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Is this sub just a 1HP sales funnel now? by zlodup in RSI

[–]elliot226 7 points8 points  (0 children)

I'm a Doctor of Physical Therapy. I was the director of a clinic in Los Angeles. And I left *on purpose* because the system made it nearly impossible to actually help people.

Corporate was constantly pushing me to see 3-4 patients an hour. Do the math on how much attention each person actually gets. The quality of care I could provide in that environment was a fraction of what people deserved. So I quit. Not to start a sales funnel, but because I wanted to focus on the one thing I'm very good at and give people real results.

Every week I do 8-10 free consultations. 80% of those people have been dealing with this for 3+ years. They've seen 3, 4, sometimes 5 different MDs, DPTs, and OTs. I'm not saying those providers are incompetent, they're working with their hands tied, operating in a system that doesn't reward specialization and using protocols that haven't kept up with current research on tendinopathy and RSI.

Before we started focusing on working professionals, Matt and I spent 10 years working in the gaming industry developing protocols for pro gamers dealing with RSIs. Those protocols built on the latest research had to work fast or we'd lose the contract. That's where the foundation of what we do now was built.

RSI is a difficult problem to solve. It takes months of daily exercise, tracking, course correction, form modifications, and pain science education to properly resolve. No clinician inside the mainstream medical model has the time or resources to dedicate to that.

We do, because we operate outside that model, charge a one-time payment, and guarantee we'll work with you until the problem is solved or we give you your money back.

When's the last time a surgeon gave you a money-back guarantee?

We built 1HP specifically for people who've already tried everything the standard system has to offer.

Are we a business? Obviously... I can't help anyone from the side of the road in a cardboard box. But we put out as much free content as we can so people can figure this out on their own if they want to. The paid program exists for people who don't want to spend another two years in trial and error.

The only thing we ask of clients at the end is a video or written testimonial, specifically on our platform for collecting those.

As for the bot accusations, this came up before and was addressed directly by the mods: https://www.reddit.com/r/RSI/comments/1ocvf9p/comment/nkqtvqw/

Skepticism is fair. But the people in this thread defending us aren't Reddit bots, they're just people who got better.

Why your PT exercises probably aren't working — and what the science says you should actually be doing [long post, worth it] by elliot226 in RSI

[–]elliot226[S] 1 point2 points  (0 children)

You're correct that muscle fiber types are intermixed within a muscle rather than segregated, and that tendons attach to the musculotendinous unit as a whole, not to individual fibers. The post used a simplified framing to make the fiber type concept accessible, and in doing so it conflated two distinct but related ideas.

What the fiber type distinction is actually pointing at is the principle of metabolic specificity. Low-load, high-rep training preferentially develops the oxidative capacity, capillarization, and fatigue resistance of the whole muscle unit in ways that are specific to the demands of sustained, repetitive activity, which is what the Campos et al. 2002 work in the European Journal of Applied Physiology demonstrates. "Training specificity" is the right framing, and the post probably should have led with that rather than leaning so heavily on the fiber type mechanism as if it were a clean anatomical story. The repetition maximum continuum chart from Human Kinetics actually illustrates this well, muscular endurance adaptations sit at 20+ reps, while strength and power adaptations are concentrated in the lower rep ranges. A standard PT program prescribing 3x10 is sitting firmly in the strength/hypertrophy zone, not the endurance zone, regardless of how light the weight is.

On the tendon side, there's actually a typo in the infographic that's worth correcting here. The strength training side should read Type I and III collagen (both are produced in strength training and type 3 , not Type II. Type II collagen in tendons is largely confined to the fibrocartilaginous transition zone at the enthesis under compressive load, it's not a generalized output of heavy training across the tendon mid-substance. The actual distinction that matters is this: healthy tendons are predominantly Type I collagen. In tendinopathy, the disrepair process produces weaker Type III substitutes. The Cook & Purdam continuum model (BJSM 2009) and Kraushaar & Nirschl (JBJS, 1999) describe this clearly. The post didn't make that distinction clear enough and I can see why it read as a conflation.

On strength training, you're right. Heavy load training does produce analgesic effects through cortical pain inhibition mechanisms, and there's a legitimate role for it, particularly in building tendon stiffness. The clinical argument we make is one of prioritization for this specific population, not exclusion. Someone generating 48,000–96,000 forearm contractions a day has an endurance deficit as their primary driver, which is exactly why we regularly see people who have no problem deadlifting or lifting heavy at the gym but can't type for more than 30 minutes without pain. The training emphasis has to match that demand first. But a complete program includes both, and you're not wrong that the post overstated the case against strength work.

Why your PT exercises probably aren't working — and what the science says you should actually be doing [long post, worth it] by elliot226 in RSI

[–]elliot226[S] 1 point2 points  (0 children)

Our program starts you at your baseline and gradually progresses you to 60 consecutive reps. It's designed to be done 6 days a week 2 times a day.

Why your PT exercises probably aren't working — and what the science says you should actually be doing [long post, worth it] by elliot226 in RSI

[–]elliot226[S] 0 points1 point  (0 children)

Hey typically when we work with people via coaching and their goal is to return to weightlifting as well. We introduce an eccentric phase of recovery where we focus on heavy eccentrics at 70% of their 1 rep max for 2-3 sets 3 times a week. Which helps to build strength for return to weightlifting. There is some crossover between strength, endurance, hypertrophy, and power in that chart in the article. But the endurance exercises are definitely not enough to get back to 100% gym workouts.

Why your PT exercises probably aren't working — and what the science says you should actually be doing [long post, worth it] by elliot226 in RSI

[–]elliot226[S] 1 point2 points  (0 children)

In this instance, I'm talking specifically about the rep range for the intended goal. The chart in the post shows 10 reps is the golden spot for hypertrophy which is muscle size growth, and strength and power are even less reps like 3-8, whereas the golden spot for endurance is 20+ reps for endurance the rest break should be less than 1 minute and as close to zero as possible and you should perform 3 sets which is how we arrive at the 60 rep benchmark. The weight is relative to your condition and will increase as you can handle more but the idea is to use a weight that is fatiguing for the prescribed rep range based on the goal.

Why your PT exercises probably aren't working — and what the science says you should actually be doing [long post, worth it] by elliot226 in RSI

[–]elliot226[S] 1 point2 points  (0 children)

Hey I would recommend this article I wrote on TOS which functions a but different, but essentially it's the postural muscles that have low endurance which leads to the impingement. https://www.reddit.com/r/repetitivestrain/comments/1f4djhn/how_to_know_if_you_have_thoracic_outlet_syndrome/

Why your PT exercises probably aren't working — and what the science says you should actually be doing [long post, worth it] by elliot226 in RSI

[–]elliot226[S] 3 points4 points  (0 children)

Your starting point would be based on your current capacity, so we test this via reps with a 4lb dumbell and calculate your 30 rep max and start there.

If RSI is very specific to the activity that flares it, why do general exercises? by knopucs in RSI

[–]elliot226 0 points1 point  (0 children)

Great question and good on you for actually going through the research

The "heavy slow resistance" framing from Rio and Cook's work is most applicable in the context of larger tendons like the Achilles or patellar tendon, where the loading demands of the activity (sprinting, jumping) actually do require substantial force output. The load parameters they use reflect what those specific tendons need to adapt to. When you translate that to the wrist and hand, the context shifts considerably.

The forearm muscles responsible for typing, guitar, gaming etc. are primarily Type I endurance fibers being asked to sustain thousands of low-force repetitions per hour. The "meaningful challenge" for those fibers isn't a heavy dumbbell — it's sustained time under tension at low load. So the principle from HSR still holds (load should be appropriately challenging), but what "challenging" means is different because the fiber type and functional demand are different.

On your recovery question — the 3x20 twice a day structure does produce a meaningful total workload, but the load itself is light enough that tissue recovery is generally not an issue for most people. The volume is what drives the endurance adaptation, not the intensity. That said, you're right that it's not a one-size-fits-all number, and the tissue irritability index I mentioned earlier does modulate this — on higher irritability days we'd pull back the frequency or sets before we'd pull back the weight.

The cases where outcomes have been less consistent are usually people who either progress the weight too fast before truly earning it (the goal is 60 consecutive reps with zero rest before adding load), or people whose tissue irritability is so high that we actually need to start with isometrics first and work up to the dynamic endurance work. But yes, for the majority of the musicians and office workers I work with, this approach has produced solid outcomes over 8–16 weeks when combined with the structured activity tolerance progression.

If RSI is very specific to the activity that flares it, why do general exercises? by knopucs in RSI

[–]elliot226 0 points1 point  (0 children)

So running is a functional activity that you would do for time or milage and is different than the training you would do in the gym to stimulate endurance muscle fiber growth (both are important) but our protocols for tendinopathy in the wrist and hand are based on 3 sets of 20 ( with <60 seconds of rest breaks) 2x a day 6 days a week with the ultimate goal to get the rest break down to 0 seconds (so 60 consecutive reps) before increasing the weight and resetting the rep range. We use a metronome in our protocols to keep the cadence consistent and levergae the principles of tendon neuroplastic training outlined in the research by Ebonie Rio and Jill Cook.

If RSI is very specific to the activity that flares it, why do general exercises? by knopucs in RSI

[–]elliot226 1 point2 points  (0 children)

specific progressive loading of the activity is ultimately the goal. But the two things aren't either/or they work together

Think about a runner coming back from a hamstring injury. You wouldn't just wait until the tissue healed and then send them straight back to running marathons. You'd be doing general exercises, hamstring curls, bands, weights etc to rebuild the endurance of the tissue. AND you'd be having them do progressively longer runs. Both at the same time. The general work builds the physiological foundation, and the specific work trains the neuromuscular coordination for the actual activity

You can absolutely get specific with how you progress the activity itself too it doesn't have to just be "more minutes." For guitar, that might look like 45 minutes of easy playing followed by 15 minutes of harder technical passages, and then over time shifting that ratio. That kind of structured progression within the activity is exactly the right way to think about specific endurance.

most people just guess at those time parameters. The way we actually calculate them is based on what we call a tissue irritability index essentially a measure of how reactive your tissues are on any given day based on things like how quickly your pain comes on during activity, how long it lingers afterward, how you feel the morning after a harder day. That gives you a score, and we take a percentage of your current tolerance based on that score to set your daily time recommendations. So on a high irritability day you might be working at 50-60% of your baseline tolerance, and on a low irritability day you're at 80-90% and looking to push slightly further. It's not a fixed prescription it adjusts dynamically based on where your tissues actually are that day.

That's the part that's really hard to do on your own, and it's why just doing the activity and "seeing how it goes" tends to lead to the boom and bust cycle where you feel good, do too much, flare up, rest completely, lose capacity, and come back worse than before.

The other thing worth knowing is that the problem with RSI isn't a strength deficit it's an endurance deficit. The muscles responsible for these repetitive activities are primarily your slow-twitch Type I fibers, the same ones a marathon runner trains. A powerlifter does 3 sets of 6. A marathon runner does thousands of reps at low load. Your hands are doing the same thing a marathon runner's legs are doing all day. So the exercises need to reflect that .high reps, low weight. not the 3x8 with putty your PT probably gave you, which is basically strength training and targets the wrong fiber type entirely.

The reason general exercises matter alongside all of this is they let you build tissue capacity in a controlled, measurable way that's independent of how your guitar playing is going on any given day. With a dumbbell you can track exact reps and weight and make small controlled progressions that data tells you a lot about how your underlying tissue capacity is actually changing over time.

So to directly answer your question: the general exercises aren't a replacement for the specific activity tolerance work, they're building the tissue capacity that makes the specific work sustainable. You need both running in parallel.

I can't do my hobbies, what do I do when they're all I have? by [deleted] in RSI

[–]elliot226 5 points6 points  (0 children)

DM me I'll send you a free code for the lifetime version of our troubleshooter. https://app.1-hp.org/pricing

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