Client insights: Panic, social influences & pain science

Show Notes

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In today's episode, Brodie breaks down the comments written by his past PHT client. Here is their submission when asked what their biggest insights and revelations were during Proximal hamstring tendinopathy rehab:

"There’s a lot of ‘horror stories’ out there which can easily lead to panic and catastrophising, causing increased attention to the pain".   

"Keeping routines and contact with friends has been hugely important. It would be easy to hide away and sulk, but that wouldn’t help in the long run. I’ve continued to be very involved with my club, helping at races and making sure I’m there to support in any way I can". 

"With the pandemic, I’m just so happy to be part of the running network again! Most of my friendships are through running therefore I’ve continued to nurture and value these".

"Finally, of course, the physical rehab has to be carefully managed and progressed, and you have to listen to your body, which can be quite difficult for us runners".

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What is Overcoming Proximal Hamstring Tendinopathy?

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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today's client insight episode. panic, social influences and pain science. Welcome to the podcast, helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments, and of course, bust the widespread misconceptions. My name is Brodie Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a chronic proximal hamstring tendinopathy battler. are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Thanks for joining me once again. I have another response from a past client of mine and I will read it out. I've been doing this the last couple of episodes. I hope you've been enjoying it because it is, it's a nice idea. I do like to hear feedback, but also like to hear from people who feel like they've suffered for such a long period of time, feel like it's not going to get better. And then all of a sudden the management changes, symptoms do improve and then kind of just reevaluate or reassess their reflections, their insights that they've had throughout their management. It's really nice for me as a therapist to kind of look back on and kind of analyze and just good to hear from them in general and then repurpose it to help you with your rehab help. you know, spark a little bit of positivity, a little bit of reassurance that this condition can be negotiated and overcome with the right tools and with the right knowledge, with the right education. And so another one has come in today. Let me read it out. So this is, if you haven't listened to the past episodes, I have essentially Gone to my past clients and said, what have you, what has been your reflections, your insights, um, your revelations throughout the management plan. Can you please share this and then I'll, um, dissect it on the podcast. And so this is what this patient has wrote without doubt. This is the most difficult injury I've ever had to manage. It's been psychologically challenging and there's a lot of horror stories out there, which can easily lead to panic and catastrophizing, causing increased attention. to the pain. For a while I'd come off the PHT Facebook groups as they were too overwhelming and scary. I've learnt a lot about the nature of chronic pain over recent months which has really helped, particularly relating to the mind and body of pain. I'm back on the groups and now I've accepted there's no quick fix with this injury. Keeping routines and contact with friends has been hugely important. It would be easy to hide away and sulk. but that wouldn't help me in the long run. I've continued to be very involved with my club, helping out at races and making sure I'm there to support in any way I can. In the pandemic, I'm just so happy to be part of a running network again. Most of my friendships are through running, therefore I've continued to nurture and value these and not begrudge others, including my husband, being able to run while I'm not able to. Finally, of course, the physical rehab to be carefully managed and progressed, and you have to listen to your body, which can be quite difficult for us runners. I feel it's very helpful to have a skilled and knowledgeable PT, such as myself, she refers to, to help with, to monitor, to encourage, and provide valuable feedback. This balance between strength work and return to running is a very fine one, and one I haven't yet been able to master. This is without a doubt a biopsychosocial condition. So there's a lot to unpack there. Uh, I like how when I ask a whole bunch of different clients, PhD clients about their revelations, there's a general theme that like a common theme, but it's also a lot of different things, a lot of, um, different areas, different topics to unpack. And so today I want to mainly as a title. um, eludes just focusing on that, that panic that this person talked about, the social influences and the pain science. I have had pain episodes in the past, um, but this would be a nice little reflection. Um, first of all, I want to talk about this person talked about the, the horror stories out there, which can easily lead to panic and catastrophizing causing increased attention to the pain. Very important topic to discuss. Facebook groups, particularly around PhD Facebook groups, they can be used to be a supportive nurturing sometimes for information, for education, but we do need to realise what the natural evolution of a Facebook group would have, not just specifically for PhD, but just for any condition. This I think it's an inevitable evolution and an inevitable trend that would appear on Facebook groups particularly around a condition that can be quite chronic and can be quite fearful. So we have a, keep in mind it's just a large group of people who have the same condition and it will attract people who are quite fearful and it will attract people who do have this condition and who are unable to. negotiate this injury on their own. And it can be hundreds, it could be thousands, sometimes more of people in this group. And some of them have overcome their PhD, some PhD is very mild and very minor. Some are just don't have PhD, but they're just offer advice. However, the most prominent people who do post, so the people who are there to help mild conditions and Yeah, might've overcome this condition. They don't really post regularly. The ones who do post regularly are the ones who are really anxious, who are desperately looking for answers, who do have, it's maybe more of a chronic, maybe the worst kind of presentation, more severe symptoms. The ones who aren't getting better. They just want help. They're the ones that are going to post more often. They're going to be the ones who I guess post it all. And that's what the feed is going to be filled with. And is there's no, um, it's not like they're doing anything wrong, but this is just like the natural evolution of what would happen to a group that has so many people of this condition. It's the ones that are most severe that are going to post that are a more desperate to post to lead to that sort of action and therefore the feed itself. Is more prominent with these, um, fearful, chronic, severe. presentations. And it's not like they're doing anything wrong. They're trying to look for answers and people are trying to help in the comments. But like this client who put this forward, it can create someone who has had this for only a couple of weeks or a couple of months can read through these feeds and be like, is this going to be me? Oh my God, this is worse than I realized. I didn't realize that it could get this bad or it could draw on and become this chronic condition. And so that's not a, uh, not a very good way into handling your management and to understanding your management. And so just keep in mind that it is a skewed representation of this condition and it is fostering, creating fear and catastrophization. So we know what fear is. Catastrophization is this, um, ruminating position in your mind. of what could happen and the worst outcomes that could happen. And the thought about symptoms getting worse or symptoms prolonging all the things that you might be unable to do in the future. So as a, just a quick example, PhD, maybe you're fearful of sitting, maybe sitting is painful and you're worried that you might lose your job because losing your job requires sitting. And if you lose your job, XYZ and just following on from that. So catastrophizing. what could happen. And I see this quite often, people say they're on Facebook groups, it triggers a lot of fear, it triggers catastrophization and like this client has made the decision to step away from that and only when they're in a better space and seeing improvements to step back in and start helping people. And if you've listened to the pain episodes before, you'll know that all pain is generated from the brain. severity of the pain and to escalate it, de-escalate it or categorize the relevance of producing pain and if so the relevance of what severity of pain to produce. And so if you're on these Facebook groups and you are thinking to yourself this is worse than I realized, this is could potentially have catastrophizing events down the track, your brain is gathering evidence to highly prioritize this condition and to escalate it to the highest priority. And therefore, it's going to be harder for you to overcome this during your rehab. You might experience elevated levels of pain because you're creating a false sense of severity with this condition. So we're talking about the brain, we're talking about pain, but we're also talking about your recovery. And this is why I try to focus on success stories on this podcast. I try and find people who've overcome PhD, even those who have had it for five years, 10 years, and then they've managed to overcome it and have seen the other side, so that helps decrease the priority or the severity or sort of allay your fears and deescalate that catastrophisation, trying to take things in the opposite direction. because I understand that, um, the role of optimism, the role of reassurance and building out a management plan, how that impacts recovery. And so hopefully you're enjoying the, the success stories I've posted in the past and that's just my attempt to trying to combat a lot of the psychological catastrophizing events that I see people when they delve into things like Facebook groups. Uh, And then thankfully this client has gone back into Facebook groups and started helping people and sort of found a better space and is now using that avenue for good to try and help others. So I love that. So that was the first one talking about horror stories, talking about, um, panic and catastrophization. The next little, um, topic that I want to talk about this person mentioned was keeping routines and contact with friends. And how it's been hugely important for this person. So keeping routines and keeping in contact with friends and just social engagement, it is very important to have that social engagement during your recovery. We, I've said this on the podcast before, and this client also said this, that this condition is a biopsychosocial component. It has a biopsychosocial element, which means that. um, your severity of pain and your, um, time recovery timeframes, uh, revolving around three particular aspects, the bio, which is what's going on physically in your body, the psycho, which is how you're mentally psychologically processing this and social, so bio psycho social, the social component is your interaction with others, your engagement levels. your sense of position in like a community or within a group or within your family. Because humans are social creatures and being involved in a larger community helps create a sense of purpose, helps create a bit of a mission, goal setting moving forward, and actually interacting with people, having face to face interactions. Maybe it's like a happy engagement, laughing, socializing. actually has a direct impact on your ability to recover and your ability to deescalate the threat levels of your condition. It makes you feel better, releases the right type of endorphins, lowers pain levels, and then that's just a part, a piece of the puzzle for your recovery. And so very important with PHT that you don't feel alone with this. This is why Facebook groups can be positive because you don't feel alone, you can share. experiences and you can post something where you don't just feel alone you feel like you're being heard and you're getting the responses you need but I do think that face-to-face interactions are a hundred times better because it's very hard to convey tone it's very hard to convey emotion and it's very hard to trigger that face-to-face interaction like get those endorphins actually have fun I think it's very hard to do on social media. Last episode I did talk about this, one of the clients during this revelations insight talked about to talk to your family and friends or someone who can lend an ear about this condition so that you feel like you're not suffering with this alone, you're communicating your frustrations and that can be particularly important but on the other side of it, just making sure that you keep your social engagements, making sure that you do interact face to face, have a community, making sure that you recognise what community makes you feel good, makes you feel important, makes sure it gives you a purpose like this one. This client before said that she was involved, most of her friends are around running, she's made a lot of friendships through running and so gets involved with races and gets involved with the community, still stays active without actually participating in the running itself. So recognize that I know not everyone who listens to this is a runner. I know people with PhD might not be a runner, but just recognize what community you want to be best involved with, which makes you feel the best. And make sure you keep to that routine. Make sure you keep those social engagements and it will definitely help your recovery. This podcast is sponsored by the run smarter series. If you want to take your knowledge building to the next level, I have built out a proximal hamstring tendinopathy video course, which complements the podcast perfectly. Sometimes it's tough delivering concepts and exercises through an audio format, so the course brings a visual component full of rehab exercise examples, graphs and visual displays to enhance your understanding. Even if you sign up now, you'll have access to all current and future modules that I create. Sign up through my link in the show notes, then download the Run Smarter app. and you'll instantly have unlimited access to all the course resources on any device. And to say thanks for being a podcast listener, I want to give you a VIP offer. There will be a link in the show notes in every episode that will provide you 50% off the course price. Just click on the link and it will automatically apply your 50% discount. Lastly, I want to talk about the physical rehabilitation and... what this person talked about in terms of monitoring and progressing. Let me go back to say, let me go back to what she read. So finally, of course, physical rehab is to be carefully managed and progressed and you have to listen to your body. So the, all of that sounds fine, but let's break it up into its separate components. So monitored, making sure that you're monitoring symptoms and monitoring your exercises, making sure you're doing that carefully and making sure If you say, um, monitor variables, we're doing it one at a time. We're observing over 24 hours, all of those components that are discussed in previous episodes. I'm glad that this person just mentioned all those. So monitoring symptoms, monitoring symptoms over 24 hours. And then, uh, also progressed. So monitored and progressed. We always want to make sure that you're progressing your exercises to something that's stronger, heavier. sort of exercises. If you're listening to some like Brody's just repeating this over and over again on every episode, it's so important because I, I talk with so many people with PHT, they say strengthening doesn't work. And I say, what have you done? And they talk about their exercises. Sometimes it involves weight, but they've stuck to that exercise for two to three months without progressing and they're not seeing the results that they're wanting. And As soon as I mentioned to them, how about we try to carefully and gradually progress the exercises. All of a sudden they start seeing a response again. It triggers a response instead of that plateaued out recovery that a lot of people have experienced. And so we need to progress. Tendons love slow heavy load. They just love within the right adaptation zone. They just absolutely love it. So making sure that we monitor exercises, making sure we progress exercises. as symptoms allow. If you're stagnant for several weeks and they're still low to medium levels of pain and you're just too worried about giving it a go, just try that next wrong progression. It might be as mild as possible, but you might increase by one kilo or increase by one repetition. But as long as we keep that in mind, we can see if we start noticing an improvement once we've progressed. The other thing was listening to the body. Obviously we want to pay attention to symptoms. We want to pay attention accurately to see how, how your body is responding. So that's very, very important. So those three components, monitor, progress, and listen to the body. And if you're struggling to manage it, this client and all of my other previous clients have mentioned, find an experienced professional to be your guide. And it should be your guide. I think I I will be releasing in a few weeks time, a interview that I did discussing patient independence, which is really, really important. I'll touch briefly on it now. The health professional, the physiotherapist, whoever you decide to work with should be a guide. They shouldn't be the one saying they can help your injury because you need to be in the driver's seat. What the therapist can do is provide you with the map. on what road to take, what direction to take and how to get to your final destination. But it's important to know that you are in control of this condition and you are in control of your recovery. Don't give your power to anyone else other than yourself. Just have the right experienced professional to be your guide and to show you the direction. But how to get there or getting there is up to you. So we're creating. independence for yourself, we're empowering your own recovery instead of just taking all your power away and giving it to someone else. I interviewed Nathan Carlson last week and I'll be putting that episode out in a lot more detail, but really important that we consider that. Okay, a nice short sweet one today. Let me do a little bit of a recap. So just keep in mind that Facebook groups, their inevitable progression, their inevitable evolution is going to be a lot of doom and gloom on the posts. The people who post more frequently or the ones who are more compelled to create a post is more likely than not going to be someone who is really desperate for answers, a really severe condition, a real chronic condition, and they're just wanting to look for answers, share their story and make sure and try and find a helpful trying to find helpful advice. So when you scroll through those feeds, just keep in mind it's a bit of a skewed representation. Just keep that keep open minded and just recognise that and try to step away from the fearful catastrophizing reactions that are quite obvious when you start reading these, particularly if you have this condition. Keep routines in contact with friends, make sure you recognize the importance of social engagements, make sure you recognize the importance of face-to-face interactions, having a good time out interacting with people, doing anything, could be going for a picnic, it could be going for a walk, it could be just spending time with your family, extended family, and getting out for a barbecue. Those sort of things are really, really important for recovery. If you're having a good time, not thinking about your condition too much and just... getting that human interaction, very, very important for recovery, because then we're tapping into the biopsychosocial abstract, the whole entire puzzle that is your recovery. And lastly, when it comes to the physical rehab side of it, we've heard it time and time again, but it's there, it's repeated because it does work. Monitor your exercises, progress your exercises, listen to your body, pay attention to symptoms, interpret the symptoms correctly, and build that forward with your progress. And those three stages of PhD recovery of, it was one of the first episodes on this podcast. You might want to go back and review that if you, if it's still not fresh in your mind. And, um, if you're struggling to manage it, just finding a professional that. Foster's independence, but also has experience with this condition to help you along the way. So that's our episode today. Hope you enjoyed. I do, as I'm planning over Christmas and New Year's to have a bit of a break, I will try and record and schedule a few episodes to go out so you won't lose out on any, I won't miss any weeks. But next episode, I'm gonna do a case study on a published paper that I saw. We're gonna talk about bilateral symptoms, whether there's any red flags there. We're gonna talk about, like I said, the interview with patient independence with Nathan Carlson in it's probably a couple of months time now. But yeah, a couple of a few different, a few different episodes coming out and well, I hope you enjoy I hope you've enjoyed the progress so far. Best of luck with your recovery this week and if you do have any questions, I do have that free injury chat available. And yeah, I'll catch you in the next episode. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast, hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description, and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future, and remember... Knowledge is power.