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Graston therapy same as regular massage for carpal tunnel syndrome

PainSci » bibliography » Burke et al 2007
Tags: massage, spinal adjustment, chiropractic, carpal tunnel, manual therapy, treatment, spine, controversy, debunkery, overuse injury, injury, pain problems, hand & wrist, arm, limbs

One article on PainSci cites Burke 2007: Tissue Provocation Therapies in Musculoskeletal Medicine

PainSci notes on Burke 2007:

This small, amateurish trial compared instrument-assisted massage (Graston technique or ASTYM) to regular massage for carpal tunnel syndrome. It found no difference between the two techniques, a surprisingly negative result from a trial with a high risk of bias in favour of Graston. In other words, they couldn’t find evidence supporting tool-assisted massage even though they were almost certainly hoping to find it.

The conclusion spins the results as good news for “manual therapy,” at least — but, without a control group, they have no business drawing that conclusion.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft tissue mobilization (GISTM) and STM administered with the clinician hands.

METHODS: The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit. Eligible patients with CTS were randomly allocated to receive either GISTM or STM. Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks. Outcome measures included (1) sensory and motor nerve conduction evaluations of the median nerve; (2) subjective pain evaluations of the hand using visual analog scales and Katz hand diagrams; (3) self-reported ratings of symptom severity and functional status; and (4) clinical assessments of sensory and motor functions of the hand via physical examination procedures. Parametric and nonparametric statistics compared treated CTS hand and control hand and between the treatment interventions, across time (baseline, immediate post, and at 3 months' follow-up).

RESULTS: After both manual therapy interventions, there were improvements to nerve conduction latencies, wrist strength, and wrist motion. The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions. Data from the control hand did not change across measurement time points.

CONCLUSIONS: Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.

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