Nutritional Therapy To Reduce Pressure
Nutritional approaches to CTS are based on reducing pressure in the carpal tunnel and relieving pain.
Vitamin B6. Although more studies are needed, evidence suggests that vitamin B6 has a place in treatment of CTS and should be considered as a nutritional therapy (Aufiero 2004)
If CTS is severe, nutritional therapies are unlikely to reverse it. However, while surgery will take pressure off the nerve, it does not correct for nutritional deficiencies. Likewise, steroid injections will not correct vitamin B deficiencies.
Vitamin B6, given in conjunction with vitamins B1 and B12, has a pain-killing effect that is due to inhibition of the body's natural pain conduction system. Studies have shown that vitamin B6 is effective in relieving the pain associated with CTS, and there is evidence that B6 deficiency may cause CTS (Jurna 1998; Holm 2003). One study, which noted the controversy surrounding the use of NSAIDs and nighttime splints, recommended that 200 mg vitamin B6 daily be included in treatments for CTS (Holm 2003).
Vitamin B6, however, should be used with caution since high doses over the long term can cause damage to the central nervous system or neuropathy (damage to peripheral nerves).
There is evidence that vitamin B6 will not work properly except in combination with adequate amounts of other B vitamins. In one individual, vitamin B2 use for five months caused “nearly complete disappearance” of CTS (Folkers 1984).
Enzymes. Serrapeptase (or serratiopeptidase), a proteolytic enzyme, shows promise in the treatment of CTS. This proteolytic enzyme, which digests protein, is produced by bacteria in the gut of silkworms and digests their cocoons. When this enzyme is isolated and coated in the form of a tablet, it has been shown to reduce swelling (Esch 1989). Significant improvement in electrophysiological parameters was reported in patients with CTS who received serratiopeptidase daily for six weeks (Panagariya 1999).
Nutrition to Relieve Inflammation
Although people with CTS do not have elevated markers of systemic inflammation, there is no doubt that localized inflammation in the wrist contributes to their condition. Thus, any nutrient that reduces inflammation might be able to help relieve the symptoms of CTS. Unfortunately, however, few natural anti-inflammatories have been studied in the context of CTS. Most research has been directed toward surgery or pharmaceuticals rather than nutritional approaches. Nevertheless, the following nutrients have been shown to reduce inflammation in other diseases:
- Fish oil. Fish oil is rich in omega-3 fatty acids. These fats have shown anti-inflammatory effects in a number of diseases, including cancer, atherosclerosis, and autoimmune disorders (Babcock 2005). Fish oil works by down-regulating the levels of pro-inflammatory cytokines, which are shown to be elevated in people with CTS (Nielsen 2005). Among people with arthritis, which is also characterized by localized inflammation, fish oil, in conjunction with vitamins A, C, E and selenium, can reduce inflammation and provide an important defense against the oxidative stress that occurs in inflamed joints (Miggiano 2005). Oxidant stress within the joints has also been implicated in CTS (Sud 2005).
- Curcumin. A component of the spice turmeric, curcumin has well-known anti-inflammatory properties. A review of 300 scientific papers on curcumin found that it can inhibit pro-inflammatory cytokines and that significant curative effects have been observed in experimental animal models of a number of diseases, including atherosclerosis, cancer, diabetes, intestinal diseases, and many others (Bengmark 2006).
- Ginger. The anti-inflammatory properties of ginger have been known for centuries, and studies have shown clearly that ginger extracts can reduce inflammatory cytokines (Zhou 2005; Grzanna 2005). Specifically, ginger has been shown to reduce the inflammation associated with joint disorders such as arthritis (Phan 2005; Frondoza 2004).
A wealth of clinical data confirms that lifestyle changes can help ease the suffering of those afflicted with CTS. However, there is no single “magic potion” or change that will work for everyone. People with CTS should consider the suggestions below to determine what works for them.
- When sleeping, cock the wrists upward instead of bending them downward to minimize pressure in the carpal tunnel. A splint will help maintain this position.
- At home or work, minimize repetitive hand movements when possible.
- Alternate between activities or tasks to reduce the strain on the body.
- When using the wrists, keep them straight and let the arms and shoulders share the stress.
- Use the whole hand or both hands to pick up an item.
- Avoid holding an object the same way for a long time.
- Adjust your desk, chair, and keyboard so you are in the best possible position: back straight, feet flat on the floor or resting on a footrest, knees level with or slightly lower than your hips, shoulders in a neutral position (neither forward nor back), elbows bent at a 90-degree angle, forearms parallel to the floor, and wrists straight.
- Take breaks at least once an hour to rest, shake your hands, massage the palms and backs of your hands, and do a few stretches and loosening movements of the shoulders and arms before settling back to work.
- Keep hands warm, with gloves if necessary.
- Get regular aerobic exercise such as walking or swimming.
- Cut down on caffeine and smoking, which may reduce blood flow to your hands. Nerve tissue is the most sensitive to reduced blood flow.
- If your work requires using tools, avoid holding an object or tool the same way for a long time.
- Minimize time using vibrating tools. If that is not possible, stop frequently and follow the warm-up program below.
According to a report published by the American Academy of Orthopaedic Surgeons, a simple warm-up routine such as the following may greatly reduce the incidence of CTS.
- Hold your hands in front of you as if pushing on a wall. Count to five.
- Relax your wrists and fingers.
- Make tight fists with both hands.
- Bend both fists downward. Count to five.
- Repeat each step 10 times.
- Then shake arms loosely while they are hanging at your sides.