♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Howdy folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapists on the internet.
- In our own opinion of course, Bob.
- Darn right, we are.
Off to today, we're going to talk about after carpal tunnel
surgery, best exercise, exercises to restore
maximal functions, strength and pain.
- Bob, this is for my wife who just had surgery and my good
buddy Bruce who also had surgery within the same week.
I did research on this, this is the best comprehensive
YouTube carpal tunnel surgery is,
there it is, I had to, I mean--
- In your opinion.
- In my opinion, of course. - Yeah.
- But yeah, anyways--
- When you're doing it for a spouse and a buddy
you want to make sure that it's comprehensive.
- Absolutely because I want things to go good at home.
- By the way, if you're new to our channel
please take a second to subscribe to us.
We provide videos on how to stay healthy,
fit, pain free, and we upload every day.
Also go to www.bobandbrad.com, go to the giveaway section,
we're always giving something away.
This week, we're giving away, well, it's your selection
of books, so we're showing a couple of the books here
but you're going to be talking about these individually.
- Yep, yep.
- But you can go to Lotus Publishing--
- There you go.
- And you can see the list of books they have,
they have some really neat books.
- Right.
- So, more kind of medically related.
- Yeah, to help you out.
- Yeah, to help you out, go to Facebook,
it'll be pinned to the top of the page.
The contest, go to Twitter, Instagram,
TikTok, if you want to see a conversion
of our program, and we have what Brad?
- Podcast is out there now.
- The podcast, yeah.
- All right, so here we go, what we want to do
is have Sam give us a little hand
in showing-- - Sure.
- A little bit of an injury.
- He has a hand, huh?
- There you go, now this is a little model
that Bob and I have contrived.
I'll get that. - You want to get that, yeah.
- So what we have here is in the carpal tunnel
which is right here, formed, yep, there you go,
we take off all the skin and all the tissue.
- [Bob] Right between the two meaty parts.
- [Brad] Yep. - [Bob] Of the hand.
- And in that tunnel you have
nine tendons and a median nerve.
- [Bob] So a lot of structures are going through--
- [Brad] Right.
- [Bob] It needs, you know, a fair amount of space
and sometimes that space gets compromised.
- What happens is there's a, the carpal ligament
goes over this and with those tendons,
and now, when you move your fingers like this
those tendons actually slide up
and down in that carpal space, and if it gets tight
for whatever reason the nerve gets pinched,
pain, numbness, tingling, all those symptoms
you're already familiar with, and what happens is
the surgeon comes in there with a pair of scissors
like this and he cuts that retinaculum
or that ligament and opens up that space
and all of a sudden, yay, the nerve
is not pinched, no more pain, numbness, tingling,
life is much better for your hand.
- [Bob] So then they're actually using scissors?
- [Brad] Well, it might be a little more--
- Maybe more, a scalpel probably.
- [Brad] Well yeah, actually they
do it with a little scope too.
- [Bob] Do they?
- There's two different procedures, I'm not going to
get into it, however your surgeon does it
I'm sure he or she does an excellent job.
- [Bob] I'm sure it's not very evasive because--
- [Brad] 20 minutes is all my wife--
- [Bob] Wow.
- [Brad] She went in there, $18,000.
- [Bob] Wow.
- [Brad] Well, that was the retail price,
our insurance covered a lot of it.
- We saw, I mean I saw this surgery being done--
- [Brad] Yeah.
- They did it on someone who was getting
a hip replacement, they went and did it--
- [Brad] Oh.
- [Bob] This surgery real quick, too.
- [Brad] Probably threw that in for nothing.
- [Bob] Yep, yeah right.
- [Brad] Anyways--
- Might want to get to it free.
- [Brad] What I really want to talk about here
is when we have nine tendons and your median nerve,
and we get rid of the ligament, or open it up--
- The retinaculum.
- Retinaculum, what happens is scar tissue,
your body wants to heal, so scar tissue
is going to form over that and if you didn't move
your fingers in your hand or wrist
and kept it still for a couple of weeks,
you're going to have a tight wrist,
things are going to be snug, it's probably going
to be painful and not functional.
I had a patient that did that, she kept her hand still--
- Sure.
- [Brad] And we broke through everything
but it was a lot more work than if you start--
- Right, start from the get-go.
- [Brad] And start doing the exercises very quickly.
- So again, these tendons, which is represented
by the green ropes here--
- [Brad] Yep.
- They all attach to fingers
- [Brad] Yep.
- And they make the fingers move and so they go
right through like a pulley system almost.
- [Brad] Exactly right, it's very mechanical
that's why, I guess I can understand--
- Relate to it.
- Relate to it, there is one tendon
that goes up into the thumb that does this,
so we'll show you-- - Sure.
- [Brad] That exercise too, all right.
- [Bob] We won't ignore anybody.
- [Brad] There you go, so this will be helpful
I think so you can relate to the rest of the video.
Sam, you're done, you're retired for the day.
- Yeah, you're out of here, I'll get
Sam, oh, you're going to get Sam.
- Yeah, I got him right over here.
OK now, the next thing, so right after surgery
unless your surgeon tells you otherwise,
but typically they'll say, you know, go on,
you can start moving your fingers and get moving.
You'll have a bandage or not bandage, but wrap
around there and it typically allows motion,
so you can start these exercises right away.
- Sure.
- As long as it's not, if it creates any sharp pain,
you know, wait, you give it some time
but typically within the next day or two
you'll be doing these without much problem at all.
So now this is from the Mayo Clinic that you learned?
- They used to call it the six pack
when I worked at the Mayo Clinic.
- It really sounds like a Wisconsin--
- A drinking game, (chuckles) Wisconsin.
- But it's a six--
- Six exercises, so you'd start off,
you can do as a tabletop and then go up to the hook.
- Like this, yep.
- Yep, tabletop, hook, tabletop, hook.
- My buddy Bruce will relate to the six pack thing.
- There we go.
- Well, when we were younger,
I've known him since we were in college, so.
- You probably had a six pack done before breakfast.
(chuckles)
So all right, now we're going to do it 10 times.
- Yep.
- Each one.
- Yep.
- And if it starts increasing your pain,
maybe back off and maybe do a few less the first time.
- Right, exactly.
- Then we're going to do a full fist.
- Oh, we got to remember the thumb.
- Yeah, we'll do the thumb too.
- OK, OK, it's in there.
- I'm just jumping around.
- All right, good.
- Full fist.
- Not a tight fist though, just--
- Sure.
- A loose fist for now, that tight stuff will come later
after it heals a little better.
- All right, then we're going to do a thumb flection
where you're just going like this, you're flexing
the thumb across like this, you'll do that
10 times. - [Brad] Hmm-mm.
- But you also want to do a thumb circumduction, we call it.
So we're actually, the joint is rotating.
- Sure.
- It's a rotating joint, so you can go
to each of the fingers if you want,
you can go to each finger and rotate towards it.
- Yep, and then?
- And then you got full extension
which you were doing already with the thumb
but some people do this curl too, Brad.
- Sure.
- They don't curl all the way, you know
this is all the way, they just curl--
- Oh.
- The second knuckle there and--
- Yep, yep.
- And the first knuckle there.
- You know, this may not be in the six pack routine
but I'm going to suggest--
- Oh yeah.
- Add a little stretch-- - Yeah, absolutely.
- To the full extension, particularly
if you're a active person and you
do a lot of work with your hand.
- Are you doing the thumb later?
- Nope.
- OK, you can hook the thumb and bring
it back a little bit, stretch it out.
- Hmm-mmm, OK.
- All right.
- And you're going to do that as long
as it's tolerated 10 times, all that,
and do it two or three times a day.
Then once you go back in five to seven days
they'll take that off and look at things,
make sure there's no infection on the incision
then they'll schedule a time to get the stitches out.
- Sure.
- After the stitches, you're continuing
to do those exercises as time goes on,
but, do you want to take a second to--
- Sure.
- To get that nerve out of there?
- Sure.
- There's going to be scar tissue forming at the incision
and when there's, when the stitches, staples,
stitches are out, what's going to happen
is a doctor will say, now you can use water,
soap and water on it, at that point,
as long as it's all sealed up, you can put
your thumb on there right over that incision
and push into the skin a little bit
and make some circles, or you can go right to left,
forward and backwards, I like circles,
and if it's painful, it's too early.
- [Bob] Yeah, and you can gauge by, because you're applying
the pressure-- - Yep.
- [Brad] You know what you can tolerate.
- Yep, so you're squeezing like this
making those circles, and what you're doing
is you're breaking up the scar tissue
at the skin level and just under the skin.
It makes, it'll look better and it's going to be more
pliable quicker and it eliminates problems down the road.
- The blood flow is going to increase--
- Yep.
- And you really want to go as deep as tolerated.
So I mean, if it doesn't hurt,
go ahead and push harder.
- Yep.
- And see what you can tolerate.
- And you can see, you're going to push in
fairly hard if it's not painful.
It should feel kind of a good, you know?
Like, oh, it's feeling good.
My wife said exactly that same thing,
she said, "Yeah, that kind of feels good."
And then I said, "Go a little harder."
- So are her stitches out?
- Yeah, we're done with this phase, she's pretty much done.
- Do they talk about putting like,
vitamin E on it or anything like that?
- You know, she asked me about that
and I said, "It looks so good,"
I wasn't too concerned about it.
- Sure
- But yeah, you can ask the doctor.
- Right, ask your doctor, now this could flatten
out a scar too-- - Sure.
- Like if a scar's trying to go over roll.
- Yep, sometimes they're like a little ropy.
- Yeah.
- And don't get too concerned because
if you do this, it'll go away.
Then the other thing you can do is just put pressure
straight down and then open and close your fingers.
- Yeah, good one.
- And that gets, it's kind of like some
of the other techniques that we use.
- Yep, the techniques, yep.
- Yep.
- So you're putting pressure right on the tendons--
- Yep.
- And then, yeah, opening and closing
while the pressure is on there.
- Yep, if you think about when you watched
Sam there, when we had that model--
- Yeah, you're actually working on scar
tissue a little bit that way, too.
- Yeah exactly, making sure everything
is going to be very efficient and doable
after you get completely done.
Now the next thing is that nerve,
now that nerve, we need to stretch it
and it's a very special way, it's pretty simple
and I'm going to show you this.
You don't have to have a string like this.
- This is demonstrative, demonstrative,
demonstrative. (chuckles)
- So this represents the nerve going through that tunnel
and it actually comes up to the back
of your neck, right about in this area.
Now you put your arm out like this, you got me, Liz?
- [Liz] Yeah.
- We're trying to floss the nerve, basically.
- Right, palm up, now if I bring my head
this way, that pulls the string
and the wrist goes up this way.
Now I'm going to take my wrist, I'm going to straighten
it out and that pulls the string and pulls my neck that way.
So if you understand, the neck goes this way
as the palm goes down, when the palm comes up,
they had a neck go the opposite way
so it becomes a chain reaction
and if you look really closely,
(chuckles) can you zoom in on that?
So you can see that string going back
and forth right across there and that's what's going on
with that nerve and that carpal tunnel,
it's making sure no scar tissue
because if you get scar tissue
on a nerve and it locks it down,
it's not going to be fun. - It's going to hurt you.
- Yep, and it's going to be a problem.
- Then you'll have pain and you're wondering why,
"I had the surgery and it didn't get better."
- Right.
- But you know, with that model, you can see that--
(chuckles)
Oh what's that, don't need tape yet.
If you go like this, that's stretching the nerve,
if you go like this, that's stretching the nerve
so you don't want to do them at the same time like that,
you want to go up. - Yep.
- Coordinated. - Keep it together.
- Yeah, keep it together.
- So this is probably a couple of weeks after surgery
by now, as things are going along again
it should all be feeling good, no sharp pain.
- Do that 10 times. - Yeah.
10 times, two, three times a day,
and you know, if you're not having any problems,
with, you know, I don't think you have to continue
to do that long term. - Right.
- It just breaks it loose and you'll be fine, and by this--
- So I'm going to show them without the rope on there.
- OK, yep.
- OK, so I'm going like this, I'm going like this.
- Yep, elbow straight.
- Going like this, yep, and even back
a little bit sometimes. - Yep, this way.
- All right, that's the way you're going to
want to do it 10 times, if it makes the pain worse, stop.
- That's exactly right, now then it's time
to get it stronger because after surgery,
you had that hand not moving very much
not doing much activity, those muscles
weaken up fairly quickly. - [Brad] Hmm-mm.
- And you want to get strength back.
We got some options here, I like to just start
out with a squishy ball like this.
- [Brad] Sure.
- Something that you can squish and everything doesn't work
together because in real life you usually don't squeeze
everything together, sometimes you do with a pair of pliers,
and I know Bruce works in the shop a lot
so, but this is a good way to start.
- [Brad] Working on individual fingers, basically.
- Yep, get some mobility, I like this one,
this I got I think at a dollar store.
It's kind of fun, it lights up so it's a little entertaining
and it's got these little spikes on there,
that can actually kind of--
- [Brad] Yep.
- Desensitize over that scar tissue
and it's squishy and it's a little harder
so you're ready to go to the next phase
and you're just going to work on this,
your thumb, your fingers, you know, for a minute or two
you'll feel fatigue and then give it a rest.
Do that two or three times a day,
and here, you know, here's another,
this ball is actually more firm so as you get stronger
you go to a firmer ball and you might say
what about those grippy things, you know?
- Hmm-mm.
- So yeah, we've got some grippy things right here.
You can do this as well, these are adjustable at the spring.
- [Brad] They are adjustable.
- These are really nice, are we going
to have these in the link below?
- [Brad] Yeah, well, I don't know.
(chuckles)
- Well I just found these, we're going to do something,
and these have a counter on them as well, did you see that?
- [Brad] Yes, I did.
- So it counts for you don't have to count.
You know you might get to 15 and be fatigued
and then a week later you might find you get to 35
and you don't even have to do the effort of counting.
- You can set resistance between 10 pounds and 130 pounds.
- Wow, yeah, they're deluxe.
That's a nice, where are they at?
KDG, hand grip strengtheners.
- Yeah.
- [Bob] Yeah, they're good deal.
- I ordered them. - You did.
- Yeah, they ranked--
- Where'd you find them?
- They ranked well, just on Amazon.
- Oh, excellent job, this is the deluxe
grip strengthener, you do not have to go
to this level if you don't want.
- That's going to be, if you really
want to build up your forearms too--
- Yep. - This is good.
- Forearms and you'll see why it really does
well with the range of motion too.
You can do this with a, we don't
have a dumbbell around here, do we?
This works better than a dumbbell,
but you go like this and these are stretchy bands,
you put them around your feet.
- You could probably start off with only one band.
- Yep, you may go like this, you know?
And you could only go, like Bob
said, to one band, depending on--
- Right, how strong you you are.
- I'm going to start like this and rest on your--
- The forearms are supported by your size.
- Yep, just like this, and you can,
if you imagine that carpal tunnel right there,
imagine those tendons and that nerve going through there,
we're stretching it out, and because those tendons
go all the way to the tips of your fingers on four of them,
and then you're going to go up and you get the wrist
full flection all the way down,
and you do this 10 to 15 times.
If you've got little arthritic joints in your wrist,
in your fingers, like I do, it's pretty,
mine's pretty not severe at all,
but this definitely helps, it's going to keep me
moving as I approach that big six zero.
- Yeah, the stronger you keep the joints--
- Yep.
- The less pain they'll have.
- Yep and you know, by this time,
you know, you're pretty active, you're back to doing most--
- Sure. - All your activities unless--
- Well it does that way, you can also
go on extension-- - Oh sure, yeah, thanks Bob.
- Just to show that real quick.
- Yeah and that is a--
- Because that's a big one, part of grip.
- Yep.
- Is you go to extend it, when you grab
something, your wrist extends naturally.
- Sure.
- The stronger your extension is,
usually the stronger your grip is.
- Yeah, you know, that one I kind of forget about
and it's a good thing you reminded me.
- Really, I think that's the most important one.
- Yeah, I don't, because I like doing this one,
it feels so good, but I should do this one,
because then I have to change the loops.
You know Bob, there's only so much a guy can do.
- Yeah, I know there's only so much time in a day.
- Look at, people are all tuned out
all by now, they're getting bored.
So anyways, take care and good luck with those wrists.
- Have fun.
(playful chimes)