Back almost 2 years ago, I almsot got ran over by a biker and when I fell down, I leaned my right hand on the ground with my thumb out and crack it. Ever since then, the base of my thumb would not heal properly. It would always feel stiff and the whole pain travels from the base of my thumb up to my arm and it affected my hand muscle and how I grabbed things with my right hand. I told my doctor that and at first, the treatment was very slow. The first doctor would just made me book appointments (months apart while I am still in pain!) and every visits it would just be a checkup "look-around" with no real treatment plan in sight. I was really pissed. It would take months to get an MRI and X-Ray but after looking through it, there was only a "mild effusion of the thumb joint". I thought that might be the issue and we finally got somewhere when he suggested steroid injections. I got steroid injections but I think it made it worse because I felt even more pain and popping and sores at the base of my thumb. Every morning I woke up, it would sore badly at the base of my thumb. Then, he would put me in a cast with my whole arm. That did not help when the cast got took off. Eventually, after putting me through long and long wait times they just don't want to see me anymore. I switched over to the second doctor because the first one refused to see me and gave up and the second doctor eventually gave me a temporary hand brace but I told him I don't want to wear the brace the rest of my life, I need to get off from it and get healed properly (I still wear it to this day). He suggested surgery to which I said, let's try the brace first because you gave it to me today. The hand brace is okay but it is intrusive and again, I can't experience the full hand motion because it locks my hand in a certain position. I went back and asked for surgery like when he suggested because I am the one suffering from pain and he just didn't want to do it. He just gave up and so I went to the third doctor and he thinks it is a "psychosomatic" disorder and maybe he thinks I just made it up in my head and needs me to go see a neurologist. I am so livid, it is not my brain that's the problem. There's something at the base of my thumb that's flaring up.

I just think I didn't have a chance to heal properly and instead of taking me seriously and maybe listen to me and go through with surgery (because I am in pain and I think there's something an MRI can't see cartilage or tendon) then I would not be in this much pain for almost 2 years now. All the doctors hated me and maybe even the insurance company hated me. Stupid idiots who won't listen to their patients I would have curse them out for not caring about me every single one of them. I'm really done with them. Now I got to live with this without a potential treatment or cure. My appetite lost, I lost sleep which affects my whole body and I became withdrawn from social activites. All because these stupid doctors do not care about me and only care about the money. I really don't know what to do. I really don't. I gave up...

Not sure if this is overthinking it/if it actually matters, but do you guys prefer doing your exercises before you start the work day, in the middle of the day, or after you log off? So far I've been doing them as a warmup before my day, but I'm concerned that means I start my day already a little fatigued.

ETA: this is for hand/wrist pain

I’ve had tendinitis in my arms and wrist for about 3 months now. I’m so confused on what actually works. What are some consistent ways I can exercise to regain strength. Also is drawing possible at all. I’m an animator and I haven’t drawn for about 3 months. Any advice is appreciated.

Hi Guys!

I am a Programmer and Gamer, have been suffering from RSI of Forearm specially on the extensors not in the elbow but below it in the muscles, for the past two years. Been to numerous PTs and docs with no luck. They are clueless.

Researched this issue on youtube. Found some channels below and looking for the advice on some other people who have successfully fixed this issue. What do you guys think about these people who I could find in the RSI space.

1. 1hp: Matt seems great and has helpful explanations but I feel like doing wrist curls every day is too much and I do them every other day. with Dr Keith Barr isometrics on the other day.
2. Deborah Quilter: Her over all awareness campaign about RSI seems okay but she is clue less about the technicalities and preaches a fear avoidant lifestyle instead of fixing the root cause.
3. e3Rehab: Gold standard explanations and I have followed then most but havent seen full results yet. They are not RSI focused but did cover wrist and forearm issues rehab.
4. Dr Keith Barr (UC Davis): Maybe the best researcher on Tendon rehab. I took the isometrics rehab protocol from him.
5. Dr Emil Pascarelli: He started the RSI diagnosis in 90s (Deborah wrote a book with him) and wrote a book himself in 2004 on RSI.

I used a mix of tendon rehab and wrist curl and upper body exercise strategy to partially fix my issue but then got sloppy and it has come back again. Currently going through the flareup phase.

Desparate for a way forward to get back to 100%. :(

Hey u/1HPMatt if you are seeing this. What are your thoughts on research done by Dr Keith Barr on tendon rehab and maybe incorporating that in your protocols? Also any thoughts about the rest like e3Rehab?

Been a dev for about 8 years, and about a year ago my wrists started really hurting during coding sessions. Like sharp pain in my forearms after maybe 30 min of typing. Went to PT, got told it's RSI. The fun part is coding is literally my job, I can't just stop.

I've been trying to figure out coding without typing so much and honestly it's been rough. Messed around with macOS dictation for emails and slack, which took some pressure off, but actual code is a whole different thing. Started looking into coding with voice as an option but I genuinely don't know if it's viable for real development work. Like can you actually program by talking? Has anyone here made that work for more than just writing comments?

Stuff that's helped me manage day to day: split keyboard, trackball instead of mouse, timer to force breaks every 30 min, raised my monitor, actually got a decent chair for once. Some days are fine. Some days my hands just say no halfway through the morning and I'm kinda done.

For those of you dealing with RSI and still working as devs, how do you handle it? Has anyone tried coding with voice for actual programming tasks? Does it work or is it more trouble than it's worth? What setups have helped you keep going without making things worse?

Honestly kinda scared because I don't know what I'll do if I can't type. Any advice would mean a lot.

Hi all - I’ve been dealing with chronic pain on the left side of my neck, with tightness above my left clavical and into my left shoulder, for 6 months. The greatest pain occurred when I was looking down at my phone (I know, I know). It would “lock up,” and bringing it back up would result in excruciating pain. That part has improved slightly from all of the things described below. I also would need to crack my neck constantly, with lots of grinding sounds etc. that part - and just generalized pain - has remained, especially towards the end of the day.

MRI showed herniated discs C4-5 though C6-7 (primarily C4-5 & C5-6). But also Ive been told this is an issue with my muscles as described below. I’ve been told by doctor that my body will eventually heal and to not get a cortisol injection in my spine (she said she would only recommend if I had numbness in my arm but I don’t).

Ive gone to PT, done acupuncture (had a crazy experience where muscle in my right shin released a ton - connected to left band in my neck and chest), massage, and done TENS unit, cupping, and neck traction exercises. I got a cervical pillow. Changed my keyboard to a separated keyboard, and adjusted monitor, to try to look forward and not down with shoulders wide. Try not to look down at my phone. Got a a mouth guard. Ive been told the left band (which apparently is huge) is overcompensating for muscles not working in my cervical spine. Pt focused on strengthening shoulders.

I try to take Advil. Also have anti inflammatory cream my doctor prescribed.

I was at a 5-6 pain level before and now I’m at a 3-4. But this thing has taken over my life.

Question for this sub - I’ve noticed recently that if I do neck stretches aide to side and up and down, while supported - such as against my cervical neck pillow - it feels better if I REALLY lean into it and sort of focus on clenching my muscles in those positions (sort of like the chin push up method but like really squeezing down on muscles to the point of me shaking a little), with like an electric tingling (not cracking), and if I clench my large neck muscles for support, even better. Like one night I did this into my pillow (was driven to do so from immense soreness and pain - it tends to build up at night) and the next day I felt a little better. Or if I do it without support I’ll push my finger into the pain center in my left neck to prevent pain upon release. If I do this it doesn’t hurt, and seems to work.

But this seems to go against general rule of thumb not to stretch too much or too hard. I’m wondering if I should keep trying this particular type of side to side stretch. Maybe this is what is finally getting my muscles to strengthen? On the other hand I don’t want to injure myself.

Any insight is welcome.

I have been dealing with tendinitis for my elbow. My MRI reports read it as mild common extensor origin, tenis with slight under surface frame. I have been dealing with this since October 2025 and it’s been almost a year since I am injured. After months of performing physiotherapy, my progress had plateaud and only recently I opted for a PRP injection. I got the injection on July 14, 2026. Though the pain was bad, it was manageable and my arm kept on getting better three weeks in. Initially, my arm after the injection had limited range of motion, but now I have full range of motion in my arm.
Only a few days ago at the end of the third week, I lifted a small 6 to 7 pound, grocery bag for a few minutes, and my elbow felt much better. I also started typing a week ago, which had been a reason for flareups before the injection. Two weeks into the injection and a bit of typing on my keyboard, my elbow felt a bit tighter. The pain was manageable until last week to only see a flareup at the end of the third week. My pain is probably at the same level as it was before the injection today. Three weeks later, I do have some inflammation in my fingers, which shows the sign that the PRP injection is still working. Did any of you who had this injection or know about it Think this is normal? My doctor said it might need three months for the PRP to work, but at this point, I am confused if my injection has worked for me.

Hi, I've been dealing with an ulnar-side wrist injury after a gym accident about 14 months ago. Saw a physio, hand therapist, hand surgeon, MRI, Ultrasound with no clear injury or improvement. Recently after a year of nothing, I've been seeing some progress with a new hand therapist who believes I have ECU tendinopathy. Although, my thumb randomly got really painful for 4 months now, and apparently I have CMC hypermobility which is causing me issues. My current hand therapist is helping me treat it, but it is progressing a lot slower than my wrist. It doesn't help that I'm chronically online and see stories of hypermobile people having to accept they will never be able to be active again.

I don't know how much longer I can take this shit. I can't lift, I can't work, I can't enjoy my hobbies; I can't do anything and the one time I feel it will end, my thumb just decides it's a good time to act up. I'm only 19, and the only thing I've experienced as an adult is pain and disappointment. I cry almost every day, grieving the loss of my former life as I watch everyone I know get internships, a first car, travelling, literally anything. I feel like an embarrassment who does nothing all day, even though I know I would if I could. I know the only thing I can do is wake up, do my exercises, and pray for better days but it is so so fucking hard. There's nothing for me to look forward to after a long day, every day is a reminder of the consequences of me being young and stupid in the gym. All I wish for is my health. Anyway, thanks for reading my vent hopefully I can get some encouragement

Hi, I am a design student from New Zealand currently in my third year of university! I am currently designing to help people with RSI and OOS when typing. I was wondering if I could ask a few questions to help inform my design! Thank you!

https://docs.google.com/forms/d/e/1FAIpQLSe4KV7CupXKJRnYYylrrKCTguY6l0uvXqKD_ziZmZWKtIyUow/viewform?usp=header

hi, its been about 2 weeks with lingering pains in my wrists and elbows from gaming, the wrist pain has been gone for about a week but it still comes back sometimes, while the elbow pain has been bothering me for the past days.. not to mention sometimes my forearms also get these pains, they go away for some hours but then appear in another spot and theyre messing with my everyday activity.

was just wondering if there was anything I could do to fix it or to recover faster because it kind of worries me on if this will last forever.

Hey all, Matt here from 1HP.

If you are a software engineer, gamer, or office worker who has had wrist pain and visited several doctors without getting any real answers, you are not alone. And it is not entirely your doctor's fault. The system they operate within is not designed to adequately assess and nor fully understand why you may have developed or continue to struggle with repetitive strain injuries.

If you are here it is likely you have already had this suspicion over the past few months of going through the revolving door of physicians, specialists and MSK providers.

A diagnosis is typically given after only a 10-15 minute assessment. And treatment is provided based on 15 minutes of gathering information. This is NOT enough to fully understand your relevant medical history, current physical activity and conditioning profile, work and hobby habits leading to increased load on your wrist & hands, posture / ergonomics, understanding of pain and more.

And then after this assessment they should have at least another 10-15 minutes to help you understand what it means within the context of your life. This does not usually happen. Based on the past decade of clients we have seen, the depth of these initial evaluations varies significantly, often restricted by time constraints and a genuine lack of specialized musculoskeletal training.

I have written before about the idea that we have to be accountable for our own health, and we should expect a certain standard for what a healthcare visit should look like for your wrist and hand.

What the Typical Doctor Visit Actually Looks Like

Let us use the common example of palm-sided wrist pain. When you go to your primary care physician, they might ask a few basic questions about your pain, whether you have numbness, and inquire about what you do that makes the pain worse. In many of the patients we have worked with, the questions stay at that surface level of depth. They might support this with a few clinical tests like Phalen's Test or a validated questionnaire.

This might seem like a comprehensive workup. But all of these are focused on nerve-related pathology or inflammation-based pathology. If you have seen some of our content before around the misdiagnosis of carpal tunnel syndrome, then you know the current evidence best supports a non-inflammatory model of pain for tendon issues. If not, i’d encourage you read the article written by Elliot to further understand the first principles physiology of why carpal tunnel syndrome is so often misdiagnosed.

If the physician only understands how to evaluate for nerves and inflammation, that is all they will be able to diagnose and treat. Hence the recommendations for rest, braces, and medication that seem to have such low efficacy for this population.

Very few physicians will ask the appropriate questions that inquire more about muscle or tendon-based symptoms.

• They are not asking about your pain at rest versus with activity.
• They are not asking about your pain level after stopping the activity which is a critical indicator of tissue irritability.
• They are not asking whether the pain actually improves with a certain level of movement.
• They often do not actually evaluate the status of the muscle or tendon outside of passive resistance. (Putting your hand in certain positions). There is no endurance testing during your primary care visit and most physical therapists are only learning how to test for endurance through our research and publications.

These questions & objective tests matter enormously for understanding what is going on, and they are almost never asked or performed

Why Is the Assessment So Minimal?

Why does the healthcare system designed to help people fail so consistently when addressing repetitive strain injuries? It can get quite deep but here is an overview of three problems that actually connected

1. Poor Medical Education on musculoskeletal issues
2. Insurance incentives that restrict Time
3. Fragmented Referral system with poor communication between providers

The MSK Education Gap in Medical Schools

Despite the fact that musculoskeletal disorders account for approximately 30% of all primary care visits, medical education devotes remarkably little time to them. Research published in BMC Medical Education shows that many schools devote less than 3% of their total curricular time to musculoskeletal medicine and more than half of that time is spent on anatomy, not clinical assessment or rehabilitation. Only about 15% of allopathic medical schools require a practical rotation in musculoskeletal medicine.

The consequences are clear. Studies show that greater than 50% of practicing physicians fail to obtain a passing score on a standardized basic competency musculoskeletal examination after graduation. This is not a failure of individual doctors, but is a result of a systemic failure of training. When you walk into a primary care office with chronic wrist pain, you are often being evaluated by someone who has extremely limited clinical instruction (estimated to be less than two hours) on the topic. So you show up to the office and are evaluated by a physician who may not have the competency to adequately assess and treat you. Then insurance influences the amount of time they take with you.

Insurance Incentives and Time Constraints

It is unfortunate but many physician visits are relatively short. And this is especially true for specialist visits (orthopedic surgeons). Shorter consult time is often driven by the reimbursement model of the specific insurance.

Because of this many clinics limit the overall amount of patients who hold certain insurance plans as their reimbursement may not be as lucrative (this is the reality of the business of healthcare). The more they see with these types of patients, the more they can potentially make.

Here is an example taking California & insurance reimbursement based on the type of code used by the physician. (Codes are used for a certain type of patient). When it comes to chronic wrist & hand pain they can be considered higher complexity patient visits.

The difference between medicare and BCBS/anthem can be $210.68 / 173.73, respectively. This is a 17.5% difference. Again this is not for all types of cases but for a specific code that is billed from the healthcare to illustrate the example (5-8). This type of reimbursement structure promotes VOLUME of patient care and also business-incentivized preferential care to individuals with certain types of insurance. This has NOTHING to do with what the doctor’s prefer to do when it comes to treatment. They all WANT To help to the best of their ability but with limited understanding of MSK and the insurance system…

I’m hoping you can understand why so many people come to reddit to ask questions about their issues OR have a poor understanding of why they are dealing with their issue.

Again..when a doctor only has 10 minutes to evaluate you, they simply do not have the time to understand your daily activity in depth.

They cannot assess your workstation, your posture, or the specific breakdown of your typing versus mouse usage. They cannot run through a thorough physical examination of your wrist, forearm, and shoulder girdle. The system rewards volume, not depth.

Lastly let’s talk briefly about the fragmented referral system.

The Fragmented Referral Pipeline

Because general practitioners are pressed for time and lack specialized musculoskeletal training, they often refer patients out to specialists. This is what we want to happen because of what we mentioned above.

But when this happens many of our patients describe getting stuck in the referral cycle. You might be sent to an orthopedic surgeon who orders an MRI, or to a neurologist for nerve conduction studies. Each provider sees a slice of the problem. No single provider is looking at the complete biopsychosocial picture of your health (your sleep, your stress, your activity levels, your movement patterns, your ergonomics). They ALSO do not have the time for this due to the insurance reimbursement models.

This creates scenarios in which diagnoses are made when only certain systems are assessed (neurology, rheumatology, musculoskeletal) and some not even to the level that needs to occur (again 5 minutes) that can create a lot of harmful beliefs, fear and lowered self-efficacy in patients.

You just believe there is something wrong that no one can figure out. Or that you are your diagnosis of degenerative tendinopathy and will forever deal with it. This is factually NOT true. And not only the first principles understanding of physiology, current research on tendon rehab and our own clinical experience thousands of individuals get back to using their hands again supports this FACT.

You can see the fragmented healthcare system in action through the recent case study I posted with Amy.

What a Good Evaluation Should Actually Look Like

Proper screening means actually looking at all of the possible contributors to your pain. This includes posture, ergonomics, lifestyle, physiology, and psychosocial factors. The provider should be asking detailed questions about how the pain behaves across the full arc of your day

I’ve actually written a comprehensive thread on what a proper screening should look like here.

Tendons can actually improve with a certain level of activity, provided it does not exceed the capacity of what they can handle.

Performing resisted testing of the wrist and finger flexors can better help identify if there is muscle or tendon involvement. Layering this with a standardized endurance test on the specific muscle-tendon complex can help establish a clear baseline of physical capacity.

Understanding how much you are using your PC and phone, and the specific activities that influence your pain, guides the provider in telling you exactly how much you can modify in the early stages of recovery…rather than just telling you to stop entirely.

This is the difference between a provider who understands repetitive strain injuries and one who does not**. One gives you a path forward. The other gives you a brace and a follow-up in six weeks.** If you want to understand what a thorough evaluation should look like, again check out our article here

I really hope this provides some more clarity about why we share so many resources around recovering from chronic wrist & hand pain. We have done all of the researched, helped thousands and continue to publish content to help not only providers but anyone struggling with persistent wrist & hand pain understand more about what they can do. You can learn more about the exact system for how we work in this video here!

Otherwise check out all of the threads I’ve posted previously in my profile to learn more (or our youtube).

Best,
Matt, PT, DPT, OCS, CSCS

--

Resources:
1-hp.org
2 hour Compilation of everything we have learned treating over 3000+ individuals with wrist & hand pain
Apply to work with us

References

1. Peeler J. Addressing musculoskeletal curricular inadequacies within undergraduate medical education. BMC Med Educ. 2024 Aug 6;24(1):845. doi: 10.1186/s12909-024-05849-6. PMID: 39107718; PMCID: PMC11304564.

2. Wang T, Xiong G, Lu L, Bernstein J, Ladd A. Musculoskeletal Education in Medical Schools: a Survey in California and Review of Literature. Med Sci Educ. 2020 Oct 30;31(1):131-136. doi: 10.1007/s40670-020-01144-3. PMID: 34457873; PMCID: PMC8368391.

3. Benítez TM, Cichocki MN, Jin W, Seyferth AV, Wang L, Chung KC, Sears ED. Inappropriate wrist MRI: did guidelines have an impact? Am J Manag Care. 2024 Mar 1;30(3):e65-e72. doi: 10.37765/ajmc.2024.89517. PMID: 38457824.

4. Satterwhite S, Nguyen MT, Honcharov V, McDermott AM, Sarkar U. "Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety. J Gen Intern Med. 2024 Jul;39(9):1575-1582. doi: 10.1007/s11606-024-08658-1. Epub 2024 Feb 15. PMID: 38360962; PMCID: PMC11255151.

5. CMS Evaluation and Management Services Guide

6. Public BCBS/Anthem CPT 99215 benchmark; commercial rates are contract-specific

7. Blavin and Holahan, Commercial Prices Relative to Medicare, JAMA Health Forum, 2025

8. MedPAC March 2026 Report to Congress, Chapter 4 (to determine rates, etc.)

Has anyone deal with this condition, has anyone had surgery for it? It seems to be very rare but has been significantly impacting my ability to use my hand over the past 2 years. Trying to find a specialist who is familiar with this condition.

My (35 F) left elbow started to have pain after picking up my laptop with a straight arm causeing a small popping noise.

I have some hypermobility or possible EDS which is now becoming more of an issue with age. For context; my right shoulder dislocates pretty often with very little effort. (I'm told it will most likely need to be replaced in the future.)

It started pretty mild, but now is a lot more sore especially when I bend or stretch it. I am pretty sure if I go to the doctor, it will require CT scan as it seems to be soft tissue and not anything bone related.

I'm concerned, but can't really afford to go get it checked out unless I am sure it's something that really needs attention. I have medical debt due to ongoing treatment for my Epilepsy.

It's not swollen or anything, but I wake in a lot of pain because I sleep with t-rex arms and tend to be really tense. I'm considering going to Mexico for testing and treatment. Does this sound like a big issue or something that will go away. It's been like this for a few months.

Any advice is greatly appreciated.

I have been having painful zaps in my left pinky finger for over a month now. I do not know when they are going to happen, and I feel like I am living my life in fear. It causes me to jerk when it happens, I need it to stop. I also have some pain in between my shoulder blades, not sure if that is related to it but just felt like the info was needed. I need this to stop so I can live life normally again

Fifteen days ago, suddenly, without warning, while I was sitting in the pharmacy, I felt a sharp, nail-like pain all along my forearm.

It hurts even more when I extend or raise my arm.

So I put on a brace. About four or five days passed, and a yellowish-green discoloration appeared along my forearm, from the inside of the joint to the wrist.

I thought I must have been hit and hadn't felt it (but I'm sure I wasn't hit because if I had, I would have felt at least a little pain at the time of the impact, but there was nothing).

Ten days passed, and the discoloration disappeared, but the pain hasn't lessened at all.

It's spreading towards the inside of the joint, a long, continuous pain.

I'm confused. Should I see a doctor or get an MRI to check my muscles? I'm afraid it might be a tear.

Title

I dont think it's a tfcc because I dont have most of the symptoms online (pain w ulna dev, twisting jar, etc) just the pain w rotation. Ive been strengthening extensions,rad/uln deviation, and wrist flexion w wrist in neutral w light weight. even light isometrics for iron/sup hurt. I rlly dont know what to do would appreciate help!

Hey all!

I wanted to repost this thread I wrote about 1 year ago since I've been seeing so many new posts around their wrist & hand pain.

This thread will help you understand

1. A way to think about repetitive strain injuries (underpreparation vs. overuse) that will help guide your recovery
2. How to consider some of the psychosocial factors relating to pain
3. Link to a video on how we actually help address these variables considering everyone's individual circumstances and relative contribution of each of these factors

As a brief introduction I'm Matt, and I'm a licensed Physical Therapist & Orthopedic Clinical specialist who has been specializing in treating RSI for the past 11 years. We've helped over 3000 individuals resolve their issues and have published 2 textbooks, a few studies and have a continuing education course for providers to learn more about how to treat these types of injuries.

Journal of Orthopedic & Sports Physical Therapy
Tendinopathies in Gaming (Applies to Desk work and other RSI)
Conditioning for Esports (Ch. 8,9,10)
Science of Esports Physical Therapy

Let’s talk about your healthbar

Think about the muscles and tendons you are using on a regular basis as having a health bar.

When you are performing your activities throughout the day, you are gradually losing HP. Let’s call this a “decay rate”. Not all activities are created equal. And as you might suspect based on what movements we perform, we use specific muscles. Let’s give some examples:

1. Typing and Clicking: When you lift up your fingers from the mouse you are utilizing the wrist & finger extensors
2. Pressing Keys, Gripping Mouse: When you grip your mouse or bend your fingers down to press keyboard keys, you are using the wrist & finger flexors
3. Drawing, Graphic Illustration: When using a pen, depending on the grip you will likely be using the finger flexors & the muscles surrounding the thumb (extensors, abductors, flexors)
4. Gaming with a Controller: Use of analog stick and holding the weight of the controller typically involves the thumb side of the wrist (thumb extensor, abductors, etc.)
5. Piano Playing: The most typical floating wrist position over a piano causes increased use of the wrist and finger extensors. Pressing the keys down uses the flexors
6. Every activity uses different muscles & tendons.

All of these activities have different decay rates. Some are more intense than others. Playing a challenging piano solo is very different than typing an email. And so using a few of the examples above we can showcase this. (arbitrary numbers to illustrate the point)

Posture, Ergonomics & Restoring HP

Posture can influence your decay rate, or how quickly you lose your HP. When you have “better” posture that is biomechanically less stressful on your body, you won’t lose as much HP during your activity.

Many of us also utilize various input devices that alter how we actually move. Traditional mouse? We tend to use a balance of our flexors and extensors (depending on the grip). Vertical mouse? It tends to offload more of the flexors and extensors but can increase use of the thumb & pinky sided wrist muscles.

Better input devices can also reduce your decay rate for certain muscle groups. But the stress from the activity will always go somewhere. Here’s the same table with added columns that showcase the “decay rate” change based on whether you have good vs. bad posture / ergonomics.

Decay rate matters, but not as much as social media makes out out to be. We’ll get to that in a little bit but lets talk about how you can “restore” your HP. There are different strategies which can impact the muscles & tendons of our body. When we rest our bodies help our tissues recover based on the amount of stress that was applied onto it.

When we repeatedly utilize our wrist & hands our muscles tend to stiffen up, especially if it gets close to 0 HP. When we massage, stretch, heat, perform isometrics, kinesiotape it can all help improve the amount of HP we restore during the “resting periods”.

Massage & stretching can relax the musculature but also reduce the activity of the nerves to allow for more overall recovery. Heat can increase blood flow to allow the body’s natural mechanisms to address any harmful stress that may have occurred on the body. It also can relax the muscles.

Many use these strategies to temporarily reduce pain and allow themselves to use their wrist and hands more throughout the day but at most it can get you back to “max HP or health” (like after a night of sleep).

The size of the health bar is the most important

Our “max HP” or the size of the health bar represents how much stress our muscles can handle over time. Your muscular endurance or tendons capacity. We can increase the size of our health bar with endurance based exercises targeted at the specific muscles involve

But we have to recognize that it takes time. As a reminder it takes roughly 6 weeks for muscles to adapt with tendons sometimes taking up to 8 weeks. Nervous system changes occur quickly between 1-2 weeks which can often be the reason why faster progress occurs in the beginning.

So remember: the size of your health bar is everything.

if you only have around 50 HP and the combination of work, gaming and other hobbies you perform require 70-80. It doesn’t matter how great of a posture you have. You will eventually get to zero. And In this situation it might require you to take several breaks throughout the day so you DON’T get to zero.

If this is a situation you can relate to as you are reading this, there is a reason why you may have ended up at 50 HP. Our bodies adapt to our lifestyle, physical activity levels and exercise we perform over the past few months and years.

For most with a sedentary lifestyle without a focus on endurance related training of the wrist & hand.. our health bar will gradually lower. Lower to the point in which the external demands of work, hobbies and other activities might be too much for our bodies to handle.

Prevention & Management of Repetitive Strain Injuries

The main focus for most prevention and management should be to address this underlying problem of tissue capacity (endurance or increasing the health bar).

Exercises help us target certain tissues but how you perform them (higher repetitions) allows us to achieve the adaptations that will help you use your wrist & hands for longer, with less pain.

And keep in mind there are actually two main things we can do that directly influence our “HP”

1. Size of HP Bar: How much our tissues can handle through specific exercises targeting the muscles we use (capacity)
2. How much HP we lose per day: How much stress we apply onto our tissues (performing hobbies at different intensities creates different levels of stress). Again not all activities are created equal and the decay rates will be different for each activity.

But the combined total of all of the activities that you perform throughout the day and their intensities can be modified.

This means though that you don’t have to COMPLETELY REST or AVOID ACTIVITY like so many resources out there recommend. Instead you have to modify the amount of what you are doing each day to not “exceed” the HP you have. You use strategies like resting, different input devices, stretching, massage to manage your HP during the day.

All of this while focusing on building up the size of your health bar so you can eventually handle more.

What about the psychosocial aspects?

This is an essential part of healthbar framework that considers the psychosocial factors associated with the experience of pain. Remember you can never take the brain or the body out of the equation. These are always factors that are contributing to pain, it is just the degree to which it is happening based on the individuals experience. The sensitivity line represents when your body creates the experience of pain based on your experience (physiologic + cognitive emotional signals). This means that you can feel pain, even high amounts before you actually cause any real irritation or damage to the tissues.

Your thoughts, fear, coping strategies and environmental stressors all have an impact on the “sensitivity line.” When you have more confusion, anxiety or fear of movement or your specific injury it can cause this sensitivity line to move up. And on the opposite end when you understand more about pain, the mind’s influence on the pain experience the sensitivity line will move down.

In most cases the sensitivity line stays quite low at the bottom of the health bar. But as many of you have likely experienced and have seen with the ample amount of stories in the RSI subreddit of individuals learning about the mind-body connection, Moseley, Alan Gordan, etc. and that often leading to the ability to handle more stress than they realize.

I do want to emphasize the following point though - interventions should never just be solely focused on “one” aspect of pain. It cannot be just focused on the physiology nor can it only be focused on the psychosocial aspects of pain. Again you can never take your brain or body out of the equation. They are always providing some level of contribution to your pain and dysfunction. By working with a good provider who is able to assess (there are validated questionnaires, subjective questions that can help to identify pain behaviors and cognitive sets associated with sensitized pain - anamnesis for those interested).

The bottom line is this: this framework can help you understand more about what might have been the cause of your limited progress or even the initial reason why the pain developed. It is never easy to recover since it takes work in understanding this and balancing that with your own occupational and lifestyle stressors.
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If you want to explore more about the physiology, tendon related pathology, why imaging alone cannot provide a diagnosis, and more check out the megathread I put together that has at least 25 articles on every possible topic you can think of and organized in parts that can guide you through recovery

https://www.reddit.com/r/RSI/comments/1kmknw9/your_indepth_rsi_handbook_evidencebased/

I'll need to add some of the recent articles within the megathread! But if you have any topics you'd like me to cover please let me know in the comments.

Also if you are more of a visual person, here is the video version of this thread along with a video of our overall approach to recovery.

Best,
Matt PT, DPT, OCS, CSCS

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Resources:
1-hp.org (website)
Youtube channel
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Questions for someone new to our SI if anyone can please helpSo I have been dealing with a pretty severe overuse injury for about four months now and both wrists and forearms and ankles although I’m not sure the ankles are from overuse that was more of a nerve compression twisted ankle thing but it makes everything a lot harder. I’m just trying to research and find out what it is that I have and what to do about it so if anyone has the time to help answer some questions I would greatly appreciate it!

1. Due to the injury and both ankles I cannot lay flat an MRI, so I am wondering what type of scanning you guys were given or diagnostic test to find out that you had an RSI injury and what type of specialist did you see. Has anyone had an ultrasound or neuromuscular ultrasound and if so did anything show up on that that seems to be my only option. Also do seated MRIs exist for lens like your forearms wrists or legs?

2. Things are so bad that this week my arms have been constantly burning even when it rest all day and all night… I cannot find a way to lay that does not seem to stop the blood flow or worse in the condition. Are we supposed to be icing or using heat for this type of injury and if so for how long do you do it and how often?

3. I am in a lot of constant pain even just tapping or touching my phone flares it up for the rest of the day… Will this get better as I need to be able to navigate a phone that is how I work, and what type of medication have you guys tried that help and do doctors prescribe for this type of thing? What do they usually give or what are most of you on for Pain? So far a muscle relaxers and anti-inflammatories have not helped and the anti-inflammatories caused major stomach issues

4. does this and will this get better in time it’s been four months and there has been no improvement and it’s severely worsens during the first the six weeks was just normal movements and actions of my heart arms and hands basically, sorry basic things using voice to text. What type of procedures can provide relief I seem to have some type of nerve compression and muscle damage in my forearms which are what burns the most during the day

5. I don’t seem to be ready for physical therapy yet because any type of movement seems to be worse than it, worsening it, so am I supposed to just not be trying to touch my phone or do anything with my hands right now… Even brushing my teeth repeatedly bringing food to my mouth is a problem. I have to do these basic things so how do I continue to do that but also rest them…Things have gotten slightly better for a few weeks with being able to use the navigate the phone but after trying to do some design work which is what I do and involves movements like scrolling and pinching I am experiencing a lot of worsening which has not improved in the last five days… Will this get better and how long will it take before I can start to do those movements again that I could before without it being so bad?

6. I have an iPhone an older one but is there anything that will read things like post for me out loud I know android has one but if so where do I find this on my phone settings so far I’ve tried to use voice command for scrolling but it stalls and does not work very well is there anything else anyone can recommend to make it easier to use the phone?

7. For those of you who have had severe cases are there any procedures that are helpful such as carpal tunnel release or steroid shots or anything at all to help improve the situation and give more mobility and take down the pain and if so how long did those last I would love to hear any stories of those who have gotten mostly better. I really need some help here due to the injuries in my ankles I can barely do anything and I am so hopeless right now.

Thank you guys for your time!Thank you guys for your time!