My name is Hoang, I’m an occupational therapist and certified hand therapist, and I can tell you right now, flexor tendon injuries are some of the worst hand injuries that anyone could have. And if you’re going through this, I’m really sorry.
What Exactly is a Flexor Tendon Injury?
For those who might not know, let me break it down in simple terms: A flexor tendon injury happens when the tendons that help you bend your joints, like in your fingers, hands, or feet, are damaged or torn. Such injuries can result from trauma, lacerations, or overuse, leading to limitations in joint movement and needs special medical care to get better.
I understand the frustration and even the emotional toll that comes with a flexor tendon injury. It’s confusing and challenging to know what to do and what to expect. So, read on to discover the top five exercises that I often recommend to my patients after a flexor tendon injury. These exercises can also be done on your own, giving you more control over your recovery.
Adjusting Exercises Based on Your Recovery Stage
What you can do with a flexor tendon injury depends on how many weeks you’ve been out of surgery. So what you do at week number one and number two is completely different than what you do at week six and week eight.
So, based on where you are in your journey, talk to your therapist about what you can do. The five exercises I’m sharing are meant to be done beyond the ultra-sensitive phase, so you’re being careful without risking damage to the tendon repair. You don’t wanna do anything that’s gonna rupture the tendon repair.
If you’ve had what’s called digital nerve repair because you cut the little nerves on the side of your finger, you can’t do anything at the very beginning of the first two weeks of that repair. So, these exercises are when you’re safe to do everything. And if you’re not sure, please, please go talk to your certified hand therapist first to make sure that these are safe.
1. Managing Swelling with Gentle Massage
So, number one, first and foremost, swelling is a really huge concern for anyone who has a hand injury, and swelling goes away very slowly. Very slowly.
At first, when you’re really puffy, that amount of swelling goes away fast. But the residual swelling that remains there and it keeps coming and going and it’s like, “why I can’t put my ring on, it still feels so tight and so swollen”, that swelling takes a really long time.
You might not see it gone until like 6, 9, 12 months after your surgery. So, it does take a while, but what you’re looking for are small incremental improvements, little bit by little bit by little bit, and then one day you’re gonna notice, “I don’t have any swelling.”
But it takes a long time, so if you’re worried about swelling, please don’t worry so much about it. The movement is what’s going to help the swelling the most. So, first and foremost, gentle massage can help. Massaging from the top down and using your finger’s thickness to your advantage can aid in reducing swelling. When you massage from the top down, make sure you can move all throughout the finger, and don’t just focus on one spot. You wanna move through the whole thing.
Watch our YouTube video on 5 exercises to help you after a flexor tendon injury and discover another easy exercise which is helpful for swelling.
So, that’s one of my top exercises. As you get the swelling down, and then you just work on that a little bit, it’s gonna help you feel like “I’m getting somewhere, and I want to be able to do more.”
2. Effective Scar Massage
Number two, the most important thing is also scar massage. So, if you have a flexor tendon, you might have the scar right here on the top of your fingers. I encourage you, you can massage it up, you can massage it down which direction feels really good for you. But scars don’t just work in one-dimensional ways. Once you have swelling, you have a little bit of scarring throughout your finger, and it’s not just where the surgeon made the incisions, you have it all around.
That’s why your finger feels so tight as you move. So, you can massage all of the skin. One way to do it is massaging up and down, but I would also encourage you to massage rolling it. You can also move your hand in one direction, and that way you can massage the scar in one direction, and then also in the other direction. Find the direction that feels the best, and go into that direction first. And then move into the other direction because scars need movement.
3. Prioritizing Full Passive Range of Motion
Number three, the other exercise I like to do is a full passive range of motion. To make sure your tendons and muscles can function properly, achieving full passive range of motion is crucial. If you don’t have full passive range of motion, meaning you can push your knuckle all the way down, and you can straighten it all the way up, if you don’t have full passive range of motion, then your tendons, your muscles can’t move fully.
What this means is that you should be able to push your knuckle down to its limit and straighten it up entirely. When you lack full passive range of motion, where your knuckles can’t reach their utmost limits, your tendons and muscles won’t be able to function optimally.
Think of your muscles as being capable of both elongation and contraction. These movements are guided by tendons. However, when your joint becomes excessively rigid, your movement becomes restricted. For instance, if your joint can only allow for a fraction of the possible motion, let’s say just 25%, you’re losing out on a substantial amount of potential. Imagine this scenario: if your optimal range is represented by the full screen, it’s crucial to aim for that entire span. On the other hand, if your joint is confined and you’re limited to a fraction of the movement, you’re setting yourself up for ongoing discomfort, pain, and stiffness. Furthermore, your scar tissue may remain excessively tight. To put it in perspective, if I were to sustain a hand injury as a certified hand therapist, I’d prioritize achieving full passive range of motion for the best outcome.
If I want this for myself, why wouldn’t I want to teach this to my patients? So, this is what I teach.
If you are someone with a hand injury and you’re in Miami, Florida, I am talking to you from my clinic Hands on Therapy Services. This is exactly what I tell my patients. This is I teach online through Hand Therapy Secrets to other occupational therapists and certified hand therapists, this is exactly what I tell them as well.
How to get full passive range of motion?
So, if you don’t have full passive range of motion, what can you do to go get full passive range of motion? Even though your knuckle might not move as much as it should, you just want to have as much movement as your knuckle moves.
When it comes to flexor tendon injuries, you have to know what phase and stage you are in to be allowed to do that. In certain instances, there’s where you’re not allowed to really go into full passive extension. And that’s usually when you have a digital nerve repair, but at the very beginning of right after surgery. So, find out where you are, and when you’re allowed to do this.
However, if you’re a minimum of four to six weeks out, you’re allowed for the most part. So, you want to stretch and get as much passive range of motion as possible in every single joint, and then you want it all together. You want to get full passive range of motion.
4. Tendon Glide Exercise: Hook Fist
The fourth exercise I want to show you, it’s one type of tendon glide exercise. It’s where you’re getting your tendons to glide. Engage in tendon glide exercises to ensure your tendons move freely within your hand. The hook fist and straight fist exercises are particularly effective. Remember to perform these movements gently and deliberately.
Key thing is to keep your big knuckles straight, and then you’re gonna curl your little knuckles down, and then you’re gonna go up.
A lot of times people just focus on going down, but going up is extremely important because as far back as you can go, this is what’s gonna help stretch those flexor tendons. And then because you stretch them out, they also has a capacity to pull all the way down.
One of the biggest mistakes I see, is that everyone works in the middle, as it is comfortable, but you want to work at end ranges. So, you want to curl it all the way down, be really intentional with your exercise, and all the way up. Slide them all the way out. Curl them all the way down, and then all the way out. So, that is an exercise.
It’s probably one of my favorite exercises.
5. Strengthening with Tendon Glides: From Hook Fist to Straight Fist
So, the fifth one is a combination of a hook, full and straight fist. Again, one of the biggest mistakes that I see that my patients do because they just can’t help themselve, to be honest, is that you’re trying so hard. So, you squeeze too hard, like squeeze your fingers too hard, but what you really wanna do is do it in a gentle way where only the tendons are working. And then I say drop it like it’s hot. So, you don’t have to be so forceful, is because this is the most important part to glide the tendon. You just drop it like it’s hot because these are the little muscles inside your hand that help to pull the big knuckles down.
The reason why the straight fist and the hook fist are so important is because they get the tendons to glide separately. So, you have two tendons that make up the ability to move your finger. One is the superficialis that come to bend your middle knuckle, and then the profundus is the one that bends your little knuckle. And so, what happens is when you do a hook fist and you do it well, it gets one tendon gliding separately from the other, and then when you can do a straight fist, it will focus on this superficialis and moving it separately from the other. So, this is why they’re called tendon glide exercise because it’s specifically moving and gliding those tendons. So, number number four is hook fist and number five is straight fist.
If you could get those, then you’ll be able to tuck it all the way in, and not have a gap, and have a really full fist. Don’t forget that adjusting the intensity to what’s comfortable for your recovery stage is key.
Maintaining Hygiene and Functionality
Pay attention to hygiene and functionality during your recovery. Consider trimming your nails short to facilitate full finger movement, especially around the distal palmar crease.
During this recovery phase from a flexor tendon injury, the last thing you want to do is have anything that’s going to block your ability to get full range of motion, full function of your hand. And once you get that, and you get rid of the pain, and you reduce the risk of having a second surgery because all your tendons got stuck together and scarred down, after you have fully recovered, then you can do whatever you want.
But anytime I get a patient that comes into my clinic, and they have long nails for a hand and flexor tendon injury, I don’t make them. I ask, “Hey, for your best benefit, it might behoove you to cut those nails short, so you can get the full range, and then once you fully recover, you can do whatever you want.”
Seeking Professional Support
Those are my top five exercises after a flexor tendon injury. I hope this has helped you. I really highly recommend you find a trusted certified hand therapist in your area. If they’re not a certified hand therapist, just work with someone who has a lot of experience working with flexor injuries.
Flexor tendon injuries are some of the worst hand injuries. They can become very debilitating, they sometimes require secondary surgeries if not done correctly. Therefore, work with someone that you trust, and if you are not sure, I highly encourage getting a second opinion. Why not? It’s your hand, it’s your life.
And if you’re someone who’s looking for a second opinion, my name is Hoang and I am a certified hand therapist, located in Miami, Florida with Hands On Therapy Services. I love helping people with hand, neck, and shoulder problems because I know how bad and debilitating they can get if not addressed and treated properly (once and for all!).
My aim of Miami occupational therapy practice is to bring patients back to full functionality, without pills, injections, or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care.
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PS. Seven step by step tips that you can start right away to recover quicker after hand, wrist or shoulder surgery. Click for the After Surgery Guide.