Part 2 of this case study involves how I followed up with John over the course of 6 weeks. He was able to make significant improvements within this time – with my only needing to meet with him two times after the initial evaluation. LEARN MORE ABOUT GAMERS THUMB IN PART 1


1.5 Weeks into Recovery
We followed up 1.5 weeks later and immediately he reported he had made 33% improvement at the 1.5 weeks after the initial evaluation. The 33% improvement was an overall reduction in pain during all of his gaming and functional related activities. 

Player Progress & Changes

During this time he also reported performing the exercises for 35 minutes every day and the pain changing from sharp  to aching. He also reported he had been implementing the 6-minute post-stretch routine and the 9-minute wrist warrior routine as a bonus to exercise his hands regularly. 

During this point I also asked important pain behavior questions to assess true progress: 
P1: Thenar Eminence Pain

  1. When pressing the thumb toward the base of his pinky he would feel some stiffness and pain 2/10 (Previously 7/10)
  2. Typing / Browsing his phone for 3-4 hours, reports 3-4/10 pain at the EOD (Previously 5/10)
  3. A slower game like Xenoblade Chronicles for 2 hours will cause his pain to escalate to 3-4/10 (Previously 6/10)
  4. A faster game like Smash for 2 hours causes his pain to go up to an 6/10 (Previously 8/10)

At the two week mark we also re-evaluated John’s thumb endurance along with load management (see table below)

Despite the short amount of time, the change in his thumb endurance through his diligence with exercises led to the reduction of John’s pain. More specifically: 

  1. Regular conditioning to allow tolerance to load (although it had only been 1.5 weeks the increase in # was likely due to improved neural drive, muscle recruitment, firing rates, timing during contractions, etc.)
  2. Consistent stretching to undo the stress of repetitive use on muscles/tendons after gaming session or any activity requiring thumb use

I did not modify his exercise program as he only had been performing it for 1.5 weeks


5.5 Weeks for near full Recovery
After six weeks of consistent exercise and load management, John was able to report significant improvement to his thumb discomfort and was happy with all of the progress. I describe John as an ideal patient because he complied to nearly 100% of my rehabilitation recommendations. At 5.5 weeks, an injury he had been dealing with for 4 years was reported to be 70% improved with the remaining 30% relating to pain only associated with higher loads (longer gameplay + excessive thumb use)


P1: Thenar Eminence Pain

  1. When pressing the thumb toward the base of his pinky he would feel some stiffness and pain 0/10 (Previously 2/10)
  2. Typing / Browsing his phone for 3-4 hours, reports 2/10 pain at the EOD (Previously 3-4/10)
  3. A slower game like Xenoblade Chronicles for 2 hours, 0/10 (prev 3-4/10)
  4. A faster game like Smash for 2 hours causes his pain to go up to an 4/10 (Previously 6/10)

At this point – the majority of his pain was minimal and only associated with excessive loading or during loading with higher intensity. During this visit John also reported noticing occasions in which he had no pain at all even during the higher load situations. He reported he was confident in his ability to manage the remaining 30% – specifically with exercise and continued management of his schedule / breaks

Final measurements

As you can see, John had significantly improved his endurance over the course of the 5.5 weeks and despite the fact he had been dealing with pain for 4 years he had made significant progress in the span of 6 weeks. The changes with his pain were mainly associated with better load management and increased endurance. And as I will mention below the remaining 30% will likely be achieved with continued exercise to help his nervous system adapt (to reduce the overall sensitivity). 

Another big reminder like the previous post….

THIS IS ALWAYS THE GOAL WITH PHYSICAL THERAPY. It is our responsibility to teach players and our patients how to self-manage because we cannot be by their sides 24/7. This is why after any Physical Therapy visit or visit with a healthcare professional you should understand:

  1. What is the source of the pain?
  2. What is the cause of the pain? (Endurance, schedule management, increased pain sensitivity, etc.)
  3. What is the exact roadmap of your return to play?
  4. What can I expect with the rehab process?

If you learn how to monitor your own symptoms and understand the process of rehabilitation, you’ll be successful in the long-term, not just this one time. As a physical therapist we provide guidance and start you on your journey (and sometimes get you back on track) to better health.



John had been dealing with chronic tendinopathy and repeated muscle strain of his R. thumb due to poor load management and hand conditioning. Because he had been dealing with this issue for such a long time (as mentioned earlier) there was an overall increase in sensitivity in his “pain system” making the path to recovery more difficult. The key to his success in the 6 weeks was his discipline to consistently perform the exercise but also his beliefs associated with rehabilitation of his thumb. He had a poor understanding of how to properly manage his thumb from previous healthcare practitioners and negative beliefs associated with rehab due to repeated failed management of his thumb. 

Addressing his weakness and load management was important for this case but it was also his behavioral & change in beliefs which will lead to continued health in his professional career. 


While John was able to significantly reduce his pain after 5.5 weeks, EVERYONE IS DIFFERENT. For some of you the pain might have been bothering you on and off for several years just like John while others may have only been dealing with pain for a few weeks or months. This causes two very different states for not only the tissues but also your pain system. Exercise and all of the methods we use to address in the program address both states, but can take a different amount of time. We always begin with four to six weeks and move forward from there. But just like this case with John, most people pain will significantly reduce in six weeks and will be more healthy afterwards from adopting the healthy habits 

Take control of your own life:  understand yourself and how your body works.

This is absolutely essentially. In the end, a medical professional cannot be by your side 24/7. It is up to you to learn more about how your body works and better understand how to modify your schedule, adjust your posture, and incorporate your exercises to ensure the rehab process goes smoothly. 

That’s all guys. Hope you enjoyed this case study and learned something from it. Share this with your friends if you felt it was helpful!



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