Flexor tendon injuries, especially complete cuts, almost always require surgical repair to reattach the tendon ends. Physiotherapy, often called hand therapy, is absolutely crucial for regaining motion, strength, and function after surgery. The rehabilitation protocol is carefully phased to protect the repair while gradually increasing stress.

Advanced physiotherapy techniques, often employed by specialized hand therapists, include

Manual Therapy

• Passive Range of Motion (PROM): The therapist gently moves the patient’s finger and wrist through their available range of motion to prevent stiffness and maintain joint mobility without stressing the repair. This is typically initiated very early in the rehabilitation process.
• Assisted Active Range of Motion (AAROM): The patient actively moves the limb with assistance from the therapist or an external device.
• Active Range of Motion (AROM): The patient moves the limb independently once sufficient tendon healing has occurred and the repair is strong enough.
• Joint Mobilizations: Gentle, controlled movements applied to the joints of the hand and wrist to improve their mobility and reduce stiffness, particularly in cases of post-surgical adhesions.
• Soft Tissue Mobilization- Gentle massage to address swelling, improve circulation, and prevent excessive scar tissue formation.

Instrument-Assisted Soft Tissue Mobilization (IASTM)

IASTM utilizes specialized instruments (often made of stainless steel) to detect and treat soft tissue dysfunction, including scar tissue and adhesions.

• Mechanism: The instruments allow for deeper penetration and more precise manipulation of tissues compared to hands alone. It aims to promote a localized inflammatory response, increase blood flow, break down scar tissue, and facilitate collagen remodeling.
• Application in flexor tendon injuries: IASTM can be beneficial in later stages of rehabilitation to address scar tissue formation around the repaired tendon, which can limit gliding and range of motion. It helps to improve scar appearance, reduce thickness, and increase overall hand function.

Myofascial Release (MFR)

MFR is a specialized form of manual therapy that focuses on releasing tension and restrictions in the fascia, a connective tissue web that surrounds muscles, bones, nerves, and blood vessels.

Mechanism: Therapists apply sustained, gentle pressure to areas of fascial restriction, allowing the tissue to lengthen and release. This can help alleviate pain, improve flexibility, and restore proper movement patterns.

Application in flexor tendon injuries:

MFR can be used to address fascial restrictions that develop due to injury, surgery, or prolonged immobilization. By releasing tightness in the forearm and hand, it can improve the gliding of the flexor tendons and optimize overall hand function. It is particularly useful for reducing inflammation and swelling around the flexor tendons.

Dry Needling

Dry needling involves inserting thin needles into myofascial trigger points (hyperirritable spots in muscles) or directly into the tendon itself (percutaneous needle tenotomy).

• Mechanism
  • Trigger Point Dry Needling: Aims to release muscle tension, reduce pain, and improve range of motion by eliciting a “local twitch response” in the muscle.
  • Tendon Dry Needling (Percutaneous Needle Tenotomy): Involves repeatedly fenestrating (making small holes in) the affected tendon. This is thought to disrupt the chronic degenerative process, encourage localized bleeding, and stimulate a healing response by promoting fibroblastic proliferation and increased blood flow to the poorly vascularized tendon.
• Application in flexor tendon injuries: While primary application is for tendinopathy (chronic tendon issues), dry needling might be considered in later stages of flexor tendon rehabilitation to address persistent muscle tightness or if a chronic tendinopathic component develops, especially in surrounding musculature that can indirectly affect tendon gliding.

Kinesiology Taping

Kinesiology taping involves applying elastic therapeutic tape to the skin.

• Mechanism: The tape is designed to mimic the elasticity of human skin and can be applied with varying degrees of tension to achieve different effects. It’s thought to:
  • Provide support: Stabilize joints and muscles without restricting full range of motion.
  • Reduce swelling: By lifting the skin, it can create more space for lymphatic drainage.
  • Improve proprioception: Enhance awareness of joint position and movement.
  • Facilitate or inhibit muscle activity: Depending on the application technique.
• Application in flexor tendon injuries: Kinesiology taping can be used to:
  • Provide gentle support to the healing hand and wrist.
  • Assist with edema reduction in the early stages.
  • Facilitate specific finger or wrist movements during exercise.
  • Improve scar mobility by applying tension over the scar.