What exercises are recommended for managing carpal tunnel syndrome?

Recommended Exercises for Carpal Tunnel Syndrome

Specific nerve gliding exercises and wrist splinting should be the primary non-surgical approach for managing carpal tunnel syndrome, with exercises focused on improving hand mobility and reducing median nerve compression.

Evidence-Based Exercise Recommendations

Nerve Gliding Exercises

• Median Nerve Gliding: Extend wrist with fingers and thumb relaxed, then gently bend wrist down while keeping fingers straight
• Tendon Gliding: Progress through five positions - straight fingers, hook fist, full fist, tabletop, and straight fist
• Perform 5-10 repetitions of each exercise, 3-5 times daily

Wrist and Hand Strengthening

• Grip strengthening: Using a soft stress ball or therapy putty, squeeze and release 10-15 times
• Pinch grip exercises: Hold small objects between thumb and each finger for 5-10 seconds
• Wrist flexion and extension: With forearm supported, gently move wrist up and down with light resistance

Implementation Protocol

Daily Regimen

1. Morning routine: 5 minutes of nerve gliding exercises
2. Work breaks: Every 1-2 hours, perform 2-3 minutes of exercises
3. Evening routine: 5-10 minutes of strengthening exercises
4. Night-time: Wear neutral wrist splint while sleeping 1

Complementary Approaches

• Proper ergonomics: Maintain neutral wrist position during computer work
• Joint protection: Avoid positions that place excessive pressure on the wrist 2
• Rest breaks: Take frequent short breaks from repetitive activities

Evidence Quality and Effectiveness

The evidence supporting exercise interventions for carpal tunnel syndrome shows modest but meaningful benefits. A randomized trial found that yoga-based interventions significantly improved grip strength and reduced pain compared to controls 3. Participants performing the exercises had significant improvement in Phalen's sign (a key diagnostic indicator of carpal tunnel syndrome).

A more recent study (2024) demonstrated that office workers who performed regular preventive exercises showed significant improvements in hand grip strength and pinch grip strength 4. This suggests that consistent exercise can improve functional outcomes even in workplace settings where carpal tunnel syndrome is common.

Important Considerations and Pitfalls

• Avoid overexertion: Exercises should not cause increased pain or numbness
• Consistency matters: Regular performance of exercises (daily) yields better results than sporadic intense sessions
• Combine with splinting: Night-only splinting is as effective as continuous wear and should be used alongside exercises 1
• Severe symptoms require medical attention: Patients with objective weakness or sensory deficits should be referred for surgical evaluation 1
• Avoid aggressive stretching: Do not push joints to end ranges as this can worsen symptoms 5

When to Consider Additional Interventions

If symptoms do not improve after 4-6 weeks of consistent exercise and splinting, consider:

1. Corticosteroid injections (provide greater short-term relief than splinting alone)
2. Referral for electrodiagnostic testing to confirm diagnosis
3. Surgical consultation for persistent or worsening symptoms

The combination of specific exercises, proper ergonomics, and night splinting represents the most evidence-based non-surgical approach to managing carpal tunnel syndrome, with demonstrated benefits for grip strength, pain reduction, and functional improvement.