J. Phys. Ther. Sci.

Case Study 27: 3345–3346, 2015

Effect of the release exercise and exercise position in

Won-gyu Yoo1)
1) Department
of Physical Therapy, College of Biomedical Science and Engineering, Inje University:
607 Obangdong, Gimhae, Gyeongsangnam-do 621-749, Republic of Korea

Abstract. [Purpose] This study examined the effect of the release exercise and exercise position in carpal tunnel
syndrome (CTS). [Subject] A 40-year-old, right-hand-dominant man presented with CTS, with pain and progres-
sive tingling and numbness in the right hand. [Methods] The subject performed three exercises: (1) release, (2)
wrist flexor stretching, and (3) wrist extensor stretching. In session 1, the subject performed exercises 2 and 3 in
the standing position for 2 weeks. In session 2, the subject performed all three exercises in the supine position for
2 weeks. [Results] The pressure pain threshold decreased after session 1 and decreased further after session 2, and
the Phalen’s test and Tinel sign became progressively less positive. [Conclusion] Exercises in the supine position,
including release exercises, are recommended for CTS.
Key words: Carpal tunnel syndrome, Exercise, Wrist stretching
(This article was submitted Jun. 18, 2015, and was accepted Jul. 23, 2015)

INTRODUCTION SUBJECT AND METHODS

The carpal tunnel is an anatomical passageway bounded A 40-year-old, right-hand-dominant man presented with
dorsally and laterally by the hemicircular carpal bones, and pain and progressive tingling and numbness in his right
on the palmar surface by the transverse carpal ligament1). hand. His symptoms worsened at night. The numbness
Nine digital and thumb flexor tendons and the median nerve increased when he used a computer at work. He had no
pass through this tunnel1). Carpal tunnel syndrome (CTS) is systemic symptoms and no weakness or muscle wasting in
a common, costly neuropathology caused by compression either hand. There was no evidence of ulnar or radial nerve
of the median nerve. The median nerve undergoes acute pathology. On physical examination, he had tingling and
changes in response to repetitive manual jobs, which is numbness over the radial three digits of both hands in the
further evidence of a potential causal relationship between Tinel and Phalen’s tests. The purpose and methods of the
repetitive manual jobs and median nerve injuries such as study were explained to the patient, who provided informed
CTS2). The prevalence of CTS is greater in workers who consent according to the principles of the Declaration of
perform highly repetitive manual jobs3). Overall, CTS is Helsinki.
ranked sixth among recognized occupational diseases4). To measure the amount of pressure applied by the thera-
Surgical treatment for CTS involves opening the carpal pist, a dolorimeter (Fabrication Enterprises, White Plains,
tunnel at the wrist. Currently, there are several non-surgical NY, USA) pressure algometer was used to measure pressure
treatments for CTS, including non-steroidal anti-inflamma- pain. The dolorimeter consists of a metal probe that can
tory drugs, injection of various medications, immobilization measure pressures up to 20 lb in 0.25-lb increments. This
by splinting, rehabilitation modalities, and biofeedback was tested at a trigger point approximately 4 cm from the
devices5, 6). While drugs, injections, and splinting relieve distal crease in the wrist, medial to the radioulnar joint7). The
the symptoms of CTS, the long-term outcomes are poor1). participant reported when he felt that the pressure exerted
Therefore, we developed exercises for CTS and then investi- by the algometer approximated the pressure exerted by the
gated the effect of the release exercise and exercise position therapist. The study used three exercises. (1) In the release
on CTS in a patient. exercise: the subject elevated his hands overhead and then
shook them for a few seconds and stretched his fingers wide
apart. Then, he relaxed them, and then stretched them again.
In addition, the subject’s thumb was stretched by pulling it
Corresponding author. Won-gyu Yoo (E-mail: won7y@inje. back gently, holding it, and then releasing it. (2) During the
ac.kr) wrist flexor stretching exercise, the subject extended his arm
©2015 The Society of Physical Therapy Science. Published by IPEC Inc. in front of him with his with his palm up. Then, he flexed his
This is an open-access article distributed under the terms of the Cre- wrist and, with his other hand, gently flexed his wrist farther
ative Commons Attribution Non-Commercial No Derivatives (by-nc- until he felt a mild-to-moderate stretch in the forearm. This
nd) License <http://creativecommons.org/licenses/by-nc-nd/3.0/>. stretch was held for at least 30 seconds. (3) In the wrist
3346 J. Phys. Ther. Sci. Vol. 27, No. 10, 2015

extensor stretching exercise, the subject extended his arm in the pressure pain threshold increased progressively after ses-
front him with the palm down. Then, he flexed his wrist and, sions 1 (standing position) and 2 (supine position, including
with his other hand, gently extended his wrist farther until he the release exercise), while the fractions of positive Phalen’s
felt a moderate stretch in his forearm. This stretch was held tests and Tinel signs decreased progressively. Therefore,
for at least 30 seconds. CTS exercises in the supine position may elevate the wrist
In session 1, the subject performed exercises 2 and 3 in more, effectively reducing swelling in the carpal tunnel,
a standing position for 30 minutes each (total 60 minutes), thereby enabling the patient to exercise with less pain. Most
once a day for 2 weeks. Then, in session 2, the subject patients tend to overlook the release exercise. These stretch-
performed all three exercises in the supine position for 20 ing exercises can relieve the symptoms of mild-to-moderate
minutes each (total = 60 minutes), once a day for 2 weeks. CTS1, 6). However, these exercises should be pain free. If a
Before and after each session, the therapist performed the patient feels pain, numbness, or worse symptoms, it might
Tinel and Phalen’s tests 10 times each and measured the have a negative effect on the performance of exercises for
pressure pain. CTS1, 6). Our results indicate that the release exercise for
CTS is very important for effective stretching. I recommend
RESULTS that patients perform the CTS exercises in the supine posi-
tion, including the release exercise.
Initially, the pressure pain threshold was 1.3 lb, Phalen’s
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