A few weeks ago someone told me, essentially: "grip and wrist exercises won't fix a real diagnosis - if it's actually carpal tunnel or tennis elbow, you need a physio or a surgeon, not a strength program."

Fair challenge. So let's actually dig into it, because the research says something more interesting than "exercise vs. surgery."

This one's a bit heavier than usual. Skim for the golden nuggets if you're short on time.

P.s. Hand + Wrist Foundations launches soon 👀

FIRST: TENDONS RESPOND TO LOAD, NOT REST

For lateral epicondylitis (tennis elbow) specifically, trials comparing eccentric strength training against cortisone injections and even tendon needling have found that structured, progressive loading holds up as well as - or better than - more invasive options, especially over the medium-to-long term. Other trials comparing different loading protocols (eccentric-only vs. eccentric-concentric vs. adding isometrics) all point the same direction: the tendon needs graded resistance to remodel. Immobilizing it doesn't heal it - it just delays the inevitable reloading.

None of this means skip your doctor. If you've got acute nerve symptoms, something that's rapidly getting worse, or a diagnosis your surgeon says needs to be addressed surgically.. go do that. This is about the much larger bucket of chronic, nagging hand/wrist/elbow pain that gets waved off as "just needing surgery eventually" when loading was never actually tried.

(I wrote a short and digestible blog on tendinopathies if you're interested, HERE)

NOW THE UNCOMFORTABLE PART: SHAM SURGERY RESEARCH

Here's something that gets almost no airtime outside of academic circles: when researchers have actually tested elective orthopaedic surgeries against a fake version of the same surgery (same incision, same anesthesia, no actual repair done), the results have been surprising more than once.

• A well-known 2002 trial published in the New England Journal of Medicine compared arthroscopic knee surgery for osteoarthritis to a sham version (surgeons made the incisions, but performed no actual debridement or lavage). Patients in the sham group improved just as much as the real surgery group.
• A 2018 trial published in The Lancet tested shoulder decompression surgery (one of the most common shoulder procedures) against sham surgery. Same result: no meaningful difference.
• A broader systematic review in the journal Pain Medicine (2017) looked across multiple orthopaedic sham-surgery trials and found this pattern repeats often enough that it's now taken seriously as a category of finding, not a fluke.

To be extremely clear: none of this is wrist-specific, and none of it means "surgery doesn't work" as a blanket statement. Some surgeries clearly do outperform sham controls, and some injuries genuinely need a scalpel, not a resistance band. What it does mean is that "it's structural, so only surgery can fix it" is a much shakier assumption than most people (including a lot of well-meaning doctors) treat it as. Some of what we attribute to a successful surgery may actually be the anesthesia, the forced rest afterward, the physio you're finally sent to, or plain old placebo.

The practical takeaway: if you're being told your only option is surgery for a chronic (not acute, not urgent) hand or wrist issue, it's a completely reasonable question to ask what a real trial of progressive loading looks like first, and to ask your surgeon directly whether there's sham-controlled evidence behind the specific procedure they're recommending.

SHAM SURGERY, MORE BROADLY

The knee and shoulder trials I mentioned aren't the only ones. Spine surgery has its own version of this story, and it's arguably even more striking.

Two trials - one published in the New England Journal of Medicine in 2009 (Kallmes et al., the INVEST trial) and a companion Australian trial by Buchbinder et al. the same year - tested vertebroplasty (injecting bone cement into fractured spinal vertebrae) against a sham procedure where patients got the needle and the positioning, but no cement injected. Both found no meaningful difference between real and sham. This was for a procedure that, at the time, was being done tens of thousands of times a year.

There's also a well-known 2013 trial (Sihvonen et al., published in NEJM) on arthroscopic surgery for degenerative meniscus tears in the knee (one of the most commonly performed orthopaedic procedures worldwide). Same pattern: sham surgery patients improved just as much as those who had the actual procedure.

Put together with the knee OA and shoulder decompression trials, you've got results spanning spine, knee, and shoulder... different body parts, different surgeons, different decades.... all pointing to the same uncomfortable question: how much of "the surgery worked" is actually the surgery?

IF YOU DO END UP NEEDING SURGERY

This isn't an argument against surgery when it's actually indicated. If that's where you land, the research on "prehab" - training the area before surgery - consistently points to better post-op outcomes: you're not starting your rebuild from zero, and you haven't lost as much strength and tissue capacity to disuse beforehand. So even in that outcome, the work isn't wasted.

That's the honest, slightly uncomfortable truth. We built Hand + Wrist Foundations because "just get surgery" and "just rest it" are both being handed out more often than the evidence really supports - and there's a structured, boring, evidence-backed middle option most people never get offered.

[GET ON THE WAITLIST HERE] - launching SUPER soon.

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Carla (in the middle) & the Vital Performance Care team