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Health, Wrist

Carpal Tunnel Exercises: Avoid Surgery

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Carpal tunnel syndrome causes pain, numbness, and weakness in the wrist and hand and with nearly 50% of all work-related injuries are linked to to it, finding carpal tunnel exercises that help avoid surgery is key.

We explained in greater detail in our earlier post about Carpel Tunnel Syndrome, what causes it and the aspects needed to treat it non surgically.

Because of the potential side effects and risks of surgery, not to mention the at times long recovery, many patients are now being advised to do a period of physical therapy first, to help avoid surgery all-together.1

In this post we cover an important aspect of con-surgical carpel tunnel treatment: Carpel Tunnel exercises.

The exercises should look to address:

  • Muscle tension and nerve mobility through the side of your neck
  • Forearm muscle flexibility
  • Nerve and tendon mobility/gliding through the carpel tunnel
  • Grip and thumb strength

If you just pick one or two of these, you risk missing an important component, potentially taking a lot longer to get better or worse yet, leading to unnecessary surgery – So go all-in and do it properly!

1. Starting at the top, we need to keep the neck mobile, where the arm nerves originate: Perform all of the below three stretches twice a day for 30 seconds, each way. Remember that stretches should be gentle.

carpel tunnel exercises

Carpal tunnel stretch2. Stretch out your forearm by pulling your fingers and wrist into extension, as shown and holding for 30 seconds and then in the opposite direction, into flexion for another 30 seconds. If either of these bring on wrist or hand pain and is not giving a gentle stretch in the forearm, don’t do it yet.


3. Floss your median nerve:Carpal tunnel median nerve glider This is a great one. It essentially mobilizes and lubricates the median nerve along it’s entire pathway (including the carpal tunnel of course). Repeat 20 times, 2 x daily.

This exercise needs to be gentle, and pain free, so only stay within the comfortable range, which may mean you aren’t straightening your arm right out initially.


4. Take your hand to the gym

Through pain inhibition, lack of use and the median nerve being affected, sufferers of Carpal Tunnel Syndrome typically lose strength in their hand and particularly their thumb. If this isn’t sorted, this can mean the injury really hangs around and afterwards, leaves you at risk of future recurrence of the injury.

carpal tunnel syndrome exercsies hand strengtheningSo the best way to sort this, is to work out your hand.

An awesome little tool for this is the Eggzerciser (which you can get Amazon Here), which is an ergonomically shaped hand therapy ball to offer resistance to the muscles of your forearm and hand to build strength back up, safely.

Level 1: Start off by performing the 6 exercises shown here by doing 10 holds of about 5 seconds. I say “about” because everyone is different and you are better off just aiming to be fatigued by the end of the 10 holds of each exercise.

Level 2: When improving, you can then step it up to 3 sets of 10 squeezes (reps) for each exercise, without holds.

Do the strengthening just once daily and if needed you can step this back to every second day.

Reminder: Do not push into of through pain.


Persevere with this exercise regime and our previous advice for at least 6 weeks as it can take this long to start seeing significant results and of course if there is any worsening of symptoms, consults your local doctor of physio.


Health, Wrist

Carpal Tunnel syndrome: Avoid Surgery

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Carpal Tunnel Syndrome is very, very common with nearly 50% of all work-related injuries linked to carpal tunnel syndrome.  Fortunately, there are effective and evidence-based Carpal Tunnel syndrome exercises and conservative treatment that can help fix carpal tunnel pain and avoid surgery! (1)


Firstly, what is carpal tunnel syndrome?Carpal tunnel syndrome avoid surgery

The Carpal Tunnel is a channel at the front of your wrist which is covered by a band of strong connective tissue (retinaculum). Through the tunnel that is formed, runs tendons, a blood vessel, and your median nerve. Carpal tunnel syndrome occurs when these structures don’t slide nicely through your tunnel and with repetitive or sustained tasks, can lead to pain, numbness, and weakness.

Note that symptoms are variable due to the different structures that pass through the tunnel – Sometimes there is more median nerve involvement that tendons and vice versa.

What causes it:

Anything that causes compressed, irritates or effects mobility of the median nerve in the carpal tunnel can cause this which can be from a huge number of causes, with many cases not having a clear cause.

Carpel Tunnel syndrome can be caused by wrist or hand sprain and fractures, inflammation involved with rheumatoid arthritis and commonly certain activities or jobs that require a lot of bending of the wrist, gripping or vibration, among other things.

Some known risk factors are

  • diabetes – a chronic (long-term) condition caused by having too much sugar (glucose) in the blood
  • any kind of arthritis – a condition where the joints become painful and inflamed
  • hypothyroidism – an underactive thyroid gland
  • obesity in young people
  • some drugs used to treat breast cancer – such as exemestane (Aromasin)
  • pregnancy



Carpel tunnel syndrome can be treated with Physiotherapy or surgery, with surgery often only for the more severe or unresponsive cases as one-third of patients don’t return to work within 8 weeks after an operation as it has a significant recovery period and is not always straight forward and the quick fix that people want as surgery can lead to scarring.

The main aspects of non-surgical treatment that need to be covered for best results are:

    • Brace: Wearing a splint during aggravating activities and at night time can be very beneficial and help speed up recovery by decreasing load on the wrist and holding it in the optimal position for maximal space in the carpal tunnel. The best braces have a metal bar in the palmar aspect specific to carpal tunnel syndrome, so ideally don’t just get any old wrist brace. A good example of one is theMueller Carpal Tunnel Brace
    • Reduce load: Even though there is often 1-2 risk factors such as swelling in pregnancy, inflammation from a fracture close by or a congenitally narrower tunnel – That does not often cause carpal tunnel syndrome by itself. In the majority of cases, you still need repetitive or sustained movement of the wrist or hand, more that it is used to. So, to give the wrist a chance to settle down, you need to figure out what it was that over-loaded the wrist, whether it be using a hammer a lot, writing or typing all day or obsessively cleaning your house and then decrease how much you do that where possible. You don’t need to completely stop the task often, just change how you’re doing it, decrease it and maybe even become a little ambidextrous for a while.
    • Exercises to improve: The third and final thing is home exercises to address any excessive neural tension, muscle tension or lack of joint mobility. The exercises should look to address:
      • Muscle tension and nerve mobility through the side of your neck
      • Forearm muscle flexibility
      • Nerve and tendon mobility/gliding through the carpel tunnel
      • Grip and thumb strength

So there you have it, a rough blueprint on helping lessen the pain from carpal tunnel and start on the road to recovery. We will be putting up another post in in two weeks detailing effective home exercises for Carpal tunnel pain so stay tuned!

Elbow, Health

Tennis Elbow Exercises – Heal Fast and Strong

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Tennis elbow exercisesTennis Elbow, also known as lateral epicondylitis, is far too common, but luckily there are some easy and effective tennis elbow exercises to help you recover faster.

Following on from our popular post on what tennis elbow really is and what causes it (not just tennis!) We are going to show you the three things that will speed things up.

Why exercises for tennis elbow?

Studies have shown (as well as clinical experience) that physiotherapy and rehab exercises are better than the wait and see approach, better than ultrasound and have better long-term results than cortisone injection!(1,2)


So here are our best tennis elbow exercises and tips:


Ice: in the early stages ice is very effective in easing pain. Apply in ten minutes at a time, making sure you avoid ice-burn by wrapping it up. Also if your injury is not in the acute/early stages then heat can also be effective.



Brace up:tennis elbow exercises

Tennis elbow braces really do help the majority of people. They work by importantly altering the line of pull of the tendons, adding compression and by retaining heat. You can find good braces all over the place and here is a good example.



And last but most importantly, this great rehab regime combines two tennis elbow exercises for great results. Because tennis elbow is basically where the tendon fibres have become bunched up and messy, tennis elbow exercises need to progressively work to re-align these fibers to correct and fix the problem. So here is the exercise regimen:

Step 1:tennis elbow exercises

Forearm stretch. Straighten your elbow and pull your fingers towards the front of your wrist. Hold this for 30 seconds.

Step 2:

Eccentric strengthening. Place your forearm on a bench with your wrist and hand off the edge. Holding a weight, extend your wrist up and then lower it down again (this needs to be in control, so slow it down).Tennis elbow exercises

Repeat for 3 sets of ten repetitions.

The weight used needs to be started small and gradually increased. Start with either nothing or 250grams (a can of beans) and gradually increase as it becomes comfortable a pain-free.

Step 3:

Forearm stretch. Yep, stretch it out again to finish it off – a 30-second hold.


And that’s it, incorporate #1 and #2 in whenever needed and do the exercise regime once a day.

Note: You will need perseverance as no matter what you do, there is never a quick fix with tennis elbow and usually takes 6-12 weeks to resolve with good treatment. But, if you do these tennis elbow exercises everyday, you will have a good shot at sorting it out.

Elbow, Health, Upper limb

Epicondylitis: What is it and why Tennis…

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Tennis elbow or Epicondylitis is very common, affecting 1-3% of the population but the name can be very misleading and misunderstood(1). I am going to clear that up for you by telling you what it is, why it happens and how to treat lateral Epicondylitis through effective exercises at home!

Epicondylitis tennis elbow exercises

Epicondylitis is actually an overuse injury – rather than an inflammatory problem as is commonly thought. The research is fairly conclusive that it is not an inflammatory condition, so technically it should be called lateral elbow tendinopathy… but lets just stick with tennis elbow! (2)


Tennis elbow originates from the extensor muscles of your wrist, just before it attached onto the lateral epicondyle as you can see int he image to the left. It is brought on by any work or sports that need repetitive wrist movement or gripping. So not just tennis but a wide range of activities can cause it, such as:

  • Building, plumbing and electrical work
  • Computer work – yes using a mouse can cause injury!
  • Racquet sports
  • Mechanical work and much, much more…

So, yes it does affect a lot of tennis players (more than 50% of amateur tennis players!), hence the name, but it can also cause pain and limitation in a range of other sports and professions as well.

Tennis elbow physiosteps ashburton nz

Courtesy of: M. Waseem et al. / Lateral epicondylitis: A review of the literature


It happens through repetitive overloading of the tendons, leading to micro-tears and the initiation of degenerative changes – Thickening of the tendons, sensitization, increase in blood vessels and building cells.

Think of it like this: You are using the tendon the same way over and over and over again and this overuse is too much for the tendon to handle – it gets tired, and fair enough too. So because of this it gets little micro-tears, kicking your body into action. It decides it needs to make it stronger by laying down more tendon fibres and other building blocks. But the problem is that this makes it thicker and dysfunctional because the new fibers are layed down all over the show – not in the correct alignment, leading to weakness and a real pain in the elbow.

Pain usually comes on gradually and generally worsens with use, such as gripping or lifting.

Main points:

  • Epicondylitis initially is a degenerative over-use injury
  • It is caused be repeated or sustained gripping or wrist movement
  • It can improve faster in the short term with rehab exercises and physio


So what can you do to help your Tennis Elbow?

  1. Relative rest: This has happened because the arm was overused, so it makes sense to ease off on the aggravating activity if possible. So try to avoid things that make it sore and ensure you have plenty of mini-breaks to that the muscles can have a breather
  2. Pain relief: Both ice and heat are effective in decreasing pain – use what works for you and if in doubt ask your local health professional
  3. Brace up: Tennis elbow braces really do help – in the majority of cases. They act to: Provide compression, warmth for healing and change the angle of pull on the tendons, reducing the stress and strain. These give some great relief, especially during work or sport.
  4. Most importantly – do the right exercises. Doing the right exercises is so important because as mentioned above, the tendon fibers become messy and not aligned well at all. In order for it to heal strongly the fibers need to be re-aligned along the correct line of pull. So putting the right, controlled force through the tendons helps align the fibers in the right direction, meaning it heals strong and fast! This is why doing the right exercises are so important – better than old mister wait and see. In my next post I will be outlining the most important rehab exercises for tennis elbow to get you back to it as soon as possible – so keep tuned!


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Health, Shoulder pain, Upper limb

Shoulder dislocations – Don’t brush it off – Prevent Re-injury Now

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Have you had a shoulder dislocation physioshoulder dislocation playing contact sport? If you are young and want to keep playing sport – you are at massive risk of re-injury.

There is growing evidence that if a young athlete dislocates his shoulder and plays a physically demanding contact sport – They should have surgery. This is because the shoulder becomes unstable following this and the chances of further dislocations are incredibly high.

In a study by Slaa et al, it was found that:

  • Over-all recurrence rate of 24%
  • There is a huge 64% recurrence rate in patients under 20 years of age

Also a literature review found an average recurrence rate of 67%, with much less chance of re-injury if the patient is older than 40 years of age.

The most important findings in these studies are that you have very high chance of sustaining further dislocations if you are an athlete (82% – simonet and Cofield) and/or are a young person.


shoulder labral tearA large part of this is because damage has occurred to the labrum – This is the tissue that helps make the shoulder socket larger and suck the ball of the shoulder joint in. If the labrum is torn (which it often is in shoulder dislocation) this causes a break in the negative pressure in the joint – it has lost the suction – meaning it is easier to “pop out” again.


Thedislocated shoulder, do you need surgery? shoulder joint has a tiny socket to start with!

Think of shoulder joint like a golf ball sitting on a tee – The ball of the shoulder is much larger than the socket (the tee), so to make the socket larger, the labrum comes off the socket to add more stability.


So if you have dislocated your shoulder, are young and/or want to continue playing a contact sport…

  • Go have your shoulder assessed by your Physio
  • Get referred to an orthopedic specialist if they deem it necessary
  • Rehab your shoulder well and get your rotator cuff as strong and stable as you can.

Do it right the first time.


Yours in good in health,



Health, Mobility, Shoulder pain, Upper limb

Shoulder Stretches: Only the Best

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Shoulder stretching is an essential part of gaining a Pain-free, functional and strong shoulder. Whether you have had shoulder injury in the past, have tight shoulders due to poor work posture or you just want to have full range for an overhead squat – then these shoulder stretches and for you – all of you!

(Skip down the page if you want to get straight to the Shoulder Stretches!)

Following injury: regaining flexibility and range in the joints and soft tissues is an important aspect to the rehab process and if not addressed, you can develop other, secondary injuries such as sub-acromial impingement, postural dysfunction and any number of neck problems.

Poor posture: In today’s world, too many of us have sedentary jobs which require a lot of time sitting at a desk or behind the wheel. This leads tightness in muscles the pull your shoulders forward (namely your Pecs and Upper Traps) and weakness in muscles that hold your shoulder in a good, functional position (lower traps, Serratus ant etc). This is explained well by the Jandas Upper Crossed Syndrome.

Overhead squat and shoulder range: To hold a barbell overhead and squat down  we need great mobility around the shoulder and hip to do this safely. The main muscle that affects this is the Lat (along with your Glutes and Thoracic extension) as the come all the way from your pelvis to your shoulder.


Ideally you should do these everyday – You can water it down and do it less often but you will not get thew best result and it will take longer.

Horizontal abduction stretch for the shoulder. posterior capsule and deltoid stretch

1. Posterior capsule stretch:

Action: Pull your arm across your body.

Hold for 1 Minute.



Shoulder stretch for the triceps muscle and inferior capsule to decrease shoulder pain

2. Triceps and inferior capsule:

Action: gripping the elbow as shown, pull back and across.

Hold for 1 minute.

Tip: bend upper body away from side being stretched.




sleeper stretch for the shoulder - to stretch the post capsule and rotator cuff

3. Sleeper stretch:

Lye on your shoulder with your arm in front of you and your elbow bent to 90 degrees. using your free arm, grip your wrist and rotate it down towards your feet until you feel a moderate stretch.

Hold for 1 minute

shoulder stretch for the pectorals and thoracic spine. good for swimmers, cyclists etc4. Streamline stretch:

This is a great stretch as it stretches, Pecs , Lats and thoracic spine.

No balls – You do not have to use a Swiss/Physio ball – I use the back of my couch.

Action: when on your knee place both arms on the surface and relax your shoulder and upper back down. you can adjust the force that goes through your shoulders by moving your knees further away or closer.

Hold for 1 minute.

TIP: to get more of a tricep stretch place your hands behind your neck with elbows on the ball/couch!

5: Lat Band Stretch: 

The best way I have found for stretching Lats is using a band (a technique picked up from Crossfit) – now you can use a proper exercise band or a simple belt (yes one of the ones that holds your pants up) at home. Below is a nice simple video on how to do it:

Overhead distraction with Band

Hold for 1 minute.

Tip: you can also do this by holding on to a pole.


And THAT my fiends is ten minutes well spent!

For Best results combine the above stretches with a good Shoulder stabilisation regime and you will really reap the rewards.


Note if you feel any pain (other than stretching pain) or have range of motion limitations post surgery then consult a trained health professional.



neck pain, Shoulder pain, Upper limb

Scapula stabilising exercises – Beat shoulder pain for good.

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winging scapula shoulder bladeWhy does your shoulder pain not get better or keep coming back??  Scapula stability and control is often overlooked yet it is absolutely necessary for good shoulder function. Here we will increase shoulder girdle strength, stability and control to get rid of and minimise the chances of:

  • Rotator cuff impingement
  • Shoulder tendinopathy
  • Subacromial Bursitis
  • Neck pain and Headaches
  • And much more

Scapula Dyskinesia is a very very common response to shoulder pain and leads to ongoing, prolonged and frustrating shoulder pain. This is basically abnormal movement of your shoulder-blade. For more detail: Skapula dyskineia

Normal shoulder movement, strength, control and performance is fully dependent on the scapula – and not just movement but it’s stability as well. The scapula is the base that your arm works off and if you don’t have a stable base, you will be much more likely to have shoulder and neck pain – It would be like trying to walk in an earthquake!

Normally when you lift your arm, your shoulder blade rotates upwards as seen in the picture below. If your shoulder-blade doesn’t rotate – your shoulder gets jammed against it, leading to pain and tightness.

So given that Scapula Dyskinesia occurs in 68-100% of shoulder injuries, this is something that needs to be addressed in EVERY PERSON WITH SHOULDER PAIN. So below is your exercise regime to address this yourself at home or the gym.

1. Push-up Plus: skapual, serratus anterior strengthening exercises, physiotherapy, shoulder pain

keeping your body and arms straight, push your shoulders forward(body upwards and then control your shoulders back to the starting position).

Too easy? do a push up and add the press at the top of each push-up (this is the plus!)

2×12 reps (to start with!)and start on your knees if you need to.


2. Shoulder external rotation: shoulder ER

Remember to always keep your elbow into your side and at 90degress.

You can also do theses in side lying with a 1-2kg dumbell in your upper hand.

2 x 12reps, increase the stretch to progress.



3. Chariot Pull: chdariot pull

Keeping your arms straight and shoulder back and down, take your arms back untill they are level with your body.

2 x 12reps, increase the stretch to progress.





4. Thoracic Mobility: I have included this as if you have a stiff spine, your shoulder chariot pull, shoulder strengtheningblades are always going to be in a bad position, so it is important to address this so that you don’t get stuck at 95%!

Using either a full or preferably 1.2 foam roller (high density!) lie on it, placed below your shoulder blades as shown, bridge up and extend your arms overhead and then elbows down to your sides.

Tip: Keep your head up and chin tucked in.

spend 1-2minutes working on your spine.

Do these exercises two times daily (Ideally!) for 6 weeks for awesome shoulder stability and a pain-free shoulder.



Also see:

Mobilise yourself

Beating neck pain and headaches

Please share and let me know how you get on.


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