During massage sessions, nerve pain and muscle pain are addressed using different techniques, since each has its own complexities and underlying causes. Massage and bodywork therapy can be highly effective in freeing impinged nerve structures and relieving nerve pain, but understanding the neuroanatomy, pathophysiology, and proper assessment of nerve injuries is critical to ensure nerve conditions are treated safely and effectively without causing further irritation.
Here are three common nerve impingements I see the most as a massage therapist.
Tarsal Tunnel Syndrome
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Tarsal Tunnel Syndrome (TTS) occurs when the tibial nerve becomes compressed, typically along the inside of the ankle. It’s often caused by improper footwear, poor foot posture, or repetitive stress while walking or standing. There are nerves that branch out along and throughout the bottom of your foot, and TTS symptoms can sometimes mimic those of Plantar Fasciitis. When the two are mistaken, treatments aimed at Plantar Fasciitis might bring temporary relief, but they won’t address the true source of the pain.
To effectively treat TTS, your massage therapist should focus on the muscles in the back of the leg, particularly the gastrocnemius (calf muscle) and the deeper tibialis posterior. Treatment should also include correcting improper foot mechanics and movement patterns to prevent the nerve from becoming compressed again.
Thoracic Outlet Syndrome
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Thoracic Outlet Syndrome (TOS) symptoms can arise when certain structures compress the brachial plexus, the nerve bundle that runs from the neck down the arm. These compressions most often occur near the anterior scalenes in the neck, the pectoralis minor, or within the cervical rib/thoracic outlet area. Working with a massage therapist who understands exactly where that compression is coming from can make a world of difference, which leads to more effective treatment outcomes and lasting relief.
It’s not just about identifying where the compression is, but also understanding why it’s happening. This means looking at muscular imbalances and how they affect posture and movement. For example, the pectoralis minor attaches to the coracoid process on the shoulder blade. If this muscle is causing nerve compression, it may be because the muscles that stabilize the shoulder blade from the back are weak, allowing the pec minor to pull it forward. Another common cause is tightness in the scalene muscles, which can pull on their attachment at the first rib, leading to restriction or bracing in the neck and contributing to the imbalance.
Carpal Tunnel Syndrome
Image Credit: Sunway Medical Center
Carpal Tunnel Syndrome (CTS) affects many people, especially those who spend long hours working at a computer or doing repetitive, hands-on tasks. Symptoms like pain, numbness, and tingling in the wrist and hand often result from overuse or excessive wrist flexion and extension that irritate the median nerve. However, other factors, such as diabetes, arthritis, or nerve compression higher up the arm can also contribute. In some cases, the actual carpal tunnel (the passage the median nerve travels through) is actually too small, leading to nerve irritation and those familiar symptoms.
Having a massage therapist skilled in proper assessment is essential — both to identify whether the nerve compression can be effectively treated through massage or to determine if a referral to another healthcare professional is needed for further evaluation.