What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition marked by discomfort and functional limitations in the wrist and hand due to excessive pressure on the median nerve, which runs down the inner arm through the center of the wrist to the hand. Pressure between the median nerve and wrist ligament are a common pressure point.
- Kellen Scantlebury, DPT, certified physical therapist and strength and conditioning specialist who founded Fit Club NY
- Sarah Whitworth, OTR, OTD, CHT, occupational therapist, certified hand therapist, and owner of a FYZICAL Therapy and Balance Center in Sherman, TX
- Tori Russell, MS, OTR/L, CHT, occupational therapist and certified hand therapist at FYZICAL Therapy and Balance Centers in Woodstock, GA.
"Carpal tunnel is caused when the ligament on the bottom side of the wrist falls on top of the median nerve over time or when the tunnel has increased pressure with activities," says Sarah Whitworth, OTR, OTD, a certified hand therapist and owner of a FYZICAL Therapy and Balance Center in Sherman, Texas. However, that's not the only potential problem area.
“The pressure can happen anywhere along the route of the median nerve, but is commonly seen in the neck as a result of a herniated disc,” explains physical therapist and founder of Fit Club NY, Kellen Scantlebury, DPT.
That compression leads to numbness, tingling, and potentially weakness into the hands, wrist, and even elbow, which are all hallmark signs of carpal tunnel syndrome.
The median nerve innervates the thumb, index, and middle finger, along with the inner surface of the ring finger, so any or all of these fingers can be affected. “Typically someone with carpal tunnel syndrome will notice that these fingers get numb often during sleep, computer work, or other activities involving the hands,” shares Dr. Scantlebury.
What causes the median nerve pressure that leads to carpal tunnel syndrome?
"Direct sustained pressure" is the main culprit in carpal tunnel syndrome, according to Tori Russell, MS, OTR/L, a certified hand therapist at FYZICAL Therapy and Balance Centers in Woodstock, GA. This can come from activities where you're in one position for too long.
"Common examples include pressing down on a mouse pad or table for long periods of time, forced prolonged wrist flexion or extension such as riding a mountain/road bike and pressing palms on the handlebars, [or] sleeping with wrists flexed," Russell says. But your wrist activity might only be half the story if you have "swelling for any reason such as post-op, pregnancy, arthritis, tendonitis, or injury," Russell says. "These can cause carpal tunnel from repetitive use with edema compressing the space in the carpal tunnel."
Who does carpal tunnel syndrome affect?
Aside from children, multiple different demographic groups are susceptible to carpal tunnel syndrome. So if you're wondering what age carpal tunnel might start, the answer is, sadly, any age.
Carpal tunnel "does not discriminate in regard to age or race," Whitworth says. "I have seen patients in their 20s and patients well advanced in age all with varying degrees of carpal tunnel symptomatology."
What you do might play more of a role than who you are, in terms of whether you should be concerned about carpal tunnel syndrome.
Carpal tunnel "mostly affects the middle-aged to elderly populations, but it is considered more situational and activity-related rather than age-related," Russell says.
How can strengthening exercises prevent and alleviate carpal tunnel syndrome?
According to Dr. Scantlebury, strengthening exercises can help reduce the risk of developing carpal tunnel syndrome, and alleviate symptoms. "Exercises that strengthen the finger flexors and extensors as well as the wrist flexors and extensors are most effective," he says. “Training your postural muscles is also important, [since] many times, posture habits are the main contributing factor leading to carpal tunnel syndrome.”
Since poor posture can lead to nerve compression, Whitworth describes posture exercises as "the first line of defense." These include strengthening the shoulders, core, and back.
But before you can get to strengthening, you might have to do some basic pain relief. "Modalities such as heat/ice, ultrasound and [electrical stimulation] help," Russell says. "As symptoms decrease, you can add light strengthening exercises." Russell also says some activities can promote mobility and bloodflow.
Six easy exercises for carpal tunnel syndrome
Although seeing a physical therapist is usually the best approach for getting a rehab program tailored exactly to your needs, there are some basic carpal tunnel wrist exercises, hand exercises, and posture moves you can try at home.
1. Towel or ball grips with wrist extension
Dr. Scantlebury says this is one of the best exercises for carpal tunnel syndrome because it improves your grip strength and the strength of your wrist extensors simultaneously.
“Both of these areas can be impacted with carpal tunnel syndrome,” he says. “These are especially important as we spend more time typing on a computer.”
To perform this exercise, grip a soft ball (like a stress ball) or a hand towel, squeezing your fist as tight as possible, while simultaneously extending your wrist, as though you're putting your hand up to signal someone to stop—the back of your hand should come towards the hairy side of your arm.
2. Towel or ball grips with wrist flexion
This one addresses grip strength and wrist flexion, so it helps to prevent and alleviate carpal tunnel syndrome by strengthening the muscles surrounding the median nerve.
For this one, perform the exact same tight-fisted ball or towel squeeze, but this time, flex your wrist by bringing your palm towards the inner arm.
3. Prone Ts
This exercise strengthens the trapezius muscles in the upper back, which support shoulder and neck postural muscles.
“Oftentimes, weakness of these muscles leads to bad posture that can cause carpal tunnel syndrome over time,” says Dr. Scantlebury. “This is a great exercise to increase their endurance.”
Here's how to do it:
- Lie on your stomach with a small towel rolled up under your forehead for comfort.
- Bring your arms out to the sides so that your body is in a giant letter “T.”
- Squeeze your shoulder blades together to lift your arms up off the ground, as if trying to fly. Keep your elbows straight.
- Complete three sets of 20 to 30 reps, building up the number of reps you do.
Add small hand weights or hold water bottles to increase the difficulty.
4. Tendon glides
Dr. Scantlebury says that the muscles and tendons that control our fingers need to slide and glide easily on one another to produce efficient, painless movement.
“In our hands, we have a bunch of tendons that connect to the bones to help us move our fingers. If these tendons get stuck, we have difficulty accomplishing movement and fine motor tasks,” he explains. “Tendon glides help us improve this movement and can increase finger strength.”
There are four basic tendon glide exercises you can do to get started:
- Make a fist, squeeze, and relax.
- Bend just the fingers so that the fingers curl over and the pads touch the lower third of your fingers (claw hand position), and then straighten them again.
- Keep your fingers completely straight and bend your hand into an L, so that your fingers are at a 90-degree angle with your palm. Relax back.
- Fold your fingers all the way down to touch your palm and then open them back up.
Complete each exercise 20 to 30 times, as tolerated.
5. Finger taps
Dr. Scantlebury says this exercise increases the strength and endurance of the muscles in the hand, which can alleviate symptoms and prevent functional deficits.
To do it, tap the thumb to each finger in the hand (thumb to index finger, thumb to middle finger, thumb to ring finger, etc.). Complete 10 rounds per hand. You can increase the intensity by adding putty to your fingers; this forces you to pull away against resistance.
6. Shoebox treasure hunt
Russell has patients get a shoebox and add two to three bags of dried beans, then hide small objects in it like coins, marbles, or paperclips. "Moving your hand around in it at room temperature [helps] with lymph mobilization, desensitization, numbness/tingling and edema," Russell says. "Picking out these objects with each finger helps improve fine motor control and strength. I usually recommend this exercise is done for about five to 10 minutes daily."
Exercises have their limitations
There also might be some activities you want to avoid. Dr. Scantlebury notes that one of the primary symptoms—weakness—can make general strength training difficult (“push-ups need to be avoided,” he says), but doing targeted strengthening exercises for carpal tunnel syndrome can help counteract this issue.
Carpal tunnel strengthening exercises (as well as general strength training exercises) also must be done with good form. “Many need to be performed with a neutral wrist to reduce pressure on the median nerve,” says Dr. Scantlebury. (Meaning, find ways to keep the wrist straight rather than bent.)
Additionally, strengthening exercises are most helpful for people with mild, intermittent symptoms, that are not greatly interfering with daily life. "If carpal tunnel becomes more advanced as diagnosed with a test called an EMG (electromyography), research does show that therapy will not help, and the patient will require surgery to correct the compression," Whitworth says.
And remember, no matter how many exercises you do, opt for position changes and the occasional shake-out when you're using your hands throughout the day.
"My patients often ask, 'Why does shaking my hands out seem to help?'" Russell says. "Your body craves movement, and when you are in one position for too long, your body needs to take a break, so by moving your hands, you are able to increase the circulation in your wrist(s) to get the blood flow moving through the carpal tunnel to your hands."
When to see a doctor for carpal tunnel syndrome
When symptoms stop coming and going, and become constant or near-constant, and if you are dropping things daily, it's time to escalate your level of care beyond doing exercises on your own.
"Red flags include numbness and tingling that are not intermittent in nature," Whitworth says. "Constant numbness and tingling often equate to a greater degree of carpal tunnel."
Other signs to look out for are if you've made changes to what you think the activity causing the problem was, but your symptoms persist.
"If after a month of symptoms, especially if you have changed what you believe was causing you pain and irritation, it’s time to seek medical attention," Russell says.
Remember the bigger picture
While strengthening can help prevent and alleviate symptoms, Dr. Scantlebury says that exercises should not be the only component of your prehab/rehab program.
“A balanced program consisting of strength training, mobility training for the wrist joint, and nerve lengthening are your best options,” he says. “If you suspect you are suffering from carpal tunnel syndrome, get an evaluation performed by a doctor of physical therapy. If your treatment does not progress well, a recommendation can be made to an orthopedic surgeon.”
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