The Ultimate Guide to Carpal Tunnel Syndrome Exercises

Disclaimer: please consult with your local medical doctor and/or physical therapist before attempting any of the exercises in this video. These exercises for general carpal tunnel syndrome and might not apply to your specific condition or need. There are also many different conditions that resemble carpal tunnel syndrome that may require very different treatment and/or exercises. Any injury and/or increased symptoms that might occur from you attempting these exercises are your own responsibility. In this video I have analyzed and categorized physical therapy exercises for carpal tunnel syndrome, after studying 17 different YouTube channels.

Here are the list of YouTube Channels I sampled: Bob & Brad, AskDoctorJo, Airrosti Rehab Centers, OrthoIndy Northwest, Cleveland Clinic, E3 Rehab, Tone and Tighten, Rehab Science, Rehab and Revive, SmashweRx, Goodful, Virtual Hand Care, ZHealthPerformance, Milton Chiropractic Clinic Cambridge, Sunit PhysioTHerapist, Rachel Richards Massage, and Body Fix Exercises. My favorite for massage is Bob & Brad Massage gun video and Rachel Richards video. My favorite for tendon glide is E3 Rehab video. My favorite for median nerve exercise is Virtual Hand Care video. The repetitions and frequency of each exercise vary from channel to channel. Almost no two channels have the same numbers. As a general rule, go by how you tolerate the exercise. Red, Green, and Yellow lights are a good rule here: if symptoms increase (red light) stop and rest for the day. If symptoms go down (green light) then keep going. If symptoms stay the same (yellow light) proceed with caution. To summarize all the exercises that these doctors, chiropractors, physical therapist, and even massage therapist have mentioned, I have a list here. There are generally six general categories of advice/exercise types that have been mentioned. There is posture/thoracic spine exercises, shoulder stretches, wrist/forearm stretches, massages/soft tissue work, tendon glides, and median nerve exercises. These exercise categories corresponds to the type of causes for your carpal tunnel symptoms. Posture/thoracic spine exercises and shoulder stretches are appropriate for patients whose median nerves are compressed at the level of the shoulder. The remaining four categories are appropriate for patients whose median nerves are compressed at the level of the wrist and hand. It’s quite easy to determine if your symptoms come from the shoulder. If you have increased symptoms when your move your shoulder, you should probably try the exercises from the first two categories. There are some patients who have impingements both at the shoulder and at the wrist/hand. For these patients they would benefit from exercises from all six categories. Category one: Posture/thoracic spine exercises Three of the 17 channels recommended posture or thoracic spine exercises: Bob & Brad, E3 Rehab, and SmashweRx. Bob & Brad recommended a type of seated thoracic extension using a chair. E3 Rehab recommends a vigorous series of thoracic spine mobilization exercises, and SmashweRx recommended snow angel exercise on the floor. Category two: Shoulder stretches Seven of the 17 recommended some form of shoulder exercise: Bob & Brad, Airrosti Rehab Centers, E3 Rehab, Rehab and Revive, SmashweRx, Virtual Hand Care, and Body Fix Exercise. Bob & Brad recommended pec stretches and first rib stretch. Airrosti Rehab recommended a composite stretch that stretches the wrist flexors, biceps, and the pecs. E3 Rehab’s Half-Kneeling Thoracic Windmill stretches both the thoracic spine and the shoulder. Rehab and Revive recommended shoulder clocks, which is more of a scapular mobility exercise. SmashweRx recommends the overhead triceps stretch, shoulder internal rotation stretch, and snow angel which can be considered a pec stretch as well. Virtual Hand Care recommends shoulder depression exercise, which is also a type of scapular exercise. Body Fix Exercise recommends the first rib stretch. Summary: both Bob & Brad and Body Fix Exercise recommended first rib stretch. Bob & Brad, Airrosti, E3, and SmashweRx all recommended at least one exercise that stretches the pecs. All the other stretches are pretty straightforward except the first rib stretch, so I’ll go into detail a little bit here. The First Rib Stretch: This is also called the first rib mobilization. The idea is that the upper trapezius, the levator scapulae, and the scalene muscles of the neck have so much tension that they are elevating the first rib without you telling them to. For most people, if you have a tight upper trapezius, there is a good chance you have elevated first rib as well. This puts pressure on the nerves and blood vessels in the shoulder area and could lead to impingement of the median nerve. It's a good idea to release the tension in the shoulder muscles first, so you can set up the exercise by warming up the muscles with a heating pad, let it sit for 15-20 minutes. After heating up the muscles, you can massage them. You can either massage them by hand or massage them using an electric neck massager. After massaging the muscles for about 5 minutes, you can start with upper trapezius and levator scapulae stretches. Next, do depress the first rib, you can do it one of two ways. The first way is demonstrated by both Bob & Brad and Body Fix, which is using a strap or a long towel. Put the strap over the first rib and pull the straps diagonally across your body with both hands. Apply slight pressure into the strap. Take a deep breath, and as you breathe out, try to relax the involved the shoulder. I know in the other videos they move the neck away from the shoulder but that is really a modified upper trapezius stretch that I already covered from stretching out the upper trapezius and levator earlier. Take deep breath again while maintaining the tension in the strap, and as you exhale, relax the involved shoulder. Repeat. The second way to do this is my preferred way. Instead of using a strap, I just use my uninvolved hand. I put four fingers together and apply pressure on the first rib. Then, I go through the same breathing process. Each time I exhale, I relax my involved shoulder and continue to put pressure on the first rib with my uninvolved hand. If this is too complicated, it is a good idea to go to a physical therapist and have the therapist go over this with you. Category three: Wrist/forearm stretches 8 out of 17 channels recommended wrist/forearm stretches: AskDoctorJo, Airrosti Rehab Centers, Cleveland Clinic, Tone and Tighten, Rehab and Revive, Goodful, ZHealthPerformance, and Sunit PhysioTherapist. 3 of these 8 channels recommended wrist radial and ulnar deviation stretches. My personal opinion on these two stretches is that while they do stretch some of the forearm tendons, it’s more effective to stretch the flexors and extensors. I personally never give my patients these two stretches for carpal tunnel syndrome. They aren’t bad but I wouldn’t prioritize these. The remaining 5 channels all recommend some form of wrist flexion/extension stretches, which release the tension in the forearm very effectively. If your symptoms are caused by muscular tension, this could solve the problem. However, if your symptoms are caused by scar tissue in the carpal tunnel or inflammation in the carpal tunnel, these stretches won’t be enough. Category four: massage/soft tissue work 6 of the 17 channels recommended some form of massage or soft tissue work: Bob & Brad, Airrosti Rehab Centers, Rehab and Revive, ZHealthPerformance, Sunit PhysioTherapist, and Rachel Richards Massage. 2 of these 6 (Airrosti and Sunit) recommended using a tennis or lacross ball to release tension in the wrist and forearm flexors. I would not recommend this because this puts direct pressure on the median nerve. Bob & Brad recommended using the massage gun to massage the proximal forearm and the lumbricals of the hand. Rehab and Revive recommended massaging the neck. ZHealthPerformance recommended mobilizing the skin of the forearm. My opinion on this skin mobilization is, while it’s not bad, it’s more effective to massage the muscles like the wrist flexors and the lumbricals. Rachel Richards Massage goes into detail on massaging the hand and the forearm so if you have the time you could check out her video. Category five: tendon glides 7 of 17 channels recommended tendon glides: OrthoIndy Northwest, E3 Rehab, Tone and Tighten, Rehab and Revive, Goodful, Virtual Hand Care, and Body Fix Exercise. My personal opinion for these exercises is: it could be painful if you have a lot of tension in your wrist flexors and lumbricals, because every tendon glide exercise contracts at least one type of finger flexors which go from the fingers to the hand, and the wrist and forearm. I generally save this exercise for patients who are rehabilitating from carpal tunnel release surgery. Category six: Median nerve exercises 10 of 17 channels recommended some form of median nerve exercise: Bob & Brad, OrthoIndy Northwest, E3 Rehab, Tone and Tighten, Rehab Science, SmashweRx, Virtual Hand Care, Milton Chiropractic Clinic Cambridge, Rachel Richards Massage, and Body Fix Exercises. This is the number one recommended exercise for carpal tunnel syndrome that is caused by scar tissue or thickening of the carpal ligament inside the carpal tunnel. The idea is that the median nerve has trouble sliding through the carpal tunnel due to the decreased space caused by scar tissue. To improve the symptoms, we try to stretch the nerves back and forth inside the carpal tunnel gently until it frees itself and moves easier. I’m going to group median nerve exercises into three group. The first subgroup is the most commonly demonstrated. 7 of the 10 use the same arm movement: Bob & Brad, E3, Tone and Tighten, Rehab Science, SmashweRx, Virtual Hand Care, and Body Fix Exercises. When it comes to head movement for this exercise, I want to point out that 3 of the 7 recommended head away and 4 of the 7 recommended head away. Head away: Bob & Brad, E3, Virtual Hand Care Head toward: Tone and Tighten, Rehab Science, SmashweRx, Body Fix Exercises The second group of median nerve exercises focus primarily on the wrist and fingers. The two channels that only recommend wrist and finger median nerve glides are OrthoIndy Northwest and Milton Chiro. E3 also recommended a wrist and thumb only exercise. These exercises are convenient for incorporating overpressure on the thumb because you don’t have your arm extended away from your body. The last group of median nerve exercises is variations that are so different from the first two groups that I don’t know where to put them. One is from Rachel Richards and another one from Rehab Science. The one from Rachel Richards included the abducting the shoulder and extending the elbow, as well extending the wrist and fingers, but did not supinate the wrist. Her head movement is also different in that instead of side bending her neck, she flexed and extended her neck. The other unique median nerve exercise is from Rehab science. It’s not quite like any of the others but still very interesting. The mechanics makes sense to me because you are still putting the median nerve on stretch by putting your arm in this position, so it seems like it would do something to help. Lastly I want to mention that if your wrist is acutely inflamed and swollen, which means it has burning pain and your palmar wrist is tender to the touch, any and every movement will hurt and you need to take appropriate measures to decrease that inflammation. You could take your prescribed anti-inflammatory medication. You could ice your wrist with an ice pack for a few minutes or do a 10 second ice massage with an ice cube. You could soak your wrist in warm Epsom salt bath. You could try contract bath therapy by alternating soaking in warm water with cold water. If one of these methods to decrease inflammation doesn’t work, try another one until you find something that works. Please note also that your doctor probably will prescribe you’re a wrist splint to immobilize your wrist. This is to prevent your median nerve from flaring up. You should wear it 24/7 BUT make sure to take it off every hour or so to move your hand/wrist and stretch. If you don’t take it off regularly to move your wrist joint you will lose range of motion and your blood flow to your hand will decrease, and it will slow your recovery because of decreased blood flow.