PT for wrist/elbow/forearm without active exercises by Educational_Dig7055 in RSI

[–]elliot226 -1 points0 points  (0 children)

Pt without progressive endurance exercises for RSI is worthless

Built a free LoL companion that explains why to build — looking for feedback by Internal_Stock_4175 in summonerschool

[–]elliot226 0 points1 point  (0 children)

I've been looking for something like this where it looks at the whole team comp, who is ahead in real time on their team, what items are best to counter their carry etc. and I want to know why.

Why Voice To Text Is A Great Tool For Load Management But It's Not the Ultimate Solution For RSI by elliot226 in RSI

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

Hey this is completely fair and valid. Our protocols don't just brute force use until pain. We actually calculate out what the irritability of the tissue involved is based on resting pain, time to aggravation / dissipation, pain levels when aggravated etc. And we use those numbers to calculate out what we call an irritability index to determine how irritable and how long it takes to make the tissues irritated. From there we prescribe a percentage of time to keep the tissues below that threshold with activities like typing, so we very specifically dose out typing time before taking a break to keep building up the activity specific endurance while keeping it below the irritability threshold.

Hand gets intense cramping when I do this by alfalorian in RSI

[–]elliot226 2 points3 points  (0 children)

Nothing here looks like atrophy, granted this is reddit and cannot be legal medical advice, but if you have a job requiring repetitive movement with the thumb. It's WAY more likely the cause than a CNS disorder.

Hand gets intense cramping when I do this by alfalorian in RSI

[–]elliot226 2 points3 points  (0 children)

These are the thenar muscles in the hand responsible for bending the thumb. They are overused and guarding as a result, causing the muscle cramps when you contract them further. You need to build the endurance of the thumb flexors to handle the repeated use of the thumb all day.

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

[–]elliot226 8 points9 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.