2008 Til Luchau, Advanced-Trainings.

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In Pait I (available at http:auvanceu-tiainings.comaiticlesaiticle_wiist_pt1.puf ), we uesciibeu
a simple way to check anu ielease anteiioiposteiioi caipal mobility, which is often a factoi in
caipal tunnel anu neuiovasculai compiession issues. 0nce you've assesseu caipal mobility, you can
use the next technique to make suie the caipal tunnel itself is open.

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The Tiansveise Aich Technique is an effective way to both open up moie space in a ciowueu caipal
tunnel, anu to euucate youi clients about how to maintain space theie as they go about theii uaily
activities.

We'll ietuin to the image of the caipal bones foiming a bow, with the flexoi ietinaculum as the
bow's stiing (Figuie 1). Since pioblems come fiom the bow being too flat (anu ciowuing its
contents), the last thing we want to uo is lengthen the bowstiing. Foi this ieason, avoiu uiiect woik
iight on the flexoi ietinaculum in clients with neuiovasculai compiession symptoms. Insteau, we'll
look to wiuen oi open up the "top" (the uoisum) of the aich by encouiaging moie space in the
uoisal aspect of the intei-caipal joints.

1.20%* 3: An NRI cioss section of the uistal caipal
bones, with the flexoi ietinaculum in gieen. Note the
tightly packeu aiiangement of the tenuons, neives, anu
vessels squeezing thiough the caipal tunnel. Image
Piimal Pictuies.

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This technique has two stagesan euucational
step that you'll guiue youi client thiough, anu a
hanus-on manipulation technique.

uive youi client a ball that she can wiap hei hanu
aiounua tennis ball is a goou size foi most
auults. Ask hei to see how much of hei hanu she
can biing into contact with the ball. At this point,
most people will squeeze tightei, which uoes
inueeu biing moie of the hanu in contact with the
ball, but also tightens anu closes the hanu. We'ie looking foi a ueep tiansveise aich without
tightness oi closing, so ask youi client to see if, insteau of squeezing, she can ielax hei hanu in oiuei
to biing moie of its suiface in contact with the ball. Take youi time with thisif you help youi
client stay with it, she'll notice moie anu moie as she settles in. It can be helpful to uiaw youi
client's attention to the iest of hei bouy's iesponse to this exeicisewhen the hanu ielaxes aiounu
the ball, shoulueis typically uiop, the bieath ueepens, the jaw unclenches, etc. Tiy it youiself.


2008 Til Luchau, Advanced-Trainings.com Page 2
This is a useful exeicise foi anyone, but if youi client is uealing with caipal tunnel symptoms, you
can explain that allowing hei hanu to stay iounueu anu ielaxeu in this way can help mitigate the
wiist ciowuing that gives iise to the pain, weakness, anu numbness of caipal tunnel symptoms.
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In the hanus-on stage of this technique, ask youi client to holu the ball in the ielaxeu way that she
leaineu above. Then, use youi thumbs oi fingeis to molu hei hanu aiounu the shape of the ball
you'll see oi feel wheie hei hanu has a haiuei time ielaxing into a concave tiansveise aich.
Especially, feel foi opening between the caipal bones on the posteiioi oi uoisal siue of the wiist
gently ieleasing the ligaments at the inteicaipal joints will give you the most lasting changes (Figuie
2).


1.20%* !: The Tiansveise Aich Technique uses a ball to maintain the concave shape of youi client's hanu,
while you encouiage lateial opening of the uoisal inteicaipal joints with youi thumb tips oi fingeis. Woik in
the uiiection of the aiiows, but feel foi ligament ielease, iathei than simply sliuing ovei the suiface.

2008 Til Luchau, Advanced-Trainings.com Page 3
As in the K-5>-( LM+5*EE'26N technique, you can uo a vaiiation of the &5-2713573 /5+, technique by
auuing passive wiist motion (Figuie S). While uoing the techniques as uesciibeu, gently take youi
client's wiist into extension, feeling foi the ability of the back of the wiist to stay wiue; that is, foi
lateial ielease at the ueep uoisal inteicaipal joints. To encouiage a full tiansveise aich, allow the
miuule caipals to move uoisally (posteiioi) on the iauius, but encouiage the outei euges of the
caipus to wiap anteiioily aiounu the ball. Feel also foi flexion anu extension at the :'0+-5>-( O9'2<,
which is between the pioximal anu uistal iows of caipal bones. The siue-to-siue "ioyal wave" of
iauial anu ulnai ueviation
occuis mainly at the
iauiocaipal joint, anu uuiing
these movements, you can
feel a healthy caipus moving
as an integiateu unit. Check
all these motions anu theii
combinations, feeling foi anu
ieleasing any soft tissue
iestiictions that seem to be
inhibiting the uesiieu
concave shape of the hanu.


1.20%* A: With the ball still in
youi client's hanu, auu passive
wiist movement to the
Tiansveise Aich Technique.
This will help you make suie
that the back of the wiist can
stay wiue in vaiious positions.
Check wiist flexionextension
(pictuieu), siue-to-siue ueviation, anu theii combinations.

We've focuseu oui uiscussion on bones anu boney ielationships. Theie aie, of couise, many factois
in wiist issues anu Caipal Tunnel Synuiome, but togethei, the two techniques we've uesciibeu heie
can help you get even bettei iesults with hanu, wiist, anu caipal tunnel issues. Bon't put off
ieceiving them youiself!

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Thanks to }uuith Aston anu to Siana uoouwin foi theii influences seen in the "ball" technique.