Can Preventive Exercises Help Office Workers with Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a common issue among office workers, often leading to discomfort, reduced productivity and in some cases, workplace injury claims. A recent study, shared in Comcare’s Workplace Research Monthly, explored whether a targeted exercise program could prevent or alleviate CTS symptoms. In this edition of our Request for Comment series, Red Health’s expert specialists provide their insights—examining whether these findings translate into real-world clinical practice and medico-legal considerations.

Understanding Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) is a condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. This nerve passes through the carpal tunnel – a narrow passageway surrounded by bones and ligaments. When pressure is placed on the median nerve, it can result in numbness, tingling, weakness or pain in the hand and fingers, particularly the thumb, index and middle fingers. 

Common causes of CTS include repetitive hand movements, prolonged wrist flexion or extension, poor ergonomics and underlying health conditions such as diabetes or rheumatoid arthritis. Office workers, especially those who spend long hours typing or using a computer mouse, are particularly at risk of developing CTS. Left untreated, the condition can worsen over time, potentially leading to decreased hand function and chronic discomfort. 

What Did the Study Find?

The study assessed the effectiveness of an 8-week exercise protocol for office workers experiencing hand and wrist pain associated with CTS. Participants were divided into two groups: one performing seven specific hand and wrist exercises at least three times a week and the other serving as a control group.

Key findings included:

• Improved grip and pinch strength in those who completed the exercise program
• No significant reduction in pain levels, suggesting that pain management requires additional interventions
• General improvement in hand function, but not a cure for CTS itself

While the study highlighted some functional benefits, it raised an important question: do these findings actually impact clinical practice and medico-legal assessments?

What Do Red Health Experts Say?

To gain a deeper understanding, we asked three leading Red Health specialists on our Referral Network to weigh in.

• Dr Damon Thomas (Consultant Plastic and Reconstructive Surgeon)
• Dr Vaidya Bala (Consultant Rehabilitation Physician)
• Dr Praveen Vijaysegaran (Consultant Orthopaedic Surgeon)

Dr Damon Thomas – Plastic & Reconstructive Surgeon

Dr Thomas found the study’s conclusions unsurprising and largely irrelevant to clinical practice. He pointed out that the results confirm a basic principle: strength training increases muscle strength—but this does not necessarily translate to reduced CTS symptoms.

His stance is clear: this study would not change his approach to treating CTS patients, nor does it influence his medico-legal opinions. In his view, the findings offer no meaningful evidence for recommending exercise as a standalone treatment for CTS.

Full Response from Dr Damon Thomas – Consultant Plastic and Reconstructive Surgeon

RH: Is the information presented in the study surprising based on your clinical experience?

Dr Damon Thomas: The findings of the study provide very little relevance to clinical practise. The main findings are that strength exercises increase the strength of the forearm and hand. This is pretty logical for any part of the body and has no specificity for the hand only. There is no definite change in carpal tunnel symptoms, just an increase in strength. These findings are not surprising, essentially strength exercises increase strength. There is no suggestion of any symptomatic improvement in carpal tunnel which is not surprising.

RH: Does the study change the way you approach clinical duties? What about medico-legal opinion?

Dr Damon Thomas: No, the study has no relevance to clinical practise. I would not recommend it as a therapeutic modality and would not recommend it for any medico legal related cases.

Dr Vaidya Bala – Rehabilitation Physician

Dr Bala raised concerns about the study’s methodology and title, arguing that it should focus on progression rather than prevention, given that participants already had CTS symptoms. While he supports exercise for office workers, he emphasises that the prescription of forearm exercise does not prevent all upper limb musculoskeletal conditions—it only improves certain functional abilities, including the hand.

From a medico-legal perspective, he believes that while workplace exercise programs have general value, they are not a primary preventive measure for CTS-related claims.

Full Response from Dr Vaidya Bala – Consultant Rehabilitation Physician

Dr Vaidya Bala: Article Key Points

1. Objective:
   • The study aimed to evaluate the effectiveness of a preventive exercise protocol for hand and wrist pain among office workers with symptoms of Carpal Tunnel Syndrome (CTS).
2. Methodology:
   • Participants: 62 office workers with hand and wrist pain.
   • Groups: 49 participants performed the exercise protocol (exercise group), and 13 did not (non-exercise group).
   • Duration: The exercise program lasted 8 weeks, with participants advised to perform exercises at least 3 times a week.
   • Exercises: The program included 7 specific exercises targeting the hand and wrist.
   • Assessment: Physical parameters (hand grip and pinch grip strength) and questionnaires (Visual Analog Scale for pain, Carpal Tunnel Syndrome Symptom Severity Scale, and Functional Status Scale) were used to evaluate effectiveness before and after the intervention.
3. Results:
   • Hand Grip Strength: Significant improvement in the right hand grip strength in the exercise group.
   • Pinch Grip Strength: Significant improvement in both hands in the exercise group.
   • Functional Performance: Significant improvement in both groups, but more pronounced in the exercise group.
   • Pain Levels: No significant change in pain intensity, suggesting a complex etiology of pain perception.
4. Conclusions:
   • Regular preventive exercises can increase forearm muscle strength and improve functional hand performance in office workers with CTS symptoms.
   • The exercises did not significantly affect pain levels, indicating that pain management may require additional or alternative interventions.

Dr Vaidya Bala: Summary Expert Opinion

Dr Vaidya Bala:

1. The study participant were diagnosed to have CTS based only on clinical examination and nerve conduction study (NCS) was not used. The gold standard tool for diagnosis is NCS.
2. The title of the article states”Prevention exercise for CTS” but the subjects included in the study were already diagnosed with CTS. So it should be titled ‘Progression of CTS from early stages of CTS”
3. In principle, I am in support for exercise prescription for all admin staff

RH: Is the information presented in the study surprising based on your clinical experience?

Dr Vaidya Bala: Not surprising but the methodology and title should be changed as it does not clearly describe the intent as to what they are preventing with exercise.

RH: Does the study change the way you approach clinical duties? What about medico-legal opinion?

Dr Vaidya Bala: I am in support of exercise prescription for all admin staff for forearm exercise in general but it does not prevent all musculoskeletal degenerative disease of the upper limb but merely functions of the hand. In general, all admin staff should be given upper limb exercise.

Dr Praveen Vijaysegaran – Orthopaedic Surgeon

Dr Vijaysegaran echoed similar sentiments, stating that while exercise improves strength, it does not reduce CTS-related pain. He even noted that, in his experience, overuse and repetitive strain could worsen CTS symptoms.

His conclusion? The study does not influence his clinical or medico-legal approach. He continues to advocate for evidence-based strategies rather than generic exercise programs when assessing workplace injuries.

Full Response from Dr Praveen Vijaysegaran – Consultant Orthopaedic Surgeon

Dr Praveen Vijaysegaran: Summary Expert Opinion

Dr Praveen Vijaysegaran: This is an interesting study, but the conclusion really isn’t something that’s going to change clinical practice all too much. The main conclusion of the study to me is:

In office workers with symptoms of early carpal tunnel syndrome who perform a preventive exercise program regularly, an increase in forearm muscle strength is observed with no change to the level of pain.

The study’s findings clearly demonstrate as their primary outcome measure a change to forearm strength rather than a change to the symptoms of carpal tunnel. The conclusion thus has nothing to do with carpal tunnel as such, rather much more to do with forearm strength alone. I’m sure if this study had been done in a general patient population and not a cohort of patient with carpal tunnel only, the findings would have been similar.

RH: Is the information presented in the study surprising based on your clinical experience?

Dr Praveen Vijaysegaran: Not at all! Based on my clinical (and personal!) experience, exercise helps muscle to grow and become stronger, and this is all that this study shows. Pain in carpal tunnel syndrome is not improved by exercise in my experience, and this study confirms this with no change in pain levels, and this was the only outcome measure that was studied as a surrogate marker for symptoms of carpal tunnel in this study. Anecdotally, I find that overuse and overexertion in fact worsens carpal tunnel syndrome.

RH: Does the study change the way you approach clinical duties? What about medico-legal opinion?

Dr Praveen Vijaysegaran: This study will not change my clinical practice or medicolegal opinion at all, apart from generally continuing to encourage patients/clients who wish to build strength and be healthy to stay active and exercise regularly.

Comparing Expert Insights

The responses from Dr Thomas and Dr Bala illustrate the diversity of medical opinion surrounding CTS management. Dr Thomas is firm about the clinical relevance of exercise for CTS symptom relief, while Dr Bala acknowledges its value for functional improvement but cautions against overstating its preventive potential. Dr Vijaysegaran reinforces that strength gains do not equate to pain relief, highlighting a need for targeted interventions.

This range of perspectives underscores the importance of individualised patient care and highlights the complexities involved in medico-legal evaluations. It also demonstrates how Red Health’s multidisciplinary approach ensures balanced and comprehensive assessments.

The Medico-Legal Perspective: Why This Matters

For legal and insurance professionals handling workplace injury claims, it’s critical to distinguish between:

• Functional improvements (e.g., increased strength)
• Genuine symptomatic relief (e.g., reduced pain, improved nerve function)

While workplace exercise programs can be beneficial, they should not replace comprehensive injury management strategies, proper ergonomic interventions, or, in relevant matters, independent medico-legal assessments. Red Health’s experts provide evidence-based opinions to ensure accurate evaluations of workplace injury claims.

Final Thoughts: What Should Workplaces Do?

While this study contributes to the broader conversation about workplace health, it does not provide strong enough evidence to redefine CTS management. The varied responses from Red Health’s experts reveal the complexity of treating CTS and highlight the importance of evidence based, individualised care.

Key Takeaways: 

• Preventative exercises may improve functional abilities but are not a standalone solution for CTS. 
• Pain relief and overall symptom management require a multifaceted approach, including ergonomic adjustments and medical interventions. 
• In medico-legal contexts, functional improvement should not be misconstructed as a symptomatic relief or injury resolution. 

What Should Workplaces Do? 

Employers should focus on a well-rounded approach, including:

• Ergonomic adjustments to prevent strain
• Workplace wellness initiatives that go beyond exercise
• Access to independent medical assessments to ensure fair injury claims

At Red Health, we work with specialists across multiple disciplines to provide trusted, independent medico-legal opinions. If you’re handling a workplace injury case, our experts can help assess the true impact and validity of claims.

Dr Damon Thomas’s CV Extract

This is a short extract, correct as of 18/10/2024. For Dr Thomas’s full CV, please contact us.

Dr Vaidya Bala’s CV Extract

This is a short extract, correct as of 18/10/2024. For Dr Bala’s full CV, please contact us.

Dr Praveen Vijaysegaran’s CV Extract

This is a short extract, correct as of 18/10/2024. For Dr Vijaysegaran’s full CV, please contact us.