Hand surgery encompasses procedures that repair structures like tendons, nerves, and ligaments, or fix fractures in the hand, wrist, and forearm. Returning to an exercise routine requires careful planning to protect healing tissues while maintaining overall fitness. The primary goal is to adhere strictly to safety guidelines for systemic exercise, such as cardio and lower body work, while the hand recovers. All decisions regarding physical activity must first be cleared by your surgeon or physical therapist, as this information does not replace your prescribed rehabilitation program.
The Immediate Post-Operative Phase
The initial one to three weeks focus entirely on wound healing, managing swelling, and protecting the operative site. Keeping the hand elevated above heart level is an effective practice, using gravity to reduce swelling and discomfort. This period is when the surgical incision is most vulnerable, and excessive strain can compromise the repair.
General exercise is restricted initially because an elevated heart rate and blood pressure increase blood flow to the surgical site. This surge can lead to increased swelling, pain, and a higher risk of bleeding, disrupting the healing process. Monitoring the wound for signs of infection, such as excessive heat or persistent fever, is also necessary.
The only movement permitted during this early phase is light, doctor-approved finger motion, which helps prevent joint stiffness and promotes tendon gliding. These gentle movements are often started within the first few days, even while the hand is in a protective cast or splint. Any activity that causes sharp or shooting pain must be stopped immediately to avoid damaging the repaired structures.
General Body Exercise Modifications
For active individuals, the main challenge is maintaining fitness without applying stress to the operated hand, wrist, or forearm. The core principle for exercise modification is “no load, no grip, and no impact” on the injured side. Strength training must focus on exercises that do not require the hand for gripping, stabilization, or support.
Cardiovascular fitness can be maintained through exercises such as stationary cycling, where the hands rest on the handlebars without gripping. Walking is an excellent option, and an elliptical machine can be used if the hand rests lightly on the static support handles. Single-arm rowing or swimming may be introduced later, but only with specific clearance, as water resistance can place strain on the wrist.
For strength training, the focus should shift entirely to the lower body and core, using exercises that require no hand involvement. Safe substitutions include leg presses, squats, lunges, and bodyweight exercises like glute bridges. When using weight machines, ensure the operated arm is not used for stabilization, and accidental weight-bearing is avoided. Weight restrictions are strict initially, often starting at zero to five pounds.
Timelines for Returning to Hand-Involving Activities
The progression toward resuming activities that require grip strength, lifting, or impact is highly variable, depending on the type of surgery performed. Therapeutic exercises prescribed by the hand therapist are distinct from functional activities. Therapeutic exercises rebuild strength and range of motion under controlled conditions, while functional activities test the endurance and load-bearing capacity of the healed tissues.
Driving is typically restricted for four to eight weeks, depending on the surgery’s severity and whether the dominant hand was involved, as sudden steering maneuvers can cause forceful gripping. Light functional lifting, such as carrying a gallon of milk, is often the first milestone, usually starting between six and eight weeks post-operation. The initial weight limit is around five to ten pounds and is gradually increased under the guidance of a therapist.
Returning to higher-impact sports or activities requiring forceful gripping, such as golf, tennis, or heavy weightlifting, requires a much longer recovery arc. These activities may be restricted for three to six months or longer, particularly after complex surgeries like ligament reconstruction. The sudden return of sharp pain or loss of motion are warning signs that the activity is too strenuous and must be stopped immediately to prevent a setback.