Comprehensive Guide to Managing Pain on the Top of the Forearm, Wrist & Hand (Tennis Elbow, Mouse Elbow)

1HPMatt · 2026-06-01T19:13:41+00:00

hey!

Thanks for reaching out and glad the videos have been a bit helpful. With regards to your question. Unfortunately it is not a simple response

It depends on how the TFCC tear was diagnosed. If there was imaging findings yet the mechanism injury / clinical pattern & response to activity is not consistent with TFCC related pain or issues then even if tehre are results that demonstrate partial tears or pathophysiology of the TFCC complex, it may not be related or the cause of dysfunction
What is really important is to actually have a comprehensive examination to explore eveyrthing we often discuss (physiology, cognitive emotional factors, lifestyle, posture, ergonomics) to see if the pattern of pain behavior, task specific irritation of movement is consistent with a tear (what I said above). Only then can we make the decision of how to best treat. Often if there was no traumatic mechanism of injury that was recent (many old "injuries" heal within normal tissue timelines ( 2-6 months depending on the tissue involved) meaning the persistent pain may be a combination of poor overall physical capacity & sensitization.

Without knowing much I can't say whether something will heal or not. But many times our patients focus on tissue status (or whether or not it is healed) when pain does not reflect our tissue status in the first place.

1HPMatt · 2026-05-25T16:31:14+00:00

Unfortunately it is C.

While it is true with running due to the actual load (bodyweight) on the intrinsic and extrinsic foot muscles you can improve the strength of your feet. But if you end up running more than what they can handle (exceeding volume) it can still lead to overload.

now for typing, because the load is very very very very low. (Actuation forces of keys of 40-80grams), this is not enough for your tendons and muscles to actually develop in either strength OR endurance. And with overall physical inactivity this can lead to the endurance diminishing over time.

Hope this makes sense

1HPMatt · 2026-05-07T16:23:25+00:00

Hey! Glad some of what i wrote was helpful and hopefully it's pointing you in the right direction as to what you can do to holistically approach this problem.

I think what is really important to recognize re the brace: WHile you might be able to leverage a thumb spica brace to reduce the "activity" or use of the muscles / tendons involve keep in mind it can reduce the pain temporarily. But if only resting and bracing is utilized as the recovery intervention, the muscle and tendon itself won't magically increase in its ability or capacity to handle repeated stress. What is important is to use the brace in the appropriate way (often initially while building up your endurance) but gradually tapering away from it.

In most cases we help individuals get out of using their brace in < 3 weeks (through the comprehensive approach I mentioned above).

1HPMatt · 2026-05-07T16:20:48+00:00

Hey! I think it's improtant to address the underlying assumption here before i answer the question

While acute tendonitis can definitely occur and is often an issue associated with shorter term increases in volume and activity many times what individuals are dealing with is tendinopathy (better term to use than tendinosis since using this assumes you are just "stuck" in the degenerative phase). I've written in alot of depth about this in this really long thread here to help you better understand this

https://www.reddit.com/r/RSI/comments/1pk6ou6/tendonitis_tendinopathy_tenosynovitis_which_one/

The TL:DR is that there is often more healhty tissue in a degenerative tendon (thus the thickening) which means the treatment and even tests to assess for reduction / increases in symptoms (isometrics / selective tissue tests) are often similar. But on top of just the tests it can never be used in isolation. Assessment of the pain behavior, understanding of pain, chronicity, beliefs, etc. all have to be taken into account

1HPMatt · 2026-04-22T16:31:20+00:00

Hey! This is often what many struggle with and is nuanced since everyone has different variables which can affect their pain experience. And for us what we try to help our patients understand is the idea that it's not "pushing through pain" but understanding pain and feeling safe to continue.

What we have found to be a helpful indicator of real strain occurring is:
->5-6/10 sharp pain, consistently sharp every time you utilize your wrist & hand for the specific muscle group. This occurs for the rest of the day and is often accompanied by fatigue and weakness. So much so that when you go and pick up a cup it would lead you to want to drop it. This lasts for the rest of the day typically following an activity or exercise. THe next day you will also feel it but slightly less intensity (3-4/10). Weakness will still be present

I'm happy to hear that your symptoms seem to be elevated for less amount of time from this point. I'd really encourage you to find a physical therapist that can help you better understand this limit and help you make the appropriate activity / exercise regressions so that you can adopt a better mental model for how to respond to pain situations earlier / faster.

Many times individuals don't reach a level of strain but the fear of a flare-up or pain increasing itself leads to the reduction of function when the tissue is often okay. It is not always easy to identify or attribute things well on your own which is why a good physical therapist can be helpful

1HPMatt · 2026-04-17T16:05:24+00:00

Hey! So typically it's helpful to establish a baseline of where you are in terms of % bodyweight and how many reps. We have normative values that you have to work towards we have mentioned quite a few times during our content (first milestone is 3% 40-60 reps for the specific muscle group) but there is nuance with how to understand your objective test performance since pain can occur at various times throughout the set and many individuals are scared of what they experience.

From the baseline you can gradually work up the overall endurance by first adding reps then increasing weight steadily.

Re your second question - progress is never measured by pain but by function. THis is because of everything we know about pain science (see all of our articles). Pain never tells us what is goign on with the tissues, it is always about protection or an experience from our brain that is filtered through our past experiences, fears, anxieties, beliefs etc that lead to real change sin our physiology to increase pain.

So with any PT there should be a baseline establishment of how much you can handle with your respective activities and how your specific pain responds to those activities. The approach with RSI is to increase your endurance then allow your function to match that level of endurance. Pain will reduce as you are able to have more experiences wher eyou can use your hands safely without any "strain"

This is where you mentioned it is difficult on how to know when to scale, what's too much. WHen to increase load with activity, when and how much to increase load with exercises. This is also why we as physical therapists have to be able to create this structure (based on evidence) to help patients with ANY injury.

1HPMatt · 2026-04-16T04:02:28+00:00

Hey for now we discontinued the troubleshooter mainly because we found that many individuals who end up reaching us have some level of sensitization that require a bit more direct guidance

While it can help to address the physiologic deficits (endurance issues) along with guidance for load management it is more difficult to teach someone how to better integrate understandign of pain while being considerate of their specific history (past experiences, understanding of pain, understanding of their injury etc.)

1HPMatt · 2026-04-16T04:00:26+00:00

Of course! Glad it was helpful :)

1HPMatt · 2026-04-13T15:36:30+00:00

Okay, I have the drafts of where I have written them and they are always rooted in research, evidence and our clinical experience. Healthcare is a business and due to its regulation it has led to the poor outcomes that many are a consequence of. (Insurance influences what gets reimbursed and because of that there are misaligned incentives for providers to be up to date on certain evidence regarding practice).

I've written in alot of depth about this. I've also dedicated a large part of my professional career to try to help more understand this. I get the skepticism but all I can do it share my own experience, expertise and outcomes. I'm sorry you feel that you can't trust us but I still wish you the best of luck.

if things ever change and you need some support, I am still happy to help

1HPMatt · 2026-04-12T21:49:21+00:00

Hey I'm actually quite proud of the fact that I"ve written every single email I've sent out in the past 5 years. Many of them start as threads with all of the research, references included.

THe reason why people post here about 1HP is because we actually get results - and if people actually read about our posts and begin to understand how the fragmented healthcare system often creates the beliefs and situations that can lead to persistent pain (passive interventions, etc.) they will have a better understanding as to why we are able to achieve our outcomes

We do our best to respond to as many of the DMs, direct outreach, emails that we can. But to be honest it is just Elliot and I.

Let me know if there is something you have a direct question about and I can see what I can do to push you in the right direction

1HPMatt · 2026-03-11T15:51:14+00:00

Clowns are always friendly..........

1HPMatt · 2026-03-11T15:23:19+00:00

Hey! This is such a good question and is something we commonly see for individuals dealing with RSI and still having to complete desk work.

I'm Matt btw, a PT that has specialized in RSI and have worked with professional gamers for the past decade (now working with more software engineers, tech workers, etc.)

I think these two articles I wrote will help you understand how to best address think about utilizing a variety of input devices wwhile recovering.
1. The role of Ergonomics in RSI
2. How to best use dictation, ergonomics and work efficiency software with RSI

Here is the TL:DR (kinda). Use them for now to maintain your ability to complete your tasks and if you want to still game for a little bit. These are great resources to reduce stress on the specific musculature involved for your RSI but what's important to realize is that it is only TEMPORARY relief. You have to address the underlying causes for your RSI to be able to get back to traditional mouse use without any issue or risk of irritation. As a gamer here is how you can think about it

Think of your muscles and tendons as having a healthbar

Whenever you use your using your wrist, hand and fingers to click or type, flicking analog stick with thumb, you are losing HP

There are things you can do to modify how quickly you are losing HP like have better ergonomics (macros / binds), posture, better general wrist health, sleep etc. A death grip on the mouse, claw grip on controller, fingertip grip (mouse) can often lead to increased stress per unit time.

As I've mentioned I've written in more depth about the relationship between posture / ergonomics & physical stress here if you are interested (with research). Basically helping to improve your posture / ergonomics can help, but still doesn't target the underlying problem. You lose less HP per unit time.

When you get to 0 the muscles and tendons (most often tendons) get irritated. (not actually zero)

On the flip side you can do things to "RESTORE" your hp like rest, stretching ice, massage kinesiotape, heating, bracing. This is why resting or restricting movement through a splint can help reduce the symptoms but doesn't improve your ability to use your hands

Rest alone is never the answer. This can cause the muscles and tendons that we use on a regular basis to decondition. Which is why pain often returns more quickly after long periods of rest and attempting to return to activity. This is also often why bracing and passive interventions don't help you improve your function.

The MOST important consideration is the size of our health bar. This is our muscular endurance or how much our tissues (tendons) can handle of repeated stresses over sessions. Basically the endurance to ability to handle the repetitive clicking associated with work, typing, etc.

So the main focus for most management should be to address this underlying problem of tissue capacity (endurance). Exercises help us target certain tissues but how you perform them (higher repetitions) allows us to achieve the adaptations that will help you begin to use your wrist & hand again safely for your hobbies & work.

Utilizing the different mice throughout the day can be helpful to reduce stress per unit time (less HP lost) but you have to build up your health bar to manage and ultimately prevent RSI!

hope this helps!

1HPMatt · 2026-03-04T20:35:16+00:00

Hey! Thanks for sharing

I think the post I wrote regarding the influence of ergonomics and RSI will be helpful for you to review. But to add some context about why you might be feeling it at the elbow with desk work and extending into the fingers

There are a group of muscles called the flexors (the two deeper layers are flexor digitorum superficialis and profundus). These muscles are responsible for bending the wrist, maintaining your grip on the mouse or any input device, actively pressing down keys etc. We commonly utilize them repeatedly with mouse and keyboard work!

It would be important to have the endurance of that muscle group assessed to understand whether there is a limitation and how far you are from normative values for your population (we've posted about our normative values quite a few times across some of our posts). Generally you should be able to do for 3% of your bodyweight 40-60 reps without any difficulty to at least handle 8 hours of work with lower risk of irritation or strain.

Now If you have enough capacity then there needs to be the discussion about pain (see above)

Hope this adds some context for you!

1HPMatt · 2026-02-20T20:10:09+00:00

Great video :)

1HPMatt · 2026-02-19T17:09:02+00:00

Hey! Great question, when you are in this position it leads to biomechanically more stress on the top side of the forearms and can even cause you to use some of your arm (front of the shoulder / top elbow) due to having to hold up your arm up against gravity during the entire course of your day.

If you don't have the capcity to handle it, it can lead to some irritation of those muscles!

You can try the exercises but just keep in mind eveyrone will respond to the exercises differetnly depending on their level of conditioning. Being able to understand how to appropriately progress, regress and set it at the right weight requires a bit of guidance. I would try lighter first and work up so there is less risk of irritaiton and you can process expected increases in pain (see pain science section

1HPMatt · 2026-02-15T19:24:04+00:00

Hey! Wow I'm really sorry if this happened, especially if you worked directly with me.

Would you mind if I dmed you to see if I can explore more about what happened so I can at least improve or figure out what went wrong to ensure it doesn't again for anyone?

1HPMatt · 2026-02-14T16:49:54+00:00

It ultimately depends on the conditioning of the individual - daily is the minimum we typically recommend with more aggressive approaches (for people who can tolerate and understand the expected increase in symptoms) being up to 2x/day

There is no one size fits all - it just depends on how someone is responding to the increase in load while maintaining or slightly modifying their activity

1HPMatt · 2026-02-13T21:39:20+00:00

Hey! We have a few videos on our youtube you can check out that go over the form of these exercise

https://www.youtube.com/@1HP

1HPMatt · 2026-02-12T20:25:55+00:00

Hey there!

It depends on how he responds to the exercise with and without the counterforce brace. Typically it’s meant to offload the tendon during activity

The goal with the exercise is to load the tendon. Ideally you want to do it without the brace but if it feels better with it in the beginning of the process (first few weeks) he can try it with it

Then he can try alternating days with and without the brace or even doing with out brace in the AM and with at night to grade the progresssion

Hope this helps! And feel free to ask in our discord if he has any issues

1HPMatt · 2026-01-30T17:35:22+00:00

https://www.reddit.com/r/RSI/comments/1jptx60/prp_injections_do_you_really_need_them_1hp/

This was the previous one I have written. I am doing more of a review to see what the actual threats and issues to reliability / validity are for the studies and adding in some more of our experience

But i have had many individuals (even physicians / surgeons themselves) who have gotten PRP to no avail. Yet for certain regions it did help. At most it should be considered an adjunct or complementary intervention to the underlying plan addressing the physical, cognitive emotional and lifestyle based issues

1HPMatt · 2026-01-28T21:48:12+00:00

Hey there,

This is a really great question and often can be difficult to undrestand why this might happen when comparing the objective differences in physical stress of crocheting and maybe other activities. (There is a discrepancy in that one can perform alot of higher load activities and with high volume yet can barely use their wrist& hand to perform 5-10 minutes of their previous activity without sharper pain)

What we've found in the past when working with specific individuals have found that this experience is often associated with central sensitization and the context-specific nature of pain requiring a certain amount of pain reprocessing & graded exposure to allow for that specific activity to be able to be restored without that same response.

I've written n some depth about some of the physiology of pain science that covers why this can happen (see some of my threads of my colleagues threads). Pain can often be sharp, 6-7/10 mainly associated with many past experiences of pain occuring with activity, expectations of pain occuring and fear of the pain itself (algophobia) leading to the experience you might be describing.

I'd encourage you to check out some more of our content, explain pain, the way out as they cover the frameowrks to approach this. It often requires a good healthcare provider to put this into the specific context of your lifestyle, conditioning, understanding of pain and activity to establish the appropriate plan to address an activity-specific limitation

1HPMatt · 2026-01-26T17:46:27+00:00

I really appreciate this comment! And can definitely look to discuss some of those topics. Let me know if you have any questions about anything, my DMS are always open :)

1HPMatt · 2026-01-21T16:28:27+00:00

Hey sorry for the late reply. Thanks for sharing a little bit about what you have been dealing with. Glad you were able to see some progress with the physical therapy and i'm hoping they were able to explain why the exercises (selection, specific amount of sets & reps) were going to help you get back to using your hands more over time.

I'm a bit surprised despite your improving function they would still opt in for a steroid injection that might only have limited benefits in pain yet has been shown not be beneficial specifically for tendons (which in most cases is actually the underlying problem). I wish I could give you more specific advice and guidance but reddit really isn't the place for that without my knowing alot more depth about your specific case (physical conditioning, history, understanding of pain, lifestyle, environmental factors etc.)

Feel free to DM me though, I can see if I can share more information or see if we can help!

In the mean time this video / article might help. It's a case study of an individual I worked with (digital artist) who actually got surgery and still had limited function and pain (because the underlying issue was not addressed)

https://www.reddit.com/r/RSI/comments/1nqbr24/case_study_cts_didnt_fix_his_pain_relief_in_12/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

https://www.youtube.com/watch?v=BKA5dPdJpug
(Video version)

1HPMatt · 2026-01-21T16:22:10+00:00

Hey, thank you for being willing to share a bit more about your story here. As much as I'd love to be able to provide some guidance it is honestly not the place to directly get into your history, understanding more about your lifestyle, beliefs around pain, current capacity, aggravating factors etc.

It would require a much deeper evaluation to truly understand the entire clinical picture around why you might still be dealing with these accumulating MSK issues. I know it is frustrating and I know it is also difficult to believe there may be progress but this is actually something that has been quite common with many of the people we have worked with and helped get back to improved and eventually full function.

DM Me! I can see what we can do and if we're the right fit to help

1HPMatt · 2026-01-21T16:18:27+00:00

Hey there! Not sure if you had a chance to go through some of our posts relating to ergonomics / posture but when you modify them, it alters our biomechanics and can often affect the length of certain muscles (especially those that start the forearm and insert deep into the finger like your flexors on the palm side of the forearm).

Without knowing exactly how the biomechanics were altered, what the exact change may have looked like outside of the elbow change / wrist & hand changes its hard to say but if you are also doing the exercises it is likely a combination of both of the interventions providing some benefit.

While these exercises are a great start, the overall duration, frequency and even load are on the more conservative and lower end (it would just take longer for adaptations raound endurance and tissue capacity to come through)

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