What are the recommended physiotherapy (physical therapy) exercises for carpal tunnel syndrome?

Recommended Physiotherapy Exercises for Carpal Tunnel Syndrome

Therapeutic exercises including stretching, active exercises, massages, and manual lymph drainage are strongly recommended for carpal tunnel syndrome as they improve functionality, reduce pain in hands and wrists, and increase range of motion. 1

Nerve Gliding Exercises

• Nerve sliding techniques are the most effective exercise for carpal tunnel syndrome, producing 30% larger nerve excursion (12.4mm) while minimizing potentially harmful nerve strain 2
• These exercises involve simultaneous movement of neighboring joints - as one joint increases nerve bed length (e.g., wrist extension), another joint decreases it (e.g., elbow flexion) 2
• Performing the exercises with the wrist extended to 30° significantly increases median nerve excursion in CTS patients, making this position particularly beneficial 3

Hand Strengthening Exercises

• Regular hand strengthening exercises significantly improve hand grip strength, particularly in the dominant hand 4
• Pinch grip exercises show significant improvement in both hands when performed regularly 4
• A consistent 8-week daily exercise program demonstrates measurable improvements in hand strength parameters 4

Comprehensive Exercise Protocol

• A complete protocol should include:
  • Median nerve mobilization exercises to improve nerve gliding 5
  • Carpal bone mobilization techniques to address joint restrictions 5
  • Stretching exercises for wrist flexors and extensors 1
  • Active range of motion exercises for the wrist and fingers 6
  • Manual lymph drainage techniques to reduce swelling 1

Implementation Guidelines

• Exercises should be performed daily for optimal results 4
• An 8-week minimum program duration is recommended for measurable strength improvements 4
• Benefits may diminish during follow-up periods (up to 12 months), emphasizing the need for continuous and regular supervised physical therapy 1
• Biofeedback techniques can be incorporated to improve exercise performance 1

Important Considerations

• Avoid exercises that cause pain or symptom exacerbation 2
• Exercises that elongate the nerve bedding substantially may induce potentially harmful strain in the median nerve 2
• For optimal outcomes, physical therapy should be supervised initially to ensure proper technique 1
• Patients should be educated on proper ergonomics and activity modifications to complement exercise interventions 6

Exercise Progression

• Begin with gentle nerve gliding exercises in neutral wrist position 3
• Progress to performing exercises with 30° wrist extension as tolerated 3
• Gradually increase repetitions and duration as symptoms improve 6
• Add strengthening exercises once pain and inflammation are controlled 4