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Four Movements and One Dosing Rule. That’s the Whole Program.
The hand exercises that matter most after an injury are tendon glides, blocked bending, an intrinsic stretch and forearm rotation with the elbow pinned. Do them little and often: about 10 slow rounds, holding each end position for 5 seconds, every 2 to 3 hours while you’re awake. Start once your surgeon or doctor has cleared movement, and leave grip strengthening until the range is back.
Most hand exercise sheets are a page of everything.
The useful version is four movements and a rule about dosing. After almost any hand injury, the thing you’re fighting is not weakness. It’s adhesion: scar tissue sticking together structures that are supposed to slide past each other.
So the exercises that matter are the ones that make things GLIDE, and they matter most in the first six weeks, while the scar is still soft enough to be argued with.
Get the dose wrong in either direction and you lose. Too little, and the tendons set into the scar and the fist you can’t make in week 6 is the fist you still can’t make in month 6. Too much, too hard, and the hand swells…and a swollen hand will not bend, however brave you are.
Why does a hand get so stiff after an injury?
Your fingers are moved by long tendons that start as muscles in the forearm and slide through tunnels in the palm and fingers, gliding past bone, skin and each other. Healing lays down scar in that same space. Add swelling, which fills every gap in the hand like wet cement, and a few weeks in a cast or splint where nothing moves, and the tendons stop sliding.
Then there are the small muscles inside the hand, the intrinsics. They tighten after swelling and quietly pull the knuckles into a bent-but-flat position. They’re the part most home programs miss. More on the whole picture in stiff hand after a cast or surgery.
How do you do tendon glides?
Five hand positions, in order. Move slowly from one to the next and hold each for 5 seconds:
- Straight hand. Fingers straight and together, like you’re saying stop.
- Hook fist. Bend only the top two joints of the fingers, knuckles stay straight. Like a claw.
- Full fist. Fingertips into the palm, thumb wrapped over.
- Tabletop. Bend only at the big knuckles, fingers stay straight. Your hand makes an L.
- Straight fist. Bend at the knuckles and the middle joints, fingertips touch the base of the palm, end joints straight.
Each position makes the two flexor tendons slide different distances past each other and past the bone. That’s the point.
If I could give you only one hand exercise, it would be this one. Nothing else moves the tendons through their full excursion.
Dose after an injury or a cast: 10 rounds, 5-second holds, every 2 to 3 hours while awake. That works out at 5 or 6 short sessions a day. For carpal tunnel or trigger finger, where the job is keeping things sliding rather than breaking scar down, 5 to 10 rounds 2 to 3 times a day is plenty.
What are the other three hand exercises that matter?
2. Blocked bending. Hold the joint below the one you’re working, then bend just the joint above it. Hold the middle joint straight, bend the tip. Hold the knuckle straight, bend the middle joint. This is how you make a specific stiff joint work, rather than letting the mobile neighbors do it for you. Dose: 10 reps per joint, 5-second hold, 3 to 4 times a day.
3. Intrinsic stretch. Keep the big knuckles straight (even pushed slightly back), then curl the middle and end joints into a hook. Use the other hand to ease it a little further. If that feels tighter than a normal fist, your intrinsics are tight. Dose: hold 30 to 60 seconds, 3 to 5 times, 3 times a day.
4. Forearm rotation, with the elbow pinned to your side. Elbow bent to 90 degrees and tucked against your ribs. Palm up, palm down. Let the elbow drift outward and your shoulder does the movement for you, which is why most people think they have full rotation when they don’t. Dose: 10 each way, 5-second hold at the end, 3 to 4 times a day. Holding a hammer by the handle makes the end range easier to feel.
Exercises that feel productive are usually the ones a neighboring joint is doing for you. The specific ones feel awkward and small. Those are the ones working.
How often should I do hand exercises after an injury?
Short and frequent beats long and occasional. Every time.
- Little and often. 10 reps every 2 to 3 hours, not 50 reps once in the evening.
- Hold the end of the range. 5 seconds at the point of stretch, cos that’s where the change actually happens.
- Warm the hand first. 5 to 10 minutes in warm water makes a noticeable difference to how far it bends.
- Swelling down before you stretch. Hand above your heart, a few fists with it raised, gentle massage from fingertips toward the wrist. A swollen hand will not bend, and no amount of forcing changes that.
A hand improves in the gaps between sessions, not during one long heroic one.
Mr. Miyagi had the dosing right. Wax on, wax off: small, boring, hundreds of times. Daniel didn’t learn karate in one heroic Sunday session, and your hand won’t loosen in one either.
When should I start exercising my hand after an injury or surgery?
- Fingers outside a cast or splint: from day one. If they’re free, they should be moving.
- After a cast comes off: straight away, with your doctor’s go-ahead. Start with glides and blocked bending. See wrist fracture exercises after a cast for the wrist side.
- After surgery with plates or pins: whatever your surgeon has cleared, often early gentle movement of the free joints.
- After a tendon or nerve repair: ONLY your therapist’s protocol. Generic exercises can rupture a repair. See flexor tendon repair rehab.
How long does it take for a stiff hand to loosen up?
Stiffness after an injury runs on a window. Name it, find where you are in it, act while it’s open.
- Weeks 0 to 6 (OPEN): the fastest gains. The scar is soft and the exercises above change it week by week.
- Weeks 6 to 12 (still OPEN): steady gains. Most of what you’ll get from home exercise comes by month 3.
- Months 3 to 12 (CLOSING): slower. This is where a hand therapist adds splints that hold a long, gentle stretch for hours, rather than more reps.
- Past about 12 months (SHUT for exercise alone): the goal changes. More stretching rarely shifts a joint that has set. Splint programs or an operation to release the scar become the conversation.
When can I start grip strengthening?
Putty, grippers and squeeze balls are the first thing people buy and usually the last thing they should start.
Squeezing a stiff hand hard reinforces a fist you can already make, tightens the intrinsics and does nothing for the range you’re missing.
Order of operations: swelling down, range back, then strength. Skip a stage and you strengthen a hand into whatever shape it currently holds.
In practice that usually means grip work from around week 6 to 8 after a fracture (once the bone is confirmed healed), or once your fist is close to full. Start with soft putty: 10 squeezes, 3-second hold, 2 to 3 times a day.
When someone arrives with a grip ball and no range, I ask them to put it away for three weeks. It’s the least popular instruction I give.
How much pain is normal when doing hand exercises?
- Stretch discomfort during, easing within minutes. Right dose.
- An ache that fades within about 30 minutes. Acceptable, especially early.
- Still aching an hour later, or sore the next morning. Too much. Halve it.
- More swollen the next day. Clearly too much. Swelling is the feedback signal that matters most.
- Sharp pain during. Stop. That’s not stretch, and it doesn’t belong in a home program.
Can I work, drive and go to the gym while I’m doing these?
- Desk work: usually yes, and it’s a good place to dose. One round of glides every 30 to 45 minutes at the keyboard. See returning to work after a hand injury.
- Manual work: depends on the injury. Light tasks that don’t swell the hand are fine. Heavy gripping waits until the range is back and your doctor says the tissue is healed.
- Driving: when you can grip the wheel firmly and control the car in an emergency. Not in a cast.
- Gym: legs, cardio and the other arm, yes. Pressing, pulling and anything that loads the hand waits for range first, then strength. See the gym after a hand injury.
What does a hand therapist add to this?
The four exercises above are the core of most home programs I write. What a hand therapist adds is the stuff a sheet can’t do: measuring each joint so you know whether you’re gaining, finding which structure is actually stuck, making splints that hold a stretch for hours, and changing the dose when the hand says no. More in what a hand therapist does.
Get it checked today if
- The hand is getting more swollen, shiny, sweaty, color-changed or exquisitely sensitive to touch. That pattern is CRPS, and it needs a different approach entirely.
- You had a tendon repair and suddenly can’t bend the finger, or felt a pop. That can be a rupture, and repairs do better when they’re seen early.
- The hand is hot, red and throbbing, or a wound is leaking, especially with a fever.
- New numbness, or a finger that’s pale, blue or cold.
Get it checked if
- You’re inside a post-surgical protocol for a repaired tendon or nerve. Don’t self-program; those rules exist cos the repair goes through a real weak patch in the early weeks.
- A fracture hasn’t been confirmed as healed.
- Pain is increasing week on week rather than settling.
- You’ve done the exercises properly for 3 to 4 weeks and the range hasn’t moved.
- You can’t make a full fist 6 to 8 weeks after a cast came off.
The scar you’re negotiating with is softest for about six weeks and keeps changing for months after that. Leave it a year and you’re not arguing with tissue anymore, you’re arguing with the shape it set in.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. A hand that’s stopped improving for three weeks deserves a proper look while the window is still open.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.