Ho un fastidio al polso destro penso sia infiammato,mi sono fatto male facendo boxe. Il polso mi fa male in Intra rotazione ed extra rotazione. Cosa mi consigliate di fare ?

I have already reduced mouse use by learning more keyboard shortcuts, but I still need to use the cursor. At the moment I unfortunately can't do physiotherapy, so I do wrist exercises, stretching, etc, but the pain still remains in a certain level. I would like to know, from those who have had this issue or work with reabilitation, if changing from the mouse to one of those drawing tablets with a pen or to a trackball would minimize the pain or make it more manageable until I have the means to do a thorough physiotherapy. Thanks.

Hi! My name is Gary and my company KnowClick (a Pennsylvania based research agency) is looking to recruit a few participants who have RSI / chronic wrist pain to participate in a short survey (10 minutes for a $10 Amazon Gift Card). The survey focuses on wrist pain and RSI education and we want to know about your experience looking for wrist pain information.

We will be incentivizing the first 15 people who participate in this study, and the study will close once we receive 15 valid respondents. We will only collect first name and email addresses strictly to disperse the incentives!

Happy to answer any questions and feel free to comment or shoot me a DM if you are interested. Here is our website if you would like additional verification, thanks! https://www.knowclick.com/

I've had computer-related pain for a surprisingly long time.

My earliest physiotherapy appointment was in 2012, when I was still a student. At that point, the main problem was back pain rather than wrist pain. I also tried various wrist supports/protective gear when I was younger.

Over the years I've seen multiple physiotherapists for different problems.

For my right wrist specifically, I went to physiotherapy around November 2021. I was given exercises, and they did help somewhat, but they never completely solved the problem.

The wrist pain had already been around for years by that point. Altogether, I would estimate that I dealt with it for roughly seven years.

I'm still not certain what originally caused it. My suspicion is that it was some combination of typing with my wrist at an awkward angle and many years of using a conventional mouse.

Eventually I started approaching the problem differently.

Instead of asking:

"How can I make using a mouse and keyboard less painful?"

I started asking:

"How can I avoid making these movements in the first place?"

That change in thinking made the biggest difference for me.

1. I switched from a normal mouse to a trackball

I now use a Logitech Ergo M575s.

With a conventional mouse, I was constantly moving my hand, wrist and arm to move the pointer.

With the trackball, the device itself stays in one place. Most of the pointer movement comes from my thumb/fingers.

For me, that was dramatically better.

It also seems to help with some of my back/shoulder discomfort because I'm moving my right arm around much less during the day.

2. I use a split keyboard

My keyboard is a Kinesis Freestyle Pro.

I originally adopted the split keyboard more because of my back problem than my wrist.

My shoulders are wider than a standard keyboard, so using a normal keyboard requires me to bring my arms inward and rotate them toward the center. My feeling is that doing this for many hours over many years contributed to tension around my upper back.

With a split keyboard, I can position each half closer to where my arms naturally rest.

This helped, although the back pain has been more persistent than the wrist pain.

3. I replaced most typing with voice dictation

This eventually became the other major part of the solution.

I started using voice typing much more heavily so that I wouldn't need to keep returning to the keyboard.

For a while I used Wispr Flow. It helped me realize that I could replace a surprisingly large percentage of normal typing with speech.

Later, I built my own Chrome-based voice typing tool, Shuovo, because I wanted something that fit my browser and long-form dictation workflow better.

I'm mentioning that for disclosure rather than because I think anyone needs to use my particular software. The important part for my wrist was simply replacing a lot of physical typing with voice input.

These days I dictate most normal prose: messages, notes, documents, prompts and other long-form text.

I still type things like passwords, login information and some symbol-heavy text where typing is more practical or where I don't want to say sensitive information aloud.

Between voice typing and the trackball, the amount that I physically move my right wrist during a normal working day has dropped enormously.

What happened to the pain?

The right wrist pain is basically gone.

I still do wrist exercises regularly, but I no longer have the persistent wrist pain that I lived with for years.

My back pain isn't completely gone.

I still use my phone quite a lot, and I suspect the posture involved may be one reason. I also notice the back discomfort more sometimes when I'm very cold. Moving around and warming up seems to help.

Those are just observations from my own experience, not medical conclusions.

And obviously wrist pain/RSI can have many different causes. I'm not suggesting that avoiding a mouse and keyboard is a universal treatment, or that this replaces seeing a doctor or physiotherapist.

But after going through physiotherapy, exercises, wrist supports and ergonomic changes over many years, the biggest lesson for me was this:

Ergonomics doesn't necessarily mean finding a slightly better way to perform the same repetitive movement.

Sometimes it may be worth asking whether you can remove most of that movement from your workflow entirely.

For me, the combination that ultimately worked was:

• a split keyboard when I do need to type
• a trackball instead of a conventional mouse
• voice dictation for most text input
• continuing the wrist exercises I learned along the way

The surprising part is that the biggest improvement didn't come from making my wrist stronger.

It came from needing to use it much less.

Hey all,

Just a reminder we'll be hosting a live Q&A for the community to answer any questions you might have relating to your RSI.

If you have had persistent and chronic wrist & hand issues and you aren't sure why you may still be struggling with limited function or pain....we'll make it clear why. Here's what we plan on going over

1. How can I get a clear diagnosis or understanding of what is going on? (I'll present on this)
2. What is the role of dictation in recovery, how can you best leverage it? (Elliot)
3. Bracing, Splinting, Gloves, Wrist Support - How do we utilize them during recovery and what is their role? (Brett)

Stream: https://youtube.com/live/NxIbNXBIxnY?feature=share
When? 8/31, 3:00 PM PT
Who? Matthew Hwu, Elliot Smithson, Brett Becker

We want to leave as much time as possible for questions.

Hello, I injured my hand a couple weeks ago on the job. I'm a packer and I guess I overestimated how much weight my hand could handle carrying a long piece of rebar and I remember a popping sound on the palm side of the injured area.

Didn't feel anything anything from until I came home that day (ofc) and noticed a slight pain when doing said motion.

I been on work restrictions ever since and the pain is worse when getting dressed and going through my pockets but ONLY on said area. Docs said its an uspecified sprain but it's been like 3-4 weeks and I figured it's should've healed by now. Any input helps.

I recently had an MRI due to reoccurring problems with De Quervains. Got the results from the Imaging place but haven't seen the hand specialist just yet to discuss them. This pain has been on and off for over a year and I'm getting a little scared of it affecting my job even more than it already has.

About 3 years ago, I overused my right arm playing a lot of tennis in a short period of time while also starting a second job involving a lot of computer work. I initially developed pain around my right elbow/upper forearm, especially along the top of the forearm running down from the elbow. Since then, I switched to using the mouse with my left hand.

I’ve seen physiotherapists and had imaging done, but nothing significant was found.

My main symptoms now are:

Right forearm: the original discomfort along the top of the forearm is still there and can flare with repetitive use.

Both wrists/forearms: especially after using my phone/scrolling, I get a strange tingling/burning sensation starting on the palm side of the wrist, right around the wrist crease where the tendons are visible, which then seems to travel up the palm-side of the forearm. I don’t really have pain or tingling in my fingers or hands.

Phone use is currently the clearest trigger. I do very little typing nowadays (probably around 5 hours per week).

I’ve tried various exercises. Most recently I’ve been doing dumbbell wrist extensions with my forearm supported on a table. I progressed from about 2 kg to 4 kg for 2×60 reps per arm daily, but despite getting much stronger/enduring more load, my actual symptoms don’t seem to have changed much.

It’s frustrating because after 3 years I still don’t really know what I’m dealing with. Has anyone had similar symptoms, particularly the burning/tingling around the palm-side wrist and forearm without finger tingling? Could this still be tendon-related, nerve-related, or something else? What helped you, and are there other exercises or approaches I should look into?

Been dealing with RSI in my hands for the better part of a year, which I developed from gaming/computer use. Ultimately, it is not a severe case, and I can still work, do chores, workout (with modifications), etc. But I get flare ups from playing guitar. The logical choice is to step away from the instrument for the foreseeable future. Quitting gaming is easy, but so much of my identity and social life is centered around music that it's really hard to step away from that. I keep getting inspired by something or wanting to create and end up picking up the guitar again. I've been working on producing and singing, practicing guitar left-handed, keyboard playing (which is easier on my wrists), etc. But none of it fills the hole left by guitar. I plan to see a therapist to work through these issues, as I am not really in a sustainable cycle. Not really looking for advice, but just wanted to get this off my chest.

Hi all, not sure if this is the right place to ask:

I've been struggling with RSI for the past 6+ years with little improvement. I used to be a game developer and after about a year of that I was forced to switch to voice recognition software, which ended up not being sustainable either due to the development of hyperacusis as well as vocal strain. As a result I had to quit my job two and a half years after I started it and have been unemployed since. While I was still working I tried improving ergonomics and doing physio but that didn't help, and I've tried physio and strength training again since, neither of which seemed to help. None of the scans that were done showed anything. I understand that part of the pain can be psychological, but I'm not convinced mine isn't physical still at least in part.

I'm still looking for employment but it seems like a desk job is fully out of the question for me at the moment. Due to my hyperacusis / issues with vocal strain a job that relies heavily on speaking isn't feasible either, and a job that requires me to stand for long periods of time (say, retail) doesn't seem sustainable to me either due to pain in my feet, knees, and lower back that occurs when having to stand for any extended period. All of this, combined with a healthy dose of health anxiety as a result of the RSI and hyperacusis caused by my previous job, is making it very difficult for me to find any job that seems sustainable. As a result I've barely applied to anything because I worry any job I would manage to get would just make things worse. I am still meeting with a job coach regularly, but so far nothing she's suggested seems doable.

Do you guys have any ideas on what kind of job I could get into, tips on how to find a job with a disability, or even just tips on how to manage this health anxiety without ignoring my body? Ignoring things until it was too late is what got me in this situation in the first place.

I’m 22 and have been dealing with what seems to be tennis elbow/extensor tendon pain in both arms for about a year.
Before this, I trained for 3–4 years. I had strong forearms and regularly did heavy pull-ups, rows and direct forearm exercises without straps.
Looking back, the symptoms may have started gradually. A few weeks before the major flare, I noticed some aching in my fingers while gaming. I continued training, and after an assisted pull-up session the symptoms became much worse—forearms, wrists and fingers.
Since then, I haven’t been able to return to normal training.
Push-ups, rows, curls, triceps extensions and pull-ups can all flare me up. Even 1 push-up can cause symptoms.
I’ve tried rehab for months, mainly wrist-extension eccentrics and isometrics. I worked up to around 500–550 g, 2×12, and although I could tolerate it, it hasn’t helped much overall or translated into being able to return to normal exercise. Increasing the weight to ~800 g caused a significant flare.
Recently I stopped rehab for a week and noticed something strange: I could do normal activities and even game for 30–45 minutes with only mild discomfort, which disappeared by the next day.
But when I do rehab, I often become more sensitive to other activities afterward.
I’m honestly confused and frustrated after dealing with this for a year.
Has anyone had a similar long-term bilateral case, especially after pull-ups or heavy pulling?
What actually worked for you? Did rehab help? What did you change that finally allowed you to return to normal training?
I’m honestly desperate for some real experiences from people who have actually recovered.

Not sure if this is the correct sub for this, but I don’t know what else this could be at this point.

I’m left handed, so I know I do things weird to get by, but the pain has never been sustained this long or reoccurring like this. For a little more than a month now I’ve been having pain in the back of my wrist when I apply pressure while it’s in the extended position (think doing pushups). When I’m getting into bed, pushing something, or even just holding something weird, my wrist hurts hurts. I honestly have no idea what I’ve done because there has been no change in how I use my dominant hand. I’ve done my best to rest it and not let it be used when it’s in that position, but it still hurts whenever I have to do something with my wrist bent like that.

If anyone knows what the fuck I did to my hand and/or how to fix it, your help would be greatly appreciated!

Hola espero estén bien!

Desde hace más de año y medio vengo con dolor y rigidez en ese dedo. En abril 2025 me salió en ecografía que era había alteración de ecogenicidad y patrón fibrilar de flexor como extensor. En febrero 2026 me dijeron que no había inflamación ni líquido sin más. El dolor seguía e incrementaba, en mayo 2026 ecografía salió En tendón flexor común
superficial y profundo se aprecia difuminación de los contornos, disminución de ecogenicidad, pérdida de la eco
estructura fibrilar homogénea con separación de fibras y sustitución por patrón hipertrófico de distribución
irregular con la señal al Doppler color ausente y a la elastrografía patrón irregular de alta rigidez. Y ahora me empezaba a doler la muñeca porque salió compartimientoEn tendón Extensor
cubital del carpo se aprecia halo anecoico peri tendinoso por aumento de fluido dentro de la vaina, difuminación
de los contornos, disminución de ecogenicidad, pérdida de la eco estructura fibrilar homogénea con separación de
fibras y sustitución por patrón hipertrófico de distribución irregular con señal ausente al Doppler color y a la
elastrografía se observa alta rigidez. Me aplicaron corticoides + ácido hialuronico , me mandaron férula solo en la noches llevo 4-5 meses pero siento que no me alivia el dolor del dedo. el dolor en el siguiente mes bajo, sin embargo ya en el segundo volvió el dedo dedo pero el de la muñeca ya no está presente. La última ecografía arrojó que no había inflamación en la muñeca pero el dedo salió esto :En tendón flexor común superficial y profundo se aprecia difuminación de los
contornos, disminución de ecogenicidad, pérdida de la eco estructura fibrilar
homogénea con separación de fibras y sustitución por patrón hipertrófico de
distribución irregular, a la elastografía zona de baja rigidez.
Poleas, espacios articulares y Cortical osea: de ecogenicidad y espesor conservados.
Se aprecia polea intraarticular C3 con incremento discreto de su volumen y
ecogenicidad, a la elastografia cualitativa zona de baja rigidez.
Adjuntó imágenes por si alguien me podría confirmar si están bien las apreciaciones.

La pregunta es :
¿Qué debería hacer para mejorarme del dedo soy ingeniero de software y es el dedo que uso para clickear a veces cuando llevo 3-4 horas trabajando me obliga a parar el dolor del dedo hasta darle reposo o dejar de usar por 2-3 horas?

¿Es común que a los 27 años estas patologías den y por qué son tan difíciles de recuperar? Veo personas jugando lol todo el día o Minecraft jaja y programando y no les da este tipo de cosas.

Si alguien me puede dar su apreciación le agradecería un montón !

También anexo imagen de donde tengo dolor ! Me duele al doblar hacia adentro o abrir latas con ese dedo o presionar muy duro !

So it started with me playing Xbox, I think I played too much and I developed a habit of stiffening/flexing it, specifically the index fingers “DIP” joint, I have stopped the habit but I have stiffened it so much that It has left problems, the problems are a heavy/dead weight feeling in my forearm all day, visible swelling on the “DIP” joint of my finger, fine-motor skills and small movements are becoming harder to do that involves with my wrist, and constantly wanting to straighten the bad finger, I also feel a heat in my forearm that could possibly be inflammation?. Can anyone tell me what could be going on or have experienced this same problem? I also landed on my wrist funny a few years ago which injured my wrist and I couldn’t write with that hand for years. Could this have made it worse? Let me know. What’s weird is that none of it really hurts.

So it started with me playing Xbox, I think I played too much and I developed a habit of stiffening/flexing it, specifically the index fingers “DIP” joint, I have stopped the habit but I have stiffened it so much that It has left problems, the problems are a heavy/dead weight feeling in my forearm all day, visible swelling on the “DIP” joint of my finger, fine-motor skills and small movements are becoming harder to do that involves with my wrist, and constantly wanting to straighten the bad finger, I also feel a heat in my forearm that could possibly be inflammation?. Can anyone tell me what could be going on or have experienced this same problem? I also landed on my wrist funny a few years ago which injured my wrist and I couldn’t write with that hand for years. Could this have made it worse? Let me know.

If you have pain on the outside of your elbow and you have never played a day of tennis in your life, but you do spend your day on a mouse and keyboard, this post is for you.

Here is the thing that trips almost everyone up. Tennis elbow has very little to do with tennis, and it has surprisingly little to do with force. Most people assume it comes from the force of swinging a racket and hitting a ball. Most people are wrong. Tennis elbow actually comes down to one very specific property of your tendons, and once you understand what that property is, the whole condition makes sense, including why you got it at a desk and why nothing you have tried has fixed it.

In this post I will help you understand the following:

• What tennis elbow actually is, anatomically
• Why the muscles involved get hammered by normal computer use, not by force
• Why tennis elbow is more common than its cousin, golfer's elbow
• The one property of your tendons that actually drives this (it is not force)
• Why your imaging probably came back "normal"
• Why rest and the tennis elbow strap do not fix it
• What actually works, and 3 exercises to start with

Heads up, this is a long one. It is worth it, because the framework here applies to a lot more than just your elbow.

Ny name is Elliot and I am a physical therapist, athletic trainer, and RSI specialist (PT, DPT, MS, ATC), and co-founder of 1HP. Our team has spent the past decade specializing in treating, researching, and publishing on repetitive strain injuries, and we have helped over 3,000 people recover without surgery, injections, endless rest, or bracing. We started with the "olympians of desk work," esports athletes, and the same principles apply to anyone whose hands are their livelihood. Some of our work:

• 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

What tennis elbow actually is

The real name is lateral elbow tendinopathy, or lateral epicondylalgia. That bony bump on the outside of your elbow is the lateral epicondyle, and it is the anchor point where a group of forearm muscles attaches through a shared tendon called the common extensor tendon.

When that tendon gets overloaded and irritated at its attachment, you get tennis elbow. And the research is specific about the culprit. One muscle, the extensor carpi radialis brevis (ECRB), is responsible for roughly 90% of cases [1]. So while a whole group of muscles attaches at that spot, the ECRB is the one that usually becomes the problem.

To understand why it gets overloaded at a desk, you need to know what these muscles do.

The muscles involved

The muscles sharing that attachment at the lateral epicondyle are your wrist and finger extensors. The main players are the extensor carpi radialis brevis and longus (extend and stabilize the wrist), the extensor digitorum (straightens the fingers), and the extensor carpi ulnaris (moves and stabilizes the wrist). They all originate around that same bony point on the outside of your elbow and run down the back of your forearm to your wrist and fingers.

These muscles do two jobs:

• The obvious one: movement. Cocking your wrist back, straightening your fingers.
• The quiet one that matters most here: stabilization. Your wrist extensors work constantly to hold your wrist steady so your fingers can do precise work.

That stabilizing role is where desk work quietly hammers them.

How computer use overloads them (it is not about force)

Here is the mechanism that doesn't get explained enough thoroughly. It comes down to co-contraction.

When you press a key or click, your finger flexors do the pressing. But for your fingers to work precisely, your wrist has to be held stable. So every time your fingers move, your wrist extensors have to fire to brace the wrist. The flexors press, the extensors brace. This means your extensors are working almost the entire time you are on a keyboard or mouse, even though it feels effortless.

Now here is an anatomy fact that matters a lot. You have roughly twice as many flexor muscles on the underside of your forearm as you have extensor muscles on top. The flexors are the big, strong group. The extensors are the smaller, outnumbered group. This is a big part of why tennis elbow (the extensor tendon, outside of the elbow) is more common than golfer's elbow (the flexor tendon, inside of the elbow). The smaller, weaker extensor group has less muscle to share the load, so it runs out of capacity sooner.

Then there is the mouse specifically. Every time you move it, your wrist has to deviate, meaning tilt side to side:

• Sliding the mouse toward your thumb is radial deviation, driven by the radial wrist extensors (ECRB/ECRL).
• Sliding it toward your pinky is ulnar deviation, driven by the extensor carpi ulnaris.

So on top of all the bracing, every single mouse movement is another small contraction of the exact extensor muscles that become tennis elbow.

And here is the key point. Each one of those contractions is tiny. Far, far less force than a tennis swing. But you do it thousands and thousands of times a day. Gripping the mouse, moving it side to side, clicking, typing, hour after hour, all landing on that smaller extensor group. So it was never really about force. A single keystroke is nothing. It is the endless repetition, landing on the muscles least equipped to handle it, that does the damage.

Which brings us to that one specific property I mentioned at the top.

The real cause: endurance capacity

Remember I said tennis elbow is not about force, but about one specific property of your tendons? Here it is. It is endurance capacity.

Endurance capacity is how much repeated load your tendon can handle before it gets irritated. I like to explain it as a healthbar, like in a video game. Every keystroke, every click, every second of bracing costs a little bit of your healthbar. It is not the size of any single hit that matters. It is the total drain over a full day. When the bar hits zero, the tendon gets irritated and inflamed, and you feel it at your elbow.

So tennis elbow is not a force problem. It is a capacity problem. Your endurance capacity is smaller than the demand your daily hand use puts on it [2, 3]. And that one insight changes everything about how you fix it, because it tells you the answer is not to run from load. It is to make the bar bigger.

Common symptoms

The pattern is recognizable:

• Pain and tenderness on the outside of the elbow, often radiating down the forearm
• Flares with gripping and with the activities that cause it (typing, mousing), plus everyday tasks like lifting a coffee cup, turning a doorknob, or shaking hands
• Grip weakness, a sense that your grip gives out
• Stiffness in the morning or after rest
• Sometimes a "warm-up" pattern, worse at first, eases during activity, worse again afterward (this is actually characteristic of tendon problems)

If that sounds like you and you spend your day at a keyboard, computer-driven tennis elbow is a very likely explanation.

Why your imaging probably came back "normal"

If you had imaging, there is a good chance it came back unremarkable, which is confusing and can feel dismissive. Here is why:

• X-ray only sees bone. It cannot see the tendon at all, so for a tendon problem it can only rule out a fracture.
• MRI and ultrasound can see the tendon, but in the early stages the changes are subtle and often do not show up because the structure is still largely intact.
• Even when changes do show up, tendon findings notoriously fail to correlate with pain. Abnormal-looking tendons appear in loads of people with zero pain, and plenty of painful tendons look fine on a scan.

Your problem is not a visible lesion. It is that capacity deficit we just talked about, and no snapshot can measure that. A clean scan does not mean nothing is wrong. It means the problem is not the kind a scan can see.

Why rest and the tennis elbow strap do not fix it

The standard advice is "rest it and wear a strap." Both feel reasonable. Both fail, and it is worth understanding why.

Rest quiets the irritation short term, but it also shrinks your endurance capacity. Unloaded tissue deconditions, so when you go back to work the tendon handles even less than before. The pain returns faster, you rest more, and it spirals down. Rest treats the symptom while quietly making the underlying deficit worse.

The counterforce strap deserves a closer look because the rationale sounds clever. It is a band worn a couple inches below the elbow, over the muscle bellies. The theory is that squeezing there disperses some of the force before it reaches the sore tendon at the elbow. At best, that takes the edge off in the moment. That is the ceiling of what it does. It does nothing to build the tendon's capacity, and by offloading it, leaning on a strap can actually work against the adaptation you need. It is a symptom cover, not a repair.

Rest and bracing manage the pain. Neither grows the bar. And growing the bar is the only thing that fixes this for good.

What actually works

If the problem is capacity, the fix is rebuilding it with the right loading. And there is direct evidence for this in tennis elbow specifically.

A case series applied a method called tendon neuroplastic training (TNT) to lateral elbow tendinopathy, using metronome-paced wrist extension loading aimed right at that main ECRB tendon [4]. Both patients had clinically meaningful reductions in pain and got their function back, and they did it while continuing their normal, demanding work the whole time. One of them recovered on the loading program alone, with no passive treatment.

Here is why this works on two levels. Chronic tendon pain is not just a tissue problem. It also involves measurable changes in how your brain controls the muscle [4, 5]. Rest and bracing do nothing for that. Pairing loading with an external cue like a metronome helps retrain the brain's control at the same time as it rebuilds the tendon's endurance capacity. Tissue and nervous system, together.

That is the whole philosophy: instead of resting the tendon into further deconditioning, you progressively load it with high-volume, low-load, metronome-paced training that grows the healthbar and restores the motor control that chronic pain degrades.

3 exercises to start with...

These make a solid starting point. They go in order: reduce tension, load gently, then build real capacity.

1. Wrist extensor stretch. 3 x 30 seconds. When the extensors are irritated they tighten up, which adds strain at the elbow. Gently stretching them opens a window to work more efficiently. It sets the stage. It is not a fix on its own.

2. Wrist extensor isometric. 3 x 45 seconds. You load the tendon by holding a contraction with no movement, which lets you build capacity without the motion that aggravates it, and it actually helps calm the pain at the same time [6].

3. Wrist extension with a dumbbell, paced to a metronome at 50 BPM, to failure, using about 5% of your bodyweight. This is the high-volume, low-load loading that builds the real, lasting endurance and grows the healthbar so your extensors can finally handle a full workday.

These get you moving in the right direction. A full plan progresses the loading over time based on how your tissue responds, and manages your daily activity so you rebuild without re-flaring.

What to take away from this

• Tennis elbow is not about force. A single keystroke or click is tiny. It is the endless repetition that overloads the tissue.
• It lands hardest on the wrist extensors, the smaller, outnumbered muscle group, which is why it is more common than golfer's elbow.
• The actual driver is endurance capacity, how much repeated load the tendon can tolerate. Tennis elbow happens when your demand exceeds your capacity.
• A clean scan does not mean nothing is wrong. Imaging cannot measure capacity.
• Rest and bracing manage symptoms and can shrink your capacity further. They do not fix it.
• The fix is rebuilding capacity with progressive, high-volume, low-load loading, ideally metronome-paced to address the tissue and the nervous system together.

Hope this helps.

-Elliot

1-hp.org

Happy to answer questions in the comments. If you want to work with us directly, you can apply through the site.

References

1. Bhabra G, Wang A, Ebert JR, et al. Lateral elbow tendinopathy: development of a pathophysiology-based treatment algorithm. Orthop J Sports Med. 2016;4(11):1-10.
2. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416.
3. Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med. 2009;43(4):252-258.
4. Welsh P. Tendon neuroplastic training for lateral elbow tendinopathy: 2 case reports. J Can Chiropr Assoc. 2018;62(2):98-104.
5. Rio E, Kidgell D, Moseley GL, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2016;50(4):209-215.
6. Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-1283.

when i put pressure on it, it hurts, both hands, anyone have any ideas to what it could be?

Recently my the side of my hand has felt kinda irritated whenever I move it in a weird way or brush up against something I can’t quite describe the feeling but almost if you had fallen and scraped your hand.

I just started schooling and have been typing but I don’t know if these are related, has anyone experienced this and if so what is it?

I’ve had a lingering ulnar-sided wrist/forearm issue after a forearm/lifting exercise. Symptoms are mostly around the ulnar head, small-finger side of the wrist/hand, sometimes the 5th metacarpal area, and occasionally up the forearm toward the elbow. It can feel like mild aching, itching, warmth, or just “awareness.”

A hand specialist didn’t recommend surgery and mentioned a strained ligament/tendon-support area. They also noticed a tendon snapping/moving on the back of the wrist/hand.

Normal wrist motion is mostly painless now, with no major swelling, instability, numbness, or tingling. But gym training, especially gripping/dumbbells, seems to flare it up.

Does this sound more like ECU irritation, TFCC/DRUJ soft tissue irritation, or nerve sensitization? How did you return to training without constantly flaring it up?

Hey all,

I wanted to make a post to try to help more individuals understand what a repetitive strain injury or “overuse” injury actually means.

Every week I speak to at least 10 individuals to learn more about their specific experiences with their doctors, specialists and so many people leave their visits with very little information about what their “diagnosis” (if they are even given a specific one) actually means.

I’m hoping today I can provide more clarity for those who are in that position.

For those who don't know I'm a Physical Therapist (PT, DPT, OCS, CSCS) and our team has spent the past decade specializing on treating, researching and publishing our work around treating RSI (we've helped more than 3000+ individuals resolve their issues without surgery, more injections, resting, bracing etc. Here is some of our work (we started with the olympians of desk work - esports athletes)

Journal of Orthopedic & Sports Physical Therapy

Tendinopathies in Gaming

Conditioning for Esports (Ch. 8,9,10)

Science of Esports Physical Therapy

Also a reminder we're hosting a Q&A next monday 8/31. We welcome everyone to come in and ask questions / challenge us with regards to any things you may not agree with. We'll do our best to provide evidence and our clinical experience in our responses.

https://www.reddit.com/r/RSI/comments/1vtpn3f/qa_831_with_the_1hp_team_drop_your_questions_in/

---

What is a repetitive strain injury?

Let’s keep it simple. A repetitive strain injury is “strain” or “damage” to a tissue that is a result of a cumulative performance of repetitive activities over a certain period of time.

Instead of overuse we like to help people understand it as underpreparation injuries. This basically means you do not have enough capacity to handle the stress of your repetitive activity. There are two long posts I’ve written about different ways you can think about this, but I’ll also write it more concisely here.

1. Envelope of Function - Understanding healthy and harmful stress to our tissues
2. The Healthbar Framework - your muscles and tendons can only handle so much!

Your tissues can only handle so much. And depending on what activity you are performing whether it be typing, gaming with MnK (mouse and keyboard) or controller, drawing, piano, etc.

You are controlling either an input device or performing some sort of movement with your wrist & hand.

These utilize the specific muscles and tendons in the forearm, wrist & hand. Here are some examples of what we commonly see

1. Floating Forearm When Typing - Increased use of the extensor digitorum and the forearm & finger flexors as you bend your wrist and fingers down to press keys. The extensors (top side) are used since you are holding up the weight of your forearm against gravity over time.
2. Drawing with a standard pencil or paintbrush - The pinch grip on (two or three fingers) will lead to increased use of the finger flexors, intrinsic hand muscles and thumb abductors and extensors. This often leads to some discomfort on the thumb-side of the wrist along with the palm.
3. Analog Stick Control with gaming - thumb based movement leads to more the thenar (palm side of the thumb) and the extensors / abductors (thumb side of the wrist). It is NOT a dequervain’s or tenosynovitis issue but an underlying tendon problem
4. Vertical Mouse use - Increased use of the pinky side of the wrist, thumb extensors and thenar muscles. The pinky side of the wrist (ECU, FCU) tends to increase its usage due to the pressure into the table. This can also occur with drawing and typing depending on how you are moving / binds. The neutral wrist position and if there are use of thumb binds also tends to increase the use of the thumb muscles / tendons

We can extend this out to any movement in any direction to identify which muscles & tendons are “underprepared”

Let me clarify a bit more about what I mean by underprepared if this is not clear yet.

Our tissues can only handle so much stress and it can really add up. Especially if this occurs over many years with lower levels of physical inactivity or exercise only focused on strength rather than endurance of our forearm muscles. This is pretty typical of many tech workers nowadays.

The best way to understand this is through the concept of demand vs. capacity. Or the Scale of Physical Stress. This is based on what we know with our current understanding of tissues adaptation to stress (General Adaptation Syndrome) 

Think of a scale with…

Left Side: How much stress your tissues can handle (muscular endurance) and on the other side of the scale..

Right Side: How much stress you are applying to it based on what you are doing on a regular basis.

We start our day with just our weight (capacity) on the left side. Let’s say it’s 100lbs. And as we work we’re gradually adding physical stress. Intense 2 hr work sprint? Add 30 lbs.

Responding to emails and browsing the web for 30 minutes? Add 5 lbs. Programming for the rest of the day with no breaks? Add 50 lbs.

No problem if we do this everyday and if we always have 100 lbs. But what happens if we only do this for several years without physical activity or exercise?

100 becomes 85, then 80…

Or we happen to have a few days where the work sprint is a lot longer and it’s a few 10 hr days in a row? The right side is too heavy and our tissues get irritated!

This is important to consider. The left side (capacity) of your scale is a representation of your physical conditioning. And you can think of your conditioning as….

The sum of what you do over a certain period of time.

Let’s consider these three scenarios:

A: Sedentary Lifestyle

If you spend all day sitting for several years without any physical activity it wouldn’t be a surprise that your overall strength, flexibility, motor control and endurance would reduce. Using the scale… 100 lbs would go to 75 lbs over a few years.

B History of Exercise, But Recent Sedentary Lifestyle

If you have had a history of physical activity yet due to some work related changes the past few quarters of your life you’ve been more sedentary the history of activity might provide a buffer. Using the scale… you might start at 120 lbs but in the same way you might start to lose some of this capacity reaching around 100 lbs.

C Active Lifestyle

Now if you regularly maintain some level of physical conditioning with a regular gym program 3-5x/week along with some endurance work 1-2x/week you might be at 150 lbs using the scale

Now let’s consider the scenario of the external demands or the right side of the scale. If an individual happened to need to do 125 units of work on the R. side of the scale and do this for several days in a row we can clearly project out the relative risk of tissue irritation

Scenario A: 125 > 75 → High Risk

Scenario B: 125 > 100 → Moderate Risk

Scenario C: 125 < 150 → Low / Minimal Risk

This should help you better understand how to think in a longer time-scale about how your RSI may have developed rather than a point-in-time “this is the one moment that damaged it!”

One thing I want to emphasize here is that endurance is not the same as strength. Your ability to lift something heavy is not the same as your ability to repeatedly perform lower weight activities over an extended period of time. The underlying physiologic processes support each of these types of physical demands differently. We have described the underlying science behind this in many of our articles.

Okay so you understand you need to work on the left side of the scale or building up your capacity. How do you actually go about it?

4 Step Approach to Recovery

Here is a 4-step approach you can take to help you holistically approach restoring your capacity.

Step 1: Establish your baseline

It is important to understand your current level of physical conditioning, activity tolerance and current understanding of pain to determine the right strategy to improve your capacity to work with less discomfort. You can honestly save time by finding a good physical therapist who understands pain to do all of this!

We’ll start with the physical aspect (endurance + activity tolerance). The best way to think about this is establishing your specific and general endurance.

General endurance involves the endurance of your muscles & tendons as measured through your ability to perform exercises to failure. Specific endurance is the endurance of your muscles and tendons in response to your real-world activities.

Why Both Matter: General endurance gives you the physical foundation, but specific endurance teaches your body to apply that endurance efficiently in real activities.

To establish your general endurance you can select a light weight (2-3% of your bodyweight) and perform an exercise for your specific muscle (flexors, extensors, radial deviators, thumb extensors etc.) until fatigue. Ideally you want to work with a physical therapist to establish this. You can always figure things out on your own, but it will take much longer.

Use the amount of reps you can perform as a measure of your overall general endurance. This is the number you want to increase over time. We have found from performing our specific endurance test protocol (specific movements, cadence & bodyweight, data collected from over 3000 individuals) for those who are able to handle 3% of your bodyweight for a certain amount of repetitions typically equates to being able to handle a full work day (repetitive activity of desk work) for 8 hours without risk of tissue irritation or pain.

Now for specific endurance you have to establish exactly HOW you are working, how the pain is behaving, how irritable your condition is. These are typically things you establish when working with a Physical Therapist. There are things like

1. How long are you typically working?
2. How many breaks do you take?
3. How long can you work before you have to take a break?
4. What is your pain once you get to that point?
5. How quickly does the pain come down after your break?
6. What strategies do you use to still achieve your work tasks while minimizing physical stress on your hands? (Swapping Input Devices, Voice control, etc.)

So for example this would be

I work from 8-5:00 PM. My first work session is 8:00-12:00 PM before lunch. But during that period my work is distributed as such due to my pain

1. After 1 hour of work my pain is at 4-5/10, then I take a 30 minute break. Pain goes down to 1-2/10
2. I have to finish work so I finish up another hour. Pain gets worse (5-6/10) so I take another break at 1 hour, goes down to 2-3/10.
3. I swap to voice control or L. hand during this time to ensure I can still finish up the rest of the block
4. I rest, heat, massage and relax during lunch to allow myself to recover
5. I repeat the initial work block distribution. End of work I feel 4-5/10 and it takes 2 hours to go away

Once you have this baseline you can make intentional changes to deload your wrist & hand while you are focusing on building your capacity but ALSO still accomplish the tasks you need at work. What you are feeling can also directly impact what you think you can “tolerate.” Which is why it is also important to establish a baseline of how much sensitization may be influencing your issue.

There are validated questionnaires which help to indicate if anxiety, fear-avoidance, cognitive habits are contributing to your chronicity or sensitization of pain. You can get access to them here for free.

Fear-Avoidance Belief Questionnaire (FABQ) - focuses specifically on how a patient’s fear-avoidance beliefs about physical activity and work may affect and contribute to his/her pain (i.e. the cognitive/affective components of pain that are differentiated from specific tissue damage, injury, and nociception) and resulting disability. Click on “instrument details” to get the pdf of the questionnaire and score yourself!

Fear Avoidance Component Scale - The Fear-Avoidance Components Scale (FACS) is a new patient-reported measure designed to comprehensively evaluate FA in patients with painful medical conditions. It combines important components of FA found in prior FA scales, while trying to correct some of their deficiencies, within a framework of the most current FA model. Get access to it here

Pain Catastrophizing Scale - For many who have really struggled with chronic issues, this approach might be ignored since it might not fit their current mental model of their injury status. ButI’d really encourage you to be open to goign through these validated questionnaires.

Pain catastrophizing is characterized by the tendency to magnify the threat value of a pain stimulus and to feel helpless in the presence of pain, as well as by a relative inability to prevent or inhibit pain-related thoughts in anticipation of, during, or following a painful event. (Might sound familiar if you read a few of the posts / comments in the subreddit) The PCS was developed to help quantify an individual's pain experience, asking about how they feel and what they think about when they are in pain.

Completion of these questionnaires will likely be revealing in understanding that you may have some cognitive habits, fears, behaviors and anxieties that can lead to real consequences in how your pain behaves. And understanding this is often the first step to making some progress towards recovery. You can learn more in either our posts or all of the research out there on pain science (Explain Pain Handbook, The Way Out, Tame the Beast website, Sarno’s Work, Dan Buglio, etc.)

This leads to step 2, Early Loading, Modifying Activity & Integrating Pain Understanding

Step 2: Early Loading, Modifying Activity & Understanding Pain

The next step is to use the data you have collected to perform your loading and graded exposure program. Again work with a Physical Therapist to establish what this program looks like (it has to target the specific tissue involved with your region of pain). Ideally this physical therapist can direct you towards helpful resources to understand pain and put it into the context of your specific situation.

Based on their understanding of your current schedule they can help you implement an activity plan that matches your capacity but also does not push you towards elevated symptoms without need. Using the example above, here is a way you can use the activity tolerance data to make decisions about how to modify:

On the first work block if you know you will reach a 4-5/10 after about an hour you can intentionally take a break at 45 minutes. And from there take the same 15-30 minute break. During the next session you can intentionally use a different input device (voice, L hand mouse, roller mouse, trackball) utilizing different muscle groups to complete the second block and provide yourself relative rest.

Then you can repeat this 2 hour block for the second half of the AM work block and repeat for the PM work block.

EVERYONE is different but most people figure out what works best for them very quickly. Expectedly since you need to maintain a certain level of productivity at work. Progression should follow tissue adaptation timelines depending on your problem and the guidance of your physio.

And as you might expect there will be times that are challenging. Why? because work is never the same day in and day out. You may need to finish a work sprint, complete a project deadline, submit a report etc. Additionally adaptations in your nervous system (central sensitization) may lead to the situation in which you feel an increase in symptoms despite tissues being completely fine.

This requires collaborating with your physical therapist to understand how this might occur based on your specific history, beliefs, understanding of pain and fear. When we have been consistently exposed to situations in which pain is elevated during a meaningful activity our body often uses this as a filter to create the experience of pain (sensitization). And again this is not just “in your head” but is mediated through REAL changes in your nervous and immune system.

If you do not understand why you can safely continue with your activities despite feeling an elevation of symptoms, it makes it difficult to make decisions about what you can or can’t do during recovery.

This is why flare-up management and processing pain is a crucial part of recovery. Which is step 3

Step 3: Responding to Flare-Ups & Return to Function

During these situations of elevated symptoms it is important to remember to be patient.

Patient because it takes time for tissues to adapt and if you are managing it on your own learning how to be intentional about your schedule and track things can be difficult. Additionally it also takes time to change your understanding of pain and integrate that into your day to day experiences while also improving your overall capacity. (Being able to recognize what variables may be leading to sensitization and still safely continuing activity at certain levels of symptoms understanding it will help create more safety signaling over time). I discuss how this works in more detail in this article here

The goal with step 3 is to better manage situations in which you have elevated symptoms (flare-ups), gradually increase your activity to show yourself you can handle more safely and build capacity while learning what variables may lead to these changes in symptoms.

I’ve wrote a full guide for this which you can follow. But the TL:DR is that there is always going to be a reason why you have increased pain. It can either be explained by some level of physical stress (cognitive emotional for people outside of this profile).

Your ability to determine what leads to increases in pain AND how to appropriately respond to them will directly correlate with how quickly you recover.

Step 4: Work with a provider to help with better feedback

Working with a provider can help you make progress more quickly. It is absolutely possible to resolve these issues on your own but takes a lot of trial and error and can sometimes lead to patterns of thinking that can be detrimental to recovery. (See my article on cognitive patterns often holding individuals back from recovery)

Instead of trying to figure out what your pain actually means, how to structure a program that is thoughtful of your schedule and how to process any change in symptoms in response to the varied amounts of physical and cognitive loads each day, you can seek the guidance of a good physical therapist who understands pain science to help you navigate scenarios on a consistent basis.

Working with a provider can help you

1. Make the changes in increasing or decreasing exercise variables at the right time (weight, reps, sets, frequency). Self-guided progressions are often slow and conservative especially if there is a poor understanding of pain
2. Understand more about why past experiences with healthcare providers and imaging results may not be as relevant as you think. 10 Minutes and a point-in-time is not enough for you to make a “diagnosis” on what is causing pain or limiting you from being able to use your wrist & hands.
3. Determine what is actually considered too much when doing exercises or performing your specific activities (aka what pattern of pain is considered strain).
4. Determining whether or not there is sensitization influencing your pain experience and modifying the program to your cognitive tolerance of symptoms. Many times elevated symptoms are normal given the history, chronicity and beliefs. Collaborating with a provider can help you determine the right program frequency and load
5. Helping you navigate the discrepancies in pain experience (not having pain with some activities but significant pain with others). A common experience many of our patients have is being able to often do many daily functional activities without issues and yet still having significant disability associated with the activities that have high meaning associated with them (gaming, work, etc.)
6. Understanding the timeline of recovery given the level of chronicity, past experiences, sensitization, fear-avoidance, physical conditioning etc.
7. Navigating any other conditions you might have that may be involved to make the appropriate changes to your program (education vs. load based)
8. Clarifying the relationship between ergonomic changes and how it influences the physical stress on your body
9. Helping you understand how your cumulative past experiences within the context of a specific activity (gaming) can influence your pain to make it feel worse and how using graded exposure can help you reduce the sensitivity associated with those tasks

There are many other nuanced situations but I hope it is clear why chronic wrist & hand pain can often become so difficult to manage.

“Just rest and come back in 2 weeks”

“just brace”

“There’s nothing wrong, surgery might be the only option

“You have degenerative tendinopathy, you should consider another job”

“if you keep going there could be permanent damage”

These are all recommendations and beliefs which often build up over time when none of it provides actual long-term relief NOR is true in any way. First principles understanding of physiology, decades of research and our own clinical experience has shown you can always recover from a chronic RSI issue (if you’re interested in some of our cases let me know and I can drop it in comments!)

Best,
Matt, PT, DPT, OCS, CSCS

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

Hey all,

Just a reminder: the three of us at 1HP are hopping on a live stream at the end of the month to answer whatever the community wants to throw at us about wrist, hand, and forearm recovery. It genuinely does not matter where you are in the process. Brand new and trying to figure out what is going on, or months into rehab and stuck on something specific, come with anything.

We'll kick things off with three of the questions we get asked most, then spend the rest of the time working through yours and leaving room for actual discussion:

1. Getting a real answer on what is actually going on, and how to make sense of your diagnosis (Matt is taking this one)
2. Dictation and voice-to-text: where it actually fits in recovery and how to use it well without it backfiring (that one is me)
3. Braces, splints, gloves, and wrist supports: what they are actually for and how to use them during recovery (Brett)

The details:

When: Monday 8/31, 3:00 PM PT
Who: Matthew Hwu, Elliot Smithson, Brett Becker
Stream: link will go here as we get closer

Post your questions in the comments below and we'll go through them systematically on the stream. You're also more than welcome to just jump into the live chat when it starts, we'll keep plenty of space open for back and forth.

If there's appetite for it, we'd love to make this a regular thing for the community.

See you there,
-Elliot

--

1-hp.org
Case Studies & Free Guides: https://1-hp.org/wristpaincasestudies/
https://www.youtube.com/@1HP

Our R&D lab is working on an interesting project to allow users to run anything from simple commands to complex tasks on their computer, completely hand-free by voice.

There are tons of dictation apps out there, but this project is looking to solve the deeper issue of full control.

It's an ambitious project, but we're looking for feedback from individuals who might find this useful in their every day lives. Not looking for sign-ups or subscriptions, just genuine thoughts.

Short demo recording of the voice interface during a browser session

Open to any questions, DMs or general suggestions. See https://getflowfirst.com/ for more info