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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, your weekly routine to heal your PHT. 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. Thank you for joining me on another episode. I have recently done a YouTube video covering this same topic, but wanted to do a podcast episode to dive into the topics a little bit more, like expand the conversation because YouTube, I try to make it as short and punchy as possible as you know, that's what I, unfortunately it gets rewarded on YouTube. But that's why I like the podcast as well, because I can go waffle on a little bit, give several examples, repeat myself a couple of times just to get the point across, which isn't really something that we do on YouTube. yeah, today we're going to be looking at the different muscle contraction types, looking at isometrics, eccentrics, concentrics, what they are, what the evidence shows, what the research shows in terms of its effectiveness for healing tendons. and then how we can take all of that confusion, all of those multiple ways to load the tendon and combine it into a nice weekly routine for you to take away as a structure system to follow to effectively help enhance the ability for your tendon to heal. And so you may have been told or done a lot of research around tendon rehab and you may have been told that lengthening or shortening or holding your tendon in position while under load can have benefits. You can read any sort of research paper or YouTube video or PT advice and walk away thinking that either one of those is the magic bullet to enhance tendon healing. And so let's dive into the specifics. So you may have heard of isometric contractions. This is when you load and hold the position. And so for PHT, a glued bridge is an example. And the typical dosages we give for isometrics would be you hold it for about 20 seconds, you rest for two minutes, and you repeat that three to four times, so three to four sets. Whereas if we're going through movement, there is a shortening phase, say like a hamstring curl when you are under load and curling that weight, the hamstring is shortening while you're doing that, that is a concentric contraction. And typically what we can do is say three sets of eight through repetitions. But then we have eccentric loading where we bias the lengthening phase. So if we use that same hamstring curl as an example, we could curl up with quite heavy weight with two legs. and then we take one leg away and we slowly release that hamstring or that load back to the starting position. That hamstring is still under load, but it's lengthening while it's loading. And like we say, we can take the same exercise and apply each of these muscle contraction types or bias each of these muscle contraction types. So you can take that same hamstring curl. You can curl it halfway, stop halfway, and try and hold that for 20 seconds. That would be biasing the isometric contraction. We can bias the concentric by again, loading it up heavier than the isometric, focus on the concentric, the shortening phase, and then no particular emphasis on the return. It's just like a passive, whatever's most comfortable for you, return back to the start. But biasing the eccentric, could be curl with two legs, release one, And then it's the responsibility of one leg to slowly lengthen, typically like a six second eccentric phase. And then two legs go back on, curl back up. And for someone who's like an end stage rehab, if we're using this eccentric as an example, it should be a weight that's really heavy that you can't possibly curl with one. So you're curling up with two to try to get that weight up. And then when you release one leg and go, and slowly eccentrically control back to the start. It's such a heavy weight that you can only control the descent. It's like too heavy to actually hold still or curl or like do an isometric but we're eccentrically lowering that way. Similar to like a Nordic drop. That's probably a classic, the most classic eccentric exercise. You couldn't possibly lower yourself, say halfway. and then stop your Nordic drop halfway through and curl back up. That's, well, some people can do that. It's extremely hard to do. What the idea is is to slow your descent as much as possible and control as much of that descent as much as possible. And so you're getting a nice eccentric load. But these are examples for like I say, end stage rehab where someone's symptoms are quite low and their capacity is quite high, but they're just examples. We can bias the eccentric phase with quite lower capacity or more sensitive tendons, which we can dive to in a second. The deadlift also has all three of those phases. We can utilize all three of those phases. I sometimes get people to hold a single leg deadlift or a double leg deadlift at half range of movement and just hold that for 20 seconds to load the tendon. But if we lower, the lowering phase of a deadlift is eccentrically loaded. But when we come back up to the start or the top, upright standing position of the deadlift, you are concentrically contracting your hamstrings to do so. And so each of these play a role, but what does the research show in terms of which one is more advantageous? We can start with isometrics, because that's probably the most... attention grabbing, a lot of people know a lot about isometrics. The way I see it is they serve particularly two main roles. The first role is to provide a really nice analgesic effect without the cost of loading it a lot. So some people, an analgesic effect is someone who has like a temporarily dampened pain signal after doing these or during and after doing these. So you might load up the tendon, hold it in place, three sets of 30 seconds, and you notice that after each set, the pain during that exercise dampens. So you might start doing, say, long lever bridges or an isometric deadlift, and your first set is like a three out of 10 discomfort. The second set's down to a one, and the third set is pain-free. Think, great, and then you move by the rest of your day for several hours, or even the rest of the day. feeling like you've got more power, more control, less pain, that is an analgesic effect. And so analgesics can happen for eccentrics and concentrics, but they happen really nicely for isometrics without at relatively low loads. So we're not risking a lot of flare ups or risking a lot of irritation or aggravation for the benefit of a nice analgesic effect for you to be more comfortable throughout the day. So That's one advantage I like with the isometrics. One of my favourites for, one of my favourite isometrics for PhD is like I say, holding a deadlift either at like one quarter range or half range. So your hands are just above or just below your kneecaps and, a heel dig. So you're laying on your back, your knees and hips are bent at 90 and 90. So your heels are resting against a chair or a coffee table or a plyo box and you're just digging your heels down towards the floor while your toes kind of point up at the ceiling and you're pushing down hard and you're just holding that contraction. That's a nice isometric which is good under a bit of compression, some nice load and targets the upper hamstring quite nicely. And so like I say, benefit number one, that nice analgesic effect. But number two is the Keith Barr discovered, Keith Barr is the researcher who discovered or is an advocate for stress shielding and stress relaxation. So I've talked about this on podcast before. I've actually had Keith Barr on the podcast before, which was an amazing episode. The concept of stress shielding is when you load a tendon that has a tendinopathy, the especially when the load is quick and forceful, the tendon has this defense mechanism to avoid further injury. And what it does is transfers the load and that force through the healthy portions of the tendon. It completely bypasses the portions of the tendon that have the tendinopathy. So if you think of like, it just creates like these roads or these paths of loading around the damaged part of the tendon, which is great and does serve as a nice safe mechanism until we learn that the damaged part of the tendon needs load. It needs some signal to be like, oh, I get it. This is what you want me to adapt to. This is how you want me to realign my fibers. This is how you want me to get stronger. And so if stress shielding continues, the strong gets stronger, those healthy portions, continue to build and increase the capacity, but that pathological part of the tendon that has some collagen changes, the fibers of the collagen are a bit more screwed up, there's a bit more blood vessel formation, it just starts to become quite mucky. That just continues to get worse and worse and worse because it's not getting that signal. And so this is where stress relaxation comes into it because with these isometrics and Keith Barr's work in the lab, they found out that if you load a tendon and you hold it and hold it and hold it, the load spreads more evenly throughout the tendon. So they found if you hold it for 30 seconds, there's a 60 % increase in the relaxation throughout the tendon. So it's a greater opportunity for there to be load that eventually gets transmitted or sent. to the pathological part of the tendon and then that part of the tendon gets that signal, oh, the load is going in this direction, that's how I need to realign my fibres, oh, there's this much load that goes through the fibres, that's how strong you want me to become and then capacity increases and unhealthy portions of the tendon start to become healthy again through that adaptation. And we say 30 seconds because like I say, it only takes 30 seconds to have a 60 %... relaxation effect, but there is diminishing returns. The labs found that if you held it for three minutes, it only increases the stress relaxation by an additional 10%. So there is diminishing returns and if we're going to do three minute holds for three sets, we're now getting into a lot more territory that requires a lot more recovery for very little benefit. So that's why that protocol is in place. So we do three to four sets. of 20 to 30 seconds and we rest for two minutes in between those sets and we give that tendon that nice signal. And if it's relatively low load, so if we're looking at body weight, heel digs or lighter isometric deadlifts and not a lot of recovery is required, the tendon is ready for another signal about six to eight hours after. So it has that time to absorb, to adapt, to load, to recover. And then six to eight hours later, we're ready to hit that stimulus again. Again, provided that it is slow load. If we're looking at really heavy deadlifts or very, very heavy isometrics, you may need additional recovery. But that's when the frequency is prescribed as two to three times per day. Because if it's about six hours, we could probably squeeze in three sessions. But if we want to play on the safe side, I usually recommend two times per day, morning and night to do this particular isometric protocol. And my additional advice is to aim or continue chasing like a two to three out of 10 discomfort during provided that it is relatively settled afterwards and you do notice an analgesic effect afterwards. This works really nice for the tendinopathies I've had in the past where I might load the tendon, set one, I'm at a three out of 10 discomfort, but by set two, I know I'll be down to a one. So I try to chase a two to three out of 10 and I increase the load for my second set, bring it back up to a three out of 10. By the third set, that same load might be symptom free. So I make it heavier or more challenging yet again, try to push back up to a two to three out of 10. And let's just say by the end of that third set, I'm down to a one to two out of that set. And then I just walk away feeling amazing and I don't have any... noticeable uptick in pain or irritation or flare up later in the day or the next morning, I know I've responded really well to that. And I do recognise that everyone responds differently. Not a lot of people have an analgesic effect, but if you do, I do recommend following that. Just try chasing a two to three out of 10 during and then see how you feel afterwards. If you feel worse afterwards and it's irritated and we've pushed it too hard, obviously we make our adjustments. But... These are the two benefits that I see with isometrics. The ability to foster that analgesic effect, but also take effect of that stress relaxation and actually tap into a load that then triggers signals to adapt. But the one major limitation I see with isometrics is it doesn't translate nicely into functional movement. So we eventually need the hamstring tendon to tolerate running, cycling, sitting, bending over, stretching. All of these can be a nice start with isometrics, but never progress to something that's a high enough capacity or functional capacity to do the things that we love. And so if you're asking the question, what exercise is better equipped to help me return to the activities I enjoy, this is when concentrics and eccentrics need to enter the conversation. If you're asking the question, what exercise can calm down my tendon and provide a useful healing signal, that's when isometrics are a good option. And so let's talk about eccentrics. Because a long time ago, for like the last like three decades, eccentrics are the proposed as the magic. bullet when it comes to loading up tendons, especially when comes to Achilles tendonopathy, a lot of research around eccentrics. We have this Alfredson protocol. If you have an Achilles tendonopathy, we do heel drops where we do these kind of like calf raises. We calf raise up with two legs and we slowly come down with one leg and eccentrically loading that tendon. It does provide some nice benefit. It does provide a nice load. if it is like a six seconds down and say two seconds up, we're probably tapping into a bit of that stress relaxation effect because we are eventually, if it's say three sets of six and we're getting a six second eccentric, it's about 36 seconds of load. So there's probably, we're probably tapping into some of that relaxation effect, but It's nice to say, okay, eccentrics are effective for tendons. It's different to then say eccentrics have a unique advantage to healing tendons because when research comes out and combines or compares eccentric bias stuff to concentric and eccentrics, it doesn't seem to show too much. I did look up a few papers preparing for this and preparing for my YouTube video. There is one. from Tom Goom and it's titled proximal hamstring tendinopathy, clinical aspects of assessment and management. And while most of this paper is just around clinical commentary, the researchers of this being Craig Perdom, Peter Maliaris, Tom Goom, a lot of these people are just top of the field when it comes to tendinopathy management. They do their own research and what they've highlighted in this particular paper. they've stated when it comes to PHT, there is little evidence for isolating the eccentric component. And they point out that heavy, slow resistance training that combines concentric and eccentric phases compares very well against eccentric only programs. And so if they compare well, I would say the added benefit of the concentric phase is that it is enticing more function. And when it comes to the lovely Achilles where we've had all these eccentric based research come out and promote it. What happens if they compare concentric with eccentric? Again, I found another paper and the title is, Heavy Slow Resistance versus Eccentric Training as a Treatment for Achilles Tendinopathy. It is a randomized control trial. They did take 58 people with chronic Achilles pain and they split them into eccentric only. and heavy concentric groups. And then the follow-up, they had a 12-week course, and when they followed them until the end of the 12 weeks, and then at a 12-month follow-up, so a great follow-up for this cohort, both groups improved without any meaningful difference in between the groups. So again, if eccentric only is showing to have no superiority over eccentric and concentric groups, then I would definitely go with the eccentric and concentric because we are now tapping into more function when it comes to the concentric phase. I would say if I was to, in the circumstances, I would buy someone to do eccentrics. It would be one, if the concentrics produce a lot of pain, like if it really irritates them, we say, okay, for your particular reason, for whatever reason, you have a particular vulnerability to concentrics. Let's spend a little bit more time, lower level concentrics while we can focus on a bit more of a higher load eccentric. So we can give the tendon a higher load without risking too much of a flare up. But we still need to have the caveat of we are when ready, progressing the concentrics. It just seems for whatever reason you're more vulnerable to that. So pain. Guidance would influence me in some cases to do a bit more of the eccentrics. The other time I would do a lot more eccentrics is if someone, if their goals or sport of choice needs a lot of eccentrics. So this is where sprinting comes into it. Not necessarily slow running, but if someone's a sprinter, short distance runner, they require an enormous amount of eccentric control through their hamstrings. And so, while I would still give them some concentric stuff, I would definitely give them an eccentric only thing. This is probably where Nordics come into play when appropriate to do so. I don't necessarily give Nordics to someone who is just a, say a marathon runner that just does mostly light, easy running and just the occasional once a week speed stuff. But if someone is just doing their eccentric only stuff, like I say, we need to... incorporate the concentric exercises. Just if there is a vulnerability there, we just do it in our own time and just allow symptoms to judge when that time is right. But this enters the conversation around, okay, so we've talked about isometrics, eccentrics, concentrics, difference between the two, what the research shows when we combine them. We haven't necessarily talked about how heavy these things are, because As I'll talk about several times, I did mention several times in that YouTube video, the load definitely matters when it comes to tendon adaptation. I managed to come across another paper that was titled, Human Tendon Adaptation in Response to Mechanical Loading. This is a systematic review and meta-analysis of exercise intervention studies on healthy adults. So this isn't pathological tendons, this is looking at healthy tendons and seeing how does a tendon adapt and respond to different types of loading. And so what they found in the 27 individual studies that they combined within this meta-analysis, lighter loads had an effect size of just 0.04. So there's barely any measurable improvement in tendon stiffness. And they found they used tendon stiffness as a nice metric. And this isn't like the morning type of painful stiffness you get with tendinopathies. This is the tendon's ability to withstand load or like withstand stretch under load, which is a good proxy for capacity, health in general, because that's what tendons need to do to function. so, lighter loads, barely any effect size, but with higher loads, the effect size wasn't 0.04, it was 0.9, which the researchers considered a large improvement. But the paper itself got more interesting when we dive deeper and look at, okay, we know high loads important. What about high load isometrics versus high load eccentrics versus high load concentrics and eccentrics? Well, they found no difference between contraction types. And they found that like when they combined those contraction types, it was statistically insignificant. So the level of loading definitely matters. The conclusion within the study was the level of tendon loading determines the effect of the adaptation, independent of the muscle contraction type. But like I said, these are healthy tendons. But a similar conclusion was made with PHT. There was a research paper from Aidan Rich, who has been on the podcast, and the title was the effect of isotonic versus isometric strength. So isotonic is combining eccentrics and concentrics. So the effect of isotonic versus isometric strength exercise for pain and strength in proximal hamstring tendinopathy. So in this paper, they, like I say, they separated 20 people with PHT into isometrics versus movement-based exercises. And they found no difference between the groups in strength, pain with a functional task or sitting symptoms. So the key takeaway is trying to find the right contraction type. whether that's isometrics, eccentrics, concentrics, whatever, the right amount of contraction type that can deliver the strongest load, because load matters, that delivers the strongest load without aggravating symptoms. I would say for people who have quite irritated tendons, isometrics are a really nice starting point, because if there's a loading-based exercise that doesn't go in and out of movement a lot of times, that is less likely to irritate. So isometrics can be a nice starting point. E-centrics can be, I'd say nicer than concentrics. For some reason concentrics tend to aggravate more. So we wanna try to continuously test out and combine which contraction types can we get away with that we can continually apply more and more load that the tender can tolerate. Whatever that ends out to be, that's what we. sort of judge and run our little experiments. However, we eventually want to get to something that looks like combining some isometrics with some eccentrics with some concentrics that matches your goals, that fits the demands, that returns a lot of strength and function. We can't just keep to one and then hope that, you know, you're magically going to return back to running and tolerate it. It's just this classic case of someone who does a lot of isometrics, feels great, gets the right signal to adapt. feels amazing every time they return back to running their folder pieces because they're they're addressing the pain, but they're not addressing the function. And so we see this a lot of times with people who just persist with say, isometric bridges or body weight bridges, the load is too low, the function is too limited and the return back to their meaningful task falls short. Okay, so we wanna progress, wanna combine that. a lot of them and we eventually want these things to be quite heavy or strong load. How do we know what we can tolerate? How do we know what is a heavy load? How do we know when to progress? How do we know when we're ready for concentrics? All of this focuses on the pain rules that are repeat time and time again on this podcast. Pain rule one pain during needs to be less than a four out of 10. Some people have no pain during the exercise. It's only just a delayed onset afterwards, which is why we need to fall back to rule number two, which is pain needs to go back to baseline by the next morning. This isn't symptom free. This is you in your most settled state, whatever your most settled symptoms are. That's what it needs to return to by the next day. And key number three, symptoms need to improve week by week. We want to see us ever so slightly even as as slightly as you can possibly think, if that improves week by week, then we're on the right track. Tendons take a long time to heal, but we should see noticeable improvements. If it's only just slightly detectable week by week, then it's a lot more obvious month by month. If month by month, you're like, ah, still not sure, then I would say you're not really improving and we do need to change something. But we're constantly referring to these pain rules, mild pain during. back to baseline the next day, improving week by week. If that's achieved, let's try slightly more, slightly heavier, let's do a little bit more concentrics, let's do something a little bit more through range, just changing one variable at a time, continuously reinforcing these pain rules to make sure we're tolerating it. Okay, so with those things covered, how does this fall back to a nice weekly schedule? And as I mentioned on the YouTube video, I've struggled to answer this without a lot of, because context matters a lot when coming up with a weekly structure. So someone's weekly structure might look completely different to another based on their symptoms, based on how irritated they are, based on what goals they have, based on what that gym equipment or equipment they have access to, all of that will really influence, or I guess as well as like how good your recovery is. How well are you sleeping? What's your stress management like? All of those things tailor to the best weekly structure for you. That's why I work one-on-one with clients. That's why I have the PhD online course that goes a lot more into detail about all of these nuances and how that can influence your weekly structure. If you wanna learn more about the PhD online course, there's always a link in the podcast show notes that will take you to the landing page. We'll show you all the content, everything that's covered, all the testimonials, all the bonuses that come along with it. So if you are interested in a self-guided online course designed by me, then you can check that out. But I did want to try to attempt this answer because it is coming up time and time again. People keep asking how I structure this into a weekly structure. So with the caveat or with the disclaimer that everyone's ideal weekly structure is different, let me attempt it. So if your symptoms are quite severe and your capacity is low, you can start just with the Keith Bar protocol, because it is relatively safe. Like say, we can try some isometric light deadlifts or some heel digs, just digging your heels down into the box and holding that for 20 to 30 seconds. You might dig down at like 25 % of your maximum press. there might be a light load that you can tolerate, but it requires little recovery because it is lighter load. So the frequency can be quite high. So this is when we follow two times a day, that could be five to six days per week. But we want to progress to heavier isometrics or movement based when required. So we use those pain guidelines I mentioned before to then say, okay, tolerated, let's try a little bit heavier next time. But eventually as symptoms settle, capacity increases, we evolve this into having more movement based exercises with less, well it does become more challenging, which means you need more recovery because that's the tendon takes a longer time to absorb and accumulate and adapt to that load. So that's when we would do heavier isometrics or the concentric eccentric stuff two to three times per week while reducing the amount of isometrics. So If initially our isometrics were five to six days per week, let's do our isometrics now only three days per week, but layering in the heavier stuff two to three times per week, but we want to separate them out quite nicely. if it's two times per week, we're doing that Monday, Thursday. If it's three times a week, we're doing that Monday, Wednesday, Saturday, something like that. Uh, and this is where it kind of gets a bit tricky cause we do need this nice ebb and flow of training stimulus, rest adaptation, training stimulus, rest adaptation. And so how does that all combine in? How do we do cardio sessions as well? All of that sort of stuff is where it does become a bit tricky, but I typically follow, especially if you are tolerating quite higher stuff, this nice ebb and flow throughout the week of high, low, moderate rest. And you can just put that on repeat. I'll say that again, high, low, moderate rest, high, low, moderate rest. These are how much you can subject your body to or your tendon to day by day. You've got a heavy stimulus followed by a low stimulus, followed by another meaningful stimulus followed by recovery. And this is a nice ebb and flow rather than every day either choosing to completely rest or push your tendon to its limit. It can be a nice routine. So what does that look like? Monday. Let's say that's your high load day. This is building strength. This is the idea to build strength and function, restore the capacity to meet the demands of whatever goals you have. Might be return to running, cycling, sitting, stretching, whatever that might be. So we're looking at three sets of six to eight reps of something that is challenging and follows those pain guidelines I mentioned earlier. They would be deadlifts, step ups. hamstring curls, plus or minus like a resisted standing hip extension, plus or minus some Nordics, you know, but I typically find step ups, deadlifts, hamstring curls as kind of like the stock exercises that I would put in there. That is your heavy day or your high load day addressing strength and function. Tuesday would be your low load day. Remember we're going heavy, low, rest. So Tuesday, low load, perfect opportunity for you to do your Keith Bar isometric protocol, take advantage of that stress relaxation effect, give that tendon a nice signal to adapt without a lot of load. So that by Wednesday, when it comes to your moderate day, we can do some strength. It would be the same strength exercises that you did on Monday, but we're doing the same sets and reps, but we're lightening the load. So 70 to 75 % of your heavy strength day, you are then applying to your moderate strength day. And this is a good day to also put in some light cardio, a light run, something like that. Leading into Thursday, which is a rest day or a recovery day. So that might be extremely light cardio of something else. There might be like swimming or I don't know, Pilates or something, whatever you find that is really like not challenging the tendon at all. But you know, if you wanna keep moving, that's good as well. And so you can just repeat that. high, low, moderate rest, high, low, moderate rest. Just do that over several weeks and see if you're finding yourself on the right track. But some people, myself included, like to have a nice repeatable week, because that obviously doesn't follow a seven day cycle. If you wanna follow a seven day cycle, for some, I would say you'd finish the rest of the week with a Friday being another high day, Saturday being a light day or light with cardio. and Sunday being the rest. So it goes high, low, moderate rest, high, light rest, or high, low rest. And so you've got two high days in there, you've got two lights in there, you've got two rests and one moderate. That can be a nice ebb and flow of enough load throughout the week, enough signal for the tendon to adapt, yet enough, but enough recovery to balance it all out. And you know, how that works into becomes a lot more complicated, because that's only two cardio sessions, it becomes a lot more complicated with speed sessions, plyometrics. You you might say, but Brody, can't do, I don't have access to a gym, or I can only have access to a gym on these days. I completely flat out with work Monday through to Wednesday. You know, this is where it becomes extremely tailored. And that's why I love working with people one-on-one, but that's enough at least. my reasoning, rationale for those said weekly structures. But the key takeaway is understanding the pain rules and the important ebb and flow between challenging the tendon, giving a time to recover, layering on top or assigning the right exercises that address your vulnerabilities. So whatever you're irritated towards, if someone's really irritated with sitting. We want something that can tolerate more compression. So that's where the deadlifts come into it. If someone's really sensitive to something like eccentrics, any sort of speed work, then that's when eccentrics might have a bias. If you respond really well to isometrics, we might layer in some of those a little bit more here and there. And obviously your goals, if you're a hockey player versus a sprinter versus just a dancer, ballet dancer, you know, I see so many people with PhD, the exercises will then have to work at addressing your vulnerabilities or your weak links as well as what goals, what do we need this tendon to be able to do. yep, weaving all that in, these are the key concepts and hopefully you've listened to this and you've walked away with a better understanding of where the research is at and making some adjustments to your weekly schedule. to increase the effectiveness. I hope you found this interesting, enlightening, useful, 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 an active role in your rehab by listening to content like this. Together we can start ticking off all of your rehab goals and finally overcome your PHT.