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Our experts have worked with more than
3,000 people over 10 years across our practice, esports work and programs

Break Free From Chronic Wrist Pain and Return to the Work and Hobbies You Love.

Finally understand the missing link in your recovery. Overcome the frustration of failed treatments and build a sustainable, expert-backed program that supports your lifestyle and passions.

In just a few simple steps!

FEATURED IN & TRUSTED BY

ESPN
Washington Post
Razer
Wired
PC Gamer
APTA
Sports Illustrated
Kotaku
Variety
NATA
Linus Tech Tips
Red Bull
Riot Games
Allied Esports

Fix the Real Issue Behind Your Wrist Pain

Learn why “Rest it, ice it, wear a brace” doesn't address the underlying tissue capacity issues that drive wrist pain from typing.

Feel Confident in your Plan to get your Hands Back

Understand exactly what you need to do every day to safely use your hands more.

End the Frustrating Cycle

Stop starting over with new specialists. Get one clear plan built around the cause of your pain.

You Have Two Choices.

YOU CAN:

  • Keep Resting And Hoping The Pain Goes Away
  • Keep Wearing Braces That Don't Fix The Cause
  • Keep Getting Injections That Only Mask The Pain
  • Keep Wasting Hours On Reddit Looking For Answers
  • Keep Seeing Specialists Who Don't Get It

...OR, YOU CAN

Get Started With My Free Guide

Built by Doctors of Physical Therapy. Instant access.

Dr. Matthew Hwu, PT, DPT, OCS, CSCS

Dr. Matthew Hwu

PT, DPT, OCS, CSCS

Dr. Elliot Smithson, PT, DPT, MS, ATC

Dr. Elliot Smithson

PT, DPT, MS, ATC

About Us

We're two Physical Therapists with the core mission to help those suffering from wrist, hand & forearm pain.

Elliot and Matt saw a huge gap in the healthcare system of people suffering from wrist, hand & forearm pain.

People weren't getting the care they needed. And many times they were invalidated (gaming, music, programming, etc.)

So we spent the past decade specializing in wrist & hand injuries. We've read 1000s of research studies, published a few of our own (see below), spoken at national Physical Therapy Conferences (APTA CSM)…

…and have focused all of our efforts on helping you realize you have MORE CONTROL in managing your wrist pain than you realize.

▶Our Work, Publications & Features
  1. McGee C, Hwu M, Nicholson LL, Ho KKN. More Than a Game: Musculoskeletal Injuries and a Key Role for the Physical Therapist in Esports. J Orthop Sports Phys Ther. 2021 Sep;51(9):415-417. doi: 10.2519/jospt.2021.0109. PMID: 34465141.
  2. Bonnar, Daniel & Hwu, Matt & Lee, Sangha & Gradisar, Michael & Suh, Aly & Kahn, Michal. (2023). The Influence of Coaches and Support Staff on the Sleep Habits of Esports Athletes Competing at Professional and Semiprofessional Level. Journal of Electronic Gaming and Esports. 1. 10.1123/jege.2022-0023.
  3. Smithson EV, Reed Smith E, McIlvain G, Timmons MK. Effect of Arm Position on Width of the Subacromial Space of Upper String Musicians. Med Probl Perform Art. 2017 Sep;32(3):159-164. doi: 10.21091/mppa.2017.3026. PMID: 28988266.
  4. Hwu, M. (2021). Corrective Exercise Guidelines for Esport Impairments. Conditioning for esports. Human Kinetics.
  5. Hwu, M. (2021). Physical Training and Exercise Guidelines for Esport Athletes. Conditioning for esports. Human Kinetics.
  6. Hwu, M. (2021). Physical Training Programming for Esport Teams. Conditioning for esports. Human Kinetics.
  7. Schary, D. P., Jenny, S. E., & Koshy, A. (2022). Leveling Up Esports Health: Current Status and Call to Action. International Journal of Esports, 1(1). www.ijesports.org/article/70/html
  8. McGee C and Ho K (2021) Tendinopathies in Video Gaming and Esports. Front. Sports Act. Living 3:689371. doi: 10.3389/fspor.2021.689371.
  9. Washington Post (2022). Professional esports athlete injuries. www.washingtonpost.com/video-games/esports/2022/03/14/professional-esports-athlete-injuries
  10. ESPN. The health care hype man of esports. www.espn.com/gaming/story/_/id/17476003/the-health-care-hype-man-esports
  11. U.S. Academic Esports. Careers in Esports Webinar Series: Dr. Matt Hwu from 1HP. www.usacademicesports.com/career-webinars/careers-in-esports-webinar-series-dr-matt-hwu-from-1hp
  12. APTA Allied Health. Event Details: Dr. Matt Hwu. www.aptaali.org/events/EventDetails.aspx?id=1693513
  13. Razer Press. How Gaming Chairs Benefit Gamers: An Inside Look with Dr. Matthew Hwu, Founder of 1HP. web.archive.org/web/20250521054851/https://press.razer.com/featured/how-gaming-chairs-benefit-gamers-an-inside-look-with-dr-matthew-hwu-founder-of-1hp-organization
  14. Yahoo Life. Matthew Hwu, Gamer Physical Therapist. www.yahoo.com/lifestyle/matthew-hwu-gamer-physical-therapist-220000656.html
▶Key Studies & Science Supporting Our Methodology
  1. Lewis, J., Trinh, P. and Kirsh, D. (2011). A Corpus Analysis of Strategy Video Game Play in Starcraft: Brood War. UC Merced.
  2. Szeto, G.P.Y., Straker, L.M. and O’Sullivan, P.B. (2005). The effects of speed and force of keyboard operation on neck-shoulder muscle activities in symptomatic and asymptomatic office workers. International Journal of Industrial Ergonomics, 35(5), 429-444.
  3. DiFrancisco-Donoghue, J., Balentine, J., Schmidt, G. and Zwibel, H. (2019). Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport & Exercise Medicine, 5(1), e000467.
  4. Cook JL, Feller JA, Bonar SF, et al. Abnormal tenocyte morphology is more prevalent than collagen disruption in asymptomatic athletes’ patellar tendons. J Orthop Res 2004;22:334-8.
  5. Hamilton B, Purdam C. Patellar tendinosis as an adaptive process: a new hypothesis. Br J Sports Med 2004;38:758-61.
  6. Benjamin M, Ralphs JR. Fibrocartilage in tendons and ligaments-an adaptation to compressive load. J Anat 1998;193(Pt 4):481 to 94.
  7. Docking S, Samiric T, Scase E, et al. Relationship between compressive loading and ECM changes in tendons. Muscles Ligaments Tendons J 2013;3:7-11.
  8. Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? Br J Sports Med 2012;46:163-8.
  9. Zabrzyński, J., et al. (2018). Electron microscope study of the advanced tendinopathy process of the long head of the biceps brachii tendon treated arthroscopically. Folia Morphologica, 77(2), 371-377.
  10. Attia, M., et al. (2014). Greater glycosaminoglycan content in human patellar tendon biopsies is associated with more pain and a lower VISA score. Br J Sports Med, 48(6), 469-475.
  11. Wheeler PC. Nearly half of patients with chronic tendinopathy may have a neuropathic pain component. BMJ Open Sport Exerc Med 2022;8(3):e001297.
  12. Rio, E., et al. The Pain of Tendinopathy: Physiological or Pathophysiological? Sports Med 44, 9 to 23.
  13. Ackermann, P., et al. (2023). Tendon pain - what are the mechanisms behind it? Scand J Pain, 23(1), 14-24.
  14. Bashir U, Bell D, et al. Gadolinium contrast agents. Radiopaedia.org.
  15. Moseley, Lorimer. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12, 169-178.
  16. Huisman, E., et al. (2014). Enhanced collagen type I synthesis by human tenocytes subjected to periodic in vitro mechanical stimulation. BMC Musculoskelet Disord 15, 386.
  17. Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology. Br J Sports Med 2016;50:1187-91.
  18. Cook, J., & Docking, S. (2015). Defining “tissue capacity”: a core concept for clinicians. Br J Sports Med, 49(23), 1484-1485.
  19. Malliaras, P., et al. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther, 45(11), 887-898.
  20. Benjamin, M et al. Structure-function relationships in tendons: a review. J Anat 2008;212(3):211-28.
  21. Docking, S. I., Ooi, C. C., & Connell, D. (2015). Tendinopathy: Is Imaging Telling Us the Entire Story? J Orthop Sports Phys Ther, 45(11), 842-852.
  22. Bley, B. & Abid, W. Imaging of Tendinopathy: A Physician’s Perspective. J Orthop Sports Phys Ther 2015;45(11):826-8.
  23. Magnusson, S., Langberg, H. & Kjaer, M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol 6, 262-268 (2010).
▶Topics We Have Covered On Reddit

Understanding Your Injury

  • Is it actually carpal tunnel syndrome?

    Carpal tunnel accounts for less than 1% of the wrist pain cases we see. Learn how to tell the difference and why the misdiagnosis happens so often.

  • How does RSI actually develop?

    The "too much, too quick, too soon" principle explained. Why small repetitive movements cause big problems over time, and why rest alone doesn’t reverse it.

  • The healthbar framework

    Think of your tendons like a video game healthbar. Every click depletes it. Only endurance training builds it back. A simple model for understanding your capacity.

  • Can RSI cause permanent damage?

    The fear of making it permanently worse keeps many people from recovering. Here’s what a decade of working with more than 3,000 people across our practice, esports work and programs actually shows.

  • Why chronic pain won’t go away

    If you’ve been dealing with this for over a year, the problem changes. Here’s how RSI becomes chronic and what a more complete treatment approach looks like.

  • Why your doctor is right and missing the point

    All pain is processed in the brain - but that doesn’t mean it isn’t real. The structural and neuroplastic models of pain, and why you need both to fully recover.

Specific Conditions

  • Do I have thoracic outlet syndrome?

    About 8% of arm and hand pain cases are actually TOS. Includes self-assessment tests, the three compression sites, and how to tell it apart from carpal tunnel and cubital tunnel.

  • Cubital tunnel syndrome

    Pinky and ring finger tingling that worsens when your elbow is bent? This explains how forearm endurance deficits compress the ulnar nerve and what to do about it.

  • De Quervain’s tenosynovitis

    Pain at the base of the thumb when gripping or scrolling. Why surgery is rarely necessary and how to fix the underlying tendon endurance deficit instead.

  • Tennis elbow (lateral epicondylitis)

    A full breakdown of what tennis elbow actually is, why cortisone shots make it worse long-term, and a progressive loading protocol to fix it for good.

  • Before you get carpal tunnel surgery

    If your symptoms don’t include numbness in your thumb, index, and middle fingers, it may not be CTS at all. What to try before an irreversible decision.

  • Wrist tendinopathy: the full guide

    The most common RSI diagnosis, explained from first principles. Covers the tendinopathy spectrum, why it’s not the same as tendonitis, and how to treat it at each stage.

Why Traditional Treatments Fail

How To Fix It

  • The complete RSI handbook

    Everything in one place. A five-part structured guide covering the healthcare system, the physiology, treatment, what doesn’t work, and complex nerve cases.

  • Case study: pain-free in 10 weeks

    A detailed look at how we helped a programmer go from instant pain with typing to a full pain-free workday, including the full exercise program and pain science approach used.

  • For software engineers and desk workers

    Work sprints, hackathons, and long coding sessions are the most common trigger. How load management and endurance training apply specifically to a desk-work lifestyle.

  • For drummers and musicians

    14,400 wrist movements per hour of drumming. The specific muscle groups involved, why stretching alone won’t save you, and the prevention protocol that actually works.

  • For gamers: the interactive wrist guide

    Find your pain pattern, get the right exercises. Built by a DPT who works with professional esports teams, adapted for every gamer from casual to competitive.

  • Case study: helping the former #1 osu! player

    Sytho went from 40 minutes of play to 7 hours daily in 4 weeks. His endurance was fine. The real issue was fear-avoidance. A detailed breakdown of how we got him back.

Ergonomics And Setup

  • Should you get a vertical mouse?

    It depends on where your pain is. A scenario-by-scenario guide based on your specific pain pattern, with the biomechanics of why the same mouse helps some people and hurts others.

  • Should you float your wrists when typing?

    A lot of CS professors teach this. It’s wrong. Here’s the biomechanical reason floating your forearms increases strain, and what to do instead.

  • How much does ergonomics actually matter?

    Ergonomics accounts for about 10 to 20% of most RSI cases. The rest is tissue capacity and lifestyle. Why changing your peripherals without exercising is like buying better shoes for a marathon you never trained for.

  • Death gripping your mouse

    Why death gripping happens, how the stress response drives it, and how to retrain your grip using cardio, biofeedback, and specific aim training protocols.

For Gamers

Pain, Fear, And The Recovery Mindset

  • The pain-fear cycle

    Fear-avoidance beliefs predict disability more strongly than actual tissue damage. How chronic pain rewires your brain, and why addressing the psychological side is not optional.

  • Protecting your mindset during recovery

    What to look out for in online communities, how to identify fear-amplifying content, and a checklist for telling the difference between evidence-based advice and misinformation.

  • You are not making it permanently worse

    The single most common belief that slows recovery. The physiology of why peripheral nerves regenerate, why degenerative tendons are still mostly healthy, and what the research actually shows.

Trusted by Tech Professionals & Pro Gamers

Real clients who saw multiple doctors, therapists, and specialists before finding 1HP. Results vary.

“I'm able to use the computer without pain and in my cubital tunnel syndrome burning sensation is totally gone. And 6 years I had seen all of these specialists and finally found 1HP.”

History: 7 years of chronic wrist pain

Assessment: FCU Cubital Tunnel Syndrome, Extensor Tendinopathy (ED, ECRB)

Mayur B. · Consultant

20 Weeks to Recover

Results vary.

“I tried the Sarno approach and found it didn't really work anymore and knew something was missing. 1HP actually treated the underlying issues while also teaching me why the psychosomatic approach worked before.”

History: 6 years of wrist pain, psychosomatic approach stopped working

Assessment: Extensor Digitorum Tendinopathy R>L, FCU Cubital Tunnel Syndrome, L. Rotator Cuff Strain

Gareth B. · Court Reporter, Gamer

12 Week Resolution

Results vary.

“I can play for hours six hours a day if I wanted to. Type, use the mouse, just fine. Sure, I have some aches and pains still there when I do a lot, but nothing that limits me. Even my mindset when I do feel pain is completely different. No fear. No 'okay, let me stop, let me avoid what I'm doing, let me over-rest for a day or two.' I feel like I've finally broken through.”

History: 16 years of chronic wrist pain

Assessment: Multi-region muscle and tendon overuse

Julian A. · Crypto Trader, Gamer

16 Weeks for Full Resolution

Results vary.

“I'm able to work 8 hours a day without any pain and come home and cook. I had stopped cooking before. I can play with my daughter and push her on the swing without any pain now”

History: 1 Year History of Pain, Multiple Doctors & Specialists Seen

Assessment: Extensor (ECRB/ECRL) Strain & Flexor Tendinopathy, Ulnar Nerve Irritation

Amy · Fiscal Specialist

12 Weeks for Full Resolution

Results vary.

“I'm able to do everything I want to do. Play controller, mouse and keyboard as long as I used to and do what I did before without even thinking about something being wrong.”

History: 2 Months, Gradual Onset

Assessment: ECU, FDS / FDP, APL / EPB Tendinopathy with Sensitization

Nick B. · Career Coach & Gamer

10 Weeks to Recover

Results vary.

“On top of the exercises, the mental reframing to understand that pain is more of a protective mechanism rather than a signal that something is wrong was important to help me fully recover.”

History: 2 Years after Initial Spike in Work / Gaming Volume

Assessment: FDS / FDP Tendinopathy with Sensitization

Eric W. · Software Engineer (Meta)

11 Week Resolution

Results vary.

3,000+
People Over 10 Years
6-12 Wks
To Meaningful Improvement*
72%
Reached Meaningful Improvement*
10+ Yrs
Wrist Pain Specialists

* 72% of Power Leveling members who completed follow-up reached a meaningful improvement in function. Most members see meaningful improvement within 6 to 12 weeks; full recovery can take up to 18 months depending on the case. Source: The 1HP Clinical Outcomes Report 2026. Results vary.

This Is for You If…

  • You're a software engineer, designer, or executive whose wrist pain is interfering with work
  • You've been told your imaging is “normal” but your wrist pain is real and worsening
  • You want carpal tunnel guidance that doesn't start with surgery or injections
  • You've seen multiple physical therapists or doctors and still don't have a clear plan
  • You're willing to commit about 30 to 60 minutes a day to a structured recovery program: 15 to 30 minutes of exercise, twice a day, 6 days a week

How It Works

Your Path to Pain-Free Typing in 3 Steps

A clear, structured recovery process - not another generic exercise list.

01

Free 7-Point Wrist Pain Screen

A comprehensive evaluation with a Doctor of Physical Therapy covering 7 key areas: pain region, endurance capacity, schedule, pain behavior, pain science, ergonomics, and medical history.

02

Personalized Recovery Plan

Get a 1-on-1 evaluation and a customized plan covering exercises, load management, ergonomics, and pain science - built around your job, not a generic protocol.

03

Return to Pain-Free Work

Most members see meaningful improvement within 6 to 12 weeks; full recovery can take up to 18 months depending on the case. Unlimited 1-on-1 expert calls throughout. Results vary.

New Free Resources Every Week

Practical, evidence-based content from the team of Doctors of Physical Therapy who've worked with more than 3,000 people over 10 years across our practice, esports work and programs.

Frequently Asked Questions

Who is this program for?

Our typical client has been dealing with a repetitive strain injury - wrist, hand, or forearm pain - for 6+ months, has been through the mainstream medical system and seen 3 to 4 different medical professionals without lasting answers, and needs their hands for work. That includes software engineers, designers, executives, gamers, musicians, and other professionals whose careers depend on their hands.

What conditions do you NOT work with?

We specialize in repetitive strain injuries - tendinopathies, nerve entrapments, and overuse-related wrist, hand, and forearm pain. We do not work with the following conditions: arthritis, wrist sprains, fractures, stroke, gout, or cancer. If your situation falls outside our scope, we will tell you on your free screen and point you toward the right provider.

How is 1HP different from other exercise programs I've tried?

Unlike generic exercise programs or one-size-fits-all stretching protocols, 1HP provides personalized load management built specifically for repetitive strain injuries of the wrist, hand, and forearm. We don't hand you a random list of stretches - our system is built on the same tissue loading principles a Doctor of Physical Therapy uses, calibrated to your specific pain pattern, work setup, and current tissue capacity.

What if I've had this pain for years? Can 1HP still help me?

Yes. Many of our most successful clients had wrist or forearm pain for 5 to 10+ years before finding us. Chronic pain requires a different approach than an acute injury, and our system is specifically designed to address both the physical side (rebuilding tissue tolerance through progressive loading) and the neurological side (the central nervous system sensitization that drives long-standing pain). You are not too far gone.

How much time will I need to commit each day?

Plan on about 30 to 60 minutes a day: 15 to 30 minutes of exercise, twice a day, 6 days a week. Consistency matters more than duration, so short, regular sessions work better than long, occasional ones. The program is built to integrate into a working professional's routine, not become another burden on your schedule.

Will I need special equipment for the exercises?

Minimal equipment. Many early-stage exercises require no equipment at all. As you progress, simple items like resistance bands, light dumbbells (2 to 10 lbs), or household objects like water bottles can be used. We provide options for both gym-equipped and home-based setups and will tell you exactly what (if anything) to buy.

How soon will I see improvements in my pain levels?

Most members see meaningful improvement within 6 to 12 weeks. Among Power Leveling members who completed follow-up in The 1HP Clinical Outcomes Report 2026, the median time to a meaningful improvement was 45 days, and 55% had reached it by their 4-week check-in. Full recovery can take up to 18 months depending on the case, and results vary. Progress usually follows a pattern: first improved function with less pain during activities, then decreased overall pain levels, and finally increased capacity for heavier loads or longer work sessions.

Do I need to stop my current activities while recovering?

No. Our approach is based on activity modification, not activity cessation. Unlike traditional advice to "just rest," we help you find the right balance between recovery and continuing to work, train, or play. Our load management system teaches you how to stay just under your pain threshold while gradually building tolerance - so you can keep working, gaming, or playing music while you recover.

See all questions

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