Ejercicios Tunel Carpal

“The Economy of Movement”
Carpal Tunnel Syndrome Treatment
Helping you communicate with your hands rather than hearing them
scream, or them not listening to your instructions.
Understand the reason why you suffer painful symptoms.
Learn how to put your mind into your hands to reduce the pressure on
your median nerve.
Discover how to choose and apply specific orthopaedic wrist splints that
protect your wrist and impede your symptoms worsening.
Practise correct specific carpal tunnel pain relief exercises.
Greatly improve your hand mobility, flexibility and strength.
“Give yourself the very best chance” to prevent surgery, or the best
preparation for a smooth rehabilitation if you decide to operate.
1
INDEX
A Temporary Situation ............................................................................. 3
Understanding Your Symptoms ................................................................. 5
Pain Relief Exercises ................................................................................ 8
Exercises to Avoid ...................................................................................11
Protecting Your Wrist ...............................................................................12
Wrist Splints For Carpal Tunnel Syndrome Treatment ..................................14
Your Control ...........................................................................................18
Two Steps Forward, One Step Back ...........................................................19
A Reflection of Time .................................................................................20
Self Awareness Techniques .......................................................................22
10 Step Hand Mobilization Exercises ..........................................................25
Over Confidence .....................................................................................31
Compensation Techniques ........................................................................32
Hand Flexibility and Strengthening Exercises ...............................................34
Advanced Exercise Techniques ..................................................................42
Permanent Adaptations ............................................................................45
Partnerships ...........................................................................................47
Final Thoughts ........................................................................................49
Appendices .............................................................................................51
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By Blake Schofield
(H.N.D. Applied Biological Sciences - Manchester Metropolitan University) 2
A Temporary Situation
1. Hand functionality disorders in perspective.
When I received occupational therapy to improve the functionality of both my hands, I

realized that most of the other patients with me in Barcelona’s Hospital d’Esperanza
(Hospital of hope) had all suffered some kind of stroke.
One of the consequences of stroke is Hemiplegia. This is the condition part of, or all of one
half of the body is temporarily or permanently paralyzed.
Many patients recover from a stroke. However, many survivors are conditioned to live the
rest of their lives without the use of one hand (or arm and hand).
How would you confront this situation? The only answer is to get on with life in the best
way possible. It’s a question of mind over matter.
The message I’m trying to get across to you here is that carpal tunnel syndrome has a
treatment and there is a solution. You must believe your problem is only temporary to help
you get over it.
We humans have a way of motivating ourselves by making comparisons to people worse

off, or better off than we are. For example, I kept on fighting to recover by reminding
myself of people who play wheelchair basketball.
I was determined to be able to get back to a stage in my life where I could do something
that wasn’t rehabilitation. Now I can do press ups again!
In my case, I suffered a spinal stroke between my sixth and seventh vertebra. Your seventh
vertebra contains your sensitivity and mobility engine. I was left temporarily paralyzed from
my shoulders to the tips of my toes. Hospitalized, all I could feel was the pulse in the back
of my neck.
My right and left median nerves were hit so badly I even needed special electrical tests to
make sure that the nerve impulses were reaching my fingers.
I fully understand all your hand functionality difficulties, your symptoms, and your
frustrations, but first of all I need you to believe you can recover well.
Believing your situation in temporary will help you in more ways than you now realize.
2. Why did this have to happen to you?
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By Blake Schofield
“Why me?”
If you are asking yourself this question, my advise to you is that you move on from this
“why me?” phase as quickly as possible. It can lead into much negativity and self pity.
The fact is that it isn’t just you.
Thousands of people suffer from carpal tunnel syndrome. Furthermore, carpal tunnel
release surgery is one of the most frequent operations performed. Here in Spain the
waiting time is 45 days.
Until now you have had the initiative to seek help, educate yourself and orientate yourself
towards treating yourself in the best way possible. The fact that you are reading this guide
is positive.
Much of your progress will depend on your own efforts. Besides the pain, sleepless nights,
lack of mobility and frustration, other challenges that face you are:-
• Your consistency
• The distractions of every day life
• Your acceptance of living with pain against your fight for continual improvement
• Your motivation and discipline
• Surrendering against believing in your recovery
You will find much help in this guide. It’s also important that you put effort into getting
better, and keep your believing that this is only temporary.
Self discipline is in the application of these techniques when you don’t feel like performing
them.
Your performance is essential in reducing your chances of surgery, or in your preparation

for it, and in general, for an efficient rehabilitation and recovery.
Continue…
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By Blake Schofield
Understanding Your Symptoms
In order to give you structured help regarding your frustrations with painful symptoms, and
to help you think twice before making certain movements, it always helps if we look at why
you feel the pain.
If we can provide you with as much information as possible about the aspects of carpal
tunnel syndrome (CTS), we can avoid that the ignorance of basic concepts be the cause of
further injury.
If we know that something can be harmful for us, we can think twice before doing it!
To explain why you feel symptoms such as pain in the hand and forearm, numbness in the
thumb, tingling sensations in the hand, shooting pains up the arm, sleepy hands, swelling of
the hand and even burning sensations, we need to have a quick and simple look at
anatomy.
1. The Carpus
The Carpus is the group of eight bones that forms the wrist. They are cuboids, all achieve
six sides, just like a dice.
The Carpus is one of the most complex bone structures in our body. (see image i)
Image i The Eight Carpal bones
2. The median nerve

The median nerve starts in the brachial plexus (within your shoulder area), it travels down
the arm and forearm and when it reaches your wrist together with no less than nine
tendons it passes over the Carpus (like a cable running over image i).
The median nerve finally branches out through the fingers reaching the finger nails except
in the little finger.
There is a special structure in the wrist that protects the median nerve and the nine tendons
that reach the fingers.
This structure is called The Carpal Tunnel.
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By Blake Schofield
3. One delicate place.

Without doubt, I would be very satisfied if our website received the same amount of traffic
that goes through the carpal tunnel!
The carpal tunnel contains vital elements for hand movement and sensitivity.
It's interesting to consider that there are eight bones, nine tendons, and a very important
nerve, all in such a small space. We don't contemplate that when we open the car door!
An important part of our therapy is the awareness and evaluation of our movements
(biomechanics). Now, It's time for us to think twice when we pick something heavy up.
It's not so simple as passing work to our other hand. That's not always possible. There are
many other factors to work on (positivity, consistency, belief, prevention techniques, correct
splint use and application, ergonomics, correct posture, exercise, perseverance, etc.)
4. The cause of carpal tunnel syndrome

Too much pressure on the median nerve in the carpal tunnel causes carpal tunnel
syndrome. The median nerve communicates its unease with symptoms such as pain in the
hand and forearm, numbness in the thumb, tingling sensations in the hand, shooting pains
up the arm, sleepy hands, swelling of the hand and even burning sensations.
Possible causes of carpal tunnel syndrome are:-
• Variations in fluid levels (changing blood sugar levels in diabetics)

• Muscle alterations
• Joint or bone illnesses
• Hormonal changes (pregnancy, menopause, thyroid levels)
• Poor ergonomic positions (poor posture)
• Previous injuries such as fractures
• Repetitive manual labour
• Genetic inheritance
• Obesity is a risk factor
• The size of the carpal tunnel itself
• Frequently getting in and out of a wheelchair
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By Blake Schofield
We’ve learnt so far that-
• The wrist is an extremely delicate place due to its complex bone structure, and also
for the accumulation of nine tendons and the median nerve.
• Excessive pressure received by the median nerve inside of the carpal tunnel can
result in painful symptoms
• There are more than 12 causes of CTS.
Understanding the cause of your pain helps to eliminate:
1) The frustration of not knowing why you feel symptoms.

2) Some carelessness. By knowing how delicate the wrist is, we show more concern and
appreciation of its use.
Take five minutes to think about what your

wrist has done today.
Go back to the start of your day and think
about what you've done.
IMPORTANT NOTE:
As there a many factors that can influence pressure on the median nerve, we recommend
that you obtain a medical diagnosis about the real cause of your symptoms to be able to
proceed with our therapy in the appropriate way.
It is also possible that the cause of the pain may have a different origin from the carpal
tunnel.
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By Blake Schofield
Pain Relief Exercises
Introduction
The following exercises are from a specific course that teaches physiotherapists which
exercises to practise on their carpal tunnel syndrome patients to provide pain relief.
These exercises have been used by many of our customers with excellent results. My blog
is full of comments from people explaining how beneficial these exercises have been for
them.
If you have found some free exercises on the Internet which you occasionally
practice when you are suffering pain, please stop exercising like that. You need to establish
your routine and work your pain relief exercises weekly until you feel you can combine them
with the hand mobilizing exercises and the hand flexibility and strengthening series.
The following exercises also prevent the accumulation of muscle tension and stress.
Therefore, they are to prevent pain rather than just for acting upon pain. For this reason,
the regular practice of these exercises in a stipulated weekly routine is relieving and
preventive.
There are plenty of carpal tunnel exercises out there on the Internet, but I find it quite
confusing to know which ones work the best. It’s just difficult to know which ones to
practise. Plus the fact some are not even worth practising at all.
Besides that, certain exercises on the internet can be painful, especially if you are not ready
for exercise yet. For example, I once saw an exercise showing a man putting his body
weight onto his wrists, like in a press up position. I hardly think that would be appropriate
for a sixty year old woman who suffers carpal tunnel syndrome in both of her wrists. Many
people suffer CTS in both hands!
If you feel that exercise is difficult and painful, first you need to concentrate on resting and
protecting your wrist. Later on we’ll be looking at wrist protection in detail.
If you feel you are able to exercise comfortably, we recommend that you gently practise
this simple set of 7 exercises until you get to know them off by heart. Once you feel where
you are benefiting, you can practise a more confidently.
Make sure you rub your hands, wrists, and forearms to warm up. Create a little bit
of heat and feel the warmth.
The warm up is also useful for relaxing, and focusing on what you are about to do.
Exercises
1. Stretching
Certain muscle groups can shorten and tighten when they work a lot. Therefore, it's
necessary to stretch them during the day, and also at the end of your work day. This way
we can be preventive as well as acting directly on the pain.
Take short breaks to stretch. Always stretch gently, never over stretch. Make sure you
apply very little force. Remember you are stretching rather than pulling or pushing.
Overleaf, you can see I am opening the carpal tunnel, just stretching gently.
TIP: Imagine the pressure release from within your carpal tunnel. Try to imagine it with
sound.
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By Blake Schofield
Stretching exercise 1 – carpal tunnel pressure release exercise
Imágenes con uso restringido.

Consigue su copia completa en Español.
www.tunelcarpiano.es
Stretching exercise 2 – finger work

Above, the finger tips are together, I call it the spider doing press-ups on a mirror. I use
these silly little comparisons to help memorize each series of exercises.
Try to make your hands to reflect each other whilst pushing them against each other. Keep
your wrists as straight as possible.
Stretching exercise 3 – carpal tunnel pressure release.

To stretch more, this exercise (and the first) can be done with the arm straight. You can see
my arm is bent as I am only stretching gently. This is a key pain relief exercise.
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By Blake Schofield
2. Mobilizing the median nerve

The repetition of this exercise can also help the flexibility of the wrist extension.
Mobility can be improved too.

The following exercises can also reduce the painful symptoms and reduce pressure in the
carpal tunnel. It's similar to a rotation of the wrist-


It's an action similar to that of the queen of England waving to her public!
You can move your hand well back whilst doing the wave, but try not to move your hand
inwards too much.
Continue…
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By Blake Schofield
3. Tendon mobilization
Take a careful look at the photos. Use a combination of curling and pointing.
We recommend slow gentle movements keeping the neutral position. Also economy
of movement, we don't want to be moving elbows and shoulders when concentrating on the
wrist.

Out - Curl in - Out at 90º - Press Palm - Curl up & back out to the start
4. Wrist joint liberation

With the initial help of your therapist or doctor this exercise is another alternative.
Your forearm is taken, and your hand held, the wrist joint is liberated with a slight push and
pull.

Exercises to avoid
• Don't use hand strengthening objects that rest in the mouth of the carpal tunnel.
• Avoid squeezing balls, Plasticine, hard sponges, and grips with springs in them.
• Applying force onto the carpal tunnel will not help you to liberate the pressure inside
it.
Up until now we’ve learnt why you feel pain, we’ve talked about belief, considered how
delicate your wrist is and we’ve learnt some pain relief and pain prevention exercises.
These are all good foundations to build on. A little practice and repetition is needed.
Next we’re going to talk about how best to protect yourself in order to stop symptoms
getting stronger.
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By Blake Schofield
Protecting Your Wrist
Later in this guide we will be talking about the enormously important practise of
compensation techniques. However, as I mentioned before on page 5 (understanding the
symptoms) it’s important you receive structured help.
Therefore, in our build up to pain relief and improved hand functionality, let’s have a look at
the reasons why you need to incorporate good protection techniques into your every day life
so that you can fully understand when and how to protect your wrist.
The best way to do this is to explain which movements are the most unfavourable for your
carpal tunnel. In other words, the actions that can cause pressure build up.
The most unfavourable actions for your carpal tunnel are;
The maximum extensions of your wrist with the application of fine pressure or strength.
The pain relief exercises involve wrist extensions, but not combined with strength. It may
seen contradictory but it isn’t. The pain relief exercises open the carpal tunnel to promote
pressure release rather than adding pressure such as follows:-
Inward wrist extensions:

Arm wrestling and archery are two extreme examples of inward wrist extensions with the
application of tremendous strength.
- Compare to:-
 A dentist using a tooth drill every day
 Mopping the floor
 Wringing out wet cloths
 Lifting heavy boxes
Outward wrist extensions:
For years I couldn’t do press ups. I simply never had the strength in my wrists or hands. I
couldn’t even get into the press up position. I can’t think of a better example of an outward
wrist extension with the application of strength.
- Compare to:-
 Getting out of a wheelchair every day
 Accelerating a motorbike
 Lifting hospital patients
 Raising the mattress to make the bed
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By Blake Schofield
Your Wrist’s Neutral Position
Your carpal tunnel is most relaxed when your wrist is in its neutral position.
Hold your wrist straight and imagine a straight line from your elbow to your knuckles. That
is the neutral position of your wrist
CORRECT POSITION INCORRECT
You can obligate your wrist to maintain its neutral position by applying an adequate
orthopaedic wrist splint. Wrist splints are an essential part of your treatment, especially
during the night when your wrist can find itself in an unfavourable position.
Acquiring an appropriate wrist split can be difficult, especially on the internet.
It’s also potentially harmful if you make the wrong choice of splint and acquire a useless
cumbersome artefact that is left unused.
A bad experience with wrist splint could put you off them for good. If this were to happen
your wrist wouldn’t receive the protection it needs and your chances of receiving surgery
would increase significantly.
Next I’m going to dedicate some attention to wrist splints to help you choose the best one
for you.
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By Blake Schofield
Wrist Splints For Carpal Tunnel Syndrome

Treatment
Correct application of an adequate orthopaedic wrist splint can often be enough to provide
sufficient pain relief and to prevent surgery. However my advise is to use your splint as an
essential part of your treatment rather then expect it to be the cure.
Adequate wrist splints:-
• Allow excellent hand and finger mobility whilst obligating the wrist’s neutral position.
• Combine good support with comfort
• Help you rest, especially during the night.
• Protect the wrist from damaging movements
• Provide much pain relief
• Permit many everyday chores to be done pain free.
That said, it’s surprising how many carpal tunnel sufferers do not use them.
This has an explanation; It’s not pleasant when you see yourself needing an artefact on
your arm to help your hand work again.
Wrist splints do take a little bit of getting used to, but they are needed. Therefore, it’s
important that you don’t let your negative thoughts get the better of you.
Think positive, be a winner!
As wrist splints are difficult to evaluate on the internet, I’ve provided this guide to help your
with your searches and choices.
Continue...
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By Blake Schofield
7 Essentials For Choosing Your Wrist Splint
1. Is the splint made to be used on both hands, or just one hand?

If a splint is made so that it can be worn on both hands, it will have a hole for your right
thumb and a hole for you left thumb in the same splint.
We have received many samples of splints and have tested some that are made to be worn
on both hands. Some are acceptable. However wrist splints made to fit just one hand fit
more snugly.
If you have carpal tunnel syndrome in your right hand we recommend a right handed splint.
If you have carpal tunnel in both hands we recommend you have two splints, one left
handed splint, and one right handed splint.
2. Is the splint one size to fit all, or a specific size?

Wrist sizes in adults vary from approximately 15cm to 24cm. Therefore, it is possible that a
“one size fits all” splint can be too big or too small for you.
It’s better if you have a splint that fits to your wrist size. To measure your wrist all your
need to do is get a piece of A4 paper and a pen or pencil. Put your wrist on the paper. Take
one end of the paper and fold it round your wrist, then mark where the folding corner meets
on the paper. Then measure the distance between the edge and your mark.
Once you know how many centimetres your wrist measures you will have reduced your
margin of error in making a wrong purchase.
It is surprising how difficult it can be to find a web page that clearly details sizes.
3. Does the splint obligate the wrist’s neutral position?

Pictures tell a thousand words, but there are some things they simply cannot tell you. It is
impossible to see from an image whether the advertised splint really will obligate your
wrist's neutral position, or not.
It is always better to look for an orthopaedic splint rather than one made to aid sport
practice, such as squash for example.
Just because a splint has a metal bar on its underside, it doesn't guarantee it will hold your
wrist straight, especially if the splint is short.
Example of the metal bar:-
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By Blake Schofield
We find the splints that best maintain the neutral position...
• extend down the forearm with a longer metal bar in the underside
• have supports on the upper side. These supports are often in the form of plastic bars
similar to lollipop sticks, but stronger.
4. Will the splint be sweat absorbent?

Good splints should absorb sweat. Cotton interiors similar in texture to bath towels are good
for this. However, your splint doesn't have to be like this, just absorbent.
You don't want a sweaty slippery splint, do you? You'll spill your drinks!
Some splints are made of one simple absorbent material. Others can have up to three
layers with a cotton interior, a Neoprene layer, and an outer layer of flexible comfortable
polyamide.
Example of a splint with a cotton interior:-
5. Is the splint easy to put on and take off?

This is turning out a bit like buying a pair of shoes, isn’t it?
Some Velcro can be really strong and if you have difficulty with your hands you might buy a
splint and not wear it because you can’t put it on, or take it off easily.
A safe bet would to check if the supplier has a guarantee. You should be able to get your
money back if you are not satisfied with your splint.
6. Is the splint easily washable?

Can you put your splint in the washing machine?
Must it be hand washed?
Some splints are made of leather, or fake leather. These are not so easy to dry out. With
others, you can take the metal bar out so that they can be washed well.
Always look for a washable splint. It's always better to shake hands with a clean splint.
7) The question; “What’s happened to your hand”?

Another reason why many people leave their splints in the drawer is because of people's
intrusive curiosity. It is funny how people can be more curious about what has happened to
your wrist rather than actually caring about it.
Upon seeing your splint in place, most people can't resist to ask…
"What's happened to your hand"?
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By Blake Schofield
It's really not worth boring people's curiosity with a detailed answer, especially if you have
to explain what carpal tunnel syndrome is. You'll just make them sorry they asked.
Our advice is not to satisfy people’s curiosity, rather feed it for your own amusement. You
could say something like “Oh it’s nothing really; I’ll have this off soon”. If the concern is real
you might be asked more discreetly.
Understanding when to use splints and for how long
a. During how much time should I wear a splint?

Well let's face it, if you are relaxed on the sofa or out for a stroll, there's not much point in
wearing a splint. Splints should be worn to avoid maximum extensions of the wrist, and also
to stop the hand drooping down.
So it's not a question of how long, it's when you need to obligate the neutral position of
your wrist during your day.
This will become clearer later when we talk about self awareness and analysis.
IMPORTANT NOTE:
During the night your body undergoes many changes in blood fluid levels. This can affect
the pressure in your carpal tunnel. Your wrist can also find itself in odd positions whilst you
sleep.
Therefore, wear your wrist splint when you go to bed so that you can sleep better.
Later on, we’ll be breaking down your daily actions to underline the unfavourable
movements you make so you realize exactly when you should be wearing your splint to
protect your wrist from the advancement of painful symptoms.
b. How long does the treatment with a wrist splint last?

There is no single time limit. Some people recover quickly, others take longer. Some people
decide to have the operation. Splints are also important to protect yourself after the
operation.
c. Where to find adequate orthopaedic wrist splints

If you are interested in receiving your own splint that fulfils all the above points, please
send me an email with the following details:-
Subject: Wrist Splint
1) Wrist size in centimetres

2) for which wrist you require a splint (Left, right or both wrists)
3) Your address:-
My Email: jbsblake@gmail.com
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By Blake Schofield
Your Control
Establishing your daily routine of the pain relief exercises and using your wrist splint is a
correct base to build and improve on. I addition to that, to help you evaluate your
development over time, your control sheet is a very important tool to reflect back on.
Recovery takes time and progress is made by noticing and working on small improvements.
Sometimes, it can be frustrating to see that improvements are not happening, or not
coming as quickly as desired.
As time goes by it is easy to get distracted and lose your perspective on development. It is
difficult to remember exactly how you were two months ago. Therefore, it is so important to
keep focused on obtaining prolonged pain relief.
For that reason, it helps to set control sheets to compare your development. Hopefully, over
time you will be able to establish new controls and recognize your improvements. This
provides the motivation needed to boost performance and consistency.
Please fill in your first control in the table below before you continue reading.
A blank control sheet has been prepared for you in appendix 1.
The Economy of Movement; Table 1: Your Control. Date: __/__/____
Symptoms & Limitations Observations

Description of pain:
Intensity of pain:
Frequency of pain:
Unfavourable actions:
Difficult movements
Frustrating tasks and chores:
Concerns and worries:
Your next improvement goal:
Comments:
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By Blake Schofield
Two Steps Forward, One Step Back
Rehabilitation is a learning process which fortunately comes naturally. However, just like
learning anything else, it’s vital to take two steps forward, then one step back.
So far, my best intentions have been to:-
1) Make you believe your situation is temporary.
2) Provide you with pain relief through a simple set of exercises.
3) Show you why and how to protect your wrist.
4) Set your control so that you can compare your improvement.
There... you have taken a few good steps forward, but before we continue it’s important
you take one step back and make sure you practise the above 4 points.
Next... we’ll be looking at your concern about recovery time.
Then... self awareness techniques and your risk areas. It will become very clear to you
when, and where you should be wearing your splint.
After that... I’m going to be introducing compensation techniques. None of these
techniques can be dominated in a few days.
Continue...
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By Blake Schofield
A Reflection Of Time
A good way to keep motivating yourself to be consistent with your treatment is to think of
how disappointed you would be with yourself if your symptoms got worse because of your
lack of application.
I call this “The Satisfaction of Accomplishment”.
Everybody likes to feel that they have achieved something in life. After all, achievement
makes you feel proud, people congratulate you, and you feel satisfaction. All of those
sensations boost positivity which is vital for recovery. We’re looking at overcoming
negativity.
In this chapter I’m going to give you a psychological exercise. It’s an extremely powerful
tool that I’d like you to try and complete. If you give it your best shot it will prove most
helpful during your entire rehabilitation. I’d like to read your finished effort.
Please allow me to explain the psychology involved with the use of a personal story of
achievement which has nothing to do with hand functionality at all.
In 2007 I passed the official German language certificate “Die Zertifikät Deutsch”.
It took me nearly 8 years to achieve.
I went through 4 different language schools because students kept dropping out due to how
much of a jigsaw puzzle the German language is.
I had 7 or more teachers, walked out on one after getting 79% in a practice exam. The
school demanded 80% in prep exams. On a Monday night I repeated, still didn’t get 80%,
she got angry, I walked out, complained, and I took my money elsewhere.
Shame, I’d have been her first student to pass the official exam. Furthermore, she is the
wife of my best friend and I was about to pay her for extra private classes for my and her
son’s benefit. Not bad to say I drove her home every night after class.
I learnt many things, far more than German alone.
I learnt how important it is to keep introducing changes to keep motivated whilst working
towards your goals. Especially when whip lashing, slave driving, demanding teachers get
angry when you’re under achieving.
I also learnt the importance of taking action rather than letting days and weeks slip by
without working on achieving goals. In front of a rehabilitation program one year can seem
like a mountain to climb. Therefore, it’s important to keep on track, keep plugging away and
striving to look back on your control sheet in three, six or twelve months time to compare
your improvement and set new controls.
In three months time you might not have applied any of my techniques, and in twelve
months time you might not have applied my techniques every month or every week.
Time flies by so quickly it results extremely difficult to put the events that occurred over the
past year together. It can become difficult to compare improvement.
The students or participants that set time aside to apply my techniques are the ones who
recover quicker. This is the exercise: “A Reflection of Time”:-
Write down an important personal event or experience that happened to you in

each month over the last 12 months.
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By Blake Schofield
Tip: Think of Birthdays, Christmas, emotions, things you bought or sold. Please try and
describe aspects of each event. Can you associate any colours, smells, or feelings?
It is more difficult than it seems. The more descriptive and elaborative you are the more
help you will get from this during your rehabilitation. Please take 11 days to do it.
It's part of my training to keep your mind working every day. If you want to take 22 days to
do a fantastic job, that will be twice as valuable.
MONTH Personal Event

This month is:
Last month was:
3 months ago:
4 months ago:
5 months ago:
6 months ago:
7 months ago:
8 months ago:
9 months ago:
10 months ago:
11 months ago:
This time last year
This exercise just goes to show how life goes on and how much you should enjoy life even
though you may be struggling. If you can get through one day, you can get through an
entire year.
How many months have gone by since you applied specific treatment regularly?
Can you improve on that starting from today?
In appendix 2 you will find another copy of this exercise in case you would like to repeat.
I’ve also added an extra table for planning simple goals.
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By Blake Schofield
Self Awareness Techniques
If I had known how damaging many simple every day actions can be to weak wrists, I
would have gained much more hand functionality in less time. I’m talking about actions and
movements that the majority of people don’t give a second thought about.
There were so many occasions my rehabilitation and improvement was impeded because I
had damaged my wrists by performing simple every day actions.
I’m sure you will relate to what I’m saying with these following examples:-
• Opening the door of the dish washer

• Picking up dinner plates
• Tying boot laces
• Squeezing tooth paste out
• Wringing wet cloths
• Using scissors
• Changing gears when driving
• Using the hand break
• Writing and typing (please use a splint and short cut keys)
To make things worse, when I got stronger my overconfidence put me back weeks.
Examples include; lifting 5 litre bottles of water, lifting the corner of the mattress to make
the bed, pushing doors open.
Well you wouldn’t be reading this now if didn’t understand how life can be conditioned
because of the difficulty involved in performing simple every day tasks.
Wheelchair basket ball players inspired me to overcome my frustrations.
On page 12, I mentioned that the maximum extensions of the wrist whilst using your
strength or applying fine pressure are the most unfavourable actions for your carpal tunnel.
If you have a look at the examples I have given on this page they all involve a slight wrist
extension with the application of fine pressure or strength. I can honestly say there isn’t
one of those actions that I don’t do differently nowadays. I have modified nearly all my
danger areas.
With some actions it’s very obvious - you scream, take your hand away and instantly
remember to modify your approach. On the other hand, there are other actions which may
not be painful but are very unfavourable.
Self awareness is needed. You’ve got to analyse your actions over the days and weeks and
think about what kind of position your wrist is in when you use strength. Then take note.
This is the reason I bought the image on the front cover with the sign language alphabet. It
demonstrates that if you put your mind into your hands they can speak.
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By Blake Schofield
Just like Gloria Estefan did, I really put my mind into the part of my body that needed to
recover.
Compare how you thought when you were learning how to drive, or when you were first
dating your partner to how you drive now, or how you are with your partner. I’m sure
plenty of bad habits have crept in there over the years in comparison to all that effort and
energy you put into passing your test or securing that relationship.
If you never learned how to drive, and you never dated, I recommend you read Gloria
Estefan’s story. She is a very famous singer who recovered from a motorway accident.
To help you put your mind into your hands I’ve prepared the following thoughts for you to
consider potentially damaging actions and to help you reduce the build up of painful
symptoms that take you closer and closer to the operation theatre.
After this simple exercise, we’re going to go deeper into the awareness and the Economy of
Movement by practicing and dominating a series of hand mobilization techniques.
Please take the time to consider the following thoughts carefully.

You can do it on the sofa and I have left a copy in appendix 3 for your further practise and
consideration:
For the moment we’re just considering. We’re initiating self awareness
techniques.
What movements give you the most pain?

Examples, wringing wet cloths tightly, squeezing clothes pegs, accelerating a motorbike,
using the car hand break, unlocking and locking doors, drying your hair, opening cans and
tins, writing and typing, etc.
………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………
Describe the action that causes the pain.

Examples;
• Using clothes pegs involves the application of fine pressure with extensions of the
wrist.
• Wringing wet cloths requires strength and wrist extensions.
• Mopping the floor.
• Carrying dinner plates in one hand.
Now mimic the actions you wrote and look carefully at your hand and wrist whilst
you go through the motions repeatedly.
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By Blake Schofield
List similar actions, but ones which do not cause as much pain:-
Examples:-
• Lifting light bags of shopping

• Making the bed and lifting the mattress
• Opening windows, cupboards, or wardrobes
IMPORTANT NOTE
For the moment, just start thinking if you can modify any of these unfavourable and
potentially damaging actions.
Here is a quick list of movements I have either been obligated to modify due to mobility loss
or ones I have voluntarily adapted. Later on we’ll go into voluntary adaptation and talk
about why it’s requires practise.
. I refuse to hang clothes to dry with pegs. When my wife asks for extra help, I use a
clothes horse and no pegs.
. I never press the button on the car hand break with my thumb.
. Opening tins and cans is a rarity. Only tins of tuna or sardines in olive oil are worth the
fight for me. Everything else is bought fresh and preferably not in plastic packaging.
. I fill my own shopping bags with loose vegetables. I know that’s not often easy in
supermarkets. I buy in market stalls, the kind of “come and get your bananas - a pound a
pound – a pound a pound f’ya bananas folks”.
. I always lift dinner plates with both hands whilst setting or clearing the table.
I think my point has been made. Let’s move on to hand mobilization exercises to
help you get to know your hands more.
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By Blake Schofield
Hand Mobilization Exercises
VERY IMPORTANT NOTE:

The following exercises are to be practised until you can do them over and over again
without consulting the photographs.
You will get better as you go along. If you put your mind to it you will get to the stage
where you have run through the series in your mind in preparation to start the warm up.
You will also notice yourself skipping from one exercise to the next without consulting the
photos.
Your goal is to perform all the exercise by fully concentrating on the hand joints. You will
discover how your mind can efficiently move these joints on your hand.
You are looking to move the joints of your hand and nothing else. Your fingers will follow.
There should be complete relaxation, good posture, no tensing of your body and fluid
executed movements of hand joints only.
When you get to that level and you realize you have stopped moving your arm, elbow,
shoulder, neck, head, abdomen, legs, or feet you will have discovered The Economy of
Movement. This will establish the basis of your hand rehabilitation.
Please do not continue onto the hand flexibility and strengthening exercises or the
compensation techniques until you are an expert in these next exercises.
Just keep practising until you get there. You will notice.
IMPORTANT NOTE:
Please remember “The Satisfaction of Accomplishment” (on page 20). Also print appendix
2b and place The Economy of Movement in one of your quarterly goals.
MOTIVATION & WARM UP
It can often be an effort to find the motivation to go through a series of exercises. It helped
me to think about how good I feel after my exercises to motivate me to do them. I feet
good for two reasons; firstly for actually doing the exercises, and secondly because they
made my hands feel better.
Your exercises should always be done carefully without rushing.
I find this series better done relaxed at a table. It’s short but brilliant for mobilizing!
All our exercise programs start with a warm up. I memorized this one easily because it is a
little like doing a prayer. If you are a religious person, just take this opportunity to prey
that your hands get better.
Remember to keep a good relaxed posture and never over stretch.
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By Blake Schofield
Praying warm up; PALMS

1. Simply place palms together 4. Gently move your elbows upwards.

2. Relax arms and body (low elbows) 5. Feel the tendons under your wrists
3. Take a few soothing breaths 6. Repeat gently three times
Praying warm up; FINGER TIPS

. Place finger tips together . Gently move elbows upwards

. Relax arms and body . Keep finger tips together
. Take a few soothing breaths . Repeat gently three times
Continue...
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By Blake Schofield
10 STEP HAND MOBILIZATION EXERCISES

What we are looking for here is economy of movement. We don’t want to be moving our
entire arm and shoulders when these exercises are for specific joints. It helps if you
concentrate on the joints in question and limit the movement to those joints alone.
Repeat each step three times
STEP 1.
Touch your shoulders. Then move your arms down by your side until they are straight.
It’s to get the blood flowing more!
STEP 2. Wrist turn – Wrist joint from horizontal to perpendicular.
FIRST POSITION END POSITION

1. Place elbow on table 4. Move your wrist clockwise

2. Palm on table 5. Little finger flat on the table
3. Concentrate on little finger 6. Thumb nail pointing to the ceiling
STEP 3. Fist to flat hand

. Place elbow on table . Open fist slowly

. fist on table . Fingers flat and relaxed on table
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By Blake Schofield
STEP 4. Wrist Slide – left to right

. Place elbow on table . Move wrist to the right

. Palm on table . Little finger moving towards two o’clock
. Little finger at 11 o’clock . Only move the wrist and not too much
STEP 5. Finger joint curl – finger tips to under your knuckles

. Place elbow on table . Curl finger tips and thumb to palm

. Back of hand on the table . Give a little press on palm with tips
. Find a comfortable hand position . Be careful not to over do it!
. Keep knuckles flat on table
STEP 6. Knuckle Curl – make sure you see the difference from step 5!

. Elbow on table . Curl “knuckles” moving fingers in

. Palm facing up . Make an upside down fist
. Give a little squeeze
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By Blake Schofield
Step 7. Individual finger movement towards thumb

. Elbow on table, palm on table in relaxed comfortable position (as always should be).
. Move thumb out. Then one by one, move each finger individually towards the thumb.
. If you can, make semi circle movements by lifting your fingers off the table rather than
sliding your fingers along the table.
STEP 8. Individual finger movement towards the little finger
1 2 3 4

5 6

This is the opposite to STEP 7.
1. Palm on table.
2. Move little finger away.
3 - 6. Then, one by one, move each finger individually towards the little finger, finishing
with the thumb.
NOTE: If you can make large semi circles by rising instead of sliding your fingers it helps
more with mobilization.
Look for maximum extension in both step 7 and step 8.
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By Blake Schofield
STEP 9. Thumb lift with slight resistance

. Elbow and wrists wresting on table . Lift the bottom thumb

. Hands together . Apply slight resistance with upper thumb
. One thumb over the other . Change thumbs round.
STEP 10. Thumb tip to finger tips

. Elbow and wrist on table.

. Open palm fully with maximum distance from thumb tip to little finger tip.
. Move thumb tip to little finger tip (little finger helping a little).
. Open palm fully again and repeat with thumb tip and next finger.
. Make the thumb touch all four finger tips with maximum palm opening between touching.
. Don’t just touch the thumb tip with your fingers. Really open the palm each time.
This was the first series of exercises which I learnt in the Occupational Therapy
Rehabilitation Unit at Barcelona’s Hospital d’esperanza (hospital of hope).
When I was given these exercises on a sheet of paper I couldn’t feed myself or hold an
empty yogurt pot, never mind squeeze it.
Over time, they helped me regain my hand mobility.
As you can find from these exercises, they are not strenuous and don’t involve bad
movements for the wrist.
If you are having difficulty with movement in your hands, the daily application of this series
can be very beneficial.
Oh! I nearly forgot. You can always help yourself along with your other hand.
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By Blake Schofield
Over confidence
Once you have achieved The Economy of Movement by practising the 10 step hand
mobilization series you should feel a considerable improvement in your hand mobility.
This should make you more aware of actions you are able to do better.
WARNING: At this stage there is a danger of overconfidence. Here it’s most important to
ensure correct wrist protection and develop your self awareness.
Your self awareness should improve along with your mobility improvement.
The time line idea I give to reaching this point is about 6-8 weeks. That might sound like a
long time but let’s have a closer look at what new changes and adaptations you should be
introducing into your new life.
I’ve prepared this in a check list form to help you complete the individual tasks.
Subject Page Date confident with
A new motivated beginning 4-5
Understanding your problem and 6-8

causes
Pain relief exercises 9-13
Wrist protection 14-20
Your Control 21
Individual goals / achievement over 23-24

time
Self awareness 25-27
Hand Mobilization 28-35
IMPORTANT NOTE:
Please do not continue reading until you have practised all the above subjects. Later on I
will introduce hand flexibility and strengthening exercises.
Maybe you could even establish a new control at this point!
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By Blake Schofield
Compensation Techniques
Soon we’re going to move onto some specific hand flexibility and strengthening exercises
which I have included to strengthen your more able hand so that it can compensate simple
every day tasks that your less able hand should not be doing.
On page 22 I introduced self awareness, then I followed up with the mobilization exercises
that enhance your self awareness.
When you combine self awareness with gained mobility you will get better at locating your
damages and dangers. I mean your risk areas – The unfavourable passive actions that can
provoke the advancement of your symptoms closer and closer to surgery.
The more difficult part is reminding yourself to pass the work of many simple every day
actions over to your more able hand.
Compensation Techniques Require Practise

Compensation techniques require practise and I’m going to explain exactly why.
Therefore, it’s vital you have adapted the previous techniques into your new life before you
continue to practise the coming exercises.
Ambidextrousness
Ambidextrousness is the ability to use each one of both your hands indifferently.
Very few people possess this quality. I doubt you do, but you will be surprised how much
you can improve the functionality and incorporation of your hand that suffers less pain.
The vast majority of the population with two hands have one hand which is stronger and
more agile than the other. We often call it our good hand.
Obviously, that doesn't mean that the other hand is bad, it's just that the weaker hand isn't
used in the same way, or isn't used as much. Hence, many people suffer Carpal Tunnel
Syndrome in their so called good hand.
However, stop there.
Many people suffer Carpal Tunnel Syndrome in both hands. Maybe you do! Therefore, to
avoid confusion I will use the term "able hand" to describe the hand that feels less pain, or
doesn't suffer CTS.
Your able hand is the one which suffers fewer or no carpal tunnel syndrome symptoms.
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By Blake Schofield
Why Compensation Techniques Take Practise
The human body makes many movements without the brain deciding to give the order to
execute these movements. For many quick and simple actions nerve pulses travel to the
spinal cord, and it is there where the decision for the movement is made. In many cases a
journey to the brain too slow. For example, think of reflexes and simple repetitive
movements such as locking the car door with the remote control.
Do you always remember locking the car door?
Do you often have to check?
Coming back to our new friend on the production line, if he isn't ambidextrous, and
considering that most of his quick or repetitive movements can be done almost
subconsciously, I'm sure you would agree with me that it is very difficult for him to work
with both hands.
With your CTS you must think about the simple every day potentially damaging actions
that come so naturally to you. For the moment, it’s important that you just think where
you can compensate the same task with the use of both hands. Remember many of these
movements are automated in your spinal cord. So, locating them is the first step.
Go one step further in your self awareness and begin to concentrate on simple painless
wrist extensions. These painless actions don’t let your carpal tunnel rest when strength or
fine pressure is applied. No matter how painless.
Remember to keep using your splint too! Wrist protection is vital.
For now we are just locating where we can compensate and protect so that your more
painful hand can relax.
For people who suffer carpal tunnel syndrome in their less able hand it makes sense that
compensation with their stronger more able hand would come naturally.
Let’s start improving your hand flexibility and strength so that you can improve
compensating tasks with the use of both hands and the subsequent use of your more able
hand to take charge of many actions.
Please go through the motions of the following exercises

to learn the steps.
Start by using a wrist splint on your less able hand to keep

it relaxed whilst you are strengthening your able hand.
The concept of these exercises is to improve the

functionality of your more able hand so that it can
compensate more work for your hand that suffers the
most pain.
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By Blake Schofield
Hand Flexibility and Strengthening Exercises
Before we begin with this routine, it is important that we reconsider the wrist’s neutral
position. Think of it as a straight line from the arm to the knuckles. See below:
CORRECT POSITION INCORRECT POSITION
Imaginary straight line Here the hand bends backwards
Whilst you are learning this series of hand strengthening exercises, we recommend that you
wear a splint on your wrist which is experiencing carpal tunnel syndrome. This way you can
proceed safely by fully concentrating on making your more able hand as strong as possible
whilst at the same time relaxing your CTS.
Here is another example of a wrist splint:
There is a metal bar within the splint that ensures that the wrist is kept in the neutral
position. Therefore, the splint helps to keep as much pressure off the median nerve as
possible.
Ideally, this set of exercises should be done at least once a day to gain as much strength in
the shortest period of time as possible. The less the routine is done, the longer it will take
to gain strength.
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By Blake Schofield
This routine will help you:-

 Direct psychological attention away from your CTS by concentrating on
strengthening your more able hand.
 Strengthen your hands
 Alleviate your CTS by using your more able hand to do things that it normally
doesn’t do. Like opening, pulling, turning, etc.
 Become less obsessed with your CTS
 Alleviate the pressure on your median nerve
My physiotherapist needs very strong and flexible hands to perform all the message work
he does. He practises this routine twice a day to keep his hands as strong as possible
This is the very same routine I used to regain the strength in both of my hands after I was
released occupational therapy after I had regained sufficient mobility.
Motivation
Fortunately this set of hand strengthening exercises can be done sat down on the sofa.
Therefore, it’s a little easier to start as you don’t have to clean a table to do them.
I always do them in front of my favorite T.V. series in the evening. That way I’m relaxed, a
regular routine is created, and I feel good with my self after I have finished them.
The more regularly they are done, the stronger your hands will become in a shorter period
of time.
Warm Up
Rub your palms together, rub the back of your hands, and then rub your wrists until
warmth is felt from the friction.
STAGE 1:
I remember these 4 exercises as the “fingers together” part of the set.
Please apply our a b c to all exercises:
a) NEUTRAL WRIST POSITION: keep that neutral position in both hands at all times possible
(This is represented by the black arrows on the photo’s). Do not to be tense in your hands
or arms whilst exercising.
b) GOOD BODY POSTURE: As well as a good wrist posture, keep a correct body posture. Sit
up straight without slouching, legs uncrossed.
c) ECONOMY OF MOVEMENT – you don’t want to be moving elbows and shoulders when
what we want is stronger hands. Concentrate on moving only the joints of your hands.
Just slowly go through the motions at first
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By Blake Schofield
STAGE 1, STEP 1/4: – Palm cross

1. Lock hands together 5. Move right thumb under left hand

2. One index finger under the other 6. Only move your wrist and hand (not arm)
3. One middle finger under the other 7. Keep all fingers in this crossed position
4. Hands relaxed as possible 8. Gently squeeze fingers and hands together
When you squeeze your hands together, don’t just press quickly. Take your time to feel
everything being lightly squeezed, your little finger, index finger, notice everything!
Repeat with left thumb going under right hand – Repeat 5 – 10 times.
The repetition can be done faster and stronger over time, but to learn the exercises they
should be done slowly and carefully with thought and concentration.
STAGE 1, STEP 2/4: - Knuckle press

Classic neutral
position
1. Hands together, elbows on table 4. Press left knuckles with right finger tips
2. Finger tips on top of knuckles 5. Lift left fingers with right knuckles
3. Keep neutral position in both arms 6. Notice flat left wrist, only fingers rise
Repeat 3 times with your other hand.
I sometimes hear a click when pressing against the knuckles. If that happens, and as long
as that isn’t painful don’t let it alarm you. Here we are not bending the wrists back, but
only lifting the fingers whilst pressing on the knuckles.
The wrists should remain straight as possible.
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By Blake Schofield
In Step one, we did a squeeze, here a press. Just do until you feel comfortable, it’s very
important not to over do things.
Sometimes, I couldn’t do certain exercises after straining my tendons by lifting heavy

objects. So, remember your control, self awareness, and development.
The exercises should be done without pain and strain, always comfortable and relaxed and
feeling the benefit
Here’s the repeat with the opposite hand:

It’s important to feel warmth rather than pain by squeezing and pressing too much. After
all, your not going to strengthen your hands if you damage them, are you?
STAGE 1, STEP 3/4: – Tendon Stretch.
This cannot be done whilst wearing a splint, be as gentle as possible. Feel the tendons
stretch. Do not push your palms out too much.

. Hands together . Slowly move palms out

. Feel the tendons in the wrist
. Hold for 7 seconds
. Don’t over stretch, just feel tendons
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By Blake Schofield
STAGE 1, STEP 4/4: – Palm Squeeze

. Palms together & squeeze . Turn position palms touching . Squeeze again
. Repeat 5 – 10 times
Keeping the thumb bases together whilst turning obligates the fingers to stretch out. Try to
keep your thumb bases touching at all times. Look for economy of movement.
Shake your hands a little after this stage
STAGE 2 – There are 5 steps to this stage
Stage 2 involves manipulation of individual fingers. In each of the 5 steps one hand moves
all the fingers on the opposite hand. The fingers to be moved should be fully relaxed –
sleeping let’s say.
STAGE 2 STEP 1/5: - Finger back, tendon stretch.

1. Hand completely relaxed 6. Hand completely relaxed

2. Neutral position, fingers sleeping 7. Neutral position, fingers sleeping
3. Support back of little finger with thumb 8. Support back of fingers with thumb
4. Bend little finger backwards slightly 9. Bend next finger backwards slightly
5. Don’t over do it 10. Don’t stretch too far.
Repeat three times with all fingers, and thumb.
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By Blake Schofield
STAGE 2, STEP 2/5: - Finger in, and hold
This is the opposite of Step 2. Here we move the fingers in rather than back.
It is important to keep the other fingers open and only move one finger in at a time.
One by one, move the fingers into the palm and hold for a few seconds

STAGE 2, STEP 3/5: - Open gate and turn

1. Pull little finger slightly 4. Whilst still slightly pulling turn little finger
2. If possible so all three joints give 5. Turn slightly clockwise, then anti clockwise
3. Hold finger with joints slightly open 6. Keep neutral position in both wrists
Repeat with each finger two or three times. Make sure the pull and turn is gentle without
resistance from the finger that is being turned.
Continue...
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By Blake Schofield
STAGE 2, STEP 4/5: - Finger rotation, full circle (up, round, down and back up)
This exercise is similar to the one above, but here we are looking to make a full circle with
the fingers, looking for the maximum rotation whilst feeling comfortable.

. Here the fingers of one hand are to be moved in a full circle one by one
. It’s a full rotation of the knuckle joint whilst slightly pulling the finger
. Repeat clockwise and anti clockwise for each finger and thumb 2 – 3 times
STAGE 2, STEP 5/5: - Finger Fan. Thumb out Thumb in.

1. Hands open straight 3. Curl little finger in 5. Press thumb on index

2. Thumbs pointing up 4. Then the next fingers 6. Open hands out again.....

7. Hands open again . 9. Index finger over thumb 11. Press fingers on thumb
8. Move thumb in 10. Curl next fingers over thumb
Much finger strength can be gained with this exercise. Look to keep the wrists straight as
possible at all times. Only move the fingers, and look for the maximum rotation each time,
don’t be afraid to really reach out whilst moving fingers.
Over time, you will be able to do this exercise better and faster
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By Blake Schofield
STAGE 3 – Wrist Exercises
This involves 5 easy and important exercises. I couldn’t do press ups a while back, but with
time and these exercises my wrists are strong enough for me to do them again.
STAGE 3, STEP 1/5: - Palm back

1. Right palm on left fingers 4. Gently push palm back

2. Finger tips on thumb 5. Feel tendons in wrist
3. Neutral position in both hands 6. Repeat 2 – 3 times
STAGE 3 - Make a fist and keep arm straight

STEP 2/5:- STEP 3/5:- STEP 4/5:-
Fist up & down Fists left & right Fist Roll

. Move fists up then down . Move fists left & right . Roll fists around
STAGE 3, STEP 5/5:- Palms up, palms down
This is the final exercise in our set, simply alternate palms up and down:
Both down – both up Then, one up-one down

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By Blake Schofield
Advanced Exercise Techniques
Have you ever felt that you’ve walked down the street and not realized what was going on
around you? Maybe bumped into someone, or even stepped out in front of a car?
By focusing and concentrating on your exercises you will get much more out of them, but
you can do even better!
To help you get the most out of your exercises, I’m going to give you an explanation of the
very same techniques I practised to regain my mobility, flexibility, and strength.
The combined result permitted me to involve both hands more. With practise you will be
surprised how closely your hand functionality can be balanced between both hands. This is
first noticed with the mobilization routine.
Let’s have a look at how you can be as efficient as possible with your exercises.
This is how I see it:-
• Establishing and respecting your routine: 50% importance

• The physical hand exercise practise: 10% importance
• Concentration & advances techniques: 20% importance
• Relaxation 20% importance
Advanced Exercise Techniques
1. Promoting consistency by respecting your routine.
When Carpal Tunnel Symptoms are daily it is difficult to plan ahead. You just want to get
through your day (or the night).
Just the thought of the upcoming tasks that will be difficult and frustrating block us from
planning ahead.
How do you see yourself in 12 months time?

What about this time next year?
Try and set yourself a longer term goal and work towards it.
Try not to let weeks go by without sticking to you routine.

Look to establish a routine 2-3 times per week.
I did my routine in the evenings during my favourite T.V. series. That way they were
regular and there was also another factor reminding me about them whilst at the same time
motivating me and preparing me.
Besides, after completing the exercises I felt good with myself for keeping on track. My
hands also felt better too.
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By Blake Schofield
2. Preparation
Once you have established your routine (I mean your time schedule when you intend to
perform your exercise series), it can be difficult to find the motivation to respect it.
It helps if you remind yourself during your day that you must respect your routine.
When the time arrives to do your exercises, it also helps if you go through the series in your
mind before you gather yourself to perform.
3. The warm up
Use your warm up not just to warm your hands and wrists. Take your time over your warm
up to park distracting thoughts, to establish a good body posture, stop tensing, relax and
focus.
Go through what you’ve got to do in your mind first.
4. Be an albatross in flight
Have you ever seen an albatross running to take off?
The albatross is a huge bird. If it cannot take to the air by jumping off a cliff or taking
advantage of the sea wind, it must find a runway to take off from.
For a running take off, the Albatross spreads out it’s wings then runs, bobbles, flaps, flops,
jitters, jumps and somewhere down the runway manages to get the speed and lift required
to fly off.
Watching such a clumsy looking running take off is quite funny. It is such a contrast from
the elegance the Albatross shows when flying in flight. Whilst in flight they are most
majestic flyers and can fly thousands of miles with the minimum amount of effort.
The albatross is most graceful with its Economy of Movement.
The comparison I am trying to make is the clean performance of your hand exercises
against a tense performance of the same exercises with the movements of other body parts
rather than just the hand joints in question.
Can you think of any other examples?
Usain Bolt doesn’t seem to struggle when he’s running 100metres faster than any other
person. Roger Federer never seems to get ruffled when winning at Tennis.
Can you see what I’m getting at?
The exercises in this guide are most specific. They can change your life if you put your mind
into your hands and concentrate on the objective of each individual exercise.
The next piece of advice on advanced exercise techniques is also very powerful. It is most
productive when you feel your hands tingling after you have completed the repetitions of
your exercise series.
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By Blake Schofield
Development of this next piece of advise can significantly improve your hand functionality
by relaxing correctly after you have completed your exercises.
5. Let your imagination run far away whilst you relax.
After you’ve completed your workout, especially with the flexibility and strengthening
series, you will feel your hands energized and tingling.
This is a good sign and a good feeling. It’s also when to relax and channel that energy for
efficient hand functionality improvement.
Now, this might seem a little cosmic but believe me it works miracles…
...After you’ve completed the repetitions of your series, close your eyes, breathe slowly,
concentrate on feeling your hands, and let your imagination take your far away.
It is quite easy to complete your exercises and then go and do something else or
concentrate on something else. If you do this you will miss out on an extremely important
part of your routine. The relaxation.
An emotionally balanced mind that is in tune with your body will recover better.
If you take the time concentrate on feeling your hands tingle whilst promoting a relaxed
state of ming for around 10 minutes after each series of exercises you will improve all your
chances of non surgical or post surgical recovery.
The following natural elements can provide optimal relaxation:
 Wind
 Water
 Fire
Go one step further and associate sounds and colours and imagine that build up of carpal
tunnel pressure coming out of your wrist.
Things that are good to imagine are:- waterfalls, wave breaks, pneumatic sounds for
pressure release, calm breezes, soft tactful sensations like satin, etc.
Try it! Take yourself miles away to a place where you can only feel your hands whilst
managing to achieve an enjoyable relaxed state of mind.
Once you achieve this your days will change through enhanced self awareness, mobility,
and you will be ready to take your compensation techniques to the level of permanent
adaptation to counter certain conditioned behaviour.
After you have practised the relaxation techniques I suggest you have another go
at appendix 3 and compare it to your first effort.
Let’s have a closer look at permanent adaptations.
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By Blake Schofield
Permanent Adaptations
On page 23 I mentioned many problematic actions; opening the door of the dish washer,
picking up dinner plates with one hand, tying boot laces, squeezing tooth paste out,
wringing wet cloths, using scissors, changing gears when driving, using the car hand break,
writing and typing?!
On page 24, actions I now do differently.
• I refuse to hang clothes to dry with pegs. When my wife asks for extra help, I use a
clothes horse and no pegs.
• I never press the button on the car hand break with my thumb.
• Opening tins and cans is a rarity. Only tins of tuna or sardines in olive oil are worth
the fight for me. Everything else is bought fresh and preferably not in plastic
packaging.
• I fill my own shopping bags with loose vegetables. I know that’s not often easy in
supermarkets. I buy in market stalls, the kind of “come and get your bananas - a
pound a pound – a pound a pound f’ya bananas folks”.
• I always lift dinner plates with both hands whilst setting or clearing the table.
I have learnt to find it easier to change habits.
• I never dial numbers on my mobile phone with my right hand. Come to think about
it, I hardly hold or pick up my mobile phone with my right hand.
• I have adapted this behaviour for ever (Darwin was right!).
On page 33 we mentioned why some compensation techniques take practise. A quick

decision like reaching out for your mobile phone can start and finish in your spinal cord.
Therefore, if you decide to start using you phone with your left hand the change takes time
and practise before it becomes natural and permanent.
This cannot be learnt by reading. It has to be practised. I just hope you can see the
structured help I am giving you to help you communicate better with your hands.
At this point we have covered a large part of the physical part of this guide and soon we will
move on to how you can help yourself on a more social level. However, before we move on,
let us recap on the steps we have made that can take you to the point of these permanent
behavioural changes that I am touching on.
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By Blake Schofield
Structured help towards permanent changes in behaviour
Belief
Pain Relief Exercise
Wrist Protection
Self Awareness
Mobilization
Compensation
New behaviour
We are here.
Partnerships through
Social Activity
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By Blake Schofield
Partnerships
I believe we are feeling bodies who think, more than thinking minds who feel.
Social activity provokes many different kinds of feelings. From my personal experience, I
strongly recommend various kinds of social activity to help find those partners and new
friends who can stimulate your motivation levels to keep on track with my guide.
I strongly believe that these practises are immensely beneficial. They provide a basis for
you to realize how to improve on so many negative aspects in your life.
The fist example can be done in groups too:
1. Yoga / Chi-Kung / Thai-Chi

Ancient oriental exercise practise is based on the philosophy of gaining a correct flow of
energy and emotion through the body. After I was released from hospital I practised the
ancient art of Chi-Kung (it is similar to Thai Chi) which helped me regain movement and
also helped me emotionally. I learned the benefit of breathing correctly and I also learnt
the importance keeping a good posture throughout the day.
2. Acupuncture
Acupuncture now has a respected place within our society and qualified sessions could
provide necessary alleviation.
Chi-Kung is an ancient Chinese martial art considered to be acupuncture without needles.
3. Bach remedies.
This is the application of natural creams and oils from flower extracts. In the early 1930's
the reputable London Harley Street Doctor Edward Bach created different natural remedies
to help soothe pain and balance emotions.
I suffered problems with nerves throughout my body, hypersensitivity on one side and the
lack of sensitivity on the other. My body was confused, and I had many shooting twitches
and pains. I had many uncomfortable pains in my legs and strong burning sensations.
The application of Bach remedies quickly solved my leg pain and gave me enormous
alleviation. Bach remedies are most soothing and relaxing. For more information:
The Dr Edward Bach Healing Trust, The Bach Centre, Mount Vernon, Bakers Lane, Sotwell,
Oxon, OX10 0PZ, UK
4. Other ways to find encouragement, compassion, and motivation

We are approaching the end of this guide. However, improving the balance between your
mind and your body is a never ending process. Try asking the Buddhist monks!
Furthermore, there is plenty of content and suggestions in this guide to keep you on the
road to recovery for months, if not years.
Let us have a look at where else you can find partnerships through social activity.
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By Blake Schofield
- Facebook (the social networking website) is an example of how you can find friends who
are in the same boat as you. Afterall, it´s not every day you meet in person someone who
suffers CTS. In Facebook you can ask other people about there first hand experiences every
day.
All you need to do is create an account in Facebook and search for carpal tunnel syndrome.
I have my own Facebook group at the following Facebook address.
http://es-la.facebook.com/
Once you have created your account you can find my group by searching for the following
email address: blake@tunelcarpiano.es
Once you have found a group all you need to do is join and give it a whirl.
Personally, I´m not a fan of Facebook. I much prefer blogs. With blogs you avoid all the log
in process and extra email.
- Blogs My advice is to find an active blog written by someone sharing his or her personal
experiences with plenty of comments from readers.
Here mine.
www.tunelcarpiano.es/blog
Neither am I trying to plug my blog, nor my Facebook group. I urge you to use your
preferred search methods and find the groups and blogs you prefer in the hope to find a
friendly partner that can inspire you and motivate you.
You never know you might read one simple piece of advice that could motivate you for ever.
Continue...
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By Blake Schofield
Final Thoughts
I´d like to finish off by mentioning conventional medicine, your self discipline, and your
health.
Conventional Medicine (not alternative therapy)

Some people can achieve much pain relief from their symptoms with the use of anti-
inflammatories. Normally they are taken orally.
IMPORTANT:
In cases of diabetes, rheumatoid arthritis, or pregnancy, medical control of this illness is
obligatory.
Injection of steroids:
When the use of an anti-inflammatory proves insufficient to alleviate symptoms, an
injection close to the carpal tunnel can provide alleviation for a high percentage of CTS
sufferers.
The probability of the symptoms reducing decreases with repeated injections.
If the symptoms are alleviated by the strength of the pharmaceutical aid but no
other change in behaviour is applied to cure the problem, it is the pain that is
being removed but not the cause.
Self Discipline
We've talked about the importance of the positive emotions prevailing. Try to use your
strength of character to quickly eliminate negative emotions and attitudes.
If you find yourself hitting a low for a continued period of time, it would be such a shame to
have followed our advice consistently throughout two months, just to slack and see yourself
going back due that dip in consistency / emotion.
Remember; Self discipline is all about taking action when you don’t always feel
like doing so, rather than waiting to until you feel like doing something to get it
done.
Your Health
George Best was one of the greatest footballers ever.
At one time he was better at kicking the ball with his right foot. Funnily, he practiced so
hard with his left, he said that his left foot became better than his right.
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By Blake Schofield
My left hand was initially less able than my right. Now, my right hand needs more work on
it as I concentrated more to get the left one working.
In the end, George best didn’t follow doctors advice and drank himself to death.
It’s all about helping yourself as much as possible. If you live an unhealthy life, maybe your
carpal tunnel would become easier to treat if you were healthier.
Go over your day, realize when you’ve had a good hand day, and also when you’ve had a
bad hand day. Notice your mistakes, and build on the good days. Realize where you have
made changes, be conscious and decide to take those adaptations towards permanent
changes in your behaviour.
After time compare to your forms and compare developments over time, be extra careful
not to return to the habits of old. We looking at adapting changes for life!
I understand it’s not easy to accept that something comes your way and conditions your
life, but we’re strong and possess great spirit and humour.
Use the threat of surgery as a tool to motivate you to prepare as well as you can for the
best recovery possible.
Sincerely, I wish you all the very best.
I would love to hear your comments about the benefits of the application of these
techniques. Please feel to post in my blog or send me an email.
My blog: www.tunelcarpiano.es/blog
Email: info@tunelcarpiano.es
Email: jbsblake@gmail.com
All my very best
Blake Schofield
The appendix follows this page.
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By Blake Schofield
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By Blake Schofield
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By Blake Schofield
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By Blake Schofield
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By Blake Schofield

Ejercicios Tunel Carpal

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“The Economy of Movement”

Carpal Tunnel Syndrome Treatment

Understand the reason why you suffer painful symptoms.

Practise correct specific carpal tunnel pain relief exercises.

Greatly improve your hand mobility, flexibility and strength.

A Temporary Situation ............................................................................. 3

Understanding Your Symptoms ................................................................. 5

Pain Relief Exercises ................................................................................ 8

Exercises to Avoid ...................................................................................11

Protecting Your Wrist ...............................................................................12

Wrist Splints For Carpal Tunnel Syndrome Treatment ..................................14

Your Control ...........................................................................................18

Two Steps Forward, One Step Back ...........................................................19

A Reflection of Time .................................................................................20

Self Awareness Techniques .......................................................................22

10 Step Hand Mobilization Exercises ..........................................................25

Over Confidence .....................................................................................31

Compensation Techniques ........................................................................32

Hand Flexibility and Strengthening Exercises ...............................................34

Advanced Exercise Techniques ..................................................................42

Permanent Adaptations ............................................................................45

Final Thoughts ........................................................................................49

1. Hand functionality disorders in perspective.

When I received occupational therapy to improve the functionality of both my hands, I

We humans have a way of motivating ourselves by making comparisons to people worse

2. Why did this have to happen to you?

The fact is that it isn’t just you.

Your performance is essential in reducing your chances of surgery, or in your preparation

Understanding Your Symptoms

2. The median nerve

3. One delicate place.

4. The cause of carpal tunnel syndrome

Possible causes of carpal tunnel syndrome are:-

• Variations in fluid levels (changing blood sugar levels in diabetics)

We’ve learnt so far that-

Understanding the cause of your pain helps to eliminate:

1) The frustration of not knowing why you feel symptoms.

Take five minutes to think about what your

Pain Relief Exercises

Stretching exercise 1 – carpal tunnel pressure release exercise

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Stretching exercise 2 – finger work

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Stretching exercise 3 – carpal tunnel pressure release.

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2. Mobilizing the median nerve

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4. Wrist joint liberation

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Protecting Your Wrist

Inward wrist extensions:

Your Wrist’s Neutral Position

CORRECT POSITION INCORRECT

Wrist Splints For Carpal Tunnel Syndrome

7 Essentials For Choosing Your Wrist Splint

1. Is the splint made to be used on both hands, or just one hand?

2. Is the splint one size to fit all, or a specific size?

3. Does the splint obligate the wrist’s neutral position?

Example of the metal bar:-

The Economy of Movement; Table 1: Your Control. Date: //____