Carpal tunnel syndrome is the most common condition suffered by women during pregnancy. In fact, it is nine times more prevalent in pregnant woman compared with the general population.
But why is it so common? It all comes down to swelling. Pregnant women have a tendency to retain more fluid. This leads to generalised swelling across the body, meaning less space in the carpal tunnel, which then compresses the nerves in the forearm and hand. The result is numbness, tingling, and pain in the hands.
[An important note: Not all swelling in the hands is normal during pregnancy! If you have a sudden increase in hand and feet swelling, it’s important to check in with your midwife or obstetrician ASAP, as this can be an early sign of pre-eclampsia.]
Carpal tunnel syndrome usually starts in the 3rd trimester and 85% of cases resolve within 2-4 weeks after the baby is born. Management during this time often involves soaking the hands in cold water before bed and wearing a soft splint overnight.
But what happens when it doesn’t resolve? Let’s explore an interesting example of this by looking at Ms X’s case.
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When Carpal Tunnel Syndrome Doesn’t Go Away
Ms X presented to our clinic with carpal tunnel syndrome affecting her right and left hand. It had started several months ago during her 2nd trimester. She had been told by her doctor at the time that it was related to her pregnancy and would resolve after her baby was born. Unfortunately for her, her baby was now two months old and the problem had not gone away – in fact, it was getting worse.
What did we find?
When I saw her, her symptoms were constant numbness, stiffness, and pain in both hands, especially on her right side. In addition to waking up to feed her newborn, she was waking up 1-2 times a night due to pain and numbness. Fine movements like doing up buttons and changing the nappy were difficult. Pushing the pram with her newborn for a walk made things even worse. As you can imagine, experiencing this painful condition on top of adjusting to life with a newborn was a lot to handle!
I assessed Ms X and found:
- Significant nerve tension in both arms
- Rounded shoulder posture
- Muscle tightness and joint stiffness across both shoulders
- Weakness in hands and arms, especially with gripping
- Overall weakness in her core muscles
Returning to full pain-free function
Ms X’s improvements were slow in the beginning. With disrupted sleep, having to constantly pick up her baby, and breastfeeding, getting the rest required for her carpal tunnel to settle was an uphill battle. But little by little, changes started happening!
The tingling gradually reduced – there was less spread, less intensity, and finally, less frequency. The left resolved first, then the right. We’re now at the point where the pain is much less severe and only occurring at night (usually when the baby sleeps on her right arm). She feels stronger overall and able to do many of her daily tasks without the weakness and pain that limited her before.
So what did we focus on to get this result?
First of all, most of the problem was coming from excessive tension around the neck and shoulders further upstream from where she was feeling her pain. This impacted the nerve pathways and led to the symptoms in the wrists and hands. We released this region in our sessions together as part of a whole body approach, which helped improve her flexibility and grip strength week by week.
Next, we made corrections to Ms X’s posture. Keeping her wrists in a neutral position while breastfeeding and carrying her baby were paramount. We also adjusted her posture while pushing the pram – keeping the pram closer to her body, lower the handle height, and squeezing her shoulder blades together helped support her hands and protect her nerves while walking.
We encouraged the use of ice and anti-inflammatory gel nightly over her forearms to reduce swelling and inflammation.
Lastly, the key thing that helped Ms X improve was a gentle program of strengthening her shoulder and core stabilising muscles. We started off with gentle holds and gradually progressed to resistance bands. This proved to be one of the most significant factors to her condition – the stronger she became, the less symptoms she had.
Why Was Strength So Important in Ms X’s Case?
Unfortunately, the advice she had been given regarding strengthening exercise during pregnancy had been unclear. Was it safe? What were the dos/don’ts? Without clear guidelines, she decided it was best to err on the side of caution and pause exercise until after the birth.
This is not an uncommon story, as many pregnant women receive conflicting or even no advice at all about exercise. Unfortunately, this meant she was much weaker following the birth of her child and the initial carpal tunnel problem was able to linger and become a chronic issue.
What Can We Learn From Ms X’s case?
If you experience any pain or problems during pregnancy, it is important to get a full assessment as soon as you can. There’s no reason you should suffer with persistent pain and discomfort during this special time in your life! A Women’s Health physio can help assess the factors contributing to your painful condition, fix them, and guide you in ways to stay well during your pregnancy.
Lastly, aerobic and strengthening exercise is encouraged in uncomplicated pregnancies! If you are pregnant and you’re not sure about what’s safe for you, arrange an appointment today to see our Women’s Health physio. Nicole can help demystify the dos/don’ts, treat areas contributing to your pain, and tailor your exercise to your specific needs. This will help you stay mobile, pain-free, and enjoy your pregnancy journey!