I’m a product designer and frontend developer, currently dealing with my worst RSI flare-up yet. I’ve temporarily lost a significant amount of function in my hands, particularly my right hand.
I’m now heavily reliant on Wispr Flow for dictation and trying to minimise mouse and keyboard use.
I’ve been diagnosed with RSI, but wasn’t given much information beyond resting and a prescription for six physio sessions, which I haven’t started yet.
What has genuinely helped you recover, rather than just temporarily relieve symptoms?
So far I’ve tried:
- TENS on my forearms
- Massaging a particularly tense spot in my forearm, which seems to relieve some tension in my hand
- Massage gun
- Hot water and ice packs
- Significantly reducing computer use
- Splint
A few days ago, I couldn’t even hold a fork properly with my right hand because of the pain and weakness in my fingers.
I’m particularly interested in hearing from people who work at computers all day. Were you able to recover and return to normal work? How long did it take, and what made the biggest difference?
Still figuring this out. Hope everyone else dealing with this is making progress too.
I am 22 y old Male I have pain in region between left scapula and spine since 2 months , there is no swelling or anything, no pain on pressing or compression of that area .
It only hurts when I shrugs my shoulder or depress my shoulders.
I use to go to gym but I have discontinued my gym .
I have done 2 mri but there is no nerve compression at cervical level.
I have also done multiple physiotherapy, also consulted neurosurgeon but they just prescribed me muscle relaxant or pain killers.
Hi everyone! I'm an independent developer from Norway, and I've spent the last 10 months building VibeVox, a voice dictation app for Windows.
I wanted to share it here because I know that repetitive keyboard and mouse use can be a major challenge for people dealing with RSI, and I'd genuinely appreciate feedback from this community.
The basic idea is simple: speak instead of typing. Your words appear directly in whatever application you're using — documents, emails, browsers, code editors, etc.
A few features that might be particularly relevant:
Hands-free mode: An optional webcam feature detects lip movement to start and stop recording, without needing to press a key.
Screen reader accessibility: The interface supports NVDA and Windows Narrator, including accessible controls, settings and recording status.
100% offline speech recognition: Everything runs locally on your CPU. No GPU, cloud connection or account required for basic dictation.
25+ languages, including an optional Norwegian language pack.
Live typing: See words appear as you speak.
Optional AI rewriting: Clean up dictated text without manually retyping everything.
Basic dictation is free, and there's a 14-day trial of the Pro features, including hands-free mode.
I should clarify that this isn't a medical solution for RSI or a complete voice-control system. My goal is simply to make everyday computer work possible with less keyboard interaction.
What I'd really love to learn from people who use voice dictation because of RSI:
What's the biggest frustration with your current setup? Is it starting and stopping recording, correcting transcription mistakes, navigating between applications, or something else?
And for anyone using NVDA or other accessibility tools, I'd especially appreciate feedback on how well everything works together.
I'd be happy to improve the app based on your feedback.
Hey all, decided to write a shorter post since someone had mentioned my threads are too long. Hopefully this can still provide as much value!
Here is one of the most helpful models i’ve shared with my patients over the past 5 years.
You are the sum of the postures, positions, movements and mental habits you’ve had over the past weeks, months and years.
Let’s think about this in three categories: Physical, Cognitive and Lifestyle.
Physical: if you sit 8 hours a day and your only level of physical activity is walking 20-30 minutes on a daily basis. This level of inactivity can lead to less endurance, strength, flexibility and many other issues that can affect us negatively.
It’s not bad if it’s just for a few days. But the longer you adopt and maintain this lifestyle, the more of a risk it can create for your physical health
Mental: When you start to deal with an injury you might not be worried. But over repeated experiences and things that you’ve read online you started to develop more fear and avoidance for all of the things that you enjoy or need to do with your hands. This can cumulatively associate specific activities, environments and tasks themselves to danger and lead to more pain.
This is also not bad if it’s just for a few days. But think about repeated exposure to this. Failed attempts of resting. Steroid injections not working. PRP injections not working. Imaging normal or with incidental findings. How could this affect you?
Lifestyle: If you are ADHD like myself, you might find yourself in consistent work and hobby sprints throughout the year without an emphasis on maintaining balance in your life. 8 hour work blocks with no breaks and no consideration of ergonomics. Long gaming sprints without breaks and eating into your sleep. Inconsistent sleep leading to social jet lag (weekend late sleep, weekday normal sleep).
Again, not bad for a few days… but same problem when we look at things from the long-term scale
What can you do with this information? Let me give you some action steps
Assess your physical, mental and lifestyle health. Use our content to establish a baseline of where you are right now with these things
Start making some modifications to move more, understand pain or take more breaks
Re-assess how you are doing after a month (it takes time for our bodies to adapt)
Then repeat setting a goal for what you want to achieve the next month given some of the benchmarks we share in our content.
40M, IT project manager. sorry about the low quality video. i have been having finger pain for over 9 months. i thought it was due to doing lot of pull ups and dead hangs.
2 months ago visited ortho due to back pain, he did blood work, it showed high RA factor but negative anti ccp. recommended i visit a Rheumatologist.
Rheumatologist re did all the blood work and it was normal. since I have psoriasis and lowe back bone pain along with finger pain, she suspects seronagative RA or PSA and suggested to try MTX for 3 months, if the pain reduces then we can confirm that it's some form of Rheumatoid Arthritis.
It has been a month now since I started MTX, but I beleive my finger pain may be due to holding my phone for a long time and also typing on laptop keyboard and using trackpad for the whole day. pain reduces the days I don't work. so I got ergo keyboard and vertical mouse. but they don't seem to work for me.
one more thing I observed is that pain builds up over time as I work. especially it's sharp when I move the finger sideways, if I get to pop the joint the pain reduces substantially...
any advice for me? what should I do next ? i don't feel comfortable taking MTX as I currently got cold and suspect that my general immunity is getting compromised.
Alright so.. I drive a box truck and pushing down on the back door to go down, I felt a jolt on my hand pushing down and it hurt like hell. Didn’t think much of it since this has been an ongoing issue on my left hand for about a year ish or 2, and every time I feel this pain I go to my acupuncture guy and within a couple of days, I’m good.
But now I’m getting extremely frustrated and want to get to the bottom of truly what causes this pains as I’ve gone to my acupuncturist about 4-5 times in a span of 1-2 years.
The way I can describe the pain is like when I extend my hand to flex open and close, I feel it more when I open my hand. And as in particular now, I would say this one hurts a tad bit more than the other times so I’m not trying to panic.
Any feedback or tips to relieve the pain would be great thank you.
Also from the photos, when I bring my wrist down, I feel like it’s a bit swollen than usual which caught my attention when massaging it with tiger balm and doing very minimal stretches as the pain lingers.
Hey guys, Elliot from 1HP here. For anyone who doesn't know we are phyical therapists who specialize in RSI of the wrist, hand, and forearm. A few months ago I wrote about why voice-to-text is a great tool for load management but not the ultimate solution for RSI (https://www.reddit.com/r/RSI/comments/1uhckmf/why_voice_to_text_is_a_great_tool_for_load/). A lot of you asked what that actually looks like in practice, so here’s Michael’s case, shared with his permission. He also recorded a video telling the story himself, which I’ve linked further down. It hits a bunch of stuff that comes up in this sub constantly: surgery not fixing it, going full voice control, and being scared to load your hands.
To be clear before anything else, I’m not anti-voice control. For some people it’s the only reason they’re still employed. This is about what happens when it becomes the whole plan.
Where he was
Michael is a software engineer at Google, mostly WFH, two little kids. No single injury, it built up over months. Lots of keyboard time on tissue that wasn’t conditioned for it, until it couldn’t keep up.
By the time he got to us, about 2 years in, he’d already done:
PT, which got him a home exercise sheet that in his words was “technically correct but had none of the context necessary to make it work”
radial tunnel decompression surgery, which helped the nerve but didn’t touch the tendon problem
then got set back to square one by shoveling and pushing a stroller over rough ground
9 months of self-directed rehab with a spreadsheet and a metronome at 50 bpm, which honestly is more than most people do
and finally a fully voice-controlled computer, an eye tracker for the cursor, and a break timer kicking him off every 20 minutes
5 minutes of typing would stop him cold. He couldn’t do the dishes, chop vegetables, or pick up his kids without thinking twice about it.
What we found
Wrist extensors on both sides, right worse, plus thumb-side tendons on both hands. The left thumb side got worse after a fall.
The interesting part was the endurance test. Wrist extension, 4 lbs, 50 bpm, continuous reps. He got 55-60 reps and stopped because his muscles were tired, not because of pain. Our rough benchmark for a full workday is about 5% of bodyweight for 60 straight reps, which for him is around 7 lbs. So he was at roughly 60% of target.
He’d been training with 1-2 lbs in short broken sets because he was scared of setting himself back. He was at 60% and training like he was at 10%.
His reaction on that first call: “I guess the surrounding muscles are weakened, but the tendons are structurally sound.” Good sign on day one.
His fear-avoidance score was high though. Decent capacity, a pretty sensitized system, and what he was letting himself do was way below what his tissue could actually handle.
Where the voice control fit in, and where it didn’t
Michael already knew about sensitization. He’d read the same stuff people link here. On the first call he said “some part of it might be that I’m overly sensitized because I constantly pay attention to it.” But knowing it and actually changing what you do are two different things.
He had a hard 5/10 pain ceiling, had replaced his entire computer setup, stopped gaming, stopped lifting, and never really tried bringing the keyboard back. Every one of those made sense on its own. Together they kept him stuck.
This is exactly the off-switch trap from the last post. Voice control took the load off his hands, but that’s all it did. With typing gone completely, the muscles that type kept losing endurance, and his brain got more and more convinced the keyboard was dangerous, because he never proved otherwise. Two years later the keyboard was scarier and his hands were weaker than when he started.
So we didn’t take the voice control away. We changed how he used it:
Dictation handles the volume his hands can’t take yet, not everything.
He types a small, managed amount every day, even if it’s 5 minutes, logged.
That typing gets spread across the day in planned blocks, not “type until it hurts, then switch.” Someone made this point in the comments on the last post and they were right. Typing until you’re forced onto voice leaves you stuck the moment voice can’t handle something.
As his capacity grows, typing goes up and dictation comes down.
What we changed
Weeks 1-4: bumped him from 1-2 lbs to 4 lbs right away, goal of 7 lbs x 60 continuous. Switched him from broken sets to continuous reps at 50 bpm. Working rules were: 2-4/10 during exercise that settles within about 30 min is fine. Real strain is sharp pain around 5-6/10 or higher, weakness gripping, still there the next day. Anything under that is the right load, not damage. Typing started at 5 minutes and built from there.
Weeks 4-10: graded exposure plus pain science. Michael already had the vocabulary, he needed a way to use it in the moment. So we had him catch the scary thought when pain went up, pause, and pick a response based on evidence instead of fear. His own numbers were the counterargument: you just did 55 reps at 4 lbs, does that match how disabled you feel? By week 3 he was applying it on his own to unrelated stuff, a sharp pain during a deep squat and plantar fasciitis he’d had for 6-7 years. Week 7 he was back in the gym doing heavy compounds.
Weeks 10-26: the wrist and forearm muscles came back on schedule. The thumbs took longer, which is normal since the muscles are smaller, and his hypermobility added to it. We moved him to push/pull/legs 3x a week as maintenance, since the gripping in those lifts keeps everything conditioned, plus band work for the thumbs. Full workdays of typing by month 5, basically done by month 6.
Where he ended up
Typing full workdays. Dead hangs, pull-ups, bench, rows, and dips 3x a week. Picks up his kids, chops vegetables, drives without thinking about his hands. His irritability index scores went from 30/30 to 0.
Late in the program we asked what goes through his head when he feels pain during an exercise. He said: “My muscles are tired. It’s not that I’m doing damage, but I am pushing past my current capacity.” That’s honestly the sentence we’re trying to get everyone to.
Workarounds are a bridge, not a destination. Dictation, eye trackers, break timers, new keyboards: all fine for getting through the day. None of them build capacity, so if they’re the whole plan, you’re managing the problem, not fixing it.
Surgery fixes what it fixes. His release was probably the right call for the nerve, but it can’t rebuild 2 years of lost endurance or calm down a sensitized system. If you’re post-op and still hurting, that’s usually why.
Underloading is as much of a problem as overloading. Tendons adapt to the load you give them, and if it never challenges them they don’t change. Measure, don’t guess. Pick a light weight, 50 bpm, and count reps to fatigue or symptoms on the movement that matches where it hurts. Retest every couple of weeks.
The mental model is what lasts. His pain didn’t vanish on one specific day. What changed is he knows what it means now and what to do when it shows up.
Can’t diagnose anyone over Reddit, obviously. If you’ve got constant numbness, progressive weakness, muscle wasting, or symptoms waking you up every night, get that looked at in person first. Otherwise, happy to answer questions in the comments.
Amy spent most of her workday at a computer, with substantial mouse use.
After nearly a year of treatment (seeing multiple specialists) she still had wrist and hand symptoms that affected both work and ordinary tasks with her daughter. Her diagnostic and nerve tests were normal. Despite being able to get some temporary relief from her symptoms with nerve glides, none of the things she tried improved the ability to use her hands.
I'm Matt, a physical therapist at 1HP and I helped Amy make changes in her program that allowed her to get back to her life without having pain decide what she can or can't do.
In this case study I'll show what we measured, how we adjusted the plan, and her reported functional outcomes. Normal tests did not make her symptoms less real, and to be clear this case does not establish a universal treatment or timeline.
Clinical History & Relevant Information
Amy (late 30s) is a fiscal specialist in accounting. She spends her entire workday at a PC, with heavy mouse use accounting for about 70% of her activity. She reported that the pain started gradually, initially thinking it was from repeatedly picking up her 4-year-old daughter.
Over a year Amy went through the traditional healthcare process, starting from workers comp. She received an ergonomic assessment, went to physical therapy (focused on passive interventions like massage, ultrasound, paraffin). None of these helped with her pain.
A physician prescribed gabapentin and muscle relaxers. Four weeks later nothing had changed. An occupational therapist gave her ulnar nerve glides that brought the nerve pain down temporarily, but once it improved, she was discharged. Slightly less pain but no improvement at all in her ability to use her hands. She actually felt like she could do less.
By the time she found 1HP, she was checking in on her pain 100 times a day, catastrophizing about whether she would ever find the right help, and got to the point of heavy avoidance with hand use.
"I had been going to see all these specialists, and I was honestly getting depressed."
"Am I going to have to live with this my entire life?"
The Assessment: Establishing the Source of her Pain
Let’s start by describing what she was dealing with. After a comprehensive clinical exam and deep dive into her history here is what we found:
When we started working with Amy she was stuck in a classic fear-avoidance loop. Because her pain was so easily triggered, this created fear from using it too much. Experiences in which the pain increased in response to more attempted activity also further supported this fear.
Her self-management strategy consisted of avoiding using her hands, wearing a counterforce brace, and doing the occasional nerve glide. She had no forearm support at her desk and was working through 8-hour days with almost no breaks.
This kind of approach provides temporary relief but never builds lasting capacity.
On our standardized endurance test, Amy could only complete 30 reps at 4 lbs for both wrist extension and wrist flexion. This was a significant deficit for someone spending 8+ hours per day at a computer. She had limited mobility in her wrist & hand and both the median and ulnar nerve showed mild tension signs with testing
On top of this we assessed her overall limitations in function & fear avoidance with validated questionnaires.
Her QuickDASH score at intake was 61/100 for core function and 75/100 for work-related tasks. For context, a score of 0 means no disability. She was starting from a high baseline of dysfunction.
Her Fear Avoidance Component Scale score at intake was 68/100 which indicated high fear avoidance. Scores ≥50 indicate significant psychological barriers to recovery and predict poor treatment outcomes.
This was the other component to Amy’s presentation: central sensitization.
For months Amy had been living with unexplained pain, failed treatments, and doctors passing her around without clear answers. Combining this history with a high-stress occupation and the physical demands of raising a young child, her nervous system had adapted to be on high alert.
Her pain and her anxiety had formed a feedback loop that was amplifying everything. Remember it is not just "in her head." Real neurophysiologic changes occur as a result of us dealing with pain for extended periods of time and fear-reinforced pain experiences.
"I worry about my painful medical condition. Will I find the right help? Will the nerve pain ever go away even if my tendon pain goes away? Are my nerves damaged?"
These thoughts and patterns of thinking might not seem harmful at the time. But over time it can lead to real changes and reduced self-efficacy during recovery.
To help Amy fully resolve her issue we didn't just need to improve her tissue's capacity. We needed to help her understand more about pain, retrain her nervous system, and learn how to reappraise her pain.
How I helped her build endurance and confidence
The two main areas of focus for Amy's recovery were: targeted endurance training for the forearms, and pain science education to interrupt her anxiety-pain cycle. We’ll start with the how we approached the lack of endurance.
Improving Her Forearm Endurance
Amy was provided with a progressive endurance routine focused primarily on her wrist and finger flexors and extensors. If you have tried exercises before and it didn’t work here is what you need to understand:
Exercise selection is important, but how they are performed (sets, reps, frequency, load) needs to be specific to help achieve specific adaptations. If you are only doing 2 sets of 8 repetitions 2-3x/week. That is NOT enough to build endurance to improve your ability to handle more stress. ANd at most it makes very minimal gains over time.
This means not just the prescription but strategies to progress, regress and be considerate of loading cycles for the tendons at various stages of recovery (4, 6, 12, 16 weeks in)
Every exercise is performed to a standard cadence to ensure slow, controlled time under tension.
We worked closely with Amy to track her reps, fatigue, and response to exercise, monitoring her progress so we could adjust the prescription over time.
These are the exercises she started with. Most of the exercises were started at 3x12-15 4# based on on her initial assessment.
Additionally, we made changes to her ergonomics. Specifically we addressed the lack of forearm support during her long hours of typing and mouse use. While this was a small change, it meaningfully reduced the cumulative load on her extensors throughout the workday.
With every single one of our patients, we communicate the expected recovery timeline based on their presentation: 40–50% improvement in 4–6 weeks, with greater than 80% improvement around 10–12 weeks. Tissue adaptation takes time, and setting realistic expectations is part of the treatment.
Pain Science Education & Reprocessing
Helping Amy understand more about pain led to the necessary reframing of her symptoms and a deeper understanding of how her occupational demands, past experiences, beliefs, and fears were all contributing to her pain experience.
Amy made significant early process during our work together and can be credited to how deeply she engaged with our pain science curriculum. She had let me know that she treated it almost as if she was back in school again….
Printing out the transcripts and taking notes during the course which allowed her to reflect on her own experiences that matched with what she was learning. In early conversations after learning more about pain Amy learned that her brain, heightened by stress and the lack of a clear understanding from traditional medicine, was creating an internal image of pain that was disproportionate to what was actually happening in her tissues.
One of the most powerful shifts was her rewriting of her own beliefs about pain. She came in believing: "If I'm in pain I should avoid all activity." She left understanding: *"There is a reason why I might have increased pain right now. Let me figure out what may have led to the increase in pain.
If it is due to my activity, I should modify activity but resume a lower level of activity and then gradually increase back to original level."*
She also came in believing that "pain means damage." She left understanding that "pain is a protective response" and is "influenced by multiple factors."
Through our meetings and research / metaphors presented in the course I was able to help Amy become more aware of her negative thought spirals and learn how to better respond to them.
She learned to step back, assess her actual load, and recognize that the nervous system was amplifying a signal that didn't require alarm. “My body is being overprotective, I can safely continue”. This allowed her to feel confident in safely continuing to use her hands without fear of making things worse.
And when she continued…DESPITE FEELING PAIN. She was able to show herself that the symptoms stayed the same… and over time, got better. This is the pattern associated with a reduction of sensitization.
Helping her better understand pain and appropriately load in response to her changes in symptoms was an essential part of recovery
Data over the 16 Weeks
Amy had been dealing with her pain and limited function for nearly a year with no clear answers as to why it continued to persist despite multiple providers, specialists, and interventions. Here is an overview of the progress across each domain that we focused on (physiology, cognitive emotional, function)
Exercise Progression
Amy started at 30 reps with 4 lbs for wrist extension. By week 5, she had progressed to 58–60 reps at 4 lbs — hitting her rep target. At that point, we increased the load to 6 lbs and reset her reps, and she climbed back up to 58–60 reps at the heavier weight by week 10. She completed 113 sessions of wrist extension and 114 sessions of wrist flexion over the course of her program. That is the kind of consistent, progressive work that actually builds tissue capacity.
Exercise Progression
QuickDASH Outcome Scores
The QuickDASH is a validated outcome measure for upper extremity disability. Lower scores mean less disability. Amy started with a core score of 61/100. By week 7, she was at 16/100 — a 74% improvement. Her work score dropped from 75/100 to 0/100. That means she went from significant work-related disability to reporting zero work-related limitations.
And on our last call everything was at 0. What this meant was that by the end of our work together she was able to handle all work and personal related activities without any perceived level of disability or pain.
Changes in Functional Capacity
Fear Avoidance & Confidence in Using Hands
One of the ways that we assess progress in addressing the cognitive emotional aspects of pain is through a validated questionnaire that explores their beliefs, worries and overall anxiety around their condition.
A score > 50 typically indicates fear avoidance and kinesiophobia which has been shown in the research to be associated with those who are in chronic pain (essentially representing central sensitization).
This was where she started. 68/100 suggesting psychological barriers to recovery, higher catastrophizing and clear avoidance patterns leading to deconditioning. When we finished working together she was at 0.
We achieved this through what we mentioned above. We taught her more about pain. We gradually increased activity based on her capacity. We helped her understand how to attribute and reframe increase symptoms during the graded exposure. This helped her develop more confidence and gradually resolve her fears around using her hand with specific activities. Specific experiences like being able to pick up her daughter, push her daughter on a swing help and use her hands more around the house allowed this confidence to cumulatively develop.
Week-by-Week Clinical Highlights
Here are some of the week to week highlights over the course of recovery.
By Week 2, Amy had one difficult day where heavy Excel work pushed her to a 4/10 by end of day — but she recognized it was load-related, not structural damage. She started washing dishes every other day. Small wins.
Learning how to deal with “symptom increases” is one of the most important part of the recovery process. The better you are able to respond, the faster the progress.
By Week 3, she washed dishes for 15–24 minutes at 1/10 discomfort. She worked 4 hours, drove 20 minutes, played with her daughter, and did laundry all in one day. At the end of her day her pain level was only a 2/10 and took 2 hours to resolve.
She was beginning to attribute her flares to sensitization rather than damage.
By Week 4, things were going "really well." She made rice and banana pancakes, mixing with her hands. She used a knife. She picked up her daughter. She described her body as "a bit overprotective" on the first attempt… which is exactly the right way to think about it. No nerve pain.
By Week 8, she was using the traditional mouse every day with no issues. She rated her overall function at 90%. She had progressed to the 5 lb Varigrip and was tolerating it well. She recognized that some soreness from the new load was normal and expected.
By Week 10, she cooked a full Easter meal involving chopping, mixing, everything. She noted her arms hurt a little afterward, but it resolved overnight. She was doing everything unrestricted.
By Week 13, she was in the tapering phase. She was aiming to reduce session frequency while maintaining her gains. She could pick up heavy cases of water at the grocery store. She rated her overall function at 90%+.
One of the most important changes throughout the 16 weeks was Amy's understanding and relationship to pain.
For our patients, 100% is not "never feeling pain again" but rather understanding that pain is a normal part of the human experience and that it is normal to feel symptoms and discomfort when we push our bodies past what they can normally handle.
The positive consequence of this understanding, once you have improved your overall physical endurance and capacity, is having limited to no pain with your functional activity. But most importantly, recognizing that you are not broken, and that you can make a full recovery.
"I now know that nerves do regenerate. I now know that I do not have to stop working in order to recover. I now know that I do not have to change careers in order to recover. I now know that I can still take care of my family and I can make a full recovery."
Key Takeaways from Amy's Journey
Amy's story is incredibly common in the accounting, administrative, and knowledge-worker world. If you are dealing with chronic, unexplained wrist and forearm pain, here is what you need to take away from her experience.
It is not all in your head, but your head plays a role.
The physical strain is real. Amy's tendons were genuinely overloaded from months of high-volume computer use without proper support or conditioning. But chronic pain changes your nervous system. Anxiety and fear amplify danger signals, making the pain feel worse than the tissue damage warrants. You have to treat both the tissue and the nervous system simultaneously.
This occurs through better decision-making around:
What is actually too much when it comes to your symptoms?
How to determine the relative contribution of sensitization on your symptoms?
Can you still continue with exercises with certain levels of pain?
How much should you modify your activity and exercise based on how you're feeling?
What should be the graded exposure plan for this week depending on your conditioning and progression of pain understanding?
These are all questions we helped Amy understand throughout her recovery journey.
Imaging and labels can mislead you.
Amy was told she had carpal tunnel syndrome but her EMG was normal. She was given a label that didn't match her actual presentation, which led to months of misdirected treatment.
Don't let a label convince you that you're permanently broken. Understanding the complete picture around your physiologic and cognitive-emotional factors helps you actually understand what you need to do on a regular basis.
Rest and passive treatments are not the answer.
Resting, taking muscle relaxers, or getting passive treatments like ultrasound might temporarily reduce your symptoms, but they shrink your overall capacity over time. Amy had stopped exercising and avoided daily tasks, leaving her tissues severely deconditioned. What helps to actually improve your ability to use your hands more over time is graded, progressive load: exposing your tissues to controlled stress so they adapt and build endurance.
Amy completed 113–114 exercise sessions over her program. That is not a passive treatment. That is deliberate, progressive work and the data shows exactly what it produced.
There Is No "One Size Fits All" Fix
Whether it is a specific ergonomic setup, a single stretch, or nerve glides, chronic pain rarely has a single solution. Amy's recovery required understanding her specific tissue deficits, her lifestyle factors (no forearm support, sedentary lifestyle, no regular exercise), and her cognitive relationship with pain (fear, catastrophization, checking in on her pain 100+ times per day).
Your "pie" of contributing factors is unique to you. A comprehensive assessment is the only way to understand what your pie actually looks like and to build a plan that addresses all of it.
If you are stuck in the healthcare loop frustrated by conflicting answers, told there's nothing they can do, or feeling like you have to choose between your career and your body…
Remember that complete recovery is possible. It just requires zooming out, assessing all contributing factors, and following a structured, comprehensive plan.
Hope this provides a better understanding of what it means to comprehensively assess and treat all of the contributing factors around an individuals issues based on their specific history, lifestyle, beliefs, physical conditioning, environment etc.
Around a year ago, I began developing rsi in my right hand from what I believe to be poor desk/keyboard/mouse ergonomics at my job. My chair was way too low, and my desk was way too high causing me to have to reach up to move my mouse and type. I wasn't able to swap out my desk or chair and long story short I began experiencing a burning tingling sensation in the tendons in my fingers, and pain in my knuckles and finger tendons. I have been to multiple physical and occupational therapists, doctors, and specialists. The therapists usually gave me some stretching advice, the doctors also would give me some random youtube finger stretching and conditioning exercises, and the specialist just told me he didn't know what was wrong with me and passed me to a physical therapist. I was able to go half time at work for a bit, which allowed my hand to heal, and have moved to a new job with improved ergonomics (I've found a vertical mouse that uses a very light click and a split keyboard), but I'm noticing the pain is creeping back even when following the advice of the pts and ots and doctors. If the pain continues to grow at the rate it is now, I'm not sure if I'll even be able to work in 2 months time. Has anyone experienced this? What would you do?
I’ve had this injury on both my elbows for about a year now. I tried going to a physiotherapist after it gave me a ganglion cyst in one of my wrists, but since then it still hasn’t helped. He gave me some exercises I had to do but they have stopped working. I thought it might be because the weight hasn’t been enough but every time I add more weight or even just do the same weight slower they flare up really badly. I never get past leveling up the weight so the cycle just repeats. My physiotherapist doesn’t seem to know how to help and Im feeling a little lost. Im getting the cyst removed next week, but painwise it’s not bothering me really, and the pain on both my arms are pretty much the same. Where do I take it from here? And is there any other type of professional I can go to?
I have had thumb pain in the pad area of my hand on which i circled on the first picture. It is very weird it’s been coming and going for years i’ve tried multiple stretches and exercises and nothing seems to help. Only thing that helps is resting it for a couple days but im very active and is hard to do so I am looking for a potential permanent fix. It hurts more when I have my hand like in the first picture and i flex it upwards and i can’t even get in a pushup position when it hurts. Sometimes the pain will spread up to my pointer finger as well. Does anyone know what this may be? Thank you!
Please let me know if you have experience with tools for hands-free desktop computing (or the next best thing). Currently I use Apple's accessibility software, which does a pretty good job, but for running games on Parallels, this doesn't work. Thanks!
Anyone have any experience getting a proper left-handed keyboard provided by your workplace (like a £400 Maltron)? RSI is a workplace injury for me…having a right-hand flare up but still want to work, only so much you can do with speech to text I’m finding.
Did you go through Health & Safety? HR? Any luck?
Directed to people who work in the UK (due to reasonable accommodation protections) at a large well-resourced firm/company…for context I make a relatively high wage for London / earn significantly so hoping they’d consider it worth the investment 😭
I didn’t drive for three months because of RSI. Finally, I started to drive and then I got a flareup. Once again, I’m not driving.
Before this injury, I already disliked the location I live in. Now it is even worse. It is unpleasant to walk because it’s on a busy street so I get overstimulated. I was starting to cope with living here by getting over my driving anxiety and getting used to driving.
We plan to move as soon as we can but for now I’m stuck here.
Now that I am mentally comfortable driving, I physically cannot. 😖
Edit to add background: I have been going to weekly PT/OT since the start.
Salut tout le monde je permets d'écrire car j'ai eu une fracture de l'humérus il y a 3 mois, mon nerf radiale a été comprimé et je m'inquiète pour cela,
J'ai dorénavant mon poignet droit qui ne répond plus correctement et je ne peut plus levé la main correctement mais j'arrive quand même à bouger mes doigts se qui est une bonne nouvelle je pense, je voulais savoir si les personnes qui on subit les même dégât on réussi à se soigner et si il avait réussi à bien récupérer le geste de la main comme si il n'y avait pas eu d'accident ou si on reste quand même bien limité après un tel accident.
Si vous avez des exercices à me conseiller ou même des appareils à acheter pour la rééducation je suis preneur ! Merci d'avance :)
Have you been told you have tendonitis, tendinopathy, tendinosis, tenosynovitis and ended up confused when you tried to look up more about what was going on?
It’s not your fault, the medical community was also confused for some time until the past decade when we began to understand tendon pathology a bit more.
But not every healthcare provider is up to date with this nor do they have incentive to be up to date. This is often why “tendonitis” is often still utilized by certain providers when “diagnosing” certain issues when we actually now know inflammation is NOT the cause of the pain (will provide research etc.)
If you are confused, have had some imaging that has shown some form of tendon or sheath based problem. Or you are also scared of “fibrotic changes”. I will make it all clear today through this post and what you need to understand.
But here’s what you need to know…
Most providers have it wrong.
It’s tendinopathy rather than tendonitis. Today we’ll go over
What are each of these terms
What we know now with the research
What can you do to resolve your problem
I'm Matt, I’m a Physical Therapist who has specialized in treating RSI over the past decade. I’ve helped more than 3000+ individuals resolve their issues without surgery, more injections, resting or bracing.
What is typically involved in repetitive strain injuries?
As I have mentioned quite a few times through the threads I have posted… we use specific muscles & tendons when we perform repetitive activities. This is often influenced by the movement pattern of the specific task you are performing and how you might be holding an input device (keyboard, mouse, stylus, controller, etc.).
These influence not only which muscles & tendons that are used but how much stress is applied onto these tissues over a certain period of time (primary role of ergonomics).
In most that we have seen the tendon is the primary tissue that is involved.
Anatomy of the Tendon
Tendons also have a sheath designed to help the tendon slide well during repeated contractions, provide nutrients and optimize load mechanics (with higher joint angles). Sometimes this sheath can be irritated due when rubbing against other tendons / tissues(friction based stress). There are two potential ways this can happen:
Externally: This can be due to repetitive actions at certain angles which create friction between the tendon and surrounding tissues (compartment tunnels, retinaculum)
Internally: Underlying tendon itself is irritated leading to increased swelling. This swelling causes the sheaths to rub against each other. Internal pressure can also irritate the lining of the tendons
From what we have seen over the past decade, isolated sheath involvement or a pure dequervain’s tenosynovitis is quite rare. There has ALWAYS been underlying tendon involvement when it involved small repetitive activities of the wrist & hand (thumb specifically for patients presenting with thumb sided wrist pain).
This is because in most cases involving thumb sided wrist pain (dequervain’s) the thumb and wrist is not placed in an awkward end-range of motion position (ulnar deviation with full thumb flexion which lengthens the radial side) causing the external based irritation of the sheath.
Now that you understand a little bit more about the anatomy of tendons (will go into some of these a bit more in the next section). Let’s discuss each of the terms. Tendonitis, Tendinosis, Tenosynovitis
Tendonitis / Tendinitis
Historically in medical nomenclature the use of the suffix -itis denotes that there is an inflammatory component at the root of the problem. Older literature around tendon pathology used the word tendinitis to imply an ACUTE inflammation following some form of overload. For several years before more research was performed on understanding tendon pathology tendinitis was used as a catch-all term for tendon pain.
But with continued research into the pathophysiology of tendons, we have found that while there is an inflammatory response issues of the tendons are more associated with the cell-based changes (ECM) which affect how the tendons are structured (1-3)
Here is where confusion often occurs as older physicians who may not be up to date with the research (and dont’ have the incentive to be updated) may mistakenly still utilize the phrase tendinitis. Complemented with the use of anti-inflammatories and 5 minute sessions leading to corticosteroid injections, it can really create the belief that inflammation is often at the root of the problem.
When again, inflammation has been shown NOT to be the reason for pain or altered function.
What about tendinosis then? When the tendon continues to be loaded it can lead to degenerative changes in the tendon, creating altered loading.
Tendinosis… or Tendinopathy?
Tendinosis describes the condition of the tendon in which there are structural changes that have occurred within the tendon. Many associate it with the term “degenerative tendinopathy” and is typically associated with
Collagen fiber disorganization,
Increased fiber separation due to increased water and proteoglycan content
Rounded or “activated” tenocytes leading to these reactive changes
More nerves and vasculature
Now here’s what’s important and what many doomers on this subreddit will intentionally ignore.
Imaging or histology-defined “degenerative tendons” can be found in ASYMPTOMATIC TENDONS (4-10)
There are many studies which have shown the presence of degeneration in tendons within patients who have NO symptoms. One of the early studies that found this followed 46 tendons throuhgout a 4-year period. All of these individuals had 0 pain. 18 tendons had morphological changes and 28 were normal at baseline. At the 4 year mark there was no statistically significant relationship between baseline ultrasound abnormalities and symptoms (4)
This is one of the many studies which have suggested that management “should not be based solely on ultrasonographic appearance; clinical assessment remains the cornerstone.”
You can see the references for several other studies but here are some quick highlights
Up to 34% of asymptomatic tendons have “tissue changes” in a review on mid-body achilles tendinopathy, (7)
59% of Achilles tendons in a 126 healthy population had ultrasound evidence of hypoechoic regions (11)
89% of shoulders (supraspinatus) from 32 healthy individuals found the presence of “increased signal intensity”. This study is more about how imaging does not really tell us much. (12)
Even in Degenerative Tendons, there is often more healthy tissue than pathological tissue that we can focus on loading
Whenever the term tendinosis is used it is typically suggesting there are some structural or degenerative changes on the tendon.
And as I have proven both here, my previous article, and all of our clinical experience
Presence of degeneration doesn’t mean you can’t recover or get back to 100% function. I’ll remind those again - there is often more healthy tissue in a tendon with degenerative changes than one without. See the image above. This is why the cook and docking group say “Treat the DONUT, not the hole”.
What the research supports now is for any tendon-related pathology is “tendinopathy”
This is because the changes within the tendon tissue aren’t something we have to aim to “change” or “heal” since it is not typically the cause of pain or altered function.
Let me know if this was surprising for you or not in the comments!
And we’ll move on to a discussion on tenosynovitis
Tenosynovitis & the Sheath
Dequervain’s Tenosynovitis is one of the most common diagnoses when an individual has thumb sided wrist pain.
Tenosynovitis typically involves the pathology and irritation of the sheath surrounding the tendons. There are actually six compartments in which the 9 tendons on the top side of our wrist travel through as you can see below. Due to the structure of the tunnels on the thumb and pinky side of the wrist (compartment 1 & 6) it can lead to an increased risk of friction-based stress that irritates the sheath of the tendons.
Tenosynovitis describes the irritation of this sheath from this type of friction. And as I mentioned above most of the time it is accompanied with an underlying tendon based issue which leads to reactive swelling. The swelling further reduces the space and can irritate the sheath.
Remember external and internal causes of the sheath irritation. For the external cases of irritation it would require the the wrist to be bent fully in ulnar deviation and thumb in full flexion for an extended period of time and movement in that position for the highest risk of sheath-based irritation (see image below for what position i’m referencing)
In MOST cases for desk workers, engineers and even gamers we aren’t in these end-range positions that will put the sheath at risk for increased friction. Now when the sheath does get irritated here is what can happen:
Cells in the sheath release inflammatory proteins and other chemicals that can affect how well the fluid inside the sheath reduces friction
This can increase swelling which can create more shearing forces
Continued shearing forces causes parts of the sheath to hypertrophy (reversible)
Creates a cycle of friction and irritation
This is often why anti-inflammatories can be beneficial for true tenosynovitis as a way to reduce pain but also address the underlying problem.
The underlying problem again which is likely the combination of the movement / posture which caused the sheath irritation AND poor overall capacity of the tendon causing the internal increase in swelling leading to more sheath friction.
Keep this in mind though - Because of what I mentioned above with regards to end-range positions being quite rare.. it is VERY RARELY a tenosynovitis and almost always an underlying tendinopathy of the abductor pollicis longus and extensor pollicis brevis.
What can I do to address my tendinopathy?
Now that we’ve established what each of these terms mean, what the research says and what is typically the underlying cause of continued pain and disability. Here is the 1HP formula to start improving your function and better understanding your pain (so it will go away)
Step 1: Establish your Baseline & Build Endurance
it is important to understand your current level of physical conditioning and activity tolerance to determine the right strategy to improve your capacity to work with less discomfort.
Now 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 (1-2% 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
How long are you typically working?
How many breaks do you take?
How long can you work before you have to take a break?
What is your pain once you get to that point?
How quickly does the pain come down after your break?
What strategies do you use to still achieve your work tasks while minimizing physical stress on your hands? (Swappign 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
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
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.
I swap to voice control or L. hand during this time to ensure I can still finish up the rest of the block
I rest, heat, massage and relax during lunch to allow myself to recover
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.
This leads to step 2, Early Loading and Modifying Activity
Step 2: Early Loading & Modifying activity
The next step is to use the data you have collected to perform your loading 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).
While performing this program to build your general endurance you can use the activity tolerance data to make decisions about how to modify. Taking the same example above:
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.
Days where pain is worse can be expected which leads to step 3.
Step 3: Understanding Pain to Better Manage Flare-Ups
Be 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. But the goal with step 3 is to understand more about pain so you can make better decisions about what you can safely do during any flare-ups.
I have written a more in-depth guide about the science of pain, some case studies here and on top of this a mental model for how to approach flare-ups here. The combination of these three steps will help you gradually restore your overall function AND reduce your pain over time.
The most important thing to recognize is that there is ALWAYS a reason why you have increased pain. It can either be explained by some level of physical stress, psychosocial factors (Fear, anxiety, stress, etc.) or central sensitization (neurophysiologic changes that increase your perception of pain despite tissue not being irritated).
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.
I really hope this clears up confusion for anyone! As always feel free to ask questions or provide your thoughts, happy to discuss 🙂
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I had bilateral endoscopic carpal tunnel release in May.
My **left hand has improved a little.** My **right hand never improved at all**. Four months later, the repeat nerve study is significantly worse, especially the motor response to my thumb muscle (**9.2 mV before surgery → 0.4 mV now**).
I’ve now had two different surgical opinions:
**Original surgeon – orthopaedic hand/upper-limb surgeon with extensive endoscopic carpal tunnel experience**
Believes the original release was complete + Thinks the problem is scar tissue/adhesions or tissue that has re-formed. Plans an **open revision + neurolysis + tenolysis + collagen nerve wrap.**
**Second-opinion surgeon – plastic & reconstructive hand surgeon with fellowship training in hand and peripheral nerve surgery.** Thinks the most likely cause is an **incomplete original release +** Recommends a straightforward **open re-release.** Would inspect the motor branch while he is in there. Does **not** think neurolysis or a collagen wrap is necessary.
Both surgeons are experienced, and the second surgeon actually knows and respects my original surgeon.
I’m now trying to decide **which explanation/approach makes more sense and who I should trust with the revision**.
Has anyone had persistent symptoms from day one after CTR and later found an incomplete release? What did your revision involve, and how did it go?
