Tendon gliding exercises (TGEs) are structured movements designed to promote the smooth, independent mobility of the flexor tendons within the hand and wrist. These exercises involve sequential positioning of the fingers and hand to move each tendon across its maximum possible range. The goal is to improve the flow of tendons through the narrow anatomical passages of the hand, maintaining flexibility and reducing stiffness.
The Anatomical Purpose of the Exercises
The deep, intricate structure of the hand requires a complex mechanism for smooth finger movement, which is the primary focus of these exercises. Within the fingers and hand, the flexor tendons—specifically the Flexor Digitorum Superficialis and Flexor Digitorum Profundus—are responsible for bending the digits. These tendons do not simply float freely; they are housed within protective sheaths and held close to the bone by a series of fibrous bands called pulleys.
This tight housing is necessary to translate muscle contraction into effective finger motion, but it also creates an environment where friction and sticking can occur. If the hand experiences trauma, injury, surgery, or prolonged inflammation, the natural healing process can lead to the formation of scar tissue, known as adhesions. These adhesions act like glue, causing the tendons to stick to the pulley system or to each other, which severely limits their ability to slide.
The consequence of this limited movement is a reduction in joint range of motion, decreased strength, and a loss of coordination. Tendon gliding exercises are specifically engineered to encourage differential gliding, which means promoting the necessary individual sliding motion between the two flexor tendons and the surrounding sheath. By pushing the tendons to their maximum excursion, these movements help to gently stretch and break up developing scar tissue, ensuring the hand retains its full functional capacity.
Step-by-Step Tendon Gliding Sequence
The exercise core is a sequence of five distinct hand shapes, each designed to maximize the excursion of different segments of the flexor tendons. The sequence begins from the neutral position, with the hand and fingers held completely straight (the starting position). This initial position ensures the tendons are fully relaxed and extended.
The five positions are:
- Straight Hand: The hand and fingers are held completely straight, often described as a flat hand or the starting position.
- Hook Fist: The fingertips are bent toward the palm while the main knuckles (metacarpophalangeal joints) remain straight. Forming this shape primarily maximizes the gliding of the Flexor Digitorum Profundus tendon.
- Tabletop: This position is achieved by bending only the main knuckles until the fingers are perpendicular to the palm, while the middle and end joints of the fingers remain straight. This movement focuses on gliding the Flexor Digitorum Superficialis tendon.
- Straight Fist: The main knuckles and the middle joints of the fingers are bent, with the fingertips remaining straight, resting near the base of the palm. This movement involves a more complete excursion of both flexor tendons.
- Full Fist: All finger joints are bent as tightly as possible, with the thumb wrapping around the outside of the curled fingers. This final position achieves the maximum possible length and gliding of the flexor tendons.
After each of the four active positions, the hand should return to the straight starting position before moving to the next shape, ensuring a complete cycle of tendon movement.
When and How to Integrate Gliding Exercises
TGEs are most commonly prescribed as a rehabilitation tool following hand or wrist trauma, inflammation, or surgery. Conditions such as tenosynovitis, generalized hand stiffness, and recovery from carpal tunnel release surgery often benefit from a structured TGE routine. Controlled movement is necessary after any procedure that involves tendon repair to prevent the formation of restrictive adhesions during the healing phase.
The exercises are generally integrated into a daily routine, with most protocols advising performance multiple times per day, often three to five cycles daily. Within each cycle, each of the five positions is typically held for a short duration, such as three to five seconds, and repeated approximately ten times. The key to effective gliding is performing the movements gently and deliberately, ensuring that the movement is achieved at the end of the available range of motion.
While these exercises are generally low-impact, adherence to safety precautions is important. It is always best to consult with a physical or occupational therapist, especially following a medical event, to receive a tailored routine specific to the individual’s condition and recovery stage. The most critical safety rule is to discontinue the exercise immediately if sharp pain is felt, as the goal is gentle movement, not forceful stretching. A therapist can ensure the movements are performed correctly and safely, maximizing the therapeutic benefit while minimizing the risk of re-injury.