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Proximal Hamstring Tendinopathy is a horrible condition affecting athletes and non-athletes alike. If you fall victim to the misguided information that is circulating the internet, symptoms can persist for months, sometimes years and start impacting your everyday life.
This podcast is for those looking for clear, evidence-based guidance to overcome Proximal Hamstring Tendinopathy. Hosted by Brodie Sharpe, an experienced physiotherapist and content creator, this podcast aims to provide you with the clarity & control you desperately need.
Each episode brings you one step closer to finally overcoming your proximal hamstring tendinopathy. With solo episodes by Brodie, success stories from past sufferers and professional interviews from physiotherapists, coaches, researchers and other health professionals so you get world class content.
Tune in from episode #1 to reap the full benefits and let's get your rehabilitation back on track!
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On today's episode, what to focus on when you can't exercise. Welcome to the podcast that gives you the most up-to-date evidence-based information on PHT rehab. My name is Brodie. I am an online physio, but I've also managed to overcome my own battle with PHT in the past. And now I've made it my mission to give you all the resources you need to overcome this condition yourself. So with that, let's dive into today's episode. Welcome back everyone. This has been a topic that's been on my mind for a while now. Ever since my last injury, I was trying to think of how I best managed and negotiated uh time off, time of just like looking down at my watch and seeing that I've done zero kilometres this week and being very mentally out of it. But ah obviously working as an online therapist as well and seeing a lot of injured runners and a lot of people with PhD and having to take time out of. their cardio or sport that they enjoy. um I plan to put this out on the Run Smarter podcast, but also my PhD podcast and I know not everyone on the PhD podcast is a runner, but uh there's a lot of interesting takeaways or lot of insights that I'd like to share so that you can handle this both physically and mentally if you are injured and having to take significant time off. uh Why I think this episode excites me why I really want to record this episode is that let's just say you're injured. Let's just say you're runner, you get injured, you have time off. And if you don't choose to find a suitable substitute or layer in interventions to help you physically and mentally, it's you're taking you having this double whammy effect. One for most running or cardio is your mental health outlet. And so, and also in combination with being injured is a very mentally, emotionally taxing endeavor. So not only are we more stressed or our emotions are tipped towards the negative, but we're also taking away that one thing that was your mental health outlet. So like I said, it's this double whammy effect that puts you in a really poor state, state of mind. And this can lead to, if not addressed properly, things like misery. things like depression, things like stress. And we know that those emotional states offer really poor rehab outcomes. And so this is where it becomes a really important topic to discuss. And a lot of people become anti-social as well. Like not only is it a mental health outlet, but for some, it's also a social outlet. People run with friends, people have run clubs, people attend races and get enjoyment out of that. They run with... family members and compete with one another and they have that healthy competition. And that can start to become anti-social if you do have time off running, you have to skip races. And some people, it leads to resentment. They see other people running and that resentment is not helpful either. And so all of this situation, this whole situation, the mental state that you put yourself in leads to poor healing. what... better opportunity than to create an episode that talks about what we can do proactively, even though you are injured, even though there is pain and discomfort, what we can do to be more proactive, not only physically, but mentally as well. So I've got, what is it, three different domains that I want to cover in terms of what you need to focus on. One being the injury side of things, one being just general fitness side of things, and the other being general health and wellbeing. So I want to start with the injury. When you are injured, and you have to take significant time off. The first thing I want you to draw your attention to is like, well, what caused this in the first place? Because it might seem obvious, but I see a lot of people that repeat the same mistakes over and over again, because they don't take time to really remember or dive deep into what actually caused this in the first place. Are there patterns that have emerged if you constantly have the same injury or if you have flare ups or if you have different types of injuries? Are they is the same pattern that's repeating itself? Maybe you're going through this boom bust cycle of I feel great and I want to get back to exercise and you just ramp things up way too quickly. Get through a bust things. symptoms increase or another injury emerges and you have to take significant time off again. You're down in the dumps, then finally see that first glimpse of things feeling better. You rush back into it and you repeat. Maybe you get injured six weeks before every race that you sign up for, because maybe your training plan is too aggressive. Maybe not following a training plan at all, just getting really, really excited. And maybe you're not really sticking to a plan. Maybe you go off the cuff just because you know, the date is approaching and you want to feel good and you want to do better and you want to run faster and you just push out a little bit more potential than you think you have and you overreach and lead to an injury. Maybe it's something specific about the running. Maybe it's increasing hills, maybe it's increasing speed work, maybe it's transitioning your shoes too abruptly because as we know, most running related injuries are an abrupt shift that exceeds the capacity of what your body's ability to adapt is and that sudden shift that leads to that overreaching is one of the main reasons and the most common reason why people end up with running related injuries or overuse injuries. So yep, if you are injured, we can look back. It doesn't have to be inside running as well. It could be outside we could could be like hit classes if you attend gym classes and maybe you attended too many or went too intense or was too competitive. um Maybe it was just something to do with general health. Maybe you persevere with a training plan whenever you get sick or jet lag, or maybe there's a lack of sleep, or maybe there's more stress at work and you're just not listening to the signals that your body is giving you that I feel slightly over trained here, but you ignore those signals and just push through your training plan because I need to commit to every single kilometer that's written in my training plan. Maybe that is what constantly brings you undone. Maybe it's a little bit more emotional. Maybe it's a little bit more, I get too competitive or I set myself unrealistic goals. Maybe I just don't have a plan altogether. These are things that we can analyze when we are injured to say, okay, I want to bounce back stronger. The step one of bouncing back stronger is learning where it wrong in the first place. And so that's what, and even just going through that process, at least puts us in a better mindset. Hey, I'm actually learning from this experience. And this experience is going to make me build back stronger. Because I think that's just a slight emotional mindset shift that's tending more towards positive rather than focusing on all the negative of I can't run. This is the worst. I hate being in pain. I hate always being injured. And yeah, just down in the dumps. So we can focus on your setbacks as an opportunity to identify weak links. uh Not only in your training plans, how you schedule them out, but also in your behavior, but also weak links in your body, you can say, man, I always just get calf and Achilles issues. My knees are totally fine. My hips are totally fine. But what's going on with this calf and Achilles was the right last year, now it's left this year. And ah if we're constantly noticing that maybe that's a weak link that we need to identify and fortify. And we want to focus on the long term as well. Like a lot of people are quite short sighted and thinking just about the next race, about the next race, and they can't race that one, what's the next one? And they're thinking, you know, six months ahead at the longest. But let's look five to 10 years ahead. If I encounter five injuries in that time, and bounce back stronger every time, and learn and adapt from those every time, I'm in such a better position than if I just repeat the same patterns and never really get anywhere. Okay, so we need to act upon these lessons. So that's just like focusing on the injury prevention and sort of just like honing in on a little bit more on the original causes. We can also focus on the rehab. And this is something that we can focus on some people don't like rehab, but we can sort of switch it to being a bit more proactive and a bit more of a optimistic fortifying those weak links, something like that. So we can focus on um any imbalances that you might have. So if we do your rehab and we identify, okay, if I do this on the injured side compared to the uninjured side, I noticed there's a big strength deficit. ah You might notice just imbalances right to left or front to back. You might notice, okay, my hamstrings are weaker compared to my quadriceps. There's a quite a strong imbalance from quads to hamstrings. You might notice that your balance is off. Like you have really poor neuromuscular control when... doing some single leg deadlifts or single leg balance exercises. And that might be something that we really identify we need to work on. We know that the biggest predictors of injury are whether you've had injuries in the past. And one of the reasons I suspect for that is just because when we get injured, we're really lacking in the rehab department, we just rehab just enough until you're symptom free and then You think that's enough to get back to running and keep running, but you really haven't exceeded the mark for injury prevention. So there might still be something lurking like an imbalance or some weakness lying in the background that only just reveals itself once you have another injury again. So really spend this time being very proactive, doing the right exercises, but really becoming robust and bouncing back even stronger than when you were pre-injury. So that, like we say, we're fortifying and strengthening the weakest link in your armor. And I've come across a lot of clients who learn to do some exercises, some balance exercises, single leg exercises, and they learn to enjoy it. And they're like, oh, let me build this exercise into my routine. Some people don't do strength training at all. And then they get injured. They learn these rehab exercises. They learn to squat, deadlift, lunge. And actually enjoy it, actually start to learn to enjoy going into the gym. And then once they're better and they're back into race prep and marathon training, they're implementing these exercises, which should be a crucial part of any runners program. But maybe there's a different exercise. Maybe there's a single leg variation, or maybe there's just a different exercise in general that you're like, Oh, I start to like this exercise. Let me implement it into my regular routine. Even once I'm symptom free. And so that's plenty of ways that we can focus on just the injury side. What caused in the first place? Was it something emotionally, mentally, physically that was too abrupt? Let me focus on my opportunity to learn from those mistakes and bounce back stronger. What about the rehab side of things? Can I identify any exercises so I can become more resilient, become more robust, learn about imbalances from right to left or balance or whatever have you. And again, let's. be really proactive in saying, okay, I can't run right now. Let's spend some time to really work on these weak links and bounce back stronger. But the other thing we can do, which is gonna be tailored for everyone, the injury that you have is just focusing around general fitness. So not the injury, not the rehab side of things, working on improving or preserving your cardiovascular fitness. And because this is one of the people's This is a big worry for a lot of people. It's once I'm injured, I've spent all this time building up my weekly mileage, working on my VO2 max, working on my zone two training. And now that I'm injured, all that's going to go out the door. I'm going to lose all this fitness that I've worked so hard to build upon. And that's what leads people to sustain the game a bit longer, probably running a bit faster and a bit further than what they should because they're desperate to preserve this level of fitness. But we can cross train. That's why cross training is here to create and preserve some fitness, preserve some enjoyment in your weekly routine. And like I said, this is going to be pending the type of injury, but you've got options like the elliptical, like the bike, the assault bike, a ski erg, you've got swimming. I know a lot of people don't love swimming, but that's an option as well. And we can even just turn this into like a hit circuit, like a lot of clients that I have. uh Pending on the injury, like I say, for PhD, most people can tolerate like a ski-er because it's not a great hinging range of movement. um They can even just swim, but just put a pool boy in between their legs. um If they can tolerate the bike, it's typically okay. And because there's no like open chain swinging action for the elliptical, PhD clients, for the most part, can mostly tolerate the elliptical. If it's something to do with the Achilles, That's where swimming and sometimes bike can be better tolerated. If it's something like the knee, then we've got the elliptical, the ski erg, swimming. Those are good options as well. um Bone stress injuries or bony injuries. That's where swimming comes into it. But we can just tailor this to you. Like I say, I can come up with a uh circuit of, you know, star jumps, jump rope, pushups, dips. burpees, box jumps and say, okay, based on your injury, this is no good. These are okay. These are really good. Let's put that in. Let's do 10 movements or let's do 10 repeats, 10 star jumps, 10 pushups, 10 burpees, 10 box jumps and do that as quick as you can. And then we're going to have a two minute break. Then we're going to do that all over again. We'll do three rounds. That's a great high intensity interval training circuit, HIIT circuit. that keeps people engaged. Like it's really nice. And then if they're finding that that's a good routine or they find an elliptical or bike or something that's a good routine, you can eventually turn it into a pretty decent workout. Even like a VO2 max workout. This is what I've been really enjoying when I'm injured. I'm fortunate enough to have access to a ski-erg machine, a sled, a rower, an assault bike and... Despite my various injuries that I have had, I've managed to still do my VO2 max workouts. I either do the Norwegian four by four where I do try to go as intense as I possibly can for four minutes, pushing that out as much as I can, then rest for about three minutes and do four rounds of that. uh I mix up those four intense rounds of four minutes by like maybe doing one round of four minutes on the assault bike and one round on the ski erg. tend to find when I try to do that on the rower, I can't get my heart rate high enough. It's just like my legs just burn quicker than my heart and lungs can do it for me. But the assault bike and the ski-og work really, really well for me. So the four by four, I find works sometimes, but one of my favorites or my usual go-tos are 30 seconds all out effort, followed by 30 second rest and doing that eight times, then having a two and a half minute rest and repeating all that again for three rounds. Um, yeah, most injuries that I've had in the past can tolerate ski yoke because it's mainly upper body and the assault bike because it's a lot of arms and legs. And so, yeah, and that just jacks up my heart rate quite high and actually helps improve my cardiovascular fitness despite being injured. And so what this does for me and hopefully does for you is just keep you really mentally engaged. Like exercise and movement is really important when you're injured. gets the heart rate pumping, gets the blood circulating, gets the hormones going. And it's just an overall positive of I've accomplished something. Like even though I'm sidelined from what I love doing, i.e. running, I still feel like I've accomplished something and that is profound and really powerful. And so that's what we want to really lean towards. um It could just be like uphill walking, like with a vest. I don't know, get creative, see what you have at your disposal, be really resourceful and thinking rather than um being down in the dumps and just thinking, oh, I have to wait this out. Um, and a lot of times I suggest these with clients and it's something that they implement post rehab as well. So many times I've given someone just a really hard bike session or a VO two max on the bike or skier or a row on they're like, I actually really enjoyed this. And once I'm back to running, I might actually keep this in once a week. And not only are you doing this to preserve your fitness, but it's actually good once you're back to running. of distributing the load throughout the week. That's a great injury prevention strategy of layering in cross training. So that's uh a good component of it as well. And also put in here strength and conditioning just for on the general fitness side of things. Rehab aside, you might say, oh, let me just use this as a good opportunity to focus on trying to do one chin up or focus on my chest press or improve my squat technique or work on my deadlift technique or. work on balance, neuromuscular control, plyometrics. Like I've always wanted to do jump rope and now that I've got this knee injury, maybe now is a good time to implement that. And strength training, strength and conditioning ah isn't just something that's doing it for the sake of doing it. I mean, there's so many benefits to strength training, talking about like fat burning, bone density, you know, it seems to be a very important topic these days, which should always be important. Like when we're talking about bone density, Runners don't have a lot of strong bone density. I've done podcasts on this in the past of uh they're not much better in the, compared to the general population in terms of running as an exercise in terms of bone density, but strength training and plyometric training and sports, team sports, they're very good at building upon your bone density, bone mineral density and muscle mass. Like how important is muscle mass for your metabolic health? preserving strength and function as we age like all of this is really important. You know, you're not going to put on five, 10 kilos of muscle, but even just putting on half a kilo or one kilo will prove dividends to your strength function. And like I say, metabolic flexibility, because I learned this on a different podcast, but they phrase it in a really nice way. Muscle mass is your metabolic currency. If we're really, if we're looking at insulin control, insulin sensitivity, I mean, Your muscles are what shuttle in all of these glucose molecules and the more muscle you have that is more metabolic currency. So why not take some time off if you have, if you're forced to take time off running, let's focus on building muscle, building bone density, uh, very, very important. So that's what I have to say on the general fitness side of things. The other thing, this is just taking a little bit of a tangent. It's just health and wellbeing just in general. Um, because. We do need to be kinder on ourselves and we do need to take more of a holistic approach. It's not all just about running, running, Maybe we, you know, you can self reflect on some maybe things you haven't paid much attention to like sleep, sleep quality, stress management. That's another big one. I've in the past when I have been injured thinking, Oh, I haven't really done a lot of like nervous system resets or parasympathetic activation. I've always wanted to give that a try but uh you know, now that I've taken some time off, I'm not really focusing on running right now. Let me just see if I want to implement this. uh Last time I was injured, or maybe two injuries ago, I picked up the Wim Hof book and learnt about the Wim Hof breathing method, which I've sort of just uh slightly modified for myself but lay down, get comfortable, take 30 really deep breaths in and out really fast. And once you finish that 30th breath, you breathe out and you just hold that for as long as you can. And once you have a big urge to breathe, you take a deep breath in and hold that, hold that for 10 to 15 seconds and take a nice slow breath out. And then I do two more cycles of that 30 deep breaths, breathe out, hold, breathe in, hold, and then go through that again. And you just get put into a trance. It is like a euphoric state of like my hands get really warm. The top of my head gets really tingly. I can hold my breath for like two minutes without like I can I breathe out and I hold my breath and I just lose track. I sometimes fall asleep holding my breath. like, Oh, I like catch myself waking up being like, okay, where am I up to in this breathing cycle? And one of the things I do wish I had improve better quality of his sleep. I'm constantly trying to improve my sleep and happy with where it is at the moment, but trying to cut with more interventions. What about if I do this Wim Hof breathing before I sleep? How is my heart rate variability when I wake up? How is my resting heart rate overnight? How is my quality of sleep overnight? And I'm just testing these things out. And I didn't learn it until I was injured and like just focused on, let me do this and see how it feels for me. And now I do it when I'm sick because I I've learned while the book says that it increases your response, like your immune system jacks up and your parasympathetic nervous system really goes into overdrive, which is really what you want for rest, digest, recovery, those sorts of things. So yes, health and wellbeing, maybe focus on sleep if you're lacking in that department, maybe stress management. Social connection is a huge one when it comes to being injured. Like I say, sometimes we tend to pull away or are restricted from doing what is a social interaction. Some people have run clubs, some people like running with friends, and that's stripped away when you are injured. And so let's be proactive on that side of things. Let's still attend the run clubs. Let's volunteer for races. Let's purposefully catch up with friends. Let's call friends like maybe when you're doing a cardio session, or you're cross training, call a friend and catch up. These are really important to put you in a better frame of mind, as opposed to feeling more drawn away, antisocial, like we say, because mentally that puts in a really poor state and as the studies show that leads to poorer recovery outcomes. Nutrition is another thing for general health and well being. Hey, I haven't really focused on my protein intake. Let me just see and evaluate how much protein I actually have throughout the day. Is it enough? This helps with healing injuries too, like I've created a PDF on tendon rehab. apart from making sure you're getting the total amount of calories is getting the right amount of protein. And in particular, an amino acid within the protein group, which is leucine, which is responsible for uh muscle recovery and tendons collagen as well, um making sure you're getting the right balance of your essential amino acids in the protein that you do have. And when you get back to running, am I maintaining the protein that I require for running or for making sure I'm recovering, rebuilding my body from the barrage of exercise that I'm doing? Maybe now's a good opportunity for me to stomach more carbs because the last marathons that I've done I have my stomach and gut haven't been well trained to tolerate carbs. So maybe I focus on having a bigger breakfast before my cardio workouts. And then when I'm back to running, I can have trained my gut a bit better. You'll find, you know, now that you have like a mission like this, all of a sudden, you know, goals and enthusiasm and motivation start to take place. Maybe it's hydration. Maybe it's like, I don't really drink enough water. Let me focus on coming up with strategies so that I have a better nutrition and hydration strategy. Personally, like the last time I was injured, I had a few gut issues. It was the start of the year and I was getting really feeling really bloated and really gassy after having most of my meals really. And I suspected that it might've been like just to I think I was ramping up my fiber too much. And so when I was injured, I'm like, hey, let's just research this. Let's spend some more time on this. I spent several weeks, uh, dis- well, lowering and distributing my fiber throughout the day. And I slowly started to notice that my symptoms were feeling better. And then I slowly ramped up my, uh, intake of fiber. And personally, like I've mentioned a couple of times on the podcast before, but I've been really big over the last couple of years of fermenting my own foods. I ferment my own kombucha, my own kimchi, my own sauerkraut, my own lacto-fermented pickles as well. Just little experiments here and there. Over the next few months, I'm like investigating maybe some sprouts, like doing my own sprouts as well. And I looked at a herb garden, started venturing out and just doing a little herb garden at the backyard. Like all these things are... Contributing to general health and wellbeing. I know this is doing really well for my gut line. I'm pretty sure I've had leaky gut in the past and I am trying and coming up with all these interventions to be really proactive in helping my gut health because that's going to translate into me being less sick in the future, increasing my ability to absorb more macronutrients and. better tolerate more protein, more carbs. Like all of this is really gonna translate into better performance, injury prevention side of things. And that's what I focus on anyway. And no matter what injury I have, I can always just make slight adjustments to improve my nutrition for the better. And that's something you can focus on as well. And so just general recap, ah what to focus on. On the injury side of things, it is any patterns, whether that's emotionally or physically in your training, any boom busts, any missteps, any mistakes you keep continuously making, learn from it, adjust, bounce back stronger because of it. The rehab side of things, again, learn about imbalances, learn about the right exercises, proactively get stronger, bounce back stronger. On the general fitness side of things, we're looking at cross training. Again, this is gonna be pending on the injury, but you have a ton of examples that I've laid out at your disposal. that you can start utilizing to be more proactive, get the heart pumping, get the hormones circulating, feeling good mentally and physically. And then just the general health. Do we need to make some adjustments on things you're lacking on? Is it sleep? Is it stress? Is it social connection? Is it nutrition? Identify those. And if you can write down a plan and be like, these are the things I want to work on. These are the weak links. This is what I've let fall by the wayside. And this is what I'm going to build upon. Therefore, when I'm back to my sport of choice and back to running, I'm now better equipped. You're going to find that those goals help put you in a better state physically and mentally. So there's a bit of a ramble this topic, but hopefully you found a few takeaways. Hopefully it's led you to being a bit more of a better state emotionally, because I know injuries are never fun. They're accompanied with a lot of like pain, despair. and yeah, it's very taxing, especially emotionally. So like I say, hopefully something that I've said has resonated with you. We could bounce back stronger together. So let me know what you think of this episode. Reach out to me via social media and we'll catch you in the next episode. If you are looking for more PhD resources, then check out my website link in the show notes. There you will find my free PhD five day course, other online content and ways you can personally connect with me. Well done for taking. active role in your rehab by listening to content like this and together we can start ticking off all of your rehab goals and finally overcome your PHT.