I've spent the last year with various elbow/tricep/glute/hamstring/wrist pulls/ and tweaks and can't seem to get recovered enough to heal fully. It is a cycle of me healing 90% and then reinjuring because I thought I was fully healed. Any advice on vitamins or training that can help me to recover?
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.
Hey all,
Matt here! Today I wanted to post another case study of an individual who had deal with pain for around 16 years. I will go into full depth into his case and how we were able to help him address the contributing factors that led to his dysfunction and chronicity over the years.
Like every case study, I was given approval to post his story (along with his video testimonial you can check out here).
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
Conditioning for Esports (Ch. 8,9,10)
Science of Esports Physical Therapy
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Julian spent 16 years trying to fix his hands. He saw multiple doctors and specialists. Tried occupational & physical therapy. And through all of these he also tried every device he could find: a vertical mouse, a foot mouse, dictation software (we'll go over some of this later). He even tried seeking AI (ChatGPT) to get some guidance.
Throughout the years and visits every MRI came back normal. Every EMG came back normal. Every specialist told him some version of the same thing: "We don't know what's wrong” and kept him a loop of care that never yielded any results. At his worst, Julian could not hold a mouse for five minutes.
Julian is a trader and lifelong gamer and over the years of dealing with his wrist pain he saw his ability to work and play games steadily disappear. He was pretty hopeless after this many years of dealing with his wrist & hand pain.
This is when he came to us and with 16 weeks of hard work and commitment to understanding what led to his level of functional limitation (physical, mental, lifestyle related) he was able to get back to full function in 16 weeks. In this time Julian went from full dictation with NO mouse use to a full day of work with the mouse and six-hour gaming sessions (same day).
I'll do my best to help you understand how we helped him achieve this.
Julian is a full-time crypto trader. His entire workday is spent at his PC for trading, researching and monitoring his positions. On top of that, he is an avid gamer who would spend several hours after work gaming.
His daily schedule at intake looked like this: 8–10 hours of PC use split across trading and gaming, with walking as his only physical activity (ONLY DICTATION)
The pain started gradually and spread. By the time Julian found 1HP, he described it as pain "from my fingertips down to my forearm on both arms in a dozen different spots." He could not point to a single trigger. This is important to point to as we get into the later sections around sensitization. The pain was moderate to severe every day, with limited moments of relief.
Over the 16 years that Julian had dealt with the pain he spent more than $15,000 going throuhg the full gauntlet of traditional care. He saw a hand specialist who ordered X-rays and an EMG (which both came back negative). He had an MRI which was “normal” and after all of these his specialist’s only options were to try pain management and cortisone shots (he declined).
During this time he also attempted two courses of physical therapy which had caused him too much pain to stay consistent. He would perform them for a few days and felt an increase in symptoms. During these moments he was never...
Ultimately after trying everything he became fearful of using his hands, adopted alot of avoidance patterns and was not able to use his hands at all. This is when he found us on reddit.
Here is what we found after our initial full clinical assessment to understand everything about his injury. We explored pain regions and behavior, complete medical history, his daily activity patterns, his ergonomics, understanding of pain and our standardized endurance test
Pain Regions: Bilateral wrist and hand pain (right dominant), extending into both forearms. Thumb involvement bilaterally. Pain at a dozen different sites, with no clear single diagnosis from prior providers.
Baseline Endurance Test (Right Hand):
For someone spending 8–10 hours a day at a computer, this was a significant deficit. His muscles simply did not have the capacity to handle what he was asking of them.
Overview of Pathomechanics, Baseline Endurance Test & Functional Deficits
The Fear-Avoidance Component
Julian was stuck in a classic fear-avoidance loop that developed as a result of his experiences with healthcare and what he had been exposed to online for 16 years. Every time he tried to push through, the pain spiked. So he stopped. He rested. He avoided. His hands got weaker. The next time he tried, the pain came back faster. He rested again. And the cycle continued, year after year.
He had tried at-home exercises multiple times. But because he had no guidance on how to dose them, he would do too much, flare up badly, and stop for a week. And again he was NEVER educated on what his pain meant, what was actually too much and why it can be normal sometimes to feel an increase in symptoms. This led to an inconsistency in how often he performed his exercises (often also prescribed with too low overall volume) which also meant he never built any real capacity.
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These repeated cycles were a result of 16 years without any clarity from any healthcare providers about
This lack of clarity and understanding led to maladaptations in his nervous system. His brain had learned that hand use equals danger. And of course his directed experiences of rest and passive interventions would reinforce this. Every time he tried to use a mouse again he would feel pain that would last for hours to days. Even lower loads of wrist & hand activity were being interpreted as threatening. This is called central sensitization. We have covered this endlessly in our content and to be clear
it is not "just in your head."
Real neurological changes occur when pain persists for this long without resolution.
His fear of re-injury was not irrational. It was a learned response to 16 years of failed treatments and no clear answers. But it was also the thing keeping him stuck. This was an essential cognitive pattern we had to address.
Julian’s program was focused on
Phase 1: Building the Foundation (Weeks 1–4)
We started conservatively with his exercises (specific to Julian, may not be conservative for others depending on their starting point). Three sets of 12–15 reps for wrist flexion and extension, targeting the specific muscles that were failing him. We kept the load light at the 1% of bodyweight and focused on consistency over intensity.
The key instruction: some discomfort during exercise is normal and expected. It does not mean damage.
This is likely the sticking point for many individuals when they try load based program. Without an understanding of pain it can feel scary to feel “safe” or understand that you aren’t damaging anything when you feel an increase in symptoms after performing some exercises challenging your endurance.
It was absolutely NECESSARY to teach Julian how to distinguish between the pattern of sharp, alarming pain with associated weakness of true tissue strain and the dull, achy discomfort of muscles being asked to work harder than they are used to. This is not EASY to understand and took consistent education and reassurance based on REAL evidence (normative values & sensitization established through the fear avoidance component scale).
We also addressed his how he was managing his overall schedule. During his work periods he would have no structured breaks for a duration of up to 10 hours of PC use. We gradually exposed him to more overall load that we knew he could handle each week. Starting with 75/25 (Dictation / typing) to 50/50 with movement breaks.
Phase 2: Progressive Loading (Weeks 4–8)
As Julian saw progress it helped motivate him to stay consistent with his programming. Since day 1 Julian committed to every aspect of the program from the high exercise volume to the daily and weekly pain reframing work. This was a large reason why Julian was able to make such great progress throughout this phase despite his long-standing chronicity.
By week 4 Julian was tolerating the exercises well which allowed us to progress him to 3 sets of 20–25 reps and increased the extension load to 5 lbs. We added thumb-specific exercises using a variable-resistance finger device to target the functional strength he needed for gaming and trading. The combined reps across the prescribed for each of the muscle groups were up to 240 PER DAY.
Yes, this sounds like a lot but with the lower % bodyweight and focus on endurance Julian was able to handle this and promote faster overall adaptations to his endurance. Keep in mind that this volume is NOT what everyone can handle but is only representative of what Julian’s specific case, history, understanding of pain, tolerance to discomfort and other environmental variables allowed him to handle. For everyone we work with we have to establish the volume that works best considering these specific variables and continually modify based on the response to that volume (for others it can be once a day or once every other day to start depending on their status)
By week 7, Julian completed a 4.5-hour gaming session which was something he had not been able to do in years. This was a major accomplishment for him after years of not being able to use his hands to actually game.
We also introduced conditional deloading during more aggressive pushes. After any day where we pushed the overall activity, due to the increase in real load we intentionally reduced the load the next day by 30-40% to allow adaptation (physically and mentally).
In many cases fear holds individuals back more than the actual physical capacity. (Fear in the form of increased symptoms as an individual plays longer, AGAIN WITHOUT ANY REAL STRAIN OR DAMAGE TO TISSUES).
Phase 3: Reintegration & Self-Management (Weeks 8–16)
By week 8, Julian was typing 3–5 hours per day and gaming 3–4 hours with manageable symptoms. As he developed more overall confidence in the hands we also shifted focus to building his overall conditioning by integrating walking 60–90 minutes daily, general strength work, and gradually expanding his activity tolerance.
The goal in this phase was to continue to help him build confidence in using his hands for more overall activities and show himself (and his brain) that he has built the capacity to handle more than he realizes. Graded exposure with integrated cognitive behavioral therapy helped to ensure Julian knew how to better process any symptoms as he introduced more activity.
It was important for us throughout this process to work on his response to flare-ups. In week 8, Julian had a pain spike after a longer gaming session. (cognitive behavioral therapy & other pain reprocessing exercises). In the past for Julian this would have meant a week of rest having to “stop gaming” for an extended period of time.
Instead through everything he learned and our cumulative work in building confidence in using his wrist & hands, he recognized it as an elevated symptom not a setback.
He was able to reflect appropriately to determine the actual variables that led to the increase in symptoms (a sharp increase in the volume of his gaming over a short period of time) and continued his program. With relative deloading while STILL doing the exercises, the pain resolved within a few days.
This was a milestone during his recovery because it showed him that his response and understanding of pain was crucial in helping him better navigate the natural ups and downs with recovery.
Pain Science Education
Alongside the physical programming, Julian worked through our pain science curriculum (partnered with a researcher to build a course specific to RSI injuries). The module on fear-avoidance was the one that really helped him better understand how to respond to pain.
"Learning how to respond to pain was the big thing. I would always think, 'Oh, I'm feeling pain, let me stop.' After going through the module on pain and the fear-avoidance response, I realized… okay, I'm not damaging myself just from feeling pain. It's okay to continue with my activity, and I'll be fine.”
This shift in mindset… from "pain equals damage" to "pain is information, not a stop sign" is what allowed Julian to stay consistent for the first time in 16 years.
Let’s go over how he did in the latter part of his recovery. Remember he had been struggling for 16 years with this issue.
By week 12, Julian reported approximately 90% recovery. Occasional aching after prolonged activity or on waking but nothing that limited him.
By week 16, Julian was completing 3 sets of 20–25 reps at 7 lbs for wrist extension and flexion, with rubber band exercises at 3 sets of 30 reps. He was gaming 4–6 hours per day. He was working full days as a trader. He was using a mouse without a second thought.
In his own words: (see video testimonial)
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I wanted to include this quote for a reason. Julian at 16 weeks was able to handle EVERYTHING he wanted to functionally yet on only SOME days he did have some pain, not all days. The frequency of this scenario was reducing gradually over time but what was more important was his shift in his mental model of pain.
Our goal is actually NEVER just to “get rid of the pain.”
Yes the pain will go away eventually with higher volumes of activity but the goal with our work is actually to help individuals recognize that pain is actually a normal part of the human experience.
When you consider all of the variables around any time where you feel pain, you can determine why it makes sense you would be feeling some level of discomfort.
If you got back to doing everything you wanted then tried bowling 3 days in a row, 4 games each on those days with a 10 lb bowling ball it would make sense that you would have some soreness in the forearm.
You would not think “oh my injury never healed” but rather “it makes sense that with the amount of physical load I placed on my hand, my body couldn’t handle that.” This mental shift IS the goal. And this only represents a scenario around increased physical load. Stress, poor sleep, high occupational stress can also lead to increased symptoms. This is why we work together over the course of recovery to expose the individual to more overall physical load situations but real increases in activity and environmental stressors (naturally as they get back to work or start work) to understand how to best respond to those situations and feel safe.
>"The first couple times I was able to play for six hours and wake up the next day with minimal pain and when I did feel pain, my response to it was different. I was able to continue the next day as normal, as opposed to falling back into that cycle once again. That gave me a lot of confidence and hope."
There are so many things you can take away from this case study. And i’m sure depending on your own individual circumstances one may be more meaningful than another. Here are some of the larger lessons you can takeaway from Julian’s case
Normal imaging does not mean nothing is wrong.
Julian's MRIs, X-rays, and EMG all came back normal. That is actually very common with chronic tendinopathy and sensitization. The absence of a structural finding does not mean the pain is imaginary. And in many cases physicians do not know how to help you actually understand why you may still be in pain or functionally limited.
This is often what creates so much anxiety and stress around results and how you are feeling after being told you are “normal”. Your pain is REAL and there is ALWAYS a reason for it whether it be the physical, mental or environmental stressors. Being able to work with someone who can provide you this clarity only after assessing EVERYTHING is how you can feel more safe in using your hands more over time.
This is also why all of the interventions directed at the “tissue” even when nothing is wrong still does not help and often can make things worse as the continuous rest cycles can lead to deconditioning but also reduced self-efficacy. This leads to the the next big takeaway
Avoidance is not rest. It is deconditioning.
Every time Julian stopped using his hands to "protect" them, he was making the problem worse.
Tendons need progressive stress to adapt and handle more repetitive stress over time (endurance). When we continually avoid activity and load the tendon has been consistently shown to weaken and have altered structure. But as we highlighted throughout this case study this can also lead to more sensitization through
The goal is NEVER to rest but to find ways to load appropriately for both your physical and mental curls.
Consistency beats intensity every time.
Julian missed at most two days of exercises over three months. This was 190 days sessions of his exercise program which often involved the 120 reps per muscle group per day all the while increasing the overall resistance and reps over time.
This discipline and consistency (not just the physical and mental exercises) was what drove the main results. This is NOT easy to do but I cannot emphasize more how important it is to fully commit on the understanding of why you can perform a certain amount of repetitions for your specific case AND how to understand your symptoms as you increase activity and exercise.
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I’ve repeated this multiple times throughout the case study and all of our other pieces of content but i’m hoping it is clear that your response to pain.. can change.
The pain response is trainable.
Julian did not just fix his hands. Through consistent work to better understand pain and why his symptoms would be elevated in certain scenarios he was able to rewired how his nervous system responds to discomfort.
This is the part that makes the results last. Without changing the fear-avoidance pattern, the physical improvements would have been temporary. Without understanding why you are safe despite certain levels of pain it can make it difficult to make progress as you push with your specific activity that may be associated with pain.
Through his disciplined effort and collaborative work to help him reprocess certain scenarios with elevated pain throughout his recovery he was able to build a better internal framework for managing musculoskeletal / orthopedic issues for the rest of his life. I want to emphasize here that this takes time for every individual. But it is something that NEEDS to be addressed for long-term lasting recovery and better overall quality of life in response to pain.
If you got all the way down here, I appreciate your taking the time to read through this and hope itw as helpful in some way. Feel free to let us know if you have any questions around anything relating to this case.|
And remember Julian came to us after 16 years and $15,000 in failed treatments. He was skeptical. He did his research. And once he committed he was able to show himself he could get back to the life he thought was impossible to have again in 16 weeks.
Hope this helps anyone that is struggling. It's possible but it takes actually addressing the underlying physical, cognitive emotional and lifestyle components that lead to continued sensitization of pain and functional limitations.
Best,
Matt, PT, DPT, OCS, CSCS
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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
Posting this because I remember coming on this sub when I first was injured four years ago and only saw stories of DOOM that made everything worse. Healed people don’t post so I’m doing my bit haha. I had bilateral neuropathy, elbow and wrist tendinitis all visible on nerve conduction and MRI. Thought my career was over. I was terrified. Read scary things on the internet. Medical leave and graded return to work for over six months, then for a year was using Dragon software. I am hypermobile which caused the underlying vulnerability. Did strength training. The pain subsided but came back in a big way a year after my first injury when I was in a stressful environment. Another lot of scans showed the injury had healed but the pain was there due to the brain’s threat detection mechanisms. A huge cliche but I read Alan Gordon’s The Way Out and did the whole somatic tracking thing, and I was out of pain very quickly. This doesn’t work for all chronic pain and I think he over states the effectiveness of it but the point remains that the body can heal, you can heal from RSI, I have friends who have healed from it, it is not a life sentence. I have been pain free now for three years and using a computer as normal. I keep up the exercise and stress reduction and am not in a toxic team anymore. DO NOT DOOM SCROLL ON THIS SUB REDDIT. RESPECT THE STRONG LINK BETWEEN YOUR STRESS AND ANXIETY LEVELS AND THE SEVERITY OF YOUR SYMPTOMS. YOU CAN GET BETTER. As a side note I have some mild tinnitus how and am totally avoiding Reddit and totally tuning in to the stories of people who habituate it at live beside it. You won’t find anything helpful here.
So I have pain and tingling in my hands and forearms, awaiting diagnosis but I want to get back into writing on my laptop. Pain in my hands when typing stops this however so I thought i would try voice to speech.
I'm confused on how to do this however, and which is the best to use. Are any free ones any good? I'm on Windows. Struggling massively with being unable to do anything enjoyable while I rest my hands, so trying to find something to fill the void besides tv show as my mental health is tanking
Hey all ,
9 weeks ago I started a desk job and long story short faulty equipment has caused c5-c6 Nerve irritation
Deltoid pain , tight neck , hand burning bilaterally
I've had a clear MRI but neck is just tense
Work seems to me the main driver and maintainer of my symptoms.
When I pull cahir in and rest arms on desk elbows are slightly out and shoulders roll forward which apparently isn't good for this never bundle
So for weeks I have had keyboard at end of desk so I can have elbows in line with shoulders and elbows s next to ribs but this seems to have caused my neck to keep tensing dimue to having to hold my arms all day at work
The cahir arm rest caus super abduction and I'm not allowed a new chair
Has anyone dealt with this before and how you managed I'm so close to quitting and then losing my mortgage as this is disabling me
When I leave work and weekends symptoms improve dramatically
Thank you all
Hello, I'm new here. For over a month starting in the beginning of July I've had a left that is very prone to pain, strain, and tension compared to my right arm. I initially feared the worst and had two doctors take a look at me and they didn't seem too concerned. One prescribed me meloxicam and since I've been taking it, I've been having less pain, but I still get tension and strain whenever I lift up heavy objects. I've been doing light weightlifting with each arm daily (50 regular curls and 50 overhead curls). Should I continue with that or stop? Also let me know if anyone can relate.
I’ve been carrying this for over five years now and I think I just need to put it somewhere and, honestly, hope someone out there recognizes it. I’m a M 27.
It started right when I finished school and began my first job. I’m a programmer, so I spend long days at a desk. Around that time the symptoms showed up and they’ve never really left:
Every morning I wake up, and the pain is just there again, waiting. And every evening feels like I’ve pulled several all-nighters in a row.
What I’ve already tried/ruled out:
So there’s nothing “visible” wrong with me. On one hand, that’s a relief. On the other hand, I have no idea what’s actually causing this, and I feel stuck.
I know sitting at a desk all day isn’t great for the body. But I genuinely love programming, and I don’t want to, and can’t really, give it up.
The hardest part is that people around me don’t really get what this does to me, and I don’t want to burden them with it. I’m supposed to be in the prime of my life, and I just don’t feel that way at all.
If you’ve experienced anything like this, the heaviness, the pressure, symptoms that don’t show up on any scan, I’d really appreciate hearing what helped you, or even just what you’d try next. Anything I might not have thought of.
Thanks for reading.
No injury, but I’m prone two tendinitis and overruse issues. It doesn’t seem like DeQuervains (had that before) since any popping/clicking is painless and doesnt happen frequently. Negative Finkelstein, b it was irritated afterwards for a while. I’m stumped. Anyone know else could cause pain in this area?
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.
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 everyone,
I am looking for people who have experienced symptoms similar to mine. I am not diagnosed with Thoracic Outlet Syndrome (TOS), but it has been considered as a possibility, and I am trying to find people with similar symptoms who can share what helped them.
For about 3 months I have had severe, constant pain in my:
The pain feels like pressure, tightness, pulling, and a feeling of fullness or pressure inside. It is present every day and has become very exhausting.
I also noticed that the veins in both of my hands become very prominent when I lower my arms down and also when I first get out of bed. My hands are not swollen, red, or blue — the veins simply become much more visible.
My symptoms started before I developed a brachial vein DVT. The blood clot happened later, and my doctors do not believe it explains the original pain and vein changes.
I have already seen:
Many tests have been normal, but I still have severe daily pain and no clear explanation.
I am not asking anyone to diagnose me online. I am hoping to hear from people who had similar symptoms:
I would really appreciate any advice or personal experiences. Thank you.
I feel like I have been searching for answers for months and I would really appreciate hearing from anyone who went through a similar situation.”
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.
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.
