If you’ve ever felt a deep ache in your wrist while typing at Blue Bottle Coffee or noticed soreness after a few long gaming sessions in your SoMa apartment, you’re not alone. Wrist and hand pain are incredibly common in active communities like San Francisco, especially among remote workers, gamers, cyclists, and fitness enthusiasts. Yet most people are still told to “just rest it,” wear a brace, or take anti-inflammatories—interventions that often fail to address the underlying cause.

Understanding RSI in the Wrist & Hand

Many residents here use their hands in repetitive ways—whether it’s keyboarding, playing instruments, or rock climbing at places like Planet Granite. Yet few understand that the pain they feel often stems from the tendon’s inability to tolerate repeated mechanical stress, not just inflammation. This leads to what we know as Repetitive Strain Injuries (RSIs), which is our body’s lack of capacity for what we’re asking of it. What we will be discussing is how Isometrics give the tendon a chance to strengthen gradually without flaring things up.

 

Beyond just the exercises, managing RSI well means assessing how your lifestyle and habits interact with pain. For example, someone working remotely from a rooftop in the Mission might not notice how their wrist is constantly bent while on a laptop. Small ergonomic tweaks—like adjusting hand position or using a wrist rest—can have a surprisingly large impact. Physical therapists here in San Francisco, especially those who understand modern pain science, can help you fine-tune these variables.

Why Isometrics Work for Wrist & Hand Pain-The Science Behind it

Fortunately, there’s a growing body of science supporting a better approach: isometric exercise. These are muscle contractions where you apply effort without moving the joint—essentially, working the muscle statically. This method has shown promise not only in reducing pain but also in helping tendons adapt and strengthen over time, especially in conditions like repetitive strain injuries (RSIs) where traditional inflammation-based treatments fall short.

 

In San Francisco, where people are constantly on the move—from yoga in Golden Gate Park to working remotely from coffee shops—finding efficient and sustainable solutions is essential. Isometrics offer a low-barrier, accessible way to manage pain without needing fancy gym equipment or large time blocks. You can perform them from your desk, your picnic blanket at Dolores Park, or even while people-watching along the Embarcadero.

Scientific Literature Surrounding Isometrics

A well known researcher (Ebonie Rio) in the tendinopathy space published a study in 2015 on 6 volleyball players (not a lot, I know) that showed performing isometric exercises for 5 sets, 45 contraction at 70% maximal effort (with 2 minutes rest in between) was able to lead to an immediate decrease in pain from 7/10 → 0/10!

Small sample size yes, but this is the first study to demonstrate potential benefits. The author suggested that it was likely due to changes in the brain to muscle signaling (cortical changes) along with some local tissue changes. Basically the brain becomes better at sending signals to the muscles & tendons along with the release of some chemicals that can reduce pain. 

 

Of course there was a follow-up study performed in 2017 which also showed a reduction in pain for individuals with knee tendinopathy (patellar tendinopathy). This led to pain reduction that would last for around 45 minutes to an hour (sometimes even longer for certain cases that we’ve seen). The science also showed something we experienced – It doesn’t help everyone (most interventions don’t, since it requires nuance in considering individual circumstances). This does however show that for a certain type of individual isometric exercise could be helpful in reducing pain.

It's Not for Everyone

Why didn’t it help everyone? We experienced some cases where the isometric protocol made things worse temporarily or did not do much at all to reduce pain at all. Again, there are reasons for this – PAIN IS COMPLICATED. But when we layer on what we know now with pain science, it provides more of a reason why it leads to this clear distribution of three responses.

1. Helps to reduce pain (in our experience helps more than 70% of people)
2. Doesn’t do anything (20% of our cases)
3. Makes pain worse temporarily (10% of our cases)

 

For the individuals where the pain is less mediated by cognitive emotional & contextual drivers of pain (see PDDM model of pain) and more a problem of our body structures… isometrics are helpful. This is most people actually.

PDDM Model (Holistic Understanding of Pain)

But when pain is a bit more complex after we’ve dealt with it for a while, what we are experiencing with pain can be a result of those same factors. This leads to the other 30% of experiences. So again, it can help some while it may not help others, but overall it does seem to be helpful to the vast majority!

How to actually use Isometrics with your issue

If you are someone who has been dealing with the pain for less than 3 months. Maybe you haven’t had many doctor visits (which might have confused you as to what is going on) and the pain is only limiting you when you use it for really extended periods of time (think… at the end of your work day as a programmer, desk worker etc. or when you game at the end of the day). Then you likely fall into the 70% of people that it will help, So TRY IT! It won’t hurt you which is what makes this exercise so great. There is no way that low level contraction can lead to any lasting damage or problems for any RSI-related issues. You can feel safe trying it for any of these scenarios.

 

For those that have more doctors visits, have been dealing with it for longer with some cycles of rest that have likely led to your muscles and tissues getting weaker. There is just more of a CHANCE that it won’t help. This is mainly influenced by what you believe to be going on based on your healthcare visits, your current level of deconditioning and of course how you perform the exercise. What we have seen is that those who have dealt with the problem for 4+ years and are extremely confused about what is happening. All the traditional interventions seemed to have failed, etc. The isometrics sometimes don’t work. Because of all of the cognitive emotional aspects that come along with 4+ years of limited progress.

 

The practical advice is this. It doesn’t hurt to try isometric exercises. It is something we tend to utilize earlier in the recovery process for MOST people we work with because it is a simple way to provide healthy load to the muscle & tendons and the amount of resistance can be controlled (it’s mostly applied by your own hand).

Cook et al’s “Four Stages of Rehabilitation” (General approach, was designed for lower extremity) can be adapted for upper extremity.

 

So again, try it out and see if it’s for you where and if not then you can try the isotonic exercises and be patient as you build up your tissues capacity. Lastly, if you’re in the 10% where it feels worse than it really requires some reflection as to whether it was from the exercise, activity you performed on the day or how much you might have been focusing or obsessing about the symptoms (I know it seems weird, but this can actually increase pain and keep things sensitive).

Isometric vs Isotonic Strengthening

Isometric Strengthening (Static Holds)

 

Definition: Muscle contracts without changing length (no movement at the joint).

• Example Exercises:
  • Wall sits
  • Plank holds
  • Holding a dumbbell in place (static bicep hold)

• Benefits:
  • Builds stability & endurance
  • Strengthens tendons and joints
  • Reduces strain on injured muscles (More gentle and should be pain free)

• Best For: Rehab, injury prevention, and improving muscle endurance

 

 

Isotonic Strengthening (Dynamic Movements)

 

Definition: Muscle contracts while changing length (movement occurs).

• Concentric → Muscle shortens (e.g., lifting a dumbbell in a bicep curl).
• Eccentric → Muscle lengthens under tension (e.g., lowering the dumbbell)

• Example Exercises:

• Squats
• Push-ups
• Bicep curls

• Benefits:

• Builds strength, power, and muscle mass

• Improves functional movement & coordination
• Enhances muscle flexibility & resilience

Best For: General strength training, muscle growth, and athletic performance

Evidence-Based 1HP Protocol:

Over the past decade we created a modified protocol for the upper extremity that led to similar results. The 1HP protocol involves isometric exercises for the tendons at the wrist & hand:

• 3 Sets
• 5-10 reps
• 45 Second holds
• 50-70% Effort (Should not cause pain or increase symptoms)
• 30 Seconds rest between the sets

 

Research and clinical practice suggest that this type of loading can calm irritated tendons and kickstart the remodeling process, especially when paired with proper posture and workload management.

 

Isometric Exercises

Take a look at the videos below and determine which is best for you to perform based on your pain location. For each isometric exercise perform them in this fashion: 

 

1HP Protocol

Sets, Reps, Rest: 3 sets of 5-10 reps with 45 seconds holds and 30 seconds rest in between

Intensity: 30-70% effort (The amount of resistance where you DO NOT feel an increase in symptoms or pain)

 

Finger Flexor Isometric 

Helps with: Strengthening wrist and finger flexor muscles

Pain Location: Pain on palm side of the forearm, wrist, and fingers

 

Finger Extension Isometric

Helps with: Strengthening wrist/finger extensor muscles

Pain Location: Pain on back (dorsal) side of the forearm, wrist, and fingers

 

Wrist Extension Isometric

Helps with: Strengthening wrist extensor muscles

Pain Location: Pain on back (dorsal) side of the forearm, wrist, and fingers

 

Wrist Flexion Isometric

Helps with: Strengthening wrist and finger flexor muscles

Pain Location: Pain on palm side of the forearm, wrist, and fingers

 

Ulnar Deviation Isometric

Helps with: Strengthening wrist ulnar deviation muscles

Pain Location: Pain on pinky (ulnar) side of the forearm, wrist, and fingers

 

Radial Deviation Isometric

Helps with: Strengthening wrist radial deviation muscles

Pain Location: Pain on thumb (radial) side of the forearm, wrist, and fingers

Conclusion

 If you’re dealing with hand or wrist pain and are tired of passive solutions like resting and hoping it gets better, consider asking your provider about an isometric-based strategy. And if you haven’t yet found a local specialist who sees beyond inflammation and braces, it may be time to look into clinics that specialize in active recovery models.

 

In a city that values movement, vitality, and long-term wellness, it only makes sense to adopt treatment strategies that reflect that. Isometric exercise isn’t just a trend—it’s a science-backed, empowering way to take control of your recovery and get back to everything San Francisco has to offer.

 

Remember isometrics are just one component of a recovery program. It is typically the starting point for the cases we see that are really severe or irritable. From there it’s important to build up your tissues capacity with endurance-based exercises focusing on isotonic strengthening. Remember, there is no way that low level contraction can lead to any lasting damage or problems for any RSI-related issues so JUST TRY IT. It could be the exercise for you and help out immensely. 

 

Hope this gives anyone who has had any questions about isometrics a better understanding of its role within wrist & hand pain & recovery. If there are questions or you’re interested in joining the community that we’ve created then feel free to join our discord where we answer questions and you can get support from others in a similar position!

References

1 Coombes BK, Wiebusch M, Heales L, Stephenson A, Vicenzino B. Isometric exercise above but not below an individual’s pain threshold influences pain perception in people with lateral Epicondylalgia. The Clinical journal of pain. 2016 Dec 1;32(12):1069-75.

 

2 Holden S, Lyng K, Graven-Nielsen T, Riel H, Olesen JL, Larsen LH, Rathleff MS. Isometric exercise and pain in patellar tendinopathy: A randomized crossover trial. Journal of Science and Medicine in Sport. 2020 Mar 1;23(3):208-14.

 

3 O’Neill S, Radia J, Bird K, Rathleff MS, Bandholm T, Jorgensen M, Thorborg K. Acute sensory and motor response to 45-S heavy isometric holds for the plantar flexors in patients with Achilles tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy. 2019 Sep 1;27(9):2765-73.

 

4 Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, Cook J. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British journal of sports medicine. 2015 Oct 1;49(19):1277-83.

 

5 Rio E, Van Ark M, Docking S, Moseley GL, Kidgell D, Gaida JE, Van Den Akker-Scheek I, Zwerver J, Cook J. Isometric contractions are more analgesic than isotonic contractions for patellar tendon pain: an in-season randomized clinical trial. Clinical Journal of Sport Medicine. 2017 May 1;27(3):253-9.

 

6 Silbernagel KG, Vicenzino BT, Rathleff MS, Thorborg K. Isometric exercise for acute pain relief: is it relevant in tendinopathy management?.

 

7 Riel H, Vicenzino B, Jensen MB, Olesen JL, Holden S, Rathleff MS. The effect of isometric exercise on pain in individuals with plantar fasciopathy: a randomized crossover trial. Scandinavian journal of medicine & science in sports. 2018 Dec;28(12):2643-50.

 

8 Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of Hand Therapy. 2017 Jan 1;30(1):13-9.

 

9 Longtin, C., Lacasse, A., Cook, C. E., Tousignant, M., & Tousignant‐Laflamme, Y. (2023). Management of low back pain by primary care physiotherapists using the pain and disability drivers management model: An improver analysis. Musculoskeletal Care.

 

10 Naye, F., Décary, S., & Tousignant-Laflamme, Y. (2022). Development and content validity of a rating scale for the pain and disability drivers management model. Archives of Physiotherapy, 12(1), 1-11.

 

11 Naye, F., Décary, S., & Tousignant-Laflamme, Y. (2022). Inter-rater agreement of the pain and disability drivers management rating scale. Journal of Back and Musculoskeletal Rehabilitation, 35(4), 893-900.

 

12 Tousignant-Laflamme, Y., Martel, M. O., Joshi, A. B., & Cook, C. E. (2017). Rehabilitation management of low back pain–it’s time to pull it all together!. Journal of pain research, 2373-2385.

 

13 Tousignant‐Laflamme, Y., Cook, C. E., Mathieu, A., Naye, F., Wellens, F., Wideman, T., … & Lam, O. T. T. (2020). Operationalization of the new Pain and Disability Drivers Management model: A modified Delphi survey of multidisciplinary pain management experts. Journal of Evaluation in Clinical Practice, 26(1), 316-325.

Written By: Brett Becker, OTR/L, ACE-CPT & CMES