In carpal tunnel syndrome it is important to protect and relieve the structures, but not to keep them completely still. Movement is still important to keep the metabolism going, which is essential for wound healing, and also to keep the structures mobile and protect muscles from degradation. The body adapts to its needs very quickly – what is not needed is broken down.
Physiotherapy is used to avoid this and to support the structures in their wound healing. In the following, exercises from the areas of mobilization, stretching, strengthening, coordination and also muscle relaxation are presented. It is important in therapy and also in everyday life to never work into the pain – pain is a warning signal and should never be ignored.
Exercises
For the mobilization of the affected structures in carpal tunnel syndrome, various simple movements are suitable, which should be performed several times a day. As passive mobilization by the therapist, so-called PNF patterns can be performed. Here, three-dimensional movement patterns in different directions, adapted to the individual problem, are performed – first passively by the therapist, later actively by the patient and as a last step with set resistances, which simultaneously trains the affected muscle chains.
- At first, an attempt is made to bend and stretch the fingers one by one to the full extent of the possible movement.
- Then these movements are performed by all fingers simultaneously – the closing and opening of the fist is trained.
- This exercise can finally be performed with a flexion and extension of the wrist: when closing the finger, the closed hand bends inwards, when opening the finger, the wrist stretches. These movements are practiced several times as a flowing sequence.
In carpal tunnel syndrome, it is important to stretch the affected structures to keep them mobile and protect them from shortening. Muscle tension is also released and can thus contribute to pain relief.
These exercises are also easy for the patient to perform themselves and should be performed daily. Place the palms of your hands together at chest height so that the fingertips are facing the ceiling. The elbows are at shoulder height during the exercise.
From this position, now bring the hands together downwards, the elbows do not move. If you feel a stretch, hold it for 15 seconds and then return to the starting position. 3 passes.
You will find more exercises in the article Exercises for tendinitis.
- First, sit in an upright position. Both arms are stretched out forward.
The affected arm now turns the palm towards the ceiling, the fingertips pointing to the floor. In this position, the other hand is placed on the palm of the affected hand and gives slight pressure towards the body until a – not painful – feeling of stretching occurs on the flexed side of the forearm. Stretching positions are held for at least 30 seconds to achieve an effect in the muscle.
- For another exercise, the four-footed position is taken.
Both arms turn outwards until the fingertips point towards the knees. Now the buttocks are pushed backwards, the hands remain on the floor, so that the arms are stretched further until a feeling of stretch is felt on the inside of the forearms.
- Place your palms together at chest height with your fingertips facing the ceiling. The elbows are at shoulder height during the exercise.
From this position, now bring the hands together downwards, the elbows do not move. If you feel a stretch, hold it for 15 seconds and then return to the starting position. 3 passes.
As mentioned above, PNF patterns can be used to strengthen the muscles in carpal tunnel syndrome.
As a self-exercise, the patient can perform various grasping exercises.
- First, a fist is formed, pressed firmly together, held for a few seconds and released again. A small soft ball can also be used for this, which is pressed together in the fist.
Also a piece of plasticine is suitable, which is worked with one hand in the hand.
- To train not only the hand muscles, but also the flexors and extensors of the forearm, the forearm is placed on one end of the table so that the hand overhangs at the end. An initially light weight is held in the hand. Now the hand with the forearm resting on it is slowly brought into flexion and extension (lowered and raised) so that only one movement takes place in the wrist.
If the back of the hand points to the ceiling, the extensors are trained, if the palm points to the ceiling, the flexors are trained. As healing progresses and the pain decreases, the weight can be increased.
Exercising fine motor skills and coordination are also important elements during regeneration from carpal tunnel syndrome in order to regain unrestricted functionality in everyday life.
- A simple exercise can be performed in which the thumb briefly taps each finger of the same hand.
Tasks for the fine motor skills are, for example, the grasping of small objects, which can be practiced playfully with a plug game.
In order to release tensions, classical massage techniques can be used. With slow longitudinal and transverse kneading and strokes, the muscles of the forearm and the carpus can be worked. Always work towards the body in order to stimulate the metabolism and thus the healing process and to direct the outflow in the right direction. Fascial techniques, deep strokes along the muscle chains, performed with the thumb, are also a more intensive method.
