Skip to main content
HandTherapy.app
Back to regimens

Universal recovery phases

Every hand recovers through phases — but the timing differs. Move up when symptoms stay calm. Drop back without guilt when they don't.

0
Phase 0

Protection & red flags

Avoid making the injury worse.

Common situations

  • Fresh fracture
  • Fresh tendon repair
  • Fresh nerve repair
  • Fresh surgery
  • Severe swelling
  • Open wound
  • New numbness or color change
  • Unclear diagnosis

Approach

  • Follow splint, cast, or surgical restrictions exactly.
  • Move only joints that are cleared to move.
  • Focus on elevation, swelling control, shoulder and elbow movement.
  • Gentle finger motion only if allowed.
Typical dose: Elevation many times daily; cleared motion 3–6 micro-sessions/day; no heavy grip; no aggressive stretching.

Do not push through

  • Sharp pain
  • Spreading numbness
  • Increasing swelling
  • Wound drainage
  • Finger color change
  • Sudden loss of motion
1
Phase 1

Early motion & swelling control

Keep tissue moving without stressing healing structures.

Common situations

  • After immobilization begins to loosen
  • Mild sprain
  • Early arthritis flare settling
  • Post-op with cleared gentle motion
  • Stiff fingers after swelling

Approach

  • Tendon glides, hook fist, tabletop, finger spreads, thumb touches.
  • Wrist flexion and extension if allowed.
  • Edema massage toward the heart, elevation, compression if prescribed.
Typical dose: 5–10 min/session × 3–5/day; low intensity; smooth movement; no forcing end range.

Do not push through

  • Increasing swelling after sessions
  • Persistent next-morning soreness
  • Sharp pain
2
Phase 2

Active range of motion & tendon gliding

Restore normal joint motion and tendon sliding.

Common situations

  • Stiff fingers after cast removal
  • Tendon adhesions
  • Scar tightness
  • Post-surgical stiffness
  • Hand feels 'stuck' in the morning

Approach

  • Tendon glide sequence, blocking, reverse blocking, finger walking.
  • Thumb opposition, wrist alphabet.
  • Gentle passive stretches if cleared; warm water before exercises.
Typical dose: 10–15 min × 3/day; hold gentle end-ranges 3–10s; track fist closure & finger straightening.

Do not push through

  • Pain that increases hour over hour
  • Worse motion later that day
  • Increasing swelling
3
Phase 3

Light strengthening

Rebuild grip, pinch, wrist, and endurance without irritating tissue.

Common situations

  • Post-cast weakness
  • Mild chronic weakness
  • Later tendon recovery
  • Carpal tunnel recovery after symptoms calm
  • Arthritis with stable symptoms

Approach

  • Soft ball squeeze, putty grip, putty roll/pinch.
  • Rubber band finger extensions, clothespin pinch.
  • Light wrist curls or isometrics; towel wringing.
Typical dose: 1–3 sets × 8–15 reps; 2–4 days/week; increase only when symptoms stay calm 24h.

Do not push through

  • Joint pain (not muscle effort)
  • Symptoms lingering hours after
  • Next-morning regression
4
Phase 4

Dexterity & coordination

Make the hand useful in real life again.

Common situations

  • Nerve symptoms
  • Post-surgery clumsiness
  • Stroke-like coordination deficit
  • Long immobilization
  • Return to typing, cooking, instruments, gaming, tools, sports

Approach

  • Coin pickup, buttoning, peg board, marble transfer, rice bin search.
  • Typing intervals, handwriting practice.
  • Object rotation, key turning, jar opening simulation.
Typical dose: 5–15 min daily; short and precise; stop before fatigue causes sloppy movement.

Do not push through

  • Movement quality dropping mid-session
  • Pain or numbness during precise tasks
5
Phase 5

Endurance & return to work / sport

Tolerate real loads, speed, vibration, repetition, and awkward positions.

Common situations

  • Return to manual labor
  • Return to weightlifting
  • Return to instruments
  • Return to sports
  • Long typing sessions
  • Cooking, childcare, driving, gaming

Approach

  • Timed grip holds, light farmer carries, progressive jar opening.
  • Repeated pinch tasks, tool simulation, sport-specific ball handling.
  • Typing endurance blocks; wrist endurance with light dumbbell or band.
Typical dose: 3–5 days/week; change one variable at a time (time, load, speed, range, complexity); 24h symptom check.

Do not push through

  • Hand fails the next day after passing today
  • Vibration symptoms persist hours after
The dominant limitation

Pick the program by what's limiting you most

  • Stiffness dominant
    More mobility and tendon/nerve gliding.
  • Weakness dominant
    Progressive strength after clearance.
  • Numbness dominant
    Sensory retraining and safety awareness.
  • Pain dominant
    Lower dose, flare management, joint protection.
  • Scar dominant
    Scar mobility plus tendon gliding.
  • Dexterity dominant
    Task-specific fine motor drills.
  • Endurance dominant
    Longer functional intervals.
Progression rules

Green, yellow, red

Apply after every session. The next morning is the truth serum.

Green light — progress slightly

  • Pain stays 0–3 / 10
  • Swelling does not increase
  • Motion improves or stays stable
  • Symptoms settle within a few hours
  • Next morning is not worse
Actions
  • Add 1–2 reps
  • Add 1 set
  • Add 1 daily session
  • Move to slightly firmer putty
  • Add a more complex task
  • Extend typing or work intervals

Yellow light — hold or reduce

  • Pain reaches 4–5 / 10
  • Hand feels more swollen afterward
  • Tingling increases but settles quickly
  • Motion is worse later that day
Actions
  • Reduce resistance
  • Reduce reps
  • Shorten the session
  • Add a rest day
  • Return to mobility-only routine

Red light — stop and seek professional guidance

  • Pain is sharp or escalating
  • Numbness worsens and persists
  • Fingers become cold, blue, pale, or very swollen
  • Wound opens or drains
  • Sudden pop or loss of motion
  • Finger locks repeatedly and painfully
  • New deformity appears
Actions
  • Stop the routine
  • Contact your clinician or seek urgent care
  • Document what changed and when

Find a program that fits your phase

Browse condition regimens