®Ball squeeze
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10 reps, 2 sets7 typesThe types of tremor distinguished by the US National Institute of Neurological Disorders and Stroke; treatment depends on the type
50–70%The share of cases that are inherited in essential tremor, the most common type
6 weeksLength of an arm-strengthening programme that improved manual dexterity in small studies
20 trialsThe review of acupuncture in essential tremor; all the trials were done in China and the evidence is not conclusive
What is it?
Tremor is an involuntary shaking movement in one or more parts of the body, most often the hands. It can be a condition in its own right or a sign of another illness or of a medicine.
A slight tremor is normal. Age, stress, tiredness, anxiety, anger, caffeine, alcohol, smoking and being very hot or cold can make it worse.
The main types
- Essential tremor: the hands shake while doing something; 50–70% of cases are inherited
- Enhanced physiological tremor: not due to a neurological disease but to certain medicines, alcohol withdrawal, an overactive thyroid or low blood sugar
- Parkinsonian tremor: mostly seen when the hand is at rest
- Dystonic tremor: together with involuntary muscle contractions; in the neck, the vocal cords or the arms and legs
- Cerebellar tremor: due to damage to the cerebellum; a slow, wide tremor that increases at the end of a movement
- Functional tremor: a variable tremor that increases with attention and decreases when distracted
- Orthostatic tremor: rare; in the legs when standing
How is the cause investigated?
See a doctor if your tremor is getting worse over time or affecting your daily activities. The doctor looks at when the tremor appears (at rest or while doing something), where it is, other symptoms, the medicines you take and whether anyone in your family has something similar. Alongside a neurological examination, blood and urine tests may be requested and, if needed, imaging and a nerve and muscle test (EMG).
When the tests are normal, two possibilities are commonly left: enhanced physiological tremor and essential tremor. The first may ease when the triggers are reduced; in the second, medicines often reduce the tremor even if they do not stop it completely. If the pattern of your tremor changes, you need to be reassessed.
Do not stop your medicines on your own. If you think your tremor may be linked to a medicine, talk to your doctor; adjusting the dose or changing the medicine may be an option.
Treatment
- MedicationDepending on the type of tremor, beta-blockers, anti-seizure medicines and other groups of medicines are used; your neurologist makes the choice. Medicines do not cure the tremor, but they often reduce it.
- InjectionsFor head and voice tremor, botulinum toxin injections that reduce nerve signals may be used.
- Interventional proceduresFor severe tremor that does not respond to medicines, procedures such as deep brain stimulation or focused ultrasound are occasionally considered.
- Physiotherapy and occupational therapyThese help to improve muscle control, strength and balance, and to learn methods and aids that make tasks such as writing and eating easier.
- Strengthening exerciseIn a small study of 10 older adults with essential tremor, a 6-week arm-strengthening programme improved manual dexterity and reduced force tremor in the more affected arm; in a preliminary study of six people, manual dexterity also improved. Because the studies were very small, these are preliminary findings.
- LifestyleCutting down on caffeine, managing stress and getting enough sleep can ease the tremor.
Ways to make daily life easier
- Fill your glass only halfway, hold it with both hands, or use a cup with a lid and a straw.
- Rest your elbow on the table or against your body when eating and writing.
- Try cutlery with thick, heavy handles and a pen with a thick barrel.
- Choose clothes and shoes with Velcro or zips instead of buttons and laces.
- Leave tasks that need fine control for the times of day when your tremor is at its least, and do not rush.
Complementary approaches: what does the evidence say?
A 2026 review of acupuncture in essential tremor combined 20 randomised controlled trials with 1,067 participants and reported improved tremor scores in the groups given acupuncture. However, all the trials were done in China, and the authors themselves note that the samples were small, there was no blinding and the allocation of participants to groups was not adequately concealed. The result should therefore be regarded as a promising preliminary finding; firmer trials are needed before anything definite can be said.
Relaxation and breathing practices do not treat the tremor itself; but because stress and anxiety make tremor worse, they can help to reduce the trigger.
In Turkey, traditional and complementary medicine practices such as acupuncture may be carried out only by doctors who hold a practice certificate in that field, in units authorised by the Ministry of Health. If you would like to try a complementary method, first make sure the underlying cause has been looked into, and think of the method as an addition to medical treatment, not a replacement for it.
Exercises at home
Six exercises for tremor
The aim is not to stop the tremor; it is to strengthen the arm and hand muscles, keep up manual dexterity and reduce tension. Do the exercises slowly; if tiredness makes your tremor worse, take a break.
Wrist lift with a weight
Rest your forearm on a table with the palm facing down. Hold a full water bottle or a light weight in your hand. Lift your wrist up, then lower it slowly over 3–4 seconds. Then turn your palm up and do the same.
8–10 reps, 2 setsIsometric wrist press
Rest your forearm on a table. Try to lift your wrist while pressing down on it with your other hand, so that the hand does not move. Hold for 5 seconds, then relax.
8 repsResistance band row
Fix the resistance band to something secure at chest height. Breathe out as you pull your elbows back and draw your shoulder blades together; breathe in as you slowly return. Do not hunch your shoulders up towards your ears.
10 reps, 2 setsOpening and closing the hands
Hold your hands out in front of you. Make tight fists, then open and stretch your fingers as wide as you can; repeat at a lively pace.
20 reps, 2 roundsSlow breathing
Sit comfortably and relax your shoulders. Take a calm breath in through your nose; purse your lips slightly and breathe out for longer than you breathed in. Use it when excitement and tension make your tremor worse.
5–10 breathsDo the exercises that use a weight sitting at a table, in case you drop it.
Video
Videos for tremor
From the YouTube channels of the International Essential Tremor Foundation (IETF) and VCU Health in the US.
Essential tremor is more than a tremor
The foundation’s video introducing essential tremor.
The range of symptoms in essential tremor
A video on how the symptoms differ from person to person.
Frequently asked questions
My hands shake. Is it Parkinson’s?
Not every shaking hand is Parkinson’s. Parkinsonian tremor is mostly seen when the hand is at rest; in essential tremor, the most common type, the hand shakes while doing something. A neurologist tells them apart by examination; see one if your tremor is getting worse over time.
My tests were normal. Why is my tremor not going away?
Normal tests help to rule out causes such as thyroid problems and low blood sugar. In that case the two common possibilities are enhanced physiological tremor and essential tremor. Review triggers such as caffeine, lack of sleep, stress and the medicines you take; if the tremor affects your daily life, talk to your neurologist about medicines.
Does acupuncture help with tremor?
A review combining 20 trials in essential tremor reports an improvement; but all the trials were done in China, were small and had no blinding. The evidence is promising but not conclusive. If you would like to try it, think of it as an addition to the treatment your neurologist recommends, not a replacement for it. In Turkey, acupuncture may be performed only by doctors certified in this field.
Does exercise make tremor worse?
Tiredness can make a tremor worse for a while; this is not harmful. In small studies, a six-week arm-strengthening programme improved manual dexterity in essential tremor. Do the exercises sitting down, slowly and with control.
When to seek help right away
See a doctor without delay if you have any of the following:
- A tremor that starts suddenly, especially with slurred speech, a drooping face or weakness in an arm or leg (emergency)
- Tremor, sweating and restlessness in the days after stopping alcohol (emergency)
- A tremor that appears after starting a new medicine or changing a dose
- Tremor together with palpitations, sweating and weight loss
- Problems with walking and balance, or slowed movements
- A tremor that is getting worse over time and getting in the way of daily tasks
Sources
- National Institute of Neurological Disorders and Stroke. Tremor. Last reviewed 23 July 2026.
- NHS. Tremor or shaking hands. Page last reviewed 14 November 2023.
- Kavanagh JJ, Wedderburn-Bisshop J, Keogh JWL. Resistance training reduces force tremor and improves manual dexterity in older individuals with essential tremor. J Mot Behav. 2016;48(1):20-30.
- Sequeira G, Keogh JW, Kavanagh JJ. Resistance training can improve fine manual dexterity in essential tremor patients: a preliminary study. Arch Phys Med Rehabil. 2012;93(8):1466-1468.
- Shen M, Shi Q, Han J, Chen B, Gao S. Comparative efficacy of acupuncture therapy in primary essential tremor: a network meta-analysis and systematic review. Healthcare. 2026;14(6):803.
- Regulation on Traditional and Complementary Medicine Practices (in Turkish). Turkish Official Gazette, 27 October 2014, no. 29158.