep disturbance, Tinel’s sign, and median nerve motor and sensory conduction time.

We conclude that a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.

Comment

A major cause of lost work days and wages, carpal tunnel syndrome is hard to treat. Many patients are reluctant to undergo surgery; many insurers are reluctant to pay for operations unless splints have been worn and nerve conduction velocities have slowed markedly.

In an industrial site and a geriatric clinic, these Penn investigators asked all enrolled subjects not to change medicines or job responsibilities during the study. Inclusion criteria included delayed median nerve conduction latencies; exclusion criteria included systemic disease as an etiology.

The investigators used "the Ijengar approach to hatha yoga, which emphasizes proper structural alignment of the body." The 11 postures are held for 30 seconds each and then repeated.

The postures are sitting with extension of the trunk; hands in prayer position, arms extended overhead; arms extended overhead with fingers interlocked; arms interlocked in front of the body; chair twists; standing, mountain pose; 90-degree forward bend to wall; arms extended overhead with palms together in prayer position; dog pose with chair; hands joined in prayer position behind the back; relaxation.

Why might carpal tunnel respond to yoga? These investigators postulate "...stretching may relieve compression in the carpal tunnel, better joint posture may decrease intermittent compression, and blood flow may be improved to decrease ischemic effects on the median nerve."

Methodological problems are evident in this preliminary communication. Though 42 of the 51 randomized subjects finished the trial, for example, the data are too few to analyze in detail. The subjects’ analgesic regimen was neither studied nor optimized. There was no assessment of adherence with yoga or with the splint; there was no follow up; there were no reasons given for dropouts.

There were also no complications reported. This type of yoga, believed to improve strength, coordination, and flexibility, has little, if any, morbidity.

Recommendation

Yoga may improve the pain of carpal tunnel syndrome, with almost no risk. Consider it for patients who reject splints, who have trouble with non-steroidals, or who want to delay surgery and will practice conscientiously.