Stretching the Wrist & Fingers to Prevent/Treat Carpal Tunnel Syndrome 

Yes, I know. You've heard it all before...you need to adjust the desk and seat height to correct work station ergonomics. (That does help)...you need a wrist support at your keyboard (not a bad idea, makes you conscientious about maintaining a neutral wrist posture while typing). However, the main point is missed: nearly every action you take, whether grasping a steering wheel while driving to and from work, carrying a purse or briefcase, opening a doorknob...we are spending more time grabbing (flexing the wrist and fingers) than extending the wrist and fingers. This sets us up for a muscle imbalance whereby the increased tension in the wrist and finger flexors (muscles on the underside or palm side of your forearm) can over time dislocate the eight carpal bones in the wrist, eventually producing impingment of the median nerve, commonly referred to as Carpal Tunnel Syndrome. What most people don't know is that this syndrome is entirely preventable with daily performance of the following stretching techniques, in addition to performance of strengthening exercises of the wrist and finger extensor musculature (muscles on the top of your forearm or same side as the back of your hand).

Wrist Flexor Stretch

With the elbow extended (straight) stand in front of a table or counter-top and place the palms of both hands flat on the surface, fingertips pointing towards each other. As you get more flexible, you can stand with the palms gradually further apart. This should result in a posture of the wrist being extended approximately 85 degrees, while the fingers are hyper-extended at the PIP and DIP joints (hyper-extension is normal anatomical motion at these joints).

Finger Pull ("Popping Your Knuckles")

Let's end an old controversy right now. I can recall that when I was in grade school, teachers told students not to pop their knuckles, that this would cause arthritis. Unfortunately, this was false information. Properly stretching your fingers actually has been proven to greatly minimize the incidence of the development of digital arthritis. The only correct method is to stretch the wrist flexor and extensor musculature first; then proceed to applying longitudinal distraction of the fingers individually. A loud popping sound may or may not occur, but this is normal as long as there is no pain associated with this stretch. Never perform finger stretching by interlacing your fingers, palms held outward, and then hyper-extending the fingers to pop the digits. Never apply overpressure to a fist to pop your knuckles. These last two stretches are very dangerous as they apply a huge amount of compressive force to the finger joint surfaces, and can easily result in the development of premature arthritis. Unfortunately, these last two stretches are most popular with teenagers, who think they're cool by making a very sudden loud sound as several fingers pop at one time. This stretch, when performed correctly as outlined above, actually helps to prevent arthritis in the fingers and wrists.

Regarding Stretching Technique:

Maintain stretch for 60 seconds on extremity. During performance of the Wrist Flexor Stretch, at approximately every 20 seconds, push down with the fingers you are stretching, then try to lean farther forward into the stretch (draw the hands farther apart and/or straighten the elbows more). This is known as the contract-relax technique of stretching, and this stimulates muscle stretch-reflex to relax, permitting you to obtain a better stretch with less discomfort.

To Correct Carpal Tunnel Syndrome, You Additionally Need to Strengthen the Wrist & Finger Extensors

Wrist Extensor Strengthening

The wrist extensors, however, are used in a more synergistic vs. direct manner, and by this means it is possible to hypertrophy the wrist flexors with overwork (including keyboarding and needlepoint) while wrist extensor strength does not increase. As time passes, there will be a tendency for a volar (palmar) dislocation of the wrist, with narrowing of the carpal tunnel, due to the increase muscle tension in the wrist flexors, which are located at the volar surface of the forearm. Maintaining normal strength of the wrist extensors is the number one protection for preventing the occurrence of Carpal Tunnel Syndrome (CTS).

Regarding Strengthening Technique:

In sitting, place your left elbow on the left knee and the left wrist on the right knee. Now rest your right wrist over the left wrist, and, holding a 5# dumbbell, lift the right wrist for up to 15 repetitions, performed throughout the full range of motion. Once you can perform 15 repetitions throughout the full range of motion, increase the amount of weight resistance.
 

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site last updated on February 11, 2010 by Paul J. Fransen, P.T.

 

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